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National Health Amendment Regulations 1999 (No. 6)

Authoritative Version
  • - F1999B00240
  • No longer in force
SR 1999 No. 236 Regulations as made
These Regulations amend the National Health Regulations 1954.
Administered by: Health
General Comments: This instrument was backcaptured in accordance with Section 36 of the Legislative Instruments Act 2003
Registered 01 Jan 2005
Tabling HistoryDate
Tabled HR22-Nov-1999
Tabled Senate22-Nov-1999
Gazetted 20 Oct 1999
Date of repeal 19 Mar 2014
Repealed by Health (Spent and Redundant Instruments) Repeal Regulation 2014
Table of contents.

National Health Amendment Regulations 1999 (No. 6)

Statutory Rules 1999 No. 236

I, WILLIAM PATRICK DEANE, Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the National Health Act 1953.

Dated 13 October 1999.

WILLIAM DEANE
Governor-General

By His Excellency’s Command,

MICHAEL WOOLDRIDGE

Minister for Health and Aged Care

 


National Health Amendment Regulations 1999 (No. 6)1

Statutory Rules 1999 No. 2362

made under the

 

 

 

Contents

                                                                                                                 Page

                        1  Name of Regulations                                                         2

                        2  Commencement                                                                2

                        3  Amendment of National Health Regulations 1954                 2

Schedule 1       Amendments                                                               3

 


Do not delete : Part placeholder

Do not delete : Division placeholder

1              Name of Regulations

                These Regulations are the National Health Amendment Regulations 1999 (No. 6).

2              Commencement

                These Regulations commence on 1 November 1999.

3              Amendment of National Health Regulations 1954

                Schedule 1 amends the National Health Regulations 1954.

 


Schedule 1        Amendments

Do not delete : Schedule Part placeholder

(regulation 3)

[1]         Subregulation 49A (2)

substitute

         (2)   A reference to a document in the Hospital Casemix Protocol is a reference to that document as in existence on the day the reference takes effect.

[2]         Paragraph 49B (1) (e)

omit

Version 3.1.

insert

Version 3.1;

[3]         After paragraph 49B (1) (e)

insert

                (f)    Australian Refined Diagnosis Related Groups Definitions Manual Version 4.0;

               (g)    Australian Refined Diagnosis Related Groups Definitions Manual Version 4.1.

[4]         Subregulation 49B (2)

substitute

         (2)   A reference to a document in a paragraph of subregulation (1) is a reference to that document as in existence on the day the paragraph commences.

[5]         Schedule 7, Part 1, item 2, after definition of fund

insert

ICD-10-AM means The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification.

ICU means the Intensive Care Unit of a hospital.

[6]         Schedule 7, Part 1, item 2, definition of ICD-9-CM

omit

[7]         Schedule 7, Part 1, item 2, definition of NHDD

substitute

NHDD means version 8 of the National Health Data Dictionary, published in 1999.

[8]         Schedule 7, Part 1, item 8

substitute

8.       A record will be rejected by the Department if any of the following data items is coded as blank:

           (a)         Fund/Payer identifier in either Part 4 or 5;

           (b)         Link identifier in either Part 4 or 5;

           (c)         Provider (hospital) code in Part 5;

          (d)         Date of birth in Part 5;

           (e)         Postcode in Part 5;

           (f)         Sex in Part 5;

           (g)         Admission date in Part 5;

           (h)         Separation date in Part 5;

            (i)         Mode of separation in Part 5;

            (j)         Principal diagnosis code in Part 5.

[9]         Schedule 7, Part 1, paragraph 14 (d)

omit

ICD-9-CM

insert

ICD-10-AM

[10]      Schedule 7, Part 1, paragraphs 19 (a) and (b)

omit

27-56

insert

29-67

[11]      Schedule 7, Part 2, item 1

omit

Fund identifier

insert

Fund/Payer identifier

[12]      Schedule 7, Part 2, items 3, 4, 5, 6, 7, 8 and 9

substitute

3

CMBS item/ Miscellaneous service code



28



14



1

4

Item charge

42

5

1

5

CMBS benefit

47

5

1

6

Fund benefit

52

5

1

7

CMBS date of service

57

8

1

8

Contracted doctor

65

1

1

9

Total record length

65

 

