National Health Act 1953 - Determination under Schedule 1, paragraph (1)(bj) (Hib 20/2006) (Cth)

Australian Government

NATIONAL HEALTH ACT 1953

Determination under Schedule 1, paragraph (1)(bj)

(HIB 20/2006)

I, LOUISE CLARKE, Acting Assistant Secretary, Private Health Insurance Branch, delegate of the Minister for Health and Ageing pursuant to Schedule 1, paragraph (1)(bj) of the National Health Act 1953 (the Act):

REVOKE, with effect on and from 20 September 2006, all previous determinations made under Schedule 1, paragraph (1)(bj) to the Act; and

DETERMINE, with effect on and from 20 September 2006, for the purposes of Schedule 1, paragraph (1)(bj) to the Act that the minimum level of benefits payable in respect of episodes of hospital treatment specified under Schedule 1, subparagraph (1)(bh)(ii) to the Act, be those applicable in the attached Schedules.

In this Determination the “Medicare Benefits Schedule” (MBS) means the table of medical services made in accordance with subsection 3(1) of the Health Insurance Act 1973, as in force from time to time.

In this Determination “Diagnostic Imaging Services” means the table of diagnostic imaging services made in accordance with section 4AA of the Health Insurance Act 1973, as in force from time to time.

In this Determination “Pathology Services” means the table of pathology services made in accordance with section 4A of the Health Insurance Act 1973, as in force from time to time.

For the purposes of this Determination:

(a)the level of benefits payable for overnight accommodation in private hospitals in all States and Territories and shared ward accommodation in recognised hospitals in Victoria and Tasmania are set out in Schedule 1 to this Determination;

(b)the level of benefits payable for overnight shared ward accommodation in recognised hospitals in the Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia and Western Australia are set out in Schedule 2 to this Determination;

(c)the level of benefits payable for same day accommodation in hospitals and day hospital facilities in all States and Territories are set out in Schedule 3 to this Determination;

(d)the level of benefits payable for nursing home type patient accommodation in hospitals in all States and Territories are set out in Schedule 4 to this Determination;

(e)the second tier level of benefits payable for accommodation in private hospitals and day hospital facilities are set out in Schedule 5 to this Determination;

(f)the level of benefits payable for Care Plans and Case Conferencing in hospitals and day hospital facilities in all States and Territories are set out in Schedule 6 to this Determination;

(g)the level of benefits payable for Outreach Services provided to a patient by, or on behalf of, a hospital or day hospital facility in all States and Territories are set out in Schedule 7 to this Determination.

Dated this 19^th day of September 2006.

LOUISE CLARKE

Acting Assistant Secretary

Private Health Insurance Branch

Position No: 01202874

Delegate of the Minister for Health and Ageing

SCHEDULE 1 including Part 1 – OVERNIGHT ACCOMMODATION

PRIVATE HOSPITALS IN ALL STATES/TERRITORIES and Shared Ward Accommodation in RECOGNISED HOSPITALS IN VICTORIA AND TASMANIA

In respect of hospital treatment provided to patients (other than nursing-home type patients or patients in situations of emergency) in private hospitals in all States/Territories and in shared ward accommodation in recognised hospitals in Victoria and Tasmania for the purpose of permitting the provision to them at the hospital of hospital treatment for a period that includes part of an overnight stay for a continuous period of hospitalisation, benefits are payable as specified hereunder, for patients falling within a class of patient as specified hereunder:

PRIVATE HOSPITALS AND SHARED WARD ACCOMMODATION

(all States/Territories)

CLASS OF PATIENT	BENEFIT PAYABLE PER NIGHT
Advanced Surgical
- first 14 days	$325
- over 14 days	$226
Surgical/Obstetric
- first 14 days	$301
- over 14 days	$226
Psychiatric
- first 42 days	$301
- 43 – 65 days	$262
- over 65 days	$226
Rehabilitation
- first 49 days	$301
- 50 - 65 days	$262
- over 65 days	$226
Other
- first 14 days	$262
- over 14 days	$226

VICTORIA – shared ward accommodation in recognised hospitals

CLASS OF PATIENT	BENEFIT PAYABLE PER NIGHT
Advanced Surgical
- first 14 days	$325
- over 14 days	$226
Surgical/Obstetric
- first 14 days	$301
- over 14 days	$226
Psychiatric
- first 42 days	$301
- 43 – 65 days	$262
- over 65 days	$226
Rehabilitation
- first 49 days	$301
- 50 – 65 days	$262
- over 65 days	$226
Other
- first 14 days	$262
- over 14 days	$226

TASMANIA – shared ward accommodation in recognised hospitals

CLASS OF PATIENT	BENEFIT PAYABLE PER NIGHT
Advanced Surgical
- first 14 days	$325
- over 14 days	$226
Surgical/Obstetric
- first 14 days	$301
- over 14 days	$226
Psychiatric
- first 42 days	$301
- 43 – 65 days	$262
- over 65 days	$226
Rehabilitation
- first 49 days	$301
- 50 – 65 days	$262
- over 65 days	$226
Other
- first 14 days	$262
- over 14 days	$226

For the purposes of Schedule 1:

- in counting days, a continuous period of hospitalisation is deemed to be any two periods, being periods during which a patient was, or is, a patient in a hospital (whether or not the same hospital), that are separated from each other by a period of not more than seven days during which a patient was not a patient in any hospital.

- an advanced surgical patient is specified in Part 1 of this Schedule and the item numbers are derived from the MBS and apply to those MBS items that have an MBS fee that is greater than $738.22.

- an obstetric patient is specified in Part one of this Schedule.

- a surgical patient is specified in Part 1 of this Schedule and the item numbers are derived from the MBS and apply to those MBS items that have an MBS fee within the range of $219.81 to $738.22.

- a psychiatric patient is deemed to be a patient in a hospital who, subject to approval by individual health benefits organizations, is admitted for the purposes of undertaking a specific psychiatric treatment program.

- a rehabilitation patient is deemed to be a patient in a hospital who, subject to approval by individual health benefits organizations, is admitted for the purposes of undertaking a specific rehabilitation treatment program.

- other patients are deemed to be any patients in a hospital other than advanced surgical, surgical, obstetric, psychiatric, or rehabilitation patients.

Overnight benefits in relation to Type B procedures:

Overnight accommodation benefits are not payable for Type B professional attention (as specified in Part 1 of Schedule 3) unless overnight certification is provided. In order for an overnight benefit to be payable to a patient in receipt of a Type B procedure requiring overnight hospitalisation, the:

(a) practitioner providing the professional attention; or

(b) a professional employed by a hospital or day hospital facility who is involved in the provision of the professional attention provided by that hospital or day hospital facility;

must certify in writing that:

(a) because of the medical condition of the patient specified in the certificate; or

(b) because of the special circumstances specified in the certificate;

it would be contrary to accepted medical practice to provide the professional attention to the patient unless the patient were given hospital treatment in the hospital for a period that included part of an overnight stay.

Overnight Benefits in relation to Type C Procedures

Overnight accommodation benefits are not payable for Type C professional attention (as defined in Part 2 of Schedule 3) unless overnight certification, in addition to day certification, is provided. In order for an overnight benefit to be payable to a patient in receipt of a Type C procedure requiring hospitalisation, the practitioner providing the professional attention must certify in writing that:

(a) because of the medical condition of the patient specified in the certificate; or

(b) because of the special circumstances specified in the certificate;

PART 1 of SCHEDULE 1

Advanced Surgical Patient

A patient shall be taken to be an advanced surgical patient upon admission to a hospital from and including the day before a professional service, the MBS item number of which is specified hereunder, is rendered to the patient in that hospital, unless the particular advanced surgical procedure to be rendered is recognised as requiring a longer pre-operative period. If advanced surgery is rendered to a patient during an admission, the patient shall be taken to be an advanced surgical patient from the day the advanced surgery is performed (not the day before).

13218 15600 30177 30250 30251 30255 30275 30294 30296 30297 30309 30315 30317 30318 30320 30321 30323 30324 30335 30336 30379 30382 30384 30388 30396 30405 30415 30417 30418 30421 30425 30427 30428 30430 30438 30448 30449 30454 30455 30457 30458 30460 30461 30463 30464 30466 30467 30469 30472 30500 30502 30503 30506 30508 30509 30512 30514 30517 30518 30521 30523 30524 30526 30527 30529 30532 30533 30535 30536 30538 30539 30541 30542 30545 30547 30548 30550 30551 30553 30554 30556 30557 30560 30565 30566 30577 30578 30580 30583 30584 30589 30590 30593 30594 30596 30599 30601 30602 30603 30605 30606 31002 31409 31412 31429 31432 31435 31438 31464 31466 31468 31472 31524 32000 32003 32004 32005 32006 32009 32012 32015 32018 32024 32025 32026 32028 32030 32033 32036 32039 32042 32047 32051 32054 32060 32063 32069 32104 32106 32108 32117 32209 32514 32517 32700 32703 32708 32710 32711 32712 32715 32718 32721 32724 32730 32733 32739 32742 32745 32748 32751 32754 32763 33050 33055 33075 33080 33100 33103 33109 33112 33115 33116 33118 33119 33121 33124 33127 33130 33133 33136 33139 33142 33145 33148 33151 33154 33157 33160 33163 33166 33169 33172 33175 33178 33181 33500 33506 33509 33512 33515 33518 33521 33524 33527 33530 33533 33536 33539 33542 33800 33803 33811 33812 33815 33818 33821 33824 33827 33830 33833 33836 33839 33842 34112 34115 34118 34121 34124 34127 34136 34139 34142 34148 34151 34154 34157 34160 34163 34166 34169 34172 34175 34509 34512 34518 34533 34803 34806 34809 34812 34815 34818 34821 34833 35003 35006 35307 35009 35312 35315 35320 35561 35562 35595 35597 35641 35661 35664 35667 35670 35697 35753 35754 36500 36503 36506 36516 36519 36522 36525 36526 36527 36528 36529 36531 36532 36533 36540 36543 36564 36567 36570 36573 36576 36588 36591 36594 36597 36600 36603 36606 36645 36648 36656 37014 37029 37042 37045 37047 37053 37200 37203 37207 37209 37210 37211 37220 37230 37309 37341 37343 37375 37384 37390 37405 37411 37423 37426 37432 37444 37607 37610 37824 37842 37848 37851 38212 38228 38231 38234 38237 38240 38246 38270 38272 38287 38290 38293 38309 38312 38315 38318 38324 38327 38330 38358 38368 38390 38418 38421 38424 38427 38438 38440 38441 38446 38447 38449 38450 38453 38455 38456 38457 38466 38468 38469 38470

