National Health Act 1953 - Determination pursuant to subsection 5D(1) (PSO 2/2006)

Administered by Department of Health, Disability and Ageing

Legislation au F2006L01282 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 2 / 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, Albury Wodonga Private Hospital, Bethesda Hospital, Mayo Private Hospital and Monash Medical Centre – Clayton Campus.

 

 

 

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  - Albury Wodonga Private Hospital – Beltana Home Nursing Service Outreach

 

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

Albury Wodonga Private Hospital in New South Wales as part of Albury Wodonga Private Hospital – Beltana Home Nursing Service Outreach 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  -   Albury Wodonga Private Hospital- Karinya Centre Outreach Service

 

This item specifies that relevant health services provided to patients by, or on behalf of, Albury Wodonga Private Hospital in New South Wales as part of Albury Wodonga Private Hospital – Karinya Centre Outreach Service 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 4 -  Bethesda Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, Bethesda Hospital in Western Australia as part of Bethesda 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.

 

Item 5 – 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 Mental Healthcare Outreach Program 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 – Monash Medical Centre – Clayton Campus – Care Link Nursing Services for Paediatric Patients

 

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 – Care Link Nursing Services for Paediatric Patients 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 2007.  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, amended by the Health Legislation Amendment Act (No. 1) 2001, introduced provisions for outreach services, allowing health funds to pay benefits for services provided as direct substitutes for hospital treatment. This was enacted to expand the scope of services that could be reimbursed under applicable benefits arrangements without needing regulatory changes. Pursuant to subsection 5D(1) of the Act, the Minister for Health and Ageing has the authority to specify services provided by certain hospitals or day hospital facilities as outreach services, effectively deeming them hospital treatment and enabling health funds to pay benefits for these services. The policy objective is to improve patient access to healthcare services by facilitating treatment in non-hospital settings, subject to clinical standards and patient outcome criteria. Applications for such determinations are assessed by the Private Sector Outreach Services Working Party, which includes representatives from various health sectors, and recommendations are made to the Minister for final determination. The determination issued under subsection 5D(1) of the National Health Act 1953 specifies outreach services provided by Albury Wodonga Private Hospital, Bethesda Hospital, Mayo Private Hospital, and Monash Medical Centre – Clayton Campus. These services involve the provision of nursing care, medical treatment, or allied health services to patients in their homes, intended as substitutes for hospital treatment. The determination, which was issued by the Department of Health and Ageing, was made to ensure that these specified outreach services meet the required clinical standards and patient outcomes, and it remains in force until 30 April 2007. The assessment and recommendation process involves the Private Sector Outreach Services Working Party, which considers each application against established guidelines.

Scope and Application

The National Health Act 1953, through its Determination pursuant to Subsection 5D(1) (PSO 2/2006), specifies certain services provided by or on behalf of particular hospitals or day hospital facilities as outreach services. This determination, made by the Minister for Health and Ageing, identifies the services that qualify as outreach services under the Act and are deemed hospital treatment, thereby allowing health funds to pay benefits for these services under applicable benefits arrangements. The outreach services identified are those provided by Albury Wodonga Private Hospital, Bethesda Hospital, Mayo Private Hospital, and Monash Medical Centre – Clayton Campus. These services include various forms of treatment such as nursing care, medical treatment, and allied health services delivered in patients' own homes. The determination applies to these specified hospitals, with each hospital offering specific outreach services such as home nursing and psychiatric treatment. The application for such a determination is made by the facility to the Department of Health and Ageing and is assessed by the Private Sector Outreach Services Working Party, which comprises representatives from various healthcare associations and consumer groups. The Working Party recommends to the Minister whether the services meet the required clinical standards and patient outcomes, and the Minister then decides whether to make the determination. This determination is in effect from 1 May 2006 to 30 April 2007 and is registered on the Federal Register of Legislative Instruments.

Key Provisions

The main operative sections of this determination (F2006L01282) under the National Health Act 1953 (the Act) are subsection 5D(1) and section 5C. Subsection 5D(1) allows the Minister to specify, in writing, which services provided by, or on behalf of, particular hospitals or day hospitals are considered outreach services for the purposes of defining hospital treatment under the Act. Section 5C then deems these specified outreach services as hospital treatment, thereby enabling health funds to pay benefits for these services under applicable benefits arrangements. This determination specifically applies to services provided by Albury Wodonga Private Hospital, Bethesda Hospital, Mayo Private Hospital, and Monash Medical Centre – Clayton Campus, each of which offers various outreach services to patients in their homes. The obligations imposed by this determination on the specified hospitals and day hospitals include ensuring that the outreach services they provide meet the criteria set out in the guidelines. These guidelines, which the Private Sector Outreach Services Working Party uses to assess the quality of the services, are based on clinical standards and patient outcomes. The hospitals must therefore maintain the requisite standards of care and ensure that their outreach services are of a suitable quality to meet these criteria. Additionally, the hospitals must adhere to any further requirements or conditions that may be stipulated by the Minister or the Working Party. Failure to comply with the conditions set out in this determination could lead to civil or criminal consequences. While the Act does not explicitly state the penalties for breach, non-compliance with legislative requirements can typically lead to fines, legal action, or other administrative sanctions. Such penalties are intended to ensure that the hospitals maintain the required standards of care and that the benefits arrangements remain valid and effective. The Working Party's recommendations and the Minister's decision are pivotal in determining whether the services provided meet the necessary standards, thereby influencing the hospitals' compliance with the Act.

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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.