EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination pursuant to Subsection 5D(1)
(PSO 3 / 2005)
Subsection 5D(1) of the National Health Act 1953 (the Act) provides that the Minister may, by written determination, specify services provided by, or on behalf of, a specified hospital or day hospital facility for the purposes of the definition of outreach service in subsection 4(1) of the Act. Once a service is determined to be an outreach service then it is deemed to be hospital treatment (section 5C of the Act). Health funds can then pay benefits for those services (and associated professional services) under applicable benefits arrangements (hospital cover policies), provided that the services are provided as a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility.
The provisions relating to outreach services were inserted into the Act by the Health Legislation Amendment Act (No. 1) 2001. These provisions were enacted to allow health funds to pay benefits for services that are provided to a patient as a direct substitute for hospital treatment, such as hospital in the home, under applicable benefits arrangements. Prior to these provisions being inserted, health funds could only pay benefits for such services if regulations modifying the Act were made under subsection 140(2) of the Act.
Consultation
A facility that wishes a determination to be made in relation to an outreach service it provides makes an application to the Department of Health and Ageing. Each application is initially assessed by the Private Sector Outreach Services Working Party (the ‘Working Party’). The Working Party members are drawn from: the Australian Health Insurance Association, the Australian Private Hospitals Association, the Committee of Presidents of Medical Colleges, the Royal College of Nursing Australia, Catholic Health Australia, Ambulatory Care Australia and the Consumers’ Health Forum. The Working Party considers each application against guidelines that contain criteria about clinical standards and patient outcomes. The guidelines have been designed to assist the Working Party to assess whether the services to be provided are of a suitable quality. The Working Party makes a recommendation to the Minister as to whether the services meet the guidelines, and the Minister (or delegate) decides whether to make a determination under subsection 5D(1) of the Act, taking into account the recommendation of the Working Party.
This Determination specifies outreach services provided by Northeast Health Wangaratta.
Item-by-item details of the Schedule
Specified services provided by, or on behalf of, specified hospitals or day hospital facilities.
Item 1 – Definitions
This item defines terms used in the Schedule.
Items 2 - Specified service and hospital
Item 2 – Northeast Health Wangaratta Outreach Program
This item specifies that relevant health services provided to patients by, or on behalf of, Northeast Health Wangaratta in Victoria as part of Northeast Health Wangaratta Outreach Program are outreach services for the purposes of subsection 4(1) of the Act. This outreach service involves the provision of treatment (which may include nursing care, treatment by a medical practitioner or the provision of allied health services) to patients in their own homes.
This determination commences on 1 May 2005 and remains in force until and including
31 December 2005. The determination and this explanatory statement have been lodged for registration on the Federal Register of Legislative Instruments
ACUTE CARE DIVISION
DEPARTMENT OF HEALTH AND AGEING
March 2005
Overview
The National Health Act 1953 was enacted by the Parliament of Australia to facilitate the provision of health services across the nation. The Act was amended by the Health Legislation Amendment Act (No. 1) 2001, which introduced provisions for outreach services to enable health funds to cover services provided as a direct substitute for hospital treatment, such as hospital in the home. This was necessary as, prior to these amendments, health funds could only pay benefits for such services if specific regulations were made under the Act. The 2005 determination under subsection 5D(1) of the Act, made by the Minister for Health and Ageing, specifies services provided by Northeast Health Wangaratta in Victoria as part of their Outreach Program. This allows health funds to pay benefits for these outreach services, which include nursing care, treatment by medical practitioners, and allied health services provided to patients in their own homes. The determination, which was made following a recommendation by the Private Sector Outreach Services Working Party, aims to ensure that the services meet the required clinical standards and patient outcomes.
Scope and Application
The National Health Act 1953, as amended, and specifically the provisions under subsection 5D(1), allow the Minister for Health and Ageing to determine which services provided by specified hospitals or day hospital facilities qualify as outreach services. Such a determination enables health funds to pay benefits for these services under applicable benefits arrangements, provided they are direct substitutes for hospital treatment. This legislative framework was established to facilitate payment for services like hospital in the home. The current determination specifies outreach services provided by Northeast Health Wangaratta in Victoria as part of its outreach program, effective from 1 May 2005 to 31 December 2005. The application process involves the Private Sector Outreach Services Working Party, which assesses the services against clinical standards and patient outcomes guidelines before recommending to the Minister. The outreach service in question includes treatments such as nursing care, medical practitioner treatments, and allied health services provided to patients in their homes.
Key Provisions
The main sections of the Determination under Subsection 5D(1) of the National Health Act 1953 specify services provided by Northeast Health Wangaratta in Victoria as outreach services for the purposes of subsection 4(1) of the Act (Item 2). This outreach service involves the provision of treatment, including nursing care, treatment by a medical practitioner, or the provision of allied health services, to patients in their own homes as part of the Northeast Health Wangaratta Outreach Program. This determination is effective from 1 May 2005 to 31 December 2005 (Item 2).
The obligations imposed by this Determination require the specified services to meet the criteria outlined in the guidelines developed by the Private Sector Outreach Services Working Party. These guidelines are designed to ensure that the services provided are of a suitable quality and meet clinical standards and patient outcomes (Item 1). The Working Party, comprising representatives from various healthcare and consumer organisations, assesses applications for such services and makes a recommendation to the Minister regarding whether the services meet these criteria. The Minister then decides whether to make a determination under subsection 5D(1) of the Act.
In the event of a breach of the conditions outlined in this Determination, there are potential civil and criminal consequences. Although specific penalties are not detailed in the Determination, breaches of the National Health Act 1953 can lead to substantial fines and, in severe cases, imprisonment. Health funds that do not comply with the Act may also face legal action from patients or regulatory penalties. The determination of the exact penalties would depend on the specific circumstances of the breach and the provisions of the National Health Act 1953.