EXPLANATORY STATEMENT
Health Insurance Amendment (Enduring Agreements) Regulations 2026
Health Insurance Regulations 2018
Purpose and operation
The Health Insurance Amendment (Enduring Agreements) Regulations 2026 (these Regulations) amends the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025 and the Health Insurance Regulations 2018 to make consequential changes following passage of the Health Legislation Amendment (Miscellaneous Measures No. 1) Act 2025 (HLA Act 2025).
The Health Insurance Act 1973 (the Act) sets out the principles and definitions governing Medicare benefits, including the assignment of Medicare benefits and claiming arrangements. Amendments made by the Health Insurance Legislation Amendment (Assignment of Medicare Benefits) Act 2024 (AOB Act 2024) modernised and strengthened assignment of Medicare benefit requirements for bulk billed services.
These Regulations make further amendments to support enduring assignment agreements for bulk billed services. Regulations for enduring assignment set out the circumstances in which these agreements may be entered into or terminated, the kind of services to which they apply and specifies providers notification and record keeping requirements.
Background
The purpose of these Regulations is to amend the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025 to specify when and how enduring assignment of benefit agreements can be made, and notification and record keeping obligations.
The amending Regulations include requirements relating to the use and disclosure of personal information and new requirements for health professionals, and medical practices and clinics including Aboriginal Community Controlled Health Organisations (ACCHS) and Aboriginal Medical Services (AMS) to collect and retain certain records containing personal information. This could include sensitive personal information such as information about medical treatments a patient receives.
Section 89AA sets out the notification requirements for the enduring arrangements, including the requirement notify the assignor of the claim for payment of a medicare benefit, as well as the manner and form of notification. The notification requirements provide the assignor with assurance and transparency regarding medicare benefits that they have assigned, which has been received on their behalf.
The amending Regulations reduce the volume of information required to evidence an assignment agreement and does not require the inclusion of any additional sensitive health information. Amending Regulations echo existing powers under the Act, which are necessary to enable compliance activities to administer the integrity of medicare payments, including for bulk billed and simplified billing.
Authority
Subsection 133(1) of the Act provides that the Governor‑General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Subsection 33(3) of the Acts Interpretation Act 1901 provides that where an Act confers a power to make an instrument of a legislative character, the power includes a power to amend that instrument, exercisable in the like manner and subject to the like conditions (if any).
Reliance on subsection 33(3) of the Acts Interpretation Act 1901
Subsection 33(3) of the Acts Interpretation Act 1901 provides that where an Act confers a power to make, grant or issue any instrument of a legislative or administrative character (including rules, regulations or by-laws), the power shall be construed as including a power exercisable in the like manner and subject to the like conditions (if any) to repeal, rescind, revoke, amend, or vary any such instrument.
Commencement
The Regulations form part of the package of bulk billed reforms intended to take effect from 1 July 2026. Schedule 1, Part 1 commences immediately after the commencement of the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025. Enduring agreements will commence on 1 July 2026.
Consultation
The Department has engaged with Services Australia regarding the development of enduring assignment agreements, especially regarding software to facilitate the documentation of enduring agreements.
These amendments build on the stakeholder engagement undertaken for the assignment of benefits reforms, including consultation activities and stakeholder forums supporting readiness for the 1 July 2026 commencement of bulk billed changes. Extensive stakeholder engagement has occurred throughout 2025 and 2026 to inform enduring assignment requirements; this includes extensive discussions with representatives of Aboriginal Community Controlled Health Organisations (ACCHS) and Aboriginal Medical Services (AMS). Ongoing engagement material and resources have been provided to stakeholders to support implementation.
General
This instrument is a legislative instrument for the purposes of the Legislation Act 2003.
Details of this instrument are set out in Attachment A.
This instrument is compatible with the human rights and freedoms recognised or declared under section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011. A full statement of compatibility is set out in Attachment B.
ATTACHMENT A
Details of the Health Insurance Amendment (Enduring Agreements) Regulations 2026
Section 1 – Name
Section 1 provides that the name of the instrument is the Health Insurance Amendment (Enduring Assignments) Regulations 2026.
Section 2 – Commencement
Section 2 specifies the commencement is immediately after the commencement of the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025. The effect is the instrument commences 1 July 2026.
Section 3 – Authority
Section 3 provides that the instrument is made under the Health Insurance Act 1973.
Section 4 - Schedules
This section provides that each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
Schedule 1 –Enduring agreements
Health Insurance Regulations 2018
Item 1 – Section 4
This item provides for definitions including enduring agreement to have the same meaning as in subsection 20A(1A) of the Act, MyMedicare to mean the registration program by that name administered by the Department and responsible person to refer to the same definition as subsection 65(CA)(3).
Item 2 – Section 65B
This item amends the requirements for bulk-billing assignments to include not only an episodic agreement that meets the requirements specified in section 65C of this instrument, but to now include an enduring agreement that meets the requirements specified in section 65CB of this instrument. The effect is to include enduring agreements in the regulations.
