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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 (No. 1) 2026

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 (No. 1) 2026

Administered by Department of Health, Disability and Ageing

Legislation au F2026N00021 Not in force Notifiable Instrument

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AUSTRALIAN GOVERNMENT

DEPARTMENT OF HEALTH, DISABILITY AND AGEING

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 (No. 1) 2026

I, Michelle Trainor, Acting Assistant Secretary, MBS Policy and Specialist Programs Branch, Medicare Benefits and Digital Health Division, Health Resourcing Group, delegate for the Minister for Health and Ageing, acting under subsection 19(2) of the Health Insurance Act 1973 (the Act), hereby:

REPEAL 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 (No. 2) 2025; and

DIRECT that Medicare Benefits shall be payable in respect of:

A professional service (as defined in Section 3 of the Act) which has been agreed to be provided under the Memorandum of Understanding (MOU) between the Department of Health, Disability and Ageing (ABN: 83 605 426 759) and South Australia (ABN: 52 786 403 404) dated 28 April 2025 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:
1. 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 Act), diagnostic imaging services table (means the table prescribed under subsection 4AA(1) of the Act) or pathology services table (means the table prescribed under subsection 4A(1) of the Act) relates; and
Where the professional service is provided to:
1. an eligible person (as defined in Section 3 of the Act); and
2. 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
The professional service referred to in paragraph (2)(a):
1. 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
2. is either:
  1. a professional non-referred service provided by a state remunerated prescribed medical practitioner, participating midwife, or participating nurse practitioner; or
  2. a professional referred service provided by a state remunerated allied health professional or dental practitioner.

DECLARE that this Direction commences on the day after registration and ceases to have effect at the end of 30 June 2027 unless earlier repealed.

Note, a number of expressions used in this direction are defined in the below instruments:

Health Insurance Act 1973: the meaning of dental practitioner, participating midwife, participating nurse practitioner, and professional service; and
Health Insurance (General Medical Services Table) Regulations 2021: the meaning of prescribed medical practitioner.
Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024: the meaning of allied health professional.

Date: 6 January 2026

Michelle Trainor

Acting Assistant Secretary

MBS Policy and Specialist Programs Branch

Medicare Benefits and Digital Health Division

Health Resourcing Group

Department of Health, Disability and Ageing

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	Item Number
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
A10	Optometric services provided by optometrist
A11	Urgent attendances after hours
A14	Health assessments
A15	GP chronic condition management plans, multidisciplinary care plans and case conferences	1	GP chronic condition management plans and multidisciplinary care plans
A15		2	Case Conferences	735, 739, 743, 747-758, 930-945
A17	Domiciliary and residential medication management reviews
A20	Mental health care
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
A29	Attendance services for complex neurodevelopmental disorder or disability			139
A35	Non‑referred attendance at a residential aged care facility
A36	Eating disorders	1	Preparation of eating disorder treatment and management plans: general practitioners and non‑specialist medical practitioners	90250-90257
		3	Review of eating disorder treatment and management plans	90264, 90265
		4	Providing treatments under eating disorder treatment and management plans	90271-90278
A40	Telehealth attendance services	1	General practice video services
		2	General practice phone services
		3	Focussed Psychological Strategies ‑ Video Services
		10	Focussed Psychological Strategies phone services
		11	Health Assessments for Aboriginal and Torres Strait Islander People ‑ Video Services
		13	GP management plans, team care arrangements and multidisciplinary care plans services – Video Services
		15	GP Pregnancy Support Counselling ‑ Video Services
		16	GP Pregnancy Support Counselling ‑ Phone Service
		17	GP, specialist and consultant physician complex neurodevelopmental disorder or disability service ‑ Video Services	92142
		19	GP Mental Health Treatment Plan ‑ Video Services
		20	GP Mental Health Treatment Plan ‑ Phone Service
		21	GP Eating Disorder Treatment and Management Plan – Video Services
		25	Review of an Eating Disorder Plan ‑ Video Services	92170, 92171
		26	Review of an Eating Disorder Plan – Phone Service	92176, 92177
		27	Eating Disorder Psychological Treatment Services – Video Services
		28	Eating Disorder Psychological Treatment Strategies – Phone Service
		29	GP and Other Medical Practitioner ‑ Urgent After Hours Service in Unsociable Hours ‑ Video Services
		39	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Video Services
		40	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Phone Service
D1	Miscellaneous diagnostic procedures and investigations	3	Otolaryngology	11300-11318
		4	Respiratory	11505, 11506
		5	Vascular	11602-11615
		6	Cardiovascular	11707, 11729, 11730
		9	Allergy testing	12001-12004, 12012, 12017
		10	Other diagnostic procedures and investigations	12200, 12306, 12312, 12315, 12320-12322, 12325, 12326
D2	Nuclear medicine (non‑imaging)			12500, 12524, 12527
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 (Allied Mental Health)
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, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner
M13	Midwifery Services	1	MBS items for participating midwives	82100-82115, 82130-82140
M14	Nurse practitioners
M15	Diagnostic audiology services
M16	Eating disorders services
M18	Allied Health telehealth services	1	Psychological therapies video services
		2	Psychologist focussed psychological strategies video services
		3	Occupational Therapist focussed psychological strategies video services
		4	Social Worker focussed psychological strategies video services
		5	Nurse practitioner video 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 video services
		12	General allied health phone services
		13	Pregnancy support counselling video services
		14	Pregnancy support counselling phone services
		15	Complex neurodevelopmental disorder and disability video services
		16	Complex neurodevelopmental disorder and disability phone services
		17	Video 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 video services
		26	Allied health, group dietetics phone services
T1	Miscellaneous therapeutic procedures	2	Dialysis	13105
		6	Gastroenterology
		13	Miscellaneous therapeutic procedures	14206
T4	Obstetrics			16400, 16406-16500, 16502-16514, 16530, 16590, 16591
		1	Obstetric video services	91850-91853
		2	Obstetric phone services	91855-91858
T8	Surgical operations	1	General	30003, 30006, 30023, 30026-30055, 30061-30072, 30107, 30192-30207, 30216, 30219, 31356
		2	Colorectal	32072, 32147
		4	Gynaecological	35503
		8	Ear, nose and throat	41500
		15	Orthopaedic	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
O1	Consultations			51700, 51703
		1	dental practitioner video services	54001, 54002
		2	dental practitioner phone services	54004

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 and Ceduna Family Medical Practice	Eyre and Far North Local Health Network Inc	3 Eyre Highway, Ceduna SA 5690	PO Box 178, Ceduna SA 5690
Cleve (Outreach service of Ceduna)	Mid Eyre Medical Practice – Cleve	Eyre and Far North Local Health Network Inc	15 Main Street, Cleve SA 5640	PO Box 178, Ceduna SA 5690
Coober Pedy (Outreach service of Ceduna)	Coober Pedy Hospital and Coober Pedy Medical Practice	Eyre and Far North Local Health Network Inc	89 McDougall Street, Coober Pedy SA 5723	PO Box 178, Ceduna SA 5690
Cowell (Outreach service of Ceduna)	Cowell Hospital and Mid Eyre Medical Practice – Cowell	Eyre and Far North Local Health Network Inc	17 South Terrace, Cowell SA 5602	PO Box 178, Ceduna SA 5690
Elliston (Outreach service of Ceduna)	Elliston Hospital and Mid Eyre Medical Practice – Elliston	Eyre and Far North Local Health Network Inc	1 Memorial Drive, Elliston SA 5670	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
Kimba (Outreach service of Ceduna)	Mid Eyre Medical Practice – Kimba	Eyre and Far North Local Health Network Inc	34 Park Terrace, Kimba SA 5641	PO Box 178, Ceduna SA 5690
Lameroo	Mallee Medical Practice, Lameroo	Riverland Mallee Coorong Local Health Network Inc	1 Vardon Terrace, Lameroo SA 5302	1 Vardon Terrace, Lameroo SA 5302
Peterborough	Peterborough Soldiers Memorial Hospital	Yorke and Northern Local Health Network Inc	23 Hurlstone Street, Peterborough SA 5422	PO Box 119, Peterborough SA 5422
Pinnaroo	Pinnaroo Soldiers’ Memorial Hospital	Riverland Mallee Coorong Local Health Network Inc	Bundey Terrace, Pinnaroo SA 5304	PO Box 234, Pinnaroo SA 5304
Pinnaroo (Outreach service of Pinnaroo)	Mallee Medical Practice, Pinnaroo	Riverland Mallee Coorong Local Health Network Inc	1 Gilbert Avenue, Pinnaroo SA 5304	1 Gilbert Avenue, Pinnaroo SA 5304
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 (No. 1) 2026 was enacted to address the gap in primary healthcare services for residents in rural and remote areas in South Australia. This notifiable instrument, issued under the authority of the Health Insurance Act 1973, aims to enhance access to primary care by allowing Medicare Benefits to be paid for specified professional services provided in approved locations within Modified Monash Model 5-7 areas. The policy objective is to support the implementation of the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas initiative, which seeks to improve healthcare outcomes for people living in underserved regions. This direction repeals the previous direction from 2025 and establishes new provisions to ensure that eligible individuals receive timely and appropriate care from state remunerated medical professionals, including prescribed medical practitioners, midwives, nurse practitioners, allied health professionals, and dental practitioners. The Direction is effective from the day after its registration and will cease on 30 June 2027 unless otherwise repealed.

