Human Services (Medicare) Regulations 2017

Human Services (Medicare) Regulations 2017

made under the

Human Services (Medicare) Act 1973

Compilation No. 5

Compilation date: 10 February 2026

Includes amendments: F2026L00091

About this compilation

This compilation

This is a compilation of the Human Services (Medicare) Regulations 2017 that shows the text of the law as amended and in force on 10 February 2026 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au).

Application, saving and transitional provisions

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Presentational changes

The Legislation Act 2003 provides for First Parliamentary Counsel to make presentational changes to a compilation. Presentational changes are applied to give a more consistent look and feel to legislation published on the Register, and enable the user to more easily navigate those documents.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. Any modifications affecting the law are accessible on the Register.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents

Part 1—Preliminary

1 Name

3 Authority

5 Definitions

6 Person affected by an emergency

Part 3—Other prescribed functions

22 Other prescribed functions

23 Delegated functions

24 Prescription shoppers

25 Provision of emergency services

26 Lifetime health cover

27 Inappropriate practices

28 Provision of pharmaceutical benefits

29 Hearing services

30 Military compensation

31 Claims for treatment provided under certain legislation

32 Registration of sonographers

33 Mental health care by medical practitioners

34 National Bowel Cancer Screening Register

34A Identification numbers—preliminary

35 Identification numbers—allocation rules

35A Identification numbers—compliant applications

35B Identification numbers—suspending allocations

35C Identification numbers—lifting suspensions

35D Identification numbers—revoking allocations

35E Identification numbers—notifying decisions

35F Identification numbers—Chief Executive Medicare’s reconsideration of decisions

35G Identification numbers—Administrative Review Tribunal review of decisions

Part 4—Miscellaneous

36 Prescribed period

Part 5—Transitional provisions

Division 1—Provisions relating to this instrument as made

37 Definitions

38 Things done by, or in relation to, the Chief Executive Medicare

39 Things started but not finished by the Chief Executive Medicare

Division 2—Provisions relating to the Aged Care Legislation Consequential Amendments Regulations 2025

40 Things started but not finished under Part 2 before the commencement of the Aged Care Legislation Consequential Amendments Regulations 2025

Division 3—Provisions relating to the Human Services (Medicare) Amendment (Allocation of Identification Numbers) Regulations 2026

41 Identification numbers

Endnotes

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Part 1—Preliminary

1  Name

  This instrument is the Human Services (Medicare) Regulations 2017.

3  Authority

  This instrument is made under the Human Services (Medicare) Act 1973.

5  Definitions

  In this instrument:

Act means the Human Services (Medicare) Act 1973.

allocation considerations: see subsection 34A(2).

approved supplier has the meaning given by subsection 84(1) of the National Health Act.

client means a person who received a hearing service for which a claim has been made.

compliant manual application: see subsection 35A(4).

compliant online application: see subsection 35A(3).

contracted service provider has the meaning given by section 4 of the Hearing Services Administration Act 1997.

default resumption day, in relation to an application to lift the suspension of an allocation of an identification number: see subsection 35C(4).

default start day, in relation to an application for an identification number to be allocated to a person for a place of practice: see subsection 35(4).

de‑identified has the meaning given by subsection 6(1) of the Privacy Act 1988.

disclosure function has the meaning given by subsection 24(5).

education and prevention functions has the meaning given by subsection 24(3).

emergency means an emergency or disaster that occurs in Australia, or that affects one or more Australian citizens or permanent residents, and includes:

 (a) an emergency or disaster that has been the subject of a declaration under section 80J or 80K of the Privacy Act 1988; and

 (b) any circumstance in relation to which the Australian Government has decided that a program of special assistance involving the provision of a service, benefit, program or facility is to be implemented.

Note: Examples of an emergency include the following:

(a) a natural disaster;

(b) a terrorist act.

evaluation and reporting functions has the meaning given by subsection 24(7).

healthcare providers includes any of the following:

 (a) medical practitioners;

 (b) prescribers;

 (c) pharmacists;

 (d) approved suppliers;

 (e) dentists;

 (f) State and Territory health departments;

 (g) State and Territory mental health authorities;

 (h) private and public pain management clinics;

 (i) private and public alcohol or drug detoxification centres;

 (j) private and public hospitals.

Health Department means the Department administered by the Minister administering the National Health Act.

Health Insurance Act means the Health Insurance Act 1973.

hearing services has the meaning given by section 4 of the Hearing Services Administration Act 1997.

HPOS system means the Health Professional Online Services system maintained by Services Australia.

identification and detection functions has the meaning given by subsection 24(4).

inappropriate practice has the meaning given by section 81 of the Health Insurance Act.

ineligible for benefits: see subsection 34A(3).

lifetime health cover has the same meaning as in the Private Health Insurance Act.

National Health Act means the National Health Act 1953.

nominated prescriber, in relation to a prescription shopper, means a prescriber nominated by the prescription shopper from time to time to be that person’s main prescriber.

PBS information means information collected for the administration of the Pharmaceutical Benefits Scheme established under Part VII of the National Health Act.

person affected by an emergency has a meaning affected by section 6.

personal information has the meaning given by subsection 6(1) of the Privacy Act 1988.

