National Health Amendment Regulations 1999 (No. 6) (Cth)

National Health Amendment Regulations 1999 (No. 6)

Statutory Rules 1999 No. 236

I, WILLIAM PATRICK DEANE, Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under theNational Health Act 1953.

Dated 13 October 1999.

WILLIAM DEANE

Governor-General

By His Excellency’s Command,

MICHAEL WOOLDRIDGE

Minister for Health and Aged Care

National Health Amendment Regulations 1999 (No. 6)1

Statutory Rules 1999 No. 2362

made under the

National Health Act 1953

   

Contents

Page

• •
• •

 

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1Name of Regulations

 These Regulations are the National Health Amendment Regulations 1999 (No. 6).

2Commencement

 These Regulations commence on 1 November 1999.

3Amendment of National Health Regulations 1954

Schedule 1 amends the National Health Regulations 1954.

Schedule 1Amendments

Do not delete: Schedule Part placeholder

(regulation 3)

[1]Subregulation 49A (2)

substitute

• (2)

  A reference to a document in the Hospital Casemix Protocol is a reference to that document as in existence on the day the reference takes effect.

[2]Paragraph 49B (1) (e)

omit

Version 3.1.

insert

Version 3.1;

[3]After paragraph 49B (1) (e)

insert

• (f)

  Australian Refined Diagnosis Related Groups Definitions Manual Version 4.0;

• (g)

  Australian Refined Diagnosis Related Groups Definitions Manual Version 4.1.

[4]Subregulation 49B (2)

substitute

• (2)

  A reference to a document in a paragraph of subregulation (1) is a reference to that document as in existence on the day the paragraph commences.

[5]Schedule 7, Part 1, item 2, after definition of fund

insert

ICD-10-AM means The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification.

ICU means the Intensive Care Unit of a hospital.

[6]Schedule 7, Part 1, item 2, definition of ICD-9-CM

omit

[7]Schedule 7, Part 1, item 2, definition of NHDD

substitute

NHDD means version 8 of the National Health Data Dictionary, published in 1999.

[8]Schedule 7, Part 1, item 8

substitute

8. A record will be rejected by the Department if any of the following data items is coded as blank:

• (a)

  Fund/Payer identifier in either Part 4 or 5;

• (b)

  Link identifier in either Part 4 or 5;

• (c)

  Provider (hospital) code in Part 5;

• (d)

  Date of birth in Part 5;

• (e)

  Postcode in Part 5;

• (f)

  Sex in Part 5;

• (g)

  Admission date in Part 5;

• (h)

  Separation date in Part 5;

• (i)

  Mode of separation in Part 5;

• (j)

  Principal diagnosis code in Part 5.

[9]Schedule 7, Part 1, paragraph 14 (d)

omit

ICD-9-CM

insert

ICD-10-AM

[10]Schedule 7, Part 1, paragraphs 19 (a) and (b)

omit

27-56

insert

29-67

[11]Schedule 7, Part 2, item 1

omit

Fund identifier

insert

Fund/Payer identifier

[12]Schedule 7, Part 2, items 3, 4, 5, 6, 7, 8 and 9

substitute

3	CMBS item/ Miscellaneous service code	28	14	1
4	Item charge	42	5	1
5	CMBS benefit	47	5	1
6	Fund benefit	52	5	1
7	CMBS date of service	57	8	1
8	Contracted doctor	65	1	1
9	Total record length	65

