AUSTRALIAN GOVERNMENT
DEPARTMENT OF HEALTH AND AGED CARE
HEALTH INSURANCE ACT 1973
Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Riverland Mallee Coorong Local Health Network) Direction 2022
I, Travis Haslam, Acting First Assistant Secretary, Medical Benefits 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 Generalist Single Employer Model Trial between the Department of Health and Aged Care (ABN: 24 004 196 909), the Riverland Mallee Coorong Local Health Network (ABN: 44 685 908 941) and the South Australian Department for Health and Wellbeing (ABN: 97 643 356 590) in relation to the 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 3-7 (as defined in Section 7.1.1 of the general medical services table); or
- A location described in the Rural Generalist Single Employer Model Trial Memorandum of Understanding between the department, the Riverland Mallee Coorong Local Health Network and the South Australian Department for Health and Wellbeing; and
(iii) by a participating rural generalist trainee mentioned in (a):
- who is formally enrolled in:
- the Australian College of Rural and Remote Medicine Independent Pathway;
- The Royal Australian College of General Practitioners Practice Experience Program, or equivalent;
- The Australian General Practice Training Program;
- The Rural Generalist Training Scheme; or
- The Remote Vocational Training Scheme; and
- who is employed by the Riverland Mallee Coorong Local Health Network for the provision of primary and acute care services;
- is registered in the Riverland Academy of Clinical Excellence rural generalist training program within the Riverland Mallee Coorong Local Health Network region; and
(iv) by one of the twenty rural generalist participants who are eligible to use this Direction at any one time.
DECLARED that this Direction shall have effect from the date of signature until
30 June 2027 inclusive unless earlier revoked.
Date this 4th day of November 2022
Travis Haslam
Acting First Assistant Secretary
Medical Benefits Division
Health Resourcing Group
Department of Health and Aged Care
SCHEDULE A
MEDICARE BENEFITS SCHEDULE ITEMS AS AGREED under the Riverland Mallee Coorong Local Health Network 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 | ||
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 | ||
37 | Specialist, anaesthesia – Telehealth Services | ||
39 | GP Sexual and Reproductive Health Consultation – Telehealth Service | ||
40 | GP Sexual and Reproductive Health Consultation – Phone Service | ||
A41 | Additional focussed psychological strategies | 1 | GP additional focussed psychological strategies |
2 | Non specialist practitioner addition focussed psychological strategies | ||
A42 | Mental health planning for care recipients of an residential aged care facility | ||
A45 | Nicotine and Smoking Cessation Counselling | ||
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 | 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 Modified Monash 3-7 rural and remote Practice Locations AS AGREED under the Riverland Mallee Coorong Local Health Network rural Generalist SINGLE EMPLOYERModel TRIAL
Approved primary care Modified Monash Model (MMM) 3 locations:
MMM 3 location | Practice Name | Street Address |
Murray Bridge | Bridge Clinic | 8 Standen Street, Murray Bridge SA 5253 |
Approved primary care Modified Monash Model (MMM) 5 locations:
MMM 5 location | Practice Name | Street Address |
Renmark | Renmark Medical Clinic | 64 Thurk Street, Renmark SA 5341 |
Berri | Berri Medical Clinic | 29 McGilton Road, Berri SA 5343 |
Barmera | Barmera Medical Clinic | 24 Hawdon Street, Barmera SA 5345 |
Loxton | Loxton Health Centre | 11 Anzac Crs, Loxton SA 5333 |
Waikerie | Waikerie Medical Centre | 2 Strangman Road, Waikerie SA 5330 |
Mannum | Mannum Medical Centre | Box & Parker Street, Mannum SA 5238 |
Meningie | Coorong Medical Centre | 2 South Terrace, Meningie SA 5264 |