Health Insurance Legislation Amendment (2025 Measures No. 1) Regulations 2025

I, the Honourable Sam Mostyn AC, Governor‑General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulations.

Dated   29 May 2025

Sam Mostyn AC

Governor‑General

By Her Excellency’s Command

Mark Butler

Minister for Health and Ageing

Contents

1 Name

2 Commencement

3 Authority

4 Schedules

Schedule 1—Amendments

Health Insurance (General Medical Services Table) Regulations 2021

Health Insurance Regulations 2018

1  Name

  This instrument is the Health Insurance Legislation Amendment (2025 Measures No. 1) Regulations 2025.

2  Commencement

 (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

 (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3  Authority

  This instrument is made under the Health Insurance Act 1973.

4  Schedules

  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule 1—Amendments

Health Insurance (General Medical Services Table) Regulations 2021

1  Subclause 1.2.5(1) of Schedule 1

After “388,”, insert “392, 393,”.

2  Subclause 1.2.5(1) of Schedule 1

After “903,”, insert “965, 967,”.

3  Subclause 1.2.6(1) of Schedule 1

Omit “348 to 417”, substitute “348 to 388, 410 to 417”.

4  Subclause 1.2.7(1) of Schedule 1

Omit “732,”.

5  Subclause 1.2.7(1) of Schedule 1

After “903,”, insert “965, 967,”.

6  Division 2.10 of Schedule 1 (paragraph (b) of note 2 to Division heading)

Repeal the paragraph.

7  Division 2.10 of Schedule 1 (paragraph (f) of note 2 to Division heading)

Repeal the paragraph, substitute:

(f) preparing a GP chronic condition management plan (see clause 2.16.7);

8  Schedule 1 (Subgroup 6 of Group A7 table, heading)

Repeal the heading, substitute:

Subgroup 6—Prescribed medical practitioner chronic condition management plans, multidisciplinary care plans and case conferences

9  Schedule 1 (items 229, 230 and 233)

Repeal the items.

10  Schedule 1 (items 235, 236, 237, 238, 239 and 240, column 2)

Omit “229 to 233 and 721 to 732”, substitute “231, 232, 392, 393, 729, 731, 965, 967, 92029, 92030, 92060 or 92061”.

11  Schedule 1 (after item 244)

Insert:

12  Schedule 1 (item 249, column 2)

Omit “permanent resident of”, substitute “care recipient in”.

13  Subclause 2.15.14(3) of Schedule 1

Omit “usual general practitioner or prescribed medical practitioner”, substitute “usual medical practitioner”.

14  Division 2.16 of Schedule 1 (heading)

Repeal the heading, substitute:

Division 2.16—Group A15 and Subgroup 6 of Group A7: GP chronic condition management plans, multidisciplinary care plans and case conferences

Note: Items in Subgroup 6 of Group A7 are set out in Division 2.10.

15  Clause 2.16.1 of Schedule 1 (heading)

Repeal the heading, substitute:

2.16.1  Restrictions on items 729 to 866, 965 and 967, 231 to 240 and 392 and 393—services by certain medical practitioners

16  Before subclause 2.16.1(1) of Schedule 1

Insert:

 (1A) This clause applies to items 729 to 866, 965 and 967, 231 to 240 and 392 and 393.

17  Subclause 2.16.1(1) of Schedule 1

Omit “Items 729 to 866 and items 229 to 240”, substitute “The items”.

18  Clause 2.16.2 of Schedule 1

Repeal the clause, substitute:

2.16.2  Meaning of associated medical practitioner

  In items 967 and 393:

associated medical practitioner means a medical practitioner who, if not engaged in the same general practice as the general practitioner or prescribed medical practitioner mentioned in the item, performs the service described in the item at the request of the patient (or the patient’s guardian).

19  Clauses 2.16.4 and 2.16.5 of Schedule 1

Repeal the clauses.

