About the COAG Section 19(2) Exemptions Initiative

The initiative allows states and the Northern Territory to bulk bill primary care services in rural and remote areas. Find out how we define rural and remote areas, what health facilities are eligible, and how funding must be used.


This initiative supports rural and remote communities. It aims to improve access to bulk-billed primary health care:

  • at all times, including after hours
  • at state or territory health services, such as public hospitals and multipurpose services.

States and territories cannot usually bulk bill primary health care at these sites. This initiative recognises that in rural and remote communities:

  • people have limited access to primary health care
  • many public hospitals and health services have employed medical officers to provide this care.

How it works

The Australian Government:

The current MOUs are for 2022 to 2025. The Australian Capital Territory is not eligible because it does not have any rural or remote areas.

We administer this initiative for the Australian Government.


We use the Modified Monash Model (MMM) categories to define eligibility. Under the current MOUs, sites must be one of the following:

  • small rural towns (MMM5)
  • remote communities (MMM6)
  • very remote communities (MMM7).

The MMM is reviewed after each Australian Bureau of Statistics Census (every 5 years), which may change the MMM categories This may mean a site becomes ineligible.

If this happens, we will continue to treat it as eligible for the term of the MOU. This gives the site some time to find other funding.

Proposing sites for the initiative

The states and the NT can propose sites for the Australian Government to consider. They must:

  • consult with and seek support from local primary health care providers and other relevant stakeholders
  • submit a site operational plan.

If approved, they must:

  • review the operational plan every year
  • provide site annual reports
  • provide summary statistics every financial year.

Guidance and support

A guide is available to help you apply for a COAG section 19(2) exemption. It provides an overview of the initiative, eligibility criteria, other requirements and application process.

Use of funding

At least 70% of the initiative funding must be used to improve access to primary care. This includes buying new equipment.

Approved sites can bulk bill MBS for professional services if they meet all the following:

  • They are provided in emergency departments and outpatient clinics.
  • They are for patients who have not been admitted to the hospital or health facility.
  • Non-referred services are provided by state-funded medical practitioners, participating midwives and participating nurses.
  • Referred services are provided by state-funded allied health and dental health professionals.

To find out more about what services can be bulk billed, see the Minister’s directions.

Approved sites

There are over 120 approved sites under this initiative.

View approved sites by state and territory


Read the final report of the 2021 independent review of this initiative.


The national Health Insurance Act 1973 (subsection 19(2)) allows the Minister to make directions for this initiative. The directions exempt states from the rule that they cannot bulk bill for certain services.

Minister’s directions

View the directions for:

These directions set out the:

  • sites that are approved to take part in this initiative
  • MBS groups, subgroups and items that can be bulk billed under this initiative.
Date last updated:

Help us improve health.gov.au

If you would like a response please use the enquiries form instead.