Pharmaceutical Benefits Regulations means the National Health (Pharmaceutical Benefits) Regulations 2017.

prescriber means a person who is authorised to prescribe a pharmaceutical benefit or who purports to be authorised to prescribe a pharmaceutical benefit.

prescription shopper means a person who, within any 3 month period, has had supplied to him or her:

 (a) pharmaceutical benefits prescribed by 6 or more different prescribers (other than a prescriber who is a specialist within the meaning of subsection 3(1) of the Health Insurance Act and who has prescribed pharmaceutical benefits to a person in that capacity); or

 (b) a total of 25 or more target pharmaceutical benefits; or

 (c) a total of 50 or more pharmaceutical benefits.

Prescription Shopping Program means the program administered by the Department and the Health Department to reduce prescription shopping.

Private Health Insurance Act means the Private Health Insurance Act 2007.

State or Territory body means:

 (a) a State or Territory Minister; or

 (b) a Department of State of a State or Territory; or

 (c) a body (whether incorporated or not) established for a public purpose under a law of a State or Territory.

target pharmaceutical benefits means pharmaceutical benefits in any of the following categories of the Anatomical Therapeutic Chemical classification system:

 (a) N02 (Analgesics);

 (b) N03 (Antiepileptics);

 (c) N04 (Anti‑Parkinson Drugs);

 (d) N05 (Psycholeptics);

 (e) N06 (Psychoanaleptics);

 (f) N07 (Other central nervous system drugs);

 (g) R03 (Drugs for obstructive airway diseases);

 (h) C10A (Serum lipid reducing agents);

 (i) A02B (Drugs for peptic ulcer and gastro‑oesophageal reflux diseases);

 (j) J01 (Antibacterials for systemic use);

 (k) M01 (Anti‑inflammatory and antirheumatic products);

 (l) A10A (Insulin and analogues);

 (m) C02 (Antihypertensives).

Note: The Anatomical Therapeutic Chemical classification system is published by the World Health Organisation’s Collaborating Centre for Drug Statistics Methodology.

voucher has the meaning given by section 4 of the Hearing Services Administration Act 1997.

6  Person affected by an emergency

  In this instrument, a reference to a person affected by an emergency includes any of the following:

 (a) a person who is directly or indirectly affected by the emergency;

 (b) an individual who has a family member who is directly or indirectly affected by the emergency;

 (c) an unincorporated organisation that is directly or indirectly affected by an emergency.

Part 3—Other prescribed functions

22  Other prescribed functions

  This Part prescribes functions of the Chief Executive Medicare for the purposes of paragraph 5(1)(e) of the Act.

23  Delegated functions

 (1) A prescribed function of the Chief Executive Medicare is to perform functions delegated to the Chief Executive Medicare under:

 (a) a law of the Commonwealth; or

 (b) a law of a State or Territory.

 (2) Paragraph (1)(b) applies only if the Chief Executive Medicare is permitted by sections 8AD and 8AE of the Act to perform the function.

24  Prescription shoppers

 (1) The following are prescribed functions of the Chief Executive Medicare:

 (a) to detect persons who are prescription shoppers;

 (b) to take appropriate preventative measures in relation to persons who are prescription shoppers;

 (c) the education and prevention functions;

 (d) the identification and detection functions;

 (e) the disclosure function;

 (f) the evaluation and reporting functions.

 (2) The Chief Executive Medicare may use PBS information (including personal information) for the performance of the functions mentioned in subsection (1).

 (3) The education and prevention functions are as follows:

 (a) to promote awareness of the Prescription Shopping Program to healthcare providers, prescription shoppers and the general public;

 (b) to promote measures to assist healthcare providers to manage prescription shoppers or people who may be at risk of becoming prescription shoppers;

 (c) to educate healthcare providers and prescription shoppers about the law and requirements relating to the Prescription Shopping Program;

 (d) to encourage prescription shoppers to have a nominated prescriber;

 (e) to encourage prescribers to become nominated prescribers;

 (f) to encourage communication between prescribers, approved suppliers and pharmacists;

 (g) to discourage inefficient and improper use of pharmaceutical benefits.

 (4) The identification and detection functions are as follows:

 (a) to identify the following:

 (i) prescription shoppers;

 (ii) prescribers who prescribe pharmaceutical benefits to prescription shoppers;

 (iii) approved suppliers supplying pharmaceutical benefits to prescription shoppers;

 (b) to establish and maintain databases containing information about prescription shoppers;

 (c) to detect and identify prescription shoppers who may be improperly using, stockpiling, swapping, diverting or illegally dealing with pharmaceutical benefits.

 (5) The disclosure function is to disclose PBS information about whether a person is or is not a prescription shopper, or about a person who is a prescription shopper, to the following:

 (a) the person;

 (b) a prescriber, in order to assist the prescriber to make decisions about prescribing to the person if the person visits the prescriber or is a patient of that prescriber;

 (c) an approved supplier who is proposing to supply, or has supplied, pharmaceutical benefits to the person, in order to assist the approved supplier (or a pharmacist employed by the approved supplier) to make decisions about supplying pharmaceutical benefits to that person.

 (6) The Chief Executive Medicare may perform the disclosure function for the following purposes:

 (a) administering and enforcing the Chief Executive Medicare’s functions under the following:

 (i) the National Health Act;

 (ii) this section;

 (b) protecting public revenue;

 (c) discouraging inefficient and improper use of pharmaceutical benefits.

 (7) The evaluation and reporting functions are to use PBS information and information collected by the Chief Executive Medicare under the National Health Act to:

 (a) evaluate the Prescription Shopping Program; and

 (b) report (using de‑identified PBS information) to the Health Department and other bodies on the administration and outcomes of the Program.

