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: