Legal Research
Legislations
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 – Victoria) Direction (No.1) 2025

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 – Victoria) Direction (No.1) 2025

Administered by Department of Health, Disability and Ageing

Legislation au F2025N00227 Not in force Notifiable Instrument

Select Document

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 – Victoria) Direction (No.1) 2025

I, Nigel Murray, Assistant Secretary, MBS Policy and Specialist Programs Branch, 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:

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 – Victoria) Direction 2024; and
DIRECT that Medicare Benefits shall be payable in respect of:

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 the Victorian Department of Health (ABN: 74 410 330 756) dated 10 June 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:
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 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
where the profession service is provided to:
1. an eligible person (as defined in Section 3 of the Health Insurance Act 1973); 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 (1)(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 medical practitioner, participating midwife, or participating nurse practitioner; or
  2. a professional referred service provided by a state remunerated allied health and dental health practitioner.

DECLARED that this Direction commences on 11 March 2025 and ceases to have effect at the end of 30 June 2025 unless earlier revoked.

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 March 2025

Nigel Murray

Assistant Secretary

MBS Policy and Specialist Programs Branch

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 – Victoria

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
A10	Optometricl services provided by an optometrist
A11	Urgent attendance after hours
A14	Health assessments
A15	GP management plans, team care arrangements and multidisciplinary care plans and case conferences	1	GP management plans, team care arrangements and multidisciplinary care plans
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
A35	Non-referred attendance at a residential aged care facility
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 Service
		13	GP management plans, team care arrangements and multidisciplinary care plans via telehealth attendance
		15	GP Pregnancy Support Counselling - Telehealth Service
		16	GP Pregnancy Support Counselling - Phone Service
		19	GP Mental Health Treatment Plan - Telehealth Service
		20	GP Mental Health Treatment Plan - Phone Service
		21	GP Eating Disorder Treatment and Management Plan - Telehealth Service
		27	Eating Disorder Psychological Treatment Services -Telehealth Service
		28	Eating Disorder Psychological Treatment Strategies - Phone Service
		29	GP and Other Medical Practitioner - Urgent After-Hours Service in Unsociable Hours - Telehealth Service
		39	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Telehealth Service
		40	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Phone 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 (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 or Aboriginal health worker or an 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 and phone 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 – Victoria

Approved locations and outreach services:

Location	Practice Name	Legal Name	Street Address	Mailing Address
Alexandra	Alexandra District Hospital	Alexandra District Health	12 Cooper Street Alexandra VIC 3714	PO Box 21, Alexandra VIC 3714
Clunes	Central Highlands Rural Health – Clunes Health	Central Highlands Rural Health	69 Service Street Clunes VIC 3370	PO Box 465 Daylesford VIC 3460
Marysville (Outreach Service of Alexandra)	Community Centre, Marysville	Alexandra District Health	31 Falls Road Marysville VIC 3779	31 Falls Road, Marysville VIC 3779
Trentham	Central Highlands Rural Health – Trentham Health	Central Highlands Rural Health	22–24 Victoria Street Trentham VIC 3458	PO Box 465 Daylesford VIC 3460

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 – Victoria) Direction 2025I, issued under the Health Insurance Act 1973, aims to facilitate access to primary care services in rural and remote areas of Victoria. This notifiable instrument was introduced to address the identified gap in healthcare services for patients in these regions. Enacted by the Australian Government Department of Health and Aged Care, the primary policy objective of this direction is to ensure that Medicare benefits are payable for specific professional services agreed upon in a Memorandum of Understanding between the Department of Health and Aged Care and the Victorian Department of Health. This initiative is designed to enhance healthcare delivery in underserved areas, ensuring that eligible patients receive necessary medical services without being part of an episode of hospital treatment. The direction came into effect on 11 March 2025 and will remain in force until 30 June 2025 unless earlier revoked.

Scope and Application

This legislation, issued under the Health Insurance Act 1973, specifically applies to the provision of Medicare benefits in respect of professional services within the framework of the Council of Australian Governments' Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative for Victoria. The Direction applies to state-remunerated medical practitioners, participating midwives, participating nurse practitioners, and state-remunerated allied health and dental health practitioners providing professional services to eligible persons who are not part of an episode of hospital treatment. These services must be provided in approved Modified Monash Model 5-7 areas, as specified in the Direction. The legislation encompasses a variety of professional services listed in Schedule A, including general medical, diagnostic imaging, and pathology services, and applies to locations detailed in Schedule B. The Direction repeals the previous Direction issued in 2024 and is effective from 11 March 2025 until 30 June 2025, unless earlier revoked. The application of the Act is further governed by the definitions and regulations provided in 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

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 – Victoria) Direction (No.1) 2025 (the Direction) made under subsection 19(2) of the Health Insurance Act 1973 (the Act) repeals 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 – Victoria) Direction 2024 and provides that Medicare Benefits shall be payable in respect of a professional service agreed to be provided under the Memorandum of Understanding between the Department of Health and Aged Care and the Victorian Department of Health, dated 10 June 2022 (the MOU) (section 2). The Direction specifies that Medicare Benefits are payable in respect of professional services that are provided to eligible persons who are not part of an episode of hospital treatment, and that are provided at an approved Modified Monash Model 5-7 area practice location specified in Schedule B of the Direction (section 2(1)(a)-(d)). The Direction also specifies that the professional service must be either a professional non-referred service provided by a state remunerated medical practitioner, participating midwife, or participating nurse practitioner, or a professional referred service provided by a state remunerated allied health and dental health practitioner (section 2(1)(a)(ii)). The Direction imposes several obligations and requirements on parties and entities governed by the Act. Firstly, the Direction requires that professional services be provided in accordance with the terms of the MOU (section 2(1)(a)). Secondly, the Direction requires that professional services be provided at an approved practice location specified in Schedule B of the Direction (section 2(1)(d)). Thirdly, the Direction requires that professional services be provided by a state remunerated medical practitioner, participating midwife, participating nurse practitioner, or state remunerated allied health and dental health practitioner, as specified in section 2(1)(a)(ii) (section 2(1)(a)(ii)). Fourthly, the Direction requires that professional services be provided to eligible persons who are not part of an episode of hospital treatment (section 2(1)(c)). The Direction also sets out the consequences for breach of the Act. Any person who contravenes the Act or any provision of a regulation made under the Act may be liable to a penalty of up to 50 penalty units for each contravention (subsection 22(1) of the Act). Additionally, any person who contravenes a direction made under the Act may be liable to a penalty of up to 100 penalty units for each contravention (subsection 22(2) of the Act). A penalty unit is currently equal to $222 (subsection 4AA(4) of the Crimes Act 1914). It is important to note that the maximum penalties for contraventions of the Act or regulations made under the Act are subject to change, as the value of a penalty unit is reviewed and updated annually.

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

Interactions

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.

Legislation content

Overview

Scope and Application

Key Provisions

Legal classification tags

Interactions

Authorises

All Versions