38477 38478 38480 38481 38483 38487 38488 38489 38493 38497 38498 38500 38501 38503 38504 38506 38507 38508 38509 38512 38515 38518 38550 38553 38556 38559 38562 38565 38568 38571 38572 38600 38603 38615 38618 38624 38640 38643 38647 38650 38653 38654 38656 38670 38673 38677 38680 38700 38703 38706 38709 38712 38715 38718 38721 38724 38727 38730 38733 38736 38739 38742 38745 38748 38751 38754 38757 38760 38763 38766 39106 39112 39124 39139 39315 39500 39503 39603 39609 39612 39615 39640 39642 39646 39650 39653 39654 39656 39658 39660 39662 39706 39709 39712 39715 39718 39800 39803 39806 39815 39818 39821 39903 40000 40003 40012 40103 40106 40109 40112 40118 40300 40301 40303 40306 40309 40312 40315 40316 40318 40321 40330 40331 40332 40334 40335 40339 40342 40345 40348 40351 40600 40700 40703 40706 40712 40801 40803 41518 41521 41530 41533 41536 41539 41542 41551 41554 41557 41560 41563 41564 41566 41569 41572 41575 41576 41578 41579 41581 41584 41587 41590 41593 41596 41599 41608 41614 41615 41617 41623 41635 41638 41728 41734 41782 41785 41834 41837 41840 41843 41879 42521 42539 42543 42545 42557 42569 42626 42653 42656 42659 42662 42672 42702 42710 42716 42725 42731 42746 42749 42752 42767 42773 42776 42779 42842 42851 42860 43801 43804 43807 43810 43813 43816 43819 43822 43825 43828 43831 43834 43837 43840 43843 43846 43852 43855 43861 43864 43870 43873 43876 43879 43882 43900 43903 43906 43909 43912 43915 43936 43945 43951 43954 43957 43963 43966 43969 43972 43975 43978 43984 43987 43990 43993 43996 44334 44373 45006 45036 45215 45415 45418 45460 45461 45464 45465 45466 45468 45469 45471 45472 45474 45475 45477 45478 45480 45481 45483 45484 45490 45491 45492 45494 45500 45501 45502 45503 45504 45505 45520 45528 45530 45533 45539 45558 45562 45563 45564 45565 45566 45587 45588 45596 45597 45599 45624 45638 45639 45641 45644 45646 45647 45660 45661 45686 45720 45723 45726 45729 45731 45732 45735 45738 45741 45744 45747 45752 45753 45754 45767 45770 45773 45776 45779 45782 45785 45788 45791 45853 45861 45863 45869 45871 45873 46315 46318 46321 46393 46477 46504 46507 47486 47489 47501 47504 47507 47510 47519 47525 47531 47534 47566 47588 47591 47687 47690 47693 47699 47702 48203 48427 48512 48606 48609 48612 48613 48618 48621 48624 48627 48630 48632 48639 48640 48645 48648 48651 48654 48657 48660 48669 48672 48681 48684 48687 48690 48918 48921 48924 48933 48939 48942 48951 48954 48957 48960 49106 49115 49306 49312 49318 49319 49321 49324 49327 49330 49333 49339 49342 49345 49512 49517 49518 49519 49521 49524 49527 49530 49533 49536 49539 49542 49548 49551 49554 49564 49715 49836 49838 49842 50212 50215 50218 50221 50224 50227 50230 50233 50236 50239 50300 50303 50306 50321 50324 50327 50336 50351 50354 50366 50372 50378 50384 50394 50399 50408 50411 50414 50417 50420 50423 52123 52126 52129 52158 52337 52342 52345 52348 52351 52354 52357 52360 52363 52366 52369 52372 52375 52379 52380 52382 52430 52446 52821 53209 53212 53221 53224 53227 53230 53233

PART 1 of SCHEDULE 1

Obstetric Patient

A patient shall be taken to be an obstetric patient during an admission to a hospital from and including:

- the day on which the patient commences labour leading to delivery in that hospital or the day on which a professional service the MBS item number of which is 16515, 16518, 16519, 16522 (excluding caesarean) or 16525 is rendered to the patient in that hospital, whichever is the earlier; or

- the day before a professional service, the MBS item number of which is 16520 and 16522 (including caesarean) is rendered to the patient in that hospital, unless the particular obstetric procedure to be rendered is recognised as requiring a longer pre-operative period.

Surgical Patient

A patient shall be taken to be a surgical patient upon admission to a hospital from and including the day before a professional service, the MBS item number of which is specified hereunder, is rendered to the patient in that hospital, unless the particular surgical procedure to be rendered is recognised as requiring a longer pre-operative period. If surgical treatment is rendered to a patient during admission, the patient shall be taken to be a surgical patient from the day the surgery is performed (not the day before).

13212 13700 14130 14132 14230 14233 14236 14242 15303 15304 15307 15308 15311 15312 15315 15316 15319 15320 15323 15324 15327 15328 15331 15332 15335 15336 15345 15360 15363 15541 16567 16570 16571 16573 30017 30020 30023 30024 30068 30110 30111 30114 30165 30168 30171 30174 30178 30187 30190 30197 30225 30229 30235 30241 30244 30246 30247 30253 30256 30272 30286 30289 30293 30299 30300 30302 30303 30306 30308 30310 30313 30314 30330 30332 30373 30375 30376 30378 30385 30387 30391 30392 30393 30394 30399 30400 30402 30403 30408 30414 30416 30419 30422 30431 30433 30434 30436 30437 30440 30443 30445 30446 30450 30451 30452 30475 30479 30481 30484 30485 30490 30491 30492 30493 30494 30495 30496 30497 30499 30505 30511 30515 30520 30530 30544 30559 30562 30563 30564 30568 30569 30571 30572 30575 30581 30586 30587 30597 30600 30609 30612 30614 30615 30616 30617 30620 30621 30635 30638 30641 30644 30672 30675 30676 31000 31001 31225 31245 31250 31260 31270 31275 31295 31300 31305 31310 31315 31320 31325 31330 31335 31340 31350

31355 31400 31403 31406 31423 31426 31450 31452 31454 31460 31462 31470 31500 31503 31506 31509 31512 31515 31518 31521 31527 31539 31545 31554 32021 32029 32045 32046 32057 32066 32090 32093 32094 32096 32099 32102 32103 32105 32111 32112 32120 32123 32126 32129 32131 32138 32139 32150 32159 32162 32165 32180 32183 32186 32200 32203 32206 32210 32213 32214 32216 32504 32507 32508 32511 32736 32757 32760 32766 32769 33070 33545 33548 33551 33554 33806 33810 33845 33848 34100 34103 34106 34109 34130 34133 34145 34500 34503 34515 34521 34524 34527 34528 34538 34800 34824 34827 34830 35000 35012 35100 35202 35300 35303 35306 35309 35317 35319 35321 35324 35327 35330 35331 35360 35361 35362 35363 35400 35402 35404 35406 35408 35508 35530 35533 35536 35539 35542 35548 35551 35560 35564 35565 35566 35568 35570 35571 35573 35577 35578 35596 35599 35602 35605 35612 35613 35622 35623 35634 35635 35636 35637 35638 35645 35648 35649 35653 35657 35658 35673 35676 35677 35678 35680 35683 35684 35687 35688 35694 35700 35710 35712 35713 35716 35717 35720 35723 35726 35750 35756 35759 36502 36509 36537 36546 36549 36552 36558 36579 36585 36604 36605 36607 36608 36609 36612 36615 36618 36621 36624 36627 36630 36633 36636 36639 36642 36649 36650 36652 36654 36803 36806 36809 36811 36818 36821 36825 36833 36839 36840 36842 36845 36854 36857 36863 37000 37004 37008 37020 37023 37026 37038 37043 37044 37050 37201 37202 37206 37208 37212 37215 37219 37221 37224 37233 37306 37318 37327 37330 37333 37336 37340 37342 37345 37348 37351 37354 37372 37381 37387 37396 37402 37408 37417 37418 37420 37429 37438 37601 37604 37613 37616 37619 37800 37803 37806 37809 37812 37818 37821 37827 37830 37833 37836 37839 37845 37854 38200 38203 38206 38209 38213 38215 38218 38222 38225 38243 38256 38275 38300 38303 38306 38321 38350 38353 38356 38362 38365 38393 38415 38430 38448 38452 38458 38460 38462 38464 38473 38475 38485 38490 38496 38505 38577 38588 3860938612 38613 38621 38627 38637 39015 39018 39109 39118 39121 39125 39126 39127 39128 39130 39133 39134 39137 39138 39140 39300 39303 39306 39309 39312 39318 39321 39323 39324 39327 39330 39331 39333 39600 39606 39700 39703 39721 39812 39900 39906 40006 40009 40015 40100 40115 40324 40327 40333 40336 40709 40800 40903 40905 41512 41515 41524 41527 41545 41548 41611 41620 41629 41671 41672 41707 41710 41713 41716 41722 41725 41729 41731 41737 41743 41746 41749 41752 41767 41770 41773 41776 41779 41786 41787 41789 41792 41793 41813 41819 41820 41825 41831 41849 41852 41855 41858 41861 41864 41867 41868 41869 41870 41873 41876 41880 41881 41885 41895 41898 41901 41905 41910 42506 42509 42510 42512 42515 42518 42527 42530 42533 42536 42542 42548 42551 42554 42560 42563 42566 42574 42578 42584 42590 42596 42599 42602 42605 42608 42623 42629 42635 42638 42641 42665 42680 42686 42692 42695 42698 42701 42703 42704 42707 42713 42719 42722 42734 42737 42740 42743 42758 42761 42764 42770 42771 42782 42783 42785 42786 42788 42789 42791 42792 42805 42806 42807 42808 42809 42810 42815 42818 42833 42836 42839 42848 42854 42857 42863 42866 42869 43506 43509 43512 43515 43518 43521 43524 43849 43858 43867

