We continue to advocate for fairer and more effective Medicare arrangements to support people with communication and swallowing needs to access speech pathology.
The Medicare Benefits Schedule Review Advisory Committee (MRAC) is currently reviewing MBS allied health chronic condition management services.
The Medicare Benefits Schedule (MBS) chronic conditions management (CCM) items provide access to rebated allied health services for people with chronic conditions and complex care needs. These items - including 10970, 93000 and 93013 for speech pathology services - currently allow for only five allied health sessions per calendar year, shared across all eligible allied health professions. For people requiring support from multiple providers, this cap may mean no sessions are available for speech pathology, or that treatment is incomplete, leading to poorer outcomes.
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.
We recently interviewed with the consultant and outlined systemic issues and opportunities for reform. We reflected members' concerns about funding and access, and the relevant published literature. Here are the key issues we raised:
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Current limits don't reflect real care needs: the five Medicare-funded allied health sessions available each year under CCM are not enough to support evidence-based speech pathology. Most clients need significantly more.
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Rebates fall short: Medicare rebates often don't cover the full cost of a session, leaving families out-of-pocket. The lack of tiered funding options aligned with actual session length is also a barrier to accessing care.
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Group therapy should be covered: there's currently no Medicare item for group-based speech pathology, despite its proven benefits for some client groups. Introducing this option would help improve affordability and access.
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Referral pathways must be easier: navigating the system can be confusing and slow, leading to delays in care. Better referral processes would support continuity and timely intervention, including recognising direct referrals between allied health professionals, such as between a speech pathologist and an audiologist.
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Unmet needs have lifelong consequences: when people don't get the speech pathology support they need, it can impact their education, employment, mental health, and has been linked to involvement with the justice system.
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Investing now saves later: international evidence suggests that greater access to speech pathology offers a significant return on investment. It can reduce costs in other parts of the health and social services system over time and improve education and employment outcomes.
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We need more data: ongoing gaps in data make it harder to show the full impact of speech pathology and advocate for the funding people with communication and swallowing needs deserve.
The review commenced in August 2024 and is expected to take 18 months to complete. Public consultation will also occur in 2026.
We will continue to advocate for better access to speech pathology throughout this review and keep members informed.