Document ID: chunk:federal_register_of_legislation:F2025C00117:body:0:p25
Version: federal_register_of_legislation:F2025C00117
Segment Type: other
Provision Reference: 
Character Range: 71452–74156

by subclause 1A(6).

     Hospital Casemix Protocol Data has the meaning given by rule 4 of the Private Health Insurance (Health Insurance Business) Rules 2018.

     second‑tier eligible hospital means a hospital in the class set out in rule 7A of the Private Health Insurance (Health Insurance Business) Rules 2018.

      (2) In this Schedule, except in subclauses 1A(8) and (9), the Australian Capital Territory is taken to be part of New South Wales, and the Northern Territory is taken to be part of South Australia.

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