43930 43933 43939 43960 43981 43999 44102 44108 44111 44114 44130 44133 44325 44328 44331 44350 44354 44359 44361 44364 44367 44370 45000 45003 45009 45012 45015 45018 45019 45020 45024 45026 45035 45042 45045 45048 45051 45200 45203 45206 45209 45218 45221 45227 45233 45236 45239 45403 45406 45409 45412 45439 45442 45445 45448 45451 45462 45485 45486 45487 45488 45489 45493 45496 45497 45498 45512 45519 45522 45524 45527 45536 45542 45545 45548 45551 45552 45554 45555 45556 45557 45560 45568 45572 45575 45578 45581 45584 45585 45586 45590 45593 45602 45605 45608 45611 45614 45620 45623 45626 45629 45632 45635 45652 45653 45656 45659 45662 45665 45668 45669 45671 45675 45676 45677 45680 45683 45689 45692 45695 45698 45701 45704 45707 45710 45713 45714 45716 45755 45758 45761 45794 45803 45809 45811 45813 45815 45817 45819 45821 45825 45827 45831 45833 45835 45837 45839 45841 45843 45845 45849 45855 45857 45859 45865 45867 45875 45877 45879 46300 46303 46306 46307 46309 46312 46324 46325 46330 46333 46336 46339 46342 46345 46351 46354 46357 46360 46372 46375 46378 46381 46384 46387 46390 46396 46399 46402 46405 46408 46411 46414 46417 46423 46426 46429 46432 46435 46441 46442 46444 46447 46453 46462 46468 46471 46474 46480 46483 46489 46492 46500 46501 46502 46503 46510 46522 47012 47021 47027 47033 47048 47051 47054 47063 47066 47333 47345 47357 47366 47372 47375 47381 47384 47385 47386 47387 47390 47393 47399 47402 47408 47417 47420 47426 47429 47432 47435 47438 47441 47447 47450 47451 47453 47456 47459 47468 47480 47483 47495 47498 47513 47516 47522 47528 47537 47546 47549 47552 47555 47558 47561 47564 47565 47567 47570 47573 47582 47585 47597 47600 47603 47609 47612 47615 47618 47621 47624 47630 47648 47654 47657 47684 47696 47705 47711 47717 47720 47723 47732 47741 47753 47756 47765 47768 47771 47774 47777 47780 47783 47786 47789 47920 47930 47936 47954 47957 47966 47969 47975 47982 48200 48206 48209 48212 48215 48218 48221 48224 48227 48230 48233 48236 48239 48242 48400 48403 48406 48409 48412 48415 48418 48421 48424 48500 48503 48506 48615 48636 48642 48663 48666 48675 48678 48900 48903 48906 48909 48912 48915 48927 48930 48936 48945 48948 49100 49103 49109 49112 49118 49121 49200 49203 49206 49209 49215 49218 49221 49224 49227 49300 49303 49309 49315 49336 49346 49360 49363 49366 49500 49503 49506 49509 49515 49534 49545 49557 49558 49559 49560 49561 49562 49563 49566 49569 49700 49703 49706 49709 49712 49718 49724 49727 49812 49815 49818 49821 49824 49827 49830 49833 49837 49839 49845 49854 49857 49860 49863 49866 50100 50102 50103 50104 50106 50109 50112 50118 50121 50127 50130 50201 50203 50206 50209 50309 50312 50315 50318 50333 50339 50342 50345 50353 50357 50360 50363 50369 50375 50381 50387 50393 50396 50402 50405 50426 50952 51900 51904 51906 52018 52035 52039 52048 52051 52054 52059 52063 52066 52078 52090 52092 52094 52095 52105 52108 52111 52114 52117 52120 52122 52130 52131 52138 52141 52144 52147 52148 52182 52184 52186 52300 52303 52306 52312

52315 52321 52324 52330 52333 52336 52339 52378 52424 52440 52442 52444 52450 52452 52456 52458 52460 52480 52482 52484 52600 52603 52609 52612 52615 52618 52621 52624 52626 52627 52633 52800 52803 52806 52809 52812 52815 52818 52824 52828 52830 52832 53006 53009 53015 53016 53017 53019 53215 53218 53220 53225 53226 53236 53239 53242 53406 53409 53412 53413 53414 53415 53416 53418 53419 53422 53423 53424 53425 53427 53429 53453 53455 53460 55135 57351 57356

SCHEDULE 2 – OVERNIGHT ACCOMMODATION

Shared ward accommodation in RECOGNISED HOSPITALS IN THE AUSTRALIAN CAPITAL TERRITORY, NEW SOUTH WALES, NORTHERN TERRITORY, QUEENSLAND, SOUTH AUSTRALIA AND WESTERN AUSTRALIA

In respect of hospital treatment provided to patients (other than nursing-home type patients or patients in situations of emergency) in shared ward accommodation in a hospital in a State or Territory for the purpose of permitting the provision to them at the hospital of hospital treatment for a period that includes part of an overnight stay for a continuous period of hospitalisation (as specified hereunder), benefits will be as follows:

STATE/TERRITORY	BENEFIT PAYABLE PER NIGHT
Australian Capital Territory	$269
New South Wales	$269
Northern Territory	$261
Queensland	$269
South Australia	$269
Western Australia	$269

In counting days, a continuous period of hospitalisation is deemed to be any two periods, being periods during which a patient was, or is, a patient in a hospital (whether or not the same hospital), that are separated from each other by a period of not more that seven days during which a patient was not a patient in any hospital.

Overnight benefits in relation to Type B procedures:

(a) practitioner providing professional attention; or

(b) a professional employed by a hospital or day hospital facility who is involved in the provision of the professional attention provided by that hospital or day hospital facility;

must certify in writing that:

(a) because of the medical condition of the patient specified in the certificate; or

(b) because of the special circumstances specified in the certificate;

Overnight benefits in relation to Type C procedures:

Overnight accommodation benefits are not payable for Type C professional attention (as specified in Part 2 of Schedule 3) unless overnight certification, in addition to day certification, is provided. In order for an overnight benefit to be payable to a patient in receipt of a Type C procedure requiring hospitalisation, the practitioner providing the professional attention must certify in writing that:

(a) because of the medical condition of the patient specified in the certificate; or

(b) because of the special circumstances specified in the certificate;

SCHEDULE 3 including Parts 1 & 2 – SAME DAY ACCOMMODATION

HOSPITAL AND DAY HOSPITAL FACILITIES IN ALL STATES/TERRITORIES

In respect of hospital treatment provided to patients in all hospitals or day hospital facilities (otherwise than in situations of emergency) in a State or Territory for the purpose of permitting the provision of hospital treatment to them for a period that does not include part of an overnight stay benefits are payable per day as specified hereunder, for patients receiving Type B professional attention as specified in Part 1 of this Schedule:

BAND 1	BAND 2	BAND 3	BAND 4
NSW	$194	$218	$240	$269
ACT	$195	$219	$240	$269
NT	$189	$216	$238	$261
QLD	$196.50	$219.50	$241.50	$269
SA	$195	$222	$244	$269
TAS	$188	$225	$261	$301
VIC	$190	$226	$262	$301
WA	$212	$212	$212	$212
Private Hospitals	$169	$212	$258	$301
Private Day Hospitals	$169	$212	$258	$301

The above day only accommodation benefits are not payable for Type C professional attention (as specified in Part 2 of this Schedule) unless certification is provided. In order for a day benefit to be payable to a patient in receipt of a Type C procedure requiring hospitalisation the medical practitioner providing the professional attention must certify in writing that:

(a) because of the medical condition of the patient specified in the certificate; or

(b) because of the special circumstances specified in the certificate;

PART 1 of SCHEDULE 3

TYPE B PROFESSIONAL ATTENTION PROCEDURES

These procedures normally require hospital treatment that does

not include part of an over-night stay

The following item numbers are from the Medicare Benefits Schedule

BAND 1:

(a) CATEGORY 3 – THERAPEUTIC PROCEDURES

T1: Miscellaneous Therapeutic Procedures:

13100 13103 13703 13706 13915 13918 13921 13927 13930

T8: Surgical Operations:

30210 30473 30475 30476 30478 30679 32075 32078 32081 32084 32087 32090 32095 35500 35539 35545 35703 37011 39000 39100 41647 41674 41680 42575 45027

CATEGORY 5 – DIAGNOSTIC IMAGING SERVICES

I1: Ultrasound:

55118 55600 55603

(b) Professional Attention that embraces all other day admission to hospital not related to Bands 2, 3 or 4.

