Commonwealth legislation

National Health Act 1953 - Determination under Schedule 1, paragraph (1)(bj) (HIB 14/2006)

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This Act has been repealed and is no longer in force. It is retained for historical reference.

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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.

It 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.

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Current sections

Direct links to the current provisions in National Health Act 1953 - Determination under Schedule 1, paragraph (1)(bj) (HIB 14/2006).

1. Interpretation

(1) In this Schedule:

AN-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;

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

HPPA means hospital-purchaser provider agreement;

rehabilitation 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;

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 (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:

(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:

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Where: j = group of equivalent episodes

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 (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.

(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:

(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:

(i) treatment was provided in a facility that was a private hospital; and

(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

(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:

(i) the treatment was provided in a facility that was a private day hospital facility); and

(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

(c) in any other case, an amount based on the AN-SNAP rehabilitation classification system negotiated by the RHBO and the facility.

(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.

3. Specified Private Hospitals And Priva

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	Albury Wodonga Private Hospital	1125 Pemberton Road, WEST ALBURY NSW 2640
2	Alpha Westmead Private Hospital	Corner Mons & Darcy Roads, WESTMEAD NSW 2145
3	Armidale Private Hospital	Rusden St, ARMIDALE NSW 2350
4	Attadale Private Hospital	21 Hislop Road, ATTADALE WA 6156
5	Baringa Private Hospital	Mackays Road, COFFS HARBOUR NSW 2450
6	Bega Valley Day Surgery Centre and Private Hospital	31 Parker Street, BEGA NSW 2550
7	Beleura Private Hospital	925 Nepean Highway, MORNINGTON VIC 3931
8	Berkeley Vale Private Hospital	Lorraine Avenue, BERKELEY VALE NSW 2259
9	Blackwood Hospital Group	13 Laffers Road, BELAIR SA 5052
10	Bondi Junction Private Hospital	21 Spring Street, BONDI JUNCTION NSW 2022
11	Brisbane Private Hospital	259 Wickham Tce, BRISBANE QLD 4000
12	Burnside War Memorial Hospital	120 Kensington Road, TOORAK GARDENS SA 5065
13	Caboolture Private Hospital	McKean Street, CABOOLTURE QLD 4510
14	Cabrini Brighton	243 New Street, BRIGHTON VIC 3186
15	Cabrini Hospital	183 Wattletree Road, MALVERN VIC 3144
16	Cairns Private Hospital	1 Upward Street, CAIRNS QLD 4870
17	Caloundra Private Hospital	96 Beerburrum Street, CALOUNDRA QLD 4566
18	Calvary Health Care – Lenah Valley Campus	49 Augusta Road, LENAH VALLEY TAS 7008
19	Calvary Health Care – St Johns Campus	30 Cascade Road, SOUTH HOBART TAS 7000
20	Calvary Health Care Riverina	Hardy Avenue, WAGGA WAGGA NSW 2650
21	Calvary Health Care Sydney Hurstville Community	37 Gloucester Road, HURTSVILLE NSW 2220
22	Calvary Health Care Tasmania - St Lukes Campus	24 Lyttleton Street, LAUNCESTON TAS 7250
23	Calvary Hospital - Adelaide	89 Strangways Terrace, NORTH ADELAIDE SA 5006
24	Calvary Private Hospital ACT	Haydon Drive, BRUCE ACT 2617
25	Castle Hill Hospital	72-74 Cecil Avenue, CASTLE HILL NSW 2154
