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Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Noarlunga and Smaller Medical Services in South Australia) Direction (No.2) 2021

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Noarlunga and Smaller Medical Services in South Australia) Direction (No.2) 2021

Administered by Department of Health, Disability and Ageing

Legislation au F2021N00330 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 – Noarlunga and Smaller Medical Services in South Australia) Direction (No.2) 2021

I, NIGEL MURRAY, ASSISTANT SECRETARY, 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
1 July 2021, in respect of professional services provided by, or on behalf of, or under an arrangement with South Australia Health; 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 by, or on behalf of, or under an arrangement with South Australia Health (ABN: 97 643 356 590) for which:

(i) items specified in Schedule A of this Direction; and

(ii) 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 professional 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 receiving hospital treatment or an episode of hospital treatment (as defined in Section 121-5 of the Private Health Insurance Act 2007); and

(i) is provided at a practice location specified in Schedule B of this Direction.

DECLARED that this Direction shall have effect from the date of signature until
30 June 2025 inclusive unless earlier revoked.

Date this 22 day of December 2021

Nigel Murray

Assistant Secretary

Medical Benefits Division

Health Resourcing Group

Department of Health

SCHEDULE A

MEDICARE BENEFITS SCHEDULE ITEMS AS AGREED BETWEEN THE DEPARTMENT OF HEALTH AND south australia health

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.

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	All
A11	Urgent attendances after-hours
A14	Health assessments
A15	GP Management plans, team care arrangements and multidisciplinary care plans and case	1	GP Management plans, team care arrangements and multidisciplinary care plans
A15		2	Case conferences
A17	Domiciliary and residential medication management reviews
A18	Attendances associated with Practice Incentive Program payments	All
A19	Attendances associated with Practice Incentive Program payments	All
A20	Mental health Care	All
A22	General practitioner after-hours attendances to which no other item applies
A23	Other non-referred after-hour attendances to which no other item applies
A27	Pregnancy support counselling
A29	Early intervention services for children with autism, pervasive development disorder or disability
A30	Medical practitioner video conferencing consultation	1	Video conferencing consultation attendance at consulting rooms, home visit of other institution
		2	Video conferencing consultation attendance at a residential aged care facility
		3	Mental health and well-being video conferencing consultation
		5	General practitioner video conferencing consultation attendance for patients in rural and remote areas
		6	Other non-referred video conferencing consultation attendance for patients in rural and remote areas
		7	Non-specialist practitioner video conferencing consultation for patients in rural and remote areas
A35	Non-referred attendance at a residential aged care facility
A36	Eating Disorder Services	1	GP and Medical Practitioner eating disorder treatment and management plans
		3	Review of eating disorder treatment and management plan
		4	GP and medical practitioner eating disorder s psychological treatment services
A39	Bushfire Recovery Access Initiative – GP and Medical Practitioner Focussed Psychological Strategies
A40	COVID-19 Services	1	COVID-19 general practice - telehealth services
		2	COVID-19 general practice - phone services
		3	COVID-19 Focussed psychological strategies - telehealth services
		10	COVID-19 Focussed psychological strategies - phone services
		11	Health assessments for Aboriginal and Torres Strait Islander People - telehealth services
		12	Health assessments for Aboriginal and Torres Strait Islander People - phone Services
		13	GP management plans, team care arrangements and multidisciplinary care plans via telehealth attendance
		14	GP management plans, team care arrangements and multidisciplinary care plans via phone attendance
		15	GP pregnancy support counselling - telehealth services
		16	GP pregnancy support counselling - phone services
		17	GP, Specialist and Consultant Physician autism service - telehealth services
		18	GP, Specialist and Consultant Physician autism service - phone services
		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
		22	GP Eating Disorder Treatment and Management Plans - phone services
		25	Review of an eating disorder Plan - telehealth services
		26	Review of an Eating Disorder Plan – phone 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
		30	GP and Other Medical Practitioner - urgent after hours service in unsociable hours - phone services
M1	Management of bulk billed services
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	1	Video conferencing consultation support service provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner
		2	Video conferencing consultation support service provided at a residential aged care facility on behalf of a medical practitioner
		3	Services provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner
D1	Miscellaneous diagnostic procedures and investigations	2	Ophthalmology
		3	Otolaryngology
		4	Respiratory
		5	Vascular
		6	Cardiovascular
		8	Genito-urinary physiological investigations
		9	Allergy testing
		10	Other diagnostic procedures and investigations
D2	Nuclear Medicine (non-imaging)
T1	Miscellaneous therapeutic procedures	2	Dialysis
		4	Paediatric and neonatal
		5	Cardiovascular
		8	Haematology
		9	Procedures associated with intensive care and cardiopulmonary support
		11	Chemotherapeutic procedures
		13	Miscellaneous therapeutic procedures
T2	Radiation oncology	1	Superficial
T3	Therapeutic nuclear medicine
T4	Obstetrics
T6	Examination by anaesthetist
T7	Regional or field nerve blocks
T8	Surgical Operations	1	General
		2	Colorectal
		3	Vascular
		4	Ear, nose and throat
		5	Urological
		6	Cardio-thoracic
		7	Neurosurgical
		8	Ear, nose and throat
		9	Ophthalmology
		11	Paediatric
		12	Amputations
		13	Plastic and reconstructive surgery
		14	Hand surgery
		15	Orthopaedic
T9	Assistance at operations
T10	Anaesthesia performed in connect with certain services (relative value guide)	All