[13]Schedule 7, Part 3

substitute

Part 3File structure: hospital episode record

Column 1	Column 2	Column 3	Column 4	Column 5
Item	Data item	Start position	Field size	Repetitions
1	Fund/Payer identifier	1	3	1
2	Link identifier	4	24	1
3	Provider (hospital) code	28	8	1
4	Product code	36	8	1
5	Hospital contract status	44	1	1
6	Total days paid	45	4	1
7	Accommodation charge	49	6	1
8	Accommodation benefit	55	6	1
9	Theatre charge	61	5	1
10	Theatre benefit	66	5	1
11	Labour ward charge	71	5	1
12	Labour ward benefit	76	5	1
13	ICU charge	81	5	1
14	ICU benefit	86	5	1
15	Prosthesis charge	91	5	1
16	Prosthesis benefit	96	5	1
17	Pharmacy charge	101	5	1
18	Pharmacy benefit	106	5	1
19	Bundled charge	111	6	1
20	Bundled benefit	117	6	1
21	Other charges	123	5	1
22	Other benefits	128	5	1
23	Front end deductible	133	5	1
24	Ancillary cover status	138	1	1
25	Ancillary charges	139	5	1
26	Ancillary benefits	144	5	1
27	Item charges	149	6	1
28	Total CMBS and fund benefits	155	6	1
29	Date of birth	161	8	1
30	Postcode	169	4	1
31	Sex	173	1	1
32	Admission date	174	8	1
33	Separation date	182	8	1
34	Hospital type	190	1	1
35	ICU days	191	3	1
36	DRG code	194	4	1
37	DRG version	198	2	1
38	Admission time	200	4	1
39	Neonatal admission weight	204	4	1
40	Hours of mechanical ventilation	208	4	1
41	Mode of separation	212	2	1
42	Separation time	214	4	1
43	Source of referral	218	1	1
44	Service category on admission	219	1	1
45	Total leave days	220	4	1
46	Non-acute days of stay	224	4	1
47	Principal diagnosis code	228	5	1
48	Additional diagnoses	233	5	19
49	Procedure codes	328	7	20
50	Sameday status	468	1	1
51	Principal CMBS item number/ Miscellaneous service code	469	14	1
52	Principal CMBS date	483	8	1
53	Time in theatre (Principal CMBS)	491	4	1
54	Secondary CMBS item numbers/ Miscellaneous service codes	495	14	9
55	Total days spent at home	621	2	1
56	Total psychiatric care days	623	3	1
57	Mental health legal status	626	1	1
58	ICU hours	627	4	1
59	Admission status	631	1	1
60	Contract status on admission	632	1	1
61	Palliative care status	633	1	1
62	Unplanned readmission within 28 days	634	1	1
63	Unplanned theatre visit during episode	635	1	1
64	Marital status	636	1	1
65	Provider number of hospital from which transferred	637	8	1
66	Provider number of hospital to which transferred	645	8	1
67	Discharge intention on admission	653	1	1
68	Total record length	653

[14]Schedule 7, Part 4, item 1

omit

Fund identifier

insert

Fund/Payer identifier

[15]Schedule 7, Part 4, item 3

substitute

3	CMBS item/ Miscellaneous service code	C(14)	MAA	The CMBS item number, miscellaneous service code or Australian Dental Association code
Blank = no CMBS item billed

