Changes coming to MBS telehealth regulations

Since the height of the COVID-19 pandemic, the majority of Australians have had access to rebated GP telehealth services under the Medicare Benefits Schedule (MBS), as long as they have seen their GP in person in the last 12 months.
 
But that rule is set to change.
 
As of 1 November, patients will be able to access these services, even if they have not seen their GP face-to-face in the previous 12 months. But it has to be with the practice they are registered with under MyMedicare. 
 
The move is expected to make it easier for practices to verify whether a patient is eligible for telehealth, as they will be able to do so by confirming whether the patient is registered under MyMedicare.
 
‘This change supports findings from the MBS Review Advisory Committee post-implementation review of MBS telehealth,’ a spokesperson from the Department of Health and Aged Care (DoHAC) told newsGP.
 
‘[It] recognises that higher quality care is achieved through telehealth when it is provided in the context of a continuous clinical relationship.’
 
RACGP President Dr Michael Wright described the change as ‘good news’ for both patients and practices.
 
He said that for MyMedicare to work, it must have clearer benefits for patients and for GPs.
 
‘It’s going to make it easy for practices to check eligibility, because if people are registered, they’re eligible, so you’re not going to have to check the date of when they were last seen,’ Dr Wright told newsGP.
 
‘It also does put some incentive within MyMedicare for people to go back to their regular GP.
 
‘The college has been supportive if it encourages patients to get follow-up care with their regular GP, so encouraging continuity of care. So, it does make sense in that it allows ongoing access to telehealth if you’ve been to a practice.’
 
In addition to maintaining continuity of care, the move is expected to protect patients from online business models, focused primarily on delivering healthcare through telehealth, which often have no prior knowledge of a patient’s medical history.
 
The 12-month compliance rule was first introduced by the Federal Government in July 2020.  
 
While there have been exemptions for certain services and patient groups, the rule currently applies to the majority of GP MBS telehealth items.
 
GPs will still be able to provide telehealth items to patients not enrolled in MyMedicare, however, in these cases, the 12-month requirement will continue to apply, unless the patient or service is exempt.
 
Level C and D phone consultation items 91900 and 91910 will continue to require patients to register with MyMedicare for the service to be provided.
 
Changes to mental health telehealth services
As it stands, all GP mental health telehealth items are exempt from the 12-month rule. However, from 1 November, the exemption will be lifted for some items.
 
MBS rebates for GP Mental Health Treatment Plan telehealth items will only be available to patients through their MyMedicare registered practice or through a GP or practice they have had a face-to-face consultation with in the previous 12 months.
 
Focussed Psychological Strategies will continue to be exempt from the 12-month rule and be available to patients through any GP.
 
The announcement is part of a series of changes being introduced to MBS telehealth services by the DoHAC from the start of November.
 
On Tuesday it was revealed that the 12-month rule will be applied to MBS telehealth items delivered by nurse practitioners, bringing the clinical relationship criteria in line with current GP telehealth requirements.
 
Since telehealth’s introduction, there have been a number of changes, which Dr Wright acknowledged has been confusing for both GPs and their patients.
 
‘But hopefully these changes will make it easier for practices and will also make it more obvious for patients of the benefits of seeing their regular GP,’ he said.
 
‘The most benefit you have is from having a regular GP, but also having a regular practice, does give you some of the benefits of continuity of care because you share the record. So, creating incentives for people to go to the same practice is worthwhile.
 
‘We’ve just got to make sure we find this balance of giving patients flexibility and also trying to make it easier for them to see their preferred GP.’
 
However, Dr Wright said more needed to be done to make patients aware of the benefits of registering with a practice.
 
‘It would be really helpful if the DoHAC could provide more and could raise patient awareness, so they know the program’s benefits, rather than relying on practices to do so,’ he said.
 
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Focussed Psychological Strategies MBS Medicare Mental Health Treatment Plans MyMedicare rebate telehealth