Document ID: chunk:federal_register_of_legislation:C2005A00031:clause:1_73bdaaa
Version: federal_register_of_legislation:C2005A00031
Segment Type: clause
Provision Reference: sch 1 cl 73BDAAA
Character Range: 7148–8693

73BDAAA  Prosthesis payments under hospital purchaser‑provider agreements

When this section applies

 (1) This section applies if:
 (a) a hospital purchaser‑provider agreement between a registered organization and a hospital or day hospital facility deals with the payment to be made by the organization to the hospital or day hospital facility in relation to a particular episode of hospital treatment; and
 (b) a no gap prosthesis, or a gap permitted prosthesis, is provided as part of that episode of hospital treatment; and
 (c) the person to whom the prothesis is provided is a contributor to the health benefits fund conducted by the organization; and
 (d) under the terms on which the person is a contributor, the person is covered (wholly or partly) in respect of that episode of hospital treatment or of the professional service associated with the provision of the prosthesis; and
 (e) 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.

Cost of prosthesis

 (2) In working out the amount the organization must pay the hospital or day hospital facility for the episode of hospital treatment, the amount taken into account to cover the cost of the prosthesis is determined using the following table:

Cost of prosthesis
Item                If the prosthesis is...     and the payment is to...  the amount taken into account to cover the cost of the prosthesis...