AUSTRALIAN GOVERNMENT
DEPARTMENT OF HEALTH AND AGED CARE
HEALTH INSURANCE ACT 1973
Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Queensland - Medical Services performed under the Single Employer Model Trial) Direction 2023
I, Louise Riley, Acting First Assistant Secretary, Medicare Benefits and Digital Health Division, Health Resourcing Group, delegate for the Minister for Health and Aged Care, acting under subsection 19(2) of the Health Insurance Act 1973, hereby:
- 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 Rural General Practice and Rural Generalist Single Employer Model Trial Memorandum of Understanding between the Department of Health and Aged Care (ABN: 83 605 426 759) and the State of Queensland acting through Queensland Health (ABN: 66 329 169 412) in relation to the rural general practice and rural generalists single employer model 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 professional service is provided to:
(i) an eligible person (as defined in Section 3 of the Health Insurance Act 1973);
(ii) a patient 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
(iii) a patient who also is not receiving a service which attracts a payment through the 2020-2025 Addendum to the National Health Reform Agreement for a service rendered to a public patient; and
(c) the professional services referred to in clause (a) must be provided:
(i) at a general practice (as defined in Section 7.1.1 of the general medical services table); and
(ii) at:
- a rural or remote practice location specified in Schedule B in Modified Monash Model 2-7 (as defined in Section 7.1.1 of the general medical services table); or
- A location described in the Rural General Practice and Rural Generalist Single Employer Model Trial Memorandum of Understanding between the Department of Health and Aged Care and Queensland Health; and
(iii) by a participating rural generalist and rural general practice trainee mentioned in (a):
- who is formally enrolled in a fellowship training program that meets the standards of either the:
- The Australian College of Rural and Remote Medicine; and/or
- The Royal Australian College of General Practitioners; and
- who is employed by Queensland Health for the provision of primary and acute care services; and
(iv) by one of the twenty rural generalist and rural general practice participants who are eligible to use this Direction at any one time.
DECLARE that this Direction commences on 8 January 2024 and ceases to have effect at the end of 31 January 2025 unless earlier revoked.
Date this 14 day of December 2023
Louise Riley
Acting First Assistant Secretary
Medicare Benefits and Digital Health Division
Health Resourcing Group
Department of Health and Aged Care
SCHEDULE A
MEDICARE BENEFITS SCHEDULE ITEMS AS AGREED under the Queesnland Department of Health rural general practice and rural Generalist SINGLE EMPLOYER Model TRIAL
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 | 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 |
2 | Case conferences | ||
A17 | Domiciliary and residential medication management reviews | ||
A20 | GP Mental Health treatment | 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 | Attendance services for complex neurodevelopmental disorder or disability | ||
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 | ||
A40 | Telehealth and phone attendance 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 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 | 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 | ||
37 | Specialist, anaesthesia – Telehealth Services | ||
39 | GP Sexual and Reproductive Health Consultation – Telehealth Service | ||
40 | GP Sexual and Reproductive Health Consultation – Phone Service | ||
A44 | General practice attendance for assessing patient suitability for a COVID-19 vaccine | All |
|
A46 | COVID-19 management support service | ||
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 | Other 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 | Gynaecological | ||
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 | Bone age study and skeletal survey | ||
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 Modified Monash 2-7 rural and remote Practice Locations AS AGREED under the Queensland department of health rural general practice and rural Generalist SINGLE EMPLOYERModel TRIAL
Approved primary care Modified Monash Model (MMM) 4 locations:
MMM 4 location | Practice Name | Legal Name | Street Address |
Ayr | Outback Family Medicine Pty Ltd | Alexander Medical Pty Ltd | 140 MacKenzie St Ayr, QLD 4807 |
Emerald | Emerald Medical Group | Central Highlands Healthcare Ltd | Lot 1, Pilot Farm Rd Emerald, QLD 4720 |
Mareeba | Amaroo Medical Centre Mareeba | The Trustee for YourGP@Amaroo Medical Centre Trust | 10 Karobean Dr, Mareeba QLD 4880 |
Warwick | Condamine Medical Centre | Condamine Medical Centre (QLD) Pty. Ltd. | 53 Wood Street Warwick, QLD, 4370 |