EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination pursuant to Subsection 5D(1)
(PSO 8 / 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 Sydney Clinic and Bendigo Health Care Group.
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 2-3 - Specified services and hospitals
Item 2 - The Sydney Clinic
This item specifies that relevant health services provided to patients by, or on behalf of,
The Sydney Clinic in New South Wales as part of The Sydney 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 - Bendigo Health Care Group
This item specifies that relevant health services provided to patients by, or on behalf of, Bendigo Health Care Group in Victoria as part of Bendigo Health Care Group 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.
This determination commences on 1 October 2005 and remains in force until and including 30 September 2008. 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 2005
Overview
The National Health Act 1953, as amended by the Health Legislation Amendment Act (No. 1) 2001, was enacted to address the gap in health fund benefits for services that serve as a direct substitute for hospital treatment, such as hospital in the home. The Act allows the Minister for Health and Ageing to specify services provided by, or on behalf of, a hospital or day hospital facility as outreach services, thereby deeming them to be hospital treatment and enabling health funds to pay benefits for these services under applicable arrangements. This legislative framework was designed to improve access to healthcare by allowing patients to receive treatment in their own homes, while ensuring that the services provided meet certain clinical standards and patient outcomes. The determination process involves an application to the Department of Health and Ageing, assessment by the Private Sector Outreach Services Working Party, and final decision by the Minister, all aimed at maintaining the quality and integrity of the outreach services.
This specific determination, issued under subsection 5D(1) of the National Health Act 1953, identifies outreach services provided by The Sydney Clinic in New South Wales and Bendigo Health Care Group in Victoria as qualifying services, effective from 1 October 2005 until 30 September 2008. This determination ensures these services meet the criteria set forth in the guidelines, facilitating appropriate benefits for patients receiving treatment in their homes. The determination and accompanying explanatory statement have been lodged for registration on the Federal Register of Legislative Instruments, ensuring transparency and legal formality in the process.
Scope and Application
The National Health Act 1953, through its Subsection 5D(1), allows the Minister for Health and Ageing to specify certain services provided by or on behalf of specified hospitals or day hospitals as outreach services, thereby deeming them as hospital treatment for the purposes of health fund benefits. This particular determination pertains to services offered by The Sydney Clinic in New South Wales and Bendigo Health Care Group in Victoria. These services, which include nursing care, medical treatment, and allied health services provided in patients' homes, are recognised as outreach services under the Act. The determination facilitates health funds to pay benefits for these services, provided they serve as direct substitutes for in-hospital treatment. The application process for such a determination involves the Private Sector Outreach Services Working Party, which assesses applications against clinical and patient outcome criteria before recommending to the Minister. This determination is effective from 1 October 2005 until 30 September 2008, and the determination and explanatory statement have been registered on the Federal Register of Legislative Instruments.
Key Provisions
The National Health Act 1953 (the Act) includes provisions that allow the Minister to determine certain services provided by specified hospitals or day hospital facilities as outreach services, which are then deemed to be hospital treatment. This determination, made under subsection 5D(1) of the Act, specifies that particular services provided by The Sydney Clinic in New South Wales and Bendigo Health Care Group in Victoria qualify as outreach services. Outreach services, as outlined in this determination, involve the provision of treatment, including nursing care, medical treatment, or allied health services, to patients in their own homes (section 5C of the Act).
Under the Act, entities like The Sydney Clinic and Bendigo Health Care Group must meet specific criteria to have their services recognised as outreach services. This involves an application process where the facility seeks a determination from the Department of Health and Ageing. The application is assessed by the Private Sector Outreach Services Working Party, which includes representatives from various health-related associations and consumer groups. The Working Party evaluates the application against established guidelines that focus on clinical standards and patient outcomes. Following the Working Party's recommendation, the Minister (or delegate) decides whether to approve the services as outreach services.
Failure to comply with the provisions of the Act and this determination can lead to serious consequences. Although the explanatory statement does not detail specific offences or penalties, breaches of the Act can generally result in civil or criminal penalties, including fines and other sanctions. These penalties are determined by the severity of the breach and are set out in the relevant sections of the Act. It is essential for the facilities to adhere to the outlined guidelines and criteria to avoid any legal repercussions.