National Health Act 1953 - Determination pursuant to subsection 5D(1) (PSO 4/2006)

Administered by Department of Health, Disability and Ageing

Legislation au F2006L01989 Not in force Legislative Instrument

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AUSTRALIAN GOVERNMENT

 

 

 

NATIONAL HEALTH ACT 1953

 

 

DETERMINATION PURSUANT TO SUBSECTION 5D(1)

 

 

This compilation was prepared on 12 April 2007 by the Department of Health and Ageing.

 

It is a compilation of the determinations made under subsection 5D(1) of the National Health Act 1953 (the Act) specifying services provided by, or on behalf of, hospitals and day hospital facilities for the purposes of the definition of outreach services in subsection 4(1) of the Act.

 

It comprises determination PSO 4/2006 made on 23 June 2006, with effect from 1 July 2006, as amended by determination PSO 5/2006, made on 14 August 2006, with effect from 19 August 2006.

 

 

I, DAMIAN COBURN, delegate of the Minister for Health and Ageing, acting pursuant to subsection 5D(1) of the National Health Act 1953 (the Act) hereby specify the services set out in the Schedule to this Determination provided by, or on behalf of, the hospitals and day hospital facilities specified in the Schedule to this Determination for the purposes of the definition of outreach services in subsection 4(1) of the Act.

 

This Determination shall come into force on 1 July 2006 and shall remain in force until, and including, 30 June 2007.

 

 

 


SCHEDULE

 

Specified services provided by, or on behalf of, specified hospitals or day hospital facilities

 

 

Definitions

 

  1. In this Schedule:

(a)            "relevant health services" means all medical, surgical, diagnostic, nursing, dental, chiropody, chiropractic, eye therapy, occupational therapy, physiotherapy, speech therapy or similar services or treatment that are not professional services; and

(b)           "professional service" has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

 

 

 

Specified services and hospitals

 

2.      Relevant health services provided to a patient as part of Epworth Freemasons /Hospital in the Hotel by, or on behalf of, Epworth Freemasons, East Melbourne, Victoria.

 

 Epworth Freemasons /Hospital in the Hotel provides obstetric treatment to patients in their homes.

 

3.      Relevant health services provided to a patient as part of Royal Rehabilitation HomeReach by, or on behalf of, Royal Rehabilitation Centre Sydney, Ryde, New South Wales.

 

 Royal Rehabilitation HomeReach provides treatment to patients in their homes.

 

4.      Relevant health services provided to a patient as part of Bairnsdale Regional Health Outreach Program by, or on behalf of, Bairnsdale Regional Health Service, Bairnsdale, Victoria. 

 

 Bairnsdale Regional Health Outreach Program provides treatment to patients in their homes.

 

5.      Relevant health services provided to a patient as part of Parenting Program at the Novotel by, or on behalf of, Waverley Private Hospital, Mt Waverley, Victoria.

 

 Parenting Program at the Novotel provides obstetric treatment to patients in their homes. 

 

 

 

Notes

 

Note 1: Health funds can pay benefits under an applicable benefits arrangement (sometimes referred to as a “hospital cover policy”) for any service specified in this Determination if, and only if, the service is provided to a patient as a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility (see the definition of "outreach service" in subsection 4(1) of the National Health Act 1953 (the Act) as well as sections 5A, 5C and 5D of the Act).

 

Note 2: Health funds can also pay benefits for professional services that are rendered to a patient by a medical practitioner while the services specified in this Determination are being provided, so long as those services are being provided as a direct substitute for treatment that would ordinarily be provided in a hospital or day hospital facility. Under section 5C of the Act outreach services (defined in subsection 4(1) of the Act) are deemed to be a form of "hospital treatment". Under section 5A of the Act health funds can provide benefits under an applicable benefits arrangement for hospital treatment and any professional services rendered to a patient by a medical practitioner while the hospital treatment is being provided. The Determination in effect allows health funds to provide benefits under an applicable benefits arrangement for those out-of-hospital professional services that are provided while services that are specified in this Determination are being provided as a direct substitute for treatment that would ordinarily be provided in a hospital or day hospital facility. However, the Determination does not permit health funds to provide benefits for professional services provided out-of-hospital in any other situation.

