Medicare provider number legislation

Section 19AB of the Health Insurance Act 1973 (the Act)

Section 19AB of the Act applies to overseas trained doctors (OTDs) and foreign graduates of accredited medical schools (FGAMS) who gained their first medical registration or became permanent Australian residents or citizens on or after 1 January 1997. Section 19AB restricts their access to Medicare provider numbers and requires them to work in a district of workforce shortage (DWS) for their medical specialty in order to access Medicare benefits arrangements.

These restrictions apply for a minimum period of 10 years (referred to as the 10 year moratorium requirement) from the date of their first Australian medical registration.

What is a district of workforce shortage (DWS)?

A DWS is an area where the general population’s need for medical services is deemed to be unmet. An area is a DWS if it has less access to medical services than the national average.

District of Workforce Shortage factsheet
Map locator (shows current DWS areas for GPs)

Section 19AB(3) Exemptions

OTDs may obtain an exemption under section 19AB of the Act if they choose to practise within a DWS for their specialty. If an OTD holds a valid section 19AB exemption for a particular location, they are able to access the Medicare benefits arrangements for the professional services they provide at that location.

OTDs or FGAMS with permanent resident or Australian citizen status are also subject to the requirements of section 19AA of the Act. If your residency status changes you must notify DHS as soon as possible, as this will affect your access to the Medicare benefits arrangements.

Section 19AB factsheet
Section 19AA fact sheet

Exemptions in non-DWS locations

Doctors who have satisfied the vocational recognition requirements under s19AA of the Health Insurance Act 1973 (ie hold Fellowship with the relevant College) may seek an exemption to access Medicare benefits arrangement at non-DWS locations under the below provisions.

Doctors who are permanent residents or citizens of Australia, and have not achieved a Fellowship qualification, are not eligible to apply for an exemption under the below provisions.

Spousal provision

Spousal exemptions are assessed under section 9 of the Health Insurance (Section 19AB Exemptions) Guidelines 2017 (the Guidelines). When assessing a spousal exemption application, Health is required to base decisions on the applicant doctor's spousal relationship at the time of application. Further information on this provision, and the application form, can be downloaded from the link below.

Locum provision

A locum exemption may be obtained at a non-DWS location for a maximum period of up to six months. This is in recognition of the relief that locum services provide to medical practitioners across Australia. Section 19AB(3) exemptions granted in a locum capacity enable all-hours access to Medicare benefits for a maximum period of six months per service location and are unable to be extended. When applying for a locum exemption, please ensure that you include start and end dates that do not exceed a six month period on both your letter of support, and Medicare provider number application form.

After-hours provision

Accessing the Medicare benefits arrangements in an after-hours capacity is currently considered to meet DWS requirements across Australia for all medical specialties. The after-hours period is defined by Health as 6pm to 8am Monday to Friday and all day Saturday, Sunday and Public Holidays. When applying for the after-hours period, please ensure that this is clearly stated in your letter of support.

Replacement provision

The replacement provision allows Health to grant an OTD or FGAMS an exemption in order to access Medicare benefits arrangements in an area that is not considered to be a DWS for their medical specialty. The replacement provisions apply in cases where an OTD or FGAMS is being employed to replace another doctor who:
  • was granted a s19AB(3) exemption that enabled unrestricted (i.e. full-time, ongoing) Medicare access at the medical practice;
  • provided a Medicare-subsidised service at that location within the last 12 months; and
  • has ceased practising in the local area.
Health applies the replacement provision when assessing a s19AB(3) exemption application received from the Department of Human Services – Medicare (DHS) on an applicant doctor's behalf as part of the Medicare provider number application process. To consider an application under the replacement provision, Health requires two key pieces of evidence to be supplied with the replacement doctor's Medicare provider number application (in addition to the standard supporting documents that are stipulated on the provider number application form):
  1. evidence that the departing doctor has cancelled their Medicare provider number for all locations within the local area; and
  2. a signed statutory declaration from the departing doctor that indicates that they have ceased, and have no intention of returning to, practising privately in the local area.

