Document ID: chunk:federal_register_of_legislation:F2025C00117:body:0:p27
Version: federal_register_of_legislation:F2025C00117
Segment Type: other
Provision Reference: 
Character Range: 76492–79349

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.

1B. Internal review of a categorisation determination

      (1) A private hospital subject to a determination made under subclause 1A(1), (2), (3) or (4) may request internal review of its categorisation by the determination.

      (2) An application for internal review under subclause (1) must be made in writing within 28 days after the day the determination is notified to the hospital.

      (3) If an application for internal review is made, an authorised officer (who must not be the authorised officer who made the original determination) must:
            (a) review the determination; and
            (b) either confirm the determination or make a fresh one within 28 days after the day on which the application was received by the Department.

2. Circumstances

     For rules 4 and 5 of Part 2 of these Rules, the circumstances for hospital treatment to which this Schedule applies are that the treatment is provided to a patient who is not a nursing‑home type patient and the treatment is  provided at a second‑tier eligible hospital.

           Note: The definition of hospital treatment in section 121‑5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital.  This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121‑5(1)(c) of the Act.

3. Minimum benefit

      (1) Despite anything in Schedules 1, 2 or 3, but subject to subclause (2) of this clause, the minimum benefit for hospital treatment provided in the circumstances described in clause 2 of this Schedule is the amount worked out in accordance with this clause.

      (2) Where hospital treatment is provided in the circumstances described in clause 2 of this Schedule, but:

           (a) the minimum benefit worked out in accordance with this clause for the hospital treatment is below the amount determined in accordance with Schedules 1, 2 or 3 of these Rules; or
           (b) an amount for the hospital treatment cannot be worked out in accordance with this clause,

     the minimum benefit for that hospital treatment is the amount worked out in accordance with Schedules 1, 2 or 3 for that hospital treatment.

      (3) If a hospital ceases to be a second‑tier eligible hospital for the purposes of this Schedule, the minimum benefit in relation to an episode of hospital treatment for an insured person who was an admitted patient at the hospital or booked for hospital treatment at the hospital (as opposed to merely being on the hospital's waiting list) before the day that