Scope and Application

This legislation applies to the provision of professional services under the Health Insurance Act 1973, specifically targeting primary care services in rural and remote areas of South Australia. It affects entities such as prescribed medical practitioners, participating midwives, participating nurse practitioners, allied health professionals, and dental practitioners who provide these services in approved practice locations. The scope of the Act is geographically focused on South Australia, particularly targeting Modified Monash Model 5-7 areas, which are remote and rural regions. The Direction applies to professional services rendered in these areas, provided they fall under the specified items in the General Medical Services Table, Diagnostic Imaging Services Table, or Pathology Services Table, and are performed at locations listed in Schedule B of the Direction. The professional services must be non-referred or referred, and provided to eligible persons outside an episode of hospital treatment. This Direction repeals a previous Direction from 2025, thereby updating the specific items and conditions under which Medicare benefits are payable. The Direction comes into effect following its registration and will cease on 30 June 2027 unless repealed earlier. The provisions of the Direction extend to all items listed in Schedule A, and it incorporates definitions from the Health Insurance Act 1973, the Health Insurance (General Medical Services Table) Regulations 2021, and the Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024.

Key Provisions

This legislation, 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 (No. 1) 2026", specifies the conditions under which Medicare benefits are payable for professional services in certain areas of South Australia. The direction repeals a previous initiative (No. 2, 2025) and sets out new provisions for professional services to be eligible for Medicare benefits. According to Section 2 of the Direction, Medicare benefits are payable for professional services specified in Schedule A, provided by eligible practitioners at approved locations in Modified Monash Model 5-7 areas, and for services rendered to eligible persons who are not part of a hospital treatment episode. The services eligible for Medicare benefits include various general medical, diagnostic imaging, and pathology services, as well as telehealth services and specific mental health services, among others. The Act imposes several obligations on the parties involved. Firstly, the professional services must be provided in accordance with the terms of the Memorandum of Understanding between the Department of Health, Disability and Ageing and South Australia, dated 28 April 2025. The services must be provided by eligible practitioners, such as state remunerated prescribed medical practitioners, participating midwives, participating nurse practitioners, state remunerated allied health professionals, or dental practitioners. Additionally, the services must be provided to eligible individuals who meet the criteria of being outside a hospital treatment episode and in need of primary care services in rural and remote areas. Furthermore, the services must be rendered at the specified approved practice locations listed in Schedule B, which include various healthcare facilities across South Australia. The legislation does not explicitly state any offences, penalties, or consequences for breach; however, the Health Insurance Act 1973 and related regulations do provide for penalties in case of non-compliance. Under Section 100 of the Health Insurance Act, a person who contravenes any provision of the Act, or any regulation made under it, is liable to a penalty of up to 50 penalty units for each contravention. Additionally, a person who makes a false or misleading statement for the purpose of obtaining a benefit under the Act is liable to a penalty of up to 100 penalty units for each such statement. A penalty unit, as defined in the Crimes Act 1914, is currently equivalent to $222. The Act also allows for civil or criminal proceedings to be taken in cases of non-compliance, which may result in further penalties or legal consequences.

Area of Law: Health Law
Instrument: Direction
Concepts: Definitions & Interpretation; Regulatory Standards; Reporting & Disclosure Obligations

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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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