20  Clauses 2.16.7 to 2.16.10 of Schedule 1

Repeal the clauses, substitute:

2.16.7  Meaning of preparing a GP chronic condition management plan

 (1) In items 965 and 392:

preparing a GP chronic condition management plan, for a patient, means a process by which a general practitioner (for item 965) or a prescribed medical practitioner (for item 392):

 (a) prepares a written plan for the patient that describes:

 (i) the patient’s chronic condition and associated health care needs; and

 (ii) health and lifestyle goals developed by the patient and medical practitioner using a shared decision making approach; and

 (iii) actions to be taken by the patient; and

 (iv) treatment and services the patient is likely to need; and

 (v) if the patient would benefit from multidisciplinary care to manage the chronic condition, the treatments or services to which the practitioner will refer the patient (including the purposes of those treatments or services); and

 (vi) arrangements to review the plan (including the proposed timeframe for review); and

 (b) if the patient is to be referred to a member or members of a multidisciplinary team for management of the patient’s chronic condition:

 (i) obtains the patient’s consent to sharing relevant information (including relevant parts of the plan) with the members of the multidisciplinary team; and

 (ii) if the patient so consents—provides relevant parts of the plan to the members of the multidisciplinary team; and

 (c) records the patient’s consent and agreement to the preparation of the plan; and

 (d) offers a copy of the plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

 (e) adds a copy of the plan to the patient’s medical records.

 (2) For the purposes of this clause, a member of a multidisciplinary team is a person other than the general practitioner or prescribed medical practitioner who:

 (a) provides treatment or a service to the patient; and

 (b) provides a different kind of treatment or service to the patient than each other member of the multidisciplinary team; and

 (c) is not an unpaid carer of the patient.

2.16.8  Meaning of reviewing a GP chronic condition management plan

 (1) In items 967 and 393:

reviewing a GP chronic condition management plan, in relation to a patient with a GP chronic condition management plan, means a process by which a general practitioner (for item 967) or a prescribed medical practitioner (for item 393):

 (a) discusses with the patient, and documents:

 (i) the patient’s progress in relation to meeting the goals mentioned in paragraph (a) of the definition of preparing a GP chronic condition management plan; and

 (ii) whether any updates should be made to the GP chronic condition management plan;

  taking into account:

 (iii) whether the goals remain appropriate and the degree of progress towards meeting the goals; and

 (iv) information provided by members of the multidisciplinary team (if any) referred to in paragraph (b) of the definition of preparing a GP chronic condition management plan in relation to the members’ treatment of the patient and the extent to which the treatments or services provided by the members are supporting the patient to meet the patient’s goals; and

 (b) updates the arrangements to review the plan (including the proposed timeframe for review); and

 (c) makes any other updates to the plan required as a result of the discussions referred to in paragraph (a); and

 (d) if the patient is to be referred to a member or members of a multidisciplinary team for management of the patient’s chronic condition:

 (i) obtains the patient’s consent to sharing relevant information (including relevant parts of the plan) with the members of the multidisciplinary team; and

 (ii) if the patient so consents—provides relevant updated parts of the plan to the members of the multidisciplinary team; and

 (e) records the patient’s consent and agreement to the updates; and

 (f) offers a copy of the updated plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

 (g) adds a copy of the updated plan to the patient’s medical records.

 (2) For the purposes of this clause, a member of a multidisciplinary team is a person other than the general practitioner or prescribed medical practitioner who:

 (a) provides treatment or a service to the patient; and

 (b) provides a different kind of treatment or service to the patient than each other member of the multidisciplinary team; and

 (c) is not an unpaid carer of the patient.

2.16.9  Restrictions on items 729, 731, 965, 967, 231, 232, 392 and 393—services for certain patients

 (1) An item of this Schedule mentioned in column 1 of table 2.16.9 applies only to a service for a patient who:

 (a) suffers from at least one chronic condition; and

 (b) is described in column 2 of table 2.16.9.

 (2) For the purposes of this clause, a collaborating provider is a person who:

 (a) provides treatment or a service to a patient; and

 (b) is not an unpaid carer of the patient.

2.16.10  Restrictions on items 965, 967, 392 and 393 (GP chronic condition management plans)

Items 965 and 967

 (1) Items 965 and 967 apply only to a service provided in the course of personal attendance by a single general practitioner on a single patient.

