National Health Act 1953 - Determination under subsection 84BA(2) (19/06/2009)

Administered by Department of Health, Disability and Ageing

Legislation au F2009L02492 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

Issued by Authority of the Minister for Health and Ageing

 

National Health Act 1953

Determination under subsection 84BA(2)

 

This determination will commence on 1 July 2009.  This determination is made under subsection 84BA (2) of the National Health Act 1953 (Cth) (the Act). 

 

The Act provides for the supply of drugs and medicinal preparations that are declared to be pharmaceutical benefits under Part VII of the Act.  Division 1A of Part VII of the Act, provides for a “safety net scheme” in relation to pharmaceutical benefits.  The safety net scheme is designed to provide financial protection for those patients and their families who require a large number of pharmaceutical benefits.

 

Subsection 84BA(1) of the Act provides for account to be taken of payments made by a person to a public hospital authority for supplies of out-patient medication, when it is being ascertained, for the purpose of the Part VII of the Act, whether the person is eligible to be issued with a concession card or an entitlement card. 

 

Subsection 84BA (2) of the Act provides that, before the beginning of the relevant entitlement period, the Minister must determine in writing the amounts that, for the purposes of Part VII of the Act, will be taken to have been paid to a public hospital for supplies of out-patient medication made, against payment, by the hospital during the relevant entitlement period. 

 

This determination sets out amounts for the purposes of subsection 84BA (2) of the Act.  The amounts set out in paragraphs 5 and 6 of this determination apply to out-patients at public hospitals throughout Australia, with the exception of public hospitals in Queensland and public hospitals that are participating in arrangements under Pharmaceutical Reform Arrangements within the meaning of the National Healthcare Agreement.  The amounts for out-patients at public hospitals in Queensland and public hospitals participating in arrangements under Pharmaceutical Reform Arrangements within the meaning of the National Healthcare Agreement are determined in accordance with paragraphs 7 and 8 of this determination.

 

The National Healthcare Agreement, to commence on 1 July 2009, will replace the Australian Health Care Agreements made under the Health Care (Appropriation) Act 1998.  Section 6 and 8 of this instrument are updated to reflect this change.

 

The National Healthcare Agreement is a schedule to the Intergovernmental Agreement on Federal Financial Relations (IGA) which took effect on 1 January 2009. This instrument refers to the National Healthcare Agreement as in force on 1 July 2009. The Federal Financial Relations Act 2009, which refers to the IGA, implements the Australian government’s reforms to modernise federal financial relations in accordance with the new financial framework agreed by the Council of Australian Governments (COAG) in the Intergovernmental Agreement on Federal Financial Relations.

 

A copy of the IGA, and National Healthcare Agreement which is a schedule to the IGA, can be obtained from the COAG website on http://www.coag.gov.au/intergov_agreements/federal_financial_relations/index.cfm

 

Paragraph 4 of this determination provides that the amount, which for the purposes of Part VII of the Act, will be taken to have been paid to a public hospital for the supply of out-patient medication shall be the maximum value of the supply of out-patient medication for safety net purposes or the amount charged, whichever is the lesser.

 

Subsection 84BA (3) of the Act provides that, in making a determination, the Minister may determine: different amounts in respect of a supply of out-patient medication having regard to the State or Territory in which the hospital supplying the medication is situated; and different amounts in respect of supplies made to concessional beneficiaries and their dependants, holders of a concession card, and general patients (other than holders of a concession card).

 

Paragraph 5 of this determination provides that the maximum value of the supply of out-patient medication to a concessional beneficiary, a dependant of a concessional beneficiary or the holder of a concession card shall be the amount referred to in paragraph 87(2)(a) of the Act.  Paragraph 87(2)(a) of the Act refers to the charge in relation to supply of pharmaceutical benefits by an approved pharmacist or approved medical practitioner, where they are presented with a concession card prescription (except where the supply is an early supply of a specified pharmaceutical benefit), or a concessional benefit prescription, or an entitlement card prescription where the supply is an early supply of a specified pharmaceutical benefit.  These charges are periodically adjusted under section 99G of the Act.  Paragraph 5 of this determination does not provide a maximum value for the supply of out-patient medication to those patients who present prescriptions for the early supply of specified pharmaceutical benefits.

 

Paragraph 6 of this determination provides that except in the case of a public hospital situated in Queensland or a public hospital that is participating in arrangements under Pharmaceutical Reform Arrangements within the meaning of the National Healthcare Agreement, the maximum value of the supply of out patient medication to a general patient who is not the holder of a concession card shall be $26.30.  The amount of $26.30 represents an average of the range of co-payments patients would pay if they received their medication from approved pharmacists approved under section 90 of the Act to supply pharmaceutical benefits from particular premises, and is determined in relation to general patients.

