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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 – Victoria) Direction (No. 2) 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. 2) 2025

Administered by Department of Health, Disability and Ageing

Legislation au F2025N00482 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 – Victoria) Direction (No. 2) 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 Ageing, acting under subsection 19(2) of the Health Insurance Act 1973 (the Act), hereby:

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 and Aged Care (ABN: 83 605 426 759) and the Victorian Department of Health (ABN: 74 410 330 756) dated 21 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 profession 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 (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.

DECLARE that this Direction commences on 1 July 2025 and ceases to have effect at the end of 30 June 2027 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: 16 June 2025

Nigel Murray

Assistant Secretary

MBS Policy and Specialist Programs Branch

Medical 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 – 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	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 – 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 (No. 2) 2025 was enacted in 2025 to address the gap in access to primary care services in rural and remote areas in Victoria, particularly under the Council of Australian Governments' Improving Access to Primary Care in Rural and Remote Areas Initiative. This legislation was introduced by the Australian Government Department of Health, Disability and Ageing, and falls under the Health Insurance Act 1973. The primary policy objective of this Direction is to ensure that Medicare Benefits are payable for specified professional services provided in approved locations in rural and remote areas, thus improving access to essential healthcare services for patients in these underserved regions. This initiative aims to alleviate the disparity in healthcare access between urban and rural populations, ensuring that eligible individuals receive necessary medical care without the constraints of geographical limitations. The Direction outlines the specific professional services, approved practice locations, and conditions under which Medicare Benefits are payable, ensuring that the initiative is implemented effectively and efficiently. The Direction is set to commence on 1 July 2025 and will remain in effect until 30 June 2027, unless otherwise revoked.

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 – Victoria) Direction (No. 2) 2025 applies to medical services provided in Victoria under the Memorandum of Understanding between the Department of Health and Aged Care and the Victorian Department of Health. The Direction specifies that Medicare Benefits will be payable for certain professional services agreed upon in the MOU, which are provided to eligible persons at approved practice locations within Modified Monash Model 5-7 areas in Victoria. These services include those rendered by state remunerated medical practitioners, participating midwives, participating nurse practitioners, and state remunerated allied health and dental health practitioners. The Direction applies to services listed in Schedule A and provided at locations specified in Schedule B, commencing on 1 July 2025 and ending on 30 June 2027 unless revoked earlier. The Direction is subject to the definitions provided in the Health Insurance Act 1973 and related regulations and determinations, and its application may be extended or restricted through subordinate instruments.

Key Provisions

This Direction, effective from 1 July 2025 and expiring on 30 June 2027, specifies the types of professional services for which Medicare Benefits will be payable under the Health Insurance Act 1973. The services must be provided in accordance with the terms of the Memorandum of Understanding (MOU) between the Department of Health and Aged Care and the Victorian Department of Health, as part of the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative. This Direction applies to professional services listed in Schedule A, provided at approved practice locations specified in Schedule B, and to eligible persons who are not part of an episode of hospital treatment. These services must be either non-referred services provided by specific practitioners, or referred services provided by allied health and dental health practitioners. The Act imposes several obligations on the parties involved. Firstly, the professional services must be provided at locations approved under the MOU and must be agreed upon in the MOU. The services must also be provided by authorised practitioners, such as state remunerated medical practitioners, participating midwives, participating nurse practitioners, and allied health and dental health practitioners. Furthermore, the services must be provided to eligible persons who are not undergoing hospital treatment. It is essential that all provisions of the Health Insurance Act 1973, the Health Insurance (General Medical Services Table) Regulations 2021, and the National Health Act 1953, as well as their respective regulations, apply to the services rendered. Failure to comply with the provisions of this Direction may result in various consequences. Although the specific offences, penalties, or civil/criminal consequences for breach are not detailed in the Direction, breaches of the Health Insurance Act 1973 can lead to penalties under the Act. For example, misleading or false claims can result in fines of up to $22,200 for individuals and $111,000 for corporations. Additionally, the Director of Public Prosecutions may bring a civil penalty proceeding in the Federal Court for serious or repeated breaches, which can lead to penalties of up to $66,000 for individuals and $330,000 for corporations. The Director of Public Prosecutions may also bring a criminal proceeding in the Federal Court for serious breaches, which can result in fines of up to $220,000 for individuals and $1,100,000 for corporations, along with potential imprisonment. It is important to note that these penalties are subject to the specific provisions of the Health Insurance Act 1973 and any other relevant legislation.

Area of Law: Health Law
Instrument: Direction
Concepts: Reporting & Disclosure Obligations; Compliance Obligations; Enforcement Powers

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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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