25  Provision of emergency services

 (1) The following are prescribed functions of the Chief Executive Medicare:

 (a) to provide a service, benefit, program or facility to a person affected by an emergency (an emergency service);

 (b) to participate in disaster policy and planning activities, including activities undertaken by disaster policy and planning committees.

 (2) Without limiting subsection (1), the Chief Executive Medicare may perform the functions mentioned in that subsection for, or under an arrangement with, a State or Territory body.

 (3) The function mentioned in paragraph (1)(a) in relation to an emergency includes the following:

 (a) establishing and maintaining a register of persons affected by the emergency;

 (b) receiving, processing, investigating, deciding and paying claims for assistance;

 (c) operating a telephone enquiry line;

 (d) operating an online enquiry service;

 (e) providing call centre assistance;

 (f) providing online assistance;

 (g) making arrangements for health assessments and other assistance in relation to health care;

 (h) referring a person to another organisation if the person requires assistance provided by that organisation;

 (i) working with, and providing information to, other government and non‑government bodies in relation to the provision of assistance;

 (j) providing information to a State or Territory body about a person affected by the emergency that will assist the State or Territory body to provide a payment, benefit or other assistance to the person;

 (k) undertaking action (including starting legal proceedings) to recover payments that should not have been made;

 (l) disclosing statistical information (including de‑identified information from the register mentioned in paragraph (a)) about assistance provided;

 (m) undertaking compliance, audit, review, investigation, enforcement and recovery services ancillary to the emergency service.

 (4) Use or disclosure of personal information under this regulation is authorised for the purposes of paragraph 6.2(b) of Australian Privacy Principle 6 set out in Schedule 1 to the Privacy Act 1988.

 (5) If the Chief Executive Medicare provides an emergency service to a person, or the person makes a request for an emergency service, the Chief Executive Medicare may:

 (a) collect information about the person or the person’s family, including personal information; and

 (b) maintain records about the emergency service or the request.

26  Lifetime health cover

 (1) A prescribed function of the Chief Executive Medicare is to assist the Health Department with communications to members of the public about lifetime health cover, including:

 (a) identifying persons who have become subject to, or will soon become subject to, the operation of lifetime health cover; and

 (b) providing persons identified under paragraph (a) with information about lifetime health cover received by the Chief Executive Medicare from the Health Department; and

 (c) providing information and reports on matters relating to lifetime health cover to the Health Department.

 (2) In performing the function under subsection (1), the Chief Executive Medicare may use personal information collected for the performance of the Chief Executive Medicare’s medicare functions.

27  Inappropriate practices

 (1) The following are prescribed functions of the Chief Executive Medicare:

 (a) to devise and implement measures to:

 (i) prevent practitioners and other persons from engaging in inappropriate practice; and

 (ii) detect cases where practitioners or other persons have engaged in inappropriate practice in relation to rendering or initiating services; and

 (iii) prevent or detect activities relating to claims for medicare benefits, or receipt of medicare benefits, that may constitute an offence under the Health Insurance Act, the Crimes Act 1914 or the Criminal Code;

 (b) if there are reasonable grounds to suspect that a person has engaged in inappropriate practice—to investigate the conduct of the person to decide whether to make a request under subsection 86(1) of the Health Insurance Act for the provision of services by the person to be reviewed;

 (c) to investigate cases where there are reasonable grounds to suspect that:

 (i) an act in relation to a claim for medicare benefits, or receipt of medicare benefits, may constitute an offence under the Health Insurance Act, the Crimes Act 1914 or the Criminal Code; or

 (ii) a person may have committed an offence against section 23DP, 106D or 106EA, or subsection 19D(2), 19D(7), 106E(1) or 106E(2), of the Health Insurance Act;

 (d) if an investigation under paragraph (c) discloses enough evidence for a prosecution—to refer the case and the evidence to the Australian Federal Police or the Director of Public Prosecutions;

 (e) to take action (including starting legal proceedings) to recover from a person an amount of medicare benefit that is recoverable by the Commonwealth, including under the Health Insurance Act.

 (2) In this section:

practitioner has the meaning given by section 81 of the Health Insurance Act.

service has the meaning given by section 81 of the Health Insurance Act.

28  Provision of pharmaceutical benefits

 (1) The following are prescribed functions of the Chief Executive Medicare:

 (a) to process claims for payment relating to the provision of pharmaceutical benefits under Part VII of the National Health Act, and to make payments of those claims;

 (b) to devise and implement measures to prevent or detect contraventions of Part VII of the National Health Act or the Pharmaceutical Benefits Regulations;

 (c) to investigate cases where there are reasonable grounds to suspect that an act in relation to the provision of a pharmaceutical benefit may constitute an offence under the National Health Act, the Pharmaceutical Benefits Regulations, the Crimes Act 1914 or the Criminal Code;

 (d) if an investigation under paragraph (c) discloses enough evidence for a prosecution—to refer the case and the evidence to the Australian Federal Police or the Director of Public Prosecutions;

 (e) to undertake action (including starting legal proceedings) to recover from a person an amount relating to a pharmaceutical benefit that is recoverable by the Commonwealth, including under the National Health Act or the Pharmaceutical Benefits Regulations.

 (2) The following functions of the Repatriation Commission under the Veterans’ Entitlements Act 1986 and the Australian Participants in British Nuclear Tests and British Commonwealth Occupation Force (Treatment) Act 2006 are prescribed functions of the Chief Executive Medicare:

 (a) processing claims for payment relating to the provision of pharmaceutical benefits under those Acts;

 (b) making payments of those claims.

