1Name#
This instrument is the Health Insurance Legislation Amendment (2026 Measures No. 3) Regulations 2026.
2Commencement#
(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.
| Commencement information | ||
|---|---|---|
| Column 1 | Column 2 | Column 3 |
| Provisions | Commencement | Date/Details |
| 1. The whole of this instrument | 1 November 2026. | 1 November 2026 |
Note: This table relates only to the provisions of this instrument as originally made.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.
4Schedules#
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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
Part 1 · Thriving kids
Health Insurance (General Medical Services Table) Regulations 2021#
1 At the end of subclause 2.15.2(1) of Schedule 1
Add:
; (h) a Medicare Healthy Kids Check, in accordance with clause 2.15.11, for a patient who:
(i)is 3 years old; and
(ii)has not already received such an assessment; and
(iii)is not an in-patient of a hospital.
2 After clause 2.15.10 of Schedule 1
Insert:
2.15.11Medicare Healthy Kids Check#
(1)A Medicare Healthy Kids Check is an assessment of:
(a)the patient’s physical, social and emotional development, health and wellbeing; and
(b)whether health care (including preventive health care), education, referrals or other assistance should be offered to the patient, or the patient’s parent or carer, to improve the patient’s physical, social and emotional development, health and wellbeing.
(2)The health assessment must include the following:
(a)taking a relevant history, including the following:
(i)the patient’s medical history, including previous presentations, hospital admissions, medication, immunisation status and allergies;
(ii)the patient’s behaviours and wellbeing;
(iii)an assessment of the patient against age-appropriate developmental milestones;
(iv)the patient’s family relationships, social circumstances, care arrangements and engagement in early childhood education and care;
(v)the patient’s family environment and exposures, including nutrition, physical activity, screen use, sleep hygiene and sleep patterns;
(vi)the patient’s toileting, including bowel habits and urinary continence;
(b)undertaking a basic physical examination of the patient, including by:
(i)examining the patient’s eyesight, hearing and oral health (teeth and gums); and
(ii)undertaking measurements of the patient’s height and weight to assess the patient’s growth against published centile charts, including body mass index;
(c)assessing the patient using the information gained in the health assessment;
(d)providing advice to the patient’s parent or carer to support:
(i)the patient’s physical, social and emotional development, health and wellbeing; and
(ii)the patient’s family to engage in activities that support the best potential outcomes for the patient’s physical, social and emotional development, health and wellbeing;
(e)making or arranging any necessary interventions and referrals for the patient;
(f)adding a record of the health assessment to the patient’s medical record;
(g)offering a written report on the health assessment to the patient’s parent or carer, with recommendations on matters covered by the health assessment.
Part 2 · Telehealth phone items for chronic condition management plans
Health Insurance (General Medical Services Table) Regulations 2021#
3 Schedule 1 (items 235, 236, 237, 238, 239 and 240, column 2)
Omit “92030, 92060 or 92061”, substitute “92030, 92033, 92034, 92060, 92061, 92063 or 92064”.
4 Clause 2.16.11 of Schedule 1 (heading)
Omit “92030, 92060 and 92061”, substitute “92030, 92033, 92034, 92060, 92061, 92063 and 92064”.
5 Clause 2.16.11 of Schedule 1
Omit “92030, 92060 and 92061”, substitute “92030, 92033, 92034, 92060, 92061, 92063 and 92064”.
6 Subclause 2.16.12(3) of Schedule 1 (item 1, column 2, paragraph (a))
Omit “92030 or 92061”, substitute “92030, 92034, 92061 or 92064”.
7 Subclause 2.16.12(3) of Schedule 1 (item 1, column 2, subparagraph (b)(i))
Omit “92029 or 92060”, substitute “92029, 92033, 92060 or 92063”.
8 Subclause 2.16.12(3) of Schedule 1 (item 2, column 2)
Omit “967, 92027, 92029, 92030, 92057, 92060 or 92061”, substitute “967, 92026, 92027, 92029, 92030, 92033, 92034, 92057, 92058, 92060, 92061, 92063 or 92064”.
9 Subclause 2.16.12(3) of Schedule 1 (item 3, column 2, paragraph (b))
Omit “92030, 92057, 92059 or 92061”, substitute “92030, 92034, 92057, 92058, 92061 or 92064”.
10 Subclause 2.16.12(3) of Schedule 1 (item 3, column 2, paragraph (c))
Omit “92029 or 92060”, substitute “92029, 92033, 92060 or 92063”.
11 Subclause 2.16.12(3) of Schedule 1 (item 4, column 2, paragraph (b))
Omit “92030 or 92061”, substitute “92030, 92034, 92061 or 92064”.
