Health Insurance Legislation Amendment (Consequential Amendment - Schedules of the Addendum to the National Health Reform Agreement) Direction 2026

Administered by Department of Health, Disability and Ageing

Legislation au F2026N00468 Not in force Notifiable Instrument

Legislation content

 

Health Insurance Legislation Amendment (Consequential Amendment - Schedules of the Addendum to the National Health Reform Agreement) Direction 2026

I, Nigel Murray, delegate for the Minister of Health and Ageing, make the following Notifiable Instrument.

Dated  29 June 2026    

Nigel Murray

Assistant Secretary
MBS Policy and Specialist Programs Branch
Medicare Benefits and Digital Health Division
Health Resourcing Group

Department of Health, Disability and Ageing

 

Contents

1  Name

2  Commencement

3  Authority

4  Schedules

Schedule 1—Amendments

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Primary Health Networks Program: General Practice Incentive Fund) Direction (No. 1) 2026

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – First Nations Molecular Point-of-Care Testing Program) Direction (No. 1) 2025

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Victoria - Medical Services performed under the Single Employer Model Trial) Direction 2025

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Queensland - Medical Services performed under the Single Employer Model Trial) Direction (No. 2) 2025

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Tasmania - Medical Services performed under the Single Employer Model Trial) Direction (No.1) 2026

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Charleville and Western Areas Aboriginal and Torres Strait Islanders Community Health – Medical Services performed under the Single Employer Model Trial) Direction 2026

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – South Australia - Medical Services performed under the Single Employer Model Trial) Direction (No. 2) 2025

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – New South Wales - Medical Services performed under the Single Employer Model Trial) Direction (No. 3) 2026

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Riverland Mallee Coorong Local Health Network - Medical Services performed under the Single Employer Model Trial) Direction 2025

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Northern Territory – Medical Services performed under the Single Employer Model Trial) Direction (No. 1) 2026

 

 

1  Name

  This instrument is the Health Insurance Legislation Amendment (Consequential Amendment - Schedules of the Addendum to the National Health Reform Agreement) Direction 2026.

2  Commencement

 (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  The whole of this instrument

1 July 2026.

1 July 2026

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

 (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3  Authority

  This instrument is made under subsection 19(2) of the Health Insurance Act 1973.

4  Schedules

  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 (Medicare Benefits Payable in Respect of Professional Services – Primary Health Networks Program: General Practice Incentive Fund) Direction (No. 1) 2026

1  Sub-subparagraph (2)(b)(i)(B)

Omit “2020-2025 Addendum, Schedule K, one year extension, to the National Health Reform Agreement”, substitute “Schedule L of the 2026-31 Addendum to the National Health Reform Agreement”.

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – First Nations Molecular Point-of-Care Testing Program) Direction (No. 1) 2025

2  Sub-subparagraph (2)(b)(i)(A)

Omit “Schedule K of the 2020-2025 Addendum to the National Health Reform Agreement”, substitute “Schedule L of the 2026-31 Addendum to the National Health Reform Agreement”.

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Victoria - Medical Services performed under the Single Employer Model Trial) Direction 2025

3  Subparagraph (2)(b)(iii)

Omit “Schedule K of the 2020-2025 Addendum to the National Health Reform Agreement”, substitute “Schedule L of the 2026-31 Addendum to the National Health Reform Agreement”.

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Queensland - Medical Services performed under the Single Employer Model Trial) Direction (No. 2) 2025

4  Subparagraph (2)(b)(iii)

Omit “Schedule K of the 2020-2025 Addendum to the National Health Reform Agreement”, substitute “Schedule L of the 2026-31 Addendum to the National Health Reform Agreement”.

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Tasmania - Medical Services performed under the Single Employer Model Trial) Direction (No.1) 2026

5  Subparagraph (2)(b)(iii)

Omit “Schedule K of the 2020-2025 Addendum to the National Health Reform Agreement”, substitute “Schedule L of the 2026-31 Addendum to the National Health Reform Agreement”.

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Charleville and Western Areas Aboriginal and Torres Strait Islanders Community Health – Medical Services performed under the Single Employer Model Trial) Direction 2026

6  Sub-subparagraph 6(b)(iii)(A)

Omit “Schedule K – Addendum to the National Health Reform Agreement: Revised Public Hospital Funding and Health Reform Arrangements (dated 2025)”, substitute “Schedule L of the 2026-31 Addendum to the National Health Reform Agreement”.

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – South Australia - Medical Services performed under the Single Employer Model Trial) Direction (No. 2) 2025

7  Subparagraph (2)(b)(iii)

Omit “Schedule K of the 2020-2025 Addendum to the National Health Reform Agreement”, substitute “Schedule L of the 2026-31 Addendum to the National Health Reform Agreement”.

