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Section 19AB of the Health Insurance Act 1973 - Scaling Factsheet

Printable version of Section 19AB of the Health Insurance Act 1973 - Scaling Factsheet (PDF 22 KB)

Medicare provider number restrictions

Overseas trained doctors (OTDs) and foreign graduates of an accredited medical school (FGAMS) are subject to the Medicare provider number restrictions under section 19 AB of the Health Insurance Act 1973 (the Act). OTDs and FGAMS are required to practise in designated districts of workforce shortage (DWS) for a minimum period to obtain Medicare access. This requirement remains in effect for a minimum period of ten years from the medical practitioner's first Australian medical registration and is referred to as the 'ten year moratorium requirement'.

A DWS is a geographic area of Australia in which the population's need for healthcare has not been met. Population needs for health care are deemed to be unmet if a district has less access to medical services than the national average, as measured by Medicare billings for that type of service.

Scaling for OTDs and FGAMS

Scaling is a non-cash incentive offering OTDs and FGAMS opportunities to reduce the 10 year moratorium restriction period. The table below shows that the scaling bonuses are significantly greater for doctors who practise in more remote areas.

ASGCR-RA ClassificationASGC-RA Category:Scaling % discountRestriction period reduced to:
RA 1Major CitiesNil10 years
RA 2Inner Regional10%9 years
RA 3Outer Regional30%7 years
RA 4Remote40%6 years
RA 5Very Remote50%5 years

Scaling initiative start date

Scaling began on 1 July 2010. Discounts under the scaling initiative were not applied retrospectively.

Eligibility criteria

OTDs and FGAMS are eligible for scaling if they:
  • hold a valid section 19AB(3) exemption for the location where the services were provided (i.e. their medical services attracted Medicare benefits); and
  • achieve a minimum Medicare monthly billing threshold of $5,000 within an eligible regional or remote area (ASGC-RA 2,3, 4 or 5).

Calculation of discounts

Discounts are calculated by the Department of Human Services (DHS) - Medicare every month. DHS calculates doctors' claiming activities in all eligible ASGC-RA locations irrespective of the number of services provided in each category.

Where considered eligible each month, doctors receive the scaling discount applicable to the major ASGC-RA· category (for that month). The major ASGC-RA category is that of the location where the highest value of claims was made by the doctor.

How does an OTD or FGAMS access their scaling information?

Doctors with a Public Key Infrastructure (PKI) individual certificate will be able to view their scaling progress using DHS’ Health Professionals Online Services (HPOS) System. Further advice regarding the HPOS and the process for applying for a PKI certificate is available by calling the DHS-Medicare's eBusiness Service Centre: 1800700 199

Completion of return of service obligation

Each month, DHS calculates each doctor's revised 'scaled' end dates for their ten year moratorium requirement. This process continues until the revised scaled end date is equal to the actual date (i.e. today's date).

When this happens the doctor has satisfied the return of service obligation under the Act and no longer has to practise in a DWS to obtain Medicare access.

DHS automatically applies an open-ended 'scaling class' 19AB(3) exemption to a doctor's record. This exemption is not location specific, allowing the doctor to apply for a Medicare provider number to cover any practice locations of their choice.

DHS provides written notification to doctors when the 'scaling class' 19AB(3) exemption is applied.

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scaling factsheet.pdf