EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under Subsection 5D(1)
(PSO 5 /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.
The current Determination dated 23 June 2006 (PSO 4/2006) is comprised of one schedule and specifies outreach services to be provided by, or on behalf of, Freemasons Hospital, Royal Rehabilitation Centre Sydney, Bairnsdale Regional Health Service and Waverley Private Hospital.
This Determination amends the Determination PSO 4/2006 dated 23 June 2006 by omitting the Schedule and substituting a new Schedule (PSO 5/2006). The new Schedule amends Item 2 by OMITTING “2.Relevant health services provided to a patient as part of Freemasons Hospital/Hospital in the Hotel by, or on behalf of, Freemasons Hospital, East Melbourne, Victoria. Freemasons Hospital/Hospital in the Hotel provides obstetric treatment to patients in their homes.” and SUBSTITUTING “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.”
The outreach program provided by Freemasons Hospital was recently assessed by the Private Sector Outreach Services Working Party for the purposes of whether it should be reapproved. It is an existing program that was required to reapply as its existing approval was due to expire. It was assessed by the Working Group (who assesses all outreach applications and makes a recommendation to the Delegate for approval if they are satisfied that facilities have met the guidelines) as meeting the guidelines and was recommended to the Delegate for reapproval. Subsequent to the Working Party’s consideration of the renewal application, the Department of Health and Ageing was advised that the hospital was purchased by the Epworth Group and changed its name to Epworth Freemasons. The existing program continues to operate.
This change is necessary to remove the anomaly of having an approved hospital wrongly named in a determination. Freemasons Hospital changed its name from Freemasons Hospital to Epworth Freemasons following its purchase by the Epworth Group. Epworth Freemasons continues operating under the same hospital provider number, that is, 0035290W. The change of name was omitted from the determination that became PSO4/2006.
This amendment to THE DETERMINATION (PSO 4/2006) is of a machinery nature and does not substantially alter existing arrangements.
The Determination was made on 14 August 2006 and takes effect FROM THE DAY AFTER THE DATE OF REGISTRATION OF THIS DETERMINATION. The Determination and this explanatory statement have been lodged for registration on the Federal Register of Legislative Instruments.
ACUTE CARE STRATEGIES BRANCH
DEPARTMENT OF HEALTH AND AGEING
AUGUST 2006