EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination pursuant to Subsection 5D(1)
(PSO 4 / 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 new outreach services to be provided by, or on behalf of, Pinelodge Clinic Private Hospital, Bethesda Hospital, Belmont Private Hospital, The Hobart Clinic, Royal Adelaide Hospital, and Albury Wodonga 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.
Items 2 – 5 – Specified services and hospitals
Item 2 – Pinelodge Clinic Private Hospital
This item specifies that relevant health services provided to patients by, or on behalf of, Pinelodge Clinic Private Hospital in Queensland as part of Pinelodge Clinic Private Hospital Community 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 3 – 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 4 - 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 5 - The Hobart Clinic
This item specifies that relevant health services provided to patients by, or on behalf of, The Hobart Clinic in Tasmania as part of The Hobart Clinic Outreach Services 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.
Item 7 – 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 8 - 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.
This determination commences on 1 May 2005 and remains in force until and including
30 April 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
April 2005