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Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Queensland - Medical Services performed under the Single Employer Model Trial) Direction 2025

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Queensland - Medical Services performed under the Single Employer Model Trial) Direction 2025

Administered by Department of Health, Disability and Ageing

Legislation au F2025N00182 Not in force Notifiable Instrument

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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 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 Aged Care, 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 – Queensland - Medical Services performed under the Single Employer Model Trial) Direction 2024; and
DIRECT that Medicare Benefits shall be payable in respect of:
1. A professional service (as defined in Section 3 of the Act) 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 Generalist Single Employer Model Trial for which:
  1. 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), diagnostic imaging services table (means the table prescribed under subsection 4AA(1) of the Act) and pathology services table (means the table prescribed under subsection 4A(1) of the Act) relates: and
2. Where the professional service is provided to:
  1. an eligible person (as defined in Section 3 of the Health Insurance Act 1973);
  2. 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
  3. 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
3. The professional services referred to in paragraph (2)(a) must be provided:
  1. at a general practice (as defined in Section 7.1.1 of the general medical services table); and
  2. at a rural or remote practice location specified in Schedule B in an eligible area (as defined in the Dictionary of the of the general medical services table); and
  3. by a participating rural generalist or rural general practice trainee participating in the program mentioned in paragraph (2)(a):
    1. who is formally enrolled in a fellowship training program that meets the standards of either the:
      1. The Australian College of Rural and Remote Medicine; and/or
      2. The Royal Australian College of General Practitioners; and
    2. who is employed by Queensland Health for the provision of primary and acute care services; and
DECLARE that this Direction commences on the day after registration and ceases to have effect at the end of 31 December 2028 unless earlier revoked.

Note, this program covers the sixty rural generalist and rural general practice participants who are eligible to use this Direction at any one time.

Date: 20 February 2025

Nigel Murray
Assistant Secretary
MBS Policy and Specialist Programs Branch
Medicare Benefits and Digital Health Division
Health Resourcing Group
Department of Health and Aged Care

SCHEDULE A

MEDICARE BENEFITS SCHEDULE (MBS) ITEMS AS AGREED under the QUEENSLAND 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. Medical practitioners and health services must ensure they fulfil the MBS requirements for all items.

General Medical Services Table

Standard Primary Care Services Table

For services listed in the below table, this list of items includes MBS items that are commonly claimed by doctors in primary care.

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
A11	Urgent attendances after—hours
A14	Health assessments
A15	GP management plans, team care arrangements and multidisciplinary care plans and case conferences	1	GP management plans, team care arrangements and multidisciplinary care plans
A15		2	Case conferences
A17	Domiciliary and residential medication management reviews
A20	Mental health care
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
A29	Attendance services for complex neurodevelopmental disorder or disability
A35	Non‑referred attendance at a residential aged care facility
A36	Eating disorder services	1	Preparation of eating disorder treatment and management plans: general practitioners and non‑specialist medical practitioners
		3	Review of eating disorder treatment and management plans
		4	Providing treatments under eating disorder treatment and management plans
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 Service
		13	GP management plans, team care arrangements and multidisciplinary care plans via telehealth attendance
		15	GP Pregnancy Support Counselling ‑ Telehealth Service
		16	GP Pregnancy Support Counselling ‑ Phone Service
		17	GP, specialist and consultant physician complex neurodevelopmental disorder or disability service ‑ telehealth service
		19	GP Mental Health Treatment Plan ‑ Telehealth Service
		20	GP Mental Health Treatment Plan ‑ Phone Service
		21	GP Eating Disorder Treatment and Management Plan – Telehealth Service
		25	Review of an Eating Disorder Plan ‑ Telehealth Service
		26	Review of an Eating Disorder Plan – Phone Service
		27	Eating Disorder Psychological Treatment Services – Telehealth Service
		28	Eating Disorder Psychological Treatment Strategies – Phone Service
		29	GP and Other Medical Practitioner ‑ Urgent After Hours Service in Unsociable Hours ‑ Telehealth Service
		37	Specialist, anaesthesia telehealth services
		39	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Telehealth Service
		40	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Phone Service
A44	General Practice Attendance for Assessing Patient Suitability for a COVID‑19 Vaccine
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
M12		3	Services provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner

Non-Standard Primary Care Services Table

For services listed in the below table, this list of items includes MBS items that are not commonly claimed by doctors in primary care.

