EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Amendment (Eligible Disability) Determination 2025
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by legislative instrument, determine that a health service not specified in an item in the general medical services table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were specified in the Table.
The Table is set out in the regulations made under subsection 4(1) of the Act. The most recent version of the regulations is the Health Insurance (General Medical Services Table) Regulations 2021 (the GMST Regulations).
This instrument relies on subsection 33(3) of the Acts Interpretation Act 1901 (AIA). Subsection 33(3) of the AIA provides that where an Act confers a power to make, grant or issue any instrument of a legislative or administrative character (including rules, regulations or by-laws), the power shall be construed as including a power exercisable in the like manner and subject to the like conditions (if any) to repeal, rescind, revoke, amend, or vary any such instrument.
Purpose
The purpose of the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Amendment (Eligible Disability) Determination 2025 (Amendment Determination) is to amend the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024 (Principal Determination) to amend the definition of ‘eligible disability’ from 1 March 2026.
The definition of ‘eligible disability’ will be aligned with the meaning given by the GMST Regulations which, from 1 March 2026, will expand the definition to include stuttering, speech sound disorders, and cleft lip and/or cleft palate. This will enable people with these disabilities to access eight Medicare Benefits Schedule (MBS) assessment services and 20 MBS treatment allied health services in their lifetime, particularly from speech pathologists.
This change is in response to recommendation 10 of the Medicare Benefits Schedule (MBS) Review Taskforce - Report on Primary Care (the Report), released June 2020. Policy authority was obtained through the 2025-26 Budget Strengthening Medicare measure.
Consultation
Consultation was undertaken on the Report with the Allied Health Reference Group who supported the Report, including:
- Audiology Australia
- Australian College of Physiotherapy
- Australian Primary Health Care Nurse Association
- Breast Cancer Network Australia
- Cancer Australia
- Chiropractors Association of Australia
- Dietitians Association of Australia
- Osteopathy Australia
- Royal Australian College of General Practitioners
Consultation on recommendation 10 of the Report was undertaken with the following stakeholders who supported the recommendation:
- Allied Health Professions’ Office of Queensland (AHPOQ)
- Audiology Australia
- Australian Medical Association
- Australian Physiotherapy Association
- Australian Psychological Society
- Central and Eastern Sydney PHN Clinical Council
- Dietitians Association of Australia
- Services for Australian Rural and Remote Allied Health
- Speech Pathology Australia
- Indigenous Allied Health Australia
- Speech Pathology Australia
- CleftPALS NSW
- CleftPALS VIC
The Amendment Determination is a legislative instrument for the purposes of the Legislation Act 2003.
The Amendment Determination commences on 1 March 2026.
Details of the Amendment Determination are set out in the Attachment.
Authority: Subsection 3C(1) of the
Health Insurance Act 1973
ATTACHMENT
Details of the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Amendment (Eligible Disability) Determination 2025
Section 1 – Name
Section 1 provides for the instrument to be referred to as the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Amendment (Eligible Disability) Determination 2025 (the Amendment Determination).
Section 2 – Commencement
Section 2 provides for the Amendment Determination to commence on 1 March 2026.
Section 3 – Authority
Section 3 provides that the Amendment Determination is made under subsection 3C(1) of the Health Insurance Act 1973.
Section 4 – Schedules
Section 4 provides that each instrument that is specified in a Schedule to this Amendment Determination is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Amendment Determination has effect according to its terms.
Schedule 1 – Amendments
Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024
Item 1 repeals the definition of ‘eligible disability’ and substitutes it to have the meaning given by clause 2.6.1 of the GMST Regulations.
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Amendment (Eligible Disability) Determination 2025
This instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Determination
The purpose of the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Amendment (Eligible Disability) Determination 2025 (Amendment Determination) is to amend the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024 (Principal Determination) to amend the definition of ‘eligible disability’ from 1 March 2026.
The definition of ‘eligible disability’ will be aligned with the meaning given by the GMST Regulations which, from 1 March 2026, will expand the definition to include stuttering, speech sound disorders, and cleft lip and/or cleft palate. This will enable people with these disabilities to access eight Medicare Benefits Schedule (MBS) assessment services and 20 MBS treatment allied health services in their lifetime, particularly from speech pathologists.
This change is in response to recommendation 10 of the Medicare Benefits Schedule (MBS) Review Taskforce - Report on Primary Care (the Report), released June 2020. Policy authority was obtained through the 2025-26 Budget Strengthening Medicare measure.
Human rights implications
This instrument engages Articles 3, 9 and 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR), specifically the rights to health and social security, equality and non-discrimination.
The Right to Health
The right to the enjoyment of the highest attainable standard of physical and mental health is contained in Article 12(1) of the ICESCR. The UN Committee on Economic Social and Cultural Rights (the Committee) has stated that the right to health is not a right for each individual to be healthy, but is a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.
The Committee reports that the ‘highest attainable standard of health’ takes into account the country’s available resources. This right may be understood as a right of access to a variety of public health and health care facilities, goods, services, programs, and conditions necessary for the realisation of the highest attainable standard of health.
The Right to Social Security
The right to social security is contained in Article 9 of the ICESCR. It requires that a country must, within its maximum available resources, ensure access to a social security scheme that provides a minimum essential level of benefits to all individuals and families that will enable them to acquire at least essential health care. Countries are obliged to demonstrate that every effort has been made to use all resources that are at their disposal in an effort to satisfy, as a matter of priority, this minimum obligation.
The Committee reports that there is a strong presumption that retrogressive measures taken in relation to the right to social security are prohibited under ICESCR. In this context, a retrogressive measure would be one taken without adequate justification that had the effect of reducing existing levels of social security benefits, or of denying benefits to persons or groups previously entitled to them. However, it is legitimate for a Government to re-direct its limited resources in ways that it considers to be more effective at meeting the general health needs of all society, particularly the needs of the more disadvantaged members of society.
The right of equality and non-discrimination
The rights of equality and non-discrimination are contained in articles 2, 16 and 26 of the International Covenant on Civil and Political Rights (ICCPR). Article 26 of the ICCPR requires that all persons are equal before the law, are entitled without any discrimination to the equal protection of the law and in this respect, the law shall prohibit any discrimination and guarantee to all persons equal and effective protection against discrimination on any ground such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.
Analysis
This instrument will reflect contemporary clinical practice to ensure that patients with severe speech and language disorders have access to health and social security through relevant subsidised services on the MBS.
Conclusion
This instrument is compatible with human rights as it maintains the right to health, the right to social security, and the right of equality and non-discrimination.
Louise Riley
Assistant Secretary
MBS Policy and Reviews Branch
Medicare Benefits and Digital Health Division
Health Resourcing Group
Department of Health, Disability and Ageing