 

[13]      Schedule 7, Part 3

substitute

Part 3          File structure: hospital episode record

 

Column 1

Column 2

Column 3

Column 4

Column 5

Item

Data item

Start position

Field size

Repetitions

1

Fund/Payer identifier

1

3

1

2

Link identifier

4

24

1

3

Provider (hospital) code

28

8

1

4

Product code

36

8

1

5

Hospital contract status

44

1

1

6

Total days paid

45

4

1

7

Accommodation charge

49

6

1

8

Accommodation benefit

55

6

1

9

Theatre charge

61

5

1

10

Theatre benefit

66

5

1

11

Labour ward charge

71

5

1

12

Labour ward benefit

76

5

1

13

ICU charge

81

5

1

14

ICU benefit

86

5

1

15

Prosthesis charge

91

5

1

16

Prosthesis benefit

96

5

1

17

Pharmacy charge

101

5

1

18

Pharmacy benefit

106

5

1

19

Bundled charge

111

6

1

20

Bundled benefit

117

6

1

21

Other charges

123

5

1

22

Other benefits

128

5

1

23

Front end deductible

133

5

1

24

Ancillary cover status

138

1

1

25

Ancillary charges

139

5

1

26

Ancillary benefits

144

5

1

27

Item charges

149

6

1

28

Total CMBS and fund benefits

155

6

1

29

Date of birth

161

8

1

30

Postcode

169

4

1

31

Sex

173

1

1

32

Admission date

174

8

1

33

Separation date

182

8

1

34

Hospital type

190

1

1

35

ICU days

191

3

1

36

DRG code

194

4

1

37

DRG version

198

2

1

38

Admission time

200

4

1

39

Neonatal admission weight

204

4

1

40

Hours of mechanical ventilation

208

4

1

41

Mode of separation

212

2

1

42

Separation time

214

4

1

43

Source of referral

218

1

1

44

Service category on admission

219

1

1

45

Total leave days

220

4

1

46

Non-acute days of stay

224

4

1

47

Principal diagnosis code

228

5

1

48

Additional diagnoses

233

5

19

49

Procedure codes

328

7

20

50

Sameday status

468

1

1

51

Principal CMBS item number/ Miscellaneous service code

469

14

1

52

Principal CMBS date

483

8

1

53

Time in theatre (Principal CMBS)

491

4

1

54

Secondary CMBS item numbers/ Miscellaneous service codes

495

14

9

55

Total days spent at home

621

2

1

56

Total psychiatric care days

623

3

1

57

Mental health legal status

626

1

1

58

ICU hours

627

4

1

59

Admission status

631

1

1

60

Contract status on admission

632

1

1

61

Palliative care status

633

1

1

62

Unplanned readmission within 28 days

634

1

1

63

Unplanned theatre visit during episode

635

1

1

64

Marital status

636

1

1

65

Provider number of hospital from which transferred

637

8

1

66

Provider number of hospital to which transferred

645

8

1

67

Discharge intention on admission

653

1

1

68

Total record length

653

 

 

[14]      Schedule 7, Part 4, item 1

omit

Fund identifier

insert

Fund/Payer identifier

[15]      Schedule 7, Part 4, item 3

substitute

3

CMBS item/ Miscellaneous service code

C(14)

MAA

The CMBS item number, miscellaneous service code or Australian Dental Association code

 

 

 

 

Blank = no CMBS item billed

[16]      Schedule 7, Part 4, item 4

substitute

4

Item charge

N(5)

MAA

The amount the patient was billed by the doctor or health service provider

 

 

 

 

0 = no amount billed

[17]      Schedule 7, Part 5

substitute

Part 5          Record content: hospital episode record

 

Item

Data item

Field size

Required

Coding description

1

Fund/Payer identifier

C(3)

MAA

See fund codes

2

Link identifier

C(24)

MAA

A unique identifier of the episode linking data items from this Part (Part 5) to the medical record (Part 4)

 

 

 

 

The fund may encrypt the membership identifier for this purpose

3

Provider (hospital) code

C(8)

MAA

The hospital provider number

4

Product code

C(8)

MAA

The product code for the patient’s insurance cover at separation

 

 

 

 

The fund must supply documentation of cover field values

5

Hospital contract status

C(1)

