National Health Act 1953 - Determination pursuant to subsection 5D(1) (PSO 7/2005)

Administered by Department of Health, Disability and Ageing

Legislation au F2005L01874 Not in force Legislative Instrument

Legislation content

 

 

EXPLANATORY STATEMENT

 

Issued by Authority of the Minister for Health and Ageing

 

National Health Act 1953

 

Determination pursuant to Subsection 5D(1)

 

(PSO 7 / 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 outreach services to be provided by, or on behalf of The Palm Beach Currumbin Clinic, Pine Rivers Private Hospital, St John of God Health Care Inc., Allamanda Private Hospital, Freemasons Hospital, Port Pirie Regional Health Service, The Northern Hospital, Broadmeadows Health Service, Bundoora Extended Care Centre and Home Nurses Infusion Centre.

 

 

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 – 9   -  Specified services and hospitals

 

Item 2  -  The Palm Beach Currumbin Clinic and Pine Rivers Private Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of,

The Palm Beach Currumbin Clinic or Pine Rivers Private Hospital  in Queensland as part of The Palm Beach Currumbin Clinic 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 3  -  St John of God Health Care Inc

 

This item specifies that relevant health services provided to patients by, or on behalf of, St John of God Health Care Inc in Western Australia as part of St John of God Health Care (SJGHC) Bunbury 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 - Allamanda Private Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, Allamanda Private Hospital in Queensland as part of Allamanda Outreach Services 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 5 - Freemasons Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, Freemasons Hospital in Victoria as part of Freemasons Hospital/Hospital in the Hotel 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 6 - Port Pirie Regional Health Service

 

This item specifies that relevant health services provided to patients by, or on behalf of, Port Pirie Regional Health Service in South Australia as part of Port Pirie Regional Health Service/Hospital in the Home (HITH) 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 - The Northern Hospital, Broadmeadows Health Service and Bundoor Extended Care Centre

 

This item specifies that relevant health services provided to patients by, or on behalf of, The Northern Hospital, Broadmeadows Health Service or Bundoora Extended Care Centre in Victoria as part of Northern Health Outreach Services 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 - Home Nurses Infusion Centre

 

This item specifies that relevant health services provided to patients by, or on behalf of, Home Nurses Infusion Centre in South Australia as part of Home Nurses 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.

 

 

This determination commences on 1 July 2005 and remains in force until and including 30 June 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

June 2005

 

Overview

The National Health Act 1953, amended by the Health Legislation Amendment Act (No. 1) 2001, introduced provisions for the specification of outreach services to allow health funds to pay benefits for services provided as a direct substitute for hospital treatment, such as hospital in the home. This legislation was enacted by the Australian Parliament to address the gap in health fund benefits for such services, previously requiring regulation modifications under subsection 140(2) of the Act. Pursuant to subsection 5D(1) of the Act, the Minister for Health and Ageing can specify these services through a written determination, facilitating the payment of benefits under applicable benefits arrangements. The policy objective is to ensure that patients receive quality healthcare services in their own homes, thereby enhancing access to care. The process involves applications from facilities to the Department of Health and Ageing, assessed by the Private Sector Outreach Services Working Party against criteria for clinical standards and patient outcomes, with recommendations leading to ministerial decisions.

Scope and Application

The National Health Act 1953, through its Subsection 5D(1) and the Health Legislation Amendment Act (No. 1) 2001, provides a framework for the Minister to specify services provided by certain hospitals or day hospital facilities as outreach services, which are deemed to be hospital treatment. These outreach services, which include treatments such as nursing care, medical treatment, or allied health services provided to patients in their own homes, are intended to substitute for traditional hospital treatment. The specified services are provided by or on behalf of The Palm Beach Currumbin Clinic, Pine Rivers Private Hospital, St John of God Health Care Inc., Allamanda Private Hospital, Freemasons Hospital, Port Pirie Regional Health Service, The Northern Hospital, Broadmeadows Health Service, Bundoora Extended Care Centre, and Home Nurses Infusion Centre across various states in Australia. This determination, which applies from 1 July 2005 to 30 June 2006, allows health funds to pay benefits for these services under applicable benefits arrangements, provided they meet the specified clinical standards and patient outcomes as assessed by the Private Sector Outreach Services Working Party. The Working Party, comprising representatives from relevant health associations and consumer groups, reviews each application against established guidelines before recommending to the Minister whether the services should be approved. The Minister, or their delegate, then decides whether to make a determination based on this recommendation.

Key Provisions

The main operative sections of the Determination pursuant to Subsection 5D(1) of the National Health Act 1953 (the Act) are those that specify the services provided by, or on behalf of, certain hospitals or day hospital facilities as outreach services (sections 2 to 8). These services, which are defined in the Schedule, are deemed to be hospital treatment under section 5C of the Act, thus enabling 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. The Determination applies to services provided by The Palm Beach Currumbin Clinic, Pine Rivers Private Hospital, St John of God Health Care Inc., Allamanda Private Hospital, Freemasons Hospital, Port Pirie Regional Health Service, The Northern Hospital, Broadmeadows Health Service, Bundoora Extended Care Centre, and Home Nurses Infusion Centre. The Act imposes obligations on the specified facilities to ensure that the services they provide meet the criteria set out in the guidelines for clinical standards and patient outcomes. The Private Sector Outreach Services Working Party assesses each application against these guidelines and recommends to the Minister whether the services meet the required standards. The Minister, or their delegate, then decides whether to make a determination under subsection 5D(1) of the Act based on this recommendation. Failure to comply with the requirements of the Act, including providing services that do not meet the specified criteria, may result in consequences such as the services not being recognised as outreach services and, consequently, not being eligible for benefits payments from health funds. There are no specific penalties outlined in the Determination for non-compliance with the Act, but breaches could lead to the denial of benefits payments for the services in question. The Determination itself remains in force until 30 June 2006 and has been lodged for registration on the Federal Register of Legislative Instruments.

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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.