This Act has been repealed and is no longer in force. It is retained for historical reference.

This rule creates a “second tier default benefit” that sets minimum payments private insurers (RHBOs) must pay private hospitals and day-surgery centres when no contract exists, protecting insured patients from large out-of-pocket bills. It applies to 220+ listed facilities and requires insurers to pay at least 85% of their average contract rate with comparable hospitals in the same state (or a higher standard schedule rate).

Special rules: small insurers use state-wide averages; chronic care plans are paid at 25% of the Medicare fee; outreach services $162/day ($157 NT); ACT treated as NSW, NT as SA.

1. Interpretation

(1) In this Schedule:

facility means a private hospital or private day hospital facility specified in clause 3;

HPPA means hospital-purchaser provider agreement; and

RHBO means registered health benefits organization; and

similar 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.

(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.

(3) In this Schedule, private hospitals are comparable if they fall within the same class from the following list:

(a) private hospitals which provide psychiatric care for at least 50% of the episodes of hospital treatment;

(b) private hospitals which provide rehabilitation care for at least 50% of the episodes of hospital treatment;

(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;

(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;

(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.

Note: 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:

day hospital facility;
hospital-purchaser provider agreement;
private hospital; and
registered health benefits organization.

(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.

2. Minimum Level of Benefit

(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.

Note 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.

Schedule 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.

Schedule 3 sets the minimum level of benefit payable for same day accommodation in hospitals and day hospital facilities in all States and Territories.

Schedule 7 sets the minimum level of benefit payable for outreach services provided by, or on behalf of, specified hospitals and day hospital facilities.

Note 2: In situations of emergency paragraph (1)(bi) of Schedule 1 of the Act applies.

(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.

Note: RHBOs must continue to pay benefits for:

nursing-home type patients as prescribed in Schedule 4 of the Determination made under paragraph (1)(bj) of Schedule 1 of the Act;
no gap prostheses and gap permitted prostheses determined under subsections 73AAG(6) and (7) of the Act; and
care plans and case conferencing in accordance with Schedule 6 of the Determination made under paragraph (1) (bj) of Schedule 1 of the Act.

(3)(a) Subject to subclauses (6), and (7), the minimum level of benefit payable by a RHBO in respect of an 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:

(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

(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).

(b) The formula for calculating the “average charge for the equivalent episode of hospital treatment” by a RHBO in each State is as follows:

View image in the official source

Where: j = group of equivalent episodes of hospital treatment under the RHBO’s HPPAs (or similar arrangements)

i = 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= 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

Rji = charge for episode of hospital treatment type j in contract i

Rj = average charge for episode of hospital treatment type j

(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:

(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

(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).

(5) In subclause (3), for the purpose of calculating the “average charge for the equivalent episode of hospital treatment” in a State:

(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.

Note: RHBO members’ financial obligations under such levels of cover will still apply.

(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

(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.

(6) Subject to subclause (7), 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.

(7) If the minimum level of benefit payable under subclauses (3) or (6) 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.

3. Specified Private Hospitals and Private Day Hospital Facilities

(1) Table A specifies private hospitals for the purpose of the definition of “facility” in subclause 1(1) of this Schedule 5.