MAA

Y = a hospital with which a fund has a contract

N = a hospital with which the fund does not have a contract

6

Total days paid

N(4)

MAA

The total number of days benefits were paid for by the fund, including days benefits were paid for as an NHTP

7

Accommodation charge

N(6)

MAA

Accommodation charge rounded to the nearest dollar

 

 

 

 

0 = no accommodation charge billed

 

 

 

 

Blanks only valid if an accommodation charge was not separately identified but billed under another charge item

8

Accommodation benefit

N(6)

MAA

Accommodation benefit rounded to the nearest dollar

 

 

 

 

0 = no accommodation benefit paid

 

 

 

 

Blanks only valid if an accommodation benefit was not separately identified but paid under another benefit item

9

Theatre charge

N(5)

MAA

Theatre charge rounded to the nearest dollar

 

 

 

 

0 = no theatre charge billed

 

 

 

 

Blanks only valid if a theatre charge was not separately identified but billed under another charge item

10

Theatre benefit

N(5)

MAA

Theatre benefit rounded to the nearest dollar

 

 

 

 

0 = no theatre benefit paid

 

 

 

 

Blanks only valid if a theatre benefit was not separately identified but paid under another benefit item

11

Labour ward charge

N(5)

MAA

Labour ward charge rounded to the nearest dollar

 

 

 

 

0 = no labour ward charge billed

 

 

 

 

Blanks only valid if a labour ward charge was not separately identified but billed under another charge item

12

Labour ward benefit

N(5)

MAA

Labour ward benefit rounded to the nearest dollar

 

 

 

 

0 = no labour ward benefit paid

 

 

 

 

Blanks only valid if a labour ward benefit was not separately identified but paid under another benefit item

13

ICU charge

N(5)

MAA

ICU charge rounded to the nearest dollar

 

 

 

 

0 = no ICU charge billed

 

 

 

 

Blanks only valid if an ICU charge was not separately identified but billed under another charge item

14

ICU benefit

N(5)

MAA

ICU benefit rounded to the nearest dollar

 

 

 

 

0 = no ICU benefit paid

 

 

 

 

Blanks only valid if an ICU benefit was not separately identified but paid under another benefit item

15

Prosthesis charge

N(5)

MAA

Prosthesis charge rounded to the nearest dollar

 

 

 

 

0 = no prosthesis charge billed

 

 

 

 

Blanks only valid if a prosthesis charge was not separately identified but billed under another charge item

16

Prosthesis benefit

N(5)

MAA

Prosthesis benefit rounded to the nearest dollar

 

 

 

 

0 = no prosthesis benefit paid

 

 

 

 

Blanks only valid if a prothesis benefit was not separately identified but paid under another benefit item

17

Pharmacy charge

N(5)

MAA

Pharmacy charge rounded to the nearest dollar

 

 

 

 

0 = no pharmacy charge billed

 

 

 

 

Blanks only valid if a pharmacy charge was not separately identified but billed under another charge item

18

Pharmacy benefit

N(5)

MAA

Pharmacy benefit rounded to the nearest dollar

 

 

 

 

0 = no pharmacy benefit paid

 

 

 

 

Blanks only valid if a pharmacy benefit was not separately identified but paid under another benefit item

19

Bundled charges

N(6)

MAA

Bundled charge rounded to the nearest dollar

 

 

 

 

0 = no bundled charge billed

20

Bundled benefits

N(6)

MAA

Bundled benefit rounded to the nearest dollar

 

 

 

 

0 = no bundled benefit paid

21

Other charges

N(5)

MAA

Other charges rounded to the nearest dollar

 

 

 

 

0 = no other charge billed

22

Other benefits

N(5)

MAA

Other benefits rounded to the nearest dollar

 

 

 

 

0 = no other benefit paid

23

Front end deductible

N(5)

MAA

The amount of FED deducted from the benefit, otherwise payable by the fund to the patient

 

 

 

 

Blank = there is a FED but the amount is unknown

0 = no FED applicable

24

Ancillary cover status

C(1)

MAA

Y = patient has ancillary cover

N = patient does not have ancillary cover

25

Ancillary charges

N(5)

OPA

The ancillary charges incurred during the episode and billed against an ancillary table

26

Ancillary benefits

N(5)

