AUSTRALIAN GOVERNMENT
DEPARTMENT OF HEALTH
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 2022
I, Nigel Murray, Assistant Secretary, MBS Policy and Specialist Services Branch,
Medical Benefits Division, Health Resourcing Group, delegate for the Minister for Health, acting under subsection 19(2) of the Health Insurance Act 1973, hereby:
(1) REVOKE the Direction made under subsection 19(2) of the Act that was granted on
16 December 2021, 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 13 December 2016; 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 (ABN: 24 004 196 909) and the South Australia (ABN: 52 786 403 404) 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
(c) The professional services referred to in a clause in (2)(a):
(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
- is a professional non-referred service provided by a state remunerated medical practitioner, participating midwife, or participating nurse practitioner; or
- is a professional referred service provided by a state remunerated allied health and dental health practitioner; and
DECLARED that this Direction shall have effect from the date of signature until
30 July 2025 inclusive unless earlier revoked.
Date this 29th day of June 2022
Nigel Murray
Assistant Secretary
MBS Policy and Specialist Services Branch
Medical Benefits Division
Health Resourcing Group
Department of Health
SCHEDULE A
MEDICARE BENEFITS SCHEDULE ITEMS AS 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 attendances | ||
A11 | Urgent attendance after hours | ||
A14 | Health assessments | ||
A15 | GP management plans, team care arrangements, multidisciplinary care plans | ||
A17 | Domiciliary and residential management plans | ||
A18 | General Practitioner attendance associated with PIP incentive payments to which no other item applies | ||
A19 | Other non-referred attendances associated with PIP incentive payments to which no other item applies | ||
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 | ||
A30 | Medical practitioner (including General Practitioner, specialist or consultant physician) telehealth attendances* | ||
A35 | Services for patients in Residential Aged Care Facilities | ||
A40 | Telehealth and phone 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 | ||
17 | GP, Specialist and Consultant Physician Autism Service Telehealth Service | ||
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 and Other Medical Practitioner - urgent after hours service in unsociable hours phone services | ||
40 | GP Blood borne viruses, sexual or reproductive health consultation telehealth service | ||
A41 | Additional focussed psychological strategies | ||
A42 | Mental health planning for care recipients of a residential aged care facility | ||
A43 | Care recipient of a Residential Aged Care Facility planning and contribution items | ||
A45 | Nicotine and Smoking Cessation Counselling | ||
M1 | Management of bulk-billed services | ||
M3 | Allied Health services | ||
M6 | Psychological therapy services | ||
M7 | Focussed psychological strategies | ||
M8 | Pregnancy support counselling | ||
M9 | Allied Health group services | ||
M10 | Autism, pervasive developmental disorder and disability services | ||
M11 | Allied Health services for Indigenous Australians who have had a health check | ||
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 | Autism, pervasive developmental disorder and disability telehealth services | ||
16 | Autism, pervasive developmental 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 | COVID-19 Follow up service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner – Telehealth Services | ||
25 | COVID-19 Allied health, group dietetics telehealth services | ||
26 | COVID-19 Allied health, group dietetics phone | ||
M25 | Additional psychological therapy services | ||
M26 | Additional focussed psychological strategies (allied mental health) | ||
M27 | Initial psychological therapy services | ||
M28 | Initial focussed psychological strategies (allied mental health) | ||
M29 | Additional allied health services | ||
M30 | Allied health services for Indigenous Australians in RACF | ||
M31 | Allied health group services in RACF | ||
D1 | Miscellaneous diagnostic procedures and investigations | 1 | Neurology |
2 | Ophthalmology | ||
5 | Vascular | ||
7 | Gastroenterology and colorectal | ||
8 | Genito/urinary physiological investigations | ||
D2 | Nuclear medicine (non-imaging) | ||
T1 | Miscellaneous therapeutic procedures | 6 | Gastroenterology |
* Note: Claims under any item Group A30 in the General Medical Services Table may only be exempt from Subsection 19(2) of the HIA 1973 when the services are claimed by a General Practitioner.
General Medical Services Table – permitted items
Group | Group Name | Items | Item overview |
A29 | Early intervention services for children with autism, pervasive developmental 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 | COVID-19 services | 92170, 92171, 92176, 92177 | General Practitioner and Other Medical Practitioner items |
A44 | General Practice attendance for assessing patient suitability for a COVID-19 vaccine | 93625, 93627, 93635, 93637, 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, 11330, 11333-11339, 11503-11507, 11512, 11707, 12000-12004, 12012-12024, 12200, 12306-12326 | Non-referred services only |
M13 | Midwifery services | 82100-82115, 82130-82152 | Midwifery items |
T1 | Miscellaneous therapeutic procedures | 13105-13110 | Haemodialysis provided by a registered nurse, Aboriginal health worker or Aboriginal and Torres Strait Islander health practitioner in a very remote location. |
T4 | Obstetrics | 16400, 16406-16500, 16502-16591, 91850, 91855, 91851, 91856, 91852, 91857, 91853, 91858, 91855 | Antenatal and postnatal attendances |
T8 | Surgical operations | 30001-30006, 30010, 30023, 30026-30055, 30061-30072, 30187, 30189, 30192-30219, 47015, 47042, 47057, 47069, 47301, 47348, 47354, 47361, 47387, 47423, 47444, 47453, 47462, 47466. 47471, 47543, 47561, 47579, 47595, 47663, 47735, 47904-47918 | 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 | Street Address | Mailing Address |
Ceduna | Ceduna District Health Service | 3 Eyre Highway, Ceduna SA 5690 | 3 Eyre Highway CEDUNA SA 5690 |
Lameroo | Riverland Mallee Coorong Local Health Network – Mallee Medical Practice | 1 Vardon Terrace, Lameroo SA 5302 | 1 Vardon Terrace LAMEROO SA 5302 |
Wallaroo | Northern Yorke Peninsula Health Service – Wallaroo | 1 Ernest Terrace, Wallaroo SA 5556 | 1 Ernest Terrace WALLAROO SA 5556 |