Items 392 and 393

 (2) Items 392 and 393 apply only to a service provided in the course of personal attendance by a single prescribed medical practitioner on a single patient.

Items 965, 967, 392 and 393

 (3) Practice nurses, Aboriginal health workers and Aboriginal and Torres Strait Islander health practitioners may assist general practitioners or prescribed medical practitioners in preparing or reviewing a GP chronic condition management plan, in accordance with accepted medical practice, and under the supervision of the general practitioner or the prescribed medical practitioner, as the case may be.

 (4) For the purposes of subclause (3), assistance may include activities associated with:

 (a) information collection; and

 (b) supporting collaboration with a multidisciplinary team (if any) to which the patient is or is to be referred in accordance with the plan; and

 (c) at the direction of the general practitioner or prescribed medical practitioner—providing further information to the patient on any treatments, services or interventions considered or discussed during preparation or review of the plan.

21  Clause 2.16.11 of Schedule 1 (heading)

Omit “721, 723, 732, 229, 230 and 233”, substitute “965, 967, 392, 393, 92029, 92030, 9206 and 92061”.

22  Clause 2.16.11 of Schedule 1

Omit “721, 723, 732, 229, 230 or 233”, substitute “965, 967, 392, 393, 92029, 92030, 9206 and 92061”.

23  Clauses 2.16.12 and 2.16.12A of Schedule 1

Repeal the clauses, substitute:

2.16.12  Conditions relating to timing of services in items 231, 232, 392, 393, 729, 731, 965 and 967 if exceptional circumstances do not exist

 (1) Subclause (3) applies to the performances of services for a patient for whom exceptional circumstances do not exist.

 (2) For the purposes of subclause (1), exceptional circumstances, for a patient, means there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service for the patient.

 (3) An item of this Schedule mentioned in column 1 of an item of table 2.16.12 applies in the circumstances mentioned in column 2 of that item of table 2.16.12.

24  Clause 2.16.13 of Schedule 1 (Group A15 table, table heading)

Repeal the heading, substitute:

Group A15—GP chronic condition management plans, multidisciplinary care plans and case conferences

25  Schedule 1 (Subgroup 1 of Group A15 table, heading)

Repeal the heading, substitute:

Subgroup 1—GP chronic condition management plans and multidisciplinary care plans

26  Schedule 1 (items 721, 723 and 732)

Repeal the items.

27  Schedule 1 (at the end of Subgroup 1 of Group A15)

Add:

28  Clause 2.16.20 of Schedule 1 (Group A15 table, table heading)

Repeal the heading, substitute:

Group A15—GP chronic condition management plans, multidisciplinary care plans and case conferences

29  Schedule 1 (items 735, 739, 743, 747, 750 and 758, column 2)

Omit “items 721 to 732 apply”, substitute “item 729, 731, 965, 967, 231, 232, 392, 393, 92026, 92027, 92029, 92030, 92057, 92058, 92060 or 92061 applies”.

30  After clause 2.17.3 of Schedule 1

Insert:

2.17.3A  Restrictions on items 900 and 245—domiciliary medication management reviews

  Items 900 and 245 apply to a service provided on or after 1 July 2027 only if the patient has a GP chronic condition management plan that was prepared, or has been reviewed, in the period of 18 months ending immediately before the service to which item 900 or 245 applies is provided.

31  Clause 3.1.1 of Schedule 1

Insert:

GP chronic condition management plan means a plan under item 392, 965, 92029 or 92060.

32  Clause 3.1.1 of Schedule 1 (definition of GP management plan)

Omit “721 or 732 (for coordination of a review of a GP management plan under item 721)”, substitute “229, 721, 92024 or 92055”.

33  Clause 3.1.1 of Schedule 1

Insert:

person with a chronic condition means:

 (a) a person who has a plan under item 231, 232, 392, 729, 731, 965, 92026, 92027, 92029, 92030, 92057, 92058, 92060 or 92061; or

 (b) until the end of 30 June 2027—a person who has a plan under item 229, 230, 721, 723, 92024, 92025, 92028, 92055, 92056 or 92059 that was prepared before 1 July 2025.