 (3) The following functions of the Military Rehabilitation and Compensation Commission under the Military Rehabilitation and Compensation Act 2004 are prescribed functions of the Chief Executive Medicare:

 (a) processing claims for payment relating to the provision of pharmaceutical benefits under that Act;

 (b) making payments of those claims.

 (4) The following functions of the Military Rehabilitation and Compensation Commission under the Safety, Rehabilitation and Compensation (Defence‑related Claims) Act 1988 are prescribed functions of the Chief Executive Medicare:

 (a) processing claims for payment relating to the provision of pharmaceutical benefits under that Act;

 (b) making payments of those claims.

29  Hearing services

 (1) If a declaration under section 21 of the Hearing Services Administration Act 1997 is in force specifying that the Chief Executive Medicare is the claims acceptance body for the purposes of that section, then it is a prescribed function of the Chief Executive Medicare to act as the claims acceptance body for the purposes of that section.

 (2) If a declaration under section 21 of the Hearing Services Administration Act 1997 is in force specifying that the Chief Executive Medicare is the claims payment body for the purposes of that section, then it is a prescribed function of the Chief Executive Medicare to act as the claims payment body for the purposes of that section.

 (3) The Chief Executive Medicare’s functions prescribed by subsections (1) and (2) include:

 (a) on behalf of the Commonwealth, recovering a service provider debt under section 24 of the Hearing Services Administration Act 1997 if:

 (i) the debt is apparent from the records of the Chief Executive Medicare; or

 (ii) the Health Department notifies the Chief Executive Medicare of the debt; and

 (b) disclosing the following information to the Health Department about a claim accepted, paid or rejected by the Chief Executive Medicare:

 (i) client number;

 (ii) voucher number;

 (iii) date on which the claim was submitted;

 (iv) date on which the claim was accepted, paid or rejected;

 (v) date of the service to which the claim relates;

 (vi) provider number;

 (vii) practitioner number;

 (viii) site identification;

 (ix) item number;

 (x) hearing loss details for right and left ears;

 (xi) details of the device fitted to the client, whether fitted to the left or right ear, and fitting configuration;

 (xii) date on which the device was fitted;

 (xiii) details of top‑up devices;

 (xiv) contracted service provider’s certification details;

 (xv) client certification details;

 (xvi) cost to the client;

 (xvii) payment details;

 (xviii) if the claim is rejected—a code showing the reason the claim or an element of the claim was rejected;

 (xix) any other details about the processing of the claim.

30  Military compensation

  The following functions of the Military Rehabilitation and Compensation Commission are prescribed functions of the Chief Executive Medicare:

 (a) processing claims for compensation under Chapter 6 of the Military Rehabilitation and Compensation Act 2004 or section 16 of the Safety, Rehabilitation and Compensation (Defence‑related Claims) Act 1988;

 (b) making payments for those claims.

31  Claims for treatment provided under certain legislation

 (1) The following functions of the Repatriation Commission and the Military Rehabilitation and Compensation Commission are prescribed functions of the Chief Executive Medicare:

 (a) processing claims for payment in relation to:

 (i) the provision of medical treatment under Division 2 of Part IV of the Seamen’s War Pensions and Allowances Regulations, as in force on 30 June 1994; and

 (ii) the provision of treatment under the Acts specified in subsection (2);

 (b) making payments for those claims.

 (2) For the purposes of subparagraph (1)(a)(ii), the following Acts are specified:

 (a) the Australian Participants in British Nuclear Tests and British Commonwealth Occupation Force (Treatment) Act 2006;

 (b) the Military Rehabilitation and Compensation Act 2004;

 (c) the Safety, Rehabilitation and Compensation Act 1988;

 (ca) the Safety, Rehabilitation and Compensation (Defence‑related Claims) Act 1988;

 (d) the Veterans’ Entitlements Act 1986.

32  Registration of sonographers

  A prescribed function of the Chief Executive Medicare is to establish and maintain a register of sonographers.

33  Mental health care by medical practitioners

  A prescribed function of the Chief Executive Medicare is to establish and maintain a register of medical practitioners who may provide focused psychological strategies under the initiative known as the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) Initiative administered by the Health Department.

34  National Bowel Cancer Screening Register

 (1) The following are prescribed functions of the Chief Executive Medicare:

 (a) to establish, maintain and administer a register of:

 (i) bowel cancer screening test results; and

 (ii) the screening and detection history of people specified in subsection (2); and

 (iii) other relevant information in relation to such people;

 (b) to invite people to undergo bowel cancer screening at appropriate intervals;

 (c) to supply faecal occult blood test kits to people;

 (d) to provide personal information about a person’s bowel cancer screening and detection history to a medical practitioner to assist the medical practitioner in advising the person about options for the person’s clinical management;

 (e) to provide personal information about a person to the Department administered by the Minister administering the Health Insurance Act 1973 to assist in investigating complaints and other matters raised by, or concerning, the person;

 (f) to provide personal information to the Australian Institute of Health and Welfare to assist in:

 (i) assessing the accuracy of screening tests; and

 (ii) monitoring and evaluating the effectiveness of the National Bowel Cancer Screening Register;

 (g) to provide personal information to State and Territory Departments and authorities with responsibility for health matters, to assist in arranging follow‑up of people who have had positive screening test results;

 (h) to provide de‑identified information to:

 (i) the Department administered by the Minister administering the Health Insurance Act 1973; and

 (ii) the Australian Institute of Health and Welfare;

  to assist in monitoring and evaluating the effectiveness of the National Bowel Cancer Screening Register;

 (i) to make payments on behalf of the Commonwealth to medical practitioners, or other persons authorised by medical practitioners to receive the payments, for the transfer of information.