Table A: Specified Private Hospitals

Item	Facility Name	Address
1	(Alpha) Westmead Private Hospital	Corner of Mons and Darcy Roads, WESTMEAD NSW 2145
2	Albury-Wodonga Private Hospital	1125 Pemberton Street, ALBURY NSW 2640
3	Armidale Private Hospital	Rusden St, ARMIDALE NSW 2350
4	Attadale Private Hospital	21 Hislop Road, ATTADALE WA 6156
5	Baringa Private Hospital	Mackay’s Road, COFFS HARBOUR NSW 2450
6	Bega Valley Private Hospital	31 Parker Street, BEGA NSW 2550
7	Beleura Private Hospital	925 Nepean Highway, MORNINGTON VIC 3931
8	Berkeley Vale Private Hospital	8 Lorraine Avenue, BERKELEY VALE NSW 2261
9	Bethesda Hospital	25 Queenslea Drive, CLAREMONT WA 6010
10	Blackwood Hospital Group	13 Laffers Road, BELAIR SA 5052
11	Bondi Junction Private Hospital	21 Spring St, BONDI JUNCTION NSW 2022
12	Brisbane Private Hospital	259 Wickham Tce, BRISBANE QLD 4000
13	Caboolture Private Hospital	McKean Street, CABOOLTURE QLD 4510
14	Cabrini Brighton	243 New Street, BRIGHTON VIC 3186
15	Cairns Private Hospital	1 Upward Street, CAIRNS QLD 4870
16	Caloundra Private Hospital	96 Beerburrum Street, CALOUNDRA QLD 4566
17	Calvary Health Care ACT	Calvary Public and Private Hospital, Haydon Drive, BRUCE ACT 2617
18	Calvary Health Care Tasmania – Hobart (Lenah Valley Campus)	49 Augusta Road, LENAH VALLEY TAS 5333
19	Calvary Health Care Sydney – Hurtstville Community	37 Gloucester Road, HURSTVILLE NSW 2220
20	Calvary Health Care Tasmania – Hobart (St John’s Campus)	30 Cascade Road, SOUTH HOBART TAS 7004
21	Calvary Health Care Tasmania – Launceston (St Luke’s Campus)	24 Lyttleton Street, LAUNCESTON TAS 7250
22	Calvary Health Care Tasmania – Launceston (St Vincent’s Campus)	5 Frederick Street, LAUNCESTON TAS 7250
23	Calvary Hospital Adelaide	89 Strangways Terrace, NORTH ADELAIDE SA 5006
24	Calvary Private Hospital (Riverina)	Hardy Ave, WAGGA WAGGA NSW 2650
25	Castle Hill Hospital	72-74 Cecil Avenue, CASTLE HILL NSW 2154
26	Canada Bay Private Hospital	55-57 Burwood Road, CONCORD NSW 2137
27	Castlecrag Private Hospital	150 Edinburgh Road, CASTLECRAG NSW 2068
28	Cedar Court Healthsouth Rehabilitation Hospital	888 Toorak Road, CAMBERWELL VIC 3124
29	Central Districts Private Hospital	25-37 Jarvis Road, ELIZABETH VALE SA 5112
30	Coastal Private Hospital	221 Willmott Drive. WAIKIKI WA 6169
31	College Grove Rehabilitation Hospital	18 North East Road, WALKERVILLE SA 5081
32	Dalcross Private Hospital	28 Stanhope Road , KILLARA NSW 2071
33	Delmar Private Hospital	58 Quirk Street, DEE WHY NSW 2099
34	Delmont Private Hospital	298 Warrigal Road, GLEN IRIS VIC 3146
35	Donvale Rehabilitation Hospital	1119-1121 Doncaster Road, DONVALE VIC 3111
36	Dudley Private Hospital	261 March Street, ORANGE NSW 2800
37	Eastern Suburbs Private Hospital	8 Chapel Street, RANDWICK NSW 2031
38	Figtree Private Hospital	1 Suttor Place, FIGTREE NSW 2525
39	Frances Perry Private Hospital	285 Cardigan Street, CARLTON 3053
