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Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia) Direction 2024

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia) Direction 2024

Administered by Department of Health, Disability and Ageing

Legislation au F2024N00451 Not in force Notifiable Instrument

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AUSTRALIAN GOVERNMENT

DEPARTMENT OF HEALTH AND AGED CARE

HEALTH INSURANCE ACT 1973

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia) Direction 2024

I, Louise Riley, First Assistant Secretary, Medical Benefits and Digital Health Division, Health Resourcing Group, delegate for the Minister for Health and Aged Care, acting under subsection 19(2) of the Health Insurance Act 1973, hereby:

(1) REVOKE the Direction made under subsection 19(2) of the Act titled Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia Direction 2022 that was granted on 29 June 2022, that Medicare benefits shall be payable in respect of professional services provided by health services in South Australia that are a part of the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative, as described in the Memorandum of Understanding between the Australian Government and South Australia dated 19 May 2022; and

(2) DIRECT that Medicare Benefits shall be payable in respect of:

(a) A professional service (as defined in Section 3 of the Health Insurance Act 1973) which has been agreed to be provided under the Memorandum of Understanding (MOU) between the Department of Health and Aged Care (ABN: 83 605 426 759)) and South Australia (ABN: 52 786 403 404) dated 19 May 2022 as part of the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative relating to primary care services for which:

(i) items specified in Schedule A of this Direction; and of the general medical services table (means the table prescribed under subsection 4(1) of the Health Insurance Act 1973), diagnostic imaging services table (means the table prescribed under subsection 4AA(1) of the Health Insurance Act 1973) and pathology services table (means the table prescribed under subsection 4A(1) of the Health Insurance Act 1973) relates; and

(b) where the profession service is provided to:

(i) an eligible person (as defined in Section 3 of the Health Insurance Act 1973); and

(ii) a patient who is not part of an episode of hospital treatment (as defined in Section 121-5 of the Private Health Insurance Act 2007); and

(i) is provided at an approved Modified Monash Model 5-7 area (as defined in Section 7.1.1 of the general medical services table) practice location specified in Schedule B; and

(ii) is either:

(A) a professional non-referred service provided by a state remunerated medical practitioner, participating midwife, or participating nurse practitioner; or

(B) a professional referred service provided by a state remunerated allied health and dental health practitioner.

DECLARED that this Direction commences on 3 June 2024 and ceases to have effect at the end of 30 June 2025 unless earlier revoked.

Date this 22 day of May 2024

Louise Riley

Acting First Assistant Secretary

Medical Benefits and Digital Health Division

Health Resourcing Group

Department of Health and Aged Care

SCHEDULE A

MEDICARE BENEFITS SCHEDULE ITEMS AT Approved Practice Locations AS AGREED under the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – south australia

For services listed in the below tables, all provisions of the Health Insurance Act 1973 (the Act) and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items apply.

