Funding Allied Health Services

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

Download MBS items supporting allied health professional care provision (175kb pdf) from CareSearch to find out more on the Medicare rebates for allied health professionals.

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 accessed at Medicare Basics for new Health Professionals on the Services Australia website.
• 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 MBS 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
• Dietetics
• Occupational therapy
• Speech pathology
• Psychology.

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 Support at Home program replaces the Home Care Packages Program and Short-Term Restorative Care Program. It will provide:

• upfront supports to maintain independence, such as assistive technology and home modifications
• new classification and budget levels to better meet a person’s aged care needs
• participant contributions based on an assessment of income and assets*.

*Allied health named on the Support at Home service list, currently do not attract any contribution or co-payment. All activities delivered by allied health must meet the following criteria to be eligible for payment, 'the activities must be to assist the participant to regain or maintain physical, functional and/or cognitive abilities, which support them to remain safe and independent at home'.

Prices for allied health services can have a billable unit for direct and indirect activities, and travel costs can only be incorporated within the billable unit of care. All services, including those covering indirect activities, must be agreed between the allied health professional and the older adult (referred to as the ‘participant’) through their care plan and budget. The Department of Disability, Health and Ageing has released pricing guidance for allied health providers to support practice.

The Restorative Care Pathway (371kb pdf) is an additional funded pathway under Support at Home providing up to 16 weeks of restorative care services (from a maximum budget of ~$6000) alongside any Support at Home services, which can include allied health. The pathway is designed to regain independence and prevent the need for higher levels of ongoing care. A Restorative Care Pathway can be delivered in the home, or in residential aged care (RAC) as a mixed location program, as long as the older adult is not a permanent resident in RAC. The newly developed Restorative Care Pathway Clinical Guidelines are evidence-based guidelines designed to help providers not just manage functional decline in older people, but to actively prevent it - supporting older Australians to live independently, confidently, and with purpose.

There is also separate funding for assistive technology or home modifications through the Assistive Technology and Home Modifications scheme, if approved.

The Assistive Technology and Home Modifications (AT-HM) scheme is separate funding for products, equipment and home modifications for Support at Home participants. AT-HM funding may only be used for products, equipment and home modifications on the defined list where it optimises the older person’s functioning or manages their disability or age-related functional decline. The AT-HM scheme guidelines (1MB pdf) set out the intent and details for operationalising the scheme.

Support at Home providers who wish to deliver the AT-HM scheme to older people must be registered in Category 2 – Assistive Technology and Home Modifications and may also consider if they need to be registered in Category 4 – Allied Health Services to source prescription or wraparound services from Allied Health professionals.

The Support at Home program End-of-Life Pathway is another short term funding program for the last 12-16 weeks of life, to help older adults die at home. The End-of-Life Pathway form must be completed by a medical practitioner or nurse practitioner, but once in place provides $25,000 for care services. This could include allied health, as they support older people and their families with activities such as (but not limited to):

• mobility and positioning
• review and recommendations for adaptations of the physical environment or equipment as health deteriorates
• supporting informed risk conversations e.g. eating and drinking with acknowledged risk
• advance care planning – final wishes, keepsakes for family etc.

It will be important for the health team to note health deterioration that may indicate someone could be eligible for the End-of-Life Pathway, to initiate a timely assessment for this pathway.

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.