[16]Schedule 7, Part 4, item 4

substitute

4	Item charge	N(5)	MAA	The amount the patient was billed by the doctor or health service provider
0 = no amount billed

[17]Schedule 7, Part 5

substitute

Part 5Record content: hospital episode record

Item	Data item	Field size	Required	Coding description
1	Fund/Payer identifier	C(3)	MAA	See fund codes
2	Link identifier	C(24)	MAA	A unique identifier of the episode linking data items from this Part (Part 5) to the medical record (Part 4)
The fund may encrypt the membership identifier for this purpose
3	Provider (hospital) code	C(8)	MAA	The hospital provider number
4	Product code	C(8)	MAA	The product code for the patient’s insurance cover at separation
The fund must supply documentation of cover field values
5	Hospital contract status	C(1)	MAA	Y = a hospital with which a fund has a contract N = a hospital with which the fund does not have a contract
6	Total days paid	N(4)	MAA	The total number of days benefits were paid for by the fund, including days benefits were paid for as an NHTP
7	Accommodation charge	N(6)	MAA	Accommodation charge rounded to the nearest dollar
0 = no accommodation charge billed
Blanks only valid if an accommodation charge was not separately identified but billed under another charge item
8	Accommodation benefit	N(6)	MAA	Accommodation benefit rounded to the nearest dollar
0 = no accommodation benefit paid
Blanks only valid if an accommodation benefit was not separately identified but paid under another benefit item
9	Theatre charge	N(5)	MAA	Theatre charge rounded to the nearest dollar
0 = no theatre charge billed
Blanks only valid if a theatre charge was not separately identified but billed under another charge item
10	Theatre benefit	N(5)	MAA	Theatre benefit rounded to the nearest dollar
0 = no theatre benefit paid
Blanks only valid if a theatre benefit was not separately identified but paid under another benefit item
11	Labour ward charge	N(5)	MAA	Labour ward charge rounded to the nearest dollar
0 = no labour ward charge billed
Blanks only valid if a labour ward charge was not separately identified but billed under another charge item
12	Labour ward benefit	N(5)	MAA	Labour ward benefit rounded to the nearest dollar
0 = no labour ward benefit paid
Blanks only valid if a labour ward benefit was not separately identified but paid under another benefit item
13	ICU charge	N(5)	MAA	ICU charge rounded to the nearest dollar
0 = no ICU charge billed
Blanks only valid if an ICU charge was not separately identified but billed under another charge item
14	ICU benefit	N(5)	MAA	ICU benefit rounded to the nearest dollar
0 = no ICU benefit paid
Blanks only valid if an ICU benefit was not separately identified but paid under another benefit item
15	Prosthesis charge	N(5)	MAA	Prosthesis charge rounded to the nearest dollar
0 = no prosthesis charge billed
Blanks only valid if a prosthesis charge was not separately identified but billed under another charge item
16	Prosthesis benefit	N(5)	MAA	Prosthesis benefit rounded to the nearest dollar
0 = no prosthesis benefit paid
Blanks only valid if a prothesis benefit was not separately identified but paid under another benefit item
17	Pharmacy charge	N(5)	MAA	Pharmacy charge rounded to the nearest dollar
0 = no pharmacy charge billed
Blanks only valid if a pharmacy charge was not separately identified but billed under another charge item
18	Pharmacy benefit	N(5)	MAA	Pharmacy benefit rounded to the nearest dollar
0 = no pharmacy benefit paid
Blanks only valid if a pharmacy benefit was not separately identified but paid under another benefit item
19	Bundled charges	N(6)	MAA	Bundled charge rounded to the nearest dollar
0 = no bundled charge billed
20	Bundled benefits	N(6)	MAA	Bundled benefit rounded to the nearest dollar
0 = no bundled benefit paid
21	Other charges	N(5)	MAA	Other charges rounded to the nearest dollar
0 = no other charge billed
22	Other benefits	N(5)	MAA	Other benefits rounded to the nearest dollar