Diagnostic Imaging Services Table

Group	Group Name	Subgroup	Subgroup Name
I1	Ultrasound	6	Musculoskeletal ultrasound
I3	Diagnostic Radiology	1	Radiographic examination of extremities
		2	Radiographic examination of shoulder or pelvis
		3	Radiographic examination of head
		4	Radiographic examination of spine
		5	Cardiovascular
		6	Radiographic examination of thoracic region
		7	Radiographic examination of urinary tract
		8	Radiographic examination of alimentary tract and biliary system
		12	Radiographic examination with opaque or contrast media
I6	Management of bulk billed Services

Pathology Services Table

Group	Group Name
P1	Haematology
P2	Chemical
P9	Simple Basic Pathology Tests
P12	Management of bulk billed services

SCHEDULE B

Approved Practice Locations

Approved locations:

Location	Practice Name	Street Address	Mailing Address
Sefton Park	Sefton Park Community Health Care Service	Shop 5, 22 Main North Road, Sefton Park, South Australia 5083	Shop 5, 22 Main North Road, Sefton Park, South Australia 5083
Port Adelaide	Watto Purrunna Aboriginal Health Service	Wonggangga Turtpandi, 11 Church Street, Port Adelaide, South Australia 5015	Wonggangga Turtpandi, 11 Church Street, Port Adelaide, South Australia 5015
Elizabeth	Youth Health Service	6 Gillingham Street, Elizabeth, South Australia 5112	6 Gillingham Street, Elizabeth, South Australia 5112
Angel Park	Youth Health Service	40-44 Trafford Street, Angle Park, South Australia 5010	40-44 Trafford Street, Angle Park, South Australia 5010
Christies Beach	Youth Health Service	50A Beach Road, Christies Beach, South Australia 5165	50A Beach Road, Christies Beach, South Australia 5165
Noarlunga Centre	Noarlunga Health Service	20 Alexander Kelly Drive, Noarlunga Centre, South Australia 5168.	20 Alexander Kelly Drive, Noarlunga Centre, South Australia 5168.

Overview

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Noarlunga and Smaller Medical Services in South Australia) Direction (No.2) 2021 was enacted by the Australian Government Department of Health to address the problem of ensuring continued Medicare benefits coverage for professional services provided by South Australia Health, particularly in Noarlunga and smaller medical services across the state. This Direction revokes a previous Direction issued on 1 July 2021 and sets out new provisions to ensure that Medicare benefits are payable for specified professional services provided by South Australia Health. The enacting body is the Assistant Secretary, Medical Benefits Division, Health Resourcing Group, who acts on behalf of the Minister for Health under subsection 19(2) of the Health Insurance Act 1973. The policy objective is to maintain consistent and adequate healthcare services for eligible patients, ensuring they receive necessary professional services without disruption.

Scope and Application

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Noarlunga and Smaller Medical Services in South Australia) Direction (No.2) 2021, issued under the Health Insurance Act 1973, pertains to the payment of Medicare Benefits for specific professional services provided by, or on behalf of, or under an arrangement with South Australia Health. This direction applies to medical services specified in Schedule A of the Direction, which encompasses a range of general medical, diagnostic imaging, and pathology services. These services are to be rendered to eligible individuals who are not receiving hospital treatment or an episode of hospital treatment, and must be performed at locations detailed in Schedule B of the Direction, which lists approved practice locations in South Australia. The direction, effective from the date of signature until 30 June 2025, unless earlier revoked, ensures that all provisions of the Health Insurance Act 1973, and regulations made under it, as well as the National Health Act 1953 and its regulations, relating to medical services, professional services, or items, apply to the services specified. The scope of the direction extends to various healthcare services, including mental health care, COVID-19 services, and video conferencing consultations, among others, thereby formalising the eligibility and payment structure for these services under Medicare.

Key Provisions

The main operative sections of this Direction (No.2) 2021 under the Health Insurance Act 1973 involve the revocation of a previous Direction and the establishment of new provisions for Medicare Benefits payable in respect of professional services in South Australia. Specifically, section (1) revokes the previous Direction made on 1 July 2021 concerning professional services provided by South Australia Health, while section (2) introduces new provisions for Medicare Benefits to be payable for specific professional services under certain conditions. These conditions include the type of service, the eligibility of the person receiving the service, and the location where the service is provided, as outlined in Schedules A and B of this Direction. The Direction specifies that Medicare Benefits will be payable for professional services listed in Schedule A, provided to eligible persons at practice locations listed in Schedule B. The Act imposes obligations on parties, particularly South Australia Health, to ensure that the professional services they provide meet the criteria outlined in this Direction. This includes providing services at approved locations and adhering to the specific items and conditions listed in Schedules A and B. Furthermore, the Act requires that all provisions of the Health Insurance Act 1973 and the National Health Act 1953, along with their respective regulations, apply to these services. This ensures that the services are provided in compliance with broader health legislation and regulations. Breaches of this Direction may result in civil or criminal consequences, depending on the nature and severity of the breach. While the specific penalties are not detailed in the Direction itself, breaches of the Health Insurance Act 1973 can typically lead to fines and other penalties as stipulated by the relevant legislation. These penalties can vary widely based on the specific breach and the discretion of the courts. The maximum penalties under the Health Insurance Act 1973 for offences related to fraudulent claims or misrepresentation can include significant fines and, in severe cases, imprisonment. It is important for parties involved to comply with the Act to avoid these potential consequences.

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

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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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