12 Schedule 1 (items 735, 739, 743, 747, 750 and 758, column 2)
Omit “92030, 92057, 92058, 92060 or 92061”, substitute “92030, 92033, 92034, 92057, 92058, 92060, 92061, 92063 or 92064”.
13 Clause 3.1.1 of Schedule 1 (definition of GP chronic condition management plan)
Omit “92029 or 92060”, substitute “92029, 92033, 92060 or 92063”.
14 Clause 3.1.1 of Schedule 1 (paragraph (a) of the definition of person with a chronic condition)
Omit “92030, 92057, 92058, 92060 or 92061”, substitute “92033, 92057, 92058, 92060 or 92063”.
15 Schedule 1 (item 11607, column 2, sub-subparagraph (g)(ii)(J))
Omit “92030, 92057, 92058, 92060 or 92061”, substitute “92030, 92033, 92034, 92057, 92058, 92060, 92061, 92063 or 92064”.
Health Insurance Regulations 2018#
15A Subsection 28(1) (after item 28H of the table)
Insert:
| 28HA | Subgroup 14 of Group A40 | 92033, 92034, 92063, 92064 |
Part 3 · Modified Monash Model amendments
Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020#
16 Clause 3.1 of Schedule 1
Insert:
2023 MM category has the same meaning as in the general medical services table.
17 Clause 3.1 of Schedule 1 (definition of Modified Monash 1 area)
Repeal the definition, substitute:
Modified Monash 1 area means an area with a 2023 MM category known as a Modified Monash 1 area or MM 1.
Health Insurance (General Medical Services Table) Regulations 2021#
18 Clause 7.1.1 of Schedule 1 (definition of 2016 estimated resident population)
Repeal the definition.
19 Clause 7.1.1 of Schedule 1
Insert:
2023 MM category means a category for an area provided for by the model known as the Modified Monash Model developed by the Department for categorising metropolitan, regional, rural and remote locations according to both geographical remoteness and population size, based on population data published by the Australian Bureau of Statistics, as the model exists on 1 November 2026.
Note: In 2026, the Modified Monash Model categorisation for a location could be viewed on the Department’s website (https://www.health.gov.au).
20 Clause 7.1.1 of Schedule 1 (definition of ASGS)
Repeal the definition.
21 Clause 7.1.1 of Schedule 1 (definition of Modified Monash 2 area)
Repeal the definition, substitute:
Modified Monash 2 area means an area with a 2023 MM category known as a Modified Monash 2 area or MM 2.
22 Clause 7.1.1 of Schedule 1 (definition of Modified Monash 3 area)
Repeal the definition, substitute:
Modified Monash 3 area means an area with a 2023 MM category known as a Modified Monash 3 area or MM 3.
23 Clause 7.1.1 of Schedule 1 (definition of Modified Monash 4 area)
Repeal the definition, substitute:
Modified Monash 4 area means an area with a 2023 MM category known as a Modified Monash 4 area or MM 4.
24 Clause 7.1.1 of Schedule 1 (definition of Modified Monash 5 area)
Repeal the definition, substitute:
Modified Monash 5 area means an area with a 2023 MM category known as a Modified Monash 5 area or MM 5.
25 Clause 7.1.1 of Schedule 1 (definition of Modified Monash 6 area)
Repeal the definition, substitute:
Modified Monash 6 area means an area with a 2023 MM category known as a Modified Monash 6 area or MM 6.
26 Clause 7.1.1 of Schedule 1 (definition of Modified Monash 7 area)
Repeal the definition, substitute:
Modified Monash 7 area means an area with a 2023 MM category known as a Modified Monash 7 area or MM 7.
27 Clause 7.1.1 of Schedule 1 (definition of Urban Centre and Locality)
Repeal the definition.
Part 4 · Consequential amendments arising from enactment of Aged Care Act 2024
Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020#
28 Clause 2.3.3 of Schedule 1 (heading)
Omit “residential aged care facilities”, substitute “residential care homes”.
29 Paragraph 2.3.3(2)(a) of Schedule 1
Omit “residential aged care facility during an attendance at the facility”, substitute “residential care home during an attendance at the residential care home”.
30 Paragraph 2.3.3(2)(c) of Schedule 1
Omit “facility”, substitute “residential care home”.
31 Paragraph 2.3.3(3)(a) of Schedule 1
Omit “residential aged care facility during an attendance at the facility”, substitute “residential care home during an attendance at the residential care home”.
32 Paragraph 2.3.3(3)(b) of Schedule 1
Omit “facility”, substitute “residential care home”.
33 Subclause 2.3.3(4) of Schedule 1
Omit “residential aged care facility”, substitute “residential care home”.