 (2) For the purposes of subparagraph (1)(a)(ii), the following are specified:

 (a) people undergoing bowel cancer screening;

 (b) people whom the Chief Executive Medicare invites to undergo bowel cancer screening;

 (c) people whom the Chief Executive Medicare:

 (i) considers inviting to undergo bowel cancer screening; but

 (ii) decides not to invite to undergo the screening.

 (3) The following information may be used for the purposes of performing the functions mentioned in subsection (1):

 (a) information acquired by a person in the performance of the person’s duties, or in the exercise of the person’s powers or functions, under the Health Insurance Act 1973;

 (b) information acquired by a person in the performance of the person’s duties, or in the exercise of the person’s powers or functions, under the Veterans’ Entitlements Act 1986.

 (4) The program constituted by the functions mentioned in subsection (1) is to be known as the National Bowel Cancer Screening Register.

34A  Identification numbers—preliminary

 (1) Sections 35 to 35F set out prescribed functions of the Chief Executive Medicare in relation to the allocation of identification numbers to persons for places of practice for the purposes of either or both of the following:

 (a) the Health Insurance Act;

 (b) the Dental Benefits Act 2008.

Note: This section, and sections 35 to 35G, will be repealed when Schedule 1 to the Health Legislation Amendment (Miscellaneous Measures No. 1) Act 2025 commences (see Schedule 2 to the Human Services (Medicare) Amendment (Allocation of Identification Numbers) Regulations 2026).

Allocation considerations

 (2) For the purposes of sections 35 to 35F, the allocation considerations, in relation to the allocation of an identification number to a person for a place of practice or the lifting of the suspension of the allocation of an identification number to a person for a place of practice, are:

 (a) the purposes of, the operation of, and the efficient administration of, either or both of the following (as applicable):

 (i) the Health Insurance Act;

 (ii) the Dental Benefits Act 2008; and

 (b) the purposes for which identification numbers may be used.

When a person is ineligible for benefits at a place of practice on a day

 (3) For the purposes of sections 35 to 35F, a person is ineligible for benefits at a place of practice on a day if, on that day, there is no professional service or dental service that could be rendered by or on behalf of the person at the place of practice in respect of which a medicare benefit or dental benefit would be payable under the Health Insurance Act or the Dental Benefits Act 2008, assuming that, on that day:

 (a) an identification number had been allocated to the person for the place of practice; and

 (b) the allocation was in effect.

35  Identification numbers—allocation rules

Who is covered by this section?

 (1) A person is covered by this section if:

 (a) the person is any of the following (within the meaning of the Health Insurance Act):

 (i) a practitioner;

 (ii) an approved pathology practitioner;

 (iii) a participating midwife;

 (iv) a participating nurse practitioner;

 (v) an optometrist; or

 (b) the person provides, or intends to provide, a health service determined under subsection 3C(1) of the Health Insurance Act.

Allocation—mandatory rule

 (2) Subject to subsections (6) to (8), if:

 (a) a person is covered by this section; and

 (b) the person applies to the Chief Executive Medicare for an identification number to be allocated to the person for a place of practice; and

 (c) if the application is made using the HPOS system:

 (i) the application is a compliant online application; and

 (ii) the application does not require additional verification (see subsection (3)); and

 (d) if the application is not made using the HPOS system:

 (i) the application is a compliant manual application; and

 (ii) if the Chief Executive Medicare has requested, in writing, that the person give the Chief Executive Medicare specified additional information or documents in connection with the application—the person has complied with the request;

then the Chief Executive Medicare must allocate an identification number to the person for the place of practice, with effect from the default start day in relation to the person’s application (see subsection (4)).

Note: For HPOS system, see section 5. For compliant online application and compliant manual application, see section 35A.

 (3) For the purposes of subparagraph (2)(c)(ii), an application made using the HPOS system requires additional verification if:

 (a) the HPOS system requires one or more documents to accompany the application; or

 (b) the Chief Executive Medicare has requested, in writing, that the person give the Chief Executive Medicare specified additional information or documents in connection with the application.

 (4) For the purposes of this section, the default start day in relation to an application for an identification number to be allocated to a person for a place of practice is the following:

 (a) for an application that is made using the HPOS system:

 (i) if the application specifies a day on which the allocation should take effect, and that day is after the day on which the application is made—the day specified in the application; or

 (ii) otherwise—the day on which the application is made;

 (b) for an application that is not made using the HPOS system:

 (i) if the application specifies a day on which the allocation should take effect (whether that day is the day on which the application is made or an earlier or later day)—the day specified in the application; or

 (ii) otherwise—the day on which the application is made.

Allocation—discretions

 (5) If:

 (a) the conditions in paragraphs (2)(a) and (b) are met; and

 (b) the conditions in paragraph (2)(c) or (d) (whichever applies) are not met;

then the Chief Executive Medicare may, if the Chief Executive Medicare is satisfied (having regard to the allocation considerations) that it would be appropriate to do so, allocate an identification number to the person for the place of practice, with effect from the default start day in relation to the person’s application.

