National Health Act 1953 - Determination pursuant to subsection 5D(1) (PSO 1/2007)

Administered by Department of Health, Disability and Ageing

Legislation au F2007L00253 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

Issued by Authority of the Minister for Health and Ageing

 

National Health Act 1953

 

Determination pursuant to Subsection 5D(1)

 

(PSO 1 / 2007)

 

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 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, Campbelltown Hospital, Hobart Private Hospital, John Fawkner Private Hospital, Kyneton District Health Service, Mayo Private Hospital, St Vincents and Mercy Private Hospital, The Queen Elizabeth Hospital, The Wesley Hospital and St Vincent’s Private 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.

 

Item 2 – 10  -  Specified services and hospitals

 

Item 2  - Campbelltown Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, Campbelltown Hospital in New South Wales as part of Campbelltown Hospital Paediatric 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  - Hobart Private Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, Hobart Private Hospital in Tasmania as part of Hobart Private Hospital in the Home 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 4  - John Fawkner Private Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, John Fawkner Private Hospital in Victoria as part of John Fawkner Private 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.

 

Item 5  - Kyneton District Health Service

 

This item specifies that relevant health services provided to patients by, or on behalf of, Kyneton District Health Service in Victoria as part of Kyneton District Health Service 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.

 

Item 6  - Mayo Private Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, Mayo Private Hospital in New South Wales as part of Mayo Private 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.

 

Item 7  - St Vincents and Mercy Private Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, St Vincents and Mercy Private Hospital in Victoria as part of St Vincents and Mercy Private Hospital Breastfeeding Support Centre 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 a location other than a hospital.

 

Item 8  - The Queen Elizabeth Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, The Queen Elizabeth Hospital in South Australia as part of The Queen Elizabeth 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.

 

Item 9  - The Wesley Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, The Wesley Hospital in Queensland as part of The Wesley Hospital Maternity Outreach Service are outreach services for the purposes of subsection 4(1) of the Act.  This outreach service involves the provision of obstetric 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 10  - St Vincent’s Private Hospital
 

This item specifies that relevant health services provided to patients by, or on behalf of, St Vincent’s Private Hospital in New South Wales as part of St Vincent’s Private Hospital Outreach 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.

 

 

This determination commences on 5 February 2007 and remains in force until and including 4 February 2008. 

 

 

 

ACUTE CARE DIVISION

DEPARTMENT OF HEALTH AND AGEING

February 2006

Overview

The National Health Act 1953 was enacted to establish a framework for the delivery of health services in Australia, including the provision of hospital services. The Act was introduced to address the need for a coherent and comprehensive legislative framework governing health services. This particular determination, issued under subsection 5D(1) of the Act by the Minister for Health and Ageing, was enacted to clarify and specify certain services provided by, or on behalf of, specified hospitals or day hospitals as outreach services. The policy objective of this determination is to ensure that health funds can pay benefits for these specified outreach services, which are provided as a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility. This aims to enhance patient care by facilitating the provision of hospital-like treatment in non-hospital settings, thereby improving access and convenience for patients.

Scope and Application

The National Health Act 1953, as amended, authorises the Minister for Health and Ageing to determine specific outreach services provided by or on behalf of certain hospitals or day hospitals, deeming these services as hospital treatment. This provision allows health funds to pay benefits for these services under applicable benefits arrangements, provided they are a direct substitute for hospital treatment. The Act applies to specific hospitals and their designated outreach services, which include treatments provided in patients' homes or other locations outside a hospital setting, such as paediatric care, maternity services, and breastfeeding support. This determination applies to Campbelltown Hospital, Hobart Private Hospital, John Fawkner Private Hospital, Kyneton District Health Service, Mayo Private Hospital, St Vincents and Mercy Private Hospital, The Queen Elizabeth Hospital, The Wesley Hospital, and St Vincent’s Private Hospital, and it is effective from 5 February 2007 until 4 February 2008. The application process for determining these services involves the Private Sector Outreach Services Working Party, which assesses each application against established clinical and patient outcome criteria before recommending to the Minister for a final decision.

Key Provisions

Subsection 5D(1) of the National Health Act 1953 allows the Minister to specify, through a written determination, the services provided by or on behalf of particular hospitals or day hospitals that qualify as outreach services. Once a service is designated as an outreach service, it is considered hospital treatment, and health funds can pay benefits for these services under applicable benefits arrangements, provided they are a direct substitute for hospital treatment. The determination process starts with an application by the facility to the Department of Health and Ageing, which is then reviewed by the Private Sector Outreach Services Working Party. This Working Party evaluates the application against guidelines that focus on clinical standards and patient outcomes before making a recommendation to the Minister. The Minister, or their delegate, then decides whether to make the determination. The Act imposes specific obligations on the hospitals or day hospitals that wish to have their services recognised as outreach services. These facilities must apply to the Department of Health and Ageing for a determination. The application must be assessed by the Working Party against the set guidelines, which detail criteria for clinical standards and patient outcomes. The Working Party’s recommendation is then considered by the Minister or their delegate, who makes the final decision on whether to designate the services as outreach services. These obligations ensure that only services meeting certain quality and outcome standards are recognised. Failure to comply with the requirements set out in the Act or the guidelines can result in legal consequences. While the Act does not explicitly detail specific offences or penalties for non-compliance, it is understood that any breach of the conditions under which the outreach services are recognised could lead to civil or administrative penalties. The exact nature and severity of these penalties would depend on the specific circumstances of the breach and would be determined under relevant Australian laws and regulations. The overarching goal is to ensure that services provided as outreach are of a high standard and genuinely substitute for hospital treatment.

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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.