 

Paragraph 7 of this determination provides for the maximum value of a supply of out-patient medication to general patients who are not holders of a concession card in the case of public hospitals situated in Queensland.

 

Paragraph 8 of this determination provides for the maximum value of a supply of out-patient medication to general patients who are not holders of a concession card in the case of public hospitals that are participating in arrangements under Pharmaceutical Reform Arrangements within the meaning of the National Healthcare Agreement.

 

The Department of Health and Ageing has consulted with the State and Territory Health Departments through the Highly Specialised Drugs Working Party (HSDWP).  The HSDWP is a working party of the Australian Health Ministers’ Advisory Council and is made up of representatives from each State and Territory Health Department and the Australian Government.  It has the responsibility to review the hospital safety net arrangements on an annual basis including the calculation of the general patient average co-payment.  The State and Territory Health Departments have agreed to the value of out-patient medication for 2009.

 

This Determination was made on 19 June 2009 and commences on 1 July 2009.

 

This Determination is a legislative instrument for the purpose of the Legislative Instrument Act 2003.

 

 

 

 

 

PHARMACEUTICAL BENEFITS DIVISION

DEPARTMENT OF HEALTH AND AGEING

19 June 2009

Overview

The National Health Act 1953, enacted by the Parliament of Australia, addresses the need for financial protection for patients requiring a large number of pharmaceutical benefits through its safety net scheme. This scheme is intended to safeguard patients and their families from excessive out-of-pocket expenses for medication. Under subsection 84BA(2) of the Act, the Minister for Health and Ageing is mandated to determine the amounts considered as payments to public hospitals for outpatient medication, which is crucial for ascertaining patient eligibility for concession or entitlement cards. This determination, issued on 19 June 2009 and commencing on 1 July 2009, sets out specific amounts for different categories of patients across various states and territories, ensuring consistency and fairness in the application of the safety net scheme. The policy objective is to provide clear guidelines for the maximum values of outpatient medication, thereby protecting patients from excessive costs while ensuring the scheme operates effectively.

Scope and Application

The National Health Act 1953, under which this determination is made, applies to the supply of drugs and medicinal preparations that are declared to be pharmaceutical benefits. This determination specifically addresses the amounts that will be taken into account for the purposes of determining eligibility for the safety net scheme, which provides financial protection for patients and their families who require a large number of pharmaceutical benefits. The Act applies to individuals and entities involved in the supply of such pharmaceutical benefits and is enacted at the Commonwealth level, with its provisions extending throughout Australia. The amounts set out in this determination apply to out-patients at public hospitals across Australia, except for those in Queensland and those participating in arrangements under Pharmaceutical Reform Arrangements as defined in the National Healthcare Agreement. Different maximum values are set for concessional beneficiaries, dependants of concessional beneficiaries, holders of a concession card, and general patients who are not holders of a concession card, with adjustments made for public hospitals in Queensland and those participating in Pharmaceutical Reform Arrangements. This determination does not apply to the early supply of specified pharmaceutical benefits and is subject to periodic adjustments under section 99G of the Act.

Key Provisions

The main operative sections of this determination, as stipulated under subsection 84BA(2) of the National Health Act 1953 (Cth), concern the amounts that will be deemed paid to public hospitals for out-patient medication supplies. Paragraph 4 of the determination establishes that the deemed payment for out-patient medication is the lesser of the maximum value of the supply for safety net purposes or the actual amount charged. Paragraph 5 specifies that for concessional beneficiaries, dependants of concessional beneficiaries, and holders of a concession card, the maximum value is the charge under paragraph 87(2)(a) of the Act. Paragraph 6 sets the maximum value at $26.30 for general patients at public hospitals, excluding those in Queensland or participating in Pharmaceutical Reform Arrangements. Paragraphs 7 and 8 detail different maximum values for public hospitals in Queensland and those participating in Pharmaceutical Reform Arrangements. The obligations imposed by this Act on the parties governed include the calculation of deemed payments for out-patient medication supplies provided by public hospitals. The Minister must determine these amounts before the beginning of the relevant entitlement period. Public hospitals must adhere to these maximum values when supplying out-patient medication. The Department of Health and Ageing, through the Highly Specialised Drugs Working Party, consults with State and Territory Health Departments to agree on these values annually. These obligations ensure that the safety net scheme operates effectively, providing financial protection for patients requiring extensive pharmaceutical benefits. Breaches of this determination could lead to civil or criminal consequences, although specific offences and penalties are not detailed within the determination itself. Under the National Health Act 1953, penalties for non-compliance with provisions regarding pharmaceutical benefits can include fines and imprisonment, depending on the nature and severity of the breach. The maximum penalties are not explicitly stated in this determination but can be found within the broader legislative framework of the National Health Act. The intent is to ensure compliance with the safety net scheme and protect the interests of patients and public hospitals.

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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.