National Health Act 1953 Determination pursuant to subsection 5D(1) (Pso 1/2007) (Cth)

AUSTRALIAN GOVERNMENT

NATIONAL HEALTH ACT 1953

DETERMINATION PURSUANT TO SUBSECTION 5D(1)

(PSO 1 / 2007)

I, GAIL ANNE YAPP, 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 5 February 2007 and shall remain in force until, and including, 4 February 2008.

Dated this                 31st          day of        January   2007

………………………………

GAIL ANNE YAPP

Assistant Secretary

Acute Care Strategies Branch

(Position no. 200 036 37)

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 Campbelltown Hospital Paediatric Ambulatory Care Service by, or on behalf of, Campbelltown Hospital, Campbelltown, New South Wales.

Campbelltown Hospital Paediatric Ambulatory Care Service provides treatment to patients in their homes.

1. Relevant health services provided to a patient as part of Hobart Private Hospital in the Home Service by, or on behalf of, Hobart Private Hospital, Hobart, Tasmania.

Hobart Private Hospital in the Home Service provides treatment to patients in their homes.

1. Relevant health services provided to a patient as part of John Fawkner Private Hospital in the Home by, or on behalf of, John Fawkner Private Hospital, Coburg, Victoria.

John Fawkner Private Hospital in the Home provides treatment to patients in their homes.

1. Relevant health services provided to a patient as part of Kyneton District Health Service Hospital in the Home by, or on behalf of, Kyneton District Health Service, Kyneton, Victoria.

Kyneton District Health Service Hospital in the Home provides treatment to patients in their homes.

1. Relevant health services provided to a patient as part of Mayo Private Hospital in the Home by, or on behalf of, Mayo Private Hospital, Taree, New South Wales.

Mayo Private Hospital in the Home provides treatment to patients in their homes.

1. Relevant health services provided to a patient as part of St Vincents and Mercy Private Hospital Breastfeeding Support Centre by, or on behalf of, St Vincents and Mercy Private Hospital, Fitzroy, Victoria.

St Vincents and Mercy Private Hospital Breastfeeding Support Centre provides treatment to patients in a location other than a hospital.

1. Relevant health services provided to a patient as part of The Queen Elizabeth Hospital in the Home by, or on behalf of, The Queen Elizabeth Hospital, Woodville, South Australia.

The Queen Elizabeth Hospital in the Home provides treatment to patients in their homes.

1. Relevant health services provided to a patient as part of The Wesley Hospital Maternity Outreach Service by, or on behalf of, The Wesley Hospital, Auchenflower, Queensland.

The Wesley Hospital Maternity Outreach Service provides obstetric treatment to patients in their homes.

10.  Relevant health services provided to a patient as part of St Vincent’s Private Hospital Outreach Service by, or on behalf of, St Vincent’s Private Hospital, Darlinghurst, New South Wales.

St Vincent’s Private Hospital Outreach Service 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.