{"id":"F2019L00361","name":"Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Determination 2019","slug":"health-insurance-section-3c-general-medical-services-heart-health-assessment-no-2-determination-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":98960,"registerId":"commonwealth-F2019L00361-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Contents","sectionType":"subdivision","heading":"Contents","content":"#### Contents\n\n1. Name 1\n\n3. Authority 1\n\n3A. Repeal 1\n\n5. Definitions 1\n\n6. Treatment of relevant services 2\n\n7. Application of item 699 and 177 2\n\n8. Indexation 2\n\nSchedule 1 – relevant services 4\n\nEndnotes 5\n\nEndnote 1—About the endnotes 5\n\nEndnote 2—Abbreviation key 6\n\nEndnote 3—Legislation history 7\n\nEndnote 4—Amendment history 9","sortOrder":0},{"sectionNumber":"1. Name","sectionType":"part","heading":"1. Name","content":"# 1. Name\n\nThis Determination is the Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Determination 2019.","sortOrder":1},{"sectionNumber":"3. Authority","sectionType":"part","heading":"3. Authority","content":"# 3. Authority\n\nThis Determination is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":2},{"sectionNumber":"3A. Repeal","sectionType":"part","heading":"3A. Repeal","content":"# 3A. Repeal\n\nThis instrument is repealed on 30 June 2028 at 11:59pm.","sortOrder":3},{"sectionNumber":"5. Definitions","sectionType":"part","heading":"5. Definitions","content":"# 5. Definitions\n\n(1) In this Determination:\n\nAct means the Health Insurance Act 1973.\n\nhealth screening service has the same meaning as in subsection 19(5) of the Act.\n\nprescribed medical practitioner has the meaning given by clause 7.1.1 of the Health Insurance (General Medical Services Table) Regulations 2021.\n\nrelevant 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 or items.\n\nrelevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.\n\nSchedule means a Schedule to this Determination.\n\nNote: The following terms are defined in subsection 3(1) of the Act:\n\n clinically relevant service\n\n general medical services table\n\n item\n\n professional service\n\n(2) Unless the contrary intention appears, a reference in this Determination to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 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. Treatment of relevant services","sectionType":"part","heading":"6. Treatment of relevant services","content":"# 6. Treatment of relevant services\n\nFor subsection 3C(1) of the Act a relevant service, provided in accordance with this Determination and as a clinically relevant service, is to be treated, for the relevant provisions, as if:\n\n(a) it were both a professional service and a medical service; and\n\n(b) there were an item in the general medical services table that:\n\n(i) related to the service; and\n\n(ii) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.","sortOrder":5},{"sectionNumber":"7. Application of item 699 and 177","sectionType":"part","heading":"7. Application of item 699 and 177","content":"# 7. Application of item 699 and 177\n\n(1) Clause 2.15.1 of the general medical services table shall have effect as if:\n\n(a) item 699 is specified in subclause 2.15.1(1) for the purposes of this clause; or\n\n(b) item 177 is specified in subclause 2.15.1(2) for the purposes of this clause.\n\n(2) Clause 2.15.14 of the general medical services table shall have effect as if item 699 or 177 contained in the Schedule was also specified in clause 2.15.14.\n\n(3) For any particular patient, item 699 or 177 is not applicable:\n\n(a) if the patient has been provided a service to which item 699 or 177 applies in the previous 12 month period; or\n\n(b) if, prior to a service, the patient has been provided a service mentioned in:\n\n(i) Group A14 of the general medical services table within the previous 12 months, excluding item 715; or\n\n(ii) Group A7, Subgroup 5 of the Health Insurance (General Medical Services Table) Regulations 2021 within the previous 12 months, excluding item 228.","sortOrder":6},{"sectionNumber":"8","sectionType":"part","heading":"Indexation","content":"# 8 Indexation\n\n(1) At the start of 1 July 2025 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:\n\n![Start formula 1.024 times the amount immediately before the indexation time end formula](image.002.png)\n\n Note: The indexed fees could in 2025 be viewed on the Department of Health and Aged Care’s MBS Online website (https://www.mbsonline.gov.au).\n\n(2) The amounts covered by this subsection are the fee for each item in Schedule 1 of this Determination.\n\n(3) An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).","sortOrder":7},{"sectionNumber":"Schedule 1","sectionType":"part","heading":"relevant services","content":"# Schedule 1 – relevant services\n\n```html\n

Category 1 – Professional Attendances

Group A14 – Health assessments

Item

Service

Fee ($)

699

Professional attendance on a patient who is 30 years of age or over for a heart health assessment by a general practitioner at consulting rooms lasting at least 20 minutes and including:

(a) collection of relevant information, including taking a patient history; and

(b) a basic physical examination, which must include recording blood pressure and cholesterol; and

(c) initiating interventions and referrals as indicated; and

(d) implementing a management plan; and

(e) providing the patient with preventative health care advice and information.

