EXPLANATORY STATEMENT
Health Insurance Amendment (Episodic Agreements and Simplified Billing Assignments) Regulations 2026
Health Insurance Regulations 2018
Purpose and operation
The Health Insurance Amendment (Episodic Agreements and Simplified Billing Assignments) 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 and simplified billing services, including to better enable assignment using digital technologies.
These Regulations make further amendments to support simplified billing arrangements and ensure the new assignment of benefit requirements are operationalised as per the policy intent. These amendments include clarifying who can be the assignor, and how certain notification and record‑keeping requirements apply. For bulk billing, these Regulations make further amendments to provide greater flexibility for episodic pre- and post-service assignments. This means enabling multiple services per assignment agreement, including different kinds of services. All relevant information must be complete and provided to the assignor.
Background
The purpose of the these Regulations is to amend the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures Regulations 2025 to support bulk billed and simplified billing assignment arrangements by clarifying who can assign Medicare benefits, updating notification provisions to reduce administrative burden on health care providers and enable greater flexibility on who can receive a notification, and refining associated record‑keeping requirements.
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 and simplified billing 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.
Consultation
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 and simplified billing changes. 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 (Episodic Agreements and Simplified Billing Assignments) Regulations 2026
Section 1 – Name
Section 1 provides that the name of the instrument is the Health Insurance Amendment (Episodic Agreements and Simplified Billing Assignments) Regulations 2026.
Section 2 – Commencement
Section 2 provides that the instrument commences immediately after the commencement of the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025.
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.
Part 1 – Episodic agreements
Health Insurance Regulations 2018
Item 1 – Subsection 65C(2)
This item omits “a particular professional service (the agreement service)”, substitute “a professional service (an agreement service) described in the agreement”.
Item 2 – Subsection 65C(3)
This amended subsection now solidifies the intention to enable a single agreement for a single or multiple professional service(s) and multiple agreements with one or multiple professional service(s) per agreement. It also enables episodic pre-agreements to cover more than one agreement service to be rendered during a 6-month period. It will also clarify episodic post-agreements to include multiple MBS items per agreement, consistent with longstanding provisions.
Item 3 – Subsection 65C(4)(a)
This item omits and substitutes wording to include scenarios where an agreement may contain more than one agreement service.
Item 4 – Paragraph 65C(4)(d)
This item repeals and substitutes the paragraph to ensure consistency with the amendments from item 2.
Item 5 – Subsection 65C(4)(table heading)
This item omits “Kind of agreement” and substitutes it with “Kind of agreement service” to ensure consistency with the amendments from item 2.
Item 6 – Subsection 65C(4)(cell table item 1, column 1)
This item repeals the cell and substitutes with an amended descriptions of an episodic pre-agreement for a pathology service (other than Group P9 of the pathology services table) for which the information in cell table item 1, column 2 will be required.
Item 7 – Subsection 65C(4)(table item 1, column 2, paragraph (a))
This item omits “the date on which the specimen” and substitutes it with “the date (or, if there is more than one date, the first such date) on which a specimen” to allow for multiple services under one agreement.
Item 8 – Subsection 65C(4)(cell table item 2, column 1)
This item repeals the cell and substitutes with an amended descriptions of an episodic post-agreement for a pathology service (other than Group P9 of the pathology services table) for which the information in cell table item 2, column 2 will be required.
Item 9 – Subsection 65C(4)(table item 2, column 2, paragraph (b))
This item omits “the date on which the specimen” and substitutes it with “the date (or, if there is more than one date, the first such date) on which a specimen” to allow for multiple services under one agreement.
Item 10 – Subsection 65C(4)(cell table item 3, column 1)
This item repeals the cell and substitutes with an amended description of an episodic pre-agreement for a diagnostic imaging service for which the information in cell table item 3, column 2 will be required.
Item 11 – Subsection 65C(4)(cell table item 4, column 1)
This item repeals the cell and substitutes with an amended description of an episodic post-agreement for a diagnostic imaging service for which the information in cell table item 4, column 2 will be required.
Item 12 – Subsection 65C(4)(cell table item 5, column 1)
This item repeals the cell and substitutes with an amended description of an episodic pre-agreement for an agreement service (other than an agreement service which table item 1 or 3 applies).
Item 13 – Subsection 65C(4)(cell table item 5, column 2, paragraph (c))
This item repeals the cell and substitutes to recognise the Health Insurance (Assignment of Medicare Benefits - Categories of Professional Services) Determination 2026.
Item 14 – Subsection 65C(4)(cell table item 6, column 1)
This item repeals the cell and substitutes with an amended description of an episodic post-agreement for an agreement service (other than an agreement service which table item 2 or 4 applies).
Item 15 – Subsection 65C(6)(c) and (d)
This item repeals the two paragraphs and combines them into a singular one. The amendment means a single document may comprise multiple agreements rather than one agreement per document, for consistency with Item 2.
Part 2 – Simplified billing assignments
Health Insurance Regulations 2018
Item 16 – Section 65A
Following amendments made by Item 4 of Schedule 3 of the HLA Act 2025, Item 1 amends the outline to specify that an assignor or another person must be covered for liability to pay fees and charges under a complying health insurance policy (CHIP) issued by a private health insurer.
It replaces the reference to an eligible person who holds a complying health insurance policy with a reference to an eligible person or another person who is covered by a complying health insurance policy issued by a private health insurer.