26	Castlecrag Private Hospital	150 Edinburgh Road, CASTLECRAG NSW 2068
27	Cedar Court Healthsouth Rehabilitation Hospital	888 Toorak Road, CAMBERWELL VIC 3124
28	Central District Private Hospital	25 Jarvis Road, ELIZABETH VALE SA 5112
29	Coastal Private Hospital	221 Willmott Drive. WAIKIKI WA 6169
30	College Grove Hospital	18 North East Road, WALKERVILLE SA 5081
31	Delmont Private Hospital	298 Warrigal Road, GLEN IRIS VIC 3146
32	Donvale Rehabilitation Hospital	1119 Doncaster Road, DONVALE VIC 3111
33	Dudley Private Hospital	261 March Street, ORANGE NSW 2800
34	Evesham Clinic Private Hospital	3 Harrison Street, CREMORNE NSW 2090
35	Frances Perry Private Hospital	285 Cardigan Street, CARLTON 3053
36	Friendly Society Private Hospital	19-23 Bingera Street, BUNDABERG QLD 4670
37	Fullarton Private Hospital	295 Fullarton Road, PARKSIDE SA 5063
38	Glenferrie Private Hospital	25 Linda Crescent, HAWTHORN 3122
39	Glengarry Private Hospital	53 Arnisdale Road, DUNCRAIG WA 6023
40	Greenslopes Private Hospital	Newdegate Street, GREENSLOPES QLD 4120
41	Hawkesbury District Health Service	Level 2, 16-18 Bridge Street, EPPING NSW 2121
42	Hillcrest-Rockhampton Private Hospital	4 Talford Street, ROCKHAMPTON QLD 4700
43	Hollywood Private Hospital	Monash Avenue, NEDLANDS WA 6009
44	Holy Spirit Northside	627 Rode Road, CHERMSIDE QLD 4032
45	Hopetoun Rehabilitation Hospital	2-6 Hopetoun Street, ELSTERNWICK VIC 3185
46	Hunters Hill Private Hospital	9 Mount Street, HUNTERS HILL NSW 2110
47	Illawarra Private Hospital	1 Suttor Place, FIGTREE NSW 2525
48	John Flynn Private Hospital	42 Inland Drive, TUGUN QLD 4224
49	Joondalup Private Hospital	Corner Grand Boulevard and Shenton Avenue, JOONDALUP WA 6027
50	Kahlyn Private Hospital	40 Briant Road, MAGILL SA 5072
51	Kareena Private Hospital	86 Kareena Road, CARINGTON NSW 2229
52	Lake Macquarie Private Hospital	3 Sydney Street, GATESHEAD NSW 2290
53	Lawrence Hargrave Hospital	72 Phillip Street, THIRROUL NSW 2515
54	Linacre Private Hospital	12 Linacre Road, HAMPTON VIC 3188
55	Macarthur Private Hospital	92-96 Dumaresq Street, CAMPBELLTOWN NSW 2560
56	Maitland Private Hospital	173 Chisholm Road, EAST MAITLAND NSW 2323
57	Maryvale Private Hospital	McDonald Street, MORWELL VIC 3840
58	Masada Private Hospital	26 Balaclava Road, EAST ST KILDA VIC 3183
59	Mater Hospital North Sydney	Rocklands Road, NORTH SYDNEY NSW 2060
60	Mater Hospital Yeppoon	Cnr Cliff & Hutton Streets, YEPPOON QLD 4703
61	Mater Misericordia Private Hospital Brisbane	301 Vulture Street, SOUTH BRISBANE QLD 4101
62	Mater Misericordia Women’s & Children’s Private Health Service	Cnr Raymond Terrace & Stanley Street, SOUTH BRISBANE QLD 4101
63	Mater Misericordiae Hospital Bundaberg	Bourbong Street, BUNDABERG QLD 4670
64	Mater Misericordiae Private Hospital Gladstone	Rossella Street, GLADSTONE QLD 4680
65	Mater Misericordiae Private Hospital Mackay	Gordon Street, MACKAY QLD 4740
66	Mater Misericordiae Private Hospital Rockhampton	Ward Street, ROCKHAMPTON QLD 4700
67	Mater Misericordiae Private Hospital Townsville	21 Fulham Road, PIMLICO QLD 4810
68	Mater Private Hospital Redland	Weippin Street, CLEVELAND QLD 4163
69	Mayo Private Hospital	Lot 1, Potoroo Drive, Kolodong, VIA TAREE NSW 2430
70	Mercy Private Hospital	159 Grey Street, EAST MELBOURNE VIC 3002
71	Mitcham Private Hospital	27 Doncaster East Road, MITCHAM VIC 3132
72	Mt Lawley Private Hospital	14 Alvan Street, MOUNT LAWLEY WA 6050
73	Mt Olivet Hospital	411 Main Street, KANGAROO POINT QLD 4169
74	Mt Wilga Private Hospital	2 Manor Road, HORNSBY NSW 2000
75	Murray Valley Private Hospital	Nordsvan Drive, WODONGA,VIC 3690
76	Nambour Selangor Private Hospital	62 Netherton Street, NAMBOUR QLD 4560
77	New Farm Clinic Private Hospital	22 Sargent Street, NEW FARM QLD 4005
