Draft State Insurance and Care Governance Amendment Regulation 2022

SIRA is seeking feedback on a draft regulation related to health services.

  • The Issue

    Consultation period: 26/09/2022 11:00 am to 23/10/2022 11:59 pm

    What is this about?

    SIRA is seeking feedback on a draft regulation about health services in the workers compensation and CTP schemes.

    The draft regulation supports recent legislation that empowers SIRA to issue directions to health service providers to supply claim-related information, and to take specified action, including to not provide services. The draft regulation lists the types of health services that are covered.

    Next steps

    SIRA is seeking feedback on the draft regulation by 23 October 2022.

    You can submit your feedback via our online form below or by email.

  • Milestones

    This consultation opens on Monday 26 September 2022 and closes Sunday 23 October 2022.

  • Outcomes

    The final State Insurance and Care Governance Amendment Regulation 2022 has now commenced.

    SIRA Chief Executive Adam Dent said "While most health service providers do the right thing, there are other providers who engage in poor practices like overcharging and overservicing. The new regulations that come into effect today give SIRA the power to take action against these providers by issuing directions to make sure their practices are in line with the objectives of the workers compensation or motor accident legislation."

    Under the regulation, SIRA has the option to issue a direction if a health-related service provider:

    • does not comply with a provision of the workers compensation and motor accidents legislation
    • has been referred to, or is under investigation by a relevant clinical, professional or accreditation body
    • if a service provider does not comply with guidelines (these guidelines are currently being drafted and are expected to be finalised in March 2023).

    SIRA made changes to the draft regulation in response to feedback received through 20 submissions and 16 consultation sessions.

    Feedback

    Powers were broader than required

    SIRA removed the ability to issue a direction where it:

    • reasonably believes a direction is required
    • where it reasonably believes the health, conduct or performance of a relevant service provider poses a risk to injured people.

    Public register

    SIRA will design the public register in alignment with best practice and in consultation with stakeholders.

    SIRA should not be intervening in patient care or clinical decisions

    SIRA will refer any concerns about service provider’s clinical decisions or patient care to the relevant clinical, professional or accreditation body. SIRA will be able to issue a direction to service providers while awaiting the results of any investigation.

    SIRA should not duplicate the role of health practitioner boards and professional authorities

    SIRA will refer to the relevant clinical, professional or accreditation body any matters related to a suspected breach of their codes of conducts and standards.

    Clarification was needed on some of the services covered

    SIRA made minor changes in the definition to clarify that legal staff dealing with medical reports or insurer staff dealing with administration of healthcare and treatment would not be covered under the regulation.

    List of changes

    Regulation clause

    Change

    4A (za)(iv)

    New clause 4A (za)(iv) was originally at 4A (1)(zb)(i) but has been moved as it is more appropriately situated with other services provided by health practitioners (rather than with administrative services)

    4A(2)

    Added new subsection (1)(zb) to clarify that administrative services does not include those relating to the provision of legal services to a claimant.

    4C(2)

    Removed the following as these were gave SIRA powers that were broader than necessary:

    (c) the relevant service provider has contravened an ethical or professional standard

    (d) SIRA reasonably believes the health, conduct or performance of a relevant service provider poses a risk to injured people

    (e) SIRA reasonably believes a direction is required

    Added

    (c) the relevant service provider has been referred to, or is under investigation by, a relevant clinical, professional or accreditation body

    Next steps

    Now that the regulation is complete and published, SIRA’s next steps will be to finalise:

    • the draft guidelines which will be the subject of public consultation in early 2023, with the aim of being finalised in the first quarter of 2023.
    • policy and procedures on how SIRA will manage non-compliance with SIRA and scheme requirements
    • policy on the public register, in consultation with stakeholders

    Submissions

    View the submissions here

Documents

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