OPA

The ancillary benefits paid for charges billed as occurring during the episode

27

Item charges

N(6)

MAA

The total item charges as set out in Part 4

28

Total CMBS and fund benefits

N(6)

MAA

The total CMBS and fund benefits as set out in Part 4

29

Date of birth

D(8)

MAA

DDMMCCYY

30

Postcode

C(4)

MAA

The patient’s residential postcode

31

Sex

C(1)

MAA

1 = male

2 = female

0 = unknown

32

Admission date

D(8)

MAA

DDMMCCYY

33

Separation date

D(8)

MAA

DDMMCCYY

34

Hospital type

C(1)

MAA

1 = public

2 = private

3 = private day facility

4 = public day facility

9 = other

35

ICU days

N(3)

MAA

The number of days the patient spent in one or more of the following:

• ICU

• CCU

• neonatal intensive care

• paediatric intensive care

 

 

 

 

This does not include days spent in High Dependency Units

36

DRG code

C(4)

OPA

Blank filled if not known

37

DRG version

C(2)

OPA

10 = version 1

20 = version 2

21 = version 2.1

30 = version 3

31 = version 3.1

40 = version 4

41 = version 4.1

38

Admission time

N(4)

MAA

(sameday patients only)

The admission time is based on a 24‑hour clock (for example, 6:35AM is entered as 0635)

39

Neonatal admission weight

N(4)

MAA

The admission weight rounded to the nearest gram for a neonate (patient age less than 29 days old) or an older baby weighing less than 2500 grams

40

Hours of mechanical ventilation

N(4)

MAA

The number of hours, rounded to the nearest hour, that the patient received mechanical ventilation during the episode

41

Mode of separation

C(2)

MAA

01 = separation or transfer of the patient to an acute care hospital

02 = separation or transfer of the patient to a nursing home

03 = separation or transfer of the patient to a psychiatric hospital

04 = separation or transfer of the patient to another health facility

05 = statistical separation/type change

06 = patient left the hospital against medical advice

07 = statistical separation from leave

08 = patient died

09 = patient went home/other

42

Separation time

N(4)

MAA

(sameday patients only)

The separation time is based on a 24‑hour clock (for example, 10:35PM is entered as 2235)

43

Source of referral

N(1)

MAA

0 = born in hospital

1 = admitted patient transferred from another hospital

2 = statistical admission/type change

4 = from Accident/ Emergency

5 = from community health service

6 = from Outpatients department

7 = from nursing home

8 = by outside medical practitioner

9 = other

44

Service category on admission

N(1)

MAA

The type of service for which the patient was initially admitted

 

 

 

 

1 = acute care

2 = rehabilitative care

3 = palliative care

4 = non-acute care

5 = unqualified neonate

6 = other

45

Total leave days

N(4)

MAA

This data item is calculated as the sum of leave days for all leave periods during the episode

 

 

 

 

0 = no leave days

 

 

 

 

Leave days exclude 1 day leave periods for patients and are subject to the following conditions:

 

 

 

 

• a patient who does not require treatment over a weekend or another short period may leave the hospital temporarily with the approval of the hospital or treating medical practitioner

 

 

 

 

• if there is a decision that the patient will return to the same hospital within a short time to resume treatment, this absence is defined as leave

46

Non-acute days of stay

N(4)

MAA

The number of days spent in the hospital, without certification, that exceeded 35 days

47

Principal diagnosis code

I(5)

MAA

The ICD-10-AM code for the diagnosis or condition chiefly responsible for the hospital admission

 

 

 

 

A blank entry is not valid for this field

48

Additional diagnosis

I(5)

19 times

MAA

ICD-10-AM diagnosis codes for conditions or complaints other than the principal diagnosis that arose during the patient’s stay in hospital or existed at the time of the patient’s admission to hospital

49

Procedure codes

I(7)

20 times

MAA

ICD-10-AM procedure codes for all procedures performed during the episode

 

 

 

 

Blank = no applicable

ICD-10-AM procedure code

50

Sameday status

C(1)

MAA

0 = patient with a valid arrangement allowing overnight stay for procedure normally performed on a sameday basis

1 = sameday patient

2 = overnight patient other than type 0 above

51

Principal CMBS item number/ Miscellaneous service code

C(14)

