{"id":"F2005L01874","name":"National Health Act 1953 - Determination pursuant to subsection 5D(1) (PSO 7/2005)","slug":"national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-7-2005","htmlUrl":"https://zoelaw.ai/legislation/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-7-2005","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":36065,"registerId":"commonwealth-F2005L01874-current","compilationNumber":null,"startDate":"2026-04-01","status":"Repealed","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Notes","sectionType":"part","heading":"Notes","content":"# Notes\n\nNote 1: Health funds can pay benefits under an applicable benefits arrangement (sometimes referred to as a “hospital cover policy”) for any service specified in this Determination if, and only if, the service is provided to a patient as a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility (see the definition of \"outreach service\" in subsection 4(1) of the National Health Act 1953 (the Act) as well as sections 5A, 5C and 5D of the Act).\n\nNote 2: Health funds can also pay benefits for professional services that are rendered to a patient by a medical practitioner while the services specified in this Determination are being provided, so long as those services are being provided as a direct substitute for treatment that would ordinarily be provided in a hospital or day hospital facility. Under section 5C of the Act outreach services (defined in subsection 4(1) of the Act) are deemed to be a form of \"hospital treatment\". Under section 5A of the Act health funds can provide benefits under an applicable benefits arrangement for hospital treatment and any professional services rendered to a patient by a medical practitioner while the hospital treatment is being provided. The Determination in effect allows health funds to provide benefits under an applicable benefits arrangement for those out-of-hospital professional services that are provided while services that are specified in this Determination are being provided as a direct substitute for treatment that would ordinarily be provided in a hospital or day hospital facility. However, the Determination does not permit health funds to provide benefits for professional services provided out-of-hospital in any other situation.","sortOrder":0}],"analysis":{"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-batch","completionTokens":2602},"content_quality":"rejected","complexity_score":1,"rejection_reason":"The provided text contains only the introductory Notes (Notes 1 and 2) but omits the substantive content of the Determination, specifically the list of services specified under subsection 5D(1) of the National Health Act 1953 and any operative provisions. The notes explicitly refer to 'services specified in this Determination' which are not present in the provided text, rendering it an incomplete fragment.","scope_assessment":{"changed":false,"description":"Cannot assess scope as the provided text is an incomplete fragment containing only explanatory notes, not the substantive legislative provisions."},"complexity_factors":[],"plain_english_summary":"The provided text is incomplete and cannot be fully analysed. It contains only introductory explanatory notes to a Determination made under the National Health Act 1953."}},"importantCases":[],"_links":{"self":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-7-2005","history":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-7-2005/history","analysis":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-7-2005/analysis","conflicts":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-7-2005/conflicts","importantCases":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-7-2005/important-cases","documents":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-7-2005/documents"}}