NON-BAND SPECIFIC TYPE B DAY PROCEDURES:

13110 13212 13215 13292 13750 13755 13757 13948 14218 15338 15513 15539 16512 16603 16618 18216 18230 18242 18274 18276 18280 18284 18286 18290 18294 18296 18298 30041 30042 30045 30055 30081 30084 30087 30094 30096 30099 30102 30103 30104 30106 30107 30187 30189 30190 30223 30225 30262 30269 30281 30282 30283 30390 30391 30409 30484 30493 30653 30656 30659 30660 31225 31230 31235 31240 31255 31256 31257 31258 31260 31261 31262 31263 31265 31266 31267 31268 31270 31271 31272 31273

31275 31276 31277 31278 31280 31281 31282 31283 31285 31286 31287 31288 31290 31291 31292 31293 31295 31300 31305 31310 31315 31320 31325 31330 31335 31340 31345 31346 31350 31355 31441 31456 31458 31530 31551 31557 31560 31563 31566 32093 32094 32145 32147 32150 32153 32156 32168 32171 32177 32180 32504 34109 34130 34500 34503 34506 34524 34539 35324 35507 35508 35509 35512 35513 35516 35517 35520 35523 35526 35527 35542 35557 35569 35572 35611 35615 35616 35617 35618 35622 35623 35626 35627 35630 35633 35637 35639 35640 35643 35644 35645 35646 35647 35648 35687 35688 36812 36815 36818 36821 36824 36827 36830 36833 36836 36860 37219 37315 37318 37321 37354 37369 37435 37622 37623 37803 37806 37809 37812 37815 37854 38285 38286 39013 39118 39135 39140 39331 41503 41506 41509 41626 41629 41632 41644 41650 41653 41665 41668 41677 41695 41701 41716 41761 41764 41800 41801 41816 41819 41822 41825 41831 41849 41852 41855 41858 41861 41864 41886 41889 41892 41898 42503 42572 42573 42584 42593 42610 42611 42673 42680 42683 42686 42689 42692 42812 42818 42833 42845 42869 43942 43948 44102 44105 44136 44338 45019 45020 45030 45033 45039 45200 45224 45239 45506 45515 45626 45665 45668 45823 46327 46330 46336 46363 46366 46369 46396 46420 46423 46438 46441 46450 46486 46489 46494 46495 46501 46510 46525 47738 47906 47915 47918 47927 47972 48600 48603 48945 49218 49557 49700 49800 49803 49806 49809 50100 50115 51902 52015 52025 52042 52045 52057 52058 52061 52062 52064 52072 52073 52075 52081 52084 52087 52097 52099 52102 52144 52180 52300 52303 52321 52826 53003 53006 53009 53054 53056 53058 53060 53062 53064 53070 53206 53215 53218 53225 53410 53459 58939 59903 59912 59925 59970 59971 59972 59973 59974 60000 60003 60006 60009 60012 60015 60018 60021 60024 60027 60030 60033 60036 60039 60042 60045 60048 60051 60054 60057 60060 60063 60066 60069 60072 60075 60078

THE NON-BAND SPECIFIED ITEMS LISTED ABOVE WILL QUALIFY FOR DAY BENEFITS AT THE LEVEL OF BAND 2, 3 OR 4 DEPENDING ON ANAESTHETIC TYPE AND WHERE APPLICABLE, THEATRE TIME. IN THE ABSENCE OF ANAESTHETIC OR THEATRE TIMES, A BAND 1 BENEFIT IS PAYABLE.

BAND 2: means procedures (other than Band 1) carried out under local anaesthetic, no sedation.

BAND 3: means procedures (other than Band 1) carried out under general or regional anaesthesia or intravenous sedation. Theatre time (actual time in theatre) less than one hour.

BAND 4: means procedures (other than Band 1) carried out under general or regional anaesthesia or intravenous sedation. Theatre time (actual time in theatre) one hour or more.

PART 2 of SCHEDULE 3

TYPE C PROFESSIONAL ATTENTION

These procedures do not normally require hospital treatment

The following item numbers are from the Medicare Benefits Schedule

GENERAL MEDICAL SERVICES

CATEGORY 1 – ATTENDANCES

A1:

1 2 3 4 13 19 20 23 24 25 33 35 36 37 38 40 43 44 47 48 50 51 601 602

A2:

52 53 54 57 58 59 60 65 81 83 84 86 87 89 90 91 92 93 95 96 97 98 697 698

A3:

104 105 106 107 108 109

A4:

110 116 119 122 128 131

A5:

160 161 162 163 164

A6:

170 171 172

A7:

173 193 195 197 199

A8:

291 293 300 302 304 306 308 310 312 314 316 318 319 320 322 324 326 328 330 332 334 336 338 342 344 346 348 350 352 353 355 356 357 358 364 366 367 369 370

A9:

10801 10802 10803 10804 10805 10806 10807 10808 10809 10816

A12:

385 386 387 388

A13:

410 411 412 413 414 415 416 417

A14:

700 702 704 708 706 710 712 714 716

A15:

721 723 725 727 729 731 734 736 738 740 742 744 759 762 765 768 771 773 775 778 779 820 822 823 825 826 828 855 857 858

A16:

444 445 446 447 448 449

A17:

900 903

A18:

2497 2501 2503 2504 2506 2507 2509 2517 2518 2521 2522 2525 2526 2546 2547 2552 2553 2558 2559 2574 2575 2577 2578

A19:

2598 2600 2603 2606 2610 2613 2616 2620 2622 2624 2630 2631 2633 2635 2664 2666 2668 2673 2675 2677 2704 2705 2707 2708

A20:

2721 2723 2725 2727

A21:

501 503 507 511 515 519 520 530 532 534 536

A22:

5000 5003 5007 5010 5020 5023 5026 5028 5040 5043 5046 5049 5060 5063 5064 5067

A23:

5200 5203 5207 5208 5220 5223 5227 5228 5240 5243 5247 5248 5260 5263 5265 5267

A24

2801 2806 2814 2824 2832 2840 2946 2949 2954 2958 2972 2974 3005 3010 3014 3018 3023 3028 3032 3040 3044 3051 3055 3062

M2:

10993 10996 10998 10999

10988 10989

CATEGORY 2 – DIAGNOSTIC PROCEDURES & INVESTIGATIONS

D1:

11000 11003 11006 11009 11012 11015 11018 11024 11027 11200 11203 11204 11205 11210 11211 11212 11215 11218 11221 11222 11224 11225 11235 11237 11240 11241 11242 11243 11300 11306 11309 11312 11315 11318 11321 11324 11327 11332 11333 11336 11339 11500 11503 11506 11509 11512 11602 11604 11605 11610 11611 11612 11614 11615 11700 11701 11702 11708 11709 11710 11711 11712 11713 11715 11718 11721 11722 11800 11810 11820 11830 11833 11900 11903 11906 11909 11912 11915 11917 11919 11921 12000 12003 12012 12015 12018 12021 12200 12201 12306 12309 12312 12315 12318 12321

D2:

12500 12503 12506 12509 12512 12515 12518 12521 12524 12527 12530 12533

CATEGORY 3 – THERAPEUTIC PROCEDURES

T1:

13104 13200 13203 13206 13209 13221 13290 13312 13709 13760 13839 13842 13939 13942 13945 14050 14053 14100 14106 14109 14112 14115 14118 14124 14200 14203 14206 14209 14215 14221 14227

T2:

15000 15003 15006 15009 15012 15100 15103 15106 15109 15112 15115 15211 15214 15215 15218 15221 15224 15227 15230 15233 15236 15239 15242 15245 15248 15251 15254 15257 15260 15263 15266 15269 15272 15500 15503 15506 15509 15512 15515 15518 15521 15524 15527 15530 15533 15550 15553 15556 15559 15562

T3:

16003 16006 16009 16012 16015 16018

T4:

16500 16514 16600

T6:

17603

T7:

18213 18350 18351 18352 18354 18356 18358 18360 18362 18364 18366 18368 18370 18371

T8:

30003 30006 30026 30032 30038 30061 30064 30071 30185 30186 30192 30195 30196 30202 30203 30205 30207 30213 30214 30216 30219 30628 31200 31205 31210 31215 31220 32072 32115 32132 32135 32142 32500 32501 35502 35503 35554 35608 35614 35620 36800 37041 37218 37300 37303 37415 38800 39115 41500 41659 41662 41698 41704 41755 41828 41846 42587 42614 42615 42617 42620 42644 42650 42667 42668 42676 42677 42744 42782 42783 42785 42786 42788 42789 42791 42792 42794 42797 42806 42807 42808 42809 42811 45021 45025 45026 45546 45799 45801 45805 45807 45829 45847 45851 47471 47735 47904 47912 47916 47924 50124 50125