 

OPH

Principal CMBS item or miscellaneous service code or ADA code related to the first procedure code referred to in item 49 of this Part

 

 

 

 

Blank = no applicable CMBS item

52

Principal CMBS date

D(8)

OPH

The date when the principal CMBS procedure was carried out

 

 

 

 

Blank = no principal CMBS date

53

Time in theatre (Principal CMBS)

N(4)

MAA (sameday patients only)

The time in minutes the patient spent in the theatre, from the time the patient entered the theatre until the time the patient left the theatre

 

 

 

 

0 = no time spent in the theatre

 

 

 

 

Blank = no applicable CMBS item

54

Secondary CMBS item numbers/ Miscellaneous service code

C(14) 9 times

 

OPH

Additional CMBS item numbers or miscellaneous service codes or ADA codes related to the procedure codes referred to in item 49 of this Part

 

 

 

 

Blank = no applicable CMBS item

55

Total days spent at home

N(2)

MAA

(Hospital-in-home episodes only)

The number of days the patient spent at home where part of the episode was provided through a hospital-in-the-home program

56

Total psychiatric care days

N(3)

OPA

The sum of the number of days and part days of stay that the person was an admitted patient or resident within a designated psychiatric unit, minus the sum of leave days occurring during the stay within the unit

57

Mental health legal status

N(1)

OPA

An indication that the patient was treated under relevant mental health legislation at some point during the episode

 

 

 

 

1 = involuntary patient

2 = voluntary patient

58

ICU hours

N(4)

OPA

The number of hours spent by the patient in one or more of the following:

• ICU

• CCU

• neonatal intensive care

 

 

 

 

This does not include hours spent in Special Care Nurseries or High Dependency Units

59

Admission status

N(1)

OPA

An indication of the admission status of the patient

 

 

 

 

1 = emergency

2 = planned/ elective

3 = other

60

Contract status on admission

N(1)

OPA

1 = service provided under contract on behalf of another hospital

2 = service other than 1

61

Palliative care status

N(1)

OPA

1 = palliative care required during the episode

2 = no palliative care required during the episode

62

Unplanned readmission within 28 days

A(1)

OPA

Readmission of patient to hospital within 28 days of the previous discharge for treatment of a similar or related condition

 

 

 

 

Y = unplanned readmission

N = planned readmission

Blank = no readmission

63

Unplanned theatre visit during episode

N(1)

OPA

Patient required a theatre visit that was not planned or anticipated at the time of admission

 

 

 

 

1 = unplanned theatre visit

2 = no unplanned theatre visit

64

Marital status

N(1)

OPA

1 = never married

2 = widowed

3 = divorced

4 = separated

5 = married (including de facto)

6 = not stated/ inadequately described

65

Provider number of hospital from which transferred

A(8)

OPA

If the patient was transferred from another hospital, the hospital provider number of that hospital

66

Provider number of hospital to which transferred

A(8)

OPA

If the patient was transferred to another hospital, the hospital provider number of that hospital

67

Discharge intention on admission

A(1)

OPA

The intended mode of separation at time of admission

 

 

 

 

Discharge to:

1 = acute hospital

2 = nursing home

3 = psychiatric hospital

4 = palliative care unit/hospice

5 = other health care accommodation

6 = usual residence

[18]      Schedule 7, Part 6

substitute

Part 6          Registered health benefits organisations

Column 1

Item

Column 2

Name

Column 3

Identifier

1

A.C.A. Health Benefits Fund

ACA

2

A.M.A. Health Fund Limited

AMA

3

Army Health Benefits Society

AHB

4

Australian Health Management Pty Ltd

AHM

5

Australian Unity Friendly Society*

AUF

6

C.D.H. Benefits Fund

CDH

7

Commonwealth Bank Health Society (Friendly Society)

CBH

8

Credicare Health Fund

CHF

9

Eastern District Health Fund Ltd

WDH

10

Geelong Medical and Hospital Benefits Association Limited

GMH

11

Goldfields Medical Fund (Inc.)

