National Health Act 1953 - Determination pursuant to subsection 5D(1) (PSO 10/2005)

Administered by Department of Health, Disability and Ageing

Legislation au F2005L02974 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 10 / 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 to be provided by, or on behalf of, Knox Private Hospital, St Vincents and Mercy Private Hospital, Ballarat Health Services and St Frances Xavier Cabrini 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  -  Knox Private Hospital

 

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

Knox Private Hospital in Victoria as part of Knox 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 3  -  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 Maternity 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.

 

Item 4 -  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/Hospital in the Home Outreach Services 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 - Ballarat Health Services

 

This item specifies that relevant health services provided to patients by, or on behalf of, Ballarat Health Services in Victoria as part of Ballarat Health Services 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 6 - St Frances Xavier Cabrini Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, St Frances Xavier Cabrini Hospital in Victoria as part of Cabrini Health 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.

 

 

This determination commences on 1 October 2005 and remains in force until and including 30 September 2006.  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

September 2005

Overview

The National Health Act 1953, enacted by the Australian Parliament, provides a framework for the delivery of health services in Australia. This Act was amended in 2001 to introduce provisions relating to outreach services, aiming to allow health funds to pay benefits for services that serve as a direct substitute for hospital treatment, such as hospital in the home. The 2005 determination under subsection 5D(1) of the Act, issued by the Minister for Health and Ageing, specifies services provided by certain hospitals that qualify as outreach services. This allows these services to be deemed hospital treatment, thereby enabling health funds to pay benefits for these services under applicable benefits arrangements. The policy objective behind this determination is to ensure that patients can receive suitable quality care in their own homes as an alternative to traditional hospital treatment.

Scope and Application

The National Health Act 1953, through the Determination pursuant to Subsection 5D(1) (PSO 10/2005), specifies particular outreach services provided by designated hospitals and day hospital facilities that are deemed to be hospital treatment for the purposes of the Act. This determination applies to specified hospitals in Victoria, including Knox Private Hospital, St Vincents and Mercy Private Hospital, Ballarat Health Services, and St Frances Xavier Cabrini Hospital, and pertains to services such as hospital-in-the-home and maternity outreach services. These services, when provided in the patients' own homes, are considered outreach services and are eligible for benefits under applicable benefits arrangements. The determination process involves an application by the hospital to the Department of Health and Ageing, which is assessed by a Working Party comprising representatives from various health-related associations and consumer groups. The Minister, taking into account the Working Party's recommendation, decides whether to make a determination, ensuring the services meet specified clinical standards and patient outcome criteria. This determination is effective from 1 October 2005 to 30 September 2006.

Key Provisions

The key provisions of the F2005L02974 Determination under the National Health Act 1953, as outlined in the explanatory statement, focus on defining certain services provided by specified hospitals or day hospital facilities as outreach services (subsection 5D(1)). These services, once determined as outreach, are then deemed to be hospital treatment (section 5C) and health funds are permitted to pay benefits for these services under applicable benefits arrangements (hospital cover policies). The services specified in this Determination are provided by Knox Private Hospital, St Vincents and Mercy Private Hospital, Ballarat Health Services, and St Frances Xavier Cabrini Hospital, all located in Victoria. Each of these hospitals provides home-based treatment services that include nursing care, medical practitioner treatment, or allied health services. The services provided by these hospitals are intended to be direct substitutes for hospital treatment that would otherwise be provided in a hospital or day hospital facility. The Act imposes specific obligations on the hospitals listed in the Determination to ensure that the services they provide meet the criteria set out in the guidelines. These guidelines, considered by the Private Sector Outreach Services Working Party, include criteria about clinical standards and patient outcomes. The Working Party, composed of representatives from various healthcare associations and consumer groups, assesses each application for a service to be determined as an outreach service. Their recommendation, along with other considerations, informs the Minister's decision on whether to make the determination under subsection 5D(1). This process ensures that only services of suitable quality are recognised as outreach services. In terms of compliance and enforcement, while the Determination itself does not explicitly state penalties for non-compliance, breaches of the National Health Act 1953 can lead to various civil and criminal consequences. Under the Act, breaches can result in fines and, in more severe cases, criminal charges. For instance, providing services that do not meet the specified criteria could potentially lead to the hospital being deemed non-compliant, with possible repercussions including financial penalties or legal action. The specific penalties, however, would be determined in the context of the broader Act and any related regulations or subsequent legislation.

Legal classification tags

Area of Law
Health Law
Instrument
Determination
Concepts
Definitions & Interpretation
Licensing & Registration
Compliance Obligations
Consultation Requirements

Interactions

Authorises

All Versions

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.