OTA is calling for better access to Medicare funded OT services for those with chronic conditions. The Medicare Benefits Schedule Review Advisory Committee (MRAC) is currently reviewing MBS allied health chronic disease management services.

The Medicare Benefits Schedule (MBS) chronic disease management (CDM) items support access to allied health services for people living with chronic and complex conditions. Data from 2022 estimates that 15.4 million (61%) of Australians were living with at least one long-term health condition.  

Under items 10958 and 10956, patients can access up to five allied health sessions per calendar year, shared across all eligible allied health professions. While the intent of the program is commendable, the current item rules present significant barriers that prevent the delivery of best practice occupational therapy health care. For those who require support from multiple providers, this annual cap severely limits access for effective and complete treatment.

As part of the review, the Department of Health, Disability and Ageing has commissioned a consultant to undertake interviews during the first round of consultation. OTA recently engaged with the consultant via a formal interview and used the opportunity to highlight some key systemic issues and opportunities for reform.

The preventative nature of occupational therapy interventions is particularly well suited to primary health care. The scope of occupational therapy extends beyond treating existing conditions to proactive promotion of health and well-being, and preventing the onset of illness or disability. Occupational therapists achieve this by addressing a range of factors that influence a person's ability to participate in meaningful activities, and their ability to empower individuals to take proactive steps towards maintaining and improving their health and well-being, ultimately reducing the need for more intensive interventions later on. 

To inform this report, OTA sought feedback from occupational therapists on the current operation the CDM program and the OT role within this. OTA’s national consultation survey was conducted in January and February 2025 and received 94 responses.

OTA has raised the following key issues:

Current session limits don't reflect real care needs: the five Medicare-funded allied health sessions available each year under the CDM program are not enough to support evidence-based occupational therapy, and most clients and conditions require significantly more sessions and for dedicated access to occupational therapy, not shared across other allied health services. 

Current session lengths restrict the level of care patients receive: occupational therapy services require an increase to the minimum time to conduct an initial client assessment and adequate time in ongoing sessions to conduct holistic person-centred therapies. Tiered funding options should be adopted to offer better access to care. Session lengths should also cover patient reporting requirements. 

Group therapy access should be extended: the CDM program should introduce access to group-based occupational therapy. This would increase affordability and access and strengthen patient outcomes. Group therapy items should be accessible in addition to individual therapy items. 

Allied Health assistants should be added to the list of eligible professions: adding this workforce to the CDM program, with appropriate supervision by a registered occupational therapist, could increase affordability and access to CDM services. 

Promote multidisciplinary care: enable Allied Health practitioners to initiate case conferences to discuss client care with GP and other allied health practitioners. 

Rebates are well below true cost of services: rebates available under the CDM program don't cover the full costs of sessions and often require patients to pay significant gap fees. Occupational therapists report that the current rebate and session lengths do not cover costs for therapists' salary, travel and administrative costs associated with delivering best practice care. 

ShapeChanges to the current rules surrounding annual session limits, session lengths and access to group-based programs has the opportunity to significantly increase the accessibility of OT delivered CDM services, and decrease the Australian population’s burden of disease. 

OTA has recommended the following improvements to the program to enable easier access to OT services:

1. Increase session limits to a minimum of 10 sessions per year with an occupational therapist (not shared with other allied health disciplines)

2. Expand session durations and enable tiered sessions that enable a minimum of 60 minutes for longer appointments, and a minimum of 40 minutes for shorter appointments, with appropriate increases to relevant rebates. 

3. Expand group therapy access to enable patients to access up to 10 group-based occupational therapy sessions annually. 

4. Enable occupational group therapy to be accessible in addition to individual services. 

5. Enable access to CDM services (individual and group) delivered by an Allied Health Assistant, suitably supervised by an Occupational Therapist. 

6. Enable Allied Health practitioners to initiate case conferences to discuss client care with GP and other allied health practitioners. 

7. Increase Medicare rebates to align with NDIS funding benchmarks for sustainability and ensure they reflect non face-to-face costs including report writing and travel.