78	Ngala Family Resource Centre	9 George Street, KENSINGTON WA 6151
79	Noosa Private Hospital	111 Goodchap Street, NOOSAVILLE QLD 4566
80	North Eastern Community Hospital	Lower North East Road, CAMPBELLTOWN SA 5074
81	North Shore Private Hospital	Westbourne Street, ST LEONARDS NSW 2065
82	North West Private Hospital	137 Flockton Street, EVERTON PARK QLD 4053
83	Northside Clinic	2 Greenwich Road, GREENWICH NSW 2065
84	Northside West Clinic	21-27 Lytton Street, WENTWORTHVILLE NSW 2145
85	Nowra Private Hospital	Weeroona Place, NOWRA NSW 2541
86	Pendlebury Clinic	Suite 3, 52 Pendlebury Road, CARDIFF NSW 2285
87	Peninsula Private Hospital	49 McClelland Drive, FRANKSTON VIC 3910
88	Peninsula Private Hospital (Harbord)	12 McDonald Street, HARBORD NSW 2096
89	Perth Clinic	29 Havelock St, WEST PERTH WA 6005
90	Pindara Gold Coast Private Hospital	Allchurch Avenue, BENOWA QLD 4217
91	Pinelodge Clinic Private Hospital Dandenong	1480 Heatherton Road, DANDENONG VIC 3175
92	Poplars Private Hospital	66 Norfolk Road, EPPING NSW 2121
93	Port Macquarie Private Hospital	Lake Road, PORT MACQUARIE NSW 2444
94	RiverCity Private Hospital	401 Milton Road, AUCHENFLOWER QLD 4066
95	Shepperton Private Hospital	Fitzgerald Street, SHEPPERTON VIC 3630
96	South Eastern Private Hospital	Cnr Princes Highway & Heatherton Roads, NOBLE PARK VIC 3174
97	South Pacific Private Hospital	18 Beach Street, HARBORD NSW 2096
98	Southern Highlands Private Hospital	Bowral Street, BOWRAL NSW 2576
99	Spendelove House	24 Spendelove Street, SOUTHPORT QLD 4215
100	Sportsmed SA Hospital	32 Payneham Road, STEPNEY SA 5069
101	St Andrew’s Ipswich Private Hospital	Corner Roderick and Pring Streets, IPSWICH QLD 4305
102	St Andrews Toowoomba Hospital	280 North Street, TOOWOOMBA QLD 4350
103	St George Private Hospital	1 South Street, KORARAH NSW 2217
104	St John of God Hospital Bendigo	Lily Street, BENDIGO VIC 3552
105	St John of God Hospital Bunbury	Cnr Robertson Drive & Bussell Highway, BUNBURY WA 6230
106	St John of God Hospital Geelong	80 Myers Street, GEELONG VIC 3220
107	St John of God Hospital Geraldton	12 Hermitage Street, GERALDTON WA 6530
108	St Luke’s Hospital Complex	18 Rosalyn Street, POTTS POINT NSW 2011
109	St Vincent's Private Hospital (Bathurst)	Gorman's Hill Road, BATHURST NSW 2795
110	St. Vincent’s Hospital Toowoomba	Scott Street, TOOWOOMBA QLD 4350
111	St. Vincent’s Private Hospital	406 Victoria Street, DARLINGHURST NSW 2010
112	St. Vincent’s Private Hospital	59 Victoria Parade, FITZROY VIC 3065
113	Strathfield Private Hospital	3 Everton Road, STRATHFIELD NSW 2135
114	Sydney Adventist Private Hospital	185 Fox Valley Road, WAHROONGA NSW 2076
115	Tamara Private Hospital	2-6 Dean Street, TAMWORTH NSW 2340
116	The Adelaide Clinic	33-36 Park Terrace, GILBERTON SA 5081
117	The Albert Road Clinic	31-33 Albert Road, MELBOURNE VIC 3004
118	The Avenue Private Hospital	40 The Avenue, WINDSOR VIC 3128
119	The Bays Hospital Mornington Campus	262 -272 Main Street, MORNINGTON VIC 3931
120	The Valley Private Hospital	Cnr Police & Gladstone Roads, MULGRAVE VIC 3170
121	Toowong Private Hospital	496 Milton Rd, TOOWONG QLD 4066
122	Toronto Private Hospital	Carey Street, TORONTO NSW 2283
123	Vaucluse Private Hospital	82 Moreland Road, BRUNSWICK VIC 3056
124	Wakefield Hospital	300 Wakefield Street, ADELAIDE SA 5000
125	Wangaratta Private Hospital	134-150 Templeton Street, WANGARATTA VIC 3677
126	Warners Bay Private Hospital	Fairfax Road, WARNERS BAY NSW 2282
127	Warringal Private Hospital	216 Burgundy Street, HEIDELBERG VIC 3084
128	Waverly Private Hospital	343-357 Blackburn Road, MOUNT WAVERLY VIC 3149
129	Westmead Rehabilitation Centre	7 Coleman Street, MERRYLANDS NSW 2160
130	Westside Private Hospital	55 Burwood Road, CONCORD NSW 2139
131	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

