{"id":"F2025L01479","name":"Health Insurance (Section 3C – Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination 2025","slug":"health-insurance-section-3c-diabetes-testing-in-aboriginal-and-torres-strait-islander-primary-health","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":107475,"registerId":"commonwealth-F2025L01479-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Name","content":"#### 1 Name\n\n This instrument is the Health Insurance (Section 3C – Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination 2025.","sortOrder":0},{"sectionNumber":"2","sectionType":"section","heading":"Commencement","content":"#### 2 Commencement\n\n Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.\n\n```html\n

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1. The whole of this instrument

1 March 2026.

1 March 2026

\n```\n\nNote: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.\n\n Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.","sortOrder":1},{"sectionNumber":"3","sectionType":"section","heading":"Authority","content":"#### 3 Authority\n\n This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":2},{"sectionNumber":"4","sectionType":"section","heading":"Schedules","content":"#### 4 Schedules\n\n Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.","sortOrder":3},{"sectionNumber":"5","sectionType":"section","heading":"Definitions","content":"#### 5 Definitions\n\n (1) In this instrument:\n\n> Act means the Health Insurance Act 1973.\n\n> QAAMS Program means the program, known as the Quality Assurance for Aboriginal and Torres Strait Islander Medical Services Program, funded by the Department of Health, Disability and Ageing as a program to provide a culturally appropriate and clinically effective diabetes diagnosis and management service for First Nations people.\n\n> relevant provisions means 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 oritems.\n\n> relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.\n\n> Note: Unless the contrary intention appears, expressions used in this instrument have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003.\n\n (2) Unless the contrary intention appears, in this instrument a reference to a provision of the Act or regulations made under the Act as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.","sortOrder":4},{"sectionNumber":"6","sectionType":"section","heading":"Circumstances where this instrument applies","content":"#### 6 Circumstances where this instrument applies\n\n This instrument applies to a relevant service only where all of the following circumstances apply.\n (a) the service is rendered by or on behalf of a medical practitioner; and\n (b) the practitioner referred to in paragraph (a), or the organisation for which the practitioner works, is participating in the QAAMS Program; and\n (c) the service is provided in accordance with the QAAMS Program; and\n (d) the practitioner referred to in paragraph (a) has determined the service to be necessary for their patient.","sortOrder":5},{"sectionNumber":"7","sectionType":"section","heading":"Treatment of relevant services","content":"#### 7 Treatment of relevant services\n\n For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:\n (a) it were both a professional service and a medical service; and\n (b) there were an item in the pathology services table that is related to the service.\n\nSchedule 1—Relevant services\n\n```html\n

Group P9— Simple Basic Pathology Tests

Column 1

Item

Column 2

Description

Column 3

Fee ($)

73839

Quantitation of HbA1c (glycated haemoglobin) performed for the diagnosis of diabetes in asymptomatic patients at high risk - not more than once in a 12 month period

16.80

73840

Quantitation of glycosylated haemoglobin performed in the management of established diabetes – each test to a maximum of 4 tests in a 12 month period

17.00

73844

Quantitation of urinary albumin/creatine ratio in urine on a random spot collection in the management of patients with established diabetes or patients at risk of microalbuminuria

20.35

\n```\n\nSchedule 2—Repeals","sortOrder":6},{"sectionNumber":"Health Insurance (Diabetes Testing in Ab","sectionType":"section","heading":"Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination 2015","content":"#### Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination 2015\n\n1 The whole of the instrument\n\nRepeal the instrument.","sortOrder":7}],"analysis":{"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"The instrument replaces (repeals) the 2015 Determination (Schedule 2) and sets out the services, conditions and fees that will be treated for the relevant provisions (s6, s7; Schedule 1). The text does not itself state an expansion or narrowing of eligibility beyond those conditions: it limits application to QAAMS-participating practitioners who determine the service necessary (s6) and specifies the tests and fees (Schedule 1). Any change in practical scope would depend on differences between this and the repealed 2015 instrument, which are not detailed in the text provided."},"complexity_factors":["Conditional eligibility tied to QAAMS participation and a practitioner’s clinical decision (s6) — requires coordination between sites and the QAAMS Program.","Treatment of services as both professional and medical and as if a pathology item exists (s7) — affects billing/benefit treatment under the Health Insurance Act.","Prescribed test items and fixed fees listed in Schedule 1 (HbA1c diagnostic, HbA1c monitoring up to 4/year, urinary albumin/creatinine) — creates concrete payment rules to implement.","Repeal of the 2015 Determination (Schedule 2) — may require updating local billing practice and transition planning.","Cross-references to the Act and other regulations and the ‘as in force from time to time’ rule (s5(2)) — requires administrators to track legislative/regulatory changes.","Commencement date specified (s2: 1 March 2026) — gives a clear implementation timeline for providers and payers."],"plain_english_summary":"This Determination (made under s3C(1)) says that certain diabetes tests performed at Aboriginal and Torres Strait Islander primary health care sites participating in the QAAMS Program are to be treated as both professional and medical services for the relevant provisions (s7; Schedule 1). It lists specific HbA1c diagnostic and monitoring items and a urinary albumin/creatinine test with set fees. It applies only where a medical practitioner or their organisation participates in QAAMS and the practitioner decides the test is necessary (s6), and it repeals the 2015 Determination (Schedule 2)."},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same scope as its predecessor (the 2015 Determination). It continues the specific purpose of enabling Medicare rebates for diabetes testing at Aboriginal and Torres Strait Islander primary health care sites under the QAAMS Program. The 2025 version appears to be a straightforward re-enactment or renewal with updated item numbers/fees, not an expansion into new service types or patient populations."},"complexity_factors":["Short instrument with only 7 substantive sections plus schedules","Only 3 defined terms in section 5 (Act, QAAMS Program, relevant provisions, relevant service)","Simple conditional structure in section 6 with 4 cumulative requirements (all must be met)","Single cross-reference to subsection 3C(1) of the Health Insurance Act 1973 as enabling provision","Straightforward treatment rule in section 7 with two parallel deeming provisions","Schedule contains only 3 specific pathology items with clear descriptions and fee amounts","Repeals only one previous instrument (the 2015 version)","No nested exceptions, no complex temporal provisions, no intricate administrative machinery"],"plain_english_summary":"This law allows Medicare rebates for specific point-of-care diabetes tests (HbA1c and urine albumin/creatinine) when provided at participating Aboriginal and Torres Strait Islander health services under the QAAMS Program. \n\nIt affects Indigenous patients, the medical services in the QAAMS Program, and doctors who determine the tests are necessary, improving local diagnosis and management of diabetes and replacing the 2015 scheme."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-diabetes-testing-in-aboriginal-and-torres-strait-islander-primary-health","history":"/api/acts/health-insurance-section-3c-diabetes-testing-in-aboriginal-and-torres-strait-islander-primary-health/history","analysis":"/api/acts/health-insurance-section-3c-diabetes-testing-in-aboriginal-and-torres-strait-islander-primary-health/analysis","conflicts":"/api/acts/health-insurance-section-3c-diabetes-testing-in-aboriginal-and-torres-strait-islander-primary-health/conflicts","importantCases":"/api/acts/health-insurance-section-3c-diabetes-testing-in-aboriginal-and-torres-strait-islander-primary-health/important-cases","documents":"/api/acts/health-insurance-section-3c-diabetes-testing-in-aboriginal-and-torres-strait-islander-primary-health/documents"}}