{"id":"F2006L01170","name":"National Health Act 1953 - Determination under Schedule 1, paragraph (1)(bj) (HIB 14/2006)","slug":"national-health-act-1953-determination-under-schedule-1-paragraph-1-bj-hib-14-2006","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":58572,"registerId":"commonwealth-F2006L01170-current","compilationNumber":null,"startDate":"2026-04-02","status":"Repealed","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1. Interpretation","sectionType":"part","heading":"1. Interpretation","content":"# 1. Interpretation\n\n(1) In this Schedule:\n\nAN-SNAP rehabilitation classification system means the Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) classification as described in Appendix 6 of Kathy Eagar et al, A national classification system and payment model for private rehabilitation services, University of Wollongong, 1999;\n\nfacility means a private hospital or private day hospital facility specified in clause 3;\n\nHPPA means hospital-purchaser provider agreement;\n\nrehabilitation episode of hospital treatment means an episode of hospital treatment in which the clinical intent or treatment goal is to improve the functional status of a patient with an impairment, disability or handicap. It is usually evidenced by a multi-disciplinary rehabilitation plan comprising negotiated goals and indicative time frames which are evaluated by a periodic assessment using a recognised functional assessment measure;\n\nRHBO means registered health benefits organization; and\n\nsimilar arrangement includes all agreements, except HPPAs, that have the effect of enabling payments to be made to a facility according to provisions (including pricing provisions) stated under these agreements.\n\n(2) In this Schedule, except in subclause 1(4), the Australian Capital Territory is taken to be part of the State of New South Wales and the Northern Territory is taken to be part of the State of South Australia.\n\n(3) In this Schedule, private hospitals are comparable if they fall within the same class from the following list:\n\n(a) private hospitals which provide psychiatric care for at least 50% of the episodes of hospital treatment;\n\n(b) private hospitals which provide rehabilitation care for at least 50% of the episodes of hospital treatment;\n\n(c) private hospitals which do not fall into categories (a) or (b), with up to and including 50 licensed beds;\n\n(d) private hospitals which do not fall into categories (a) or (b) with more than 50 licensed beds and up to and including 100 licensed beds;\n\n(e) private hospitals which do not fall into categories (a) or (b), with more than 100 licensed beds, without an accident and emergency unit or a specialised cardiac care unit;\n\n(f) private hospitals which do not fall into categories (a) or (b), with more than 100 licensed beds, with either (or both) an accident and emergency unit or a specialised cardiac care unit.\n\nNote: Some expressions used in this Schedule are defined in subsection 4(1) of the National Health Act 1953 (“Act”) or subsection 3(1) of the Health Insurance Act 1973 including:\n\n-   day hospital facility;\n-   hospital-purchaser provider agreement;\n-   private hospital; and\n-   registered health benefits organization.\n\n(4) In subclause 1(3), a reference to ‘licensed beds’ is a reference to the beds or patients that a private hospital is permitted, under State or Territory legislation in the State or Territory where the private hospital is located.","sortOrder":0},{"sectionNumber":"2. Minimum Level Of Benefit","sectionType":"part","heading":"2. Minimum Level Of Benefit","content":"# 2. Minimum Level Of Benefit\n\n(1) The minimum level of benefit payable by a RHBO in respect of an episode of hospital treatment (excluding in situations of emergency) in a facility that does not have a HPPA (or a similar arrangement) with the RHBO, is that set by this clause 2, being the second tier default benefit, and not the minimum level of benefit set by Schedules 1, 2, 3, or 7 of the Determination made under paragraph (1) (bj) of Schedule 1 of the Act.\n\nNote 1: Schedule 1 sets the minimum level of benefit payable for overnight shared ward accommodation in private hospitals in all States and Territories and overnight shared ward accommodation in recognised hospitals in Victoria and Tasmania.\n\nSchedule 2 sets the minimum level of benefit payable for overnight shared ward accommodation in recognised hospitals in the Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia and Western Australia.\n\nSchedule 3 sets the minimum level of benefit payable for same day accommodation in hospitals and day hospital facilities in all States and Territories.\n\nSchedule 7 sets the minimum level of benefit payable for outreach services provided by, or on behalf of, specified hospitals and day hospital facilities.\n\nNote 2: In situations of emergency paragraph (1)(bi) of Schedule 1 of the Act applies.\n\n(2) This Schedule does not apply to episodes of hospital treatment referred to in Schedules 4 and 6 of the Determination made under paragraph (1)(bj) of Schedule 1 to the Act, and the Determination made under subsections 73AAG(6) and (7) of the Act.\n\nNote: RHBOs must continue to pay benefits for:\n\n-   nursing-home type patients as prescribed in Schedule 4 of the Determination made under paragraph (1)(bj) of Schedule 1 of the Act;\n-   no gap prostheses and gap permitted prostheses determined under subsections 73AAG(6) and (7) of the Act; and\n-   care plans and case conferencing in accordance with Schedule 6 of the Determination made under paragraph (1) (bj) of Schedule 1 of the Act.