National Health Act 1953 - Determination pursuant to subsection 5D(1) (PSO 11/2005)

Administered by Department of Health, Disability and Ageing

Legislation au F2005L04247 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 11 / 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, New Farm Clinic, Northeast Health Wangaratta, Hornsby Hospital, Royal North Shore Hospital, Ryde Hospital, Mona Vale Hospital, Manly Hospital, St John of God Hospital – Murdoch and St John of God Hospital – Subiaco.

 

 

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  -  New Farm Clinic

 

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

New Farm Clinic in Queensland as part of New Farm Clinic Community 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.

 

Item 3  -  Northeast Health Wangaratta

 

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.

 

Item 4 -  Northern Sydney & Central Coast Health

 

This item specifies that relevant health services provided to patients by, or on behalf of, Hornsby Hospital, Royal North Shore Hospital, Ryde Hospital, Mona Vale Hospital or Manly Hospital in New South Wales as part of Northern Sydney Central Coast Health Acute/Post Acute Care 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 - St John of God Hospital – Murdoch

 

This item specifies that relevant health services provided to patients by, or on behalf of, St John of God Hospital - Murdoch in Western Australia as part of St John of God Health Care – Murdoch 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.

 

 

 

Item 6 - St John of God Hospital – Subiaco

 

This item specifies that relevant health services provided to patients by, or on behalf of, St John of God Hospital - Subiaco in Western Australia as part of St John of God Health Care – Subiaco 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 January 2006 and remains in force until and including 31 December 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

December 2005

Overview

The National Health Act 1953 was enacted to ensure the provision of health services in Australia. The Act was amended in 2001 by the Health Legislation Amendment Act (No. 1) 2001 to allow health funds to pay benefits for services provided as a direct substitute for hospital treatment, such as hospital in the home. To facilitate this, the Minister for Health and Ageing was empowered to specify services provided by, or on behalf of, a specified hospital or day hospital facility as outreach services under subsection 5D(1) of the Act. This Determination pursuant to Subsection 5D(1) (PSO 11 / 2005) was introduced to address the gap in the Act by identifying specific services provided by nine hospitals as outreach services. The determination is made following an application by the facility to the Department of Health and Ageing, which is assessed by the Private Sector Outreach Services Working Party against established guidelines. The Minister then decides whether to make the determination, taking into account the Working Party's recommendation. This determination, which specifies outreach services provided by New Farm Clinic, Northeast Health Wangaratta, Hornsby Hospital, Royal North Shore Hospital, Ryde Hospital, Mona Vale Hospital, Manly Hospital, St John of God Hospital – Murdoch, and St John of God Hospital – Subiaco, aims to ensure that these services are of a suitable quality and meet the necessary clinical standards and patient outcomes. The determination is effective from 1 January 2006 until 31 December 2008.

Scope and Application

The National Health Act 1953, as amended, empowers the Minister for Health and Ageing to specify outreach services provided by or on behalf of certain hospitals or day hospitals through a written determination. This authority is exercised under subsection 5D(1) of the Act, which allows the Minister to determine if a service qualifies as an outreach service, thereby deeming it hospital treatment under section 5C of the Act. Health funds are then enabled to pay benefits for these services and associated professional services under applicable benefits arrangements, provided the services act as a direct substitute for hospital treatment. The specified outreach services for this determination include those provided by New Farm Clinic, Northeast Health Wangaratta, Hornsby Hospital, Royal North Shore Hospital, Ryde Hospital, Mona Vale Hospital, Manly Hospital, St John of God Hospital – Murdoch, and St John of God Hospital – Subiaco. The outreach services involve the provision of treatment, potentially including nursing care, medical treatment, or allied health services, to patients in their own homes. This determination is made after an application process overseen by the Department of Health and Ageing, involving the Private Sector Outreach Services Working Party, which assesses the services against clinical standards and patient outcomes criteria. The determination is valid from 1 January 2006 until 31 December 2008 and has been lodged for registration on the Federal Register of Legislative Instruments.

Key Provisions

The key operative sections of this legislation pertain to the specification of outreach services provided by certain hospitals or day hospitals (subsection 5D(1) of the National Health Act 1953). These services are defined as those provided by or on behalf of specified facilities, such as New Farm Clinic, Northeast Health Wangaratta, Hornsby Hospital, Royal North Shore Hospital, Ryde Hospital, Mona Vale Hospital, Manly Hospital, St John of God Hospital – Murdoch, and St John of God Hospital – Subiaco, for the purposes of being recognised as outreach services (Items 2 to 6 in the Schedule). Once a service is determined to be an outreach service, it is deemed to be hospital treatment under section 5C of the Act. This recognition allows health funds to pay benefits for these services under applicable benefits arrangements, provided they are a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility. The Act imposes specific obligations on the parties involved. Facilities that wish to have their services recognised as outreach services must apply to the Department of Health and Ageing. Each application is assessed by the Private Sector Outreach Services Working Party, which includes representatives from various healthcare associations and consumer forums. This Working Party evaluates the application against criteria related to clinical standards and patient outcomes. The Working Party makes a recommendation to the Minister, who, in turn, decides whether to make a determination based on the recommendation and other relevant considerations. The determination process ensures that the services meet a certain quality threshold before they can be recognised as outreach services. Failure to comply with the requirements of this legislation can result in legal consequences. Although the legislation does not explicitly detail specific offences or penalties, non-compliance with the Act or the determinations made under it could potentially lead to legal actions or administrative penalties. Health funds or facilities that do not adhere to the specified outreach services may face repercussions such as fines, sanctions, or other enforcement actions under the broader framework of the National Health Act 1953 and related regulations. The determination itself specifies that it is in force from 1 January 2006 until 31 December 2008, providing a clear timeframe within which compliance is expected.

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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.