National Health Amendment Regulations 2002 (No. 1)1
I, PETER JOHN HOLLINGWORTH, 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 30 October 2002
PETER HOLLINGWORTH
Governor-General
By His Excellency’s Command
KAY PATTERSON
1 Name of Regulations
These Regulations are the National Health Amendment Regulations 2002 (No. 1).
2 Commencement
These Regulations commence on gazettal.
3 Amendment of National Health Regulations 1954
Schedule 1 amends the National Health Regulations 1954.
Schedule 1 Amendments
(regulation 3)
[1] Paragraph 49B (1) (g)
substitute
(g) Australian Refined Diagnosis Related Groups Definitions Manual Version 4.1;
(h) Australian Refined Diagnosis Related Groups Definitions Manual Version 4.2;
(i) Australian Refined Diagnosis Related Groups Definitions Manual Version 5.0.
[2] Schedule 7, Part 1, item 2, definition of NHDD
substitute
NHDD means version 10 of the National Health Data Dictionary, published in 2001.
[3] Schedule 7, Part 1, after item 4
insert
4A. If a hospital episode includes the supply of a prosthesis, the prosthetic record supplied to the Department by a fund for the episode must comply with Part 7 (File structure and record content: prosthetic record).
4B. If a patient is treated in a hospital under an AN-SNAP funding agreement between the hospital and a fund, the AN-SNAP record supplied to the Department by the fund for the hospital episode must comply with Part 8 (File structure and record content: AN-SNAP record).
[4] Schedule 7, Part 2, item 3, column 2
substitute
CMBS item/Miscellaneous service code/ADA code
[5] Schedule 7, Part 2, item 6, column 2
substitute
Fund medical benefit
[6] Schedule 7, Part 2, item 9
substitute
9 | Gap cover scheme identifier | 66 | 5 | 1 |
10 | Total record length | 70 |
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[7] Schedule 7, Part 3, item 15, column 2
substitute
Total prostheses charge
[8] Schedule 7, Part 3, item 16, column 2
substitute
Total prostheses benefit
[9] Schedule 7, Part 3, item 27, column 2
substitute
Total item charges
[10] Schedule 7, Part 3, item 39, column 2
substitute
Infant weight, neonate, stillborn
[11] Schedule 7, Part 3, items 44 to 68
substitute
44 | Care type | 219 | 3 | 1 |
45 | Total leave days | 222 | 4 | 1 |
46 | Non-certified days of stay | 226 | 4 | 1 |
47 | Principal diagnosis | 230 | 5 | 1 |
48 | Additional diagnosis | 235 | 5 | 19 |
49 | Procedure | 330 | 7 | 20 |
50 | Same-day status | 470 | 1 | 1 |
51 | Principal CMBS item number/Miscellaneous service/ADA code | 471 | 14 | 1 |
52 | Principal CMBS item date | 485 | 8 | 1 |
53 | Minutes of operating theatre time | 493 | 4 | 1 |
54 | Secondary CMBS item number/Miscellaneous service code/ADA code | 497 | 14 | 9 |
55 | Days of hospital in the home care | 623 | 2 | 1 |
56 | Total psychiatric care days | 625 | 3 | 1 |
57 | Mental health legal status | 628 | 1 | 1 |
58 | ICU hours | 629 | 4 | 1 |
59 | Urgency of admission | 633 | 1 | 1 |
60 | Inter-hospital contracted patient | 634 | 1 | 1 |
61 | Palliative care status | 635 | 1 | 1 |
62 | Unplanned readmission within 28 days | 636 | 1 | 1 |
63 | Unplanned theatre visit during episode | 637 | 1 | 1 |
64 | Marital status | 638 | 1 | 1 |
65 | Provider (hospital) code of facility from which patient transferred | 639 | 8 | 1 |
66 | Provider (hospital) code of facility to which patient transferred | 647 | 8 | 1 |
67 | Discharge intention on admission | 655 | 1 | 1 |
68 | Gap cover scheme identifier | 656 | 5 | 1 |
69 | Total record length | 660 |
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[12] Schedule 7, Part 4, item 3, column 2
substitute
CMBS item/Miscellaneous service code/ADA code
[13] Schedule 7, Part 4, item 6, column 2
substitute
Fund medical benefit
[14] Schedule 7, Part 4, after item 8
insert
9 | Gap cover scheme identifier | A(5) | MAA | Approved gap scheme identifier in the format <Fund ID><two digit code> Blank indicates no gap cover scheme applied for this medical service |
[15] Schedule 7, Part 5, item 2, column 5
after
(Part 4)
insert
, the prosthetic record (Part 7) and the AN-SNAP record (Part 8)
[16] Schedule 7, Part 5, item 3, column 5
substitute
The hospital provider number
OVERSEAS = overseas provider
[17] Schedule 7, Part 5, item 5, column 5
after
N = a hospital with which the fund does not have a contract
insert