\n\n(3)(a) Subject to subclauses (6), and (8), the minimum level of benefit payable by a RHBO in respect of a non-rehabilitation episode of hospital treatment between 1 September of a particular year (“the first year”) and 31 August of the next year will be no less than 85% of the average charge for the equivalent episode of hospital treatment under that RHBO’s HPPAs (or similar arrangements) that were in force on 1 August of the first year with:\n\n(i) all comparable private hospitals in the State in which the facility is located (if treatment was provided in a facility that was a private hospital); or\n\n(ii) all private day hospital facilities in the State in which the facility is located (if the treatment was provided in a facility that was a private day hospital facility).\n\n(b) The formula for calculating the “average charge for the equivalent episode of hospital treatment” by a RHBO in each State is as follows:\n\n![](image.001.png)","sortOrder":1},{"sectionNumber":"Where: j = group of equivalent episodes ","sectionType":"section","heading":"Where: j = group of equivalent episodes of hospital treatment under the RHBO’s HPPAs (or similar arrangements)","content":"##### Where: j = group of equivalent episodes of hospital treatment under the RHBO’s HPPAs (or similar arrangements)\n\ni = group of the RHBO’s HPPAs (or similar arrangements) in force on 1 August of the first year with comparable private hospitals, or with all private day hospital facilities, in the State\n\nn= the number of the RHBO’s HPPAs (or similar arrangements) in force on 1 August of the first year with comparable private hospitals, or with all private day hospital facilities, in the State\n\nRji = charge for episode of hospital treatment type j in contract i\n\nRj = average charge for episode of hospital treatment type j\n\n(4) In subclause (3), each “episode of hospital treatment” must be identified using the patient classification system and payment structure in the majority of the relevant RHBO’s HPPAs (or similar arrangements) in force on 1 August of the first year with:\n\n(a) all comparable private hospitals in the State in which the facility is located (if treatment was provided in a facility that was a private hospital); or\n\n(b) all private day hospital facilities in the State in which the facility is located (if the treatment was provided in a facility that was a private day hospital facility).\n\n(5) In subclause (3), for the purpose of calculating the “average charge for the equivalent episode of hospital treatment” in a State:\n\n(a) the charge will include the sum of the amount payable by the RHBO under that RHBO’s HPPAs (or similar arrangements) and any excess or co-payment amounts payable by members, in accordance with the RHBO’s rules.\n\nNote: RHBO members’ financial obligations under such levels of cover will still apply.\n\n(b) charges referred to within the RHBO’s HPPAs (or similar arrangements) for no gap prostheses and gap permitted prostheses determined under subsections 73AAG(6) and (7) of the Act must not be included; and\n\n(c) charges referred to within the RHBO’s HPPAs (or similar arrangements) for hospital treatment provided to patients who are classified as nursing-home type patients (NHTPs) must not be included.\n\n(6) Subject to subclause (8), if a RHBO has less than five HPPAs (or similar arrangements) in force on 1 August of the first year with a particular class of comparable private hospitals in a State, then all of that RHBO’s HPPA’s with all classes of private hospitals in that State are to be used to calculate the minimum benefit payable.\n\n(7) Subject to subclause (8), the minimum level of benefit payable by a RHBO in respect of a rehabilitation episode of hospital treatment between 1 September of a particular year (“the first year”) and 31 August of the next year will be:\n\n(a) no less than 85% of the average charge for rehabilitation episodes of hospital treatment under all of that RHBO’s HPPAs (or similar arrangements) that were in force on 1 August of the first year with all comparable private hospitals in the State in which the facility is located if:\n\n(i) treatment was provided in a facility that was a private hospital; and\n\n(ii) the RHBO has directly linked the payment of benefits, under its HPPAs (or similar arrangements) with comparable private hospitals in the relevant State, for rehabilitation episodes of hospital treatment to the AN-SNAP rehabilitation classification system for the 12 months preceding and including 1 August of the first year; or\n\n(b) no less than 85% of the average charge for rehabilitation episodes of hospital treatment under all of that RHBO’s HPPAs (or similar arrangements) that were in force on 1 August of the first year with all private day hospital facilities in the State in which the facility is located if:\n\n(i) the treatment was provided in a facility that was a private day hospital facility); and\n\n(ii) the RHBO has directly linked the payment of benefits, under its HPPAs (or similar arrangements) with private day hospital facilities in the relevant State, for rehabilitation episodes of hospital treatment to the AN-SNAP rehabilitation classification system for the 12 months preceding and including 1 August of the first year; or\n\n(c) in any other case, an amount based on the AN-SNAP rehabilitation classification system negotiated by the RHBO and the facility.