40	Friendly Society Private Hospital	19-23 Bingera Street, BUNDABERG QLD 4670
41	Fullarton Private Hospital	293-295 Fullarton Road, PARKSIDE SA 5063
42	Glenferrie Private Hospital	25 Linda Crescent, HAWTHORN 3122
43	Glengarry Private Hospital	53 Arnisdale Road, DUNCRAIG WA 6023
44	Greenslopes Private Hospital	Newdegate Street, GREENSLOPES QLD 4120
45	Hawkesbury District Health Service	Level 2, 16-18 Bridge Street, EPPING NSW 2121
46	Hervey Bay Surgical Centre	Cnr O’Rourke Street & Boat Harbour Drive, PIALBA QLD 4655
47	Hillcrest-Rockhampton Private Hospital	4 Talford Street, ROCKHAMPTON QLD 4700
48	Hollywood Private Hospital	Monash Avenue, NEDLANDS WA 6009
49	Holroyd Private Hospital	123-129 Chetwynd Road, GUILDFORD NSW 2161
50	Holy Spirit Northside	627 Rode Road, CHERMSIDE QLD 4032
51	Hopetoun Rehabilitation Hospital	2-6 Hopetoun Street, ELSTERNWICK VIC 3185
52	Hopewell Hospice	11 Dunkirk Close, ARUNDEL QLD 4212
53	Hunters Hill Private Hospital	9 Mount Street, HUNTERS HILL NSW 2110
54	John Flynn Private Hospital	42 Inland Drive, TUGUN QLD 4224
55	Joondalup Private Hospital	Corner Grand Boulevard and Shenton Avenue, JOONDALUP WA 6027
56	Kahlyn Private Hospital	40 Briant Road, MAGILL SA 5072
57	Kareena Private Hospital	86 Kareena Road, CARINGTON NSW 2229
58	Kawana Private Hospital	Suite 14, Level 1, Innovation Parkway, BIRTINYA QLD 4575
59	Lake Macquarie Private Hospital	3 Sydney Street, GATESHEAD NSW 2290
60	Lawrence Hargrave Private Hospital	72 Phillip Street, THIRROUL NSW 2515
61	Linacre Private Hospital	12 Linacre Road, HAMPTON VIC 3188
62	Macarthur Private Hospital	92-96 Dumaresq Street, CAMPBELLTOWN NSW 2560
63	Maitland Private Hospital	173 Chisholm Road, EAST MAITLAND NSW 2323
64	Manly Waters Private Hospital	17 Cove Avenue, MANLY NSW 2095
65	Maryvale Private Hospital	McDonald Street, MORWELL VIC 3840
66	Masada Private Hospital	26 Balaclava Road, EAST ST KILDA VIC 3183
67	Mater Hospital Yeppoon	55 Cliff Street, YEPPOON QLD 4703
68	Mater Misericordiae Hospital Bundaberg	313 Bourbong Street, BUNDABERG QLD 4670
69	Mater Misericordiae Hospital Gladstone	Rossella Street, GLADSTONE QLD 4680
70	Mater Misericordiae Hospital Mackay	76 Willetts Road, NORTH MACKAY QLD 4740
71	Mater Misericordiae Hospital Rockhampton	cnr Ward & Jessie Streets, ROCKHAMPTON QLD 4700
72	Mater Misericordiae Private Hospital (South Brisbane)	301 Vulture Street, SOUTH BRISBANE QLD 4101
73	Mater Misericordiae Private Hospital Townsville	21 Fulham Road, PIMLICO QLD 4810
74	Mater Misericordiae Women’s & Children’s Private Health Service (Children’s Campus)	Cnr Raymond Terrace & Stanley Street, SOUTH BRISBANE QLD 4101
75	Mater Misericordiae Women’s & Children’s Private Health Service (Women’s Campus)	Raymond Terrace, SOUTH BRISBANE QLD 4101
76	Mater Private Hospital Redland	Weippin Street, CLEVELAND QLD 4163
77	Mater Misericordiae Private Hospital	35 Rocklands Road, CROWS NEST NSW 2065