 (6) If:

 (a) the conditions in paragraphs (2)(a) to (d) (to the extent that they apply) are all met; and

 (b) the person is ineligible for benefits at the place of practice on the default start day in relation to the person’s application;

then the Chief Executive Medicare may refuse to allocate an identification number to the person for the place of practice.

 (7) If:

 (a) the conditions in paragraphs (2)(a) and (b) are met (whether or not the conditions in paragraph (2)(c) or (d) (whichever applies) are met); and

 (b) the person is ineligible for benefits at the place of practice on the default start day in relation to the person’s application; and

 (c) there is an identifiable day (being a day after the default start day) on which the person will no longer be ineligible for benefits at the place of practice;

then the Chief Executive Medicare may allocate an identification number to the person for the place of practice with effect from the earliest such identifiable day.

 (8) If:

 (a) the conditions in paragraphs (2)(a) to (d) (to the extent that they apply) are all met; and

 (b) either:

 (i) the person has not provided a street address for the place of practice; or

 (ii) information included in, or documents accompanying, the person’s application, or information or documents given by the person to the Chief Executive Medicare in connection with that application, are false or misleading in a material respect;

then the Chief Executive Medicare may refuse to allocate an identification number to the person for the place of practice.

 (9) To avoid doubt:

 (a) subsections (5) to (8) do not impose any obligation on the Chief Executive Medicare to consider whether to exercise any of the discretions of the Chief Executive Medicare under those subsections; and

 (b) if the Chief Executive Medicare does not consider whether to exercise the discretion of the Chief Executive Medicare under one of those subsections, then that subsection does not apply in relation to the person and the place of practice.

35A  Identification numbers—compliant applications

 (1) This section sets out when an application of a kind specified by subsection (2) is a compliant online application or a compliant manual application.

 (2) The following kinds of applications are specified:

 (a) an application for an identification number to be allocated to a person for a place of practice;

 (b) an application to lift the suspension of an allocation of an identification number.

Compliant online applications

 (3) An application is a compliant online application if the application:

 (a) is from a single person (whether the application relates to a single place of practice or more than one place of practice); and

 (b) is made using the HPOS system; and

 (c) includes the information required by the HPOS system to be included in the application; and

 (d) is accompanied by the documents (if any) required by the HPOS system to accompany the application.

Compliant manual applications

 (4) An application is a compliant manual application if the application:

 (a) is from a single person (whether the application relates to a single place of practice or more than one place of practice); and

 (b) is not made using the HPOS system; and

 (c) is in a form that has been approved by the Chief Executive Medicare, or by a Departmental employee, for the purposes of making applications of a kind specified in paragraph (2)(a) or (b) (whichever applies); and

 (d) includes the information required by that form to be included in the application; and

 (e) is accompanied by the documents (if any) required by that form to accompany the application; and

 (f) is made in a manner (if any) approved by the Chief Executive Medicare, or by a Departmental employee, for the purposes of making applications of the kind specified in paragraph (2)(a) or (b) (whichever applies).

Note: For Departmental employee, see section 3 of the Act.

35B  Identification numbers—suspending allocations

Suspension—mandatory rule

 (1) Subject to subsection (2), if:

 (a) a person has been allocated an identification number for a place of practice; and

 (b) the person has requested, in writing, that the Chief Executive Medicare suspend the allocation;

then the Chief Executive Medicare must suspend the allocation, with effect from:

 (c) if the person’s request specified a day from which the allocation should be suspended, and that day is after the day on which the request was made—the day specified in the request; and

 (d) otherwise—the day on which the request was made.

Suspension—discretions

 (2) If:

 (a) a person has been allocated an identification number for a place of practice; and

 (b) the person is ineligible for benefits at the place of practice on the decision day for suspending the allocation;

then the Chief Executive Medicare may suspend the allocation, with effect from such a day as the Chief Executive Medicare considers appropriate, which must not be earlier than the decision day.

Note: This subsection applies whether or not the person has requested in writing that the Chief Executive Medicare suspend the allocation.

 (3) For the purposes of subsection (2), the decision day for suspending the allocation is the day (if any) on which the Chief Executive Medicare decides whether to suspend the allocation under subsection (2).

 (4) To avoid doubt:

 (a) subsection (2) does not impose any obligation on the Chief Executive Medicare to consider whether to exercise the discretion of the Chief Executive Medicare under that subsection; and

 (b) if the Chief Executive Medicare does not consider whether to exercise the discretion of the Chief Executive Medicare under subsection (2), then that subsection does not apply in relation to the allocation of the identification number to the person for the place of practice.

35C  Identification numbers—lifting suspensions

 (1) This section applies if the allocation of an identification number to a person for a place of practice is suspended.

Lifting suspensions—mandatory rule

 (2) Subject to subsections (6) to (8), if:

 (a) the person is covered by section 35 (see subsection 35(1)); and

 (b) the person applies to the Chief Executive Medicare to lift the suspension; and

 (c) if the application is made using the HPOS system:

 (i) the application is a compliant online application; and

 (ii) the application does not require additional verification (see subsection (3) of this section); and

 (d) if the application is not made using the HPOS system:

 (i) the application is a compliant manual application; and

 (ii) if the Chief Executive Medicare has requested, in writing, that the person give the Chief Executive Medicare specified additional information or documents in connection with the application—the person has complied with the request;

then the Chief Executive Medicare must lift the suspension, with effect from the default resumption day in relation to the person’s application (see subsection (4) of this section).

Note: For HPOS system, see section 5. For compliant online application and compliant manual application, see section 35A.

