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
Overview
The National Health Act 1953, enacted by the Parliament of Australia, provides a legislative framework for the administration of health services and benefits. This Act was amended by the Health Legislation Amendment Act (No. 1) 2001 to introduce provisions relating to outreach services, aiming to enable health funds to pay benefits for services provided to patients as a direct substitute for hospital treatment, such as hospital in the home. The 2006 Determination under Subsection 5D(1) of the National Health Act 1953, issued by the Minister for Health and Ageing, specifies services provided by, or on behalf of, certain hospitals, including Freemasons Hospital, for the purposes of the definition of outreach service. The 2006 amendment to this Determination corrects a naming anomaly by updating the name of Freemasons Hospital to Epworth Freemasons following its acquisition by the Epworth Group, ensuring that the approved outreach services are accurately identified and continue to operate under the same provider number. This amendment serves to rectify an oversight in the previous determination and does not substantially alter the existing arrangements for outreach services.
Scope and Application
The National Health Act 1953, through its Subsection 5D(1), allows the Minister to specify services provided by or on behalf of a specified hospital or day hospital facility, which are defined as outreach services. This provision ensures that such services are deemed to be hospital treatment, thereby permitting health funds to pay benefits for these services under applicable benefits arrangements. The services must be provided as a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility. The legislation applies to entities such as hospitals and day hospitals that offer specified outreach services, ensuring they are recognised and reimbursed appropriately. Geographically, the Act operates under the Commonwealth jurisdiction, impacting health funds and hospitals across Australia. This Determination, PSO 5/2006, amends the previous PSO 4/2006 by correcting a naming discrepancy following the acquisition of Freemasons Hospital by the Epworth Group, which now operates as Epworth Freemasons. The change is administrative and does not affect the operational guidelines or benefits arrangements for these services.
Key Provisions
The key operative sections of the Determination (PSO 5/2006) under the National Health Act 1953 (the Act) are specified in section 5D(1) of the Act. This section allows the Minister to specify, through a written determination, the services provided by, or on behalf of, a particular hospital or day hospital facility to be considered as an outreach service. Once a service is determined to be an outreach service, it is deemed to be hospital treatment (section 5C of the Act). This allows health funds to pay benefits for these services under applicable benefits arrangements (hospital cover policies) if they are provided as a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility. The Determination amends the previous schedule by substituting the name of the hospital, reflecting its change from Freemasons Hospital to Epworth Freemasons following its acquisition by the Epworth Group.
The Determination imposes obligations on the specified entities, namely Freemasons Hospital (now Epworth Freemasons), Royal Rehabilitation Centre Sydney, Bairnsdale Regional Health Service, and Waverley Private Hospital. These entities must provide the outreach services as defined in the Determination and ensure they meet the guidelines set by the Private Sector Outreach Services Working Party. The Working Party assesses these services to determine if they should be reapproved, and their recommendations are pivotal in the Minister's decision-making process. The entities are also required to notify the Minister of any changes, such as mergers or name changes, to ensure the accuracy and effectiveness of the Determination.
Failure to comply with the requirements set out in the Determination could lead to various consequences. While the Determination itself does not specify penalties for non-compliance, breaches of the National Health Act 1953 can lead to both civil and criminal penalties. Under the Act, unauthorised provision of services that are deemed to be hospital treatment can result in fines, imprisonment, or both. The exact penalties depend on the nature and severity of the breach, as outlined in other provisions of the Act. Additionally, health funds that fail to adhere to the stipulated benefits arrangements may face regulatory action and financial penalties.
The Determination ensures that the outreach services provided by the specified hospitals are accurately reflected and operationally efficient. By correcting the anomaly of having an approved hospital wrongly named in the previous determination, the updated schedule maintains clarity and compliance with the Act. This amendment, being of a machinery nature, ensures that the services continue to be recognised and appropriately remunerated by health funds, without substantially altering existing arrangements. The Determination and its accompanying explanatory statement have been lodged for registration on the Federal Register of Legislative Instruments, ensuring transparency and legal validity.