National Health Act 1953 - Determination pursuant to subsection 5D(1) (PSO 1/2006)

Administered by Department of Health, Disability and Ageing

Legislation au F2006L01281 Not in force Legislative Instrument

Legislation content

 

 

EXPLANATORY STATEMENT

 

Issued by Authority of the Minister for Health and Ageing

 

National Health Act 1953

 

Determination pursuant to Subsection 5D(1)

 

(PSO 1 / 2006)

 

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 to be provided by, or on behalf of, Belmont Private Hospital, John Hunter Hospital, Monash Medical Centre – Clayton Campus, Pinelodge Clinic Private Hospital and Royal Adelaide 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 – 6   -  Specified services and hospitals

 

 

Item 2  - Belmont Private Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of,

Belmont Private Hospital in Queensland as part of Belmont Private Hospital Community Treatment Team are outreach services for the purposes of subsection 4(1) of the Act.  This outreach service involves the provision of psychiatric 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  -  John Hunter Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, John Hunter Hospital in New South Wales as part of Hunter New England Health Out & About IV Therapy 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.

 

Item 4 -  Monash Medical Centre

 

This item specifies that relevant health services provided to patients by, or on behalf of, Monash Medical Centre – Clayton Campus in Victoria as part of Southern Health – 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.

 

Item 5 – Pinelodge Clinic Private Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, Pinelodge Clinic Private Hospital in Victoria as part of St John of God Pinelodge Clinic are outreach services for the purposes of subsection 4(1) of the Act.  This outreach service involves the provision of psychiatric 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 6 – Royal Adelaide Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, Royal Adelaide Hospital in South Australia as part of Royal Adelaide Hospital/Hospital in the Home 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 2006 and remains in force until and including 30 April 2009.  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

April 2006

Overview

The National Health Act 1953 was enacted by the Parliament of Australia to provide a framework for the delivery of health services across the nation. The Act was amended by the Health Legislation Amendment Act (No. 1) 2001 to introduce provisions allowing health funds to pay benefits for services provided as a direct substitute for hospital treatment, such as hospital in the home. However, before these services could be recognised as hospital treatment, they needed to be specifically determined as outreach services under subsection 5D(1) of the Act. This was a necessary step to ensure that health funds could appropriately compensate for such services under applicable benefits arrangements. The determination process involves an application by the facility to the Department of Health and Ageing, which is assessed by a Working Party that considers the application against guidelines designed to ensure the quality of the services. The Minister for Health and Ageing, or a delegate, then decides whether to make the determination based on the Working Party's recommendation. This determination, which specifies outreach services provided by five hospitals across Australia, aims to ensure that certain health services provided outside of a hospital setting are recognised as hospital treatment, thereby facilitating payment of benefits by health funds.

Scope and Application

The National Health Act 1953, through its subsection 5D(1), authorises the Minister for Health and Ageing to specify services provided by, or on behalf of, a particular hospital or day hospital facility as outreach services for the purposes of the Act's definition of outreach service. This determination is applicable to services provided by Belmont Private Hospital in Queensland, John Hunter Hospital in New South Wales, Monash Medical Centre – Clayton Campus in Victoria, Pinelodge Clinic Private Hospital in Victoria, and Royal Adelaide Hospital in South Australia. These specified services, which may include psychiatric treatment, nursing care, treatment by medical practitioners, or allied health services provided to patients in their own homes, are deemed hospital treatment under section 5C of the Act, allowing health funds to pay benefits for such services under applicable benefits arrangements. The decision to classify these services as outreach services is made by the Minister, taking into account recommendations from the Private Sector Outreach Services Working Party, which assesses applications against guidelines focused on clinical standards and patient outcomes. This determination, which commenced on 1 May 2006 and remains in force until 30 April 2009, is subject to potential extensions or restrictions through subordinate instruments, as specified under the Act.

Key Provisions

The main operative sections of the Determination (F2006L01281) specify that certain health services provided by, or on behalf of, designated hospitals are classified as outreach services under the National Health Act 1953 (the Act). Specifically, Item 2 designates psychiatric treatment services provided by Belmont Private Hospital in Queensland, Item 3 designates treatment services provided by John Hunter Hospital in New South Wales, Item 4 designates treatment services provided by Monash Medical Centre – Clayton Campus in Victoria, Item 5 designates psychiatric treatment services provided by Pinelodge Clinic Private Hospital in Victoria, and Item 6 designates treatment services provided by Royal Adelaide Hospital in South Australia. These services, which can include nursing care, medical treatment, and allied health services, are considered outreach services when provided in patients' own homes. The Act imposes specific obligations and requirements on the parties it governs. Hospitals or facilities that wish to provide outreach services must apply to the Department of Health and Ageing for a determination under subsection 5D(1) of the Act. The application is assessed by the Private Sector Outreach Services Working Party, which reviews the services against clinical standards and patient outcomes criteria. The Working Party then makes a recommendation to the Minister, who decides whether to make the determination. Once a service is determined to be an outreach service, it is deemed to be hospital treatment, allowing health funds to pay benefits for those services under applicable benefits arrangements. Any failure to comply with the requirements and criteria set out in the Determination may result in legal consequences. While the Determination does not explicitly state penalties for non-compliance, breaches of the Act or regulations can result in civil or criminal penalties. Under the Act, civil penalties can include fines up to $22,200 for individuals and $111,000 for bodies corporate. Criminal penalties may apply in more severe cases, with potential fines and imprisonment terms depending on the specific breach and the courts' discretion. The exact penalties would be determined based on the applicable sections of the Act and relevant case law.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.