T = a hospital that is paid under 2nd Tier benefit arrangement
B = a hospital that is paid under a ‘Bulk payment’ arrangement
[18] Schedule 7, Part 5, items 15 and 16
substitute
15 | Total prostheses charge | N(5) | MAA | The total amount (rounded to the nearest dollar) that a hospital has charged for all prostheses used as part of an episode of care 0 = no prosthesis charge billed |
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| Blanks only valid if a prosthesis charge was not separately identified but billed under another charge item |
16 | Total prostheses benefit | N(5) | MAA | The total amount (rounded to the nearest dollar) that a health fund has paid as a benefit for all prostheses used as part of an episode of care 0 = no prosthesis charge paid |
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| Blanks only valid if a prosthesis charge was not separately identified but paid under another charge item |
[19] Schedule 7, Part 5, item 23, column 5
omit
Blank = there is a FED but the amount is unknown
[20] Schedule 7, Part 5, item 25, column 5
substitute
The ancillary charges incurred during the episode and billed against an ancillary table
0 = no ancillary charges incurred during the episode
[21] Schedule 7, Part 5, item 26, column 5
substitute
The ancillary benefits paid for charges billed as occurring during the episode
0 = no ancillary benefits paid during the episode
[22] Schedule 7, Part 5, item 27
substitute
27 | Total item charges | N(6) | MAA | The total amount (rounded to the nearest dollar) of all item charges shown in Part 4 associated with the episode of care |
[23] Schedule 7, Part 5, item 30, column 5
substitute
The patient’s residential postcode
9999 = unknown postcode
[24] Schedule 7, Part 5, item 31, column 5
omit
0 = unknown
insert
3 = indeterminate
9 = not stated/inadequately described
[25] Schedule 7, Part 5, item 36, column 5
substitute
The DRG code which best classifies the episode of care using an Australian National or Refined Diagnosis Related Group classification
Blank filled if not known
[26] Schedule 7, Part 5, item 37, column 5
after
41 = version 4.1
insert
42 = version 4.2
50 = version 5.0
[27] Schedule 7, Part 5, item 39
substitute
39 | Infant weight, neonate, stillborn | N(4) | MAA | The first weight (in grams) of the live born or stillborn baby obtained after birth, or the weight of the neonate or infant (if aged less than 365 days and weighing less than or equal to 9 000g) on the date admitted if this is different from the date of birth 0 = not applicable |
[28] Schedule 7, Part 5, item 40, column 5
substitute
The number of hours, rounded to the nearest hour, that the patient received mechanical ventilation during the episode
0 = no mechanical ventilation
[29] Schedule 7, Part 5, item 41, column 5
substitute
1 = discharge or transfer to an acute hospital
2 = discharge or transfer to a residential aged care service, unless this is usual place of residence
3 = discharge or transfer to a psychiatric hospital
4 = discharge or transfer to another health facility
5 = statistical discharge or type change
6 = left against medical advice or discharge at own risk
7 = statistical discharge from leave
8 = died
9 = other (includes discharge to home or usual pace of residence)
[30] Schedule 7, Part 5, item 44
substitute
44 | Care type | N(3) | MAA | 10 = acute care 20 = rehabilitation care 21 = rehabilitation care delivered in a designated unit 22 = rehabilitation care according to a designated program |
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| 23 = rehabilitation care is the principal clinical intent 30 = palliative care |
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| 31 = palliative care delivered in a designated unit |
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| 32 = palliative care according to a designated program |
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| 33 = palliative care is the principal clinical intent |
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| 40 = geriatric evaluation and management 50 = psychogeriatric care |
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| 60 = maintenance care 70 = newborn care 80 = other admitted patient care |
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| 90 = organ procurement — posthumous 100 = hospital boarder |
[31] Schedule 7, Part 5, item 46