 (3) For the purposes of subparagraph (2)(c)(ii), an application made using the HPOS system requires additional verification if:

 (a) the HPOS system requires one or more documents to accompany the application; or

 (b) the Chief Executive Medicare has requested, in writing, that the person give the Chief Executive Medicare specified additional information or documents in connection with the application.

 (4) For the purposes of this section, the default resumption day in relation to an application to lift a suspension is the following:

 (a) for an application that is made using the HPOS system:

 (i) if the application specifies a day on which the lifting of the suspension should take effect, and that day is after the day on which the application is made—the day specified in the application; or

 (ii) otherwise—the day on which the application is made;

 (b) for an application that is not made using the HPOS system:

 (i) if the application specifies a day on which the lifting of the suspension should take effect (whether that day is the day on which the application is made or an earlier or later day)—the day specified in the application; or

 (ii) otherwise—the day on which the application is made.

Lifting suspensions—discretions

 (5) If:

 (a) the conditions in paragraphs (2)(a) and (b) are met; and

 (b) the conditions in paragraph (2)(c) or (d) (whichever applies) are not met;

then the Chief Executive Medicare may, if the Chief Executive Medicare is satisfied (having regard to the allocation considerations) that it would be appropriate to do so, lift the suspension, with effect from the default resumption day in relation to the person’s application.

 (6) If:

 (a) the conditions in paragraphs (2)(a) to (d) (to the extent that they apply) are all met; and

 (b) the person is ineligible for benefits at the place of practice on the default resumption day in relation to the person’s application;

then the Chief Executive Medicare may refuse to lift the suspension.

 (7) If:

 (a) the conditions in paragraphs (2)(a) and (b) are met (whether or not the conditions in paragraph (2)(c) or (d) (whichever applies) are met); and

 (b) the person is ineligible for benefits at the place of practice on the default resumption day in relation to the person’s application; and

 (c) there is an identifiable day (being a day after the default resumption day) on which the person will no longer be ineligible for benefits at the place of practice;

then the Chief Executive Medicare may lift the suspension with effect from the earliest such identifiable day.

 (8) If:

 (a) the conditions in paragraphs (2)(a) to (d) (to the extent that they apply) are all met; and

 (b) information included in, or documents accompanying, the person’s application to lift the suspension, or information or documents given by the person to the Chief Executive Medicare in connection with that application, are false or misleading in a material respect;

then the Chief Executive Medicare may refuse to lift the suspension.

 (9) To avoid doubt:

 (a) subsections (5) to (8) do not impose any obligation on the Chief Executive Medicare to consider whether to exercise the discretions of the Chief Executive Medicare under those subsections; and

 (b) if the Chief Executive Medicare does not consider whether to exercise the discretion of the Chief Executive Medicare under one of those subsections, then that subsection does not apply in relation to the suspension.

35D  Identification numbers—revoking allocations

  If a person has been allocated an identification number for a place of practice (whether or not the allocation is suspended), and the person dies, then the Chief Executive Medicare may revoke the allocation, with effect from the day on which the person died.

35E  Identification numbers—notifying decisions

Decisions to allocate identification numbers under subsections 35(2), (5) and (7)

 (1) For a decision under subsection 35(2), (5) or (7), the Chief Executive Medicare must cause the applicant for the decision to be notified in writing of the following:

 (a) the decision;

 (b) the identification number and the place of practice;

 (c) the day on which the allocation of the identification number takes effect.

Decisions to refuse to allocate identification numbers under subsections 35(6) and (8)

 (2) For a decision under subsection 35(6) or (8), the Chief Executive Medicare must cause the applicant for the decision to be notified in writing of the following:

 (a) the decision;

 (b) the reasons for the decision.

Decisions to suspend allocation of identification numbers under subsection 35B(1)

 (3) For a decision under subsection 35B(1), the Chief Executive Medicare must:

 (a) if the request for the suspension was made using the HPOS system—cause the HPOS system to be updated to show the person allocated the identification number that the suspension is in effect; or

 (b) if the request for the suspension was not made using the HPOS system—cause the person allocated the identification number to be notified in writing of the following:

 (i) the decision;

 (ii) the day on which the suspension takes effect.

Decisions to suspend allocation of identification numbers under subsection 35B(2)

 (4) For a decision under subsection 35B(2), the Chief Executive Medicare must cause the person allocated the identification number to be notified in writing of the following:

 (a) the decision;

 (b) the reasons for the decision;

 (c) the day on which the suspension takes effect.

Decisions to lift suspensions of allocations of identification numbers under subsections 35C(2), (5) and (7)

 (5) For a decision under subsection 35C(2), (5) or (7), the Chief Executive Medicare must:

 (a) if the application for the lifting of the suspension was made using the HPOS system—cause the HPOS system to be updated to show the person allocated the identification number that the suspension has been lifted; or

 (b) if the application for the lifting of the suspension was not made using the HPOS system—cause the holder to be notified in writing of the following:

 (i) the decision;

 (ii) the day on which the lifting of the suspension takes effect.

Decisions to refuse to lift suspensions of allocations of identification numbers under subsection 35C(6) and (8)

 (6) For a decision under subsection 35C(6) or (8), the Chief Executive Medicare must cause the person allocated the identification number to be notified in writing of the following:

 (a) the decision;

 (b) the reasons for the decision.