0 = no other benefit paid
23	Front end deductible	N(5)	MAA	The amount of FED deducted from the benefit, otherwise payable by the fund to the patient
Blank = there is a FED but the amount is unknown 0 = no FED applicable
24	Ancillary cover status	C(1)	MAA	Y = patient has ancillary cover N = patient does not have ancillary cover
25	Ancillary charges	N(5)	OPA	The ancillary charges incurred during the episode and billed against an ancillary table
26	Ancillary benefits	N(5)	OPA	The ancillary benefits paid for charges billed as occurring during the episode
27	Item charges	N(6)	MAA	The total item charges as set out in Part 4
28	Total CMBS and fund benefits	N(6)	MAA	The total CMBS and fund benefits as set out in Part 4
29	Date of birth	D(8)	MAA	DDMMCCYY
30	Postcode	C(4)	MAA	The patient’s residential postcode
31	Sex	C(1)	MAA	1 = male 2 = female 0 = unknown
32	Admission date	D(8)	MAA	DDMMCCYY
33	Separation date	D(8)	MAA	DDMMCCYY
34	Hospital type	C(1)	MAA	1 = public 2 = private 3 = private day facility 4 = public day facility 9 = other
35	ICU days	N(3)	MAA	The number of days the patient spent in one or more of the following: • ICU • CCU • neonatal intensive care • paediatric intensive care
This does not include days spent in High Dependency Units
36	DRG code	C(4)	OPA	Blank filled if not known
37	DRG version	C(2)	OPA	10 = version 1 20 = version 2 21 = version 2.1 30 = version 3 31 = version 3.1 40 = version 4 41 = version 4.1
38	Admission time	N(4)	MAA (sameday patients only)	The admission time is based on a 24‑hour clock (for example, 6:35AM is entered as 0635)
39	Neonatal admission weight	N(4)	MAA	The admission weight rounded to the nearest gram for a neonate (patient age less than 29 days old) or an older baby weighing less than 2500 grams
40	Hours of mechanical ventilation	N(4)	MAA	The number of hours, rounded to the nearest hour, that the patient received mechanical ventilation during the episode
41	Mode of separation	C(2)	MAA	01 = separation or transfer of the patient to an acute care hospital 02 = separation or transfer of the patient to a nursing home 03 = separation or transfer of the patient to a psychiatric hospital 04 = separation or transfer of the patient to another health facility 05 = statistical separation/type change 06 = patient left the hospital against medical advice 07 = statistical separation from leave 08 = patient died 09 = patient went home/other
42	Separation time	N(4)	MAA (sameday patients only)	The separation time is based on a 24‑hour clock (for example, 10:35PM is entered as 2235)
43	Source of referral	N(1)	MAA	0 = born in hospital 1 = admitted patient transferred from another hospital 2 = statistical admission/type change 4 = from Accident/ Emergency 5 = from community health service 6 = from Outpatients department 7 = from nursing home 8 = by outside medical practitioner 9 = other
44	Service category on admission	N(1)	MAA	The type of service for which the patient was initially admitted
1 = acute care 2 = rehabilitative care 3 = palliative care 4 = non-acute care 5 = unqualified neonate 6 = other
45	Total leave days	N(4)	MAA	This data item is calculated as the sum of leave days for all leave periods during the episode
0 = no leave days
Leave days exclude 1 day leave periods for patients and are subject to the following conditions:
• a patient who does not require treatment over a weekend or another short period may leave the hospital temporarily with the approval of the hospital or treating medical practitioner
• if there is a decision that the patient will return to the same hospital within a short time to resume treatment, this absence is defined as leave
46	Non-acute days of stay	N(4)	MAA	The number of days spent in the hospital, without certification, that exceeded 35 days
47	Principal diagnosis code	I(5)	MAA	The ICD-10-AM code for the diagnosis or condition chiefly responsible for the hospital admission
A blank entry is not valid for this field