GMF

12

Grand United Corporate Health Limited

GUC

13

Grand United Friendly Society

GUF

14

Health Care Insurance Ltd

HCI

15

Healthguard Health Benefits Fund Limited

HHB

16

Health Insurance Fund of WA

HIF

17

Hospital Benefits Association Limited**

HBA

18

Hospital Benefits Fund of Western Australia (Inc.), The

HBF

19

Hospitals Contribution Fund of Australia, Limited, The

HCF

20

Independent Order of Odd Fellows of Victoria

IOF

21

I.O.R. Australia Pty Ltd

IOR

22

Latrobe Health Services, Inc.

LHS

23

Lysaght Hospital and Medical Club, The

LHM

24

Manchester Unity Independent Order of Oddfellows Friendly Society in New South Wales

MUI

25

Medibank Private (Health Insurance Commission)

MBP

26

Medical Benefits Fund of Australia Ltd

MBF

27

Mildura District Hospital Fund

MDH

28

MIM Employees Health Fund

MIM

29

Mutual Community Ltd**

MCL

30

National Mutual Health Insurance Pty Ltd**

NMH

31

Naval Health Benefits Society

NHB

32

New South Wales Teacher’s Federation Health Society

NTF

33

N.I.B. Health Funds Limited

NIB

34

Phoenix Welfare Association Limited, The

PWA

35

Queensland Teachers Union Health Society

QTU

36

Railway & Transport Employees’ Friendly Society Health Fund

RTE

37

Reserve Bank Health Society

RBH

38

S.G.I.C. Health Pty Limited

SGI

39

South Australian Police Employees’ Health Fund Incorporated

SPE

40

South Australian Public Servants

SPS

41

St Luke’s Medical & Hospital Benefits Association

SLM

42

Transition Benefit Fund

TBF

43

Transport Friendly Society

TFS

44

United Ancient Order of Druids

UAD

45

United Ancient Order of Druids Registered Friendly Society Grand Lodge of New South Wales, The

UAF

46

Yallourn Medical and Hospital Society, The

YMH

Notes

*   Australian Natives’ Association and Manchester Unity Independent Order of Oddfellows Friendly Society in Victoria now trade as Australian Unity Friendly Society.

**   Mutual Community is owned and operated by National Mutual.  In Victoria, Mutual Community trades as HBA.

Notes

1.       These Regulations amend Statutory Rules 1954 No. 35, as amended by 1957 No. 71; 1958 No. 63; 1962 Nos. 55, 70 and 113; 1965 Nos. 17, 94 and 185; 1966 No. 99; 1967 No. 86; 1969 Nos. 91 and 220; 1970 Nos. 70 and 166; 1971 Nos. 28, 76, 103 and 138; 1972 No. 79; 1973 Nos. 17, 75, 111, 221, 225 and 267; 1974 Nos. 52, 104, 105, 113 and 263; 1975 Nos. 14, 49, 66, 100, 124, 165 and 207; 1976 Nos. 113, 217 and 227; 1977 Nos. 11, 34, 51 and 112; 1978 Nos. 66, 178, 208 and 266; 1979 Nos. 59, 107, 208 and 231; 1980 Nos. 84, 292 and 309; 1981 Nos. 43, 97, 115, 232 and 318; 1982 Nos. 38, 82, 84, 250 and 284; 1983 Nos. 45, 247 and 267; 1984 Nos. 66, 161, 200, 308, 322 and 427; 1985 Nos. 86, 136, 186, 187, 206 and 288; 1986 Nos. 47, 53, 208, 330, 353 and 360; 1987 Nos. 50, 76, 100 and 310; 1989 Nos. 291, 292 and 334; 1990 Nos. 24, 86, 114, 292, 335 and 396; 1991 Nos. 40, 41, 232, 262, 263, 310 and 339; 1992 Nos. 136 and 187; 1993 Nos. 48, 85, 153, 260, 261, 273, 280 and 284; 1994 Nos. 2, 9, 106, 139, 201, 253, 256, 296, 349 and 451; 1995 Nos. 1, 14, 34, 52, 109, 116, 161, 220, 288, 289, 408 and 410; 1996 Nos. 46, 183 and 333; 1997 Nos. 16, 58, 133, 160, 179 and 353; 1998 Nos. 18, 73 and 262; 1999 Nos. 18, 140, 162, 174 and 175.

2.       Made by the Governor-General on 13 October 1999, and notified in the Commonwealth of Australia Gazette on 20 October 1999.