19AB & IMGs | DWS / DPA | 10 Year Moratorium

This blog is to help you understand what 19AB is, what DPA is, how to reduce your 10 year moratorium and what exemptions there are from the 19AB restrictions.

What is the 19AB Restriction?

19AB of the Health Act requires Medical Practitioners who did not complete their degree in Australia or New Zealand, and who wish to access Medicare rebatable services for their patients (allow them to get a Medicare rebate) to work in a DPA for a period of 10 years, referred to as the 10 year moratorium.

Basically- if you want your patients to get a rebate from Medicare and you did not complete your degree in Australia or New Zealand, this 19AB requirement applies to you!

Who is restricted by 19AB?

Medical Practitioners who did not complete their degree in Australia or New Zealand, and who wish to access Medicare rebatable services will be restricted.

It will also apply to Doctors who enrolled into their degree in Australia whilst they were a temporary resident.

What does DPA mean?

DPA stands for Distribution Priority Area.

This is an area where the general population’s need for medical services is not being met and they require more doctors within the area.

The classification of DPA areas is updated yearly and these changes are implemented in the first few months of the year.

If you need to check the DPA status of a practice or area, you can do so at the Health Workforce Locator – https://www.health.gov.au/resources/apps-and-tools/health-workforce-locator/app

How is DPA Location determined?

The DPA system takes into account gender and age demographics, and the socio-economic status of patients living in an area.

An area is automatically classified as DPA when it is:

classified under the Modified Monash Model as MM 2 to 7
in the Northern Territory

Other areas are classified as DPA when the level of health services available to the population does not meet a service benchmark.

Reducing or ‘Scaling Down’ the 10 Year Moratorium

There are two ways to reduce your moratorium.

Scaling means that the more rurally you work, the quicker your moratorium reduces. This works on the RA model rather than the MMM model. To be eligible you’ll need to have a rebatable provider number and be billing over $5000/month. See the table below.

The 5 year OTD Scheme is an initiative initiated by the Rural Workforce Agencies. You will reduce your moratorium to between 3 – 5 years based on what category you’re eligible for.

Category A is for RA 5 locations, and will reduce your moratorium to 3 years.
Category B is for practices who are in an RA 4, or who can demonstrate that they have had a high turnover of GPs or have had a vacancy for a considerable period of time. Other factors taken into consideration is whether they have less than 3 Doctors in the community, difficult community attributes or extreme climates. This will reduce your moratorium to 5 years,
Category C is within locations which are RRMA 4 – 7 and can demonstrate difficulty with recruiting. This will reduce your moratorium to 5 years.

To be eligible, you’ll need to be working at least 7 sessions per week, be eligible to sit Fellowship within 2 years of commencing on the program and identify that you’re intending to become a resident of Australia. For further eligibility requirements, you can check our blog here.

Be aware though, that working on this scheme will make you ineligible for the scaling credits which means you do one or the other. If you start the OTD 5 year scheme, prepare to be there for the entire time required!

How to know when your moratorium ends?

You can call Medicare, check your PRODA account or email the team at 19AB.

19AB Exemptions

Unlike 19AA, you can receive an exemption from 19AB and be allowed to work in a Non-DWS area.

There are various 19AB exemptions, so it is important to check your eligibility. We have outlined the available exemptions below:

General 19AB Exemption

A General 19AB exemption is available in 2 different circumstances. If you have commenced negotiations for employment at the practice prior to the area losing DPA status, you will be eligible for a 19AB exemption. For this, you will need to provide proof to Medicare of the negotiations.

You will also be eligible for a General Exemption if an OTD who previously held a General 19AB Exemption leaves the practice/area and closes their Medicare Provider Number. The previous GP will need to sign a Statutory Declaration confirming they do not plan to return to the area and the new GP will need to commence within 12 months of the Medicare Provider Number closing.

Provision of Services at Commonwealth funded Aboriginal and Torres Strait Islander Health Care Services

If a GP is providing medical services or has commenced negotiations to provide a medical service at an Aboriginal and Torres Strait Islander Primary Health Care Services, they may be eligible for a 19AB exemption.

The Department aims to increase the number of medical practitioners working with Aboriginal and Torres Strait Islander populations, so despite the area of the practice this exemption will be available.

Spousal Exemption

You will be eligible for a spousal exemption if your partner is a medical practitioner that is not restricted by 19AB or if your partner holds a General Skilled Migration Visa and is currently employed within this occupation.

To be granted a Spousal Exemption you will need to be working within a close proximity to your partner- the same Catchment area from the Health Workforce Locator Map is a strong indicator of success.

Locum Exemption

A 19AB exemption will be available if you are providing locum services at a practice.

The GP will be granted a 19AB exemption for the practice for a maximum of 6 months, as long as they have not previously provided services at the practice. After 6 months, you can commence locum services in another practice or change to a DPA practice.

Class Exemptions

Class exemptions are available when you are providing medical services either through a relevant 3GA program (i.e. SAPP) or through an Academic Class Exemption.

You will be eligible for an Academic Class Exemption if you are employed in an academic appointment with an Australian Medical School if the medical services are performed through their academic appointment.

After Hours Exemption

If you are working in an after-hours clinic or during the after-hours periods only, you will be eligible for a 19AB exemption during these periods. This means you will be able to work before 8am and after 6pm on Weekdays, after 12pm on Saturdays and all-day Sundays and on Public Holidays.

Who can apply?

The 19AB restrictions disable the access to Medicare benefits of a doctor who attained their medical degree in any country aside from New Zealand and Australia or a temporary resident who is currently studying to gain a medical degree in the country.

According to the Department of Health and Aged Care, you can apply for an exemption if you:

are employed in a Distribution Priority Area (DPA) or District of Workforce Shortage (DWS)
are on an approved workforce or training program
are employed at any area after regular hours which is specified as 6pm to 8am on a weekday, or any time on a weekend and public holidays

How do I apply?

To apply for 19AB exemptions, you should first complete the Medicare provider number application and attach supporting documents for the exemption.

Be aware of the different types of exemptions also since the new regulations state that certain exemptions must be given to Medicare while others go through the Department of Health and Aged Care.

Where do I apply?

If you are applying for Spousal and Discretionary exemptions, you must submit your application to 19AB@health.gov.au.

If you are applying for the other types of exemptions, you should send your application to provider.registration@servicesaustralia.gov.au.

Outcomes of the 19AB exemption applications will be provided within 28 days. For reconsiderations on the declined requests, you have 90 days to send your additional documents, reasons on why you should be exempted, and new information to support your exemption via email at 19AC@health.gov.au or directly contact the Department of Health and Aged Care for a review.

When can I apply?

Since your request for exemption is submitted along with your Medicare provider number application, you can apply when the application for Medicare provider number is open. Read more about the application of Medicare provider numbers here.

Note: The information presented above has been gathered from AHPRA web pages and has been updated as of 2023-06-21.

Please visit the following links for more information about 19AB:

DO YOU NEED HELP?

Our team offers General Practitioners assistance with finding jobs and a career pathway, and Medical Facilities to find a new Medical Practitioner. We also help with the full application process with AHPRA, RACGP, ACRRM, Department of Health, Medicare including 19AA & 19AB. If we can help, please contact us at help@peoplemedical.com.au.

People Medical Consulting are a team of professionals with a passion for guiding those specialising in the Medical industry to find their career pathway and settle into Australia. Working with both Australian trained and Overseas trained professionals, we have extensive experience in Recruitment of General Practitioners and Document Assistance for those requiring support with RACGP, AHPRA, 19AA and 19AB Medicare Exemptions.