Human Services (Medicare) (Medicare Programs) Amendment (General Practice in Aged Care Incentive and Bulk Billing Practice Incentive Program) Specification 2026

EXPLANATORY STATEMENT

Issued by the authority of the Minister for Government Services

Human Services (Medicare) Act 1973

Human Services (Medicare) (Medicare Programs) Amendment (General Practice in Aged Care Incentive and Bulk Billing Practice Incentive Program) Specification 2026

Purpose

The Human Services (Medicare) (Medicare Programs) Amendment (General Practice in Aged Care Incentive and Bulk Billing Practice Incentive Program) Specification 2026 (the Specification) is made for the purposes of paragraph 41G(b) of the Human Services (Medicare) Act 1973 (the Medicare Act) and amends the Human Services (Medicare) (Medicare Programs) Specification 2021 (the Principal Specification).

The Specification amends the Principal Specification to include the General Practice in Aged Care Incentive (GPACI) and Bulk Billing Practice Incentive Program (BBPIP) (the Programs) as a ‘medicare program’ for the purposes of paragraph 41G(b) of the Medicare Act.

Specifying GPACI and BBPIP as a ‘medicare program’ will enable Commonwealth officers to use and disclose certain information protected by Commonwealth secrecy laws for the purposes of administering the Programs.

Background

It is an offence under subsection 130(1) of the Health Insurance Act 1973 (Health Insurance Act) if a person (officer) who is, or has been an officer, uses or discloses information about the affairs of another person, and that information is obtained or generated by the officer in the performance of duties or functions, or in the exercise of powers under the Health Insurance Act, unless authorised or exempt under that Act or it is otherwise required or authorised under an Australian law. Under subsection 130(2) of the Health Insurance Act, an officer may use or disclose such information where it is for the purpose of enabling the officer or another person to perform duties or functions, or to exercise powers, in relation to a ‘medicare program’.

Section 41G of the Medicare Act defines ‘medicare programs’ as services, benefits, programs or facilities that are provided under certain health-related legislation referred to in paragraph 41G(a) or that are specified in a legislative instrument made by the Minister under paragraph 41G(b).

By defining ‘medicare programs’ to include programs specified in a legislative instrument, section 41G of the Medicare Act provides a mechanism for updating, from time to time, the list of medicare programs in relation to which information can be used and disclosed in accordance with section 130 of the Health Insurance Act.

Both GPACI and BBPIP are currently programs under the Financial Framework (Supplementary Powers) Regulations 1997 (Cth) (item 180 in Part 4 of Schedule 1AB) and are not 'medicare programs' for the purpose of paragraph 41G(b) of the Medicare Act. The Privacy Impact Assessment (PIA) on BBPIP recommended that BBPIP be specified as a medicare program to facilitate the use of protected information under the Health Insurance Act. This will enable Services Australia to verify certain patient information against their Medicare record, which is protected information acquired under the Health Insurance Act. It will also allow the information to be collected, used and disclosed to confirm the integrity or sustainability of the programs (s. 129B, 129C of that Act).

The Commonwealth currently relies on a Public Interest Certificate to enable it to collect, use and disclose protected information for the purposes of administering these programs and enabling the Department of Health, Disability and Ageing (DHDA) to undertake compliance activities in relation to both.

A register of PIAs undertaken or commissioned by Services Australia can be found on the Services Australia website at https://www.servicesaustralia.gov.au.

GPACI promotes continuous, quality care by improving access to quality, proactive general practice care for older people who live in aged care homes. Providers (general practitioners) and practices registered in MyMedicare will receive incentive payments for providing their MyMedicare registered patients who permanently live in residential aged care homes with regular visits, planned reviews and coordinated care planning.

The aim of BBPIP is to improve access to general practice care and reduce out-of-pocket-costs for all Medicare-eligible patients. BBPIP does this by providing an incentive payment program designed to encourage general practices to bulk bill all Medicare-eligible patients for all eligible services.  A bulk billed service is one where the medical practitioner accepts the relevant Medicare Benefits Scheme (MBS) rebate as full payment for the service, and the patient does not have any out-of-pocket expenses.

GPACI and BBPIP Programs

Services Australia is responsible for administering payments and payment systems, as well as the registration of participating practices, providers (and patients in the case of GPACI) as set out in respective program guidelines.

Specifying GPACI and BBPIP each as a ‘medicare program’ will be necessary for the administration of the Programs. The Specification will ensure the requisite data can be shared and accessed by authorised officers in Services Australia and DHDA to determine eligibility for GPACI and BBPIP, administer the Programs, and undertake compliance functions in relation to the Programs.