 

 

 

 


Notes to the National Health Act 1953 Determination pursuant to subsection 5D(1)

 

Note 1

The National Health Act 1953 Determination pursuant to subsection 5D(1) as set out in the principal determination (in force under subsection 5D(1) of the National Health Act 1953) as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Title

Date of registration in the Federal Register of Legislatvie Instruments

Date of
commencement

Application, saving or
transitional provisions

National Health Act 1953 Determination pursuant to subsection 5D(1) (PSO 4/2006)

27 June 2006

1 July 2006

 

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

18 August 2006

19 August 2006

 

 

Table of Amendments

ad. = added or inserted      am. = amended      rep. = repealed      rs. = repealed and substituted

Provision affected

How affected

Section 2

rs 2006 PSO 5/2006

 

Overview

The National Health Act 1953 was enacted by the Parliament of Australia to establish a national scheme of health insurance and to regulate the provision of health services. This legislation aims to ensure that health services are accessible, affordable, and of high quality for all Australians. The Act was introduced to address the need for a coordinated approach to health care funding and delivery across the country. The 2006 Determination under subsection 5D(1) of the Act was made by Damian Coburn, acting as a delegate of the Minister for Health and Ageing, to specify certain services provided by, or on behalf of, hospitals and day hospital facilities for the purposes of the definition of outreach services. This Determination ensures that health funds can provide benefits for specified services delivered outside of traditional hospital settings, provided they are a direct substitute for hospital treatment, thereby promoting flexibility and accessibility in health service delivery. The policy objective is to enhance patient care by allowing certain medical services to be provided in community settings, thereby reducing the burden on hospital resources and improving patient convenience.

Scope and Application

The National Health Act 1953 Determination pursuant to subsection 5D(1) applies to specified services provided by, or on behalf of, certain hospitals and day hospital facilities across Australia. This legislative instrument is particularly relevant to health funds and patients, as it specifies services that can be covered under hospital cover policies, provided these services act as a direct substitute for treatment that would otherwise be provided in a hospital or day hospital facility. The specified services include a range of relevant health services such as medical, surgical, diagnostic, and therapeutic treatments, excluding professional services as defined in the Health Insurance Act 1973. The determination came into effect on 1 July 2006 and was subsequently amended by PSO 5/2006, effective from 19 August 2006. The geographic reach of this determination is national, applying to all states and territories in Australia, although specific services are provided by hospitals and facilities located in East Melbourne, Ryde, Bairnsdale, and Mt Waverley. The determination does not include professional services provided out-of-hospital in any other situation, thereby restricting its application to the specified outreach services.

Key Provisions

The National Health Act 1953 Determination pursuant to subsection 5D(1), compiled on 12 April 2007, specifies the services provided by, or on behalf of, hospitals and day hospital facilities that qualify as outreach services. This Determination, effective from 1 July 2006, identifies specific services provided in patients' homes by selected hospitals and day hospitals. It includes services such as obstetric treatment and other relevant health services, excluding professional services (section 2). Health funds are permitted to cover these services under applicable benefits arrangements if they are provided as direct substitutes for hospital treatment (subsection 5C). The Act imposes obligations on the specified hospitals and day hospitals to provide the designated outreach services in accordance with the criteria outlined. These services must be rendered to patients in their homes and must be a direct substitute for hospital treatment. Furthermore, health funds must adhere to the conditions set out in the Determination to be eligible to provide benefits for these services. Failure to comply with these obligations may result in the services not being recognised as outreach services for the purposes of health fund coverage. There are no explicit offences, penalties, or civil or criminal consequences mentioned in the Determination for breach of its provisions. However, non-compliance with the conditions set out may result in health funds not being able to provide benefits for the specified services. The primary consequence of non-compliance would be the financial impact on patients who may not receive the intended benefits from their health funds for services not recognised as outreach services under the Determination.

Legal classification tags

Area of Law
Health Law
Instrument
Legislative Instrument
Concepts
Definitions & Interpretation
Reporting & Disclosure Obligations
Outreach Services

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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.