EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination pursuant to Subsection 5D(1)
(PSO 1 / 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 Macarthur Health Service, and The Canberra Hospital.
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 – 3 - Specified services and hospitals
Item 2 - Macarthur Health Service
This item specifies that relevant health services provided to patients by, or on behalf of,
Macarthur Health Service in New South Wales as part of Macarthur Health Service Ambulatory Care Service 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.
Item 3 - The Canberra Hospital
This item specifies that relevant health services provided to patients by, or on behalf of, The Canberra Hospital in the Australian Capital Territory as part of The Canberra Hospital - Hospital in the Home 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 17 March 2005 and remains in force until and including 16 March 2008. 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, as amended by the Health Legislation Amendment Act (No. 1) 2001, was enacted to address a gap in the provision of healthcare services by allowing health funds to pay benefits for services provided as a direct substitute for hospital treatment, such as hospital in the home. Pursuant to this Act, the Minister for Health and Ageing has the authority under subsection 5D(1) to specify services provided by or on behalf of certain hospitals or day hospital facilities as outreach services. This 2005 determination by the Minister, made under the authority of the National Health Act, specifies outreach services provided by Macarthur Health Service in New South Wales and The Canberra Hospital in the Australian Capital Territory. These services, which include nursing care, medical treatment, and allied health services delivered to patients in their homes, are considered suitable under the guidelines set by the Private Sector Outreach Services Working Party. The policy objective is to ensure that high-quality healthcare services are available to patients outside traditional hospital settings, thereby facilitating a more flexible and patient-centred approach to healthcare delivery.
Scope and Application
The National Health Act 1953, through its Determination pursuant to Subsection 5D(1) (PSO 1/2005), designates specific services provided by Macarthur Health Service in New South Wales and The Canberra Hospital in the Australian Capital Territory as outreach services. These services, which include nursing care, treatment by medical practitioners, and allied health services delivered to patients in their own homes, are specified to be of a suitable quality under the guidelines established by the Private Sector Outreach Services Working Party. This determination allows health funds to pay benefits for these services under applicable benefits arrangements, effectively treating them as hospital treatment. The Act applies to specified hospitals and their day hospital facilities, and the determination extends its reach by identifying particular entities and services. This legislative instrument is in force from 17 March 2005 until 16 March 2008, and it is lodged for registration on the Federal Register of Legislative Instruments.
Key Provisions
The National Health Act 1953 (the Act), as amended, allows the Minister for Health and Ageing to specify outreach services provided by certain hospitals or day hospitals through written determinations under subsection 5D(1). This determination, pursuant to PSO 1/2005, identifies specific outreach services provided by Macarthur Health Service in New South Wales and The Canberra Hospital in the Australian Capital Territory as eligible outreach services. Once specified, these services are considered hospital treatment under section 5C of the Act, and health funds can pay benefits for these services under applicable benefits arrangements, provided they serve as a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility.
The obligations imposed on the parties by this Act include the requirement for a facility to apply to the Department of Health and Ageing if it wishes to have its outreach services determined as eligible under the Act. This application process involves assessment by the Private Sector Outreach Services Working Party, which comprises representatives from various health-related organisations. The Working Party evaluates each application based on clinical standards and patient outcomes, as outlined in specific guidelines, and makes a recommendation to the Minister. The Minister, or their delegate, then decides whether to make the determination, taking into account the Working Party's recommendation. This ensures that only those services meeting the required quality and outcomes criteria are approved as outreach services.
Failure to comply with the requirements of this Act or providing services that do not meet the specified criteria can lead to several consequences. While the Act does not explicitly detail the penalties for non-compliance, breaches of health legislation can generally result in fines, legal action, or other administrative penalties as prescribed by the relevant health laws. Additionally, health funds may be liable to repay any benefits paid for services that do not meet the specified criteria, potentially leading to financial repercussions for the facilities involved. The specific penalties would depend on the nature and severity of the breach, as well as any other applicable laws or regulations.