\n\n(8) If the minimum level of benefit payable under subclauses (3), (6), or (7) in respect of an episode of hospital treatment is below the level set in Schedules 1, 2, 3 or 7 of the Determination made under paragraph (1)(bj) of Schedule 1 of the Act, then the minimum level of benefit payable under this Schedule 5 is that set in Schedules 1, 2, 3 or 7 of the Determination made under paragraph (1)(bj) of Schedule 1 of the Act for that episode of hospital treatment.","sortOrder":2},{"sectionNumber":"3. Specified Private Hospitals And Priva","sectionType":"part","heading":"3. Specified Private Hospitals And Private Day Hospital Facilities","content":"# 3. Specified Private Hospitals And Private Day Hospital Facilities\n\n(1) Table A specifies private hospitals for the purpose of the definition of “facility” in subclause 1(1) of this Schedule 5.","sortOrder":3},{"sectionNumber":"Table A: Specified Private Hospitals","sectionType":"part","heading":"Table A: Specified Private Hospitals","content":"## Table A: Specified Private Hospitals\n\n| Item | Facility Name                                                  | Address                                                       |\n| ---- | -------------------------------------------------------------- | ------------------------------------------------------------- |\n| 1    | Albury Wodonga Private Hospital                                | 1125 Pemberton Road, WEST ALBURY NSW 2640                     |\n| 2    | Alpha Westmead Private Hospital                                | Corner Mons & Darcy Roads, WESTMEAD NSW 2145                  |\n| 3    | Armidale Private Hospital                                      | Rusden St, ARMIDALE NSW 2350                                  |\n| 4    | Attadale Private Hospital                                      | 21 Hislop Road, ATTADALE WA 6156                              |\n| 5    | Baringa Private Hospital                                       | Mackays Road, COFFS HARBOUR NSW 2450                          |\n| 6    | Bega Valley Day Surgery Centre and Private Hospital            | 31 Parker Street, BEGA NSW 2550                               |\n| 7    | Beleura Private Hospital                                       | 925 Nepean Highway, MORNINGTON VIC 3931                       |\n| 8    | Berkeley Vale Private Hospital                                 | Lorraine Avenue, BERKELEY VALE NSW 2259                       |\n| 9    | Blackwood Hospital Group                                       | 13 Laffers Road, BELAIR SA 5052                               |\n| 10   | Bondi Junction Private Hospital                                | 21 Spring Street, BONDI JUNCTION NSW 2022                     |\n| 11   | Brisbane Private Hospital                                      | 259 Wickham Tce, BRISBANE QLD 4000                            |\n| 12   | Burnside War Memorial Hospital                                 | 120 Kensington Road, TOORAK GARDENS SA 5065                   |\n| 13   | Caboolture Private Hospital                                    | McKean Street, CABOOLTURE QLD 4510                            |\n| 14   | Cabrini Brighton                                               | 243 New Street, BRIGHTON VIC 3186                             |\n| 15   | Cabrini Hospital                                               | 183 Wattletree Road, MALVERN VIC 3144                         |\n| 16   | Cairns Private Hospital                                        | 1 Upward Street, CAIRNS QLD 4870                              |\n| 17   | Caloundra Private Hospital                                     | 96 Beerburrum Street, CALOUNDRA QLD 4566                      |\n| 18   | Calvary Health Care – Lenah Valley Campus                      | 49 Augusta Road, LENAH VALLEY TAS 7008                        |\n| 19   | Calvary Health Care – St Johns Campus                          | 30 Cascade Road, SOUTH HOBART TAS 7000                        |\n| 20   | Calvary Health Care Riverina                                   | Hardy Avenue, WAGGA WAGGA NSW 2650                            |\n| 21   | Calvary Health Care Sydney Hurstville Community                | 37 Gloucester Road, HURTSVILLE NSW 2220                       |\n| 22   | Calvary Health Care Tasmania - St Lukes Campus                 | 24 Lyttleton Street, LAUNCESTON TAS 7250                      |\n| 23   | Calvary Hospital - Adelaide                                    | 89 Strangways Terrace, NORTH ADELAIDE SA 5006                 |\n| 24   | Calvary Private Hospital ACT                                   | Haydon Drive, BRUCE ACT 2617                                  |\n| 25   | Castle Hill Hospital                                           | 72-74 Cecil Avenue, CASTLE HILL NSW 2154                      |\n| 26   | Castlecrag Private Hospital                                    | 150 Edinburgh Road, CASTLECRAG NSW 2068                       |\n| 27   | Cedar Court Healthsouth Rehabilitation Hospital                | 888 Toorak Road, CAMBERWELL VIC 3124                          |\n| 28   | Central District Private Hospital                              | 25 Jarvis Road, ELIZABETH VALE SA 5112                        |\n| 29   | Coastal Private Hospital                                       | 221 Willmott Drive. WAIKIKI WA 6169                           |\n| 30   | College Grove Hospital                                         | 18 North East Road, WALKERVILLE SA 5081                       |\n| 31   | Delmont Private Hospital                                       | 298 Warrigal Road, GLEN IRIS VIC 3146                         |\n| 