National Health Act 1953 - Determination pursuant to subsection 5D(1) (Pso 7/2006) (Cth)

AUSTRALIAN GOVERNMENT

NATIONAL HEALTH ACT 1953

DETERMINATION PURSUANT TO SUBSECTION 5D(1)

(PSO 7 / 2006)

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 1 October 2006 and shall remain in force until, and including, 30 September 2007.

Dated this         29            day of             September                   2006

Gail Yapp

………………………………

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 Ballarat Health Services Hospital in the Home Service by, or on behalf of, Ballarat Health Services, Ballarat, Victoria.

Ballarat Health Services Hospital in the Home Service provides treatment to patients in their homes.

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

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

1. Relevant health services provided to a patient as part of St Vincents and Mercy Private Hospital/Hospital in the Home Outreach Services by, or on behalf of, St Vincents and Mercy Private Hospital, Melbourne, Victoria.

St Vincents and Mercy Private Hospital/Hospital in the Home Outreach Services provides treatment to patients in their homes.

1. Relevant health services provided to a patient as part of St Vincents and Mercy Private Hospital Maternity Outreach Service by, or on behalf of, St Vincents and Mercy Private Hospital, Melbourne, Victoria.  

St Vincents and Mercy Private Hospital Maternity Outreach Service provides obstetric treatment to patients in their homes.

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

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

1. Relevant health services provided to a patient as part of Perth Clinic Mental Health Assertive Community Treatment Program by, or on behalf of, Perth Clinic, Perth, Western Australia.

Perth Clinic Mental Health Assertive Community Treatment Program provides psychiatric treatment to patients in their homes.

1. Relevant health services provided to a patient as part of Northern Health Neonatal & Paediatric Private Sector Outreach Services by, or on behalf of, The Northern Hospital, Epping, Victoria.

Northern Health Neonatal & Paediatric Private Sector Outreach Services provides treatment to patients in their homes.

1. Relevant health services provided to a patient as part of Ashford Hospital Maternity Hotel Service Program by, or on behalf of, Ashford Hospital, Ashford, South Australia.

Ashford Hospital Maternity Hotel Service Program 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.