Item 3 – Subsection 65C(1)
The item omits a prior reference to section 65B as an episodic agreement to now substitute paragraph 65B(a), to reflect that enduring assignments are now covered in section 65B.
Item 4 – Sections 65CA and 65CB
This item creates section 65CA, which sets out matters regarding enduring agreements.
The item provides that the circumstances under which an enduring agreement can be entered into. The item provides that for an assignor to enter into their own agreements they must be at least 14 years old, alternatively the responsible person for a person under 14 years old can enter into agreements for them.
Responsible person is defined to include a parent, stepparent, foster parent, spouse or de factor partner, a relative that is at least 18 years old that is a member of the person’s household, a guardian, or a person exercising an enduring power of attorney.
Where a person is at least 14 years old, a written declaration is provided that states the person understands that after each occasion on which an agreement service is rendered to the person a notification will be sent to the assignor in relation to the rendering of the service; and the agreement of the person to the enduring agreement being entered into and to such notifications being sent.
Where services are rendered to a patient registered with MyMedicare and the professional is a medical practitioner (excluding specialists and consultant physicians), the agreement only covers agreement services rendered at the or from the agreement location being the practice of the professional the MyMedicare agreement is with. This is identified by a provider number, and enduring agreements for that patient can only be at the same location. MyMedicare enduring agreements will generally be limited to a single location, unless the patient is of an Aboriginal Community Controlled Health Organisation or an Aboriginal Medical Service (ACCHO/AMS).
Patients of ACCHOs/AMS can be covered by multiple enduring agreements at the same time, but an agreement with a relevant ACCHO/AMS only covers the agreement location of that ACCHO/AMS. The agreement only covers agreement services to be rendered.
Patients in residential care homes (within the meaning of the Aged Care Act 2024) can be covered by multiple enduring agreements at the same time. This includes patients permanently or temporarily residing in residential care homes, including for respite care. For multiple enduring agreements, an agreement only covers agreement services at or from the agreement location identified in an agreement.
Enduring agreements can be terminated at any time by written notice of a party to the other party or be given by the patient who is not the assignor – meaning that a patient under 14 can terminate the agreement.
The item additionally sets out a number of circumstances under which an enduring agreement would cease to be in effect, such as the patient is no longer registered at the MyMedicare practice location, or the professional ceasing to work at that location. Agreements made on or before 30 June 2027 automatically cease on the first 12-month anniversary of the agreement date, unless registered with Services Australia or terminated earlier. The agreement ceases when a patient is 14 years old, whereupon the patient could presumably enter into their own agreement as an assignor if they wish. If written notice is given to terminate, the agreement is terminated at the end of 2 business days.
An enduring agreement for a patient in a residential care home ceases if the patient is no longer a resident, for example if they return to the community after temporary respite care. However, agreements continue for patients in a residential care home if they temporarily require hospital treatment.
This item also creates section 65CB which specifies the requirements that must be met in relation to an enduring agreement.
The other party must provide the assignor, in writing with an agreement that there is an enduring assignment, the name of the patient who is covered and to whom services will be rendered, a description of the professional services covered by the agreement sufficient to identify the items of the table that specify the services (by reference to Group or Subgroup), the method by which notifications made under section 89AA will be provided to the assignor in respect of professional services covered by the agreement, and how the assignor may terminate the agreement.
For MyMedicare enduring agreements, the name of the professional and the address of the location must be specified along with the provider number.
For enduring agreements for patients of an ACCHS/AMS, the name of the authorised agent must be specified, and a provider number allocated to a professional at one of the practices or clinics and the provider number identifying at least one of the clinics for which the patient attends.
For enduring agreements for a patient in a residential care home, the name of the professional and the address must be specified along with the provider number allocated to one of the practices or clinics the professional provides services at or from.
The information on how the agreement can be terminated can be given via an electronic link or website.
In addition to the requirements of what the other party must provide the assignor, the enduring agreement must be a written document that specifies whether the assignor is a patient, a signed declaration of the patient’s consent where they are 14 or over. After 1 July 2027, an enduring agreement must be lodged for registration with Services Australia, or made in software by Services Australia, by the party to the agreement that is not the assignor.
Item 5 – Section 89A and Section 89AA
The existing recordkeeping section under section 89A is repealed by this item. The new section 89A specifies records to be kept includes for enduring agreements, documents or copies of enduring agreements, consent to enter into an enduring agreement and the enduring agreement covering the kinds of professional services described under the agreement, copies of the notifications, and notices of termination of enduring agreements.
The item adds the new section 89AA which specifies notification requirements. A professional must notify the assignor within 24 hours after a claim for a benefit has been made or becoming aware of an error.