GPACI

GPACI is delivered under the MyMedicare program. To participate in GPACI, eligible healthcare practices must first register in Services Australia’s Organisation Register. After completing this registration and selecting the GPACI program, these practices are able to enrol patients who are both eligible and already registered with MyMedicare. During this process, each enrolled patient is assigned a provider who takes on the responsibility of coordinating and delivering the required services for that patient.

Practices and providers receive quarterly incentive payments for providing a minimum number of regular visits per quarter, and care planning services per year services to each of their registered patients in a residential aged care home.

Services Australia assesses eligibility quarterly via system calculation and manual quality assurance, and makes payment to eligible practices and providers in arrears. Practices and providers are able to use Services Australia’s Health Professional Online Services system to monitor their GPACI eligibility, payments (including patient-level detail), and perform a forecast of eligibility for the next payment based on data relating to the current quarter, which shows them which patients have received the required eligible MBS services.

BBPIP

BBPIP is delivered under the MyMedicare program. Healthcare practices can register to participate in BBPIP in Services Australia’s Organisation Register. Providers are included in BBPIP if they are linked to a registered practice in the Organisation Register and eligible to participate based on provider specialty codes.

Practices and providers receive quarterly incentive payments of 12.5% of MBS benefits for eligible items (split between practice and provider) if they bulk bill every eligible MBS service for all their Medicare-eligible patients. Eligible MBS services include the most common General Practitioner (GP) services such as time-tiered consultation items, health assessments, mental health treatment items, and chronic condition management items. The BBPIP incentive payment is in addition to MBS benefits paid.

Eligibility for incentive payments will be assessed quarterly by Services Australia, and payment made to practices and providers on a quarterly basis. Checks are undertaken by Services Australia staff prior to payments being approved. Practices and providers are able to see details in Services Australia’s Health Professional Online Services system regarding their BBPIP eligibility and payments, including details of claims made on behalf of serviced patients. Practices and providers can also access a forecast of their eligibility for the current quarter which shows them MBS bulk billing information and whether they have met the required percentage threshold.

Information sharing

Privacy Notice

Patients must be registered for MyMedicare before participating in GPACI. The MyMedicare Privacy notice outlines the information that will be collected, used and disclosed by Services Australia for the purposes of MyMedicare, including disclosure of information to DHDA.

There is no requirement for patients to be registered for MyMedicare for the purposes of BBPIP. By not tying eligibility for this incentive payment to MyMedicare registration ensures that all patients receiving services from registered practices benefit from increased bulk billing.

Incentive registration

When a practice is registered for GPACI or BBPIP, information relating to that practice (organisation site) which has been recorded in the Organisation Register for the purposes of MyMedicare is recorded in Services Australia’s Organisation Payment Capability system. This information includes:

• Organisation Site ID
• Organisation Site name & address
• Organisation site email address
• MyMedicare registration start & end dates
• Incentive registration start & end dates
• Modified Monash Model value (rurality indicator)
• Practice-nominated MyMedicare Bank account details
• Details of linked providers

When a provider is included in GPACI or BBPIP, information relating to that provider which has been recorded in the Organisation Register for the purposes of MyMedicare is recorded in the Organisation Payment Capability system. This information includes:

• Medicare provider number (MPN)
• Provider name & address
• Provider email address
• Provider-nominated MyMedicare bank account details
• Details of linked practice
• Details of linked GPACI patients (where applicable)

When a patient is registered for GPACI by a practice, information about that patient which has been recorded in MyMedicare is recorded in the Organisation Payment Capability system. This information is also captured for patients who receive services for BBPIP. This information includes:

• Patient Medicare card number
• Patient individual reference number
• Patient Medicare PIN
• DVA file number (if applicable)
• Patient name
• Patient date of birth
• Patient MyMedicare registration start & end dates
• Patient GPACI start & end dates
• Details of linked provider/s

Eligibility and payment assessment

When an eligibility and payment assessment is performed by Services Australia’s Organisation Payment Capability system, additional information is retrieved from other Services Australia Medicare systems and recorded. This includes when a forecast assessment is requested for a practice or provider.

Eligibility for BBPIP and GPACI payments is based on the assessment of eligible MBS items delivered within the payment quarter. Therefore, patient Medicare claim information is required to enable these assessments to be performed and payments to be made. The information used includes:

• MBS or DVA item number
• date of service
• date of lodgement
• date processed
• Provider ID
• Bulk billed indicator
• Schedule fee
• Adjustment reason code

Services Australia staff

Checks will be performed by Services Australia staff prior to payments being approved and released to ensure eligibility for payments under GPACI and BBPIP has been assessed correctly and payments are accurate.

