Section 19(2) Health Insurance Act 1973 (the Act) this section prohibits the payment of Medicare benefits where other government funding is provided for that service.
What it does
The Council of Australian Governments (COAG) introduced the Section 19(2) Exemptions Initiative (the Initiative) - Improving Access to Primary Care in Rural and Remote Areas Initiative in conjunction of the Better Health for All Australians Action Plan under the 2006-2007 Federal Budget process.
The Initiative provides for exemptions under s19(2) of the Act to allow exempted eligible sites to claim against the Medicare Benefits Schedule (MBS) for non-admitted, non-referred professional services (including nursing, midwifery, allied and dental services) provided in emergency departments and outpatient clinic settings.
Queensland, Western Australia, New South Wales, South Australia, Northern Territory and Victoria all participate in the Initiative through a bilateral Memoranda of Understanding (MoU) with the Commonwealth which have been extended from 31 December 2021 to 30 June 2022 while a new MoU with jurisdictions is being negotiated.
Tasmania originally elected not to be part of the Initiative under the original COAG agreement but remain eligible to participate.
What it Achieves?
The Initiative recognises that many patients in small rural and remote towns have limited access to primary health care services and that in response to a lack of private practices, many rural and remote public hospitals have employed medical officers to make traditional GP services available.
The 2016-2020 MoUs have been updated to a single criterion that requires an eligible public health site to be located within categories five to seven of the Modified Monash Model (MMM) classification system. The MoU also allows for sites to be phased out over a twelve month period where they are deemed no longer to be eligible.
The following hospitals and health services have been approved under the Initiative (128 sites):
In 2021 the Australian Government Department of Health conducted an independent evaluation of the Initiative.
The evaluation of the Initiative assessed the extent to which the Initiative has been appropriate, effective, efficient and of quality and value to the Commonwealth and participating jurisdictions. Consultations were undertaken with a range of stakeholders including States and the Northern Territory (noting the Australian Capital Territory is not an eligible jurisdiction) as part of the evaluation. Jurisdictions were invited to respond to the draft findings of the evaluation which were considered in the finalisation of the report. The evaluation findings has provided valuable information on the operation and implementation of the Initiative.
Read the Evaluation Report.
Please contact your health department in your State or Territory.