CATEGORY 4 – ORAL AND MAXILLOFACIAL

O1:

51700 51703

O3:

52034 52036 52039 52055 52056 52133

O7:

53000 53004 53052

O9:

53458

O10:

53600

DIAGNOSTIC IMAGING SERVICES

CATEGORY 5 – DIAGNOSTIC IMAGING SERVICES TABLE

I1:

55028 55029 55030 55031 55032 55033 55036 55037 55038 55039 55044 55045 55048 55049 55054 55070 55073 55076 55079, 55113 55114 55115 55116 55117 55238 55244 55246 55248 55252 55274 55276 55278 55280 55282 55284 55292 55294 55296 55700 55703 55704 55705 55706 55707 55708 55709 55712 55715 55718 55721 55723 55725 55728 55729 55731 55733 55736 55739 55812 55814 55816 55818 55820 55822 55824 55826 55828 55830 55832 55834 55836 55838 55840 55842 55844 55846 55852 55854

I2:

56001 56007 56010 56013 56016 56022 56028 56030 56036 56041 56047 56050 56053 56056 56062 56068 56070 56076 56101 56107 56141 56147 56220 56221 56223 56224 56225 56226 56227 56228 56229 56230 56231 56232 56233 56234 56235 56236 56237 56238 56239 56240 56259 56301 56307 56341 56347 56401 56407 56409 56412 56441 56447 56449 56501 56507 56541 56547 56549 56551 56619 56625 56659 56665 56801 56807 56841 56847 57001 57007 57041 57047 57201 57247 57341 57345 57350 57355

I3:

57506 57509 57512 57515 57518 57521 57524 57527 57700 57703 57706 57709 57712 57715 57721 57901 57902 57903 57906 57909 57912 57915 57918 57921 57924 57927 57930 57933 57939 57942 57945 57960, 57963 57966 57969 58100 58103 58106 58108 58109 58112 58115 58300 58306 58500 58503 58506 58509 58521 58524 58527 58700 58706 58715 58718 58721 58900 58903 58909 58912 58915 58916 58921 58924 58927 58933 58936 59103 59300 59303 59306 59309 59312 59314 59318 59503 59700 59703 59712 59715 59718 59724 59733 59736 59739 59751 59754 59760 59763 60100 60500 60503 60918 60927

I4:

61302 61303 61306 61307 61310 61313 61314 61316 61317 61320 61328 61340 61348 61352 61353 61356 61360 61361 61364 61368 61372 61373 61376 61381 61383 61384 61386 61387 61389 61390 61393 61397 61401 61402 61405 61409 61413 61417 61421 61425 61426 61429 61430 61433 61434 61437 61438 61441 61442 61445 61446 61449 61450 61453 61454 61457 61458 61462 61465 61469 61473 61480 61484 61485 61495 61499

MAGNETIC RESONANCE IMAGING

I5:

63001 63004 63007 63010 63040 63043 63046 63049 63052 63055 63058 63061

63064 63067 63070 63073 63101 63111 63114 63125 63128 63131 63151 63154 63161 63164 63167 63170 63173 63176 63179 63182 63185 63201 63204 63219 63222 63225 63228 63231 63234 63237 63240 63243 63271 63274 63277 63280 63301 63304 63307 63322 63325 63328 63331 63334 63337 63340 63361 63385 63388 63391 63401 63404 63416 63425 63428 63440 63443 63446 63461 63470 63473 63491 63494 63497

PATHOLOGY SERVICES

P1:

65060 65066 65070 65072 65075 65078 65081 65084 65087 65090 65093 65096 65099 65102 65105 65108 65111 65114 65117 65120 65123 65126 65129 65132 65133 65134 65135 65136 65137 65139 65140 65142 65144 65147 65150 65153 65156 65159 65162 65165 65171

P2:

66500 66503 66506 66509 66512 66515 66518 66519 66536 66539 66542 66545 66548 66551 66554 66557 66560 66563 66566 66569 66572 66575 66578 66581

66584 66587 66590 66593 66596 66599 66602 66605 66608 66623 66626 66629 66632 66635 66638 66641 66644 66647 66650 66653 66655 66656 66659 66662 66665 66667 66669 66670 66671 66672 66673 66674 66677 66680 66683 66686 66695 66698 66701 66704 66707 66710 66711 66712 66713 66716 66719 66722 66725 66728 66731 66734 66737 66743 66749 66750 66751 66752 66755 66758 66761 66764 66767 66770 66773 66776 66779 66782 66785 66788 66791 66800 66803 66806 66809 66812 66815 66818

P3:

69300 69303 69306 69309 69312 69318 69321 69324 69327 69330 69333 69336 69339 69345 69354 69357 69360 69363 69364 69365 69384 69387 69390 69393 69396 69399 69402 69405 69408 69411 69413 69442 69443 69445 69471 69472 69474 69475 69478 69481 69484

P4:

71057 71058 71059 71060 71062 71064 71066 71068 71069 71071 71072 71073 71074 71075 71077 71079 71081 71083 71085 71087 71089 71091 71093 71095 71097 71099 71101 71103 71106 71109 71113 71115 71117 71119 71121 71123 71125 71127 71129 71131 71133 71134 71135 71137 71139 71141 71143 71145 71146 71147 71149 71151 71153 71155 71157 71159 71163 71164

P5:

72813 72816 72817 72818 72823, 72824, 72825, 72826, 72830, 72836, 72844, 72846, 72847 72848 72851 72852 72855 72856 72857

P6:

73043 73045 73047 73049 73051 73053 73055 73057 73059 73060 73061

P7:

73287 73289 73300 73305 73308 73311 73314 73317 73320

P8:

73521 73523 73525 73527 73529

P9:

73801 73802 73803 73804 73805 73806 73807 73808 73809 73810 73811

P10:

73901 73903 73905 73907 73909 73910 73912 73913 73915

P11:

73921

SCHEDULE 4 - NURSING HOME TYPE PATIENT ACCOMMODATION

HOSPITALS IN ALL STATES/TERRITORIES

The default benefits that are payable per night for patients, that are classified as nursing home type patients, in recognised hospitals in particular States/Territories and private hospitals in all States/Territories are specified below:

Default Benefits
NSW	$92.80
NT	$51.80
QLD	$83.50
SA	$91.50
TAS	$87.35
VIC	$89.15
ACT	$82.85
WA	$91.60
Private Hospitals	$74.70

SCHEDULE 5 – SECOND TIER DEFAULT BENEFIT FOR OVERNIGHT AND DAY ONLY TREATMENT

Interpretation

(1) In this Schedule:

facility means a private hospital or private day hospital facility specified in clause 3;

HPPA means hospital-purchaser provider agreement; and

RHBO means registered health benefits organization; and

similar arrangement includes all agreements, except HPPAs, that have the effect of enabling payments to be made to a facility according to provisions (including pricing provisions) stated under these agreements.

(2) In this Schedule, except in subclause 1(4), the Australian Capital Territory is taken to be part of the State of New South Wales and the Northern Territory is taken to be part of the State of South Australia.

(3) In this Schedule, private hospitals are comparable if they fall within the same class from the following list:

(a)private hospitals which provide psychiatric care for at least 50% of the episodes of hospital treatment;

(b)private hospitals which provide rehabilitation care for at least 50% of the episodes of hospital treatment;

(c)private hospitals which do not fall into categories (a) or (b), with up to and including 50 licensed beds;

(d)private hospitals which do not fall into categories (a) or (b) with more than 50 licensed beds and up to and including 100 licensed beds;

(e)private hospitals which do not fall into categories (a) or (b), with more than 100 licensed beds, without an accident and emergency unit or a specialised cardiac care unit;

(f)private hospitals which do not fall into categories (a) or (b), with more than 100 licensed beds, with either (or both) an accident and emergency unit or a specialised cardiac care unit.

Note: Some expressions used in this Schedule are defined in subsection 4(1) of the National Health Act 1953 (“Act”) or subsection 3(1) of the Health Insurance Act 1973 including:

§day hospital facility;

§hospital-purchaser provider agreement;

§private hospital; and

§registered health benefits organization.

(4) In subclause 1(3), a reference to ‘licensed beds’ is a reference to the beds or patients that a private hospital is permitted, under State or Territory legislation in the State or Territory where the private hospital is located.

Minimum Level of Benefit

(1) The minimum level of benefit payable by a RHBO in respect of an episode of hospital treatment (excluding in situations of emergency) in a facility that does not have a HPPA (or a similar arrangement) with the RHBO, is that set by this clause 2, being the second tier default benefit, and not the minimum level of benefit set by Schedules 1, 2, 3, or 7 of the Determination made under paragraph (1) (bj) of Schedule 1 of the Act.

Note 1: Schedule 1 sets the minimum level of benefit payable for overnight shared ward accommodation in private hospitals in all States and Territories and overnight shared ward accommodation in recognised hospitals in Victoria and Tasmania.

Schedule 2 sets the minimum level of benefit payable for overnight shared ward accommodation in recognised hospitals in the Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia and Western Australia.

Schedule 3 sets the minimum level of benefit payable for same day accommodation in hospitals and day hospital facilities in all States and Territories.

