Person—eligibility status, Medicare code N
Data Element Attributes
Identifying and definitional attributes | |
Metadata item type: | Data Element |
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Short name: | Medicare eligibility status |
METEOR identifier: | 481841 |
Registration status: | Health!, Standard 08/02/2012 Tasmanian Health, Standard 27/06/2017 |
Definition: | An indicator of a person's eligibility for Medicare at the time of the episode of care, as specified under the Health Insurance Act 1973 (Cwlth), as represented by a code. |
Context: | Admitted patient care: To facilitate analyses of hospital utilisation and policy relating to health care financing. |
Data element concept attributes | |
Identifying and definitional attributes | |
Data element concept: | Person—eligibility status |
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METEOR identifier: | 304534 |
Registration status: | Health!, Standard 04/01/2006 Community Services (retired), Standard 04/01/2006 Tasmanian Health, Standard 27/06/2017 |
Definition: | An indicator of a person's eligibility to receive a service as determined by an assessment. |
Object class: | Person |
Property: | Eligibility status |
Source and reference attributes | |
Submitting organisation: | Australian Institute of Health and Welfare |
Value domain attributes | |
Identifying and definitional attributes | |
Value domain: | Medicare eligibility status code N |
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METEOR identifier: | 339082 |
Registration status: | Health!, Standard 29/11/2006 Tasmanian Health, Standard 27/06/2017 |
Definition: | A code set representing eligibility for Medicare. |
Representational attributes | ||
Representation class: | Code | |
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Data type: | Number | |
Format: | N | |
Maximum character length: | 1 | |
Value | Meaning | |
Permissible values: | 1 | Eligible |
2 | Not eligible | |
Supplementary values: | 9 | Not stated/unknown |
Data element attributes | |
Collection and usage attributes | |
Guide for use: | Eligible persons are
Reciprocal health care agreements Residents of countries with whom Australia has Reciprocal health care agreements are also eligible under certain circumstances. Australia has Reciprocal Health Care Agreements with Republic of Ireland, Italy, Finland, Malta, the Netherlands, New Zealand, Norway, Sweden and the United Kingdom. These Agreements give visitors from these countries access to Medicare and the Pharmaceutical Benefits Scheme for the treatment of an illness or injury which occurs during their stay, and which requires treatment before returning home (that is, these Agreements cover immediately necessary medical treatment, elective treatment is not covered). The Agreements provide for free accommodation and treatment as public hospital services, but do not cover treatment as a private patient in any kind of hospital. – The Agreements with Finland, Italy, Malta, the Netherlands, Norway, Sweden and the United Kingdom provide free care as a public patient in public hospitals, subsidised out-of-hospital medical treatment under Medicare, and subsidised medicines under the Pharmaceutical Benefits Scheme. – The Agreements with New Zealand and Ireland provide free care as a public patient in public hospitals and subsidised medicines under the Pharmaceutical Benefits Scheme, but do not cover out-of-hospital medical treatment. – Visitors from Italy and Malta are covered for a period of six months from the date of arrival in Australia only. Eligible patients may elect to be treated as either a public or a private patient. A newborn will usually take the Medicare eligibility status of the mother. However, the eligibility status of the father will be applied to the newborn if the baby is not eligible solely by virtue of the eligibility status of the mother. For example, if the mother of a newborn is an ineligible person but the father is eligible for Medicare, then the newborn will be eligible for Medicare. Not eligible/ineligible: means any person who is not Medicare eligible. Ineligible patients may not elect to be treated as a public patient. Prisoners are ineligible for Medicare, under Section 19 (2) of the Health Insurance Act 1973 (Cwlth). |
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Collection methods: | In practice, the primary method for ascertaining Medicare eligibility status is undertaken by the healthcare organisation sighting the patient’s Medicare card. |
Relational attributes | |
Related metadata references: | Supersedes Person—eligibility status, Medicare code N Health!, Superseded 08/02/2012 |
Implementation in Data Set Specifications: | Admitted patient care admission related data elements (TDLU) cluster Tasmanian Health, Standard 18/05/2021 Admitted patient care NMDS 2012-13 Health!, Superseded 02/05/2013 Implementation start date: 01/07/2012 Implementation end date: 30/06/2013 Admitted patient care NMDS 2013-14 Health!, Superseded 11/04/2014 Implementation start date: 01/07/2013 Implementation end date: 30/06/2014 Admitted patient care NMDS 2014-15 Health!, Superseded 13/11/2014 Implementation start date: 01/07/2014 Implementation end date: 30/06/2015 Admitted patient care NMDS 2015-16 Health!, Superseded 10/11/2015 Implementation start date: 01/07/2015 Implementation end date: 30/06/2016 Admitted patient care NMDS 2016-17 Health!, Superseded 05/10/2016 Implementation start date: 01/07/2016 Implementation end date: 30/06/2017 Admitted patient care NMDS 2017-18 Health!, Superseded 25/01/2018 Implementation start date: 01/07/2017 Implementation end date: 30/06/2018 Admitted patient care NMDS 2018-19 Health!, Superseded 12/12/2018 Implementation start date: 01/07/2018 Implementation end date: 30/06/2019 Admitted patient care NMDS 2019-20 Health!, Superseded 18/12/2019 Implementation start date: 01/07/2019 Implementation end date: 30/06/2020 Admitted patient care NMDS 2020–21 Health!, Superseded 05/02/2021 Implementation start date: 01/07/2020 Implementation end date: 30/06/2021 Admitted patient care NMDS 2021–22 Health!, Superseded 20/10/2021 Implementation start date: 01/07/2021 Implementation end date: 30/06/2022 Admitted patient care NMDS 2022–23 Health!, Standard 20/10/2021 Implementation start date: 01/07/2022 Implementation end date: 30/06/2023 Tasmanian Demographics Data Set - 2017 Tasmanian Health, Superseded 10/01/2018 Implementation start date: 01/07/2017 Implementation end date: 30/06/2018 Tasmanian Demographics Data Set - 2018 Tasmanian Health, Superseded 05/04/2019 Implementation start date: 01/07/2018 Implementation end date: 30/06/2019 Tasmanian Demographics Data Set - 2019 Tasmanian Health, Superseded 17/06/2020 Implementation start date: 01/07/2019 Implementation end date: 30/06/2020 Tasmanian Demographics Data Set - 2020 Tasmanian Health, Standard 15/06/2020 Implementation start date: 01/07/2020 Implementation end date: 30/06/2021 |