Table B: Specified Private Day Hospital Facilities

Item	Facility Name	Address
1	Aesthetic Day Surgery	14 Kensington Street, KOGARAH NSW 2217
2	Avenue Day Surgery	20 The Avenue, WINDSOR VIC 3181
3	Ballina Day Surgery	46 Tamar Street, BALLINA NSW 2478
4	Bankstown Primary Health Care Day Surgery	Grnd Floor, 67 Rickard Road, BANKSTOWN NSW 2200
5	Broadmeadow Day Surgery	1st Floor (Suite 1), 18 Lambton Road, BROADMEADOW NSW 2292
6	Buderim Gastroenterology Centre	139 King Street, BUDERIM QLD 4556
7	Calvary Day Procedure Centre	329,31,333 Edward Street, WAGGA WAGGA NSW 2651
8	Capital Day Surgery Centre	Calvary Clinic, Mary Potter Circuit, BRUCE ACT 2617
9	Carringbah Day Surgery	42 President Avenue, CARRINGBAH NSW 2229
10	Chasely Day Surgery	Wesley Medical Centre, 40 Chasely Street, AUCHENFLOWER QLD 4066
11	Chesterville Day Hospital	28 Chesterville Road, CHELTENHAM VIC 3192
12	Coffs Harbour Day Surgical Centre	69 Albany Street, COFFS HARBOUR NSW 2450
13	Colin Street Day Surgery	51 Colin Street, WEST PERTH WA 6005
14	Coolenberg Clinic	60 Lake Rd, PORT MACQUARIE NSW 2444
15	Dandenong Eye Clinic & Day Surgery Centre	1-3 Falkiner Crescent, DANDENONG VIC 3175
16	Epping Surgery Centre	Suite 3, Oxford Place, 44-46 Oxford Street EPPING NSW 2121
17	Griffiths Road Day Procedure Centre	182 Christo Road, WARATAH NSW 2298
18	Harley Place Day Surgery	Suite 605, 251 Oxford Street, BONDI JUNCTION NSW 2022
19	Healthwoods Specialist Centre	53 Cowper Street, GRANVILLE NSW 2142
20	Inner West Endoscopy Centre	311 Marrickville Road, MARRICKVILLE NSW 2204
21	Liverpool Day Surgery	105-119 Longstaff Avenue, MOOREBANK NSW 2170
22	Logan Endoscopy Services	Unit 2/32 76 Beaudesert Road, BROWN PLAINS QLD 4118
23	Mater Misericordiae Day Unit Mackey	1 Wellington Street, MACKAY QLD 4740
24	Montserrat Day Hospital	383 – 391 Samford Road, GAYTHORNE QLD 4051
25	Montserrat Day Hospital (Indooroopilly)	12 Riverview Tce, INDOOROOPILLY QLD 4068
26	Montserrat Day Hospital (Spring Hill)	Level 2, 35 Astor Rce, BRISBANE QLD 4000
27	Ophthalmic Surgery Centre	Suite 6, 12-14 Malvern Avenue, CHATSWOOD NSW 2067
28	Orange Day Surgery Centre	60 McNamara Street, ORANGE NSW 2800
29	Pacific Day Surgery	38 Misterton Street, FORTITUDE VALLEY QLD 4006
30	Peninsula Eye Centre	47 Redcliffe Parade, REDCLIFFE QLD 4020
31	Perfect Vision Eye Surgery	Suite 3, 25 –29 Hunter Street, HORNSBY NSW 2077
32	Pindara Day Procedure Centre	13 Carrara Street, BENOWA QLD 4217
33	QFG Day Theatres	Level 4/33 North Street, SPRING HILL QLD 4000
34	Randwick Day Surgery	2 Eurimble Avenue, RANDWICK NSW 2031
35	Roderick Street Day Surgery	23 Roderick Street, IPSWICH QLD 4305
36	Rosebud SurgiCentre	1537 Point Nepean Road, ROSEBUD WEST VIC 3940
37	Short Street Day Surgery	2 Short Street, SOUTHPORT QLD 4215
38	Solander Day Surgery	182 Grafton St, CAIRNS QLD 4870
39	South Coast Digestive Disease Centre	86 Ashmore Road, BUNDALL QLD 4217
40	South Western Day Surgery Centre	20-22 Bigge Street, LIVERPOOL NSW 2170