78	Mayo Private Hospital	Lot 1, Potoroo Drive, Kolodong, VIA TAREE NSW 2430
79	Minchinbury Community Private Hospital	Rupertswood Road, MOUNT DRUITT NSW 2770
80	Mitcham Private Hospital	27 Doncaster East Road, MITCHAM VIC 3132
81	Mosman Private Hospital	1 Ellamatta Avenue, MOSMAN NSW 2088
82	Mount Olivet Hospital	411 Main Street, KANGAROO POINT QLD 4169
83	Mt Lawley Private Hospital	14 Alvan Street, MOUNT LAWLEY WA 6050
84	Mt Wilga Private Hospital	2 Manor Road, HORNSBY NSW 2077
85	Murray Valley Private Hospital	Nordsvan Drive, WODONGA,VIC 3690
86	Nambour Selangor Private Hospital	62 Netherton Street, NAMBOUR QLD 4560
87	New Farm Private Hospital	22 Sargent Street, NEW FARM QLD 4005
88	Ngala Family Resource Centre	9 George Street, KENSINGTON WA 6151
89	Noosa Private Hospital	111 Goodchap Street, NOOSAVILLE QLD 4566
90	North Eastern Private Hospital	580 Lower North East Road , CAMPBELLTOWN SA 5074
91	North Shore Private Hospital	Westbourne Street, ST LEONARDS NSW 2065
92	North West Private Hospital	137 Flockton Street, EVERTON PARK QLD 4053
93	Northside Clinic Private Hospital	2 Greenwich Road, GREENWICH NSW 2065
94	Northside Cremorne Clinic	3 Harrison Street, CREMORNE NSW 2090
95	Northside West Clinic	23-27 Lytton Street, WENTWORTHVILLE NSW 2145
96	Nowra Private Hospital	Weeroona Place, NOWRA NSW 2541
97	Pendlebury Clinic Private Hospital	Suite 3, 52 Pendlebury Road, CARDIFF NSW 2285
98	Peninsula Private Hospital (Frankston)	Cnr Cranbourne & McClelland Drive, FRANKSTON VIC 3199
99	Peninsula Private Hospital (Kippa-Ring)	cnr George and Florence Streets, KIPPA-RING QLD 4020
100	Perth Clinic	29 Havelock St, WEST PERTH WA 6005
101	Pindara Gold Coast Private Hospital	Allchurch Avenue, BENOWA QLD 4217
102	Pinelodge Clinic Private Hospital Dandenong	1480 Heatherton Road, DANDENONG VIC 3175
103	Poplars Private Hospital	66 Norfolk Road, EPPING NSW 2121
104	Port Macquarie Private Hospital	Lake Road, PORT MACQUARIE NSW 2444
105	Rivercity Private Hospital	401 Milton Road, AUCHENFLOWER QLD 4066
106	Saint Frances Xavier Cabrini Hospital (Malvern)	181-183 Wattletree Road, MALVERN VIC 3144
107	Saint Frances Xavier Cabrini Hospital (Prahran)	646 High Street, PRAHRAN EAST VIC 3181
108	Shellharbour Private Hospital	27 Captain Cook Drive, BARRACK HEIGHTS NSW 2528
109	Shepparton Private Hospital	Fitzgerald Street, SHEPPARTON VIC 3630
110	South Pacific Private Hospital	18 Beach Street, HARBORD NSW 2096
111	South Perth Hospital	76 South Terrace, COMO WA 6152
112	Southern Highlands Private Hospital	99 Bowral Street, BOWRAL NSW 2576
113	Spendelove House Private Hospital	24 Spendelove Avenue, SOUTHPORT QLD 4215
114	Sportsmed.SA Hospital	32 Payneham Road, STEPNEY SA 5069
115	St Andrew’s Ipswich Private Hospital	Corner Roderick and Pring Streets, IPSWICH QLD 4305
116	St Andrew’s Toowoomba Hospital	280 North Street, TOOWOOMBA QLD 4350
117	St George Private Hospital	1 South Street, KOGARAH NSW 2217