Schedule 7 sets the minimum level of benefit payable for outreach services provided by, or on behalf of, specified hospitals and day hospital facilities.

Note 2: In situations of emergency paragraph (1)(bi) of Schedule 1 of the Act applies.

(2) This Schedule does not apply to episodes of hospital treatment referred to in Schedules 4 and 6 of the Determination made under paragraph (1)(bj) of Schedule 1 to the Act, and the Determination made under subsections 73AAG(6) and (7) of the Act.

Note: RHBOs must continue to pay benefits for:

§nursing-home type patients as prescribed in Schedule 4 of the Determination made under paragraph (1)(bj) of Schedule 1 of the Act;

§no gap prostheses and gap permitted prostheses determined under subsections 73AAG(6) and (7) of the Act; and

§care plans and case conferencing in accordance with Schedule 6 of the Determination made under paragraph (1) (bj) of Schedule 1 of the Act.

(3)(a) Subject to subclauses (6), and (7), the minimum level of benefit payable by a RHBO in respect of an episode of hospital treatment between 1 September of a particular year (“the first year”) and 31 August of the next year will be no less than 85% of the average charge for the equivalent episode of hospital treatment under that RHBO’s HPPAs (or similar arrangements) that were in force on 1 August of the first year with:

(i) all comparable private hospitals in the State in which the facility is located (if treatment was provided in a facility that was a private hospital); or

(ii) all private day hospital facilities in the State in which the facility is located (if the treatment was provided in a facility that was a private day hospital facility).

(b) The formula for calculating the “average charge for the equivalent episode of hospital treatment” by a RHBO in each State is as follows:

Where: j = group of equivalent episodes of hospital treatment under the RHBO’s HPPAs (or similar arrangements)

i = group of the RHBO’s HPPAs (or similar arrangements) in force on 1 August of the first year with comparable private hospitals, or with all private day hospital facilities, in the State

n= the number of the RHBO’s HPPAs (or similar arrangements) in force on 1 August of the first year with comparable private hospitals, or with all private day hospital facilities, in the State

R_ji = charge for episode of hospital treatment type j in contract i

R_j = average charge for episode of hospital treatment type j

(4) In subclause (3), each “episode of hospital treatment” must be identified using the patient classification system and payment structure in the majority of the relevant RHBO’s HPPAs (or similar arrangements) in force on 1 August of the first year with:

(a) all comparable private hospitals in the State in which the facility is located (if treatment was provided in a facility that was a private hospital); or

(b) all private day hospital facilities in the State in which the facility is located (if the treatment was provided in a facility that was a private day hospital facility).

(5) In subclause (3), for the purpose of calculating the “average charge for the equivalent episode of hospital treatment” in a State:

(a) the charge will include the sum of the amount payable by the RHBO under that RHBO’s HPPAs (or similar arrangements) and any excess or co-payment amounts payable by members, in accordance with the RHBO’s rules.

Note: RHBO members’ financial obligations under such levels of cover will still apply.

(b) charges referred to within the RHBO’s HPPAs (or similar arrangements) for no gap prostheses and gap permitted prostheses determined under subsections 73AAG(6) and (7) of the Act must not be included; and

(c) charges referred to within the RHBO’s HPPAs (or similar arrangements) for hospital treatment provided to patients who are classified as nursing-home type patients (NHTPs) must not be included.

(6) Subject to subclause (7), if a RHBO has less than five HPPAs (or similar arrangements) in force on 1 August of the first year with a particular class of comparable private hospitals in a State, then all of that RHBO’s HPPA’s with all classes of private hospitals in that State are to be used to calculate the minimum benefit payable.

(7) If the minimum level of benefit payable under subclauses (3) or (6) in respect of an episode of hospital treatment is below the level set in Schedules 1, 2, 3 or 7 of the Determination made under paragraph (1)(bj) of Schedule 1 of the Act, then the minimum level of benefit payable under this Schedule 5 is that set in Schedules 1, 2, 3 or 7 of the Determination made under paragraph (1)(bj) of Schedule 1 of the Act for that episode of hospital treatment.

Facilities Hospital Day Private and Hospitals Private3. Specified

(1) Table A specifies private hospitals for the purpose of the definition of “facility” in subclause 1(1) of this Schedule 5.

