Document ID: chunk:federal_register_of_legislation:C2005A00031:clause:1_11
Version: federal_register_of_legislation:C2005A00031
Segment Type: clause
Provision Reference: sch 1 cl 11
Character Range: 13256–14836

11  After paragraph (bk) of Schedule 1
Insert:
 (bl) This paragraph applies to a prosthesis if:
 (i) the prosthesis is a no gap prosthesis or a gap permitted prosthesis; and
 (ii) the prosthesis is provided as part of an episode of hospital treatment; and
 (iii) a medicare benefit is payable in respect of the professional service associated with the provision of the prosthesis, or the provision of the prosthesis is associated with podiatric treatment by an accredited podiatrist; and
 (iv) the person to whom the prosthesis is provided is a contributor to the health benefits fund conducted by the organization; and
 (v) under the terms on which the person is a contributor, the person is covered (wholly or partly) in respect of the episode of hospital treatment or of the professional service; and
 (vi) the episode of hospital treatment is provided in a hospital or day hospital facility with which the organization does not have a hospital purchaser‑provider agreement covering episodes of hospital treatment of that kind.
 (bm) If paragraph (bl) applies to a prosthesis:
 (i) each applicable benefits arrangement of the organization must provide for benefits to be payable in respect of the prosthesis; and
 (ii) the amount of benefit payable by the organization in respect of the prosthesis is determined by using the following table:

Amount of benefit for prosthesis
Item                              If the prosthesis is...     and the episode of hospital treatment is provided in...  the amount of benefit payable by the organization in respect of the prosthesis...