National Health Act 1953 Determination under Schedule 1, paragraph (bj) (HIB 07/2005) (Cth)
AUSTRALIAN GOVERNMENT
NATIONAL HEALTH ACT 1953
Determination under Schedule 1, paragraph (bj)
(HIB 07/2005)
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, with effect from 1 May 2005, the Determination made under Schedule 1, paragraph (bj) of the Act dated 30 June 1999 (as amended), by OMITTING Schedule 1 of that Determination and SUBSTITUTING the attached Schedule 1.
Dated this 27 day of April 2005.
(Signed By)
…………………………………
Linda Jane Addison
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 | $309 |
| - over 14 days | $214 |
| Surgical/Obstetric | |
| - first 14 days | $285 |
| - over 14 days | $214 |
| Psychiatric | |
| - first 42 days | $285 |
| - 43 – 65 days | $248 |
| - over 65 days | $214 |
| Rehabilitation | |
| - first 49 days | $285 |
| - 50 - 65 days | $248 |
| - over 65 days | $214 |
| Other | |
| - first 14 days | $248 |
| - over 14 days | $214 |
This is page 1 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005.
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VICTORIA – shared ward accommodation in recognised hospitals
| CLASS OF PATIENT | BENEFIT PAYABLE PER NIGHT |
| Advanced Surgical | |
| - first 14 days | $309 |
| - over 14 days | $214 |
| Surgical/Obstetric | |
| - first 14 days | $285 |
| - over 14 days | $214 |
| Psychiatric | |
| - first 42 days | $285 |
| - 43 – 65 days | $248 |
| - over 65 days | $214 |
| Rehabilitation | |
| - first 49 days | $285 |
| - 50 – 65 days | $248 |
| - over 65 days | $214 |
| Other | |
| - first 14 days | $248 |
| - over 14 days | $214 |
This is page 2 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005..
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TASMANIA – shared ward accommodation in recognised hospitals
| CLASS OF PATIENT | BENEFIT PAYABLE PER NIGHT |
| Advanced Surgical | |
| - first 14 days | $309 |
| - over 14 days | $214 |
| Surgical/Obstetric | |
| - first 14 days | $285 |
| - over 14 days | $214 |
| Psychiatric | |
| - first 42 days | $285 |
| - 43 – 65 days | $248 |
| - over 65 days | $214 |
| Rehabilitation | |
| - first 49 days | $285 |
| - 50 – 65 days | $248 |
| - over 65 days | $214 |
| Other | |
| - first 14 days | $248 |
| - over 14 days | $214 |
This is page 3 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005.
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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 $723.75.
- 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 $215.50 to $723.75.
- a psychiatric patient is deemed to be a patient in a hospital who, subject to approval by individual health benefits organisations, 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 organisations, 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
This is page 4 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005.
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(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.
This is page 5 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005.
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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;
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.
This is page 6 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005..
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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 35009 35312 35315 35320 35335 35338 35341 35344 35350 35353 35356 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 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 38287 38290 38293 38418 38421 38424 38427 38438 38440 38441 38446 38447 38449 38450 38453 38455 38456 38457 38466 38468 38469 38470
This is page 7 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005.
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38477 38478 38480 38481 38483 38487 38488 38489 38493 38497 38498 38500 38501 38503 38504 38506 38507 38508 38509 38512 38515 38518 38521 38550 38553 38556 38559 38562 38565 38568 38571 38572 38600 38603 38615 38618 38624 38640 38643 38647 38650 38653 38656 38670 38673 38677 38680 38700 38703 38706 38709 38712 38715 38718 38721 38724 38727 38730 38733 38736 38739 38742 38743 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 457 73 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
This is page 8 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005.
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PART 1 of SCHEDULE 1
Obstetric Patient
A patient shall be taken to be an obstetric patient during an admission to a hospital from an 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).
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This is page 9 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005.
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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 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 35304 35305 35306 35309 35310 35317 35319 35321 35324 35327 35330 35331 35347 35360 35361 35362 35363 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 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 38278 38281 38284 38415 38430 38448 38452 38458 38460 38462 38464 38473 38475 38485 38490 38496 38505 38524 38577 38588 38606 3860938612 38613 38621 38627 38637 39015 39018 39109 39118 39121 39125 39126 39127 39128 39130 39 133 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 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
This is page 10 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005.
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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 482 39 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 50350 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
This is page 11 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005.
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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
This is page 12 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 07/2005) made by the Delegate of the Minister for Health and Ageing on …27 April…2005.
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