80.10

\n```\n\n```html\n

Category 1 – Professional Attendances

Group A7 – Acupuncture and Non‑Specialist Practitioner Items

Subgroup 5 – Non‑Specialist Practitioner health assessments

Item

Service

Fee ($)

177

Professional attendance on a patient who is 30 years of age or over for a heart health assessment by a prescribed medical practitioner at consulting rooms lasting at least 20 minutes and including:

(a) collection of relevant information, including taking a patient history; and

(b) a basic physical examination, which must include recording blood pressure and cholesterol; and

(c) initiating interventions and referrals as indicated; and

(d) implementing a management plan; and

(e) providing the patient with preventative health care advice and information.

64.10

\n```","sortOrder":8}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"This Determination is narrowly focused: it establishes two MBS items for a defined heart health assessment, sets fees, specifies claim conditions (including a 12‑month exclusion), provides a short term indexation adjustment, and has a fixed repeal date. There is no material expansion beyond that original, targeted purpose in the text provided — it does not add unrelated services, broaden provider classes beyond the externally defined 'prescribed medical practitioner', or create new ongoing regulatory regimes. Therefore the scope has not grown significantly beyond what the instrument aims to do (create and manage these specific heart health assessment items)."},"complexity_factors":["Small instrument (short length) but with cross‑references to multiple external instruments (Health Insurance Act 1973; National Health Act 1953; General Medical Services Table regulations).","Only a handful of defined terms in clause 5, but one key term ('prescribed medical practitioner') is defined externally (in the GMST regulations), creating external dependency.","Two schedule items (699 and 177) with near‑identical content but different beneficiary/practitioner categories and fees (Schedule 1).","Conditional applicability and nested exceptions in clause 7(3) (12‑month lookback and exclusions for particular groups/items).","Indexation clause (clause 8) introduces a formula (multiplier 1.024), effective date, and specific rounding rule — adds a numeric calculation step.","Automatic repeal date (clause 3A) imposes temporal limitation that affects medium‑term planning and necessitates future legislative action to continue the items.","Clauses 7(1)–(2) alter how items interact with specific clauses of the general medical services table (2.15.1 and 2.15.14), requiring users to consult GMST for full operational effect.","Potential operational complexity from compliance and record‑keeping requirements (20‑minute minimum, specified clinical elements, prior service checks) though these are described in plain terms in Schedule 1."],"plain_english_summary":"**What this Determination does (mechanically)**\n\n- It creates two Medicare Benefits Schedule (MBS) items for a “heart health assessment” for patients aged 30 and over. The items are set out in Schedule 1 (item 699 and item 177) and specify what the consultation must include (history, basic exam with blood pressure and cholesterol, management plan, referrals/interventions, preventive advice) and a minimum face‑to‑face time of 20 minutes (Schedule 1). \n- Services that meet the Determination are treated, for the purposes of the Health Insurance Act 1973 and related regulations, as both a professional service and a medical service and as if there were a corresponding item in the general medical services table with the fee set in the Schedule (clause 6). \n- Fee amounts are: item 699 — $80.10; item 177 — $64.10 (Schedule 1). \n- The items are not claimable for a particular patient if that patient received the same item in the prior 12 months, or (in specified circumstances) other related assessment items in the prior 12 months (clause 7(3)). \n- The Determination explicitly makes item 699 or 177 operate in the parts of the general medical services table named in clause 2.15.1 and clause 2.15.14 as if those items were specified there (clause 7(1)–(2)). \n- The Determination is temporary: it is repealed automatically on 30 June 2028 at 11:59 pm (clause 3A). \n- From 1 July 2025 the fees in Schedule 1 are indexed by a multiplier of 1.024 (clause 8), with rounding to the nearest 5 cents (clause 8(3)).\n\n**Who is affected**\n\n- Patients aged 30 years or over who receive a qualified heart health assessment as described in Schedule 1. \n- Medical practitioners who are either general practitioners or a “prescribed medical practitioner” (the latter defined by the cited general medical services regulations) who choose to provide and claim for these assessments (definition and Schedule 1). \n- The Commonwealth (through Medicare) because it will reimburse the specified fees when the conditions are met (clause 6 and Schedule 1). \n\n**Why it matters (official rationale, then practical effects and trade‑offs)**\n\n- The instrument’s stated purpose is to specify certain heart health assessments as clinically relevant services that attract MBS benefits (clause 6 and Schedule 1). \n\nPractical effects, incentives and trade‑offs:\n\n- Who pays: Medicare rebates at the Schedule fees are payable to practitioners who provide assessments meeting the content and time requirements (clause 6; Schedule 1). That creates a direct financial incentive for practitioners to offer these 20+ minute heart health assessment consultations. \n- Behaviour change: Patients may be more likely to receive a structured heart assessment if a rebated item is available; practitioners may redesign appointment types or patient flows to capture the 20‑minute consultation. \n- Fiscal cost and opportunity cost: The Commonwealth incurs the rebate cost when claims meet the rules. Funds used to reimburse these items are not available for other services; the Determination does not itself specify offsetting savings. \n- Scope limits to avoid double claiming: Clause 7(3) prevents repeat claims within 12 months and excludes some overlapping assessment items, which limits repeated use and reduces double‑dipping risk but requires practitioners to check prior services. \n- Administrative and compliance burden: Practitioners must document that the consultation lasted at least 20 minutes and included the specified elements (history, blood pressure and cholesterol recorded, management plan, etc.) and must satisfy the prior‑12‑month checks. That increases record‑keeping and claim‑checking effort (Schedule 1; clause 7). \n- Implementation risks: The Determination depends on cross‑referenced definitions and provisions in the Health Insurance Act, the National Health Act, and the General Medical Services Table regulations (clause 5(2) and clause 7). Practical verification (e.g., confirming a patient didn’t already receive a related assessment from another provider within 12 months) can be operationally awkward and could create billing disputes. \n- Competition and private choice effects: The measure subsidises provision of a specific preventive consultation. That can increase supply of that service and affect how practitioners allocate appointment types and time; which practitioner types can provide the item depends on the external definition of “prescribed medical practitioner” in the regulations (clause 5). \n- Temporary nature: Automatic repeal in 2028 (clause 3A) limits permanency; continuation or expansion would require a new instrument or amendment. \n\n**Concrete legal levers in the text**\n\n- Treatment as a medical and professional service for the Act’s purposes — clause 6. \n- Applicability exclusions (previous 12 months / overlapping items) — clause 7(3). \n- Fee amounts and item descriptions — Schedule 1 (items 699 and 177). \n- Indexation formula and date — clause 8. \n- Repeal date — clause 3A. \n\n**Net description (who decides, who pays, what changes in behaviour)**\n\n- Who decides: The Determination sets which specific consultations are claimable and the conditions for claiming; broader definitions it relies on come from the Act and regulations (clause 5). \n- Who pays: Medicare (Commonwealth) pays the set rebate fees when claims satisfy the Determination. \n- Behaviour change: Practitioners may change scheduling and record‑keeping to deliver 20‑minute heart health assessments and claim the item; patients aged 30+ may be steered to these assessments where available.\n\n"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a discrete, time-limited determination creating specific Medicare items for heart health assessments. It remains tightly scoped to its original purpose of establishing subsidised cardiovascular risk assessments for adults 30+, with no evidence of scope creep beyond this targeted health screening function."},"complexity_factors":["Multiple cross-references to external instruments (Health Insurance Act 1973, National Health Act 1953, Health Insurance (General Medical Services Table) Regulations 2021)","Conditional eligibility rules with 12-month exclusion periods and cross-references to other Medicare item groups (Group A14, Group A7 Subgroup 5)","Incorporation of external definitions by reference ('prescribed medical practitioner' defined in 2021 Regulations)","Sunset clause with automatic repeal mechanism","Indexation formula with rounding rules to nearest 5 cents","Dual-item structure (699 and 177) with slightly different provider eligibility and fee structures"],"plain_english_summary":"This creates a Medicare rebate for comprehensive heart health assessments for Australians aged 30+, subsidising annual 20+ minute cardiovascular risk checks to identify and manage heart disease early. \n\nTwo new Medicare items fund GPs and prescribed non‑GP practitioners at set fees, are claimable once every 12 months (not if certain other recent assessments were done), indexed from 1 July 2025, and cease on 30 June 2028."},"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-general-medical-services-heart-health-assessment-no-2-determination-2019","history":"/api/acts/health-insurance-section-3c-general-medical-services-heart-health-assessment-no-2-determination-2019/history","analysis":"/api/acts/health-insurance-section-3c-general-medical-services-heart-health-assessment-no-2-determination-2019/analysis","conflicts":"/api/acts/health-insurance-section-3c-general-medical-services-heart-health-assessment-no-2-determination-2019/conflicts","importantCases":"/api/acts/health-insurance-section-3c-general-medical-services-heart-health-assessment-no-2-determination-2019/important-cases","documents":"/api/acts/health-insurance-section-3c-general-medical-services-heart-health-assessment-no-2-determination-2019/documents"}}