Bring the exemptions back, witnesses tell senate inquiry.
Not only is access to mental health care for rural and regional Australians limited; it’s “structurally constrained” – inadvertently – by changes to Medicare telehealth eligibility rules, a senate inquiry heard yesterday.
“Recent Medicare changes introduced in November 2025 rightfully highlight the importance of continuity of care. However, there’s no continuity of care when care cannot be accessed,” said Rebecca Gilchrist, a clinical psychologist from New England who chairs her local New South Wales Farmers Branch in Armidale and also provides supervision for mothers’ groups via telehealth.
During covid, an exemption was made to the MBS “established clinical relationship rule” which allowed patients to see any GP via Medicare-funded telehealth for a mental health care plan or referral to a psychologist.
From 1 November 2025, the covid-era exemption was removed and replaced by the MBS telehealth eligible telehealth practitioner requirement, meaning that a patient must either have seen a GP at least once in 12 months or was in a registered My Medicare arrangement with that GP practice. The latter requires at least two face-to-face visits at the same practice in the past 24 months, or one visit in MM6 and MM7 areas.
This change was recommended by the MBS Review Advisory Committee Telehealth Post-Implementation Review because of “perceived risks of both lower quality of care and lower value services when telehealth is not used optimally”.
But witnesses told the senate committee looking into rural, regional and remote Medicare access and funding that the exemption needed to be brought back – ideally for everyone but, if there had to be compromise, then at least for patients living in MM2-MM7 areas.
Back in 2024, the MBS review noted “that removing the exemption on mental health telehealth services may decrease access for some vulnerable populations that may not have an ongoing relationship with a regular GP or general practice” but that the review committee “was conscious of the unintended consequences of exemptions to access telehealth MBS items, such as encouraging online-only services that focus on quantity over quality, which may result in low-value, fragmented care.”
The former had come to pass, said witnesses at the inquiry, but the intended benefits had often not.
“The blanket in-person requirement that’s been enforced by the dropping of the exemption to the clinical relationship rule is not the most effective way to manage the risk of the low quality, high volume telehealth services that are out there and that we are all a little bit worried about,” said Olivia Clayton, clinical psychologist and director of an online psychology practice supporting people in rural and remote areas.
“[That’s] because really what has happened is that the smaller, high-quality providers such as ours have shut down their GP telehealth services. However, the large, impersonal providers, the ones that we’re really worried about, are often able to adapt their processes to continue operating within the rules, and some are actually flouting the rules altogether. So the policy is missing its target.”
The removal of the exemption was based on a false assumption that patients in regional, rural and remote areas could access a regular GP and maintain the ongoing relationships required for My Medicare registration – which is one of the pathways by which telehealth could be provided – said Ms Gilchrist.
“That assumption does not reflect the reality in many rural communities…
“In many rural and remote communities that I speak to quite regularly, people often rely on rotating workforces of local GPs, or they have no local GP at all. Travel distances are quite significant. Wait times are really long, and the continuity of care is difficult to establish from the beginning. In this context, telehealth is not just a convenience, it’s often the only viable pathway to primary and timely, appropriate care,” she said.
Without Medicare rebates for these telehealth appointments, people who were already disadvantaged were only able to access services by paying for them out of pocket, said Ms Gilchrist, which really meant many were “being excluded from care due to administrative requirements and not clinical ones”.
“The changes to Medicare have caused a situation where there is inequity, particularly for rural people, to be able to access appropriate mental health care,” said Dr Laura Carter, a rural generalist doctor working in the same practice as Ms Clayton.
“While we understand the intent behind this decision, particularly the need to ensure quality and continuity of care, our experience on the ground suggests that the current settings are having unintended consequences for rural patients,” said Ms Clayton.
There were few GPs available to see in the areas where these people lived, so there were long waiting times – six to eight weeks or longer – and large distances to travel, she said.
Related
In addition, “there were privacy concerns in small communities where people have social or professional connections to their local GP and didn’t want to talk about mental health with someone that they’ll also see down the footy field or at the local IGA,” she said.
“I can’t speak for my clients due to privacy and confidentiality requirements. However, I can speak to my personal experience. My GP was actually here on Friday afternoon for our Good Friday afternoon tea. She is the wife of my husband’s childhood friend, so I will not always feel comfortable. She’s lovely, but I will not always feel comfortable disclosing to her what I need,” Ms Gilchrist said by way of illustration.
Ending the exemption was also causing distress for patients who had built strong relationships with their telehealth GP, said Ms Clayton.
“This actually disrupts continuity of care and undermines integrated, team-based treatment that is working well,” she said.
“[It] is important to acknowledge that delivering [care] by telehealth does not mean that it’s of less quality and that there is continuity that we do provide to our patients via telehealth. Making these changes won’t cost the system much, but will save a lot, and particularly improve the physical health and mental health of the patients that we support,” Dr Carter said.
“From a GP’s perspective, I would like to say that it is a hard job, and a lot of the time it’s undervalued. And GPs are totally stretched. So when there are less on the ground, it means there’s more put on you to be able to deliver a service.
“And having witnessed some of my colleagues trying to deal with physical issues and mental health issues all in the space of one consult, you can see that it’s not always about quality care, just turning up and seeing a GP face-to-face.
“From the perspective of telehealth, we do believe that focusing in and giving the appropriate time allocation to someone’s mental health is able to deliver quality care,” she said.
Meanwhile, GPs who delivered care via telehealth at her practice were able to work with local services to provide quality care, she explained, through technology and connections with local health practitioners.
Low value, low quality care could be avoided by mandating that the telehealth GP always sought permission from the patient to loop in their usual GP, said Ms Clayton.
“This kind of targeted rule, alongside strong Medicare oversight of the online providers whose billing patterns suggest low value care, would preserve rural access to high quality coordinated care,” she said.
“This is what high quality online services do already, and that’s what supports continuity of care without compromising access.”
“We have very strong connections and correspond with the regular GPs to keep them all on the same page,” Dr Carter agreed.
“So I feel that we are able to provide high quality care, and being mindful that it is via telehealth, once you have seen someone for a long period of time, I can attest that I have very good, strong relationships with the patients that I’ve been seeing, and I believe in the system.”
Specialists, unlike GPs, did have an exemption to the rule, Dr Carter noted.
“Why there’s a discrepancy between us as GPs and every other specialty, I’m not really sure, but I guess it can appear to undermine the value that we have as GPs and not look at the quality of the service we’re trying to provide.”
Dr Lachlan McKeeman, GP and secretary of the Border Medical Association in Albury Wodonga, said there was some value in the changes for protecting patients from practices providing low quality care, but access barriers had been created.
However, the impact that removing the exemption was having on rural, regional and remote mental health care access was part of a broader issue about the funding model as a whole, and what was needed was “an overall combined service model”, he said. It was not just about the exclusion of one Medicare item.
“I think it’s a real pattern of an underlying disconnect between the funding model, which supports the providers of the services covered by Medicare services, but then also covers the patients to receive the best possible standard of care,” he said.
“Rather than one part facilitating the other to do its job in isolation via a telehealth consult, I’m really interested in terms of the funding model which improves the connection,” he said.
My Medicare could be a pathway for information sharing and patient-centred care, rather than a box ticked on a GP’s medical software, he said.
“Rather than just My Medicare home being a statement, it actually improves the integration and connection between all service providers for the patient at the centre.”
The next hearing is scheduled for 28 April in Kununurra, WA. The committee is due to hand in its report in November this year.
