{"id":"F2020L00074","name":"Direction to the Independent Hospital Pricing Authority on the performance of its functions under section 226 of the National Health Reform Act 2011 - No 1/2020","slug":"f2020l00074","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":329414,"registerId":"commonwealth-F2020L00074-current","compilationNumber":null,"startDate":"2026-04-08","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Name","content":"#### 1 Name\n\n This instrument is the Direction to the Independent Hospital Pricing Authority on the performance of its functions under section 226 of the National Health Reform Act 2011 - No 1/2020.","sortOrder":0},{"sectionNumber":"2","sectionType":"section","heading":"Commencement","content":"#### 2 Commencement\n\n This instrument commences on the day after it is registered on the Federal Register of Legislation.","sortOrder":1},{"sectionNumber":"3","sectionType":"section","heading":"Authority","content":"#### 3 Authority\n\n This instrument is made under section 226 of the National Health Reform Act 2011.","sortOrder":2},{"sectionNumber":"4","sectionType":"section","heading":"Definitions","content":"#### 4 Definitions\n\n> Note: A number of expressions used in this instrument are defined in section 5 of the Act, including the following:\n\n (a) COAG;\n (b) National Health Reform Agreement;\n (c) Pricing Authority;\n (d) Standing Council on Health.\n In this instrument:\n\n> Act means the National Health Reform Act 2011.\n\n> Australian Health Ministers’ Advisory Council means the advisory body established or recognised by the Standing Council on Health.\n\n> cost model includes deriving cost profiles, adjustments, parameters and relative weights of classes within each service stream for a financial year, and is based on cost and activity data for each of the historical years with only those costs and activity from Activity Based Funding (ABF) establishments being used.\n\n> direct cost means costs incurred at the Nationally Funded Centres (NFC) site (or sites) where the NFC episode of care is provided across more than one site) that are directly related to the NFC technology, including pre and post procedural care as captured in the National Health Cost Data Collection (NHCDC) Cost Bucket Matrix.\n\n> indirect cost includes, but is not limited to, the:\n\n (a) travel and accommodation costs incurred in the Nationally Funded Centres (NFC) Program in order to access a NFC service;\n (b) capital costs;\n (c) other overhead costs that are incidental to the provision of a NFC service, as deemed by the Pricing Authority.\n\n> NFC Program means the program recognised as the Nationally Funded Centres (NFC) Program endorsed by Australian health ministers in June 1990 (now meeting as the Council of Australian Governments Health Council) for the public sector provision of certain high cost, highly specialised clinical practices and technologies with limited demand. For a technology to be considered for NFC status it must require a national population base for efficient and effective service provision.\n\n> NFC service means a service that is specified in a service in column 1 of an item in the table under clause 5 of the schedule.\n\n> pricing model includes a National Efficient Price (NEP), Price Weights and adjustments, and is based on cost and activity data from three years prior.\n\n> reference cost means a standardised mean to ensure the measure of an NWAU remains constant over time, that is then used to convert the cost model into a cost weight model and pricing model.\n\n> specified site, in relation to a NFC service, means a site specified in column 2 of the table in clause 5 of the schedule for the particular NFC service.","sortOrder":3},{"sectionNumber":"5","sectionType":"section","heading":"Schedule","content":"#### 5 Schedule\n\n The schedule to this instrument sets out the direction given to the Pricing Authority on the performance of its functions and exercise of its powers.\n\n \n\nSchedule\n\n1 Function\n\n The Pricing Authority, in relation to the performance of its functions under paragraphs 131(1)(h)–(i) and (n) of the Act, is directed to undertake a costing and pricing study into the NFC Program.\n\n2 Matters Pricing Authority to study\n\n In carrying out the study, the Pricing Authority is directed to inquire into and make findings about the following matters:\n (a) the direct and indirect cost of providing each NFC service at each specified site for that NFC service;\n (b) the aggregate direct and indirect cost of providing each NFC service across all specified sites for that NFC service;\n (c) the projected cost of providing all NFC services at all specified sites; and\n (d) the existing direct and indirect cost of providing each NFC service for each patient in each specified site for that NFC service.\n\n3 Pricing Authority to recommend options\n\n In carrying out the study, the Pricing Authority must recommend options in respect of the following matters:\n (a) whether NFC services, individually and collectively, are more appropriately funded via Activity Based Funding (ABF) or block funding arrangements under the National Health Reform Agreement;\n (b) the development and operation of cost models and pricing models for the NFC Program, covering both existing and potential future services delivered under the NFC Program; and\n (c) other related matters deemed appropriate by the Pricing Authority.\n\n4 Pricing Authority must have regard to particular matters\n\n In carrying out the study, the Pricing Authority must have regard to the following:\n (a) the National Health Reform Agreement;\n (b) NFC program cost and activity data supplied by a State or Territory;\n (c) any submissions regarding the study to the Pricing Authority from:\n (i) the Commonwealth;\n (ii) a State or Territory;\n (iii) public hospitals;\n (iv) other health bodies; and\n (v) other parties deemed relevant by the Pricing Authority; and\n (d) other related matters deemed appropriate by the Pricing Authority.\n\n5 NFC services and specified sites\n\n For the purposes of section 2, at the time this direction is issued:\n (a) a service mentioned in column 1 of an item in the following table is specified as a NFC service; and\n (b) a site mentioned in column 2 of the item is specified for the particular NFC service in column 1.\n\n```html\n

