AUSTRALIAN GOVERNMENT

DEPARTMENT OF HEALTH AND AGED CARE

HEALTH INSURANCE ACT 1973

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – South Australia - Medical Services performed under the Single Employer Model Trial) Direction 2024

I, Nigel Murray, Assistant Secretary, MBS Policy and Specialist Programs Branch, Medicare Benefits and Digital Health Division, Health Resourcing Group, delegate for the Minister for Health and Aged Care, acting under subsection 19(2) of the Health Insurance Act 1973, hereby:

DIRECT that Medicare Benefits shall be payable in respect of:

(a) A professional service (as defined in section 3 of the Health Insurance Act 1973) which has been agreed to be provided under the Rural General Practice and Rural Generalist Single Employer Model Trial Memorandum of Understanding between the Department of Health and Aged Care (ABN: 83 605 426 759) and the South Australian Department of Health and Wellbeing (ABN: 97 643 356 590) in relation to the rural general practice and rural generalists single employer model trial within regional South Australia for which;

(i) items specified in Schedule A of this Direction; and of the general medical services table (means the table prescribed under subsection 4(1) of the Health Insurance Act 1973), diagnostic imaging services table (means the table prescribed under subsection 4AA(1) of the Health Insurance Act 1973) and pathology services table (means the table prescribed under subsection 4A(1) of the Health Insurance Act 1973) relates: and

(b) Where the professional service is provided to:

(i) an eligible person (as defined in section 3 of the Health Insurance Act 1973); and

(ii) a patient who is not receiving the service as part of an episode of hospital treatment (as defined in section 121-5 of the Private Health Insurance Act 2007); and

(iii) a patient who also is not receiving a service which attracts a payment through the 2020-2025 Addendum to the National Health Reform Agreement for a service rendered to a public patient; and

(i) at a general practice (as defined in section 7.1.1 of the general medical services table); and

(ii) at a rural or remote practice location specified in Schedule B in Modified Monash Model 2-7 (as defined in section 7.1.1 of the general medical services table); and

(iii) by a participating rural generalist or rural general practice trainee mentioned in paragraph 1(a):

who is formally enrolled in a fellowship training program that meets the training standards of either:
1. the Australian College of Rural and Remote Medicine; and/or;
2. The Royal Australian College of General Practitioners.
who is employed by the South Australian Department of Health and Wellbeing for the provision of primary and acute care services; and

(iv) by one of the sixty participating rural generalist and rural general practice trainees who are eligible to use this Direction at any one time.

DECLARE that this Direction commences on 5 August 2024 and ceases to have effect at the end of 31 December 2028 unless earlier revoked.

Date this 18 July 2024

Nigel Murray

Assistant Secretary

MBS Policy and Specialist Programs Branch

Medicare Benefits and Digital Health Division

Health Resourcing Group

Department of Health and Aged Care

SCHEDULE A

MEDICARE BENEFITS SCHEDULE ITEMS AS AGREED under the SOUTH AUSTRALIAN Department of Health AND WELLBEING rural general practice and rural Generalist SINGLE EMPLOYER Model TRIAL

For services listed in the below tables, all provisions of the Health Insurance Act 1973 (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 apply.