General Medical Services Table

Group	Group Name	Subgroup	Subgroup Name
A1	General practitioner attendances to which no other item applies
A2	Other non-referred attendances to which no other item applies
A5	Prolonged attendances to which no other item applies
A6	Group Therapy
A7	Acupuncture and non-specialist practitioner items
A9	Contact lenses – attendances
A10	Optometrical services provided by an optometrist
A11	Urgent attendance after hours
A14	Health assessments
A15	GP management plans, team care arrangements, multidisciplinary care plans	1	GP management plans, team care arrangements and multidisciplinary care plans
A17	Domiciliary and residential management reviews
A20	General Practitioner mental health treatment
A22	General Practitioner after-hours attendances to which no other item applies
A23	Other non-referred after-hours attendances to which no other item applies
A27	Pregnancy support counselling
A35	Services for patients in Residential Aged Care Facilities
A40	Telehealth and phone attendance services	1	General practice telehealth services
		2	General practice phone services
		3	Focussed psychological strategies telehealth services
		10	Focussed psychological strategies phone services
		11	Health assessments for Aboriginal and Torres Strait Islander People - telehealth services
		13	GP management plans, team care arrangements and multidisciplinary care plans via telehealth attendance
		15	GP pregnancy support counselling telehealth services
		16	GP pregnancy support counselling phone services
		19	GP mental health treatment plan telehealth services
		20	GP mental health treatment plan phone services
		21	GP Eating Disorder Treatment and Management Plan telehealth services
		27	GP - Eating Disorder Focussed Psychological Strategies telehealth services
		28	GP - Eating Disorder Focussed Psychological Strategies phone services
		29	GP and Other Medical Practitioner urgent after-hours service in unsociable hours telehealth services
		39	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Telehealth Service
		40	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Phone Service
A46	COVID-19 management support service
M1	Management of bulk-billed services	1	Management of General Bulk Billed Services
		2	General Support Service
		3	Patients enrolled in MyMedicare
M3	Allied Health services
M6	Psychological therapy services
M7	Focussed psychological strategies
M8	Pregnancy support counselling
M9	Allied Health group services
M10	Complex neurodevelopmental disorder and disability services
M11	Allied Health services for Aboriginal and Torres Strait Islander people
M12	Services provided by a Practice Nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner
M14	Nurse Practitioners
M15	Diagnostic audiology services
M16	Eating Disorder services
M18	Allied health telehealth services	1	Psychological therapies telehealth services
		2	Psychologist focussed psychological strategies telehealth services
		3	Occupational therapist focussed psychological strategies telehealth services
		4	Social worker focussed psychological strategies telehealth services
		5	Nurse practitioner telehealth services
		6	Psychological therapies phone services
		7	Psychologist focussed psychological strategies phone service
		8	Occupational therapist focussed psychological strategies phone services
		9	Social worker focussed psychological strategies phone services
		10	Nurse practitioner phone services
		11	General allied health telehealth services
		12	General allied health phone services
		13	Pregnancy support counselling telehealth services
		14	Pregnancy support counselling phone services
		15	Complex neurodevelopmental disorder and disability telehealth services
		16	Complex neurodevelopmental disorder and disability phone services
		17	Telehealth attendance to person of Aboriginal and Torres Strait Islander descent
		18	Phone attendance to person of Aboriginal and Torres Strait Islander descent
		23	Follow up service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner – Telehealth Services
		25	Allied health, group dietetics telehealth services
		26	Allied health, group dietetics phone services
T1	Miscellaneous therapeutic procedures	6	Gastroenterology

General Medical Services Table – permitted items

Group	Group Name	Items	Item overview
A15	GP management plans, team care arrangements and multidisciplinary care plans	735, 739, 743, 747-758, 930-945	Case conferences
A29	Attendance services for complex neurodevelopmental disorder or disability	139	Professional attendance by a general practitioner for assessment, diagnosis and preparation of a treatment and management plan for a patient with an eligible disability.
A36	Eating disorder services	90250-90257, 90264, 90265, 90271-90282	Eating disorder services provided by General Practitioners or Medical Practitioners
A40	Telehealth and phone attendance services	92142, 92170, 92171, 92176, 92177	General Practitioner and Prescribed Medical Practitioner items
A44	General Practice attendance for assessing patient suitability for a COVID-19 vaccine	93645, 93647, 93654, 93656, 93661, 93666, 10660, 10661	General Practice Attendance for Assessing Patient Suitability for a COVID-19 Vaccine
D1	Miscellaneous diagnostic procedures and investigations	11300-11318, 11505, 11506, 11602-11615, 11707, 11729, 11730, 12001-12004, 12012, 12017, 12200, 12306, 12312, 12315, 12320-12322, 12325, 12326	Non-referred services only
D2	Nuclear Medicine (non-imaging)	12500, 12524, 12527	Nuclear Medicine (non-imaging)
M13	Midwifery services	82100-82115, 82130-82140	Midwifery items
T1	Miscellaneous therapeutic procedures	13105, 14206	Haemodialysis provided by a registered nurse, Aboriginal health worker or Aboriginal and Torres Strait Islander health practitioner in a very remote location. Hormone or living tissues implantation by cannula
T4	Obstetrics	16400, 16406-16500, 16502-16514, 16530, 16590, 16591, 91850-91858	Antenatal and postnatal attendances
T8	Surgical operations	30003, 30006, 30023, 30026-30055, 30061-30072, 30107, 30192-30207, 30216, 30219, 31356, 32072, 32147, 35503, 41500, 47015, 47042, 47057, 47069, 47301, 47348, 47354, 47361, 47387, 47423, 47444, 47453, 47462, 47466, 47471, 47543, 47561, 47579, 47595, 47663, 47735, 47904, 47915, 47916, 47918	Minor surgical procedures
O1	Consultations	51700-51703, 54001-54004	Dental practitioner attendances

Diagnostic Imaging Services Table

Group	Group Name
I1	Ultrasound
I3	Diagnostic radiology
I6	Management of bulk-billed services

Pathology Services Table

Group	Group Name
P9	Simple basic pathology tests
P12	Management of bulk-billed services
P13	Bulk-billing incentive

SCHEDULE B

Approved Practice Locations AS AGREED under the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia

Approved locations:

