Part 1
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Commonwealth legislation
The Health Insurance Regulations 2018 set the detailed rules for who counts as an authorised Medicare provider, which medical, pathology and imaging services attract rebates, how referrals and requesting rights work, and requirements for records, accreditation and payments.
They affect patients, doctors, allied health, pathology/imaging centres and rural workforce programs — and they determine whether services are Medicare‑subsidised and how providers get paid, shaping everyday access to care.
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Zoe can write the in-depth analysis on top of the summary above: how it works, who it affects and what each part actually does.
Direct links to the current provisions in Health Insurance Regulations 2018.
This instrument is the Health Insurance Regulations 2018.
This instrument is made under the Health Insurance Act 1973.
Note: A number of expressions used in this instrument are defined in the Act, including the following:
(a) consultant physician;
(b) eligible midwife;
(c) eligible nurse practitioner;
(d) general practitioner;
(e) medical practitioner;
(f) participating midwife;
(g) participating nurse practitioner;
(h) specialist.
In this instrument:
Act means the Health Insurance Act 1973.
approved collection centre has the same meaning as in Part IIA of the Act.
diagnostic imaging provider: see subsection 70(5).
health practitioner means a person practising a profession that, under the Health Practitioner Regulation National Law, is regulated by a National Board.
Health Practitioner Regulation National Law means:
(a) for a State or Territory other than Western Australia—the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld), as it applies (with or without modification) as a law of the State or Territory; or
(b) for Western Australia—the Health Practitioner Regulation National Law (WA) Act 2010 (WA), so far as that Act corresponds to the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld).
identification number, in relation to an approved collection centre, means the identification number allocated to the centre under section 23DNBB of the Act.
National Board means any of the following:
(a) the Aboriginal and Torres Strait Islander Health Practice Board of Australia;
(b) the Chiropractic Board of Australia;
(c) the Dental Board of Australia;
(d) the Medical Board of Australia;
(e) the Medical Radiation Practice Board of Australia;
(f) the Nursing and Midwifery Board of Australia;
(g) the Occupational Therapy Board of Australia;
(h) the Optometry Board of Australia;
(i) the Osteopathy Board of Australia;
(j) the Physiotherapy Board of Australia;
(k) the Podiatry Board of Australia;
(l) the Psychology Board of Australia.
obstetrician means a medical practitioner who is a specialist in the specialty of obstetrics and gynaecology (however described).
paediatrician means a medical practitioner who is a specialist in the specialty of paediatrics and child health (however described).
pathology provider: see subsection 69(3).
provider number means a number that:
(a) is allocated by the Chief Executive Medicare to a medical practitioner, dental practitioner, approved pathology practitioner, optometrist, participating midwife or participating nurse practitioner; and
(b) identifies the person and a place where the person practises the person’s profession.
RACGP means the Royal Australian College of General Practitioners.
referring practitioner, in relation to a referral, means the person making the referral.
registered sonographer: see subsection 71(6).
requester number means the number allocated by the Chief Executive Medicare to a chiropractor, osteopath, physiotherapist or podiatrist.
service time: see subsection 60(5).
treating practitioner, in relation to a pathology service, has the same meaning as in section 16A of the Act.
ultrasound service: see subsection 71(6).
usual general practitioner, for a patient, includes a medical practitioner nominated by the patient.
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
This instrument is the Health Insurance Regulations 2018.
This instrument is made under the Health Insurance Act 1973.
Note: A number of expressions used in this instrument are defined in the Act, including the following:
(a) consultant physician;
(b) eligible midwife;
(c) eligible nurse practitioner;
(d) general practitioner;
(e) medical practitioner;
(f) participating midwife;
(g) participating nurse practitioner;
(h) specialist.
In this instrument:
Act means the Health Insurance Act 1973.
approved collection centre has the same meaning as in Part IIA of the Act.
diagnostic imaging provider: see subsection 70(5).
health practitioner means a person practising a profession that, under the Health Practitioner Regulation National Law, is regulated by a National Board.
Health Practitioner Regulation National Law means:
(a) for a State or Territory other than Western Australia—the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld), as it applies (with or without modification) as a law of the State or Territory; or
(b) for Western Australia—the Health Practitioner Regulation National Law (WA) Act 2010 (WA), so far as that Act corresponds to the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld).
identification number, in relation to an approved collection centre, means the identification number allocated to the centre under section 23DNBB of the Act.
