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HEALTH INSURANCE ACT 1973 - SECT 81

Definitions

             (1)  In this Part, unless the contrary intention appears:

"adequate and contemporaneous records" of the rendering or initiation of services means records that meet the standards prescribed by the regulations for the purposes of this definition.

"AMA" means the Australian Medical Association Limited (A.C.N. 008426793).

"Authority" means the Determining Authority.

"Chair" means Chair of the Authority.

"Chair of the Authority" includes a person acting in the office of Chair of the Authority.

"Chairperson" means the Chairperson of a particular Committee.

"class of services" means services of the same kind, or similar kinds.

"Committee" means a Professional Services Review Committee set up under section 93.

"Committee investigation" means an investigation by a Committee under Division 4.

"Committee member" means a member of a Committee.

"Deputy Director" means a Deputy Director of Professional Services Review appointed under section 85.

"Determining Authority" means the Determining Authority established by section 106Q.

"Director" means the Director of Professional Services Review appointed under section 83.

"Director's review" means a review undertaken by the Director under Division 3A.

"document" includes any record.

"findings" , in relation to a draft report or final report of a Committee, means the Committee's findings as to whether the person under review engaged in inappropriate practice in the provision of some or all of the services specified in the referral made to the Committee.

"inappropriate practice" has the meanings given in section 82.

"lawyer" means a barrister or a solicitor.

"legal services" means:

                     (a)  in respect of the Director--giving legal advice to the Director (including legal advice in respect of the preparation of a report to accompany a referral); and

                     (b)  in respect of a Committee:

                              (i)  giving legal advice to the Committee (including legal advice in respect of the preparation of a draft or final report); and

                             (ii)  attending hearings of the Committee to give legal assistance to the Committee in respect of the hearing; and

                     (c)  in respect of the Determining Authority--giving legal advice to the Authority in respect of:

                              (i)  its consideration of an agreement made under section 92; or

                             (ii)  the preparation of a draft or final determination.

"member of the Authority" includes a person acting in an office of member of the Authority and, to avoid doubt, includes the Chair of the Authority.

"Panel" means the Professional Services Review Panel established under subsection 84(1).

"Panel member" means a member of the Panel appointed under subsection 84(2).

"person under review" means:

                     (a)  in relation to a Director's review of the provision of services by a person--that person; or

                     (b)  in relation to a Committee investigation into whether a person engaged in inappropriate practice--that person.

"pharmaceutical benefit" means a pharmaceutical benefit as defined in Part VII of the National Health Act 1953 .

"practitioner" means:

                     (a)  a medical practitioner; or

                     (b)  a dental practitioner; or

                     (c)  a participating optometrist (other than the Commonwealth, a State, the Australian Capital Territory, the Northern Territory or an authority, being a corporation, established by a law of the Commonwealth, a State or an internal Territory); or

                     (d)  an optometrist other than a participating optometrist; or

                   (da)  a midwife; or

                   (db)  a nurse practitioner; or

                     (e)  a chiropractor; or

                      (f)  a physiotherapist; or

                     (g)  a podiatrist; or

                     (h)  an osteopath; or

                      (i)  a health professional of a kind determined by the Minister under subsection (1A) to be a practitioner for the purposes of this Part.

"prescribed pattern of services" has the meaning given by section 82A.

"profession" means the group of persons engaged in one of the following vocations:

                     (a)  medicine;

                     (b)  dentistry;

                     (c)  optometry;

                    (ca)  midwifery;

                   (cb)  the practice of a nurse practitioner;

                     (d)  chiropractic;

                     (e)  physiotherapy;

                      (f)  podiatry;

                     (g)  osteopathy;

                     (h)  a vocation determined by the Minister under subsection (1A) to be a profession for the purposes of this Part.

"provides services" has the meaning given by subsection (2).

"referral" means a referral to a Committee under section 93.

"referred services" , in relation to a Committee investigation, means the services specified in the referral made to the Committee under section 93.

"review period" , in relation to:

                     (a)  a request by the Chief Executive Medicare under section 86 (the initial request ); or

                     (b)  a Director's review arising from the initial request; or

                     (c)  a Committee investigation arising from the Director's review; or

                     (d)  a request by a Committee under subsection 106J(1) arising from the Committee investigation;

means the period specified in the initial request.

"service" means:

                     (a)  a service that has been rendered if, at the time it was rendered, medicare benefit or dental benefit was payable in respect of the service; or

                   (ab)  a service that has been initiated (whether or not it has been or will be rendered) if, at the time it was initiated, medicare benefit would have been payable in respect of the service had it been rendered at that time; or

                     (b)  a service rendered by way of a prescribing or dispensing of a pharmaceutical benefit by a medical practitioner, a dental practitioner, an optometrist, a midwife or a nurse practitioner.

Note 1:       See Part II, and in particular section 10, for when a medicare benefit is payable.

Note 2:       See the Dental Benefits Act 2008 for when a dental benefit is payable.

"specialist" , in relation to a particular specialty, includes (except for the purposes of section 95) a consultant physician in that specialty.

Practitioners and professions determined by Minister

          (1A)  The Minister may, by legislative instrument, determine:

                     (a)  that a health professional of a particular kind (being a health professional who provides a health service within the meaning of subsection 3C(8)) is a practitioner for the purposes of this Part; and

                     (b)  that a vocation engaged in by a health professional of a kind determined under this subsection is a profession for the purposes of this Part.

Meaning of provides services

             (2)  For the purposes of this Part, a person provides services if the services are rendered or initiated by:

                     (a)  the person; or

                     (b)  a practitioner employed or otherwise engaged by the person; or

                     (c)  a practitioner employed or otherwise engaged by a body corporate of which the person is an officer.



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