118	St John of God Health Care (Warrnambool)	136 Botanic Road, WARRNAMBOOL VIC 3280
119	St John of God Health Care (Ballarat)	101 Drummond Street North, BALLARAT VIC 3350
120	St John of God Health Care Berwick	Gibb Street, BERWICK VIC 3806
121	St John of God Healthcare Nepean Rehabilitation Hospital	255 Cranbourne Road, FRANKSTON VIC 3199
122	St John of God Hospital Bendigo	Lily Street, BENDIGO VIC 3552
123	St John of God Hospital Bunbury	Cnr Robertson Drive & Bussell Highway, BUNBURY WA 6230
124	St John of God Hospital Geelong	80 Myers Street, GEELONG VIC 3220
125	St John of God Hospital Geraldton	12 Hermitage Street, GERALDTON WA 6530
126	St John of God Hospital Murdoch	100 Murdoch Drive, MURDOCH WA 6150
127	St John of God Hospital Subiaco	12 Salvado Road, SUBIACO WA 6008
128	St Luke’s Hospital Complex	18 Rosalyn Street, POTTS POINT NSW 2011
129	St Vincent’s & Mercy Private Hospital, Mercy Campus	159 Grey Street, MELBOURNE EAST VIC 3002
130	St Vincent’s Hospital (Toowoomba)	Scott Street, TOOWOOMBA QLD 4350
131	St Vincent’s Private Hospital (Bathurst)	Gorman’s Hill Road, BATHURST NSW 2795
132	St Vincent’s Private Hospital (Fitzroy)	59 Victoria Parade, FITZROY VIC 3065
133	Stirling District Hospital	20 Milan Terrace, STIRLING SA 5152
134	Sydney Adventist Private Hospital	185 Fox Valley Road, WAHROONGA NSW 2076
135	Tamara Private Hospital	2-6 Dean Street, TAMWORTH NSW 2340
136	The Adelaide Clinic	33 Park Terrace, GILBERTON SA 5081
137	The Albert Road Clinic	31-33 Albert Road, SOUTH MELBOURNE SA 3004
138	The Avenue Private Hospital	40 The Avenue, WINDSOR VIC 3128
139	The Bays Hospital – Mornington	262-268 Main Street, MORNINGTON VIC 3931
140	The Hornsby Sleep Disorder and Diagnostic Centre	104 Balmoral Street, WAITARA NSW 2077
141	The Burnside War Memorial Hospital	120 Kensington Road, TOORAK GARDENS SA 5065
142	The Marian Centre	187 Cambridge Street, WEMBLEY WA 6014
143	The Sydney Private Hospital	63 Victoria Street, ASHFIELD NSW 2131
144	The Valley Private Hospital	Corner Police and Gladstone Roads, MULGRAVE VIC 3170
145	Toowong Private Hospital	496 Milton Rd, TOOWONG QLD 4066
146	Toronto Private Hospital	Cary Street, TORONTO NSW 2283
147	Vaucluse Private Hospital	82 Moreland Road, BRUNSWICK VIC 3056
148	Wakefield Hospital	300 Wakefield Street, ADELAIDE SA 5000
149	Wandene Private Hospital	7 Blake Street, KOGARAH NSW 2217
150	Wangaratta Private Hospital	134-150 Templeton Street, WANGARATTA VIC 3677
151	Warners Bay Private Hospital	Fairfax Road, WARNERS BAY NSW 2282
152	Warringal Private Hospital	216 Burgundy Street, HEIDELBERG VIC 3084
153	Waverly Private Hospital	343-357 Blackburn Road, MOUNT WAVERLY VIC 3149
154	Wesley Private Hospital	91 Milton Street, ASHFIELD NSW 2131
155	Western Private Hospital	Corner Eleanor and Marion Streets, FOOTSCRAY VIC 3012
156	Westmead Rehabilitation Centre	7 Coleman Street, MERRYLANDS NSW 2160
157	Wolper Jewish Private Hospital	8 Trelawney Street, WOOLLAHRA NSW 2025

