Health Insurance (General Medical Services Table) Amendment (After-hours Rural Area) Regulations 2018

Administered by Department of Health, Disability and Ageing

Legislation au F2018L01616 Regulations Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

Health Insurance Act 1973

 

Health Insurance (General Medical Services Table) Amendment (After-hours Rural Area) Regulations 2018

 

Subsection 133(1) of the Health Insurance Act 1973 (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.

 

Part II of the Act provides for the payment of Medicare benefits for professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits be calculated by reference to the fees for medical services set out in prescribed tables.

 

Subsection 4(1) of the Act provides that regulations may prescribe a table of medical services which set out items of services, the fees applicable for each item, and rules for interpreting the tables. The Health Insurance (General Medical Services Table) Regulations 2018 (GMST) prescribes such a table. 

 

Purpose

On 1 March 2018 changes were made to the existing Medicare urgent after-hours items and new items introduced to improve the quality of after-hours services and incentivise better value care through targeted benefits. This change was made through the Health Insurance Legislation Amendment (After-Hours Services) Regulations 2018.

 

Currently item 588 can only be claimed when the service is performed in an after-hours area (Modified Monash areas 3 to 7). Item 591 is claimed for any services outside of this area (Modified Monash areas 1 and 2). The purpose of the Health Insurance (General Medical Services Table) Amendment (After-hours Rural Area) Regulations 2018 (the Regulations) is to amend the eligible areas for these items.

 

From 1 January 2019 the eligible areas for item 588 will be Modified Monash areas 2 to 7 and, for item 591, Modified Monash area 1.  

 

Consultation

The change to the geographic eligibility for item 588 responds to concerns raised by key stakeholders, including the National After Hours Medical Deputising Service and the General Practitioner Deputising Association.

 

Details of the Regulations are set out in the Attachment.

 

The Act specifies no conditions which need to be met before the power to make the Regulations may be exercised. 

 

The Regulations are a legislative instrument for the purposes of the Legislation Act 2003.

 

The Regulations commence on 1 January 2019.

 

 

 Authority:         Subsection 133(1) of the

                                                                                                   Health Insurance Act 1973 


 

ATTACHMENT

 

Details of the Health Insurance (General Medical Services Table) Amendment (After-hours Rural Area) Regulations 2018

 

Section 1 – Name

 

This section provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Amendment (After-hours Rural Area) Regulations 2018.

 

Section 2 – Commencement

 

This section provides that the Regulations commence on 1 January 2019.
 

Section 3 – Authority 

 

This section provides that the Regulations are made under the Health Insurance Act 1973.

 

Section 4 – Schedule(s)

 

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 – Amendments

 

Health Insurance (General Medical Services Table) Regulations 2018

 

Item 1 - Clause 2.16.4 of Schedule 1 (definition of after‑hours rural area)

This item inserts “Modified Monash 2 area” after “area that is a”. This allows services provided under item 588 to be claimed in Modified Monash 2 areas from 1 January 2019.

 

This change also amends the eligible area for item 591 to restrict it to Modified Monash 1 areas. Services in Modified Monash 2 areas that were previously claimed under this item will now be billed under item 588 which has a higher patient benefit.  

 

Modified Monash is a geographical classification system developed by the Department of Health (the Department) for categorising metropolitan, regional, rural and remote locations according to both geographical remoteness and population size, based on population data published by the Australian Bureau of Statistics. The Department uses the Australian Statistical Geography Standard (ASGS) system as published by the Australian Bureau of Statistics in July 2011, but has different numbering system. Maps of the Modified Monash areas and the Department’s remoteness classification are available at www.doctorconnect.gov.au.

 

 


Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

 

Health Insurance (General Medical Services Table) Amendment (After-hours Rural Area) Regulations 2018
 

This Legislative Instrument 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 Legislative Instrument

On 1 March 2018 changes were made to the existing Medicare urgent after-hours items and new items introduced to improve the quality of after-hours services and incentivise better value care through targeted benefits. This change was made through the Health Insurance Legislation Amendment (After-Hours Services) Regulations 2018.

 

Currently item 588 can only be claimed when the service is performed in an after-hours area (Modified Monash areas 3 to 7). Item 591 is claimed for any services outside of this area (Modified Monash areas 1 and 2). The purpose of the Health Insurance (General Medical Services Table) Amendment (After-hours Rural Area) Regulations 2018 (the Regulations) is to amend the eligible areas for these items.

 

From 1 January 2019 the eligible areas for item 588 will be Modified Monash areas 2 to 7 and, for item 591, Modified Monash area 1.  

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.

Analysis

The Regulations will maintain rights to health and social security by ensuring access to publicly subsidised health services which are clinically effective and cost-effective. Patients will continue to have access to clinically necessary urgent after-hours services under Medicare.

Conclusion

This Legislative Instrument is compatible with human rights as it does not raise any human rights issues.

 

Greg Hunt

Minister for Health

 

Overview

The Health Insurance (General Medical Services Table) Amendment (After-hours Rural Area) Regulations 2018 were enacted to amend the eligibility criteria for certain Medicare items concerning after-hours medical services, particularly in rural areas. This legislative instrument was introduced to address the need for improved access to urgent after-hours healthcare services in rural areas and to ensure that the benefits provided are both clinically effective and cost-effective. The Regulations were made under the authority of Subsection 133(1) of the Health Insurance Act 1973 by the Commonwealth Parliament. The policy objective is to incentivise better value care by targeting benefits more effectively, thereby enhancing the quality of after-hours medical services. The Regulations came into effect on 1 January 2019, modifying the eligible areas for the Medicare items 588 and 591 to align with the Modified Monash classification system, thus expanding the areas where higher benefits can be claimed for after-hours services. These amendments were developed in response to concerns raised by stakeholders such as the National After Hours Medical Deputising Service and the General Practitioner Deputising Association, aiming to ensure that patients in rural areas have adequate access to urgent medical care during after-hours periods. The Regulations are designed to engage with Articles 9 and 12 of the International Covenant on Economic, Social and Cultural Rights, safeguarding the rights to health and social security by maintaining access to essential health services. The analysis concludes that these changes do not adversely affect human rights, as they ensure continued access to necessary urgent after-hours services under Medicare.

Scope and Application

The Health Insurance (General Medical Services Table) Amendment (After-hours Rural Area) Regulations 2018 apply to the administration and provision of health services under the Health Insurance Act 1973, specifically targeting medical practitioners, health service providers, and patients within Australia. These Regulations amend the eligibility criteria for certain Medicare benefits for urgent after-hours services, specifically items 588 and 591, to better cater to rural and remote areas. The Regulations are applicable across the Commonwealth of Australia, as they are made under the authority of the Health Insurance Act 1973, a federal Act. The Regulations came into effect on 1 January 2019, modifying the areas eligible for claiming item 588 to include Modified Monash areas 2 to 7 and restricting item 591 to Modified Monash area 1. The application of these Regulations can be further extended or detailed through subordinate instruments, although the explanatory statement does not elaborate on any such extensions or restrictions. The Regulations do not specify any exclusions, exemptions, or thresholds beyond the geographic and item-specific criteria outlined.

Key Provisions

The Health Insurance (General Medical Services Table) Amendment (After-hours Rural Area) Regulations 2018 (the Regulations) primarily modify the eligibility criteria for certain Medicare benefits related to urgent after-hours medical services, specifically items 588 and 591. As per Section 2 of the Regulations, these changes took effect from 1 January 2019. Section 4(1) outlines the modifications, where item 588, previously applicable only in Modified Monash areas 3 to 7, now also applies to Modified Monash areas 2 to 7. Conversely, item 591, previously applicable in Modified Monash areas 1 and 2, is now restricted to Modified Monash area 1. These amendments are designed to improve the quality of after-hours services and incentivize better value care through targeted benefits. The Regulations impose specific obligations on healthcare providers and entities involved in the provision of after-hours medical services. Healthcare providers must ensure that services claimed under item 588 are performed in the newly defined eligible areas (Modified Monash areas 2 to 7), while those under item 591 must be performed in Modified Monash area 1. Additionally, the Regulations require accurate documentation and reporting of services to comply with the new eligibility criteria, ensuring that Medicare benefits are correctly attributed and patients receive appropriate care. The Act does not explicitly outline specific offences or penalties for non-compliance with the Regulations. However, any breaches of Medicare regulations, including those related to the misuse or misreporting of services, may result in civil or criminal penalties under the Health Insurance Act 1973. For instance, knowingly making a false statement or representation to obtain a benefit can lead to fines and imprisonment. Additionally, healthcare providers may face sanctions from professional bodies and loss of accreditation if found to be in violation of Medicare regulations. The precise penalties for such breaches would depend on the nature and severity of the offence, as well as the relevant provisions of the Health Insurance Act 1973.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.