32   | Donvale Rehabilitation Hospital                                | 1119 Doncaster Road, DONVALE VIC 3111                         |\n| 33   | Dudley Private Hospital                                        | 261 March Street, ORANGE NSW 2800                             |\n| 34   | Evesham Clinic Private Hospital                                | 3 Harrison Street, CREMORNE NSW 2090                          |\n| 35   | Frances Perry Private Hospital                                 | 285 Cardigan Street, CARLTON 3053                             |\n| 36   | Friendly Society Private Hospital                              | 19-23 Bingera Street, BUNDABERG QLD 4670                      |\n| 37   | Fullarton Private Hospital                                     | 295 Fullarton Road, PARKSIDE SA 5063                          |\n| 38   | Glenferrie Private Hospital                                    | 25 Linda Crescent, HAWTHORN 3122                              |\n| 39   | Glengarry Private Hospital                                     | 53 Arnisdale Road, DUNCRAIG WA 6023                           |\n| 40   | Greenslopes Private Hospital                                   | Newdegate Street, GREENSLOPES QLD 4120                        |\n| 41   | Hawkesbury District Health Service                             | Level 2, 16-18 Bridge Street, EPPING NSW 2121                 |\n| 42   | Hillcrest-Rockhampton Private Hospital                         | 4 Talford Street, ROCKHAMPTON QLD 4700                        |\n| 43   | Hollywood Private Hospital                                     | Monash Avenue, NEDLANDS WA 6009                               |\n| 44   | Holy Spirit Northside                                          | 627 Rode Road, CHERMSIDE QLD 4032                             |\n| 45   | Hopetoun Rehabilitation Hospital                               | 2-6 Hopetoun Street, ELSTERNWICK VIC 3185                     |\n| 46   | Hunters Hill Private Hospital                                  | 9 Mount Street, HUNTERS HILL NSW 2110                         |\n| 47   | Illawarra Private Hospital                                     | 1 Suttor Place, FIGTREE NSW 2525                              |\n| 48   | John Flynn Private Hospital                                    | 42 Inland Drive, TUGUN QLD 4224                               |\n| 49   | Joondalup Private Hospital                                     | Corner Grand Boulevard and Shenton Avenue, JOONDALUP WA 6027  |\n| 50   | Kahlyn Private Hospital                                        | 40 Briant Road, MAGILL SA 5072                                |\n| 51   | Kareena Private Hospital                                       | 86 Kareena Road, CARINGTON NSW 2229                           |\n| 52   | Lake Macquarie Private Hospital                                | 3 Sydney Street, GATESHEAD NSW 2290                           |\n| 53   | Lawrence Hargrave Hospital                                     | 72 Phillip Street, THIRROUL NSW 2515                          |\n| 54   | Linacre Private Hospital                                       | 12 Linacre Road, HAMPTON VIC 3188                             |\n| 55   | Macarthur Private Hospital                                     | 92-96 Dumaresq Street, CAMPBELLTOWN NSW 2560                  |\n| 56   | Maitland Private Hospital                                      | 173 Chisholm Road, EAST MAITLAND NSW 2323                     |\n| 57   | Maryvale Private Hospital                                      | McDonald Street, MORWELL VIC 3840                             |\n| 58   | Masada Private Hospital                                        | 26 Balaclava Road, EAST ST KILDA VIC 3183                     |\n| 59   | Mater Hospital North Sydney                                    | Rocklands Road, NORTH SYDNEY NSW 2060                         |\n| 60   | Mater Hospital Yeppoon                                         | Cnr Cliff & Hutton Streets, YEPPOON QLD 4703                  |\n| 61   | Mater Misericordia Private Hospital Brisbane                   | 301 Vulture Street, SOUTH BRISBANE QLD 4101                   |\n| 62   | Mater Misericordia Women’s & Children’s Private Health Service | Cnr Raymond Terrace & Stanley Street, SOUTH BRISBANE QLD 4101 |\n| 63   | Mater Misericordiae Hospital Bundaberg                         | Bourbong Street, BUNDABERG QLD 4670                           |\n| 64   | Mater Misericordiae Private Hospital Gladstone                 | Rossella Street, GLADSTONE QLD 4680                           |\n| 65   | Mater Misericordiae Private Hospital Mackay                    | Gordon Street, MACKAY QLD 4740                                |\n| 66   | Mater Misericordiae Private Hospital Rockhampton               | Ward Street, ROCKHAMPTON QLD 4700                             |\n| 67   | Mater Misericordiae Private Hospital Townsville                | 21 Fulham Road, PIMLICO QLD 4810                              |\n| 68   | Mater Private Hospital Redland                                 | Weippin Street, CLEVELAND QLD 4163                            |\n| 69   | Mayo Private Hospital                                          | Lot 1, Potoroo Drive, Kolodong, VIA TAREE NSW 2430            |\n| 70   | Mercy Private Hospital                                         | 159 Grey Street, EAST MELBOURNE VIC 3002                      |\n| 71   | Mitcham Private Hospital                                       | 27 Doncaster East Road, MITCHAM VIC 3132                      |\n| 72   | Mt