EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination pursuant to Subsection 5D(1)
(PSO 6 / 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, St Frances Xavier Cabrini 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.
Item 2 - Specified services and hospitals
Item 2 - St Frances Xavier Cabrini Hospital
This item specifies that relevant health services provided to patients by, or on behalf of, St Frances Xavier Cabrini Hospital in Victoria as part of Cabrini Health Hospital in the Home 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.
This determination commences on 1 October 2006 and remains in force until and including 30 September 2009. 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
September 2006
Overview
The National Health Act 1953 was amended by the Health Legislation Amendment Act (No. 1) 2001 to introduce provisions for outreach services. The purpose of these provisions was to enable health funds to cover services that serve as direct substitutes for hospital treatment, such as hospital in the home, under applicable benefits arrangements. Prior to this amendment, such coverage required regulatory modifications under subsection 140(2) of the Act. The determination under subsection 5D(1) of the National Health Act 1953, issued by the Minister for Health and Ageing in 2006, specifies that certain services provided by St Frances Xavier Cabrini Hospital in Victoria as part of the Cabrini Health Hospital in the Home Service are considered outreach services. This determination facilitates the payment of benefits by health funds for these services, provided they meet the established clinical standards and patient outcomes criteria, thereby ensuring quality care in a home setting.
Scope and Application
The National Health Act 1953, as amended, allows the Minister for Health and Ageing to specify certain services as outreach services provided by a hospital or day hospital facility, thereby deeming them to be hospital treatment and enabling health funds to pay benefits for those services under applicable benefits arrangements. This determination applies specifically to St Frances Xavier Cabrini Hospital in Victoria, recognising its hospital in the home service as an outreach service. This service involves the provision of treatment, including nursing care, medical treatment, and allied health services, to patients in their own homes. The outreach service specified in this determination is applicable from 1 October 2006 until 30 September 2009. Applications for such determinations are assessed by the Private Sector Outreach Services Working Party, which comprises representatives from various health-related associations and forums, ensuring the services meet required clinical standards and patient outcomes before the Minister makes a final decision.
Key Provisions
The main operative sections of this determination, as referenced in subsection 5D(1) of the National Health Act 1953 (the Act), specify that certain services provided by, or on behalf of, St Frances Xavier Cabrini Hospital are deemed to be outreach services (section 5D(1)). These services are outlined in the Schedule to the determination and are specifically related to the Cabrini Health Hospital in the Home Service, which involves the provision of treatment to patients in their own homes, including nursing care, medical treatment, or allied health services (section 4(1)). This deeming of the services as outreach services subsequently qualifies them as hospital treatment under section 5C of the Act, which allows health funds to pay benefits for these services under applicable benefits arrangements, provided they are a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility (section 5C).
The Act imposes specific obligations on the parties involved. St Frances Xavier Cabrini Hospital must ensure that the services provided meet the criteria set out in the guidelines developed by the Private Sector Outreach Services Working Party, which include clinical standards and patient outcomes (subsection 5D(1)). The Working Party, which comprises representatives from various health-related associations and forums, assesses applications for determining outreach services and makes recommendations to the Minister. The Minister, or their delegate, then decides whether to make a determination based on these recommendations and the criteria specified in the guidelines (subsection 5D(1)). This process ensures that the outreach services provided are of suitable quality and meet the standards required under the Act.
There are no direct offences or penalties specified in the Act for breaches related to this determination. However, failure to comply with the criteria and guidelines for outreach services could potentially impact the ability of health funds to pay benefits for these services, as they must be provided as a direct substitute for hospital treatment and meet the standards outlined in the determination. Non-compliance could also result in the services not being deemed as hospital treatment under the Act, which could affect the availability and coverage of these services by health funds (section 5C). The determination itself is in force from 1 October 2006 until 30 September 2009, and any changes or extensions beyond this period would require a new determination by the Minister.