(2) Table B specifies private day hospital facilities for the purpose of the definition of “facility” in subclause 1(1) of this Schedule 5.

Table B: Specified Private Day Hospital Facilities

Item	Facility Name	Address
1	Aesthetic Day Surgery	14 Kensington Street, KOGARAH NSW 2217
2	Ballina Day Surgery	46 Tamar Street, BALLINA NSW 2478
3	Bankstown Primary Health Care Day Surgery	67 Rickard Road, BANKSTOWN NSW 2200
4	Broadmeadow Day Surgery	1st Floor (Suite 1), 18 Lambton Road, BROADMEADOW NSW 2292
5	Buderim Gastroenterology Centre(Maroochydore)	Suite 5, 102 Wises Road, MAROOCHYDORE QLD 4558
6	Calvary Day Procedure Centre	329, 331, 333 Edward Street, WAGGA WAGGA NSW 2650
7	Capital Day Surgery Centre	Calvary Clinic, Mary Potter Circuit, BRUCE ACT 2617
8	Caringbah Day Surgery	42 President Avenue, CARINGBAH NSW 2229
9	Chasely Day Surgery	Wesley Medical Centre, 40 Chasely Street, AUCHENFLOWER QLD 4066
10	Chesterville Day Hospital	26-28 Chesterville Road, CHELTENHAM VIC 3192
11	Coffs Harbour Day Surgery Centre	69 Albany Street, COFFS HARBOUR NSW 2450
12	Colin Street Day Surgery	51 Colin Street, WEST PERTH WA 6005
13	Coolenberg Clinic	60 Lake Rd, PORT MACQUARIE NSW 2444
14	Dandenong Eye Clinic & Day Surgery Centre	1-3 Falkiner Crescent, DANDENONG VIC 3175
15	Epping Surgery Centre	Suite 3, 44 Oxford Street, EPPING NSW 2121
16	Eye-Tech Day Surgeries	Level 3, St Andrew’s Place, North Street, SPRING HILL QLD 4000
17	Eye-Tech Day Surgeries Southside	22-26 Sanders Street, UPPER MOUNT GRAVATT QLD 4122
18	Griffiths Road Day Procedure Centre	182 Christo Road, WARATAH NSW 2298
19	Harley Place Day Surgery	Suite 605, 251 Oxford Street, BONDI JUNCTION NSW 2022
20	Healthwoods Specialist Centre	53 Cowper Street, GRANVILLE NSW 2142
21	Inner West Endoscopy Centre	311 Marrickville Road, MARRICKVILLE NSW 2204
22	Liverpool Day Surgery	105-119 Longstaff Avenue, MOOREBANK NSW 2170
23	Logan Endoscopy Services	Unit 2/32 76 Beaudesert Road, BROWN PLAINS QLD 4118
24	Logan Surgery Centre	Unit 12, 13-21 Mayes Avenue, LOGAN CENTRAL QLD 4114
25	Mater Misericordiae Day Unit (Mackay)	1 Wellington Street, MACKAY QLD 4740
26	Melbourne Oral & Facial Surgery	Level 12, 63 Exhibition Street, Scala House, MELBOURNE VIC 3000
27	Montserrat Day Hospital (Gaythorne)	383 – 391 Samford Road, GAYTHORNE QLD 4051
28	Montserrat Day Hospital (Indooroopilly)	12 Riverview Tce, INDOOROOPILLY QLD 4068
29	Montserrat Day Hospital (Spring Hill)	Level 2, 35 Astor Tce, BRISBANE QLD 4000
30	Murdoch Surgicentre	100 Murdoch Drive, MURDOCH WA 6150
31	Ophthalmic Surgery Centre	Suite 6, 12-14 Malvern Avenue, CHATSWOOD NSW 2067
32	Orange Day Surgery Centre	60 McNamara Street, ORANGE NSW 2800
33	Pacific Day Surgery	38 Misterton Street, FORTITUDE VALLEY QLD 4006
34	Peninsula Eye Centre	47 Redcliffe Parade, REDCLIFFE QLD 4020
35	Perfect Vision Eye Surgery	Suite 3, 25 –29 Hunter Street, HORNSBY NSW 2077
36	Pindara Day Procedure Centre	13 Carrara Street, BENOWA QLD 4217