Specified service and sites

Item

Column 1

Service

Column 2

Site

1

Islet cell transplantation for the treatment of severe hypoglycaemia unawareness and metabolic instability in p with Type-1 diabetes

(a) Royal Adelaide Hospital, South Australia

(b) St. Vincent’s Hospital, Victoria

(c) Westmead Hospital, New South Wales

2

Paediatric heart transplantation

(a) Royal Children’s Hospital, Victoria

3

Paediatric liver transplantation

(a) Queensland Children's Hospital, Queensland

(b) Royal Children’s Hospital, Victoria

(c) The Sydney Children’s Hospitals Network (Westmead), New South Wales

4

Paediatric lung and heart-lung transplantation

(a) Alfred Hospital, Victoria

5

Pancreas transplantation

(a) Monash Medical Centre, Victoria

(b) Westmead Hospital, New South Wales

\n```\n\n6 Other matters\n\n The Pricing Authority is directed to:\n (a) commence the study as soon as practicable;\n (b) provide updates about the study to the Australian Health Ministers’ Advisory Council and the Standing Council on Health as requested;\n (c) provide an interim report of the results of the study and options to the Australian Health Ministers’ Advisory Council, not later than 1 August 2020; and\n (d) submit to the Standing Council on Health a final report of the results of the study and options, not later than 31 January 2021.","sortOrder":4}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument remains tightly scoped to its original purpose. It is a specific, time-limited direction under section 226 of the National Health Reform Act 2011, which explicitly empowers the Minister to give directions to the Pricing Authority about performance of its functions. The direction does not expand beyond the NFC Program study and contains standard reporting requirements. No mission creep is evident."},"complexity_factors":["12 defined terms in the interpretation section, several cross-referencing the parent Act","Nested definitions: 'cost model' and 'pricing model' are defined with technical formulae involving historical data, relative weights, and three-year lookback periods","Multiple conditional layers in the schedule: mandatory directions ('is directed to'), mandatory considerations ('must have regard to'), and discretionary elements ('deemed appropriate by the Pricing Authority')","Cross-references to external documents: National Health Reform Agreement, NHCDC Cost Bucket Matrix, and COAG/Standing Council structures","Technical healthcare financing terminology requiring domain knowledge (Activity Based Funding, block funding, National Efficient Price, NWAU)","Tabular data specifying 5 services across 9 hospital sites with inconsistent formatting in the source HTML"],"plain_english_summary":"This is a formal instruction from the federal government to the Independent Hospital Pricing Authority (IHPA) — the body that sets prices for public hospital services. The government is telling IHPA to conduct a detailed study into how much it costs to run the **Nationally Funded Centres (NFC) Program**.\n\n**What is the NFC Program?**\nIt's a scheme dating back to 1990 that funds highly specialised, expensive medical treatments that are too rare for every hospital to offer. Because these services need a large population base to be viable, they're concentrated at specific hospitals around Australia. The five services covered by this direction include:\n- Islet cell transplantation for Type-1 diabetes (Adelaide, Melbourne, Sydney)\n- Paediatric heart, liver, and lung transplants (various children's hospitals)\n- Pancreas transplantation (Melbourne, Sydney)\n\n**What must IHPA do?**\n- Calculate the **direct costs** (medical procedures, pre- and post-care) and **indirect costs** (travel, accommodation, capital, overheads) for each service at each hospital\n- Work out total costs across all sites and project future costs\n- Recommend whether these services should be funded through **Activity Based Funding** (paying per procedure) or **block funding** (lump sum grants)\n- Develop cost and pricing models for current and future NFC services\n\n**Why does this matter?**\nThis could change how these life-saving but expensive treatments are paid for. Currently, these services are funded differently from standard hospital procedures. The study will determine if they should be brought into the mainstream hospital funding system or kept separate — with real implications for hospital budgets and patient access.\n\n**Timeline:** IHPA must deliver an interim report by August 2020 and a final report by January 2021."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/f2020l00074","history":"/api/acts/f2020l00074/history","analysis":"/api/acts/f2020l00074/analysis","conflicts":"/api/acts/f2020l00074/conflicts","importantCases":"/api/acts/f2020l00074/important-cases","documents":"/api/acts/f2020l00074/documents"}}