Table A: Specified Private Hospitals

Item	Facility Name	Address
1	(Alpha) Westmead Private Hospital	Corner of Mons and Darcy Roads, WESTMEAD NSW 2145
2	Albury-Wodonga Private Hospital	1125 Pemberton Street, ALBURY NSW 2640
3	Armidale Private Hospital	Rusden St, ARMIDALE NSW 2350
4	Attadale Private Hospital	21 Hislop Road, ATTADALE WA 6156
5	Baringa Private Hospital	Mackay’s Road, COFFS HARBOUR NSW 2450
6	Bega Valley Private Hospital	31 Parker Street, BEGA NSW 2550
7	Beleura Private Hospital	925 Nepean Highway, MORNINGTON VIC 3931
8	Berkeley Vale Private Hospital	8 Lorraine Avenue, BERKELEY VALE NSW 2261
9	Blackwood Hospital Group	13 Laffers Road, BELAIR SA 5052
10	Bondi Junction Private Hospital	21 Spring St, BONDI JUNCTION NSW 2022
11	Brisbane Private Hospital	259 Wickham Tce, BRISBANE QLD 4000
12	Caboolture Private Hospital	McKean Street, CABOOLTURE QLD 4510
13	Cabrini Brighton	243 New Street, BRIGHTON VIC 3186
14	Cairns Private Hospital	1 Upward Street, CAIRNS QLD 4870
15	Caloundra Private Hospital	96 Beerburrum Street, CALOUNDRA QLD 4566
16	Calvary Health Care ACT	Calvary Public and Private Hospital, Haydon Drive, BRUCE ACT 2617
17	Calvary Health Care Tasmania – Hobart (Lenah Valley Campus)	49 Augusta Road, LENAH VALLEY TAS 5333
18	Calvary Health Care Sydney – Hurtstville Community	37 Gloucester Road, HURSTVILLE NSW 2220
19	Calvary Health Care Tasmania – Hobart (St John’s Campus)	30 Cascade Road, SOUTH HOBART TAS 7004
20	Calvary Health Care Tasmania – Launceston (St Luke’s Campus)	24 Lyttleton Street, LAUNCESTON TAS 7250
21	Calvary Health Care Tasmania – Launceston (St Vincent’s Campus)	5 Frederick Street, LAUNCESTON TAS 7250
22	Calvary Hospital Adelaide	89 Strangways Terrace, NORTH ADELAIDE SA 5006
23	Calvary Private Hospital (Riverina)	Hardy Ave, WAGGA WAGGA NSW 2650
24	Castle Hill Hospital	72-74 Cecil Avenue, CASTLE HILL NSW 2154
25	Canada Bay Private Hospital	55-57 Burwood Road, CONCORD NSW 2137
26	Castlecrag Private Hospital	150 Edinburgh Road, CASTLECRAG NSW 2068
27	Cedar Court Healthsouth Rehabilitation Hospital	888 Toorak Road, CAMBERWELL VIC 3124
28	Central Districts Private Hospital	25-37 Jarvis Road, ELIZABETH VALE SA 5112
29	Coastal Private Hospital	221 Willmott Drive. WAIKIKI WA 6169
30	College Grove Rehabilitation Hospital	18 North East Road, WALKERVILLE SA 5081
31	Dalcross Private Hospital	28 Stanhope Road , KILLARA NSW 2071
32	Delmont Private Hospital	298 Warrigal Road, GLEN IRIS VIC 3146
33	Donvale Rehabilitation Hospital	1119-1121 Doncaster Road, DONVALE VIC 3111
34	Dudley Private Hospital	261 March Street, ORANGE NSW 2800
35	Eastern Suburbs Private Hospital	8 Chapel Street, RANDWICK NSW 2031
36	Figtree Private Hospital	1 Suttor Place, FIGTREE NSW 2525
37	Frances Perry Private Hospital	285 Cardigan Street, CARLTON 3053
38	Friendly Society Private Hospital	19-23 Bingera Street, BUNDABERG QLD 4670
39	Fullarton Private Hospital	293-295 Fullarton Road, PARKSIDE SA 5063
40	Glenferrie Private Hospital	25 Linda Crescent, HAWTHORN 3122
41	Glengarry Private Hospital	53 Arnisdale Road, DUNCRAIG WA 6023
42	Greenslopes Private Hospital	Newdegate Street, GREENSLOPES QLD 4120
43	Hawkesbury District Health Service	Level 2, 16-18 Bridge Street, EPPING NSW 2121
44	Hervey Bay Surgical Centre	Cnr O’Rourke Street & Boat Harbour Drive, PIALBA QLD 4655
45	Hillcrest-Rockhampton Private Hospital	4 Talford Street, ROCKHAMPTON QLD 4700
46	Hollywood Private Hospital	Monash Avenue, NEDLANDS WA 6009
47	Holy Spirit Northside	627 Rode Road, CHERMSIDE QLD 4032
48	Hopetoun Rehabilitation Hospital	2-6 Hopetoun Street, ELSTERNWICK VIC 3185
49	Hopewell Hospice	11 Dunkirk Close, ARUNDEL QLD 4212
50	Hunters Hill Private Hospital	9 Mount Street, HUNTERS HILL NSW 2110
51	John Flynn Private Hospital	42 Inland Drive, TUGUN QLD 4224
52	Joondalup Private Hospital	Corner Grand Boulevard and Shenton Avenue, JOONDALUP WA 6027
53	Kahlyn Private Hospital	40 Briant Road, MAGILL SA 5072
54	Kareena Private Hospital	86 Kareena Road, CARINGTON NSW 2229
55	Lake Macquarie Private Hospital	3 Sydney Street, GATESHEAD NSW 2290
56	Lawrence Hargrave Private Hospital	72 Phillip Street, THIRROUL NSW 2515
57	Linacre Private Hospital	12 Linacre Road, HAMPTON VIC 3188
58	Macarthur Private Hospital	92-96 Dumaresq Street, CAMPBELLTOWN NSW 2560
59	Maitland Private Hospital	173 Chisholm Road, EAST MAITLAND NSW 2323
60	Manly Waters Private Hospital	17 Cove Avenue, MANLY NSW 2095
61	Maryvale Private Hospital	McDonald Street, MORWELL VIC 3840
62	Masada Private Hospital	26 Balaclava Road, EAST ST KILDA VIC 3183
63	Mater Hospital Yeppoon	55 Cliff Street, YEPPOON QLD 4703
64	Mater Misericordiae Hospital Bundaberg	313 Bourbong Street, BUNDABERG QLD 4670
65	Mater Misericordiae Hospital Gladstone	Rossella Street, GLADSTONE QLD 4680
66	Mater Misericordiae Hospital Mackay	76 Willetts Road, NORTH MACKAY QLD 4740
67	Mater Misericordiae Hospital Rockhampton	cnr Ward & Jessie Streets, ROCKHAMPTON QLD 4700
68	Mater Misericordiae Private Hospital (South Brisbane)	301 Vulture Street, SOUTH BRISBANE QLD 4101
69	Mater Misericordiae Private Hospital Townsville	21 Fulham Road, PIMLICO QLD 4810
70	Mater Misericordiae Women’s & Children’s Private Health Service (Children’s Campus)	Cnr Raymond Terrace & Stanley Street, SOUTH BRISBANE QLD 4101
71	Mater Misericordiae Women’s & Children’s Private Health Service (Women’s Campus)	Raymond Terrace, SOUTH BRISBANE QLD 4101
72	Mater Private Hospital Redland	Weippin Street, CLEVELAND QLD 4163
73	Mater Misericordiae Private Hospital	35 Rocklands Road, CROWS NEST NSW 2065
74	Mayo Private Hospital	Lot 1, Potoroo Drive, Kolodong, VIA TAREE NSW 2430
75	Minchinbury Community Private Hospital	Rupertswood Road, MOUNT DRUITT NSW 2770
76	Mitcham Private Hospital	27 Doncaster East Road, MITCHAM VIC 3132
77	Mosman Private Hospital	1 Ellamatta Avenue, MOSMAN NSW 2088
78	Mount Olivet Hospital	411 Main Street, KANGAROO POINT QLD 4169
79	Mt Lawley Private Hospital	14 Alvan Street, MOUNT LAWLEY WA 6050
80	Mt Wilga Private Hospital	2 Manor Road, HORNSBY NSW 2077
81	Murray Valley Private Hospital	Nordsvan Drive, WODONGA,VIC 3690
82	Nambour Selangor Private Hospital	62 Netherton Street, NAMBOUR QLD 4560
83	New Farm Private Hospital	22 Sargent Street, NEW FARM QLD 4005
84	Ngala Family Resource Centre	9 George Street, KENSINGTON WA 6151
85	Noosa Private Hospital	111 Goodchap Street, NOOSAVILLE QLD 4566
86	North Eastern Private Hospital	580 Lower North East Road , CAMPBELLTOWN SA 5074
87	North Shore Private Hospital	Westbourne Street, ST LEONARDS NSW 2065
88	North West Private Hospital	137 Flockton Street, EVERTON PARK QLD 4053
89	Northside Clinic Private Hospital	2 Greenwich Road, GREENWICH NSW 2065
90	Northside Cremorne Clinic	3 Harrison Street, CREMORNE NSW 2090
91	Northside West Clinic	23-27 Lytton Street, WENTWORTHVILLE NSW 2145
92	Nowra Private Hospital	Weeroona Place, NOWRA NSW 2541
93	Pendlebury Clinic	Suite 3, 52 Pendlebury Road, CARDIFF NSW 2285
94	Peninsula Private Hospital (Frankston)	Cnr Cranbourne & McClelland Drive, FRANKSTON VIC 3199
95	Peninsula Private Hospital (Kippa-Ring)	cnr George and Florence Streets, KIPPA-RING QLD 4020
96	Perth Clinic	29 Havelock St, WEST PERTH WA 6005
97	Pindara Gold Coast Private Hospital	Allchurch Avenue, BENOWA QLD 4217
98	Pinelodge Clinic Private Hospital Dandenong	1480 Heatherton Road, DANDENONG VIC 3175
99	Poplars Private Hospital	66 Norfolk Road, EPPING NSW 2121
100	Port Macquarie Private Hospital	Lake Road, PORT MACQUARIE NSW 2444
101	Rivercity Private Hospital	401 Milton Road, AUCHENFLOWER QLD 4066
102	Saint Frances Xavier Cabrini Hospital (Malvern)	181-183 Wattletree Road, MALVERN VIC 3144
103	Saint Frances Xavier Cabrini Hospital (Prahran)	646 High Street, PRAHRAN EAST VIC 3181
104	Shellharbour Private Hospital	27 Captain Cook Drive, BARRACK HEIGHTS NSW 2528
105	Shepparton Private Hospital	Fitzgerald Street, SHEPPARTON VIC 3630
106	South Pacific Private Hospital	18 Beach Street, HARBORD NSW 2096
107	South Perth Hospital	76 South Terrace, COMO WA 6152
108	Southern Highlands Private Hospital	99 Bowral Street, BOWRAL NSW 2576
109	Spendelove House Private Hospital	24 Spendelove Avenue, SOUTHPORT QLD 4215
110	Sportsmed.SA Hospital	32 Payneham Road, STEPNEY SA 5069
111	St Andrew’s Ipswich Private Hospital	Corner Roderick and Pring Streets, IPSWICH QLD 4305
112	St Andrew’s Toowoomba Hospital	280 North Street, TOOWOOMBA QLD 4350
113	St George Private Hospital	1 South Street, KOGARAH NSW 2217
114	St John of God Health Care (Warrnambool)	136 Botanic Road, WARRNAMBOOL VIC 3280
115	St John of God Health Care (Ballarat)	101 Drummond Street North, BALLARAT VIC 3350
116	St John of God Health Care Berwick	Gibb Street, BERWICK VIC 3806
117	St John of God Healthcare Nepean Rehabilitation Hospital	255 Cranbourne Road, FRANKSTON VIC 3199
118	St John of God Hospital Bendigo	Lily Street, BENDIGO VIC 3552
119	St John of God Hospital Bunbury	Cnr Robertson Drive & Bussell Highway, BUNBURY WA 6230
120	St John of God Hospital Geelong	80 Myers Street, GEELONG VIC 3220
121	St John of God Hospital Geraldton	12 Hermitage Street, GERALDTON WA 6530
122	St John of God Hospital Murdoch	100 Murdoch Drive, MURDOCH WA 6150
123	St John of God Hospital Subiaco	12 Salvado Road, SUBIACO WA 6008
124	St Luke’s Hospital Complex	18 Rosalyn Street, POTTS POINT NSW 2011
125	St Vincent’s & Mercy Private Hospital, Mercy Campus	159 Grey Street, MELBOURNE EAST VIC 3002
126	St Vincent’s Hospital (Toowoomba)	Scott Street, TOOWOOMBA QLD 4350
127	St Vincent’s Private Hospital (Bathurst)	Gorman’s Hill Road, BATHURST NSW 2795
128	St Vincent’s Private Hospital (Fitzroy)	59 Victoria Parade, FITZROY VIC 3065
129	Stirling District Hospital	20 Milan Terrace, STIRLING SA 5152
130	Sydney Adventist Private Hospital	185 Fox Valley Road, WAHROONGA NSW 2076
131	Tamara Private Hospital	2-6 Dean Street, TAMWORTH NSW 2340
132	The Adelaide Clinic	33 Park Terrace, GILBERTON SA 5081
133	The Albert Road Clinic	31-33 Albert Road, SOUTH MELBOURNE SA 3004
134	The Avenue Private Hospital	40 The Avenue, WINDSOR VIC 3128
135	The Bays Hospital – Mornington	262-268 Main Street, MORNINGTON VIC 3931
136	The Valley Private Hospital	Corner Police and Gladstone Roads, MULGRAVE VIC 3170
137	Toowong Private Hospital	496 Milton Rd, TOOWONG QLD 4066
138	Toronto Private Hospital	Cary Street, TORONTO NSW 2283
139	Vaucluse Private Hospital	82 Moreland Road, BRUNSWICK VIC 3056
140	Wakefield Hospital	300 Wakefield Street, ADELAIDE SA 5000
141	Wandene Private Hospital	7 Blake Street, KOGARAH NSW 2217
142	Wangaratta Private Hospital	134-150 Templeton Street, WANGARATTA VIC 3677
143	Warners Bay Private Hospital	Fairfax Road, WARNERS BAY NSW 2282
144	Warringal Private Hospital	216 Burgundy Street, HEIDELBERG VIC 3084
145	Waverly Private Hospital	343-357 Blackburn Road, MOUNT WAVERLY VIC 3149
146	Wesley Private Hospital	91 Milton Street, ASHFIELD NSW 2131
147	Western Private Hospital	Corner Eleanor and Marion Streets, FOOTSCRAY VIC 3012
148	Westmead Rehabilitation Centre	7 Coleman Street, MERRYLANDS NSW 2160

(2) Table B specifies private day hospital facilities for the purpose of the definition of “facility” in subclause 1(1) of this Schedule 5.

