Funding Allied Health Services

Medicare is a federal health insurance program that provides coverage to people aged 65 and over. Medicare covers some allied health services when referred under plans such as a Chronic Disease management plan.

To find out more on the Medicare rebates for allied health professionals download CareSearch's MBS items supporting allied health professional care provision (175kb pdf).

A practice note to allied health professionals: Medicare rebates are unlikely to cover the cost of delivering services. Most allied health professionals need to charge a ‘gap’ payment.

New to private practice and Medicare billing?

• Services Australia has Medicare information for allied health professionals, including eligibility requirements and guides on bulk billing.
• eLearning packages on the Australian health care system, Medicare, referrals and billing can be found in Services Australia Medicare for Health Professionals.
• The Health Professional Education Resources Gateway also has guides on MBS items for allied health professionals.

Since 1 July 2022, the Medicare benefits scheme has extended its provision of payments for telehealth items.

Medicare Allied Health Case Conferencing

From 1 November 2021, the Medicare Benefits Schedule (MBS) made items available for multidisciplinary Allied Health Case Conferencing.

The new items apply to individuals under the care of an eligible allied health practitioner for:

• Chronic disease management under the care of a General Practitioner (GP) in either community or residential aged care settings.

The Medicare Benefits Schedule website has a number of fact sheets (293kb pdf) outlining eligibility, and the relevant item codes.

Another option for funding allied health services is through private health insurance. Many private health insurance plans offer coverage for allied health services. The amount of coverage can vary widely depending on the client’s policy.

It is important to advise people to check what services they are covered for, and at what level of reimbursement.

The HICAPS item number guides provide online and pdf versions of guides to private healthcare item numbers and services claimed under each. These include guides for the following professions:

• Physiotherapy
• Dietitian
• Occupational therapist
• Speech Pathologist
• Psychologist.

The Pharmaceutical Benefits Scheme (PBS) aims to improve medication access and affordability for all Australians. For people with palliative needs, this can provide a bigger range of subsidised medicines. Critically, prescribers may need to become more familiar with these, and the pharmacist has the opportunity to promote these.

In addition, the PBS funds a limited range of formulations for prescribers to carry with them on home visits. This is called the PBS prescriber bag. It is available for all prescribers providing care for people living in their homes or a residential aged care home.

The Home Care Packages Program provides individualised coordinated care and services for people over 65 with care needs. There are a few steps to getting a package, the first being an assessment by an aged care assessor.

The ELDAC Home Care Toolkit has more information on Aged Care Service Funding in the home.

The Department of Health and Aged Care provides information and resources for consumers about the Home Care Packages Program.

There are three funding assessment pathways for older people entering residential aged care summarised in this fact sheet (123kb pdf).

• Some allied health services will be paid for by the aged care provider based on assessed need.
• Services could be delivered by a team of permanent staff members, sub-contractors or a mixture of both.
• Residents are also entitled to request additional services, but may be expected to use private funding to pay for these visits.

The ELDAC Residential Aged Care Toolkit has more information on the Australian National Aged Care Classification (AN-ACC) funding model for residential aged care.