Lawley Private Hospital                                     | 14 Alvan Street, MOUNT LAWLEY WA 6050                         |\n| 73   | Mt Olivet Hospital                                             | 411 Main Street, KANGAROO POINT QLD 4169                      |\n| 74   | Mt Wilga Private Hospital                                      | 2 Manor Road, HORNSBY NSW 2000                                |\n| 75   | Murray Valley Private Hospital                                 | Nordsvan Drive, WODONGA,VIC 3690                              |\n| 76   | Nambour Selangor Private Hospital                              | 62 Netherton Street, NAMBOUR QLD 4560                         |\n| 77   | New Farm Clinic Private Hospital                               | 22 Sargent Street, NEW FARM QLD 4005                          |\n| 78   | Ngala Family Resource Centre                                   | 9 George Street, KENSINGTON WA 6151                           |\n| 79   | Noosa Private Hospital                                         | 111 Goodchap Street, NOOSAVILLE QLD 4566                      |\n| 80   | North Eastern Community Hospital                               | Lower North East Road, CAMPBELLTOWN SA 5074                   |\n| 81   | North Shore Private Hospital                                   | Westbourne Street, ST LEONARDS NSW 2065                       |\n| 82   | North West Private Hospital                                    | 137 Flockton Street, EVERTON PARK QLD 4053                    |\n| 83   | Northside Clinic                                               | 2 Greenwich Road, GREENWICH NSW 2065                          |\n| 84   | Northside West Clinic                                          | 21-27 Lytton Street, WENTWORTHVILLE NSW 2145                  |\n| 85   | Nowra Private Hospital                                         | Weeroona Place, NOWRA NSW 2541                                |\n| 86   | Pendlebury Clinic                                              | Suite 3, 52 Pendlebury Road, CARDIFF NSW 2285                 |\n| 87   | Peninsula Private Hospital                                     | 49 McClelland Drive, FRANKSTON VIC 3910                       |\n| 88   | Peninsula Private Hospital (Harbord)                           | 12 McDonald Street, HARBORD NSW 2096                          |\n| 89   | Perth Clinic                                                   | 29 Havelock St, WEST PERTH WA 6005                            |\n| 90   | Pindara Gold Coast Private Hospital                            | Allchurch Avenue, BENOWA QLD 4217                             |\n| 91   | Pinelodge Clinic Private Hospital Dandenong                    | 1480 Heatherton Road, DANDENONG VIC 3175                      |\n| 92   | Poplars Private Hospital                                       | 66 Norfolk Road, EPPING NSW 2121                              |\n| 93   | Port Macquarie Private Hospital                                | Lake Road, PORT MACQUARIE NSW 2444                            |\n| 94   | RiverCity Private Hospital                                     | 401 Milton Road, AUCHENFLOWER QLD 4066                        |\n| 95   | Shepperton Private Hospital                                    | Fitzgerald Street, SHEPPERTON VIC 3630                        |\n| 96   | South Eastern Private Hospital                                 | Cnr Princes Highway & Heatherton Roads, NOBLE PARK VIC 3174   |\n| 97   | South Pacific Private Hospital                                 | 18 Beach Street, HARBORD NSW 2096                             |\n| 98   | Southern Highlands Private Hospital                            | Bowral Street, BOWRAL NSW 2576                                |\n| 99   | Spendelove House                                               | 24 Spendelove Street, SOUTHPORT QLD 4215                      |\n| 100  | Sportsmed SA Hospital                                          | 32 Payneham Road, STEPNEY SA 5069                             |\n| 101  | St Andrew’s Ipswich Private Hospital                           | Corner Roderick and Pring Streets, IPSWICH QLD 4305           |\n| 102  | St Andrews Toowoomba Hospital                                  | 280 North Street, TOOWOOMBA QLD 4350                          |\n| 103  | St George Private Hospital                                     | 1 South Street, KORARAH NSW 2217                              |\n| 104  | St John of God Hospital Bendigo                                | Lily Street, BENDIGO VIC 3552                                 |\n| 105  | St John of God Hospital Bunbury                                | Cnr Robertson Drive & Bussell Highway, BUNBURY WA 6230        |\n| 106  | St John of God Hospital Geelong                                | 80 Myers Street, GEELONG VIC 3220                             |\n| 107  | St John of God Hospital Geraldton                              | 12 Hermitage Street, GERALDTON WA 6530                        |\n| 108  | St Luke’s Hospital Complex                                     | 18 Rosalyn Street, POTTS POINT NSW 2011                       |\n| 109  | St Vincent's Private Hospital (Bathurst)                       | Gorman's Hill Road, BATHURST NSW 2795                         |\n| 110  | St. Vincent’s Hospital Toowoomba                               | Scott Street, TOOWOOMBA QLD 4350                              |\n| 111  | St. Vincent’s Private Hospital                                 | 406 Victoria Street, DARLINGHURST NSW 2010                    |\n| 112  | St. Vincent’s