Services Australia staff require access to the information above to enable the following activities:

• Undertake payment quality assurance checking
• Manage and respond to enquiries from practices and providers
• Undertake program administration and reporting activities

Practice administration staff

Practice administration staff will be provided with information regarding practice registration, eligibility and payments. This information is made available based on whether the person has relevant access attributes in Services Australia’s Provider Digital Access (PRODA) system, relating to roles required for the administration of the practice or owning entity. Detailed information is provided to enable practice staff to reconcile their payments and the services which have contributed to eligibility outcomes.

Information made available to practice staff includes the specified information above, limited to information relating to the services provided by the relevant registered practice and linked providers.

Practice staff are able to view information regarding payments made to the practice only (including practice bank account details).

Providers

Providers will be provided with information regarding the provider’s eligibility and payments. This is also made available to any agents the provider may have nominated in PRODA. Detailed information is provided to enable the provider to reconcile their payments and the services which have contributed to eligibility outcomes.

Information made available to a provider includes the specified information above, limited to information relating to services provided by the individual provider.

Providers are able to view information regarding payments made to that provider only (including the provider’s bank account details).

The provision of this information to practices and providers is necessary to ensure that they are able to access and administer the incentives without imposing excessive administrative burden.

Department of Health, Disability and Ageing

The above information will also need to be disclosed by Services Australia to DHDA. DHDA requires this data for the purposes of:

• program assurance including post-payment compliance activities
• statistical and evaluation purposes
• program administration and reporting
• to inform policy development

Information shared with DHDA will not include individual patient Medicare card numbers or DVA file numbers.

Specifying these programs as a ‘medicare program’ will enable officers to use and disclose information protected by subsection 130(1) of the Health Insurance Act for the purposes of undertaking these eligibility assessments, payment checks, compliance functions and other administrative activities to ensure the integrity of the Program.

Additional detail about what safeguards apply to protect this information

The Privacy Act 1988 (the Privacy Act) applies to all ‘personal information’ collected for the purposes of the Programs regardless of whether it is also covered by one or more secrecy provisions.

DHDA and Services Australia are Commonwealth agencies that must adhere to the Australia Privacy Principles contained in Schedule 1 of the Privacy Act.

Medicare enrolment and claiming information acquired by an officer in the performance of his or her duties, or in the exercise of his or her powers or functions under the Health Insurance Act will remain subject to secrecy provisions to prevent unauthorised handling of that information.

Commencement

The Specification commences the day after registration on the Federal Register of Legislation.

Consultation

The Specification ensures that the use or disclosure of Medicare information for the purposes of the Programs does not contravene section 130 of the Health Insurance Act. As this Specification is of a mechanical nature, no public consultation on the Specification was considered necessary.

DHDA and Services Australia were consulted on this amendment to the Principal Specification.

General

The Specification is a disallowable legislative instrument for the purposes of the Legislation Act 2003.

Details of this instrument are set out in the Attachment A.

The instrument is compatible with the human rights and freedoms recognised or declared under section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011. A full statement of compatibility is set out in Attachment B.

ATTACHMENT A

Human Services (Medicare) (Medicare Programs) Amendment (General Practice in Aged Care Incentive and Bulk Billing Practice Incentive Program) Specification 2026

Section 1 – Name

This section provides that the name of this instrument is the Human Services (Medicare) (Medicare Programs) Amendment (General Practice in Aged Care Incentive and Bulk Billing Practice Incentive Program) Specification 2026 (the Specification).

Section 2 – Commencement

This section provides that the Specification commences the day after it is registered on the Federal Register of Legislation.

Section 3 – Authority

This section provides that the legislative authority for making the Specification is paragraph 41G(b) of the Human Services (Medicare) Act 1973 (the Medicare Act). At the end of section 3, there is a note that the power to amend a legislative instrument can be found in subsection 33(3) of the Acts Interpretation Act 1901. This subsection 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.

This gives the Minister power to amend the Human Services (Medicare) (Medicare Programs) Specification 2021 (Principal Specification) for the purposes of paragraph 41G(b) of the Medicare Act.

Section 4 – Schedules

This section provides that each instrument that is specified in a Schedule to the Specification is amended or repealed as set out in the applicable items in the Schedule concerned, and that any other item in a Schedule to the Specification has effect according to its items.

SCHEDULE 1 – AMENDMENTS

Schedule 1 amends the Principal Specification.

Item 1 inserts new table items 34 and 35 at the end of the table in Schedule 1 of the Principal Specification. New table item 34 will specify General Practice in Aged Care Incentive (GPACI) as a ‘medicare program’ for the purposes of paragraph 41G(b) of the Medicare Act, while item 35 will do the same for the Bulk Billing Practice Incentive Program (BBPIP).

The implications of this are explained in detail in the purpose and background sections above.

ATTACHMENT B

Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

Human Services (Medicare) (Medicare Programs) Amendment (General Practice in Aged Care Incentive and Bulk Billing Practice Incentive Program) Specification 2026

The legislative 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 legislative instrument

The Human Services (Medicare) (Medicare Programs) Amendment (General Practice in Aged Care Incentive and Bulk Billing Practice Incentive Program) Specification 2026 (the Specification) amends the Human Services (Medicare) (Medicare Programs) Specification 2021 (the Principal Specification). The Principal Specification specifies programs that are a ‘medicare program’ for the purposes of paragraph 41G(b) of the Human Services (Medicare) Act 1973 (the Medicare Act).

A number of Commonwealth laws allow information that has been obtained in administering one program to be used or disclosed for the administration of another program in circumstances where the other program is a ‘medicare program.’ For example, the Health Insurance Act 1973 authorise persons to use and disclose information obtained under those Acts for the purposes of enabling a person to perform functions in relation to ‘medicare programs’ or other specified Acts. These laws rely on the term ‘medicare programs’ in section 41G of the Medicare Act to identify those programs for which information may be used and disclosed.

Section 41G of the Medicare Act defines ‘medicare programs’ to be services, benefits, programs or facilities that are provided under certain health-related legislation referred to in paragraph 41G(a) or those that are specified in a legislative instrument made under paragraph 41G(b).

By expanding the term ‘medicare program’ to include programs specified in a legislative instrument, section 41G of the Medicare Act provides a mechanism to update and add to the range of programs that operate as ‘medicare programs’ (and in relation to which information can be used or disclosed).

The Specification amends the Principal Specification to include both General Practice in Aged Care Incentive (GPACI) and Bulk Billing Practice Incentive (BBPIP) (the Programs) as a ‘medicare program’ for the purposes of section 41G(b) of the Medicare Act.

Human rights implications

The Specification engages the following human rights:

• the right to health – Article 12(1) of the International Covenant on Economic Social and Cultural Rights (ICESCR)
• the right to privacy – Article 17 of the International Covenant on Civil and Political Rights (ICCPR).

Right to health

Article 12 of the ICESCR provides that the States Parties recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

The Specification specifies both of the Programs as a ‘medicare program’ under paragraph 41G(b) of the Medicare Act.

GPACI assists eligible patients who are older and live in aged care homes by promoting continuous, quality care by improving access to quality, proactive general practice care. This will be done by facilitating with regular visits, planned reviews and coordinated care planning.

BBPIP assists all Medicare eligible patients by improving access to general practice care and reducing out-of-pocket-costs. The BBPIP incentive payment will encourage general practices to bulk bill all Medicare-eligible patients for all eligible services.  A bulk billed service is one where the medical practitioner accepts the relevant MBS rebate as full payment for the service, and the patient does not have any out-of-pocket expenses.

The Specification therefore advances the right to health established by Article 12 of the ICESCR.

Right to Privacy

Article 17 to the ICCPR provides that no-one shall be subject to arbitrary or unlawful interference with their privacy.

Specifying both of the Programs as a ‘medicare program’ will authorise a person to use and disclose information obtained under certain Commonwealth laws for the purposes of administering the Programs. In practice, the change will primarily support the use of Medicare-related information held by Services Australia for the Program purposes.

For the purposes of Article 17 of the ICCPR, the collection, use or disclosure of any personal information would not be unlawful as it would be authorised under legislation.

Further, the collection use or disclosure of personal information for this purpose would not constitute an arbitrary interference with the right to privacy as it would be undertaken for legitimate and necessary objectives of administering the Program, including to do so consistently with the MBS and other health programs.

The limitation on the right to privacy is proportionate, as the provision of any personal information about patients would only be undertaken for the purposes of administering the Program. Information would be subject to secrecy provisions to prevent unauthorised disclosures as well as protections under the Privacy Act 1988.

Conclusion

The Specification is compatible with human rights because it advances the protection of right to health. To the extent that it limits the right to privacy to that end, those limitations are reasonable, necessary and proportionate.

Senator the Hon Katy Gallagher, Minister for Government Services