37	QFG Day Theatres	1st & 4th Floor, St Andrew’s Place, North Street, SPRING HILL QLD 4000
38	Randwick Day Surgery	2 Eurimble Avenue, RANDWICK NSW 2031
39	Roderick Street Day Surgery	23 Roderick Street, IPSWICH QLD 4305
40	Rosebud SurgiCentre	1537 Point Nepean Road, ROSEBUD WEST VIC 3940
41	Short Street Day Surgery	2 Short Street, SOUTHPORT QLD 4215
42	Solander Day Surgery	182 Grafton St, CAIRNS QLD 4870
43	South Coast Digestive Diseases Centre	86 Ashmore Road, BUNDALL QLD 4217
44	South Western Day Surgery Centre	20-22 Bigge Street, LIVERPOOL NSW 2170
45	St Kilda Day Hospital	26A Dickens Street, ELWOOD VIC 3184
46	Sydney Day Surgery	213-219 Darlinghurst Road, DARLINGHURST NSW 2010
47	Sydney Eastern Eye Centre	11a Fullerton Street, WOOLLAHRA NSW 2025
48	Sydney Eye Specialist Centre	2 Middle Street, KINGSFORD NSW 2032
49	Sydney Haematology & Oncology Clinics	Unit 13/49 Palmerston Road, HORNSBY NSW 2077
50	Sydney IVF – Liverpool	173-175 Biggs Street, LIVERPOOL NSW 2170
51	Sydney IVF Clinic	4 O’Connell Street, SYDNEY NSW 2000
52	Sydney Oculoplastic Surgery	229 Macquarie St, SYDNEY NSW 2000
53	Sydney Retina Clinic & Day Surgery	Level 13, 187 Macquarie Street, SYDNEY NSW 2000
54	Terrace West Endoscopy Centre	18 Limestone Street, IPSWICH QLD 4305
55	The CAPS Clinic	Strickland Crescent, DEAKIN ACT 2600
56	The Double Bay Day Surgery	20 Manning Road, DOUBLE BAY NSW 2028
57	The Eye Institute	Level 4, 270 Victoria Avenue, CHATSWOOD NSW 2057
58	The Hills Parenting Centre	103-108 Showground Road, CASTLE HILL NSW 2154
59	The San Day Surgery	1a Northcote Road, HORNSBY NSW 2077
60	Townsville Day Surgery	1 Martinez Avenue, West End, TOWNSVILLE QLD 4810
61	Vista Laser Eye Clinics NSW	1 McClaren St, NORTH SYDNEY NSW 2060
62	West Lakes Day Surgery	151 Brebner Drive, WEST LAKES SA 5021
63	Western Plains Day Surgery	62 Windsor Parade, DUBBO NSW 2850

4. Transitional provision for facilities no longer specified in clause 3

(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.

(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.

SCHEDULE 6 – CARE PLANS AND CASE CONFERENCING

The benefit payable by a Registered Health Benefits Organization (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:

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:

746, 749, 757, 830, 832, 834, 835, 837, 838, 861, 864, 866 871* 872* 880

2978 2984 2988 2992 2996 3000 3069 3074 3078 3083 3088 3093

* Only applies to private patients in a private or public hospital.

SCHEDULE 7 – OUTREACH SERVICES

HOSPITAL AND DAY HOSPITAL FACILITIES IN ALL STATES AND TERRITORIES

An 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.

The benefit payable by a Registered Health Benefits Organization (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:

	BENEFIT PAYABLE PER DAY

New South Wales	$162
Victoria	$162
Queensland	$162
South Australia	$162
Western Australia	$162
Tasmania	$162
Australian Capital Territory	$162
Northern Territory	$157
Private Hospitals	$162
Private Day Hospital Facilities	$162