Private Hospital                                 | 59 Victoria Parade, FITZROY VIC 3065                          |\n| 113  | Strathfield Private Hospital                                   | 3 Everton Road, STRATHFIELD NSW 2135                          |\n| 114  | Sydney Adventist Private Hospital                              | 185 Fox Valley Road, WAHROONGA NSW 2076                       |\n| 115  | Tamara Private Hospital                                        | 2-6 Dean Street, TAMWORTH NSW 2340                            |\n| 116  | The Adelaide Clinic                                            | 33-36 Park Terrace, GILBERTON SA 5081                         |\n| 117  | The Albert Road Clinic                                         | 31-33 Albert Road, MELBOURNE VIC 3004                         |\n| 118  | The Avenue Private Hospital                                    | 40 The Avenue, WINDSOR VIC 3128                               |\n| 119  | The Bays Hospital Mornington Campus                            | 262 -272 Main Street, MORNINGTON VIC 3931                     |\n| 120  | The Valley Private Hospital                                    | Cnr Police & Gladstone Roads, MULGRAVE VIC 3170               |\n| 121  | Toowong Private Hospital                                       | 496 Milton Rd, TOOWONG QLD 4066                               |\n| 122  | Toronto Private Hospital                                       | Carey Street, TORONTO NSW 2283                                |\n| 123  | Vaucluse Private Hospital                                      | 82 Moreland Road, BRUNSWICK VIC 3056                          |\n| 124  | Wakefield Hospital                                             | 300 Wakefield Street, ADELAIDE SA 5000                        |\n| 125  | Wangaratta Private Hospital                                    | 134-150 Templeton Street, WANGARATTA VIC 3677                 |\n| 126  | Warners Bay Private Hospital                                   | Fairfax Road, WARNERS BAY NSW 2282                            |\n| 127  | Warringal Private Hospital                                     | 216 Burgundy Street, HEIDELBERG VIC 3084                      |\n| 128  | Waverly Private Hospital                                       | 343-357 Blackburn Road, MOUNT WAVERLY VIC 3149                |\n| 129  | Westmead Rehabilitation Centre                                 | 7 Coleman Street, MERRYLANDS NSW 2160                         |\n| 130  | Westside Private Hospital                                      | 55 Burwood Road, CONCORD NSW 2139                             |\n| 131  | Wolper Jewish Private Hospital                                 | 8 Trelawney Street, WOOLLAHRA NSW 2025                        |\n\n(2) Table B specifies private day hospital facilities for the purpose of the definition of “facility” in subclause 1(1) of this Schedule 5.","sortOrder":4},{"sectionNumber":"Table B: Specified Private Day Hospital ","sectionType":"part","heading":"Table B: Specified Private Day Hospital Facilities","content":"## Table B: Specified Private Day Hospital Facilities\n\n| Item | Facility Name                             | Address                                                                 |\n| ---- | ----------------------------------------- | ----------------------------------------------------------------------- |\n| 1    | Aesthetic Day Surgery                     | 14 Kensington Street, KOGARAH NSW 2217                                  |\n| 2    | Avenue Day Surgery                        | 20 The Avenue, WINDSOR VIC 3181                                         |\n| 3    | Ballina Day Surgery                       | 46 Tamar Street, BALLINA NSW 2478                                       |\n| 4    | Bankstown Primary Health Care Day Surgery | Grnd Floor, 67 Rickard Road, BANKSTOWN NSW 2200                         |\n| 5    | Broadmeadow Day Surgery                   | 1st Floor (Suite 1), 18 Lambton Road, BROADMEADOW NSW 2292              |\n| 6    | Buderim Gastroenterology Centre           | 139 King Street, BUDERIM QLD 4556                                       |\n| 7    | Calvary Day Procedure Centre              | 329,31,333 Edward Street, WAGGA WAGGA NSW 2651                          |\n| 8    | Capital Day Surgery Centre                | Calvary Clinic, Mary Potter Circuit, BRUCE ACT 2617                     |\n| 9    | Carringbah Day Surgery                    | 42 President Avenue, CARRINGBAH NSW 2229                                |\n| 10   | Chasely Day Surgery                       | Wesley Medical Centre, 40 Chasely Street, AUCHENFLOWER QLD 4066         |\n| 11   | Chesterville Day Hospital                 | 28 Chesterville Road, CHELTENHAM VIC 3192                               |\n| 12   | Coffs Harbour Day Surgical Centre         | 69 Albany Street, COFFS HARBOUR NSW 2450                                |\n| 13   | Colin Street Day Surgery                  | 51 Colin Street, WEST PERTH WA 6005                                     |\n| 14   | Coolenberg Clinic                         | 60 Lake Rd, PORT MACQUARIE NSW 2444                                     |\n| 15   | Dandenong Eye Clinic & Day Surgery Centre | 1-3 Falkiner Crescent, DANDENONG VIC 3175                               |\n| 16   | Epping Surgery Centre                     | Suite 3, Oxford Place, 44-46 Oxford Street EPPING NSW 2121              |\n| 17   | Griffiths Road Day Procedure Centre       | 182 Christo Road, WARATAH NSW 2298                                      |\n| 18   | Harley Place Day Surgery                  | Suite 605, 251 Oxford Street, BONDI JUNCTION NSW 2022                   |\n| 19   | Healthwoods Specialist Centre             | 53 Cowper Street, GRANVILLE NSW 2142                                    |\n| 20   | Inner West Endoscopy Centre               | 311 Marrickville Road, MARRICKVILLE NSW 2204                            |\n| 21   | Liverpool Day Surgery                     | 105-119 Longstaff Avenue, MOOREBANK NSW 2170                            |\n| 22   | Logan Endoscopy Services                  | Unit 2/32 76 Beaudesert Road, BROWN PLAINS QLD 4118                     |\n| 23   | Mater Misericordiae Day Unit Mackey       | 1 Wellington Street, MACKAY QLD 4740                                    |\n| 24   | Montserrat Day Hospital                   | 383 – 391 Samford Road, GAYTHORNE QLD 4051                              |\n| 25   | Montserrat Day Hospital (Indooroopilly)   | 12 Riverview Tce, INDOOROOPILLY QLD 4068                                |\n| 26   | Montserrat Day Hospital (Spring Hill)     | Level 2, 35 Astor Rce, BRISBANE QLD 4000                                |\n| 27   | Ophthalmic Surgery Centre                 | Suite 6, 12-14 Malvern Avenue, CHATSWOOD NSW 2067                       |\n| 28   | Orange Day Surgery Centre                 | 60 McNamara Street, ORANGE NSW 2800                                     |\n| 29   | Pacific Day Surgery                       | 38 Misterton Street, FORTITUDE VALLEY QLD 4006                          |\n| 30   | Peninsula Eye Centre                      | 47 Redcliffe Parade, REDCLIFFE QLD 4020                                 |\n| 31   | Perfect Vision Eye Surgery                | Suite 3, 25 –29 Hunter Street, HORNSBY NSW 2077                         |\n| 32   | Pindara Day Procedure Centre              | 13 Carrara Street, BENOWA QLD 4217                                      |\n| 33   | QFG Day Theatres                          | Level 4/33 North Street, SPRING HILL QLD 4000                           |\n| 34   | Randwick Day Surgery                      | 2 Eurimble Avenue, RANDWICK NSW 2031                                    |\n| 35   | Roderick Street Day Surgery               | 23 Roderick Street, IPSWICH QLD 4305                                    |\n| 36   | Rosebud SurgiCentre                       | 1537 Point Nepean Road, ROSEBUD WEST VIC 3940                           |\n| 37   | Short Street Day Surgery                  | 2 Short Street, SOUTHPORT QLD 4215                                      |\n| 38   | Solander Day Surgery                      | 182 Grafton St, CAIRNS QLD 4870                                         |\n| 39   | South Coast Digestive Disease Centre      | 86 Ashmore Road, BUNDALL QLD 4217                                       |\n| 40   | South Western Day Surgery Centre          | 20-22 Bigge Street, LIVERPOOL NSW 2170                                  |\n| 41   | Sydney Day Surgery                        | 213-219 Darlinghurst Road, DARLINGHURST NSW 2010                        |\n| 42   | Sydney IVF – Liverpool                    | 173-175 Biggs Street, LIVERPOOL NSW 2170                                |\n| 43   | Sydney IVF Clinic                         | 4 O’Connell Street, SYDNEY NSW 2000                                     |\n| 44   | Sydney Oculoplastic Surgery               | 229 Macquarie St, SYDNEY NSW 2000                                       |\n| 45   | Sydney Retina Clinic & Day Surgery        | Level 13, 187 Macquarie Street, SYDNEY NSW 2000                         |\n| 46   | Terrace West Endoscopy Centre             | 18 Limestone Street, IPSWICH QLD 4305                                   |\n| 47   | The CAPS Clinic                           | John James Memorial Hospital, Strickland Crescent, DEAKIN WEST ACT 2600 |\n| 48   | The Eye Institute                         | Level 4, 270 Victoria Ave, CHATSWOOD NSW 2057                           |\n| 49   | The Hills Parenting Centre                | 103-108 Showground Road, CASTLE HILL NSW 2154                           |\n| 50   | The San Day Surgery                       | 1a Northcote Road, HORNSBY NSW 2077                                     |\n| 51   | Vista Laser Eye Clinics                   | 1 Mclaren Street, NORTH SYDNEY NSW 2060                                 |\n| 52   | West Lakes Day Surgery                    | 151 Brebner Drive, WEST LAKES SA 5021                                   |\n| 53   | Western Plains Day Surgery                | 62 Windsor Parade, DUBBO NSW 2830                                       |","sortOrder":5},{"sectionNumber":"4. Transitional provision for facilities","sectionType":"part","heading":"4. Transitional provision for facilities no longer specified in clause 3","content":"# 4. Transitional provision for facilities no longer specified in clause 3\n\n(1) If a determination is made removing a facility from clause 3, the facility is deemed to remain specified in clause 3 only for such period of time and for such purposes as are necessary to allow members of RHBOs to receive the benefit of the second tier default benefit, in relation to episodes of hospital treatment for which those members were admitted patients at the facility or booked for hospital treatment at the facility (as opposed to merely being on the facility’s waiting list) prior to the date the determination removing the facility from clause 3 took effect.