EXPLANATORY STATEMENT
Statutory Rules 1986 NO 53
SUBJECT: NATIONAL HEALTH ACT 1953
NATIONAL HEALTH REGULATIONS (AMENDMENT)
(Issued by authority of the Minister for Community Services, Senator the Hon Don Grimes.)
Regulation 29 of the National Health Regulations (the Regulations) was made pursuant to section 140 of the National Health Act 1953 (the Act).
Sub-section 47(2) of the Act provides that where a qualified nursing home patient is receiving nursing home care in a non-Government nursing home, the amount of Commonwealth benefit payable under sub-section 47(1) is reduced by the amount that the fees charged in respect of the nursing home care of that patient for that day are exceeded by the sum of -
• the amount of Commonwealth benefit otherwise payable under sub-section 47(1) (sub-paragraph 47(2)(b)(i));
• the amount (if any) of Commonwealth extensive care benefit (sub-paragraph 47(2)(b)(ii)); and
• $6.70, or the amount prescribed (sub-paragraph 47(2)(b)(iii)).
In effect, sub-paragraph 47(2)(b)(iii) of the Act prescribes the minimum rate of daily patient contribution that a qualified nursing home patient who is accommodated in an approved non-Government nursing home is required to contribute towards his or her care and treatment. The rate of $14.10 is prescribed by regulation 29 of the National Health Regulations.
The rate of the patient contribution prescribed by that regulation is currently at a level equivalent to 87.5% of the sum of the maximum standard rate of pension and rent assistance payable under the Social Security Act 1947.
The rate of patient contribution has been reviewed to take into account the increase in pension rates which will become effective on 1 May 1986. The patient contribution rate will be increased to maintain the 87.5% rate.
Accordingly, the regulations will increase the rate of patient contribution to the new level.
The regulations will come into operation on 1 May 1986, which is the date the increase in pension rates occurs.
Overview
The National Health Regulations (Amendment) Statutory Rules 1986, introduced by the Minister for Community Services, Senator the Hon Don Grimes, address a gap in the National Health Act 1953 concerning the rates of patient contributions for nursing home care. These amendments were enacted to ensure that the minimum daily patient contribution prescribed under the Act remains aligned with the changes in pension rates. Specifically, Regulation 29 of the National Health Regulations was modified to adjust the patient contribution rate to 87.5% of the maximum standard rate of pension and rent assistance, reflecting the increase in pension rates effective from 1 May 1986. This adjustment ensures that the financial burden on qualified nursing home patients remains proportionate to their economic circumstances as defined by the Social Security Act 1947. The policy objective of these amendments is to maintain the integrity of the National Health Act in supporting equitable access to nursing home care while keeping pace with changes in economic conditions.
Scope and Application
The National Health Act 1953 applies to qualified nursing home patients receiving care in non-Government nursing homes, as well as to the Commonwealth benefits and contributions associated with such care. The Act impacts both individuals, specifically those qualified nursing home patients, and entities, namely the non-Government nursing homes providing their care. The Act's reach is national, with its provisions extending across Australia as they pertain to a Commonwealth benefit scheme. The Act sets out the formula for the reduction of Commonwealth benefits payable to qualified nursing home patients based on the fees charged by the nursing home, alongside prescribed contributions. The regulations made under this Act, such as the National Health Regulations, further define and adjust the specifics of these contributions, including the minimum daily patient contribution, which is currently set at a level equivalent to 87.5% of the maximum standard rate of pension and rent assistance. These regulations, and any amendments, apply nationally and are designed to align with changes in pension rates.
Key Provisions
The National Health Regulations (Amendment) Statutory Rules 1986 No 53 introduce changes to Regulation 29, impacting the patient contribution rate for qualified nursing home patients in non-Government nursing homes. Under section 47(2) of the National Health Act 1953, the amount of Commonwealth benefit payable to a patient receiving nursing home care in a non-Government facility is adjusted based on the fees charged, the Commonwealth benefit otherwise payable, any Commonwealth extensive care benefit, and a prescribed daily patient contribution. Currently, the patient contribution is set at $6.70, but Regulation 29 now prescribes an increased rate to maintain the contribution as 87.5% of the maximum standard rate of pension and rent assistance under the Social Security Act 1947. This amendment accounts for the upcoming increase in pension rates effective from 1 May 1986.
The Act imposes specific obligations on non-Government nursing homes to ensure that the prescribed patient contribution is adhered to. Nursing homes must charge a daily fee that aligns with the new prescribed contribution rate, as outlined in Regulation 29. This means that the nursing home must not exceed the amount calculated by the sum of the Commonwealth benefit, the extensive care benefit, and the prescribed contribution rate. Compliance with these regulations ensures that the nursing home receives the appropriate level of Commonwealth benefit while also requiring the patient to contribute the stipulated amount towards their care.
Breaches of these regulations can result in civil or criminal consequences, though specific penalties are not detailed in the explanatory statement. However, it is understood that non-compliance could lead to financial penalties or other legal actions as prescribed by the relevant legislation. The Act mandates adherence to the prescribed contribution rate to maintain the integrity of the funding structure for nursing home care and to ensure that patients are not unfairly burdened or overcharged for their care.
The regulations are set to come into operation on 1 May 1986, aligning with the increase in pension rates. This ensures that the patient contribution rate is adjusted in tandem with changes in pension rates, maintaining the intended financial balance between the Commonwealth, nursing homes, and patients. By updating the patient contribution rate, the regulations aim to preserve the fairness and sustainability of the nursing home care funding model.