EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under Schedule 1, paragraph (1)(bj)
(HIB 20/2006)
Schedule 1, paragraph (1)(bj) of the National Health Act 1953 (the Act) provides that the Minister may determine the minimum levels of benefits payable by a registered health benefits organization (RHBO) for hospital treatment provided to contributors, other than in emergencies, in a hospital or day hospital facility with which the RHBO does not have a hospital purchaser-provider agreement (HPPA) which covers such treatment. These benefits are known in the industry as “default benefits”.
Rather than registering the principal determination and registering all subsequent amendments to the principal determination on the Federal Register of Legislative Instruments as required under the Legislative Instruments Act 2003, I have pursued the alternative option allowed under the Legislative Instruments Act 2003 of repealing and remaking the determination in a consolidated form.
This determination is comprised of seven schedules setting out the minimum levels of benefit which are payable for a range of hospital treatment. Namely, benefits for overnight accommodation (Schedules 1 and 2), same day accommodation (Schedule 3), nursing home type patients (Schedule 4), second tier default benefits (Schedule 5), care plans and case conferencing (Schedule 6) and outreach services (Schedule 7).
The determination HIB 18/2006 has been repealed and revoked by this determination to incorporate amendments made to Schedules 4 and 5.
Amendments to Schedule 4
Schedule 4 of this determination sets out the default benefits that are payable per night for patients that are classified as Nursing Home Type Patients (NHTPs) in recognized hospitals in particular States and Territories and private hospitals in all States and Territories.
This Determination adjusts the default benefit payable to NHTPs in recognised hospitals within Victoria to take into account the recent change to the amount of the patient contribution.
This determination does not change the default benefit payable to NHTP’s in private hospitals in all States/Territories and in recognized hospitals in Western Australia, Australian Capital Territory, Tasmania, Queensland, South Australia, New South Wales or the Northern Territory.
Amendments to Schedule 5
Schedule 5 of this determination requires a RHBO to pay second tier default benefits for most episodes of hospital treatment provided in private hospitals and private day hospital facilities that are specified in Schedule 5 with which the RHBO does not have a HPPA. Schedule 5 sets a higher minimum level of benefit (for overnight treatment and day only treatment provided in specified facilities) than the minimum benefit set for such treatment by Schedules 1, 2, 3 and 7 of this determination.
Changes to Facilities Specified as Eligible for Second Tier Default Benefits
This determination includes 22 new facilities recommended to and approved by the delegate of the Minister for Health and Ageing by the Second Tier Advisory Committee to be entitled to second tier default benefits. The new facilities are:
List facilities
1 Buderim Gastroenterology Centre
2 Cabrini Brighton
3 Saint Frances Xavier Cabrini Hospital (Malvern)
4 Saint Frances Xavier Cabrini Hospital (Prahran)
5 Calvary Health Care ACT
6 Calvary Health Care Sydney – Hurstville Community
7 Canada Bay Private Hospital;
8 Caringbah Day Surgery
9 Hervey Bay Surgical Centre
10 Inner West Endoscopy Centre
11 Melbourne Oral & Facial Surgery
12 Murdoch Surgicentre
13 South Perth Hospital
14 South Western Day Surgery Centre
15 Sydney Retina Clinic & Day Surgery
16 Terrace West Endoscopy Centre
17 The Eye Institute
18 Dalcross Private Hospital
19 Healthwoods Specialist Centre
20 The CAPS Clinic
21 Mater Misericordiae Private Hospital
22 St John of God Health Care (Ballarat)
Consultation
The amendments made to Schedule 4 relate to default benefits for NHTPs in recognized hospitals in Victoria. The increase to the default benefits for recognized hospitals were made with the agreement of the Victorian Department of Human Services.
Consultation for changes to Schedule 5 occurred with industry through the Second Tier Advisory Committee, which includes equal representation from both the private hospital and health insurance fund sectors.
This determination commences on 20 September 2006. This determination and this explanatory statement have been lodged for registration on the Federal Register of Legislative Instruments.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
SEPTEMBER 2006