General Medical Services Table

Group	Group Name	Subgroup	Subgroup Name
A1	General practitioner attendances to which no other item applies
A2	Other non-referred attendances to which no other item applies
A5	Prolonged attendances to which no other item applies
A6	Group therapy
A7	Acupuncture and non-specialist practitioner items	All
A11	Urgent attendances after-hours
A14	Health assessments
A15	GP Management plans, team care arrangements and multidisciplinary care plans and case	1	GP Management plans, team care arrangements and multidisciplinary care plans
A15		2	Case conferences
A17	Domiciliary and residential medication management reviews
A20	GP Mental Health treatment	All
A22	General practitioner after-hours attendances to which no other item applies
A23	Other non-referred after-hour attendances to which no other item applies
A27	Pregnancy support counselling
A29	Attendance services for complex neurodevelopmental disorder or disability
A35	Non-referred attendance at a residential aged care facility
A36	Eating Disorder Services	1	GP and Medical Practitioner eating disorder treatment and management plans
		3	Review of eating disorder treatment and management plan
		4	GP and medical practitioner eating disorder s psychological treatment services
A40	Telehealth and phone attendance services	1	General practice telehealth services
		2	General practice phone services
		3	Focussed psychological strategies telehealth services
		10	Focussed psychological strategies phone services
		11	Health assessments for Aboriginal and Torres Strait Islander People - telehealth services
		13	GP management plans, team care arrangements and multidisciplinary care plans via telehealth attendance
		15	GP pregnancy support counselling - telehealth services
		16	GP pregnancy support counselling - phone services
		17	GP, Specialist and Consultant Physician autism service - telehealth services
		19	GP mental health treatment plan - telehealth services
		20	GP mental health treatment plan - phone services
		21	GP Eating Disorder Treatment and Management Plan – telehealth services
		22	GP Eating Disorder Treatment and Management Plans - phone services
		25	Review of an eating disorder Plan - telehealth services
		26	Review of an Eating Disorder Plan – phone services
		27	Eating Disorder Focussed Psychological Strategies – telehealth services
		28	GP - Eating Disorder Focussed Psychological Strategies – phone services
		29	GP and Other Medical Practitioner - urgent after hours service in unsociable hours - telehealth services
		37	Specialist, anaesthesia – Telehealth Services
		39	GP Sexual and Reproductive Health Consultation – Telehealth Service
		40	GP Sexual and Reproductive Health Consultation – Phone Service
A44	General practice attendance for assessing patient suitability for a COVID-19 vaccine	All
A46	COVID-19 management support service
M1	Management of bulk billed services
M12	Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner	1	Video conferencing consultation support service provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner
		2	Video conferencing consultation support service provided at a residential aged care facility on behalf of a medical practitioner
		3	Services provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner

For services listed in the below table, this list of items includes MBS items that are not commonly claimed by doctors in primary care. Medical practitioners and health services must ensure they fulfil the MBS requirements for these items.

Non-Standard Primary Care Services Table

D1	Miscellaneous diagnostic procedures and investigations	2	Ophthalmology
		3	Otolaryngology
		4	Respiratory
		5	Vascular
		6	Cardiovascular
		8	Genito-urinary physiological investigations
		9	Allergy testing
		10	Other diagnostic procedures and investigations
D2	Nuclear Medicine (non-imaging)
T1	Miscellaneous therapeutic procedures	2	Dialysis
		4	Paediatric and neonatal
		5	Cardiovascular
		8	Haematology
		9	Procedures associated with intensive care and cardiopulmonary support
		11	Chemotherapeutic procedures
		13	Other therapeutic procedures
T2	Radiation oncology	1	Superficial
T3	Therapeutic nuclear medicine
T4	Obstetrics
T6	Examination by anaesthetist
T7	Regional or field nerve blocks
T8	Surgical Operations	1	General
		2	Colorectal
		3	Vascular
		4	Gynaecological
		5	Urological
		6	Cardio-thoracic
		7	Neurosurgical
		8	Ear, nose and throat
		9	Ophthalmology
		11	Paediatric
		12	Amputations
		13	Plastic and reconstructive surgery
		14	Hand surgery
		15	Orthopaedic
T9	Assistance at operations
T10	Anaesthesia performed in connect with certain services (relative value guide)	All

Diagnostic Imaging Services Table

Group	Group Name	Subgroup	Subgroup Name
I1	Ultrasound	6	Musculoskeletal ultrasound
I3	Diagnostic Radiology	1	Radiographic examination of extremities
		2	Radiographic examination of shoulder or pelvis
		3	Radiographic examination of head
		4	Radiographic examination of spine
		5	Bone age study and skeletal survey
		6	Radiographic examination of thoracic region
		7	Radiographic examination of urinary tract
		8	Radiographic examination of alimentary tract and biliary system
		12	Radiographic examination with opaque or contrast media
I6	Management of bulk billed Services

Pathology Services Table

Group	Group Name
P1	Haematology
P2	Chemical
P9	Simple Basic Pathology Tests
P12	Management of bulk billed services

SCHEDULE B

MEDICARE BENEFITS SCHEDULE ITEMS AS AGREED under the SOUTH AUSTRALIAN Department of Health AND WELLBEING rural general practice and rural Generalist SINGLE EMPLOYER Model TRIAL

Approved primary care Modified Monash Model (MMM) 5 locations:

MMM 5 location	Practice Name	Legal Name	Street Address
Mount Pleasant	Talunga Clinic	The Trustee for TALUNGA CLINIC UNIT TRUST	28 Hospital Road Mount Pleasant SA 5235

Approved primary care Modified Monash Model (MMM) 7 locations:

MMM 7 location	Practice Name	Legal Name	Street Address
Kingscote	Kangaroo Island Medical Clinic	The Trustee for THE KIM CLINIC UNIT TRUST	64 Murray Street Kingscote SA 5223