Relating to Eligibility for Publicly Funded Personal Health and Disability Services in New Zealand
Pursuant to section 25 of the Health and Disability Services Act 1993, the Minister of Health, after consulting as required by that section, hereby gives the following direction to the Health Funding Authority established under section 32 of that Act.
1. Title and commencement-(1) This direction may be cited as the Health and Disability Services Eligibility Direction 2000.
(2) This direction shall come into force on the 1st day of July 2000.
2. Interpretation-(1) In this direction, unless the context otherwise requires-
"AI Act" means the Accident Insurance Act 1998 and includes any regulations made or continued under that Act, and any successor to that Act and any regulations made under it;
"Community services" means services (other than disability support services) provided in a community setting outside a health care facility;
"Disability services" has the same meaning as in
section 2 of the H & DS Act;
"Disability Support Services" include-
(a) services which provide information on Disability Support Services to people with disabilities and/or their caregivers in a suitable form; and
(b) needs assessment services; and
(c) service co-ordination services; and
(d) personal care services including assistance with daily activities such as dressing, personal hygiene, assistance with eating, supervising medication, seating, positioning and toileting; and
(e) household management services for people with disabilities including assistance with domestic functions such as meal preparation, cooking, cleaning, laundering and shopping; and
(f) caregiver support services that provide relief to primary informal care givers; and
(g) residential care services that provide short and long-term care; and
(h) rehabilitation and habilitation services; and
(i) environmental support services which supply people with disabilities with-
(i) equipment and aids to meet a range of needs including mobility, household management, communication, personal care needs; and
(ii) consumables related to continence, personal care and mobility;
"Eligibility" means the right to be considered for receipt of publicly funded services, but does not equate to an entitlement to receive those services;
"Eligibility criteria" means the criteria set out in clause
5 of this direction, any of which, as a minimum, must be satisfied before any person may receive any publicly funded service purchased by the HFA;
"Funding agreement" means an agreement within the meaning of section 21 of the H & DS Act entered into by the HFA, and for the purposes of clause 5 (13), may include a funding agreement entered into under section 361 of the
AI Act;
"Guardian" has the same meaning as in section 3 of the Guardianship Act 1968;
"H & DS Act" means the Health and Disability Services Act 1993;
"Health care facility" means a hospital or other facility for the provision of services operated by a hospital (whether or not located in that hospital);
"HFA" means the Health Funding Authority established by Order-in-Council under section 32 of the H & DS Act, and includes any successor to the HFA;
"Minister" means the Minister of Health;
"New Zealand" includes all waters within the outer limits of the territorial sea of New Zealand as defined in section 3 of the Territorial Sea and Exclusive Economic Zone Act 1977, and does not include the Cook Islands, Niue, Tokelau or the Ross Dependency;
"New Zealand citizen" means a person who has
New Zealand citizenship under the Citizenship Act 1977 or the Citizenship (Western Samoa) Act 1982;
"Ordinarily resident in New Zealand" means an individual who is lawfully present in New Zealand at the time of seeking services and who-
(a) is a New Zealand citizen who, immediately prior to seeking services, has remained in New Zealand for a period that equals or exceeds 2 years, whether or not that person has been temporarily absent from New Zealand; or
(b) is a New Zealand citizen who-
(i) has his or her usual place of abode in
New Zealand; and
(ii) can demonstrate an intention, on reasonable grounds, to remain in New Zealand for a period that, together with the time that person has already been in New Zealand immediately prior to seeking the services, equals or exceeds 2 years; or