34 Paragraph 2.7.1(2)(b) of Schedule 1
Omit “residential aged care facilities”, substitute “residential care homes”.
35 Clause 3.1 of Schedule 1 (definition of residential aged care facility)
Repeal the definition.
36 Clause 3.1 of Schedule 1
Insert:
residential care home has the same meaning as in the Aged Care Act 2024.
Health Insurance (General Medical Services Table) Regulations 2021#
37 Schedule 1 (item 232, column 2, paragraph (a))
Repeal the paragraph, substitute:
(a) contribution to a multidisciplinary care plan, for a patient in a residential care home, prepared by that residential care home, or contribution to a review of a multidisciplinary care plan, for a patient, prepared by such a residential care home; or
38 Schedule 1 (item 731, column 2, paragraph (a))
Repeal the paragraph, substitute:
(a) a multidisciplinary care plan for a patient in a residential care home, prepared by that residential care home, or to a review of such a plan prepared by such a residential care home; or
39 Clause 7.1.1 of Schedule 1 (definition of residential aged care facility)
Repeal the definition.
40 Clause 7.1.1 of Schedule 1
Insert:
residential care home has the same meaning as in the Aged Care Act 2024.
41 Amendments of listed provisions
The provisions of Schedule 1 listed in the following table are amended as set out in the table.
| Amendments of listed provisions | |||
|---|---|---|---|
| Item | Provision | Omit | Substitute |
| 1 | Items 4, 24, 37, 47 and 124, column 2 | residential aged care facility | residential care home |
| 2 | Items 58, 59, 60, 65 and 165, column 2 | residential aged care facility | residential care home |
| 3 | Items 181, 187, 191, 206, 303 and 228, column 2 | residential aged care facility | residential care home |
| 4 | Items 235, 236, 237, 238, 239 and 240, column 2, paragraph (b) | residential aged care facility | residential care home |
| 5 | Item 249, column 2 | residential aged care facility | residential care home |
| 6 | Items 374, 375, 377, 378, 380, 381, 390 and 391, column 2 | residential aged care facility (wherever occurring) | residential care home |
| 7 | Item 294, column 2, subparagraph (e)(ii) | residential aged care facility | residential care home |
| 8 | Subparagraphs 2.15.2(1)(b)(iii) and (c)(ii) | residential aged care facility | residential care home |
| 9 | Paragraphs 2.15.2(1)(d) and (e) | residential aged care facility | residential care home |
| 10 | Subparagraph 2.15.2(1)(f)(iii) | residential aged care facility | residential care home |
| 11 | Subparagraph 2.15.3(1)(a)(ii) | residential aged care facility | residential care home |
| 12 | Clause 2.15.7 (heading) | residential aged care facility | residential care home |
| 13 | Subclause 2.15.7(1) | residential aged care facility | residential care home |
| 14 | Paragraphs 2.15.7(2)(e), (3)(b) and (4)(a) | residential aged care facility (wherever occurring) | residential care home |
| 15 | Item 715, column 2 | residential aged care facility | residential care home |
| 16 | Table 2.16.9, items 1, 2 and 3, column 2 | residential aged care facility (wherever occurring) | residential care home |
| 17 | Paragraph 2.16.19(1)(b) | residential aged care facility | residential care home |
| 18 | Items 735, 739, 743, 747, 750 and 758, column 2, paragraph (b) | residential aged care facility | residential care home |
| 19 | Clause 2.17.1 (definition of living in a community setting) | residential aged care facility | residential care home |
| 20 | Subclause 2.17.2(1) (definition of residential medication management review) | residential aged care facility | residential care home |
| 21 | Paragraph 2.17.2(3)(b) | residential aged care facility | residential care home |
| 22 | Item 903, column 2 | residential aged care facility | residential care home |
| 23 | Items 2485, 2486, 2488, 2489, 2491, 2492, 2494 and 2495, column 2 | residential aged care facility (wherever occurring) | residential care home |
| 24 | Paragraph 2.20.6(2)(a) | resident of an aged care facility | care recipient in a residential care home |
| 25 | Item 5003, column 2 | residential aged care facility | residential care home |
| 26 | Item 5010, column 2 | residential aged care facility (first occurring) | residential care home |
| 27 | Item 5010, column 2 | in the facility | in the residential care home |
| 28 | Item 5010, column 2 | residential aged care facility (second occurring) | residential care home |
| 29 | Item 5023, column 2 | residential aged care facility | residential care home |
| 30 | Items 5028, 5043, 5049, 5063, 5067, 5076, 5077, column 2 | residential aged care facility (wherever occurring) | residential care home |
| 31 | Items 5220, 5223, 5227, 5228 and 5261, column 2 | residential aged care facility | residential care home |
| 32 | Item 5260, column 2 | residential aged care facility (first occurring) | residential care home |
| 33 | Item 5260, column 2 | in the facility | in the residential care home |
| 34 | Item 5260, column 2 | residential aged care facility (second occurring) | residential care home |
| 35 | Item 5263, column 2 | residential aged care facility (first occurring) | residential care home |
