AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGED CARE HEALTH INSURANCE ACT 1973 Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Riverland Mallee Coorong Local Health Network) Direction 2022 I, Travis Haslam, Acting First Assistant Secretary, Medical Benefits 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: 1. 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 Generalist Single Employer Model Trial between the Department of Health and Aged Care (ABN: 24 004 196 909), the Riverland Mallee Coorong Local Health Network (ABN: 44 685 908 941) and the South Australian Department for Health and Wellbeing (ABN: 97 643 356 590) in relation to the rural generalists single employer model 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); (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 (c) the professional services referred to in clause (a) must be provided: (i) at a general practice (as defined in Section 7.1.1 of the general medical services table); and (ii) at: 1. a rural or remote practice location specified in Schedule B in Modified Monash Model 3-7 (as defined in Section 7.1.1 of the general medical services table); or 2. A location described in the Rural Generalist Single Employer Model Trial Memorandum of Understanding between the department, the Riverland Mallee Coorong Local Health Network and the South Australian Department for Health and Wellbeing; and (iii) by a participating rural generalist trainee mentioned in (a): 1. who is formally enrolled in: 1. the Australian College of Rural and Remote Medicine Independent Pathway; 2. The Royal Australian College of General Practitioners Practice Experience Program, or equivalent; 3. The Australian General Practice Training Program; 4. The Rural Generalist Training Scheme; or 5. The Remote Vocational Training Scheme; and 2. who is employed by the Riverland Mallee Coorong Local Health Network for the provision of primary and acute care services; 3. is registered in the Riverland Academy of Clinical Excellence rural generalist training program within the Riverland Mallee Coorong Local Health Network region; and (iv) by one of the twenty rural generalist participants who are eligible to use this Direction at any one time. DECLARED that this Direction shall have effect from the date of signature until 30 June 2027 inclusive unless earlier revoked. Date this 4th day of November 2022 Travis Haslam Acting First Assistant Secretary Medical Benefits Division Health Resourcing Group Department of Health and Aged Care SCHEDULE A MEDICARE BENEFITS SCHEDULE ITEMS AS AGREED under the Riverland Mallee Coorong Local Health Network 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 2 Case conferences A17 Domiciliary and residential medication management reviews A18 Attendances associated with Practice Incentive Program payments All A19 Attendances associated with Practice Incentive Program payments All A20 Mental health Care 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 Early intervention services for children with autism, pervasive development disorder or disability A30 Medical practitioner video conferencing consultation 1 Video conferencing consultation attendance at consulting rooms, home visit of other institution 2 Video conferencing consultation attendance at a residential aged care facility 3 Mental health and well-being video conferencing consultation 5 General practitioner video conferencing consultation attendance for patients in rural and remote areas 6 Other non-referred video conferencing consultation attendance for patients in rural and remote areas 7 Non-specialist practitioner video conferencing consultation for patients in rural and remote areas 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 A39 Bushfire Recovery Access Initiative – GP and Medical Practitioner Focussed Psychological Strategies A40 COVID-19 Services 1 COVID-19 general practice - telehealth services 2 COVID-19 general practice - phone services 3 COVID-19 Focussed psychological strategies - telehealth services 10 COVID-19 Focussed psychological strategies - phone services 11 Health assessments for Aboriginal and Torres Strait Islander People - telehealth services 12 Health assessments for Aboriginal and Torres Strait Islander People - phone Services 13 GP management plans, team care arrangements and multidisciplinary care plans via telehealth attendance 14 GP management plans, team care arrangements and multidisciplinary care plans via phone 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 18 GP, Specialist and Consultant Physician autism service - phone 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 GP - 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 30 GP and Other Medical Practitioner - urgent after hours service in unsociable hours - phone services 37 Specialist, anaesthesia – Telehealth Services 39 GP Sexual and Reproductive Health Consultation – Telehealth Service 40 GP Sexual and Reproductive Health Consultation – Phone Service A41 Additional focussed psychological strategies 1 GP additional focussed psychological strategies 2 Non specialist practitioner addition focussed psychological strategies A42 Mental health planning for care recipients of an residential aged care facility A45 Nicotine and Smoking Cessation Counselling 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 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 Miscellaneous 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 Ear, nose and throat 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 Cardiovascular 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 Approved Modified Monash 3-7 rural and remote Practice Locations AS AGREED under the Riverland Mallee Coorong Local Health Network rural Generalist SINGLE EMPLOYERModel TRIAL Approved primary care Modified Monash Model (MMM) 3 locations: MMM 3 location Practice Name Street Address Murray Bridge Bridge Clinic 8 Standen Street, Murray Bridge SA 5253 Approved primary care Modified Monash Model (MMM) 5 locations: MMM 5 location Practice Name Street Address Renmark Renmark Medical Clinic 64 Thurk Street, Renmark SA 5341 Berri Berri Medical Clinic 29 McGilton Road, Berri SA 5343 Barmera Barmera Medical Clinic 24 Hawdon Street, Barmera SA 5345 Loxton Loxton Health Centre 11 Anzac Crs, Loxton SA 5333 Waikerie Waikerie Medical Centre 2 Strangman Road, Waikerie SA 5330 Mannum Mannum Medical Centre Box & Parker Street, Mannum SA 5238 Meningie Coorong Medical Centre 2 South Terrace, Meningie SA 5264