Department of Health

Improving Access to Primary Care in Rural and Remote Areas Initiative

Victoria is participating in the COAG Section 19(2) Exemptions Initiative

Key messages

  • Victoria signed a Memorandum of Understanding (MoU) with the Australian Government (in effect until 30 June 2025) on the COAG Section 19(2) Exemptions Initiative to improve access to primary health care for Victorians living in eligible rural and remote communities.
  • It allows eligible health service sites, in categories 5-7 of the Modified Monash Model Classification System (MMM), to use Medicare rebate funds to support locum cover and employed medical, nursing, allied health and dental professionals – especially in rural and remote communities where there are challenges in attracting and retaining health professionals.
  • The Victorian Department of Health has developed guidance and resources to assist eligible health services and health professionals to implement this initiative with the support of the local Primary Health Network (PHN).

The Improving Access to Primary Care in Rural and Remote Areas InitiativeExternal Link supports the delivery of primary care services in small rural towns where access to these services may be limited.

It is a Council of Australian Governments (COAG) initiative – also known as the COAG Section 19(2) Exemptions Initiative. Victoria first entered into an MoU with the Australian Government to take part in February 2021. A new MoU began on 1 January 2022 and will end on 30 June 2025.

View the current MoU:

The initiative provides health services with an alternative funding model to consider in assessing the right mix of health service provision for their communities. The aim is to increase access to primary care and help Victorian Government-funded rural and remote health services to attract and retain highly specialised staff.

The initiative also supports health service collaborative planning with community stakeholders, including local general practices and PHN, to determine the future health needs of their community.

Eligibility and how it works

Under the initiative, rural and remote hospitals and bush nursing centres within categories 5-7 of the Modified Monash ModelExternal Link (MMM) are eligible for an exemption from subsection 19(2) of the Health Insurance Act 1973 (Cth) (the Act).

Eligible health services that successfully apply for the exemption can claim Medicare benefits for non-admitted, non-referred professional primary care services (including medical, nursing, midwifery, allied health and dental services) provided in urgent care centres, outpatient clinics and community outreach settings.

At least 70 per cent of the funding received under the initiative must be invested in new services and improvements at approved eligible sites or outreach services.

Learn more about the MMM classification systemExternal Link

View a list of eligible (MMM 5-7) Victorian sites:

View the list of Medicare Benefits Schedule (MBS) item numbers that can be claimed under the initiative:

How to apply

Health services must submit an operational plan to the Victorian Department of Health outlining how their particular site(s) intends to implement and operate the initiative.

Primary Health Networks (PHNs) can provide support to health services to identify potential service gaps or needs and facilitate discussions between private providers, if required.

The operational plan must include:

  • local billing, accounting, and reporting procedures (see Monitoring and reporting).
  • evidence of support in writing from:
    • local privately practicing or community-based primary healthcare practitioners. For example General Practitioner practices, in the area or nearby (if there are any such providers and can also include:
      • the local PHN
      • other stakeholder groups as appropriate, such as Aboriginal medical services and community health services.

Note, these primary healthcare practitioners may choose to be represented by a third-party representative in these negotiations.

Download the operational plan template (Schedule B of the MoU) from the Australian Department of Health’sExternal Link website.

Completed operational plans can be emailed to the Health services improvement team at

Monitoring and reporting

Eligible health services must establish local billing, accounting and reporting procedures to assist with the implementation and operation of this initiative.

Health services will be required to report annually on the investment of revenue as identified in their operational plan by submitting a site annual report.

Download the site annual report template (Schedule C of the MoU) from the Australian Department of Health’s websiteExternal Link

Email completed site annual reports by 31 July each year to the Health services improvement team at

Help and resources

Guidance and key resources to help eligible health services apply for and implement the initiative can be accessed below.

Australian Department of Health Initiative informationExternal Link (includes operational plan and site annual report templates)



Sample operational plan

Eligible Health Professional – Letter of Agreement template

Visiting Medical Officer – Letter of Agreement template

End of Financial Year – Medicare Information Letter template

More information

If you have any questions about the initiative, contact the Health services improvement team at

Reviewed 03 April 2023


Contact us

Health Services Improvement Team

Was this page helpful?