Understanding 19AB Restrictions, DPA, and Exemptions:

Understanding 19AB Restrictions, DPA, and Exemptions:

A Guide for International Medical Practitioners

What is the 19AB Restriction?

The 19AB restriction under the Health Insurance Act applies to medical practitioners who did not complete their degree in Australia or New Zealand. This regulation requires these practitioners to work in a Distribution Priority Area (DPA) for 10 years if they want their patients to access Medicare rebateable services. This period is commonly referred to as the "10-year moratorium."

In simple terms, if you want your patients to receive Medicare rebates and you did not complete your medical degree in Australia or New Zealand, you need to adhere to the 19AB requirement.

Who is Restricted by 19AB?

The 19AB restriction applies to:

• Medical practitioners who completed their medical degree outside of Australia or New Zealand.
• Doctors who enrolled in a medical degree in Australia while on a temporary visa.

What Does DPA Mean?

DPA stands for Distribution Priority Area. These are regions where the general population's medical service needs are not being adequately met, necessitating more doctors in the area. DPA classifications are updated annually, with changes typically implemented in the early months of the year.

To check the DPA status of a practice or area, visit the Health Workforce Locator.

How is a DPA Location Determined?

The DPA system considers factors like gender, age demographics, and the socio-economic status of the area's population. An area is automatically classified as DPA if it:

• Falls under the Modified Monash Model (MMM) categories MM 2 to 7.
• Is located in the Northern Territory.

Other areas are classified as DPA based on the available health services not meeting a set benchmark.

Reducing or ‘Scaling Down’ the 10-Year Moratorium

There are two ways to reduce your moratorium period:

1. Scaling Down: The more rurally you work, the quicker your moratorium reduces. This operates on the RA model rather than the MMM model. To be eligible, you must have a rebatable provider number and bill over $5000 per month.

2. The 5-Year OTD Scheme: Initiated by the Rural Workforce Agencies, this scheme can reduce your moratorium to between 3 and 5 years, depending on your eligibility category:

   • Category A: For RA 5 locations, reducing the moratorium to 3 years.
   • Category B: For RA 4 locations or practices with high GP turnover, longstanding vacancies, fewer than three doctors in the community, or extreme conditions, reducing the moratorium to 5 years.
   • Category C: For RRMA 4-7 locations with recruitment difficulties, reducing the moratorium to 5 years.

19AB Exemptions

You can receive exemptions from 19AB restrictions, allowing you to work in non-DWS areas. Here are the types of exemptions:

1. General 19AB Exemption: Available if you started employment negotiations before an area lost its DPA status or if replacing an OTD who held a General 19AB Exemption.
2. Provision of Services at Aboriginal and Torres Strait Islander Health Care Services: Available if providing or negotiating to provide services at these health care services.
3. Spousal Exemption: Available if your partner is a medical practitioner not restricted by 19AB or holds a General Skilled Migration Visa.
4. Locum Exemption: Available for providing locum services at a practice for up to 6 months.
5. Class Exemptions: Available for those on relevant 3GA programs or holding academic appointments with Australian Medical Schools.
6. After Hours Exemption: Available for services provided before 8 am and after 6 pm on weekdays, or anytime on weekends and public holidays.
7. Replacement Exemption: Available if replacing a doctor with an unrestricted 19AB exemption who is no longer working in that location.

Applying for 19AB Exemptions

To apply for exemptions:

1. Complete the Medicare provider number application and attach supporting documents for the exemption.
2. Submit spousal and discretionary exemption applications to 19AB@health.gov.au.
3. Submit other exemption applications to provider.registration@servicesaustralia.gov.au.

You will receive the outcome within 28 days, and for reconsiderations, you have 90 days to provide additional documentation.

When Can You Apply?

You can apply for an exemption when the Medicare provider number application is open. For detailed information on applying for Medicare provider numbers, visit the Medicare website.

By understanding these guidelines, international medical practitioners can navigate the 19AB restrictions, utilise exemptions, and potentially reduce their moratorium period to better serve communities in need.

For more detailed eligibility requirements and application processes, check our Health Jobs Hub blog