AUSTRALIAN GOVERNMENT
DEPARTMENT OF HEALTH, DISABILITY AND AGEING
HEALTH INSURANCE ACT 1973
Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Primary Health Networks Program: General Practice Incentive Fund) Direction 2025
I, Nigel Murray, Assistant Secretary, MBS Policy and Specialist Programs Branch, Medicare 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:
- REPEAL the Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Primary Health Networks Program: General Practice Incentive Fund Direction 2024; and
- 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 in accordance with the Primary Health Networks Program: General Practice Incentive Fund managed by the Department of Health and Aged Care (ABN: 83 605 426 759) and the organisations listed in Schedule B of this Direction, in relation to medical services for which:
- 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) relate
- Where the professional service is provided to:
- an eligible person (as defined in section 3 of the Act) who is;
- not receiving the service as part of an episode of hospital treatment (as defined in section 121-5 of the Private Health Insurance Act 2007); and
- not receiving a service which attracts a payment through the 2020-2025 Addendum, schedule K, one year extension, to the National Health Reform Agreement for a service rendered to a public patient; and
- the professional services referred to in paragraph (1)(a) must be provided:
- by a person who is employed or engaged by an organisation listed in Schedule B of this Direction; and
- by a general practitioner (as defined in section 3 of the Act) who is registered to provide services with Services Australia under the General Practice Incentive Fund Program mentioned in paragraph (1)(a).
- DECLARE that this Direction commences on 1 July 2025 and ceases to have effect at the end of 30 June 2027 unless earlier revoked.
Dated: 24 June 2025
Nigel MurrayAssistant SecretaryMBS Policy and Specialist Programs BranchMedicare Benefits and Digital Health DivisionHealth Resourcing Group Department of Health, Disability and Ageing
SCHEDULE A
MEDICARE BENEFITS SCHEDULE (MBS) ITEMS AS AGREED under the General Practice Incentive Fund
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. Medical practitioners and health services must ensure they fulfil the MBS requirements for all items.
General Medical Services Table
Group | Group Name | Subgroup | Subgroup Name | Item Number |
A7 | Acupuncture and Non‑Specialist Practitioner Items | 6 | Prescribed medical practitioner chronic condition management plans, multidisciplinary care plans and case conferences | 231, 232, 392, 393 |
5 | Prescribed medical practitioner health assessments | 228 |
9 | Prescribed medical practitioner mental health care | 281, 282, 272, 276 |
A14 | Health Assessments | | Aboriginal and Torres Strait Islander Peoples health assessment | 715 |
A15 | GP chronic condition management plans, multidisciplinary care plans and case conferences | 1 | GP chronic condition management plans and multidisciplinary care plans | 729, 731, 965, 967 |
A20 | GP Mental health treatment | 1 | GP mental health treatment plans | 2700, 2701, 2712, 2715, and 2717 |
A36 | Eating disorders | 1 | Preparation of eating disorder treatment and management plans: general practitioners and non‑specialist medical practitioners | 90250, 90251, 90252, 90253, 90254, 90255, 90256, 90257 |
3 | Review of eating disorder treatment and management plans | 90264, 90265 |
A40 | Telehealth attendance services | 13 | GP management plans, team care arrangements and multidisciplinary care plans services – Video Services | 92024, 92025, 92026, 92027, 92028, 92029, 92030, 92056, 92059,92055, 92057, 92058, 92060, 92061 |
11 | Health Assessment for Aboriginal and Torres Strait Islander People – Video Services | 92004, 92011 |
19 | GP Mental Health Treatment Plan ‑ Video Services | 92112, 92113, 92114, 92116, 92117, 92118, 92119, , 92123, 92126 |
21 | GP Eating Disorder Treatment and Management Plan – Video Services | 92146, 92147, 92148, 92149, 92150, 92151, 92152, 92153 |
25 | Review of an Eating Disorder Plan ‑ Video Services | 92170, 92171, |
26 | Review of an Eating Disorder Plan – Phone Service | 92176, 92177 |
SCHEDULE B
Approved locations for provision of services under the General PRACTICE Incentive fund
QUEENSLAND
State | Practice Name | Legal Name | Street Address |
Qld | Cardwell Medical Practice | Rural Generalist Practice Pty Ltd | 226 Victoria St, Cardwell, Qld 4849 |
Overview
The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Primary Health Networks Program: General Practice Incentive Fund) Direction 2025 is an instrument introduced by the Australian Government Department of Health, Disability and Ageing to address the need for enhancing primary health care services through the Primary Health Networks Program: General Practice Incentive Fund. Enacted under the authority of the Health Insurance Act 1973, this Direction repeals the previous Direction 2024 and specifies new conditions under which Medicare benefits will be payable for certain professional services provided by general practitioners. This initiative aims to ensure that eligible individuals receive necessary medical services without being part of an episode of hospital treatment or receiving services through the National Health Reform Agreement. The Direction is effective from 1 July 2025 and will cease to have effect on 30 June 2027 unless earlier revoked.
