Determination pursuant to subsection 5D(1) (Pso 3/2005) (Cth)

AUSTRALIAN GOVERNMENT

NATIONAL HEALTH ACT 1953

DETERMINATION PURSUANT TO SUBSECTION 5D(1)

(PSO 3 / 2005)

I, LINDA JANE ADDISON, delegate of the Minister for Health and Ageing, acting pursuant to subsection 5D(1) of the National Health Act 1953 (the Act) hereby specify the services set out in the Schedule to this Determination provided by, or on behalf of, the hospitals and day hospital facilities specified in the Schedule to this Determination for the purposes of the definition of outreach services in subsection 4(1) of the Act.

This Determination shall come into force on 1 May 2005 and shall remain in force until, and including, 31 December 2005.

Dated this 4 day of March 2005

L Addison

LINDA JANE ADDISON

Assistant Secretary

Private Health Insurance Branch

(Position no.  012 028 74)

Delegate of the Minister for Health and Ageing

SCHEDULE

Specified services provided by, or on behalf of, specified hospitals or day hospital facilities

Definitions

1. In this Schedule:

   (a)      "relevant health services" means all medical, surgical, diagnostic, nursing, dental, chiropody, chiropractic, eye therapy, occupational therapy, physiotherapy, speech therapy or similar services or treatment that are not professional services; and

   (b) "professional service" has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

Specified services and hospitals

1. Relevant health services provided to a patient as part of Northeast Health Wangaratta Outreach Program by, or on behalf of, Northeast Health Wangaratta.

Northeast Health Wangaratta Outreach Program provides treatment to patients in their homes.

Notes

Note 1:Health funds can pay benefits under an applicable benefits arrangement (sometimes referred to as a “hospital cover policy”) for any service specified in this Determination if, and only if, the service is provided to a patient as a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility (see the definition of "outreach service" in subsection 4(1) of the National Health Act 1953 (the Act) as well as sections 5A, 5C and 5D of the Act).

Note 2:Health funds can also pay benefits for professional services that are rendered to a patient by a medical practitioner while the services specified in this Determination are being provided, so long as those services are being provided as a direct substitute for treatment that would ordinarily be provided in a hospital or day hospital facility. Under section 5C of the Act outreach services (defined in subsection 4(1) of the Act) are deemed to be a form of "hospital treatment". Under section 5A of the Act health funds can provide benefits under an applicable benefits arrangement for hospital treatment and any professional services rendered to a patient by a medical practitioner while the hospital treatment is being provided. The Determination in effect allows health funds to provide benefits under an applicable benefits arrangement for those out-of-hospital professional services that are provided while services that are specified in this Determination are being provided as a direct substitute for treatment that would ordinarily be provided in a hospital or day hospital facility. However, the Determination does not permit health funds to provide benefits for professional services provided out-of-hospital in any other situation.