Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Services Rendered under the Commonwealth Urgent Care Clinic Program) Direction 2024

AUSTRALIAN GOVERNMENT

DEPARTMENT OF HEALTH AND AGED CARE

HEALTH INSURANCE ACT 1973

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Services Rendered under the Commonwealth Urgent Care Clinic Program) Direction 2024

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:

(1)               REVOKE the Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Services Rendered under the Commonwealth Urgent Care Clinic Program) Direction (No. 7) 2023 made under subsection 19(2) of the Act that was signed on 25 November 2023; and

(2)               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 Commonwealth Medicare Urgent Care Clinic Program between the Department of Health and Aged Care (ABN: 83 605 426 759) and the practices listed in Schedule D and E of this direction in relation to medical services available to patients who attend a Commonwealth Urgent Care Clinic Location for which:

(i)       items specified in Schedules A, B and C of this Direction; and of the general medical services table (means the table prescribed under subsection 4(1) of the Act) and pathology service table (means the table prescribed under section 4A of the Act) relates; and

(b)     Where the professional service is provided to:

(i)       an eligible person (as defined in section 3 of the Act);

(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);

(iii)  a patient who also is not receiving a service:

(A)   which attracts a payment through the 2020-2025 Addendum to the National Health Reform Agreement for a service rendered to a public patient; or

(B)    which attracts a payment through another government arrangement outside of the Commonwealth Medicare Urgent Care Clinic Program for a service rendered to the patient; and

(c)     The professional services referred to in paragraph (2)(a) must be provided:

(i)       if the service is specified in Schedule A:

(A)   at a practice location specified in Schedule D or E of this Direction; and

(B)    by a general practitioner, prescribed medical practitioner or participating nurse practitioner who is registered to provide services with Services Australia under the Commonwealth Urgent Care Clinic program mentioned in paragraph (2)(a).

(ii)     if the service is specified in Schedule B:

(A)   at a practice location specified in Schedule D of this Direction; and

(B)    by a prescribed medical practitioner who is registered to provide services with Services Australia under the Commonwealth Urgent Care Clinic program mentioned in paragraph (2)(a).

(iii)  if the service is specified in Schedule C:

(A)   at a practice location specified in Schedule E of this Direction; and

(B)    by a prescribed medical practitioner who is registered to provide services with Services Australia under the Commonwealth Urgent Care Clinic program mentioned in paragraph (2)(a).

DECLARE that this Direction commences on 29 June 2024 and ceases to have effect at the end of 30 June 2026 unless earlier revoked.

Date this 17 day of June 2024

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 ITEMS AS AGREED under the Urgent care clinic program

For services listed in the below tables, all provisions of 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

*Note: Claims under any item in Group A7 in the General Medical Services Table may only be exempt from subsection 19(2) of the Act when the services are claimed by a Prescribed Medical Practitioner operating under the Medicare Urgent Care Clinic Program.

Pathology Services Table

SCHEDULE B

MEDICARE BENEFITS SCHEDULE ITEMS where a clinic is located in MMM 1 locations

For services listed in the below tables, all provisions of 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

*Note: Claims under any item in Group A2 and A23 in the General Medical Services Table may only be exempt from subsection 19(2) of the Act when the services are claimed by a Prescribed Medical Practitioner operating under the Medicare Urgent Care Clinic Program.

SCHEDULE C

MEDICARE BENEFITS SCHEDULE ITEMS WHERE A CLINIC IS LOCATED IN MMM 2-7 LOCATIONS

For services listed in the below tables, all provisions of 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

*Note: Claims under any item in Group A7 in the General Medical Services Table may only be exempt from subsection 19(2) of the Act when the services are claimed by a Prescribed Medical Practitioner operating under the Medicare Urgent Care Clinic Program.

SCHEDULE D

APPROVED COMMONWEALTH URGENT CARE CLINIC MMM 1 LOCATIONS AS AGREED UNDER THE COMMONWEALTH URGENT CARE CLINIC PROGRAM

Approved primary care locations:

NEW SOUTH WALES

QUEENSLAND

SOUTH AUSTRALIA

WESTERN AUSTRALIA

SCHEDULE E

APPROVED COMMONWEALTH URGENT CARE CLINIC MMM 2-7 LOCATIONS AS AGREED UNDER THE COMMONWEALTH URGENT CARE CLINIC PROGRAM

Approved primary care locations:

NEW SOUTH WALES

QUEENSLAND

SOUTH AUSTRALIA

WESTERN AUSTRALIA