Document ID: chunk:federal_register_of_legislation:F2024C00561:body:0:p6
Version: federal_register_of_legislation:F2024C00561
Segment Type: other
Provision Reference: 
Character Range: 13180–16407

eligible hospitals class.

7C. Assessment criteria
  For the purposes of subsection 121‑8A (1) of the Act, to be included in the second‑tier eligible hospitals class, a hospital must:
 (a) be a private hospital; and
 (b) be accredited; and
 (c) not bill patients directly for the minimum benefit payable by the patient's insurer; and
 (d) make provision for informed financial consent; and
 (e) submit Hospital Casemix Protocol Data to health insurers electronically with every claim for private health insurance benefits.
         Note: If a hospital is included in the second‑tier eligible hospitals class by the Minister under section 121‑8A of the Act, it will be a second‑tier eligible hospital for the purposes of Schedule 5 to the Private Health Insurance (Benefit Requirements) Rules 2011, and therefore eligible to claim second‑tier default benefits as specified in that Schedule.

7D. Notification of change in circumstances
  A hospital that is included in the second‑tier eligible hospitals class must notify the Department in writing of any change in circumstances that may prevent that hospital from continuing to meet the assessment criteria set out in rule 7C as soon as practicable.

     7F. Covid‑19 Accreditation Arrangements
      (1) If the date on which a hospital's accreditation will expire falls within the 12 months following the hospital's eligibility expiry date, then the hospital is taken to be included in the second‑tier eligible hospitals class until 60 calendar days after the day on which that hospital's accreditation will expire.
      (2) In this rule:
      eligibility expiry date means the second‑tier expiry date listed on the Commonwealth's list of all declared hospitals with second tier.
           Note: Further information is available in Private Health Insurance Circular 'PHI 52/20 Second‑tier Update‑ arrangements due to suspended accreditation assessments' available online at https://www1.health.gov.au/internet/main/publishing.nsf/Content/health‑phicircular2020‑52 and the Australian Safety and Quality Health Care Commission at www.safetyandquality.gov.au by searching for the 'National Safety and Quality Health Service (NSQHS) Standards' or typing in this link 'https://www.safetyandquality.gov.au/standards/nsqhs‑standards/implementation‑nsqhs‑standards/nsqhs‑standards‑updates‑and‑consultations#faq:‑covid‑19‑pandemic‑and‑accreditation'.

Part 3 Hospital and general treatment

     8. Hospital treatment―excluded treatment
The following classes of treatment are specified for the purposes of subsection 121‑5 (4) of the Act:
(a) treatment which involves a procedure that has an item number that is specified in clause 8 of Schedule 3 of the Private Health Insurance (Benefit Requirements) Rules if no certificate for that procedure has been provided under clause 7 of that Schedule; and
(b) treatment provided to a person at an emergency department of a hospital; and
(c) treatment provided to a person who is not a patient within the meaning of that word in paragraph (b) of the definition of 'patient' in subsection 3 (1) of the Health Insurance Act 1973; and
                Note: 'Patient' as used in paragraph (b) of the definition of 'patient' in subsection