Location	Practice Name	Legal Name	Street Address	Mailing Address
Ceduna	Ceduna District Health Service	Eyre and Far North Local Health Network Inc	3 Eyre Highway Ceduna SA 5690	PO Box 178 Ceduna SA 5690
Karoonda	Karoonda and District Soldiers’ Memorial Hospital & Mallee Medical Practice - Karoonda	Riverland Mallee Coorong Local Health Network Inc	13 Stokes Road Karoonda SA 5307	PO Box 145 Karoonda SA 5307
Lameroo	Mallee Medical Practice, Lameroo	Riverland Mallee Coorong Local Health Network Inc	1 Vardon Terrace Lameroo SA 5302	1 Vardon Terrace Lameroo SA 5302
Wallaroo	Wallaroo Hospital and Health Service	Yorke and Northern Local Health Network Inc	1 Ernest Terrace Wallaroo SA 5556	1 Ernest Terrace Wallaroo SA 5556

Overview

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia) Direction 2024 was enacted by the Australian Government Department of Health and Aged Care under the Health Insurance Act 1973. This legislation was introduced to address the gap in healthcare services for rural and remote areas in South Australia, ensuring improved access to primary care services in these underserved regions. The policy objective is to enhance healthcare delivery in rural and remote areas by providing exemptions to Medicare benefits for certain professional services, as outlined in the Memorandum of Understanding between the Australian Government and South Australia dated 19 May 2022. This initiative aims to facilitate better healthcare outcomes and service provision in areas that are traditionally difficult to access. The Direction revokes the previous exemption granted in 2022 and updates the scope of services and locations eligible for these exemptions, effective from 3 June 2024 until 30 June 2025 unless otherwise specified.

Scope and Application

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia) Direction 2024 applies to professional services provided by health services in South Australia that are part of the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative. It pertains to specific Medicare benefits payable for services outlined in Schedule A, which includes general medical services, diagnostic imaging services, and pathology services. The Direction applies to professional services provided to eligible individuals who are not part of an episode of hospital treatment, and must be provided at an approved Modified Monash Model 5-7 area practice location as specified in Schedule B. The Direction, which revokes the 2022 Direction, commences on 3 June 2024 and will cease to have effect at the end of 30 June 2025 unless earlier revoked. The Direction is applicable nationally, with specific reference to South Australia, and extends its application through the inclusion of specific items and locations in its schedules.

Key Provisions

The main operative sections of the Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia) Direction 2024 (the Direction) are sections 1 and 2. Section 1 revokes the 2022 Direction, which previously allowed Medicare benefits to be payable for certain primary care services provided in South Australia. Section 2 directs that Medicare benefits shall now be payable for specific professional services provided under the terms of the Memorandum of Understanding (MOU) between the Australian Government and South Australia, dated 19 May 2022. This includes services provided at approved Modified Monash Model 5-7 areas, which are defined as rural and remote areas in the general medical services table. The Direction imposes several obligations and requirements on the parties it governs. Firstly, it mandates that the specified professional services must be provided under the MOU between the Department of Health and Aged Care and South Australia. The services must be those listed in Schedule A, which includes general medical, diagnostic imaging, and pathology services, and provided at the approved practice locations listed in Schedule B. Furthermore, the services must be provided to eligible persons who are not part of an episode of hospital treatment. Additionally, the Direction specifies that the services can be either non-referred or referred, and must be provided by state remunerated medical practitioners, participating midwives, participating nurse practitioners, allied health, or dental health practitioners. The Direction also outlines the consequences for breaches of its provisions. While the Direction itself does not specify offences, penalties, or consequences, violations of the Health Insurance Act 1973 and the National Health Act 1953, which the Direction references, could result in civil or criminal penalties. Under the Health Insurance Act, breaches may result in fines or imprisonment. For example, under section 111 of the Act, a person who knowingly provides a false or misleading statement to obtain a benefit may be fined up to 120 penalty units (approximately AUD 22,200) or imprisoned for up to two years, or both. Additionally, the Director-General of the Department of Health may impose administrative penalties for non-compliance with the Act. In summary, the Direction revokes the 2022 Direction and sets out new provisions for the payment of Medicare benefits for specified professional services provided in rural and remote areas of South Australia, under the terms of the MOU. It imposes obligations on the services to be provided, the locations where they can be provided, and the types of practitioners who can provide them. While the Direction does not specify penalties for breaches, violations of related Acts could result in significant civil or criminal consequences.

Area of Law: Health Law
Instrument: Direction
Concepts: Definitions & Interpretation; Offence Provisions; Regulatory Standards

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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.

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