Further information


Class section 19AB(3) exemptions

The Department of Health and the Department of Human Services have introduced several 19AB class exemptions. These class exemptions cover groups of doctors, allowing them to be granted Medicare provider numbers more quickly.

The attached sheet provides an explanation of these class exemptions and identifies each class that has been made under 19AB.

Health and DHS are exploring opportunities for additional class exemptions. The fact sheet will be updated as new class exemptions are introduced.

Class section 19AB(3) exemptions Fact Sheet

Section 19AA of the Health Insurance Act 1973 (the Act)

Section 19AA of the Act was introduced to recognise and support general practice as a vocational speciality, as well as to provide a framework for achieving long term improvements in the quality of doctors working in Australia. As section 19AA of the Act is a quality assurance measure there is no exemption from the requirement to obtain vocational recognition to be eligible to access the Medicare benefits arrangements.

Section 19AA of the Act places a requirement on all doctors who were registered in Australia after 1 November 1996 and are permanent residents or Australian citizens to obtain (or be working towards obtaining) vocational recognition as a GP, specialist or consultant physician in order to access Medicare rebates. A doctor is considered to be vocationally recognised once they have obtained a Fellowship qualification that is recognised in Australia. Doctors who are subject to section 19AA of the Act may otherwise obtain Medicare access if they are working towards obtaining a Fellowship qualification on one of the approved workforce or training programs that are included in Schedule 5, Part 2 of the Health Insurance Regulations 1975 (the Regulations), also known as a section 3GA program.


Section 3GA programs

Section 3GA of the Act allows medical practitioners undertaking placements on approved workforce or training programs to provide professional services that attract Medicare benefits.

Several of these programs have been established to assist doctors in obtaining vocational recognition as a GP; the key programs being the Australian General Practice Training Program (AGPTP), the Rural Locum Relief Program (RLRP) and the Approved Medical Deputising Service (AMDS) Program.

Section 19AA fact sheet


The Registrar Fact Sheet explains the Medicare provider number application process for GP Registrars who are participating on the AGPT Program.

Scaling

For OTDs and FGAMS, scaling is a non-cash incentive which can reduce individual practitioners’ 10 year moratorium restriction period.

Time reductions apply to doctors who choose to live and work in regional and remote areas, and are scaled as per the Australian Standard Geographical Classification – Remoteness Area (ASGC-RA) table below:
ASGC-RA (2006) Classification
ASGC-RA (2006) 1 Major Cities
ASGC-RA (2006) 2 Inner Regional
ASGC-RA (2006) 3 Outer Regional
ASGC-RA (2006) 4 Remote
ASGC-RA (2006) 5 Very Remote
Period of restriction10 years9 years7 years6 years5 years

Further information regarding scaling is available at the related links below.

Related links

Scaling information
Map locator
Scaling Fact Sheet

Privacy and your personal information

Australian Privacy Principle 5 Notification

The Australian Department of Health collects personal information about you for the purposes of determining eligibility for and administering exemptions under section 19AB of the Health Insurance Act 1973. The Department of Health can be contacted by telephone on (02) 6289 1555 or freecall 1800 020 103 or by using the online enquiries form at www.health.gov.au.

If you do not provide some of the personal information requested, the Department may not be able to determine your eligibility for an exemption.

The Department will disclose information to the Department of Human Services (DHS) - Medicare to enable Medicare benefits to be available for your services if you are determined to be eligible.

The Department has an APP privacy policy which you can read at http://www.health.gov.au/internet/main/publishing.nsf/content/privacy-policy. You can obtain a copy of the APP privacy policy by contacting the Department using the contact details set out above. The APP privacy policy contains information about:

  • how you may access the personal information the Department holds about you and how you can seek correction of it; and
  • how you may complain about a breach of the Australian Privacy Principles

The Department is unlikely to disclose your personal information to overseas recipients.