| 36 | Item 5263, column 2 | in the facility | in the residential care home |
| 37 | Item 5263, column 2 | residential aged care facility (second occurring) | residential care home |
| 38 | Item 5265, column 2 | residential aged care facility (first occurring) | residential care home |
| 39 | Item 5265, column 2 | in the facility | in the residential care home |
| 40 | Item 5265, column 2 | residential aged care facility (second occurring) | residential care home |
| 41 | Item 5267, column 2 | residential aged care facility (first occurring) | residential care home |
| 42 | Item 5267, column 2 | in the facility | in the residential care home |
| 43 | Item 5267, column 2 | residential aged care facility (second occurring) | residential care home |
| 44 | Item 5262, column 2 | residential aged care facility (first occurring) | residential care home |
| 45 | Item 5262, column 2 | at the facility and | in the residential care home who |
| 46 | Item 5262, column 2 | residential aged care facility (second occurring) | residential care home |
| 47 | Division 2.30 (heading) | residential aged care facility | residential care home |
| 48 | Clause 2.30.1 (heading) | residential aged care facility | residential care home |
| 49 | Subclauses 2.30.1(1) and (2) | residential aged care facility | residential care home |
| 50 | Group A35 table (heading) | residential aged care facility | residential care home |
| 51 | Item 90020, column 2 | residential aged care facility (first occurring) | residential care home |
| 52 | Item 90020, column 2 | in the facility | in the residential care home |
| 53 | Item 90020, column 2 | residential aged care facility (second occurring) | residential care home |
| 54 | Items 90035, 90043, 90051 and 90054, column 2 | residential aged care facility (wherever occurring) | residential care home |
| 55 | Item 90092, column 2 | residential aged care facility (first occurring) | residential care home |
| 56 | Item 90092, column 2 | in the facility | in the residential care home |
| 57 | Item 90092, column 2 | residential aged care facility (second occurring) | residential care home |
| 58 | Item 90093, column 2 | residential aged care facility (first occurring) | residential care home |
| 59 | Item 90093, column 2 | in the facility | in the residential care home |
| 60 | Item 90093, column 2 | residential aged care facility (second occurring) | residential care home |
| 61 | Item 90095, column 2 | residential aged care facility (first occurring) | residential care home |
| 62 | Item 90095, column 2 | in the facility | in the residential care home |
| 63 | Item 90095, column 2 | residential aged care facility (second occurring) | residential care home |
| 64 | Item 90096, column 2 | residential aged care facility (first occurring) | residential care home |
| 65 | Item 90096, column 2 | in the facility | in the residential care home |
| 66 | Item 90096, column 2 | residential aged care facility (second occurring) | residential care home |
| 67 | Item 90098, column 2 | residential aged care facility (first occurring) | residential care home |
| 68 | Item 90098, column 2 | in the facility | in the residential care home |
| 69 | Item 90098, column 2 | residential aged care facility (second occurring) | residential care home |
| 70 | Item 90183, column 2 | residential aged care facility (first occurring) | residential care home |
| 71 | Item 90183, column 2 | in the facility | in the residential care home |
| 72 | Item 90183, column 2 | residential aged care facility (second occurring) | residential care home |
| 73 | Item 90188, column 2 | residential aged care facility (first occurring) | residential care home |
| 74 | Item 90188, column 2 | in the facility | in the residential care home |
| 75 | Item 90188, column 2 | residential aged care facility (second occurring) | residential care home |
| 76 | Item 90202, column 2 | residential aged care facility (first occurring) | residential care home |
| 77 | Item 90202, column 2 | in the facility | in the residential care home |
| 78 | Item 90202, column 2 | residential aged care facility (second occurring) | residential care home |
| 79 | Item 90212, column 2 | residential aged care facility (first occurring) | residential care home |
| 80 | Item 90212, column 2 | in the facility | in the residential care home |
| 81 | Item 90212, column 2 | residential aged care facility (second occurring) | residential care home |
| 82 | Item 90215, column 2 | residential aged care facility (first occurring) | residential care home |
| 83 | Item 90215, column 2 | in the facility | in the residential care home |
| 84 | Item 90215, column 2 | residential aged care facility (second occurring) | residential care home |
| 85 | Item 16408, column 2 | residential aged care facility | residential care home |
| 86 | Items 51700 and 51703, column 2 | residential aged care facility | residential care home |
Health Insurance (Pathology Services Table) Regulations 2020#
42 Schedule 1 (items 73932 and 73933, column 2, paragraph (b))
Omit “residential aged care facility”, substitute “residential care home”.