Table B: Specified Private Day Hospital Facilities

Item	Facility Name	Address
1	Aesthetic Day Surgery	14 Kensington Street, KOGARAH NSW 2217
2	Ballina Day Surgery	46 Tamar Street, BALLINA NSW 2478
3	Bankstown Primary Health Care Day Surgery	67 Rickard Road, BANKSTOWN NSW 2200
4	Broadmeadow Day Surgery	1^st Floor (Suite 1), 18 Lambton Road, BROADMEADOW NSW 2292
5	Buderim Gastroenterology Centre (Maroochydore)	Suite 5, 102 Wises Road, MAROOCHYDORE QLD 4558
6	Calvary Day Procedure Centre	329, 331, 333 Edward Street, WAGGA WAGGA NSW 2650
7	Capital Day Surgery Centre	Calvary Clinic, Mary Potter Circuit, BRUCE ACT 2617
8	Caringbah Day Surgery	42 President Avenue, CARINGBAH NSW 2229
9	Chasely Day Surgery	Wesley Medical Centre, 40 Chasely Street, AUCHENFLOWER QLD 4066
10	Chesterville Day Hospital	26-28 Chesterville Road, CHELTENHAM VIC 3192
11	Coffs Harbour Day Surgery Centre	69 Albany Street, COFFS HARBOUR NSW 2450
12	Colin Street Day Surgery	51 Colin Street, WEST PERTH WA 6005
13	Coolenberg Clinic	60 Lake Rd, PORT MACQUARIE NSW 2444
14	Dandenong Eye Clinic & Day Surgery Centre	1-3 Falkiner Crescent, DANDENONG VIC 3175
15	Epping Surgery Centre	Suite 3, 44 Oxford Street, EPPING NSW 2121
16	Griffiths Road Day Procedure Centre	182 Christo Road, WARATAH NSW 2298
17	Harley Place Day Surgery	Suite 605, 251 Oxford Street, BONDI JUNCTION NSW 2022
18	Healthwoods Specialist Centre	53 Cowper Street, GRANVILLE NSW 2142
19	Inner West Endoscopy Centre	311 Marrickville Road, MARRICKVILLE NSW 2204
20	Liverpool Day Surgery	105-119 Longstaff Avenue, MOOREBANK NSW 2170
21	Logan Endoscopy Services	Unit 2/32 76 Beaudesert Road, BROWN PLAINS QLD 4118
22	Logan Surgery Centre	Unit 12, 13-21 Mayes Avenue, LOGAN CENTRAL QLD 4114
23	Mater Misericordiae Day Unit (Mackay)	1 Wellington Street, MACKAY QLD 4740
24	Melbourne Oral & Facial Surgery	Level 12, 63 Exhibition Street, Scala House, MELBOURNE VIC 3000
25	Montserrat Day Hospital (Gaythorne)	383 – 391 Samford Road, GAYTHORNE QLD 4051
26	Montserrat Day Hospital (Indooroopilly)	12 Riverview Tce, INDOOROOPILLY QLD 4068
27	Montserrat Day Hospital (Spring Hill)	Level 2, 35 Astor Tce, BRISBANE QLD 4000
28	Murdoch Surgicentre	100 Murdoch Drive, MURDOCH WA 6150
29	Ophthalmic Surgery Centre	Suite 6, 12-14 Malvern Avenue, CHATSWOOD NSW 2067
30	Orange Day Surgery Centre	60 McNamara Street, ORANGE NSW 2800
31	Pacific Day Surgery	38 Misterton Street, FORTITUDE VALLEY QLD 4006
32	Peninsula Eye Centre	47 Redcliffe Parade, REDCLIFFE QLD 4020
33	Perfect Vision Eye Surgery	Suite 3, 25 –29 Hunter Street, HORNSBY NSW 2077
34	Pindara Day Procedure Centre	13 Carrara Street, BENOWA QLD 4217
35	QFG Day Theatres	1^st & 4^th Floor, St Andrew’s Place, North Street, SPRING HILL QLD 4000
36	Randwick Day Surgery	2 Eurimble Avenue, RANDWICK NSW 2031
37	Roderick Street Day Surgery	23 Roderick Street, IPSWICH QLD 4305
38	Rosebud SurgiCentre	1537 Point Nepean Road, ROSEBUD WEST VIC 3940
39	Short Street Day Surgery	2 Short Street, SOUTHPORT QLD 4215
40	Solander Day Surgery	182 Grafton St, CAIRNS QLD 4870
41	South Coast Digestive Diseases Centre	86 Ashmore Road, BUNDALL QLD 4217
42	South Western Day Surgery Centre	20-22 Bigge Street, LIVERPOOL NSW 2170
43	St Kilda Day Hospital	26A Dickens Street, ELWOOD VIC 3184
44	Sydney Day Surgery	213-219 Darlinghurst Road, DARLINGHURST NSW 2010
45	Sydney Eastern Eye Centre	11a Fullerton Street, WOOLLAHRA NSW 2025
46	Sydney Eye Specialist Centre	2 Middle Street, KINGSFORD NSW 2032
47	Sydney IVF – Liverpool	173-175 Biggs Street, LIVERPOOL NSW 2170
48	Sydney IVF Clinic	4 O’Connell Street, SYDNEY NSW 2000
49	Sydney Oculoplastic Surgery	229 Macquarie St, SYDNEY NSW 2000
50	Sydney Retina Clinic & Day Surgery	Level 13, 187 Macquarie Street, SYDNEY NSW 2000
51	Terrace West Endoscopy Centre	18 Limestone Street, IPSWICH QLD 4305
52	The CAPS Clinic	Strickland Crescent, DEAKIN ACT 2600
53	The Double Bay Day Surgery	20 Manning Road, DOUBLE BAY NSW 2028
54	The Eye Institute	Level 4, 270 Victoria Avenue, CHATSWOOD NSW 2057
55	The Hills Parenting Centre	103-108 Showground Road, CASTLE HILL NSW 2154
56	The San Day Surgery	1a Northcote Road, HORNSBY NSW 2077
57	Vista Laser Eye Clinics NSW	1 McClaren St, NORTH SYDNEY NSW 2060
58	West Lakes Day Surgery	151 Brebner Drive, WEST LAKES SA 5021
59	Western Plains Day Surgery	62 Windsor Parade, DUBBO NSW 2850

4. Transitional provision for facilities no longer specified in clause 3

(1) If a determination is made removing a facility from clause 3, the facility is deemed to remain specified in clause 3 only for such period of time and for such purposes as are necessary to allow members of RHBOs to receive the benefit of the second tier default benefit, in relation to episodes of hospital treatment for which those members were admitted patients at the facility or booked for hospital treatment at the facility (as opposed to merely being on the facility’s waiting list) prior to the date the determination removing the facility from clause 3 took effect.

(2) If, because of a name or address change, a facility is no longer specified in clause 3, the facility is deemed to remain specified in clause 3 only for such period of time and for such purposes as are necessary to allow members of RHBOs to receive the benefit of the second tier default benefit, in relation to episodes of hospital treatment for which those members were admitted patients at the facility or booked for hospital treatment at the facility (as opposed to merely being on the facility’s waiting list) prior to the date the facility changed its name or address.

SCHEDULE 6 – CARE PLANS AND CASE CONFERENCING

The benefit payable by a Registered Health Benefits Organization (RHBO) in respect of the following episodes of hospital treatment provided in hospitals or day hospital facilities in all States and Territories must be an amount at least equal to 25% of the Schedule fee (in accordance with Schedule 1, paragraph (ea) of Schedule 1, of the Act:

Care plans and case conferencing for patients (other than nursing home type patients) with chronic conditions and multidisciplinary care needs, under Medicare Benefits Schedule item numbers:

746, 749, 757, 830, 832, 834, 835, 837, 838, 861, 864, 866 880

2978 2984 2988 2992 2996 3000 3069 3074 3078 3083 3088 3093

SCHEDULE 7 – OUTREACH SERVICES

HOSPITAL AND DAY HOSPITAL FACILITIES IN ALL STATES AND TERRITORIES

An outreach service means any service specified in a determination made under section 5D of the Act, that is provided to a patient by, or on behalf of, a hospital or a day hospital facility, as a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility, but does not include service provided by a medical practitioner that would attract a Medicare benefit of 85% of the Schedule fee.

The benefit payable by a Registered Health Benefits Organization (RHBO) in respect of an outreach service provided by a hospital or day hospital facility in the following States and Territories must be an amount of no less than:

BENEFIT PAYABLE PER DAY
New South Wales	$162
Victoria	$162
Queensland	$162
South Australia	$162
Western Australia	$162
Tasmania	$162
Australian Capital Territory	$162
Northern Territory	$157
Private Hospitals	$162
Private Day Hospital Facilities	$162