Private Health Insurance (Accreditation) Rules 2011
6. Treatments provided by hospitals and 6. Treatments provided by hospitals and health care organisations
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6. Treatments provided by hospitals and health care organisations
(1) In this rule:
(a) treatment provided by a hospital is taken to include treatment provided at a hospital or with the direct involvement of a hospital, including treatment provided by a health care provider who is:
(i) authorised by the hospital to provide the treatment; or
(ii) under the management or control of a health care provider referred to in subparagraph (a) (i); and
(b) treatment provided by a health care organisation is taken to include treatment provided by a health care provider who is:
(i) authorised by the organisation to provide the treatment; or
(ii) under the management or control of a health care provider referred to in subparagraph (b) (i).
(2) The standard for treatment provided by a hospital or health care organisation is that:
(a) for a hospital―if the hospital is required under a State or Territory law to have a permission or approval, or be registered, in the State or Territory in which it operates, so as to operate as a hospital and to provide the treatment in that State or Territory, it has the permission or approval, or is registered, under that law; and
Note: 'Hospital' is defined in the Act.
(b) for a health care organisation, including where the organisation is providing treatment on behalf of a hospital:
(i) if the organisation is required under a State or Territory law to have a permission or approval, or be registered, to provide the treatment in the State or Territory, it has the permission or approval, or is registered, under that law; and
(ii) the organisation must be:
(A) accredited or certified by an appropriate accrediting body; or
(B) formally engaged in the process of an appropriate accrediting body to be accredited or certified by that body, where 'formally engaged' means having made a valid application to the body for accreditation or certification, the application has been accepted and the applicant is undertaking the requirements of the body in the timeframes required; and
(c) the treatment must be provided by a health care provider who meets the standard in these Rules relevant to the provision of that treatment.
(d) the State and Territory law requirements referred to in subrule 6 may include the National Safety and Quality Health Service Standards.