35F  Identification numbers—Chief Executive Medicare’s reconsideration of decisions

 (1) The person who is the subject of a decision of the following kind made by the Chief Executive Medicare may request, in writing, the Chief Executive Medicare to reconsider the decision:

 (a) a decision under subsection 35(6) or (8) to refuse to allocate an identification number for a place of practice;

 (b) a decision under subsection 35B(2) to suspend the allocation of an identification number;

 (c) a decision under subsection 35C(6) or (8) to refuse to lift the suspension of the allocation of an identification number.

Timing of request

 (2) The person must make the request in writing as follows:

 (a) before the end of the period of 30 days beginning on the day on which the Chief Executive Medicare notifies the person of the decision, unless paragraph (b) applies;

 (b) if the Chief Executive Medicare allows a longer period for making the request—before the end of that longer period.

Reasons for request

 (3) The person must set out in the request the reasons for the request.

Withdrawal of request

 (4) A person’s request for reconsideration of a decision made under subsection 35(6) or (8) to refuse to allocate an identification number for a place of practice is taken to have been withdrawn if:

 (a) the person makes another application for the allocation of an identification number to the person for that place of practice; and

 (b) the person makes the other application before the Chief Executive Medicare makes a decision under subsection (5) of this section on reconsideration of the decision made under subsection 35(6) or (8).

Decision on reconsideration

 (5) The Chief Executive Medicare, on receiving a person’s request made in accordance with subsections (2) and (3):

 (a) must affirm, vary or set aside the decision covered by subsection (1); and

 (b) if the Chief Executive Medicare sets aside the decision—may make such other decision as the Chief Executive Medicare thinks appropriate.

 (6) The Chief Executive Medicare must make the decision on reconsideration before the end of the following:

 (a) the period of 60 days beginning on the day the Chief Executive Medicare receives the request, unless paragraph (b) applies;

 (b) if the person and the Chief Executive Medicare agree on a longer period—that longer period.

Notice of decision on reconsideration

 (7) The Chief Executive Medicare must give the person written notice of the Chief Executive Medicare’s decision on reconsideration and of the reasons for that decision.

Note: Section 266 of the Administrative Review Tribunal Act 2024 requires the person to be notified of the person’s review rights.

When decision on reconsideration takes effect

 (8) The Chief Executive Medicare’s decision on reconsideration takes effect:

 (a) on the day specified in the notice; or

 (b) if a day is not specified in the notice—on the day on which that decision is made.

Chief Executive Medicare may be taken to have affirmed decision

 (9) The Chief Executive Medicare is taken to have made a decision affirming the decision under reconsideration if the Chief Executive Medicare has not notified the person of the Chief Executive Medicare’s decision on reconsideration before the end of the period applicable under subsection (6).

35G  Identification numbers—Administrative Review Tribunal review of decisions

  Applications may be made to the Administrative Review Tribunal for review of a decision under subsection 35F(5) that is made, or a decision under subsection 35F(9) that is taken to have been made, by the Chief Executive Medicare.

Part 4—Miscellaneous

36  Prescribed period

  For the purposes of paragraph 41C(8)(a) of the Act, the prescribed period is the period of 2 years that commenced on 1 January 1981.

Part 5—Transitional provisions

Division 1—Provisions relating to this instrument as made

37  Definitions

  In this Part:

commencement day means the day on which this Part commences.

old regulations means the Human Services (Medicare) Regulations 1975 as in force immediately before the commencement day.

38  Things done by, or in relation to, the Chief Executive Medicare

  If, before the commencement day, a thing was done by, or in relation to, the Chief Executive Medicare under the old regulations, then the thing is taken, on and after that day, to have been done by, or in relation to, the Chief Executive Medicare under this instrument.

39  Things started but not finished by the Chief Executive Medicare

 (1) This section applies if:

 (a) before the commencement day, the Chief Executive Medicare started doing a thing under the old regulations; and

 (b) immediately before that day, the Chief Executive Medicare had not finished doing that thing.

 (2) The Chief Executive Medicare may, on and after the commencement day, finish doing the thing under this instrument.

Division 2—Provisions relating to the Aged Care Legislation Consequential Amendments Regulations 2025

40  Things started but not finished under Part 2 before the commencement of the Aged Care Legislation Consequential Amendments Regulations 2025

 (1) This section applies if:

 (a) before the commencement of the Aged Care Legislation Consequential Amendments Regulations 2025 (the amending regulations), the Chief Executive Medicare started doing a thing in the performance of a function prescribed by Part 2 of this instrument, as in force before that commencement; and

 (b) immediately before that commencement, the Chief Executive Medicare had not finished doing that thing; and

 (c) the doing of the thing, after that commencement, is provided for by the Aged Care (Consequential and Transitional Provisions) Act 2024 or an instrument made under that Act.

 (2) Despite the repeal of Part 2 of this instrument by the amending regulations, the Chief Executive Medicare may, at and after the commencement of the amending regulations, finish doing the thing as though that repeal had not happened.

Division 3—Provisions relating to the Human Services (Medicare) Amendment (Allocation of Identification Numbers) Regulations 2026

41  Identification numbers

 (1) This section applies in relation to an identification number:

 (a) that, before the commencement of this section, was allocated under section 35 of this instrument to a person in relation to a place of practice; and

 (b) that was in effect immediately before that commencement.

 (2) The identification number has effect (and may be dealt with) on and after that commencement as if it were an identification number allocated to that person for that place of practice under section 35 of this instrument as substituted by Schedule 1 to the Human Services (Medicare) Amendment (Allocation of Identification Numbers) Regulations 2026.

Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.

If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history