substitute
46 | Non-certified days of stay | N(4) | MAA | The number of days spent in the hospital, without certification, that exceeded 35 days 0 = no non-certified days |
[32] Schedule 7, Part 5, item 47, column 2
omit
code
[33] Schedule 7, Part 5, item 49, column 2
omit
codes
[34] Schedule 7, Part 5, item 51, column 2
substitute
Principal CMBS item number/Miscellaneous service code/ADA code
[35] Schedule 7, Part 5, item 52, column 2
substitute
Principal CMBS item date
[36] Schedule 7, Part 5, item 53
substitute
53 | Minutes of operating theatre time | N(4) | MAA (sameday patients only) | Total time (in minutes) spent by a patient in operating theatres during current episode of hospitalisation |
[37] Schedule 7, Part 5, item 54, column 2
substitute
Secondary CMBS item numbers/Miscellaneous service codes/ADA codes
[38] Schedule 7, Part 5, item 55
substitute
55 | Days of hospital in the home care | N(2) | MAA (Hospital-in-home episodes only) | The number of hospital in the home days occurring within the episode of care for the patient 0 = not applicable |
[39] Schedule 7, Part 5, item 57, column 5
after
2 = voluntary patient
insert
3 = not permitted to be reported under legislative arrangements in the jurisdiction
8 = not applicable
[40] Schedule 7, Part 5, items 59 and 60
substitute
59 | Urgency of admission | N(1) | OPA | 1 = urgency status assigned — emergency 2 = urgency status assigned — elective 3 = urgency status not assigned 9 = not known/not reported |
60 | Inter-hospital contracted patient | N(1) | OPA | 1 = inter-hospital contracted patient from public sector 2 = inter-hospital contracted patient from private sector 3 = other 9 = not reported |
[41] Schedule 7, Part 5, item 65, column 2
substitute
Provider (hospital) code of facility from which transferred
[42] Schedule 7, Part 5, item 66, column 2
substitute
Provider (hospital) code of facility to which transferred
[43] Schedule 7, Part 5, item 67, column 5
omit
6 = usual residence
insert
8 = died
9 = usual residence/other
[44] Schedule 7, Part 5, item 68, column 5
substitute
Approved gap scheme identifier in the format <Fund ID><two digit code>
Blank = no part of the episode was covered by a gap cover scheme
[45] Schedule 7, Part 6
substitute
Part 6 Registered health benefits organisations
Item | Name | Identifier |
1 | A.C.A. Health Benefits Fund | ACA |
2 | A.M.A. Health Fund Limited | AMA |
3 | Australian Health Management Group Limited | AHM |
4 | Australian Unity Health Limited | AUF |
5 | AXA Australia Health Insurance Pty Ltd | AXA |
6 | CBHS Friendly Society Limited | CBH |
7 | Cessnock District Health Benefits Fund Limited | CDH |
8 | Credicare Health Fund Limited | CPS |
9 | Defence Health Limited | AHB |
10 | Federation Health | YMH |
11 | GMHBA Limited | GMH |
12 | Goldfields Medical Fund (Inc) | GMF |
13 | Grand United Corporate Health Limited | FAI |
14 | Grand United Health Fund Pty Ltd | GUF |
15 | HBF Health Funds Inc | HBF |
16 | Health Care Insurance Ltd | HCI |
17 | Healthguard Health Benefits Fund Limited | HHB |
18 | Health Insurance Fund of WA | HIF |
19 | Health-Partners Inc | SPS |
20 | Hospital Benefits Association Limited | HBA |
21 | Hospital Contribution Fund of Australia Limited, The | HCF |
22 | I.O.R. Australia Pty Ltd | IOR |
23 | IOOF Health Services Ltd | IOF |
24 | Latrobe Health Services Inc | LHS |
25 | Lysaght Peoplecare | LHM |
26 | Manchester Unity Australia Ltd | MUI |
27 | Medibank Private Limited | MBP |
28 | Medical Benefits Fund of Australia Ltd | MBF |
29 | Mildura District Hospital Fund Limited | MDH |
30 | Mutual Community Ltd | MCL |
31 | N.I.B. Health Funds Limited | NIB |
32 | National Mutual Health Insurance | NMH |
33 | Naval Health Benefits Society | NHB |
34 | NRMA Health Pty Ltd | SGI |
35 | Phoenix Health Fund Limited | PWA |
36 | Queensland Country Health Limited | MIM |
37 | Railway and Transport Employees’ Friendly Society Health Fund Ltd | RTE |
38 | Reserve Bank Health Society Ltd | RBH |
39 | South Australian Police Employees’ Health Fund Inc | SPE |
40 | St Luke’s Medical and Hospital Benefits Association Limited | SLM |
41 | Teachers Federation Health Ltd | NTF |
42 | Transition Benefits Fund Pty Ltd | TBF |
43 | Transport Friendly Society Ltd | TFS |
44 | United Ancient Order of Druids Friendly Society Limited | UAD |
