HEALTH INSURANCE REGULATIONS (AMENDMENT) 1987 NO. 32 HEALTH INSURANCE REGULATIONS (AMENDMENT) 1987 NO. 32 - TABLE OF PROVISIONS 1. Commencement 2. Principal Regulations 3. Prescribed particulars for purposes of subsection 19 (6) of the Act 4. Manner of referral to specialists or consultant physicians 1987 No. 32 HEALTH INSURANCE REGULATIONS (AMENDMENT) - REG 1 Commencement 1. These Regulations shall come into operation on 7 March 1987. 1987 No. 32 HEALTH INSURANCE REGULATIONS (AMENDMENT) - REG 2 Principal Regulations 2. In these Regulations, "Principal Regulations" means the Health Insurance Regulations. 1987 No. 32 HEALTH INSURANCE REGULATIONS (AMENDMENT) - REG 3 Prescribed particulars for purposes of subsection 19 (6) of the Act 3. Regulation 2ADA of the Principal Regulations is amended: (a) by omitting subregulation (1) and substituting the following subregulations: "(1) In this regulation, 'referring medical practitioner' means a person who is a medical practitioner for the purposes of regulation 10. "(1A) For the purposes of subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services generally: (a) the name of the person to whom the professional service was rendered; (b) the date on which the professional service was rendered and a description of the professional service sufficient to identify the item that relates to that service. "(1B) For the purposes of subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services rendered by a consultant physician, or a specialist, in the practice of his or her specialty to a patient who was referred to that consultant physician or specialist in the manner prescribed in paragraph 10 (2) (a) by a referring medical practitioner: (a) the name of the referring medical practitioner; (b) the address of the place of practice, or the provider number in respect of the place of practice, of the referring medical practitioner; (c) the date on which the patient was referred by the referring medical practitioner to the consultant physician or specialist. "(1C) For the purposes of subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services rendered by a consultant physician, or a specialist, in the practice of his or her specialty to a patient who was referred to that consultant physician or specialist in the manner prescribed in paragraph 10 (2) (b) or the manner prescribed in paragraph 10 (2) (c) by a referring medical practitioner: (a) the name of the referring medical practitioner; (b) the address of the place of practice, or the provider number in respect of the place of practice, of the referring medical practitioner; (c) the means by which the referral was made; (d) the date on which the referral was made. "(1D) For the purposes of subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services rendered by a consultant physician, or a specialist, in the practice of his or her specialty to a patient who has declared to the consultant physician or specialist that a referral referring the patient to that consultant physician or specialist has been completed by a referring medical practitioner, the name of the referring medical practitioner, and that the referral has not been delivered to the consultant physician or specialist due to the referral having been lost, stolen or destroyed: (a) the name of the referring medical practitioner; (b) the words 'special circumstances-lost referral'; (c) the address of the place of practice, or the provider number in respect of the place of practice, of the referring medical practitioner (if either of these are known to the consultant physician or specialist). "(1E) For the purposes of subsection 19 (6) of the Act, the following particular is prescribed in relation to professional services rendered by a consultant physician, or a specialist, in the practice of his or her specialty to a patient, other than a patient referred to in subregulation (1A) or (1B), where the consultant physician or specialist was, at the time when the service was so rendered, of the opinion that it was necessary that the medical service be rendered as quickly as possible, namely, the words 'special circumstances-emergency'."; (b) by omitting from subregulation (3) "Part 7 of the table" and substituting "the pathology services table"; (c) by omitting from subparagraph (3) (a) (i) "provider number" and substituting "either the address of the place of practice, or the provider number in respect of the place of practice,"; (d) by omitting from subparagraph (3) (a) (iii) "employee's provider number;" and substituting "either the address of the place of practice, or the provider number, in respect of the place of practice, of the employee;"; (e) by omitting from subparagraph (4) (a) (i) "employee's provider number;" and substituting "either the address of the place of practice, or the provider number, in respect of the place of practice, of the employee;"; (f) by omitting from subregulation (4) "Part 7" and substituting "the pathology services table"; (g) by inserting in subregulation (4) "general medical services" after "or 11 of the"; (h) by omitting from subregulation (5) "Part 7" and substituting "the pathology services table"; and (i) by inserting in subregulation (5) "general medical services" after "or 11 of the". 1987 No. 32 HEALTH INSURANCE REGULATIONS (AMENDMENT) - REG 4 Manner of referral to specialists or consultant physicians 4. Regulation 10 of the Principal Regulations is amended: (a) by omitting subregulation (2) and substituting the following subregulation: "(2) Subject to subregulations (4) and (5), where an item specifies a medical service that is to be rendered by a consultant physician, or a specialist, in the practice of his specialty to a patient who has been referred to him, the patient shall, for the purposes of the item, be referred: (a) by a medical practitioner furnishing the prescribed information concerning the referral to the consultant physician, or specialist, as the case may be, in a letter of referral; (b) by delivery of a written request to treat the patient addressed by a medical practitioner to the consultant physician, or specialist, as the case may be; or (c) by an oral request from a medical practitioner, requesting the consultant physician, or specialist, as the case may be, to treat the patient."; (b) by omitting from paragraph (3) (a) "address of the medical practitioner, registered optometrist," and substituting "either the address, or the provider number, of the medical practitioner or registered optometrist, or the name and address of the"; (c) by omitting from paragraph (3) (d) "referral form" and substituting "letter of referral"; (d) by omitting subregulation (4); (e) by inserting in subregulation (5) "in the manner prescribed by paragraph (2) (a)" after "specialist radiologist"; and (f) by omitting from subregulation (5) "referral form" and substituting "letter of referral". - NOTES 1987 No. 32*1* HEALTH INSURANCE REGULATIONS*2* (AMENDMENT) *1* Notified in the Commonwealth of Australia Gazette on 6 March 1987. *2* Statutory Rules 1975 No. 80 as amended by 1975 Nos. 118, 125 and 135 (commenced 3 July 1975; disallowed 4 September 1975); 1976 Nos. 202, 214 and 215; 1977 Nos. 26 and 44; 1978 Nos. 95 and 177; 1979 No. 230; 1981 Nos. 198 and 317; 1982 Nos. 157, 251 and 287; 1983 Nos. 106, 231, 253 and 255; 1984 Nos. 5 and 162; 1985 Nos. 36, 50, 95, 205 and 290 (commenced 7 November 1985; disallowed 15 April 1986); 1986 Nos. 19, 20, 87 and 326.