National Health Act 1953 Determination pursuant to subsection 5D(1) (PSO 4/2006) (Cth)

AUSTRALIAN GOVERNMENT

NATIONAL HEALTH ACT 1953

DETERMINATION PURSUANT TO SUBSECTION 5D(1)

This compilation was prepared on 12 April 2007 by the Department of Health and Ageing.

It is a compilation of the determinations made under subsection 5D(1) of the National Health Act 1953 (the Act) specifying services provided by, or on behalf of, hospitals and day hospital facilities for the purposes of the definition of outreach services in subsection 4(1) of the Act.

It comprises determination PSO 4/2006 made on 23 June 2006, with effect from 1 July 2006, as amended by determination PSO 5/2006, made on 14 August 2006, with effect from 19 August 2006.

I, DAMIAN COBURN, 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 July 2006 and shall remain in force until, and including, 30 June 2007.

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 Epworth Freemasons /Hospital in the Hotel by, or on behalf of, Epworth Freemasons, East Melbourne, Victoria.

Epworth Freemasons /Hospital in the Hotel provides obstetric treatment to patients in their homes.

1. Relevant health services provided to a patient as part of Royal Rehabilitation HomeReach by, or on behalf of, Royal Rehabilitation Centre Sydney, Ryde, New South Wales.

Royal Rehabilitation HomeReach provides treatment to patients in their homes.

1. Relevant health services provided to a patient as part of Bairnsdale Regional Health Outreach Program by, or on behalf of, Bairnsdale Regional Health Service, Bairnsdale, Victoria. 

Bairnsdale Regional Health Outreach Program provides treatment to patients in their homes.

1. Relevant health services provided to a patient as part of Parenting Program at the Novotel by, or on behalf of, Waverley Private Hospital, Mt Waverley, Victoria.

Parenting Program at the Novotel provides obstetric 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.

Notes to the National Health Act 1953 Determination pursuant to subsection 5D(1)

Note 1

The National Health Act 1953 Determination pursuant to subsection 5D(1) as set out in the principal determination (in force under subsection 5D(1) of the National Health Act 1953) as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Title	Date of registration in the Federal Register of Legislatvie Instruments	Date of commencement	Application, saving or transitional provisions
National Health Act 1953 Determination pursuant to subsection 5D(1) (PSO 4/2006)	27 June 2006	1 July 2006
National Health Act 1953 Determination pursuant to subsection 5D(1) (PSO 5/2006)	18 August 2006	19 August 2006

Table of Amendments

ad. = added or inserted      am. = amended      rep. = repealed      rs. = repealed and substituted
Provision affected	How affected
Section 2	rs 2006 PSO 5/2006