1A. Categorisation of private hospitals1A. Categorisation of private hospitals

### 1A. Categorisation of private hospitals (1) If, as at 1 January 2019, a departmental officer authorised by the Secretary of the Department for the purpose has, in anticipation of the commencement of this provision, caused to be published on the Department’s website a list of all the hospitals for which a declaration is in force under subsection 121‑5(6) of the Act that places each hospital in a category set out in subclause (7), then each hospital is taken to be determined to be in that category. (2) If such a list has not been published, then as soon as practicable an authorised officer must determine which category of hospital from the categories set out in subclause (7) each private hospital for which a declaration is in force under subsection 121‑5(6) of the Act is to be placed in, and cause a list of the hospitals in each category to be published on the Department’s website. Note: If a patient is admitted to a hospital between 1 January 2019 and 31 August 2019 insurers may continue to work out the average charge on the basis of the provisions of this Schedule as in force immediately before the commencement of Schedule 4 to the Private Health Insurance (Reforms) Amendment Rules 2018. However, insurers must use the Department’s published list of hospitals under subclause (1) or (2) to determine in which category a hospital claiming second‑tier default benefits is placed. (3) If a private hospital is declared under subsection 121‑5(6) of the Act after 1 January 2019, an authorised officer must determine which category of hospital from the categories set out in subclause (7) that private hospital is to be placed in. (4) If a hospital has been placed in a category by a determination under this clause, an authorised officer may before 1 June of a particular year determine a different category of hospital from the categories set out in subclause (7) that the private hospital is to be placed in. (5) A list of the hospitals in each category as of 1 August of each year must be published on the Department’s website. (6) Private hospitals are comparable if they are placed in the same category by a determination made under subclause (1), (2), (3) or (4). (7) For the purposes of this clause, the categories are the following: (a) private hospitals that provide psychiatric care, including treatment of addictions, for at least 50% of the episodes of hospital treatment, and do not fall into category (g); (b) private hospitals that provide rehabilitation care for at least 50% of the episodes of hospital treatment, and do not fall into categories (a) or (g); (c) private hospitals that do not fall into categories (a), (b) or (g), with up to and including 50 licensed beds; (d) private hospitals that do not fall into categories (a), (b) or (g), with more than 50 licensed beds and up to and including 100 licensed beds; (e) private hospitals that do not fall into categories (a), (b) or (g), with more than 100 licensed beds, without an accident and emergency unit or a specialised cardiac care unit or an intensive care unit; (f) private hospitals that do not fall into categories (a), (b) or (g), with more than 100 licensed beds, with either (or any combination of) an accident and emergency unit or a specialised cardiac care unit or an intensive care unit; (g) private hospitals that provide episodes of hospital treatment only for periods of not more than 24 hours. (8) If State or Territory legislation in the State or Territory where the private hospital is located regulates the number of beds or patients that a private hospital is permitted—in subclause (7), 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. (9) If State or Territory legislation in the State or Territory where the private hospital is located does not regulate the number of beds or patients that a private hospital is permitted—in subclause (7), a reference to licensed beds is a reference to the beds and bed equivalents the private hospital operates. (10) An authorised officer must calculate proportions for the purposes of paragraphs (7)(a) and (b): (a) if Hospital Casemix Protocol Data is available for the private hospital—using the most recent year of Hospital Casemix Protocol Data available to the Department for the private hospital; and (b) otherwise—on the basis of any relevant information available to the Department about the episodes of hospital treatment at the private hospital.