Notifications must include the name of the professional, the person to whom the professional service was rendered, the date on which the professional service was rendered, and the amount of the Medicare benefit claimed. The notification must be given in writing, and in the manner agreed by the assignor. Documents of consent for a relevant person being an insurer or agent do not need to be kept.
If a professional intends to terminate the enduring agreement, this must be notified at least two days before terminating the agreement.
For episodic agreements, copies of episodic agreements must be kept.
ATTACHMENT B
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Health Insurance Amendment (Enduring Agreements) Regulations 2026
This Regulation is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Disallowable Legislative Instrument
The Health Insurance Amendment (Enduring Agreements) Regulations 2026 will support amendments introduced in the AOB Act 2024 to modernise the assignment of benefits process.
The Regulations makes consequential amendments to the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025 following passage of the Health Legislation Amendment (Miscellaneous Measures No. 1) Act 2025. This includes specifying the circumstances in which enduring assignment of benefit agreements can be entered and terminated, the kind of professional services to which they apply and the content and manner in which they are made. Enduring agreements establish an ongoing agreement by assignors to assign Medicare benefits in exchange for the provider bulk billing them for professional services that are in scope of the agreement.
Human rights implications
The Regulations engage Articles 9 and 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR), specifically the rights to health and social security.
The Right to Health
The right to the enjoyment of the highest attainable standard of physical and mental health is contained in Article 12(1) of the ICESCR. The UN Committee on Economic Social and Cultural Rights (the Committee) has stated that the right to health is not a right for each individual to be healthy, but is a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.
The Committee reports that the ‘highest attainable standard of health’ takes into account the country’s available resources. This right may be understood as a right of access to a variety of public health and health care facilities, goods, services, programs, and conditions necessary for the realisation of the highest attainable standard of health.
The Right to Social Security
The right to social security is contained in Article 9 of the ICESCR. It requires that a country must, within its maximum available resources, ensure access to a social security scheme that provides a minimum essential level of benefits to all individuals and families that will enable them to acquire at least essential health care. Countries are obliged to demonstrate that every effort has been made to use all resources that are at their disposal in an effort to satisfy, as a matter of priority, this minimum obligation.
The Committee reports that there is a strong presumption that retrogressive measures taken in relation to the right to social security are prohibited under ICESCR. In this context, a retrogressive measure would be one taken without adequate justification that had the effect of reducing existing levels of social security benefits, or of denying benefits to persons or groups previously entitled to them. However, it is legitimate for a Government to re-direct its limited resources in ways that it considers to be more effective at meeting the general health needs of all society, particularly the needs of the more disadvantaged members of society.
The right of equality and non-discrimination
The rights of equality and non-discrimination are contained in articles 2, 16 and 26 of the International Covenant on Civil and Political Rights (ICCPR). Article 26 of the ICCPR requires that all persons are equal before the law, are entitled without any discrimination to the equal prolaw and in this respect, the law shall prohibit any discrimination and guarantee to all persons equal and effective protection against discrimination on any ground such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.
Convention on the Rights of the Child
The UN Convention on the Rights of the Child provides a number of rights for people under the age of 18.
Analysis
The Regulations maintain the rights to health and social security and the right of equality and non-discrimination by ensuring access to publicly subsidised medical services are clinically and cost-effective as intended.
The Regulations improve the governing framework for the payment of Medicare benefits in the interests of consumers and improve the information provided to consumers to allow them to make more informed choices.
Modernising assignment of Medicare benefits simplifies and streamlines the administration of Medicare claiming while better ensuring payment integrity. Patients and practitioners will find it easier to use and provide Medicare services respectively and make lawful claims for services that maintain patients’ health.
The amending regulations update the foundations for ‘bulk billed’ Medicare services which enable healthcare to be provided at no cost or reduced cost to patients. The regulations outline requirements for new enduring assignment agreements for bulk billed services, which provides as an additional assignment mechanism for MyMedicare registered patients at MyMedicare practices, patients accessing services at Aboriginal Community Controlled Health Organisations (ACCHS) and Aboriginal Medical Services (AMS), and patients in residential care home (within the definition of the Aged Care Act 2024).
The regulations specify information to be included in post service notifications which service providers must provide in writing to the assignor. This includes personal information including the patient’s name, name of medical professional, date of the service and the amount of medicare benefit claimed.
The regulations specify the age of being able to enter an enduring agreement is 14, rather than matching the convention on the Rights of the Child age being under 18. This aligns with existing Services Australia provisions regarding how Medicare applies to a person aged 14, where parents cease to have access to their Medicare claims and immunisation history statement. As such it mirrors existing practice on the age of medical autonomy within Australia.
The regulations form part of broader Medicare reforms to modernise and digitise the Medicare assignment of benefit process, to improve the administration of health services to the benefit of patients and health service providers.
Conclusion
This instrument is compatible with human rights as it maintains the right to health, the right to social security and the right of equality and non-discrimination. It does not raise any human rights issues.
Mark Butler
Minister of Health, Disability and Ageing