(c) holds a residence permit issued under the Immigration Act 1987; and
(i) holds a current returning resident's visa issued under the Immigration Act 1987; or
(ii) immediately prior to seeking services, has remained in New Zealand for a period that equals or exceeds 2 years; or
(d) is a person exempted, by virtue of being a citizen of the Commonwealth of Australia or by virtue of holding a current resident return visa issued by the Government of Australia, from holding a residence visa issued under the Immigration Act 1987, and can demonstrate an intention, on reasonable grounds, to remain in New Zealand for a period that, together with the time that person has already been in
New Zealand immediately prior to seeking the services, equals or exceeds 2 years; or
(e) holds a student permit issued under section 26 of the Immigration Act 1987:
(i) entitling that person to remain in New Zealand for a period that equals or exceeds 2 years; or
(ii) entitling that person to remain in New Zealand for a period of not less than 12 months, where that individual can demonstrate a reasonable expectation of having a further student permit issued for that period which will (together with the duration of the first permit) allow that person to remain in New Zealand continuously for a period that equals or exceeds 2 years; or
(iii) entitling that person to remain in New Zealand for a specified period of time which, together with the period of time that person has already been lawfully in New Zealand immediately prior to obtaining the permit, equals or exceeds 2 years, or
(f) holds a visitor's or work permit issued under section 26 of the Immigration Act 1987:
(i) entitling that person to remain in New Zealand for a period that equals or exceeds 2 years; or
(ii) entitling that person to remain in New Zealand for a specified period of time which, together with the period of time that person has already been lawfully in New Zealand immediately prior to obtaining the permit, equals or exceeds 2 years; or
(g) is an individual under the age of 2 years who was born in New Zealand and has remained in
New Zealand since birth, whether or not that person has been temporarily absent from New Zealand;
"Outpatient services" means personal health services (including treatment, therapy, advice, diagnostic or investigatory procedures or pre-admission assessment) provided in a health care facility to a person who is not admitted to that facility at the time of receiving those services;
"Partner" means-
(a) where the parties are legally married, either the husband or the wife, as the case requires;
(b) where the parties (whether of the same or opposite gender) are not legally married but are living together in a relationship in the nature of marriage, either of the parties, as the case requires;
"Personal health services" has the same meaning as in section 2 of the H & DS Act;
"Prison" includes a Gazetted police jail, or corrective training institution;
"Publicly funded services" means personal health and disability services purchased by the HFA using funds provided by the Crown under a funding agreement, and does not include services purchased by the HFA using funds provided by any person or agency other than the Crown, whether or not the purchasing of those services results in a part charge to the person receiving the services;
"Public health acute services" has the same meaning as in section 14 (2) of the AI Act;
"Services" (except in clause 5 (13)) means personal health services or disability services or both;
(2) Words importing the singular include the plural and vice versa.
3. Disputes and payments-If any question or dispute arises as to whether or not-
(1) Any person satisfies any of the eligibility criteria for receipt of a service; or
(2) Any other criteria or any terms or conditions, set out in a funding agreement, for receipt of a service, are satisfied;
that question or dispute shall be determined by the Minister.
4. Amendment, revocation and term of direction-
(1) The Minister may from time to time, by notice under section 25 of the H & DS Act, amend or revoke this direction.
(2) The Health and Disability Services Eligibility Direction 1999 is hereby revoked.
(3) This direction (together with any amendments to it made under clause (1) of this section), shall remain in force until it is revoked by the Minister.
