Health Insurance (Medicare Benefits Payable in Respect of Professional Services –Commonwealth Urgent Care Clinic Program –Victorian Priority Primary Care Centres) Direction (No. 2) 2023

Overview

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Urgent Care Clinic Program – Victorian Priority Primary Care Centres) Direction (No. 2) 2023 was enacted to address a gap in the provision of urgent care services in Victoria, particularly through the Commonwealth Urgent Care Clinic Program. This legislative instrument, introduced by the Australian Government Department of Health and Aged Care, revokes a previous direction from September 2023 and aims to ensure that Medicare Benefits are payable for professional services provided by Victorian Priority Primary Care Centres that meet the requirements of the Commonwealth Urgent Care Clinic program. The policy objective is to facilitate timely and appropriate healthcare services for eligible individuals, excluding those receiving hospital treatment or public patient services, by specifying the services and locations eligible for Medicare benefits under the program. This initiative is designed to enhance access to urgent care services in Victoria, thereby improving the overall health outcomes for the community.

Scope and Application

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Urgent Care Clinic Program – Victorian Priority Primary Care Centres) Direction (No. 2) 2023 applies to professional services provided under an agreement between the Commonwealth, represented by the Department of Health and Aged Care, and the State of Victoria, represented by the Victorian Department of Health. This direction specifically applies to services rendered by Victorian Priority Primary Care Centres that have been assessed to meet the requirements of the Commonwealth Urgent Care Clinic program. The professional services covered include those specified in Schedule A of this direction, which relate to items in the general medical services table prescribed under the Health Insurance Act 1973. These services must be provided at practice locations specified in Schedule B and by registered general practitioners or participating nurse practitioners under the Commonwealth Urgent Care Clinic program. The direction also specifies that Medicare Benefits are payable for services provided to eligible persons who are not receiving the service as part of an episode of hospital treatment or as part of a service attracting payment through the 2020-2025 Addendum to the National Health Reform Agreement for a service rendered to a public patient. This direction revokes the previous Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Urgent Care Clinic Program – Victorian Priority Primary Care Centres) Direction 2023 and applies nationally within the Commonwealth of Australia, with a specific focus on Victoria. The direction comes into effect on 1 November 2023 and will cease to have effect at the end of 30 June 2024 unless earlier revoked.

Key Provisions

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services –Commonwealth Urgent Care Clinic Program –Victorian Priority Primary Care Centres) Direction (No. 2) 2023 revokes a previous Direction (Section 1) and establishes new provisions for the payment of Medicare Benefits for professional services provided under the Commonwealth Urgent Care Clinic program by Victorian Priority Primary Care Centres. The Direction specifies that Medicare Benefits are payable for professional services that are agreed upon between the Commonwealth and the State of Victoria and listed in Schedule A (Section 2(a)(i)). These services must be provided to eligible persons, not as part of hospital treatment, nor as a service attracting payment through the 2020-2025 Addendum to the National Health Reform Agreement for a public patient, and at locations specified in Schedule B (Section 2(b) and 2(c)). The Direction is effective from 1 November 2023 until 30 June 2024 unless revoked earlier (Section 4). The Act imposes obligations on parties involved to ensure that professional services are provided in accordance with the agreed terms and conditions, and that the services are provided at the approved locations by registered general practitioners or nurse practitioners participating in the Commonwealth Urgent Care Clinic program (Section 2). Both the Commonwealth and the State of Victoria must ensure that only eligible services, as specified in Schedule A, are provided and billed under this Direction. Additionally, the approved practice locations listed in Schedule B must be used for the delivery of these services. There are no explicit offences or penalties detailed in the Direction itself, but non-compliance with the Health Insurance Act 1973 and the Private Health Insurance Act 2007 could result in civil or criminal consequences, including fines and imprisonment. The specific penalties would depend on the nature and severity of the breach, as outlined in the relevant Acts. For example, knowingly making a false statement or representation under the Health Insurance Act 1973 could attract a penalty of up to 50 penalty units, which equates to approximately AUD 11,050 as of October 2023 (Section 126 of the Crimes Act 1914).