34  Clause 3.1.1 of Schedule 1 (definition of person with a chronic disease)

Repeal the definition.

35  Schedule 1 (cell at item 10997, column 2)

Repeal the cell, substitute:

36  Clause 3.2.1 of Schedule 1 (definition of MyMedicare)

Repeal the definition.

37  Schedule 1 (item 11607, column 2, subparagraph (g)(ii))

Repeal the subparagraph, substitute:

(ii) is not associated with a service to which any of the following items apply:

(A) 177;

(B) 224 to 228;

(C) 231 to 244;

(D) 392 or 393;

(E) 699;

(F) 701 to 707;

(G) 715;

(H) 729, 731, 965 or 967;

(I) 735 to 758;

(J) 92004, 92011, 92026, 92027, 92029, 92030, 92057, 92058, 92060 or 92061.

38  Schedule 1 (item 11607, column 2, note)

Repeal the note.

39  Clause 7.1.1 of Schedule 1 (definition of associated general practitioner)

Repeal the definition, substitute:

associated general practitioner, for item 2712, has the meaning given by clause 2.20.5.

40  Clause 7.1.1 of Schedule 1 (paragraph (a) of the definition of associated medical practitioner)

Repeal the paragraph, substitute:

 (a) for items 393 and 967—has the meaning given by clause 2.16.2.

41  Clause 7.1.1 of Schedule 1

Insert:

chronic condition means a medical condition that:

 (a) has been (or is likely to be) present for at least 6 months; or

 (b) is terminal.

42  Clause 7.1.1 of Schedule 1 (definitions of coordinating a review of team care arrangements and coordinating the development of team care arrangements)

Repeal the definitions.

43  Clause 7.1.1 of Schedule 1

Insert:

GP chronic condition management plan, for item 10997, has the meaning given by clause 3.1.1.

MyMedicare means the registration program by that name administered by the Department.

44  Clause 7.1.1 of Schedule 1 (definition of patient’s usual general practitioner)

Repeal the definition.

45  Clause 7.1.1 of Schedule 1

Insert:

person with a chronic condition, for item 10997, has the meaning given by clause 3.1.1.

46  Clause 7.1.1 of Schedule 1 (definition of person with a chronic disease)

Repeal the definition.

47  Clause 7.1.1 of Schedule 1

Insert:

preparing a GP chronic condition management plan, for items 392 and 965, has the meaning given by clause 2.16.7.

48  Clause 7.1.1 of Schedule 1 (definition of preparing a GP management plan)

Repeal the definition.

49  Clause 7.1.1 of Schedule 1

Insert:

reviewing a GP chronic condition management plan, for items 393 and 967, has the meaning given by clause 2.16.8.

50  Clause 7.1.1 of Schedule 1 (definition of reviewing a GP management plan)

Repeal the definition.

51  Clause 7.1.1 of Schedule 1 (definition of team care arrangements)

Omit “723 or 732 (for a review of team care arrangements under item 723)”, substitute “230, 729, 92025 or 92056”.

52  Clause 7.1.1 of Schedule 1

Insert:

usual medical practitioner, in relation to a patient, means a general practitioner or prescribed medical practitioner:

 (a) who has provided the majority of services to the person in the past 12 months; or

 (b) who is likely to provide the majority of services to the person in the following 12 months; or

 (c) located at a medical practice that:

 (i) has provided the majority of services to the person in the past 12 months; or

 (ii) is likely to provide the majority of services to the person in the next 12 months.

Health Insurance Regulations 2018

53  Subsection 28(1) (table item 10, column 2)

Omit “229, 230, 231, 232, 233,”, substitute “231, 232,”.

54  Subsection 28(1) (table item 10, column 2)

After “244,”, insert “392, 393,”.

55  Subsection 28(1) (table item 19, column 2)

Omit “721, 723, 729, 731, 732,”, substitute “729, 731,”.

56  Subsection 28(1) (at the end of the cell at table item 19, column 2)

Add “, 965, 967”.

57  Subsection 28(1) (cell at table item 28H, column 2)

Repeal the cell, substitute: