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

Overview

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Riverland Mallee Coorong Local Health Network - Medical Services performed under the Single Employer Model Trial) Direction 2025, issued under the authority of the Health Insurance Act 1973, aims to facilitate the payment of Medicare benefits for specific medical services rendered within the Riverland Mallee Coorong Local Health Network as part of a trial for the Rural General Practice and Rural Generalists Single Employer Model. This initiative addresses the need to enhance healthcare delivery in rural and remote areas by ensuring that Medicare benefits are payable for services provided under a trial model, subject to certain conditions and limitations. The policy objective is to support the trial model by providing financial incentives for participating rural generalists and rural general practice trainees, thus improving access to primary and acute care services in eligible areas. This direction, effective from 12 January 2026, will remain in force until the end of 31 December 2028 unless earlier repealed. The Direction specifies that Medicare benefits will be payable for professional services agreed upon under a Memorandum of Understanding between the Department of Health, Disability and Ageing, the Riverland Mallee Coorong Local Health Network, and the South Australian Department for Health and Wellbeing. These services must be provided by participating rural generalists or rural general practice trainees who are enrolled in a fellowship training program that meets the standards set by either the Australian College of Rural and Remote Medicine Independent Pathway or the Royal Australian College of General Practitioners. The services must also be rendered in approved rural or remote practice locations within the Riverland Mallee Coorong Local Health Network region and to eligible patients who are not receiving the service as part of an episode of hospital treatment or as a public patient service. This legislative measure is designed to ensure that the trial model operates effectively, supporting healthcare professionals and improving patient outcomes in rural and remote regions.

Scope and Application

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Riverland Mallee Coorong Local Health Network - Medical Services performed under the Single Employer Model Trial) Direction 2025 applies to professional services agreed to be provided under the Rural General Practice and Rural Generalists Single Employer Model Trial Memorandum of Understanding between the Department of Health, Disability and Ageing, the Riverland Mallee Coorong Local Health Network, and the South Australian Department for Health and Wellbeing. It specifies that Medicare Benefits will be payable for professional services provided in accordance with the terms of the trial. These services must be rendered to eligible persons by participating rural generalists or rural general practice trainees who meet specific training standards and are employed by the Riverland Mallee Coorong Local Health Network. The services must also be provided at general practices located in approved rural or remote areas, and must not be part of an episode of hospital treatment or services attracting payment through another schedule. This Direction has a national reach, as it is issued under the Health Insurance Act 1973, and applies to services rendered within the specified timeframe of 12 January 2026 to 31 December 2028. Subordinate instruments such as the Schedules A and B provide further details on the specific items and locations eligible under this Direction.

Key Provisions

This Direction (F2025N01032) establishes a trial to provide Medicare benefits for professional services under the Rural General Practice and Rural Generalist Single Employer Model. Specifically, the Direction repeals the previous Direction from 2022 and introduces new provisions effective from 12 January 2026 to 31 December 2028. Medicare benefits will be payable for professional services that are part of the trial, provided they meet certain conditions. These services must be agreed upon under a Memorandum of Understanding between the Department of Health, Disability and Ageing, the Riverland Mallee Coorong Local Health Network, and the South Australian Department for Health and Wellbeing. The Act imposes specific requirements on the parties involved in the trial. For instance, the professional services must be provided by participating rural generalists or rural general practice trainees who are enrolled in a recognised fellowship training program, employed by the Riverland Mallee Coorong Local Health Network, and registered in the Riverland Academy of Clinical Excellence rural generalist training program. Furthermore, the services must be provided to eligible persons, and these persons cannot be receiving the service as part of a hospital treatment episode or as a public patient service attracting payment through Schedule K of the 2020-2025 Addendum to the National Health Reform Agreement. Additionally, the Direction specifies that the services must be rendered at a general practice in a rural or remote location within an eligible area, as defined in the Dictionary of the general medical services table. The services must also be in accordance with the items listed in Schedule A and the relevant tables under the Health Insurance Act 1973 and the National Health Act 1953. Any breach of these provisions could lead to non-payment of Medicare benefits for the services provided. There are no explicit criminal or civil penalties mentioned in this Direction for failing to comply with its provisions. However, non-compliance could result in the non-payment of Medicare benefits for the services provided, which could have financial repercussions for the service providers. Given the nature of the Direction, adherence to the outlined requirements is crucial to ensure the proper administration of Medicare benefits within the trial.