Item 17 – Paragraph 65D(1)(b)
Following amendments made by Item 4 of Schedule 3 of the HLA Act 2025, Item 2 makes consequential changes to Paragraph 65D(1)(b) to specify that an assignor or another person must be covered for liability to pay fees and charges under a complying health insurance policy (CHIP) issued by a private health insurer.
Item 18 – Subsection 89B(1)
This item repeals and substitutes subsection 89B(1) to clarify the role of section 89B within the notification framework established by the Act, as it will be amended by the AOB Act 2024 and the HLA Act 2025.
The amendment makes clear that section 89B specifies the procedural requirements an insurer or approved billing agent must meet when giving a notification under paragraph 127(3)(d) of the Act. This ensures the Regulations focus on how notifications are to be given, rather than duplicating provisions in the Act that specify who must receive the notification, and supports consistent operation where notifications are given to an assignor or another eligible person under simplified billing arrangements.
Item 19 – Paragraph 89B(2)(b)
This item amends paragraph 89B(2)(b) to ensure notification requirements apply where liability relates to the assignor or another eligible person.
Item 20 – Subsection 89B(3)
This item repeals subsection 89B(3) as it is no longer required following amendments to the Act made by the AOB Act 2024 and the HLA Act 2025. The repeal simplifies the notification framework without altering substantive obligations.
Item 21 – Subsection 89B(4)
This item removes wording that limited subsection 89B(4) to notifications given to the assignor. The amendment ensures the provision can operate where a notification is given to another eligible person.
Item 22 – Paragraph 89B(4)(b)
This item inserts a reference to “other eligible person (as applicable)” so that the assignor or other eligible person, as relevant, can specify the manner in which a notification is given.
Item 23 – Paragraph 89C(1)(a)
This item relates to the record-keeping requirement for the copy of the CHIP and clarifies that the CHIP may cover the assignor or another person.
Item 24 – Paragraph 89C(1)(b)
This item ensures that notification‑related obligations under paragraph 89C(1)(b) specify that the notification can also be provided to the eligible person that was rendered the professional service, if they are not the assignor. This is in line with the changes to paragraph 127(3)(d) of the Act, as it will be amended by the AOB Act 2024 and the HLA Act 2025.
Item 25 – Paragraph 89C(2)(a)
This item relates to the record-keeping requirement for the record of the CHIP and clarifies that the CHIP may cover the assignor or another person.
Item 26 – Paragraph 89C(2)(b)
This item ensures that notification‑related obligations under paragraph 89C(2)(b) specify that the notification can also be provided to the eligible person that was rendered the professional service, if they are not the assignor. This is in line with the changes to paragraph 127(3)(d) of the Act, as it will be amended by the AOB Act 2024 and the HLA Act 2025.
Item 27 – Subparagraph 89C(4)(c)(iii)
This item omits “and” from subparagraph 89C(4)(c)(iii), as a consequential change to the structure of paragraph 89C(4)(c).
Item 28 – Subparagraph 89C(4)(c)(iv)
This item removes the requirement for a record of the notification that was required to be given under paragraph 127(5)(d) of the Act following changes made by the HLA Act 2025.
Item 29 – Subparagraph 89C(6)(c)(iii)
This item omits “and” from subparagraph 89C(6)(c)(iii), as a consequential change to the structure of paragraph 89C(6)(c).
Item 30 – Subparagraph 89C(6)(c)(iv)
This item removes the requirement for a record of the notification that was required to be given under paragraph 127(5)(d) of the Act following changes made by the Schedule 3, Item 11 of the HLA Act 2025.
Item 31 – Subparagraph 89C(8)(b)(iii)
This item omits “and” from subparagraph 89C(8)(b)(iii), as a consequential change to the structure of paragraph 89C(8)(b).
Item 32 – Subparagraph 89C(8)(b)(iv)
This item removes the requirement for a record of the notification that was required to be given under paragraph 127(5)(d) of the Act following changes made by Schedule 3, Item 11 of the HLA Act 2025.
Item 33 – Section 89D (before the table)
This item inserts a note in this section to assist in clarifying which parts of the Act, as amended by the AOB Act 2024, set out the retention periods for records that are required to be kept but are not included in the table set out in 89D of the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025.
Item 34 – Section 89D (table item 2)
This item removes the 7-year record keeping requirement for arrangements mentioned in paragraph 20AAA(1)(a) of the Act, as amended by the AOB Act 2024. Records must be kept as per the requirements set out in paragraph 127A(5)(a) of the Act, as amended by the AOB Act 2024.
Item 35 – Section 89D (table item 5, column 1)
This item amends the record‑keeping table in section 89D by substituting the cell at table item 5, column 1 so that it refers to “A copy of a notification required to be given under paragraph 127(3)(d) of the Act”.
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 (Episodic Agreements and Simplified Billing Assignments) 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 (Assignment of Medicare Benefits and Other Measures) Regulations 2026: Simplified billing assignments 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 clarifying who can be the assignor for simplified billing services, removing notification requirements for assignment requests as modified, enabling the person rendered the service and the assignor to receive notifications when a Medicare benefit is received by a private health insurer or approved billing agent, and updating the relevant record-keeping requirements.
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 protection of the law 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.
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 improves 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 and ‘simplified billing’ of privately insured hospital and hospital substitute treatment, both of which enable healthcare to be provided at no cost or reduced cost to patients.
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