48	Additional diagnosis	I(5) 19 times	MAA	ICD-10-AM diagnosis codes for conditions or complaints other than the principal diagnosis that arose during the patient’s stay in hospital or existed at the time of the patient’s admission to hospital
49	Procedure codes	I(7) 20 times	MAA	ICD-10-AM procedure codes for all procedures performed during the episode
Blank = no applicable ICD-10-AM procedure code
50	Sameday status	C(1)	MAA	0 = patient with a valid arrangement allowing overnight stay for procedure normally performed on a sameday basis 1 = sameday patient 2 = overnight patient other than type 0 above
51	Principal CMBS item number/ Miscellaneous service code	C(14)	OPH	Principal CMBS item or miscellaneous service code or ADA code related to the first procedure code referred to in item 49 of this Part
Blank = no applicable CMBS item
52	Principal CMBS date	D(8)	OPH	The date when the principal CMBS procedure was carried out
Blank = no principal CMBS date
53	Time in theatre (Principal CMBS)	N(4)	MAA (sameday patients only)	The time in minutes the patient spent in the theatre, from the time the patient entered the theatre until the time the patient left the theatre
0 = no time spent in the theatre
Blank = no applicable CMBS item
54	Secondary CMBS item numbers/ Miscellaneous service code	C(14) 9 times	OPH	Additional CMBS item numbers or miscellaneous service codes or ADA codes related to the procedure codes referred to in item 49 of this Part
Blank = no applicable CMBS item
55	Total days spent at home	N(2)	MAA (Hospital-in-home episodes only)	The number of days the patient spent at home where part of the episode was provided through a hospital-in-the-home program
56	Total psychiatric care days	N(3)	OPA	The sum of the number of days and part days of stay that the person was an admitted patient or resident within a designated psychiatric unit, minus the sum of leave days occurring during the stay within the unit
57	Mental health legal status	N(1)	OPA	An indication that the patient was treated under relevant mental health legislation at some point during the episode
1 = involuntary patient 2 = voluntary patient
58	ICU hours	N(4)	OPA	The number of hours spent by the patient in one or more of the following: • ICU • CCU • neonatal intensive care
This does not include hours spent in Special Care Nurseries or High Dependency Units
59	Admission status	N(1)	OPA	An indication of the admission status of the patient
1 = emergency 2 = planned/ elective 3 = other
60	Contract status on admission	N(1)	OPA	1 = service provided under contract on behalf of another hospital 2 = service other than 1
61	Palliative care status	N(1)	OPA	1 = palliative care required during the episode 2 = no palliative care required during the episode
62	Unplanned readmission within 28 days	A(1)	OPA	Readmission of patient to hospital within 28 days of the previous discharge for treatment of a similar or related condition
Y = unplanned readmission N = planned readmission Blank = no readmission
63	Unplanned theatre visit during episode	N(1)	OPA	Patient required a theatre visit that was not planned or anticipated at the time of admission
1 = unplanned theatre visit 2 = no unplanned theatre visit
64	Marital status	N(1)	OPA	1 = never married 2 = widowed 3 = divorced 4 = separated 5 = married (including de facto) 6 = not stated/ inadequately described
65	Provider number of hospital from which transferred	A(8)	OPA	If the patient was transferred from another hospital, the hospital provider number of that hospital
66	Provider number of hospital to which transferred	A(8)	OPA	If the patient was transferred to another hospital, the hospital provider number of that hospital
67	Discharge intention on admission	A(1)	OPA	The intended mode of separation at time of admission
Discharge to: 1 = acute hospital 2 = nursing home 3 = psychiatric hospital 4 = palliative care unit/hospice 5 = other health care accommodation 6 = usual residence