\n\n(2) If, because of a name or address change, a facility is no longer specified in clause 3, the facility is deemed to remain specified in clause 3 only for such period of time and for such purposes as are necessary to allow members of RHBOs to receive the benefit of the second tier default benefit, in relation to episodes of hospital treatment for which those members were admitted patients at the facility or booked for hospital treatment at the facility (as opposed to merely being on the facility’s waiting list) prior to the date the facility changed its name or address.\n\n  \nSCHEDULE 6 – CARE PLANS AND CASE CONFERENCING\n\nThe benefit payable by a Registered Health Benefits Organisation (RHBO) in respect of the following episodes of hospital treatment provided in hospitals or day hospital facilities in all States and Territories must be an amount at least equal to 25% of the Schedule fee (in accordance with Schedule 1, paragraph (ea) of Schedule 1, of the Act:\n\n-   Care plans and case conferencing for patients (other than nursing home type patients) with chronic conditions and multidisciplinary care needs, under Medicare Benefits Schedule item numbers:\n\n746, 749, 757, 830, 832, 834, 835, 837, 838, 861, 864, 866\n\nSCHEDULE 7 – OUTREACH SERVICES\n\nHOSPITAL AND DAY HOSPITAL FACILITIES IN ALL STATES AND TERRITORIES\n\nAn outreach service means any service specified in a determination made under section 5D of the Act, that is provided to a patient by, or on behalf of, a hospital or a day hospital facility, as a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility, but does not include service provided by a medical practitioner that would attract a Medicare benefit of 85% of the Schedule fee.\n\nThe benefit payable by a Registered Health Benefits Organisation (RHBO) in respect of an outreach service provided by a hospital or day hospital facility in the following States and Territories must be an amount of no less than:\n\n|                                 | BENEFIT PAYABLE PER DAY |\n| ------------------------------- | ----------------------- |\n|                                 |                         |\n| New South Wales                 | $157                    |\n| Victoria                        | $157                    |\n| Queensland                      | $157                    |\n| South Australia                 | $157                    |\n| Western Australia               | $157                    |\n| Tasmania                        | $157                    |\n| Australian Capital Territory    | $157                    |\n| Northern Territory              | $157                    |\n| Private Hospitals               | $157                    |\n| Private Day Hospital Facilities | $157                    |\n|                                 |                         |","sortOrder":6}],"analysis":{"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-realtime","completionTokens":1893},"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"The legislation maintains its original scope of establishing second tier default benefit mechanisms for hospital treatment episodes. The inclusion of specific facility lists, transitional provisions for de-listed hospitals, and separate schedules for care plans and outreach services operates within the primary statutory purpose of determining benefit entitlements under paragraph (1)(bj) of Schedule 1 of the National Health Act 1953."},"complexity_factors":["Mathematical formulas with variables (Rji, Rj) for calculating average charges across multiple contracts","6 distinct hospital classification categories requiring comparable facility analysis","Nested conditional logic with cascading exceptions (subclause 8 overrides clauses 3, 6, and 7 if below Schedule minimums)","Cross-references to 4 other Schedules (1, 2, 3, 7) and 2 separate Acts (National Health Act 1953 and Health Insurance Act 1973)","State-based calculation requirements with special aggregation rules when fewer than 5 contracts exist","184 specific facilities listed in tabular format requiring individual specification","Dual-track calculation system distinguishing between rehabilitation episodes (AN-SNAP classification) and non-rehabilitation episodes"],"plain_english_summary":"This law creates a safety‑net minimum payment — a \"second tier default benefit\" — that private insurers must pay when their members use certain private hospitals or day‑surgery facilities that aren’t contracted with the insurer. It requires insurers to pay at least 85% of their average contracted rate for similar care in the state, with special rules for rehabilitation (AN‑SNAP), and higher standard minimums overriding the 85% where applicable.\n\nIt also sets modest benefits for chronic care planning (25% of the Medicare fee) and outreach/hospital‑at‑home services ($157/day), and protects patients already booked or admitted if a facility is later removed from the list."}},"importantCases":[],"_links":{"self":"/api/acts/national-health-act-1953-determination-under-schedule-1-paragraph-1-bj-hib-14-2006","history":"/api/acts/national-health-act-1953-determination-under-schedule-1-paragraph-1-bj-hib-14-2006/history","analysis":"/api/acts/national-health-act-1953-determination-under-schedule-1-paragraph-1-bj-hib-14-2006/analysis","conflicts":"/api/acts/national-health-act-1953-determination-under-schedule-1-paragraph-1-bj-hib-14-2006/conflicts","importantCases":"/api/acts/national-health-act-1953-determination-under-schedule-1-paragraph-1-bj-hib-14-2006/important-cases","documents":"/api/acts/national-health-act-1953-determination-under-schedule-1-paragraph-1-bj-hib-14-2006/documents"}}