Group	Group Name	Subgroup	Subgroup Name
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
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 or wrist surgery
		15	Orthopaedic
T9	Assistance at operations
T10	Anaesthesia performed in connection with certain services (Relative Value Guide)

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 rural general practice and rural Generalist SINGLE EMPLOYER Model TRIAL

Approved primary care Modified Monash Model (MMM) 4 locations:

MMM 4 location	Practice Name	Legal Name	Street Address
Ayr	Outback Family Medicine	WIN Medical Practice Pty Ltd	140 Mackenzie Street Ayr QLD 4807
Dalby	Myall Medical Practice	The Trustee for Archibald Street Services Trust	37 North Street Dalby QLD 4405
Emerald	Emerald Medical Group	Central Highlands Healthcare Ltd	Lot 1 Pilot Farm Road Emerald QLD 4720
Goondiwindi	Goondiwindi Medical Centre	GMC Medical Services Pty Ltd	49 Bowen Street Goondiwindi QLD 4390
Innisfail	Rankin Street Medical	Bayvex Pty Ltd	57 Rankin Street Innisfail QLD 4860
Kingaroy	Taabinga Family Practice	Taabinga Family Practice Pty Ltd	213 Haly Street Kingaroy QLD 4610
Kingaroy	South Burnett Medical Centre	The Trustee for Amarula Trust	19 Avoca Street Kingaroy QLD 4610
Kingaroy	Bunya Pines Family Practice	Dolzan, Glen Alexander	219a Haly Street Kingaroy QLD 4610
Kingaroy	Kingaroy General Practice	Kingaroy General Practice Pty Ltd	25 Markwell Street Kingaroy QLD 4610
Roma	Maranoa Medical Centre	MMC Unit Trust	27 Quintin Street Roma QLD 4455
Warwick	Condamine Medical Centre	Condamine Medical Centre (QLD) Pty Ltd	53 Wood Street Warwick QLD 4370

Approved primary care Modified Monash Model (MMM) 5 locations:

MMM 5 location	Practice Name	Legal Name	Street Address
Blackbutt	Blackbutt Medical Centre	Medical First Clinics Pty Ltd	91 Coulson St Blackbutt QLD 4314
Chinchilla	Chinchilla Medical Practice	The Trustee for Chinchilla Unit Trust and T.P Clarke & K.J Gilmour	58 Middle Street Chinchilla QLD 4413
Inglewood	Inglewood Medical Centre	Owen, Colin Edward	57 Albert St Inglewood QLD 4387
Killarney	Killarney Memorial Medical Centre	Killarney Memorial Aged Care Ltd	7 Eucalyptus St Killarney QLD 4373
Maleny	Maleny Doctors	The Trustee for Hinterland Heath Unit Trust	7/15 Maple Street Maleny QLD 4552
Miles	Miles Medical Centre	The Trustee for Mandikiza Medical Trust	79 Marian Street Miles QLD 4415
Mission Beach	Mission Medical	The Trustee for The Radmak Discretionary Trust	Shop 9 & 10 Mission Beach Shopping Centre
Murgon	Murgon Family Medical Practice	G.S. McAllister Medical Pty Ltd	43 Stephens Street W Murgon QLD 4605
Ravenshoe	Ravenshoe Medical Centre	Rural Health Management Services Pty Ltd	62 Grigg Street Ravenshoe QLD 4888
Tara	Tara Medical Centre	Outback Health and Medical Services Pty LTD	33 Day Street Tara QLD 4421
Tully	Tully Medical Centre & Mission Medical	The Trustee for The Radmak Discretionary Trust	10 Watkins Steet Tully QLD 4854
Wongaling Beach	Mission Medical	The Trustee for The Radmak Discretionary Trust	34-40 Dickinson Street Wongaling Beach QLD 4852

Approved primary care Modified Monash Model (MMM) 6 locations:

MMM 6 location	Practice Name	Legal Name	Street Address
Cloncurry	Ramsay Street General Practice	Hoarec GP Pty Ltd	27 Ramsay Street Cloncurry QLD 4824
Mount Isa City	Mount Isa Medical Centre	Mbaogu, Michael	71 Camooweal Street Mount Isa City QLD 4825