41	Sydney Day Surgery	213-219 Darlinghurst Road, DARLINGHURST NSW 2010
42	Sydney IVF – Liverpool	173-175 Biggs Street, LIVERPOOL NSW 2170
43	Sydney IVF Clinic	4 O’Connell Street, SYDNEY NSW 2000
44	Sydney Oculoplastic Surgery	229 Macquarie St, SYDNEY NSW 2000
45	Sydney Retina Clinic & Day Surgery	Level 13, 187 Macquarie Street, SYDNEY NSW 2000
46	Terrace West Endoscopy Centre	18 Limestone Street, IPSWICH QLD 4305
47	The CAPS Clinic	John James Memorial Hospital, Strickland Crescent, DEAKIN WEST ACT 2600
48	The Eye Institute	Level 4, 270 Victoria Ave, CHATSWOOD NSW 2057
49	The Hills Parenting Centre	103-108 Showground Road, CASTLE HILL NSW 2154
50	The San Day Surgery	1a Northcote Road, HORNSBY NSW 2077
51	Vista Laser Eye Clinics	1 Mclaren Street, NORTH SYDNEY NSW 2060
52	West Lakes Day Surgery	151 Brebner Drive, WEST LAKES SA 5021
53	Western Plains Day Surgery	62 Windsor Parade, DUBBO NSW 2830

4. Transitional provision for facilities

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 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:

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

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 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:

	BENEFIT PAYABLE PER DAY

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

Source text: opening excerpt

Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.

1. Interpretation 1. Interpretation

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;

RHBO means registered health benefits organization; and

(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:

National Health Act 1953 - Determination under Schedule 1, paragraph (1)(bj) (HIB 14/2006)

Plain English Summary

Deep dive

Current sections

1. Interpretation

1. Interpretation

2. Minimum Level Of Benefit

2. Minimum Level Of Benefit

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

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

3. Specified Private Hospitals And Private Day Hospital Facilities

3. Specified Private Hospitals And Private Day Hospital Facilities

Table A: Specified Private Hospitals

Table A: Specified Private Hospitals

Table B: Specified Private Day Hospital Facilities

Table B: Specified Private Day Hospital Facilities

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

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

Source text: opening excerpt

1. Interpretation 1. Interpretation

1. Interpretation

2. Minimum Level Of Benefit 2. Minimum Level Of Benefit

2. Minimum Level Of Benefit

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

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

3. Specified Private Hospitals And Priva 3. Specified Private Hospitals And Private Day Hospital Facilities

3. Specified Private Hospitals And Private Day Hospital Facilities

Table A: Specified Private Hospitals Table A: Specified Private Hospitals

Table A: Specified Private Hospitals