National Health Act 1953 Determination under Schedule 1, paragraph (bj) (HIB 20/2005) (Cth)
AUSTRALIAN GOVERNMENT
NATIONAL HEALTH ACT 1953
Determination under Schedule 1, paragraph (bj)
(HIB 20/2005)
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 November 2005, the Determination made under Schedule 1, paragraph (bj) of the Act dated 24 June 2005 (as amended) (the Determination), by OMITTING Schedule 1 of the Determination and SUBSTITUTING the attached Schedule 1.
Dated this 24 day of October 2005.
(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 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 | $316 |
| - over 14 days | $219 |
| Surgical/Obstetric | |
| - first 14 days | $292 |
| - over 14 days | $219 |
| Psychiatric | |
| - first 42 days | $292 |
| - 43 – 65 days | $254 |
| - over 65 days | $219 |
| Rehabilitation | |
| - first 49 days | $292 |
| - 50 - 65 days | $254 |
| - over 65 days | $219 |
| Other | |
| - first 14 days | $254 |
| - over 14 days | $219 |
This is page 1 of 1/11 pages of Schedule 1 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005)signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 1 inserted by Determination HIB 20/2005 on 24 October 2005.
Signed Peter Callanan
……………………………
Witness
VICTORIA – shared ward accommodation in recognised hospitals
| CLASS OF PATIENT | BENEFIT PAYABLE PER NIGHT |
| Advanced Surgical | |
| - first 14 days | $316 |
| - over 14 days | $219 |
| Surgical/Obstetric | |
| - first 14 days | $292 |
| - over 14 days | $219 |
| Psychiatric | |
| - first 42 days | $292 |
| - 43 – 65 days | $254 |
| - over 65 days | $219 |
| Rehabilitation | |
| - first 49 days | $292 |
| - 50 – 65 days | $254 |
| - over 65 days | $219 |
| Other | |
| - first 14 days | $254 |
| - over 14 days | $219 |
This is page 2 of 2/11 pages of Schedule 1 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005)signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 1 inserted by Determination HIB 20/2005 on 24 October 2005.
Signed Peter Callanan
……………………………
Witness
TASMANIA – shared ward accommodation in recognised hospitals
| CLASS OF PATIENT | BENEFIT PAYABLE PER NIGHT |
| Advanced Surgical | |
| - first 14 days | $316 |
| - over 14 days | $219 |
| Surgical/Obstetric | |
| - first 14 days | $292 |
| - over 14 days | $219 |
| Psychiatric | |
| - first 42 days | $292 |
| - 43 – 65 days | $254 |
| - over 65 days | $219 |
| Rehabilitation | |
| - first 49 days | $292 |
| - 50 – 65 days | $254 |
| - over 65 days | $219 |
| Other | |
| - first 14 days | $254 |
| - over 14 days | $219 |
This is page 3 of 3/11 pages of Schedule 1 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005)signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 1 inserted by Determination HIB 20/2005 on 24 October 2005.
Signed Peter Callanan
……………………………
Witness
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 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
(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 4 of 4/11 pages of Schedule 1 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005)signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 1 inserted by Determination HIB 20/2005 on 24 October 2005.
Signed Peter Callanan
……………………………
(Witness)
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 5of 5/11 pages of Schedule 1 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005)signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 1 inserted by Determination HIB 20/2005 on 24 October 2005.
Signed Peter Callanan
……………………………
Witness
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).
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This is page 6of 6/11 pages of Schedule 1 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005)signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 1 inserted by Determination HIB 20/2005 on 24 October 2005.
Signed Peter Callanan
……………………………
Witness
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This is page 7of 7/11 pages of Schedule 1 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005)signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 1 inserted by Determination HIB 20/2005 on 24 October 2005.
Signed Peter Callanan
……………………………
Witness
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 8 of 8/11 pages of Schedule 1 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005)signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 1 inserted by Determination HIB 20/2005 on 24 October 2005.
Signed Peter Callanan
……………………………
Witness
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This is page 9 of 9/11 pages of Schedule 1 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005)signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 1 inserted by Determination HIB 20/2005 on 24 October 2005.
Signed Peter Callanan
……………………………
Witness
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This is page 10 of 10/11 pages of Schedule 1 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005)signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 1 inserted by Determination HIB 20/2005 on 24 October 2005.
Signed Peter Callanan
……………………………
Witness
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This is page 11 of 11/11 pages of Schedule 1 to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005)signed by the Delegate of the Minister for Health and Ageing on 24 June 2005, being the Schedule 1 inserted by Determination HIB 20/2005 on 24 October 2005.
Signed Peter Callanan
……………………………
Witness
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