National Health Act 1953 Determination under Schedule 1, paragraph (bj) (HIB 02/2006) (Cth)

AUSTRALIAN GOVERNMENT

NATIONAL HEALTH ACT 1953

Determination made under Schedule 1, paragraph (bj)

(HIB 02/2006)

I, LINDA JANE ADDISON, delegate of the Minister for Health and Ageing acting under Schedule 1, paragraph (bj) of the National Health Act 1953 (the Act):

AMEND, the determination made under Schedule 1, paragraph (bj) of the Act dated 24 June 2005 (HIB 11/2005) (as amended) (the Determination), by OMITTING Schedule 3 of that Determination and SUBSTITUTING the attached Schedule 3.

This determination takes effect on the day following registration on the Federal Register of Legislative Instruments.

Dated this    12                         day of     January   2006.

Signed Linda Jane Addison

…………………………..

Linda Jane Addison

Assistant Secretary

Private Health Insurance Branch

Position No: 01202874

Delegate of the Minister for Health and Ageing

SCHEDULE 3 – 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	$188	$212	$233	$261
ACT	$189	$213	$233	$261
NT	$181	$207	$227	$255
QLD	$191	$213.50	$235	$261
SA	$189	$216	$237	$261
TAS	$183	$218	$253	$292
VIC	$184	$219	$254	$292
WA	$201	$201	$201	$201
Private Hospitals	$164	$206	$250	$292
Private Day Hospitals	$164	$206	$250	$292

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;

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 does not include part of an overnight stay.

This is page 1 of 11 pages of Schedule 3 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) as amended signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 3 inserted by Determination HIB 02/2006 signed by the Delegate of the Minister for Health and Ageing on   12 January 2006.

Signed Fatimah Scott

……………………………

Witness

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 or4.

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 

This is page 2 of 11 pages of Schedule 3 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) (as amended) signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 3 inserted by Determination HIB 02/2006 signed by the Delegate of the Minister for Health and Ageing on   12 January 2006.

Signed Fatimah Scott

……………………………

Witness

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.

This is page 3 of 11 pages of Schedule 3 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) (as amended) signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 3 inserted by Determination  HIB 02/2006 signed by the Delegate of the Minister for Health and Ageing on  12 January 2006.

Signed Fatimah Scott

……………………………

Witness

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

A4:

110  116  119  122  128  131

A5:

160  161  162  163  164

A6:

170  171  172

A7:

173  193  195  197  199

This is page 4 of 11 pages of Schedule 3 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) (as amended) signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 3 inserted by Determination   HIB 02/2006 signed by the Delegate of the Minister for Health and Ageing on 12 January 2006.

Signed Fatimah Scott

……………………………

Witness

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  706  710  712

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

This is page 5 of 11 pages of Schedule 3 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) (as amended) signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 3 inserted by Determination       HIB 02/2006 signed by the Delegate of the Minister for Health and Ageing on 12 January 2006.

Signed Fatimah Scott

……………………………

Witness

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

M2:

10993  10996  10998  10999

This is page 6 of 11 pages of Schedule 3 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) (as amended) signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 3 inserted by Determination   HIB 02/2006 signed by the Delegate of the Minister for Health and Ageing on 12 January 2006

Signed Fatimah Scott

……………………………

Witness

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

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

T3:

16003  16006  16009  16012  16015  16018

T4:

16500  16514  16600

This is page 7 of 11 pages of Schedule 3 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) (as amended) signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 3 inserted by Determination HIB 02/2006 signed by the Delegate of the Minister for Health and Ageing on   12 January 2006.

Signed Fatimah Scott

……………………………

Witness
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

This is page 8 of 11 pages of Schedule 3 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) (as amended) signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 3 inserted by Determination  HIB 02/2006 signed by the Delegate of the Minister for Health and Ageing on  12 January 2006. 

Signed Fatimah Scott

……………………………

Witness

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

This is page 9 of 11 pages of Schedule 3 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) (as amended) signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 3 inserted by Determination HIB 02/2006 signed by the Delegate of the Minister for Health and Ageing on   12 January 2006.

Signed Fatimah Scott

……………………………

Witness

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  65168  65171  65174

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  66794  66800  66803  66806  66809  66812  66815  66818 

This is page 10 of 11 pages of Schedule 3 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) (as amended) signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 3 inserted by Determination  HIB 02/2006 signed by the Delegate of the Minister for Health and Ageing on  12 January 2006.

Signed Fatimah Scott

……………………………

Witness

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

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

This is page 11 of 11 pages of Schedule 3 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) (as amended) signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 3 inserted by Determination     HIB 02/2006 signed by the Delegate of the Minister for Health and Ageing on 12 January 2006.

Signed Fatimah Scott

……………………………

Witness