5. Eligibility Criteria-A person shall be eligible for publicly funded services if he or she is in New Zealand at the time of seeking services and-
(1) Is ordinarily resident in New Zealand; or
(2) Is a New Zealand citizen who is temporarily resident in New Zealand and who has at some time had his or her usual place of abode in New Zealand for a period that equalled or exceeded 2 years whether or not that person has been temporarily absent from New Zealand during that period; or
(3) Is a New Zealand citizen whose usual place of abode is in the Cook Islands, Niue, or Tokelau, and who for the time being is temporarily resident in New Zealand; or
(4) Has refugee status in New Zealand or is in the process of applying for such status; or
(5) Is a student receiving funding under the Ministry of Foreign Affairs and Trade Official Development Assistance Programme, or is the partner, or child under the age of
18 years of such student; or
(6) Is a participant in the Ministry of Education's Foreign Language Teaching Assistantship Scheme; or
(7) Is-
(a) a person having their usual place of abode (other than unlawfully) in a country or territory from time to time specified by the Minister by notice in the Gazette, being a country or territory where in the opinion of the Minister individuals who are citizens of New Zealand or ordinarily resident in
New Zealand are or will be, while in that country or territory, eligible for services that substantially correspond to services that the HFA is obliged by its funding agreement to purchase in respect of those individuals; and
(b) not of a class of persons specified by the Minister in that notice as being individuals who may not receive services purchased by the HFA; or
(8) Is a resident of Australia who is in New Zealand on a temporary basis (in respect of services required to be provided for that individual while in New Zealand by the agreement set out in the Schedule to the Health Benefits (Reciprocity with Australia) Act 1986) or any enactment which replaces, amends, supplants, or consolidates that
Act; or
(9) Is recognised by the Government of the United Kingdom as a national, and has his or her usual place of abode in the United Kingdom, and is in New Zealand on a temporary basis (in respect of services required to be provided for that individual while in New Zealand by the agreement set out in the Schedule to the Health Benefits (Reciprocity with the United Kingdom) Act 1982 or any enactment which replaces, amends, supplants or consolidates that Act; or
(10) Is a child (who is not otherwise eligible) under the age of 16 years who is lawfully in New Zealand and is for the time being in the care and control of:
(a) his or her guardian, and his or her guardian meets any of the eligibility criteria specified in clauses 5 (1), (2) or (3); or
(b) a person who is in the process of legally adopting that child and that person meets any of the eligibility criteria specified in clauses 5 (1), (2), or (3); or
(11) Is an individual receiving compulsory services under the Tuberculosis Act 1948, the Health Act 1956, the Alcoholism and Drug Addiction Act 1966, the Mental Health (Compulsory Assessment and Treatment) Act 1992 or any regulations made under such legislation, in respect only of services under those enactments, provided that any such individual may be considered for eligibility for those services only in terms of this clause 5 (12); or
(12) Is a prison inmate, including an individual on remand in prison custody, in respect only of services not available through the prison health services, provided that any such individual may be considered for eligibility for those services only in terms of this clause 12; or
(13) Is an individual who:
(a) in respect of eligibility for public health acute services required by that person for a personal injury for which that person has cover and entitlement¹ to treatment under the AI Act, is seeking services covered by a funding agreement; or
(b) in respect of eligibility for disability support services, requires those services for a personal injury for which the person has cover and entitlement² under the AI Act, but has been disentitled to any of those services under any of sections 117-123 of the
AI Act;
(c) Has cover and entitlement under the AI Act, and
seeks primary-referred pharmaceutical and laboratory services³.
Notwithstanding this clause 5 (13), a person who has cover and statutory entitlement in respect of a personal injury under the AI Act is not eligible for publicly funded services in relation to that injury except as provided in this clause 5 (13), and may not demonstrate eligibility for services in respect of that injury under clause 5 (1)-(12) of this Direction.
6. General-(1) Eligibility according to the eligibility criteria is to be assessed at the time the service is sought.
(2) A person may, unless otherwise stated, be eligible under 1 or more of the eligibility criteria.
(3) No payment shall be made by the HFA in respect of the receipt of a service by an eligible person who was not within New Zealand at the time of that receipt, unless such payment is authorised in a funding agreement.
Dated at Wellington this 27th day of July 2000.
ANNETTE KING, Minister of Health.
¹ "Entitlement" in clause 5 (13) (a) means a person who has statutory entitlements in terms of Part I of Schedule 1 to the AI Act, and who has not been disentitled under sections 117-123 of the AI Act.
² "Entitlement" in clause 5 (13) (b) means a person who has statutory entitlement to disability support services in terms of Schedule 1 to the AI Act.
³ The services covered by subclause 5 (13) (c) are outlined in the 2000/2001 Crown-ACC funding agreement for primary-referred pharmaceutical and laboratory services between ACC and the Minister of Health.