Overview

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Queensland - Medical Services performed under the Single Employer Model Trial) Direction 2025 was enacted by the Australian Government Department of Health and Aged Care. This legislation repeals the Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Queensland - Medical Services performed under the Single Employer Model Trial) Direction 2024 and establishes new provisions for the payment of Medicare Benefits for professional services provided under the Rural General Practice and Rural Generalist Single Employer Model Trial in Queensland. The policy objective is to facilitate the implementation of the trial, which aims to improve healthcare delivery in rural and remote areas by providing specific Medicare Benefits for services rendered by participating rural generalists and rural general practice trainees in eligible areas. The Direction ensures that these professionals, who are enrolled in accredited fellowship training programs and employed by Queensland Health, can provide eligible services to patients who meet the specified criteria, with benefits payable for services listed in the agreed schedules. This Direction is effective from the day after its registration and will remain in force until the end of 31 December 2028, unless earlier revoked.

Scope and Application

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Queensland - Medical Services performed under the Single Employer Model Trial) Direction 2025 applies to eligible persons and patients who are not receiving the service as part of an episode of hospital treatment or as part of a service attracting a payment through the 2020-2025 Addendum to the National Health Reform Agreement for a service rendered to a public patient. The Direction applies to professional services provided under the Rural General Practice and Rural Generalist Single Employer Model Trial Memorandum of Understanding between the Department of Health and Aged Care and the State of Queensland, through Queensland Health. These services are to be provided at a general practice located in a rural or remote area, by a participating rural generalist or rural general practice trainee who is employed by Queensland Health and is formally enrolled in a fellowship training program meeting the standards of either the Australian College of Rural and Remote Medicine or the Royal Australian College of General Practitioners. The Direction has a national jurisdictional reach, applying across Australia but specifically targeting services in eligible areas as outlined in Schedule B of the Direction. The Direction repeals the previous Direction from 2024 and is effective from the day after its registration, expiring on 31 December 2028 unless earlier revoked. It extends to the specified items listed in Schedule A, which encompass various medical services, including general medical services, diagnostic imaging services, and pathology services. The Direction does not specify any exclusions, exemptions, or thresholds beyond those outlined within the parameters of the professional services and locations specified.

Key Provisions

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Queensland - Medical Services performed under the Single Employer Model Trial) Direction 2025 (the Direction) establishes the terms under which Medicare Benefits are payable for professional services provided under the Rural General Practice and Rural Generalist Single Employer Model Trial in Queensland. The Direction specifies the services for which Medicare Benefits are payable (Section 2), the conditions under which these services must be provided (Section 2(a)), and the locations where these services must be rendered (Section 2(b)). The Direction also details the types of professionals who can provide these services (Section 2(c)) and the duration of the trial period (Section 5). Under the Direction, the Department of Health and Aged Care and Queensland Health are required to ensure that eligible services are provided in accordance with the terms of the Rural General Practice and Rural Generalist Single Employer Model Trial Memorandum of Understanding. This includes ensuring that services are provided by participating rural generalists or rural general practice trainees who are enrolled in recognised fellowship training programs and employed by Queensland Health. Medical practitioners and health services must also ensure they meet the Medicare Benefits Schedule (MBS) requirements for all items listed in Schedule A. Failure to comply with the provisions of this Direction may result in the non-payment of Medicare Benefits for the services provided, as well as potential legal consequences under the Health Insurance Act 1973 and the National Health Act 1953. While the Direction itself does not specify particular penalties for non-compliance, breaches of the Health Insurance Act 1973 and the National Health Act 1953 can result in significant civil and criminal penalties. For example, under the Health Insurance Act 1973, an individual or entity can be fined up to $22,200 for making a false or misleading statement in relation to a claim for a benefit, and up to $555,000 for each day of the period of non-compliance if they fail to comply with a direction made under the Act. Similarly, under the National Health Act 1953, an individual or entity can be fined up to $27,500 for contravening a provision of the Act. It is important for all parties involved in the Rural General Practice and Rural Generalist Single Employer Model Trial to familiarise themselves with the requirements of the Direction and ensure that they are compliant with the terms and conditions set out therein. Failure to do so may result in the non-payment of Medicare Benefits, as well as potential legal and financial consequences.

Area of Law: Health Law
Instrument: Direction
Concepts: Definitions & Interpretation; Reporting & Disclosure Obligations; 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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