National Board means any of the following:
(a) the Aboriginal and Torres Strait Islander Health Practice Board of Australia;
(b) the Chiropractic Board of Australia;
(c) the Dental Board of Australia;
(d) the Medical Board of Australia;
(e) the Medical Radiation Practice Board of Australia;
(f) the Nursing and Midwifery Board of Australia;
(g) the Occupational Therapy Board of Australia;
(h) the Optometry Board of Australia;
(i) the Osteopathy Board of Australia;
(j) the Physiotherapy Board of Australia;
(k) the Podiatry Board of Australia;
(l) the Psychology Board of Australia.
obstetrician means a medical practitioner who is a specialist in the specialty of obstetrics and gynaecology (however described).
paediatrician means a medical practitioner who is a specialist in the specialty of paediatrics and child health (however described).
pathology provider: see subsection 69(3).
provider number means a number that:
(a) is allocated by the Chief Executive Medicare to a medical practitioner, dental practitioner, approved pathology practitioner, optometrist, participating midwife or participating nurse practitioner; and
(b) identifies the person and a place where the person practises the person’s profession.
RACGP means the Royal Australian College of General Practitioners.
referring practitioner, in relation to a referral, means the person making the referral.
registered sonographer: see subsection 71(6).
requester number means the number allocated by the Chief Executive Medicare to a chiropractor, osteopath, physiotherapist or podiatrist.
service time: see subsection 60(5).
treating practitioner, in relation to a pathology service, has the same meaning as in section 16A of the Act.
ultrasound service: see subsection 71(6).
usual general practitioner, for a patient, includes a medical practitioner nominated by the patient.
This instrument is the Health Insurance Regulations 2018.
This instrument is made under the Health Insurance Act 1973.
Note: A number of expressions used in this instrument are defined in the Act, including the following:
(a) consultant physician;
(b) eligible midwife;
(c) eligible nurse practitioner;
(d) general practitioner;
(e) medical practitioner;
(f) participating midwife;
(g) participating nurse practitioner;
(h) specialist.
In this instrument:
Act means the Health Insurance Act 1973.
approved collection centre has the same meaning as in Part IIA of the Act.
diagnostic imaging provider: see subsection 70(5).
health practitioner means a person practising a profession that, under the Health Practitioner Regulation National Law, is regulated by a National Board.
Health Practitioner Regulation National Law means:
(a) for a State or Territory other than Western Australia—the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld), as it applies (with or without modification) as a law of the State or Territory; or
(b) for Western Australia—the Health Practitioner Regulation National Law (WA) Act 2010 (WA), so far as that Act corresponds to the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld).
identification number, in relation to an approved collection centre, means the identification number allocated to the centre under section 23DNBB of the Act.
National Board means any of the following:
(a) the Aboriginal and Torres Strait Islander Health Practice Board of Australia;
(b) the Chiropractic Board of Australia;
(c) the Dental Board of Australia;
(d) the Medical Board of Australia;
(e) the Medical Radiation Practice Board of Australia;
(f) the Nursing and Midwifery Board of Australia;
(g) the Occupational Therapy Board of Australia;
(h) the Optometry Board of Australia;
(i) the Osteopathy Board of Australia;
(j) the Physiotherapy Board of Australia;
(k) the Podiatry Board of Australia;
(l) the Psychology Board of Australia.
obstetrician means a medical practitioner who is a specialist in the specialty of obstetrics and gynaecology (however described).
paediatrician means a medical practitioner who is a specialist in the specialty of paediatrics and child health (however described).
pathology provider: see subsection 69(3).
provider number means a number that:
(a) is allocated by the Chief Executive Medicare to a medical practitioner, dental practitioner, approved pathology practitioner, optometrist, participating midwife or participating nurse practitioner; and
(b) identifies the person and a place where the person practises the person’s profession.
RACGP means the Royal Australian College of General Practitioners.
referring practitioner, in relation to a referral, means the person making the referral.
registered sonographer: see subsection 71(6).
requester number means the number allocated by the Chief Executive Medicare to a chiropractor, osteopath, physiotherapist or podiatrist.
service time: see subsection 60(5).
treating practitioner, in relation to a pathology service, has the same meaning as in section 16A of the Act.
ultrasound service: see subsection 71(6).
usual general practitioner, for a patient, includes a medical practitioner nominated by the patient.