[18]Schedule 7, Part 6

substitute

Part 6Registered health benefits organisations

Column 1 Item	Column 2 Name	Column 3 Identifier
1	A.C.A. Health Benefits Fund	ACA
2	A.M.A. Health Fund Limited	AMA
3	Army Health Benefits Society	AHB
4	Australian Health Management Pty Ltd	AHM
5	Australian Unity Friendly Society*	AUF
6	C.D.H. Benefits Fund	CDH
7	Commonwealth Bank Health Society (Friendly Society)	CBH
8	Credicare Health Fund	CHF
9	Eastern District Health Fund Ltd	WDH
10	Geelong Medical and Hospital Benefits Association Limited	GMH
11	Goldfields Medical Fund (Inc.)	GMF
12	Grand United Corporate Health Limited	GUC
13	Grand United Friendly Society	GUF
14	Health Care Insurance Ltd	HCI
15	Healthguard Health Benefits Fund Limited	HHB
16	Health Insurance Fund of WA	HIF
17	Hospital Benefits Association Limited**	HBA
18	Hospital Benefits Fund of Western Australia (Inc.), The	HBF
19	Hospitals Contribution Fund of Australia, Limited, The

HCF
20	Independent Order of Odd Fellows of Victoria	IOF
21	I.O.R. Australia Pty Ltd	IOR
22	Latrobe Health Services, Inc.	LHS
23	Lysaght Hospital and Medical Club, The	LHM
24	Manchester Unity Independent Order of Oddfellows Friendly Society in New South Wales	MUI
25	Medibank Private (Health Insurance Commission)	MBP
26	Medical Benefits Fund of Australia Ltd	MBF
27	Mildura District Hospital Fund	MDH
28	MIM Employees Health Fund	MIM
29	Mutual Community Ltd**	MCL
30	National Mutual Health Insurance Pty Ltd**	NMH
31	Naval Health Benefits Society	NHB
32	New South Wales Teacher’s Federation Health Society	NTF
33	N.I.B. Health Funds Limited	NIB
34	Phoenix Welfare Association Limited, The	PWA
35	Queensland Teachers Union Health Society	QTU
36	Railway & Transport Employees’ Friendly Society Health Fund	RTE
37	Reserve Bank Health Society	RBH
38	S.G.I.C. Health Pty Limited	SGI
39	South Australian Police Employees’ Health Fund Incorporated	SPE
40	South Australian Public Servants	SPS
41	St Luke’s Medical & Hospital Benefits Association	SLM
42	Transition Benefit Fund	TBF
43	Transport Friendly Society	TFS
44	United Ancient Order of Druids	UAD
45	United Ancient Order of Druids Registered Friendly Society Grand Lodge of New South Wales, The	UAF
46	Yallourn Medical and Hospital Society, The	YMH

Notes

*   Australian Natives’ Association and Manchester Unity Independent Order of Oddfellows Friendly Society in Victoria now trade as Australian Unity Friendly Society.

• ** Mutual Community is owned and operated by National Mutual.

   In Victoria, Mutual Community trades as HBA.

Notes

1. These Regulations amend Statutory Rules 1954 No. 35, as amended by 1957 No. 71; 1958 No. 63; 1962 Nos. 55, 70 and 113; 1965 Nos. 17, 94 and 185; 1966 No. 99; 1967 No. 86; 1969 Nos. 91 and 220; 1970 Nos. 70 and 166; 1971 Nos. 28, 76, 103 and 138; 1972 No. 79; 1973 Nos. 17, 75, 111, 221, 225 and 267; 1974 Nos. 52, 104, 105, 113 and 263; 1975 Nos. 14, 49, 66, 100, 124, 165 and 207; 1976 Nos. 113, 217 and 227; 1977 Nos. 11, 34, 51 and 112; 1978 Nos. 66, 178, 208 and 266; 1979 Nos. 59, 107, 208 and 231; 1980 Nos. 84, 292 and 309; 1981 Nos. 43, 97, 115, 232 and 318; 1982 Nos. 38, 82, 84, 250 and 284; 1983 Nos. 45, 247 and 267; 1984 Nos. 66, 161, 200, 308, 322 and 427; 1985 Nos. 86, 136, 186, 187, 206 and 288; 1986 Nos. 47, 53, 208, 330, 353 and 360; 1987 Nos. 50, 76, 100 and 310; 1989 Nos. 291, 292 and 334; 1990 Nos. 24, 86, 114, 292, 335 and 396; 1991 Nos. 40, 41, 232, 262, 263, 310 and 339; 1992 Nos. 136 and 187; 1993 Nos. 48, 85, 153, 260, 261, 273, 280 and 284; 1994 Nos. 2, 9, 106, 139, 201, 253, 256, 296, 349 and 451; 1995 Nos. 1, 14, 34, 52, 109, 116, 161, 220, 288, 289, 408 and 410; 1996 Nos. 46, 183 and 333; 1997 Nos. 16, 58, 133, 160, 179 and 353; 1998 Nos. 18, 73 and 262; 1999 Nos. 18, 140, 162, 174 and 175.

2. Made by the Governor-General on 13 October 1999, and notified in the Commonwealth of Australia Gazette on 20 October 1999.