43 Schedule 1 (items 73934 and 73935, column 2, paragraph (a))
Omit “residential aged care facility”, substitute “residential care home”.
44 Clause 4.1 of Schedule 1 (paragraphs (k) and (l) of the definition of care institution)
Repeal the paragraphs, substitute:
(k)a residential care home; or
(l)accommodation for aged persons that is attached to a residential care home or situated within a residential care home complex.
45 Clause 4.1 of Schedule 1 (definition of residential aged care facility)
Repeal the definition.
46 Clause 4.1 of Schedule 1
Insert:
residential care home has the same meaning as in the Aged Care Act 2024.
Part 5 · Other amendments
Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020#
46A Subclause 1.2.18(3) of Schedule 1
After “61369,”, insert “61438,”.
47 Schedule 1 (item 61564, column 2)
Omit “twice per lifetime”, substitute “once in any 12 month period”.
Health Insurance (General Medical Services Table) Regulations 2021#
48 Subclause 1.2.11(1) of Schedule 1
Omit “14221, 15900 to 15984, 16514 and 41764”, substitute “14221, 14245, 15900 to 15984, 15990 and 16514”.
49 Schedule 1 (item 10997, column 2)
Omit “92301”, substitute “93201”.
50 At the end of subclause 4.1.4(2) of Schedule 1
Add “or referred by a participating nurse practitioner”.
51 At the end of paragraph 4.1.4(3)(d) of Schedule 1
Add “or a participating nurse practitioner”.
52 Schedule 1 (item 11607, column 2, paragraph (a))
Repeal the paragraph, substitute:
(a) the patient has one or more of the following clinic blood pressure measurements (using a sphygmomanometer or a validated oscillometric blood pressure monitoring device):
(i) a measurement of systolic blood pressure greater than or equal to 140 mmHg and less than or equal to 180 mmHg;
(ii) a measurement of diastolic blood pressure greater than or equal to 90 mmHg and less than or equal to 110 mmHg;
(iii) if the patient is aged 5 years or more and under 18 years—measurements, on consecutive clinic visits, of systolic blood pressure or diastolic blood pressure between the 95th percentile and 95th percentile - 30 mmHg based on limits appropriate to the patient’s age, sex and height; and
53 Clause 5.2.8 of Schedule 1
Repeal the clause.
54 Schedule 1 (cell at item 14245, column 2)
Repeal the cell, substitute:
| Immunomodulating agent supplied under the pharmaceutical benefits scheme, administration of, by intravenous infusion lasting at least 2 hours—applicable once per day |
55 Schedule 1 (item 18360, column 2)
Omit “or Clostridium Botulinum Type A Toxin Haemagglutinin Complex (Dysport)”, substitute “, Clostridium Botulinum Type A Toxin Haemagglutinin Complex (Dysport) or IncobotulinumtoxinA (Xeomin)”.
56 Schedule 1 (item 45515, column 2, paragraph (c))
Omit “non-rebatable procedure”, substitute “procedure which does not attract a medicare benefit”.
57 Schedule 1 (item 45518, column 2, paragraph (c))
Omit “non-rebatable procedure”, substitute “procedure which does not attract a medicare benefit”.
58 Schedule 1 (item 45518, column 2)
Omit “(H)”.
Health Insurance (Pathology Services Table) Regulations 2020#
59 Schedule 1 (item 71099, column 2)
Omit “other than the Crithidia method”.
60 Schedule 1 (item 73358, column 2, subparagraph (a)(ii))
Omit “, following consultation with a clinical geneticist”.
61 Schedule 1 (item 73359, column 2, subparagraph (a)(ii))
Omit “, following consultation with a clinical geneticist”.
62 Schedule 1 (item 73360, column 2, subparagraph (a)(ii))
Omit “, following consultation with a clinical geneticist”.
Health Insurance Regulations 2018#
63 Subsection 52(1)
Repeal the subsection, substitute:
(1)This section applies to a professional service that is specified in:
(a)items 12500 to 12533 of the general medical services table; or
(b)an item in Group T2 or T3 of the general medical services table.
Sourced from the Federal Register of Legislation at legislation.gov.au, © Commonwealth of Australia, licensed under CC BY 4.0. Compilations may have been reformatted.