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – New South Wales - Medical Services performed under the Single Employer Model Trial) Direction (No. 3) 2026

8  Subparagraph (2)(b)(iii)

Omit “Schedule K of the 2020-2025 Addendum to the National Health Reform Agreement”, substitute “Schedule L of the 2026-31 Addendum to the National Health Reform Agreement”.

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Riverland Mallee Coorong Local Health Network - Medical Services performed under the Single Employer Model Trial) Direction 2025

9  Subparagraph (2)(b)(iii)

Omit “Schedule K of the 2020-2025 Addendum to the National Health Reform Agreement”, substitute “Schedule L of the 2026-31 Addendum to the National Health Reform Agreement”.

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Northern Territory – Medical Services performed under the Single Employer Model Trial) Direction (No. 1) 2026

10  Sub-subparagraph 6(b)(iii)(A)

Omit “through the Schedule K - National Health Reform Agreement - Addendum 2025-26”, substitute “through Schedule L of the 2026-31 Addendum to the National Health Reform Agreement”.

 

Overview

The Health Insurance Legislation Amendment (Consequential Amendment - Schedules of the Addendum to the National Health Reform Agreement) Direction 2026, made under subsection 19(2) of the Health Insurance Act 1973, aims to address the need to update references within the Medicare Benefits Schedule to align with the new addendum to the National Health Reform Agreement. This amendment was necessary to ensure that the Medicare Benefits Schedule accurately reflects the current funding and service arrangements agreed upon in the updated Addendum, which is set to take effect from 1 July 2026. This instrument, dated 29 June 2026, was enacted by Nigel Murray, acting as a delegate for the Minister of Health and Ageing, and is designed to bring the relevant health insurance directions in line with the new agreement's provisions, ensuring continuity and clarity in the provision of healthcare services under Medicare.

Scope and Application

The Health Insurance Legislation Amendment (Consequential Amendment - Schedules of the Addendum to the National Health Reform Agreement) Direction 2026 applies to various directions concerning Medicare benefits payable in respect of professional services under specific health programs and trials, including the Primary Health Networks Program, the First Nations Molecular Point-of-Care Testing Program, and the Single Employer Model Trials in various states and territories. The Act amends existing Health Insurance Directions to update references from the 2020-2025 Addendum to the National Health Reform Agreement to the 2026-31 Addendum. It commences on 1 July 2026 and is made under subsection 19(2) of the Health Insurance Act 1973. The amendments affect entities and professionals delivering medical services under these specified health programs and trials, ensuring they align with the updated health reform agreements. The Act applies across the Commonwealth of Australia, with no stated exclusions or exemptions, and its application may be further defined through subordinate instruments as necessary.

Key Provisions

The Health Insurance Legislation Amendment (Consequential Amendment - Schedules of the Addendum to the National Health Reform Agreement) Direction 2026 is designed to amend various Medicare benefits payable in respect of professional services as outlined in Schedule 1 of the document. Specifically, the amendments update references in several directions to reflect changes in the Addendum to the National Health Reform Agreement. For example, Section 1 updates the reference in the Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Primary Health Networks Program: General Practice Incentive Fund) Direction (No. 1) 2026 from "Schedule K, one year extension, to the National Health Reform Agreement" to "Schedule L of the 2026-31 Addendum to the National Health Reform Agreement". Similarly, Section 2 to 10 update the references in various directions to ensure they align with the updated Addendum. The obligations and requirements imposed by this Act primarily involve updating references to the Addendum in various directions. This ensures that the directions remain consistent with the current agreement and reflect any changes in the Addendum. The Act requires the relevant parties, such as healthcare providers and administrators, to comply with these updated references when claiming Medicare benefits. This includes ensuring that any services provided under the trials or programs mentioned are correctly referenced in the updated schedules of the Addendum. While the Health Insurance Legislation Amendment (Consequential Amendment - Schedules of the Addendum to the National Health Reform Agreement) Direction 2026 itself does not specify offences, penalties, or civil/criminal consequences for breach, any non-compliance with the updated references could potentially lead to issues with the validity of claims for Medicare benefits. Specifically, if a provider fails to reference the correct schedule in their claims, it could result in those claims being rejected or delayed. This could have financial implications for both the provider and the patient, as well as potential administrative consequences if the error is not rectified in a timely manner. It is important for all parties to ensure that they are compliant with the updated references to avoid any such issues.

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Health Law
Insurance Law
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Notifiable Instrument
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Repeal & Amendment
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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.