For the purposes of paragraph (b) of the definition of professional service in subsection 3(1) of the Act, a service specified in any item in Groups O1 to O11 of the general medical services table is prescribed.
For the purposes of subsection 3(20) of the Act, specialist trainee means a medical practitioner who is enrolled in and undertaking a training program with: (a) an organisation mentioned in column 1 of an item in the table in clause 1 in Schedule 1 to this instrument; or (b) the RACGP.
For the purposes of paragraph 3(18)(a) of the Act, a professional service specified in any of the following items of the general medical services table is prescribed: (a) all items in Group T1 except item 13209; (b) all items in Groups T2, T3, T4, T6, T7, T11, T10, T8 and T9.
Note: Subsection 3(18) of the Act applies when a specialist trainee renders a service under the supervision of another medical practitioner.
For the purposes of paragraph (b) of the definition of health service in subsection 3C(8) of the Act, the following classes of services are prescribed: (a) Aboriginal and Torres Strait Islander health practitioner services; (aa) Aboriginal and Torres Strait Islander health worker services; (b) audiology; (c) chiropractic services; (d) diabetes education; (e) dietetics; (f) exercise physiology; (g) focussed psychological strategies; (h) mental health services; (i) midwifery; (j) non‑directive pregnancy support counselling; (k) nurse practitioner services; (l) occupational therapy; (m) orthoptics; (n) osteopathy; (o) physiotherapy; (p) podiatry; (q) psychological therapy; (r) psychology; (s) speech pathology.
(1) For the purposes of the definition of relevant organisation in subsection 3D(5) of the Act, an organisation mentioned in column 1 of an item in the table in clause 1 in Schedule 1 to this instrument is declared to be a professional organisation in relation to each specialty mentioned in column 2 of the item. (2) For the purposes of the definition of relevant qualification in subsection 3D(5) of the Act, a qualification mentioned in column 3 of an item in the table in clause 1 in Schedule 1 to this instrument is declared to be a relevant qualification in relation to the organisation mentioned in column 1 of the item.
(1) This section prescribes a kind of medical practitioner for the purposes of paragraph (b) of the definition of general practitioner in subsection 3(1) of the Act.
Note: Medical practitioners of that kind are general practitioners as defined by that subsection.
(2) The kind is a medical practitioner for whom the following conditions are met: (a) the practitioner holds general registration in the medical profession (and is not registered in the specialty of general practice) under the National Law; (b) immediately before the commencement of Schedule 1 to the Health Insurance Amendment (General Practitioners and Quality Assurance) Act 2020: (i) the practitioner held general registration in the medical profession (and was not registered in the specialty of general practice) under the National Law; and (ii) the practitioner’s name was entered in the Vocational Register of General Practitioners.
Bodies and courses (1) For the purposes of paragraph 3GA(5)(a) of the Act: (a) a body mentioned in column 1 of an item in the following table is specified; and (b) a course that leads to a qualification mentioned in column 2 of the item from the body is specified for the body.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><thead><tr><td colspan="3" style="border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Specified bodies and qualifications that specified courses lead to</span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Item</span></p></td><td style="width:69.8%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Column 1</span></p><p class="TableHeading"><span>Body</span></p></td><td style="width:21.62%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Column 2</span></p><p class="TableHeading"><span>Qualification that course leads to</span></p></td></tr></thead><tbody><tr><td style="width:8.58%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>1</span></p></td><td style="width:69.8%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>Australasian College for Emergency Medicine</span></p></td><td style="width:21.62%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>FACEM</span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>2</span></p></td><td style="width:69.8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>Australasian College of Sport and Exercise Physicians</span></p></td><td style="width:21.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>FACSEP</span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>3</span></p></td><td style="width:69.8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>Australian and New Zealand College of Anaesthetists</span></p></td><td style="width:21.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>FANZCA</span></p><p class="Tabletext"><span>FFPMANZCA</span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>4</span></p></td><td style="width:69.8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>College of Intensive Care Medicine of Australia and New Zealand</span></p></td><td style="width:21.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>FCICM</span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>5</span></p></td><td style="width:69.8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>Royal Australasian College of Surgeons</span><
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