The policy objective of this Direction is to support primary health care through the General Practice Incentive Fund, ensuring that services are provided by qualified general practitioners to eligible persons, thus enhancing accessibility and quality of care. This legislative instrument is part of the ongoing efforts to support the healthcare system by facilitating better service provision and incentivising general practice within the framework of the Health Insurance Act 1973.
Scope and Application
The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Primary Health Networks Program: General Practice Incentive Fund) Direction 2025 applies to the provision of specific medical services under the General Practice Incentive Fund, managed by the Department of Health and Aged Care. It outlines the conditions under which Medicare benefits will be payable for professional services related to items listed in Schedule A, provided by general practitioners registered with Services Australia and employed or engaged by approved organisations listed in Schedule B. The Direction applies to these services when they are provided to eligible persons, excluding those receiving services as part of a hospital episode or under specific other payment agreements. The geographic reach of this Direction is national, extending to all services provided across Australia by entities listed in Schedule B, which currently includes a practice in Cardwell, Queensland. The Direction comes into effect on 1 July 2025 and will cease to have effect at the end of 30 June 2027 unless earlier revoked. The application of this Direction may be further extended or restricted through subordinate instruments, such as regulations or further directions issued under the Health Insurance Act 1973.
Key Provisions
The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Primary Health Networks Program: General Practice Incentive Fund) Direction 2025 (the Direction) outlines the specific professional services for which Medicare benefits will be payable under the General Practice Incentive Fund Program. This Direction, effective from 1 July 2025 and expiring on 30 June 2027, aims to support general practitioners in delivering essential healthcare services to eligible individuals (sections 1 and 2). It specifies that Medicare benefits will be payable for professional services agreed to be provided under this fund, as listed in Schedule A, and managed by the Department of Health and Aged Care. These services must be provided by general practitioners employed or engaged by organisations listed in Schedule B, and they must adhere to the criteria of being provided to eligible individuals not receiving hospital treatment or services covered by another agreement (section 1(a) and (b)).
Under the Direction, both general practitioners and the organisations employing them have specific obligations. General practitioners must be registered to provide services with Services Australia under the General Practice Incentive Fund Program and must ensure that the services they provide are listed in Schedule A of the Direction. The employing organisations, listed in Schedule B, must be approved and must ensure that the professional services provided are in line with the criteria set forth in the Direction (section 1(a)). These organisations and practitioners must also comply with all provisions of the Health Insurance Act 1973 and any related regulations, ensuring that all medical services meet the required standards and conditions for Medicare benefits (section 1(a) and Schedule A).
Failure to comply with the requirements of this Direction may result in significant consequences. While the Direction itself does not explicitly detail offences or penalties, non-compliance with the Health Insurance Act 1973 or related regulations could lead to substantial penalties. For example, under the Health Insurance Act, penalties for fraudulent claims can include fines of up to $22,200 for individuals and $111,000 for corporations, as well as potential criminal charges leading to imprisonment. Additionally, the Act provides for the recovery of benefits improperly paid and civil proceedings for penalties and damages (Health Insurance Act 1973, sections 109A and 123). Therefore, adherence to the Direction is crucial to avoid these severe repercussions.