45 | United Ancient Order of Druids Registered Friendly Society Grand Lodge of New South Wales | UAF |
46 | Western District Health Fund Ltd | WDH |
Part 7 File structure and record content: prosthetic record
Item | Data item | Start Position | Field size | Required | Coding description |
1 | Fund identifier | 1 | A(3) | MAA | See fund codes |
2 | Link identifier | 4 | A(24) | MAA | A unique identifier of an episode that links Data items from this Part (Part 7) to the medical record (Part 4) and the hospital episode record (Part 5). The fund may encrypt the membership identifier for this purpose |
3 | Prosthetic item | 28 | A(5) | MAA | Billing code in the format AA999 as specified in the database of prosthetic items maintained by the Department |
4 | Number of prosthetic items | 33 | N(3) | MAA | Number of prosthetic items identified in item 3 used |
5 | Prosthetic item charge | 36 | N(5) | MAA | Total charge for prosthetic items identified in item 3 (including the supply charge where relevant) |
6 | Prosthetic item benefit | 41 | N(5) | MAA | Total benefit for prosthetic items identified in item 3 (including the supply benefit where relevant) |
Part 8 File structure and record content: AN‑SNAP record
Item | Data item | Start position | Field size | Coding description |
1 | Fund identifier | 1 | A(3) | See fund codes |
2 | Link identifier | 4 | A(24) | A unique identifier of an episode that links Data items from this Part (Part 8) to the medical record (Part 4) and the hospital episode record (Part 5). The fund may encrypt the membership identifier for this purpose |
3 | Episode type | 28 | A(1) | O = overnight admitted patient S = sameday admitted patient |
4 | Admission FIM Item Scores | 29 | N(1) (17 Repeats) | The FIM score on admission for each of the 18 FIM motor and cognition items. Each item has a maximum score of 7 and a minimum score of 1. Total scores can range from 18 to 126. Admission data must be collected within 72 hours after admission. Guide for Uniform Data Set for Medical Rehabilitation procedures for scoring the FIM should be followed. FIM scores are as follows: |
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| No helper: |
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| Helper: Blank entries not valid for these fields |
5 | Discharge FIM Item Scores | 47 | N(1) (17 Repeats) | The FIM score on discharge for each of the 18 FIM motor and cognition items. Each item has a maximum score of 7 and a minimum score of 1. Total scores can range from 18 to 126. Discharge data must be collected within 72 hours prior to discharge. Guide for Uniform Data Set for Medical Rehabilitation procedures for scoring the FIM should be followed. FIM scores are as follows: |
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| No helper: |
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| Helper: Blank entries not valid for these fields |
6 | Functional Impairment Codes | 65 | A(7) | The Impairment Code (Version 5.0 UDS excluding ‘Medically Complex’) that best describes the primary reason for admission to the episode. To be coded as specifically as possible, avoiding the use of impairment group 13 (‘Other Disabling Impairments’) where possible. Entry should consist of: |
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| 2 digits representing impairment group a decimal point up to 4 digits that represent more specific categories within impairment groups |
7 | Assessment Only | 72 | N(1) | AN-SNAP has separate classes for Assessment Only episodes. Assessment Only occurs when the patient was seen once only for assessment or treatment and no further intervention by this service team is planned to occur within the next 90 days. If a patient is booked or seen for subsequent treatment within 90 days, the episode is not Assessment Only. If a patient is booked for subsequent assessment (but not treatment), the episode is Assessment Only. Record: |
8 | AN-SNAP Class | 73 | N(3) | The AN-SNAP class to which the episode is assigned. This can be derived from items in this Part together with patient ‘age’ (from date of birth). May be blank filled if not known |
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, 175, 236, 288 and 289; 2000 Nos. 2, 218, 242 and 315; 2001 Nos. 14, 67, 123 and 282.
2. Notified in the Commonwealth of Australia Gazette on 6 November 2002.