EXPLANATORY STATEMENT
Health Insurance (Assignment of Medicare Benefits – Categories of Professional Services) Determination 2026
Purpose and operation
The Health Insurance (Assignment of Medicare Benefits – Categories of Professional Services) Determination 2026 (this determination) has been created to determine categories of professional services for assignment of benefit purposes under section 20AAB 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.
This determination accompanies the regulations made under Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025 and Health Insurance Amendment (Episodic Agreements and Simplified Billing Assignments) Regulations 2026 to enable assignment of benefit to occur before a service has been rendered.
Background
The purpose of this determination is to allocate categories of professional services to specified professional services. This supports the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025 which specifies the kind and content of information required to be provided to persons who will be making bulk-billed assignment agreements.
The determination will not affect who is eligible to receive any professional services, who can provide any professional services, the requirements of any professional services, or the amount of Medicare benefit payable for any professional services.
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 determination is intended to take effect from 1 July 2026 at the same time as Schedule 3, Part 2 of the HLA Act 2025.
Consultation
The Department has engaged with key stakeholders, including medical industry representatives, software providers, and Services Australia regarding the content and purpose of the determination to support the legislative and regulatory amendments to the assignment of benefits process.
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 (Assignment of Medicare Benefits – Categories of Professional Services) Determination 2026
Section 1 – Name
Section 1 provides that the name of the instrument is the Health Insurance (Assignment of Medicare Benefits – Categories of Professional Services) Determination 2026.
Section 2 – Commencement
Section 2 specifies the commencement is at the same time as Schedule 3, Part 2 of the Health Legislation Amendment (Miscellaneous Measures No. 1) Act 2025. The effect is the instrument commences 1 July 2026.
Section 3 – Authority
Section 3 provides that the instrument is made under section 20AAB of 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.
Section 5 – Categories of professional services etc
This section outlines that column 1 in Schedule 1 of the instrument specifies categories of professional services and column 2 specifies the professional services that are in the specific category of professional services in column 1.
Schedule 1 – Categories of professional services and specified professional services
Item 1 – Categories of professional services and specified professional services
This item outlines a table containing items 1-23 with 2 columns. Column 1 specifies the categories of professional services and column 2 specifies the professional services that are in the specific category of professional services in column 1.
This Determination does not apply to pathology services (other than those specified in Group P9 of the pathology services table) or to diagnostic imaging services; these services do not utilise the categories of professional services.
ATTACHMENT B
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Health Insurance (Assignment of Medicare Benefits – Categories of Professional Services) Determination 2026
This Determination 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 (Assignment of Medicare Benefits – Categories of Professional Services) Determination 2026 will support amendments introduced in the AOB Act 2024 and HLA Act 2025 to modernise the assignment of benefits process.
The determination allocates categories of professional services to specified professional services. This supports the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025 which specifies the kind and content of information required to be provided to persons who will be making bulk-billed assignment agreements.
The determination will not affect who is eligible to receive any professional services, who can provide any professional services, the requirements of any professional services, or the amount of Medicare benefit payable for any professional services.
Human rights implications
The Determination 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 Determination supports amendments to legislation and regulations aimed at maintaining the rights to health and social security, as well as promoting equality and non-discrimination by ensuring access to clinically appropriate and cost-effective publicly subsidised medical services. It also strengthens the regulatory framework for the payment of Medicare benefits, improving transparency and the information available to consumers so they can make more informed choices.
As part of broader reforms, the Determination contributes to the modernisation and digitisation of the assignment of benefits process. These changes are intended to simplify and streamline Medicare claiming, improve administrative efficiency, and strengthen payment integrity, making it easier for patients to access services and for practitioners to provide care and submit lawful claims.
The Determination specifically allocates categories of professional services to specified professional services, supporting the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025, which sets out the information requirements for bulk-billed episodic assignment agreements. It does not alter eligibility for any professional services, who can provide them, the requirements for those services, or the amount of Medicare benefit payable
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