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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 andRemote Areas – COAG s19(2) Exemptions Initiative – South Australia Direction 2022

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Council of Australian Governments’ Improving Access to Primary Care in Rural andRemote Areas – COAG s19(2) Exemptions Initiative – South Australia Direction 2022

Administered by Department of Health, Disability and Ageing

Legislation au F2022N00160 Not in force Notifiable Instrument

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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

(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

Overview

The Health Insurance Act 1973 (HIA 1973) governs the payment of Medicare benefits in Australia. This Act was introduced to establish a national health insurance scheme to provide for the payment of benefits for medical services and hospital treatment. Enacted by the Australian Parliament, the HIA 1973 aims to ensure access to reasonably affordable health services for all Australians, promoting equity and efficiency in the delivery of health care. The Act was introduced to address the gap in the provision of accessible and affordable healthcare services across Australia, particularly in rural and remote areas. The Act empowers the Minister for Health to issue directions under section 19(2) to ensure the equitable distribution of health services nationwide. In this context, the Department of Health issued a direction to revise the payment of Medicare benefits for professional services in South Australia, enhancing access to primary care in rural and remote areas as part of the Council of Australian Governments' Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative.

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 2022) pertains to the provision of professional health services within the scope of the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative, specifically in South Australia. This direction applies to health services providers who are part of this initiative and have agreed to provide certain professional services as outlined in the Memorandum of Understanding between the Australian Government and South Australia dated 13 December 2016. The services in question are those listed in Schedule A, which includes general medical services, diagnostic imaging services, and pathology services, and they must be provided in accordance with the provisions of the Health Insurance Act 1973 and the National Health Act 1953. The direction specifies that Medicare benefits will be payable for these services when they are provided to eligible persons outside of an episode of hospital treatment and at approved locations specified in Schedule B. The direction applies from the date of signature until 30 July 2025, unless it is revoked earlier. The scope of the Act is limited to the specified professional services, locations, and conditions as outlined in the direction, and it does not extend to other services or areas not covered by these provisions.

Key Provisions

This legislative instrument, which is a notifiable instrument under the Health Insurance Act 1973, revokes a previous Direction (Section 1) and establishes new provisions for the payment of Medicare benefits for specified professional services in South Australia. Specifically, the instrument revokes the Direction made on 16 December 2021 that allowed for the payment of Medicare benefits for professional services provided by health services in South Australia as part of the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative (Section 1(1)). The instrument then directs that Medicare Benefits shall be payable in respect of professional services provided under an updated Memorandum of Understanding (MOU) between the Department of Health and South Australia (Section 2). These services must be provided to eligible persons 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 specified in Schedule B (Section 2(b) and (c)). The services must also fall within the items specified in Schedule A of the Direction and the general medical services table, diagnostic imaging services table, and pathology services table (Section 2(a)(i)). The Direction is effective from 19 May 2022 until 30 July 2025, unless earlier revoked (Section 3). The new provisions impose several obligations on the parties involved. Health service providers in South Australia must ensure that the professional services they provide fall within the scope of the updated MOU and the Direction, and are provided at an approved practice location (Section 2). Eligible persons must be identified and verified as such, and must not be part of an episode of hospital treatment (Section 2(b)(i) and (ii)). The Department of Health and South Australia must also ensure that the approved practice locations are appropriately specified and that the services provided fall within the scope of the Direction (Section 2(c) and Schedule B). Failure to comply with the provisions of the Direction may result in civil or criminal consequences, depending on the nature and extent of the breach. For example, knowingly making a false or misleading statement in a claim for Medicare benefits may result in a civil penalty of up to $22,200 per offence, or a criminal penalty of up to $55,500 per offence (Section 121D of the Health Insurance Act 1973). Similarly, providing professional services that are not authorised by the Direction or the MOU may result in the provider being ineligible for Medicare benefits, or even criminal prosecution for fraud (Section 121C of the Health Insurance Act 1973). It is therefore important that all parties involved in the provision of professional services in South Australia under the COAG s19(2) Exemptions Initiative ensure that they are fully aware of and comply with the requirements of the Direction and the updated MOU.

Area of Law: Health Law
Instrument: Notifiable instrument
Concepts: Definitions & Interpretation; Licensing & Registration; Compliance 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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