National Health Act 1953 - Determination pursuant to subsection 5D(1) (PSO 7/2006)

Administered by Department of Health, Disability and Ageing

Legislation au F2006L03282 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 / 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, Ballarat Health Services, Knox Private Hospital, St Vincents and Mercy Private Hospital, The Wesley Hospital, Perth Clinic, The Northern Hospital and Ashford 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.

 

Items 2 – 9   -  Specified services and hospitals

 

 

Item 2  - Ballarat Health Services

 

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

Ballarat Health Services in Victoria as part of Ballarat Health Services 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.

 

Item 3  -  Knox Private Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, Knox Private Hospital in Victoria as part of Knox Private 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.

 

Item 4 -  St Vincents and Mercy Private Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, St Vincents and Mercy Private Hospital in Victoria as part of St Vincents and Mercy Private Hospital/Hospital in the Home 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 – St Vincents and Mercy Private Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, St Vincents and Mercy Private Hospital in Victoria as part of St Vincents and Mercy Private Hospital Maternity Outreach Service are outreach services for the purposes of subsection 4(1) of the Act.  This outreach service involves the provision of obstetric 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 – The Wesley Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, The Wesley Hospital in Queensland as part of The Wesley Hospital 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 7 – Perth Clinic

 

This item specifies that relevant health services provided to patients by, or on behalf of, Perth Clinic in Western Australia as part of Perth Clinic Mental Health Assertive Community Treatment Program are outreach services for the purposes of subsection 4(1) of the Act.  This outreach service involves the provision of psychiatric 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 – The Northern Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, The Northern Hospital in Victoria as part of Northern Health Neonatal & Paediatric Private Sector 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 9 – Ashford Hospital

 

This item specifies that relevant health services provided to patients by, or on behalf of, Ashford Hospital in South Australia as part of Ashford Hospital Maternity Hotel Service Program are outreach services for the purposes of subsection 4(1) of the Act.  This outreach service involves the provision of obstetric 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 2007.   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, amended by the Health Legislation Amendment Act (No. 1) 2001, addresses the need to allow health funds to pay benefits for services provided as a direct substitute for hospital treatment, such as hospital in the home, under applicable benefits arrangements. The Act enables the Minister for Health and Ageing to specify services provided by, or on behalf of, a specified hospital or day hospital facility as outreach services, thereby deeming them to be hospital treatment. This allows health funds to compensate for these services under hospital cover policies. The policy objective of this legislation is to provide a framework for the provision of quality healthcare services in settings other than traditional hospitals, thereby enhancing patient access to care. To ensure that these services meet the required clinical standards and patient outcomes, a facility seeking a determination for its outreach services applies to the Department of Health and Ageing, and the application is assessed by a multidisciplinary Working Party before a decision is made by the Minister. This determination, issued under the authority of the Minister for Health and Ageing, specifies outreach services provided by various hospitals and day hospitals, including Ballarat Health Services, Knox Private Hospital, St Vincents and Mercy Private Hospital, The Wesley Hospital, Perth Clinic, The Northern Hospital, and Ashford Hospital. These services involve the provision of various treatments, such as nursing care, medical treatment, or allied health services, to patients in their own homes. The determination outlines the criteria and guidelines used by the Private Sector Outreach Services Working Party to assess the suitability of these services, ensuring they align with the high standards of the National Health Act. This determination is effective from 1 October 2006 to 30 September 2007 and has been lodged for registration on the Federal Register of Legislative Instruments.

Scope and Application

The National Health Act 1953 Determination pursuant to Subsection 5D(1) (PSO 7 / 2006) applies to specified services provided by, or on behalf of, named hospitals and day hospital facilities across various states in Australia, including Ballarat Health Services, Knox Private Hospital, St Vincents and Mercy Private Hospital, The Wesley Hospital, Perth Clinic, The Northern Hospital, and Ashford Hospital. This determination is made under subsection 5D(1) of the National Health Act 1953, which allows the Minister for Health and Ageing to specify services provided by these facilities as outreach services, thereby deeming them as hospital treatment under section 5C of the Act. This legal framework enables health funds to pay benefits for these services, provided they are direct substitutes for hospital treatment that would otherwise be provided in a hospital or day hospital facility. The application for determining a service as an outreach service is assessed by the Private Sector Outreach Services Working Party, which includes representatives from various healthcare associations and consumer health forums. Once the Working Party makes a recommendation, the Minister decides whether to make the determination, ensuring that the services meet the clinical standards and patient outcome criteria outlined in the guidelines. The determination is in force from 1 October 2006 until 30 September 2007 and has been lodged for registration on the Federal Register of Legislative Instruments.

Key Provisions

The key operative sections of this legislation, as outlined in the explanatory statement, are primarily found in subsection 5D(1) of the National Health Act 1953 (subsection 5D(1)). This subsection empowers the Minister to specify, through a written determination, the services provided by or on behalf of specified hospitals or day hospital facilities, thereby classifying them as outreach services. Once a service is designated as an outreach service under this subsection, it is automatically deemed to be hospital treatment (section 5C of the Act). This designation enables health funds to pay benefits for these services and associated professional services under applicable benefits arrangements (hospital cover policies), provided that the services are offered as a direct substitute for hospital treatment that would otherwise be delivered in a hospital or day hospital facility. The obligations imposed by the Act on the parties or entities it governs are primarily centred around the application process for determining outreach services. A facility that wishes a determination to be made regarding an outreach service it provides must submit an application to the Department of Health and Ageing. This application undergoes an initial assessment by the Private Sector Outreach Services Working Party, which comprises representatives from various health-related associations and forums, including the Australian Health Insurance Association and the Royal College of Nursing Australia. The Working Party evaluates each application against guidelines that outline criteria related to clinical standards and patient outcomes, ensuring the quality of the services in question. Based on this assessment, the Working Party recommends whether the services meet the guidelines. The Minister (or delegate) then makes a final decision on whether to issue a determination under subsection 5D(1) of the Act, taking into account the Working Party’s recommendation. There are no explicit offences, penalties, or civil/criminal consequences mentioned for breaches of this legislation within the explanatory statement. However, the failure to adhere to the criteria set out in the guidelines and recommendations by the Working Party could result in the Minister (or delegate) declining to make a determination, thereby not classifying the services as outreach services. Consequently, health funds may not be obligated to pay benefits for these services under hospital cover policies. This indirect consequence underscores the importance of compliance with the established guidelines and the Working Party’s recommendations for facilities seeking to provide 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.