Medicare rules haven’t kept up with the changing needs of rural patients or the changing health workforce, the Australian College of Nursing says.
Changes to Medicare funding rules for telehealth appointments have resulted in “significant unintended consequences” for rural and remote patients, the Australian College of Nursing says.
In a submission to the Senate Standing Committee on Rural and Regional Affairs and Transport, the ACN has argued that restrictions on nurse practitioner‐delivered telehealth are disadvantaging rural communities where face‐to‐face care is limited or impractical.
The ACN said changes to telehealth rules introduced on 1 November last year had disproportionately affected nurse practitioners and their communities.
Under the new rules, NPs have the same face-to-face consultation requirements as GPs, but don’t have access to the full range of Medicare Benefits Schedule item numbers such as exemptions for mental health and eating disorder services.
While patients who enrol in MyMedicare are exempt from the face-to-face rule, NPs are not eligible to participate in MyMedicare unless they are affiliated with an eligible general practice.
In its submission to the Senate committee, the ACN said “not one member believes Medicare adequately supports the mixed‐team models vital to delivering health care in rural, regional and remote communities”.
“While the changes appear to be grounded in a logic aimed at improving health outcomes through continuity of care and increased in‐person consultations, several significant unintended consequences have already emerged,” it said.
“Because NPs do not have equivalent access to the full range of Medicare Benefit Scheme (MBS) item numbers, this alignment has resulted in a disproportionate restriction on their scope of practice.
“For instance, exemptions from the 12‐month face‐to‐face requirement apply to certain mental health and eating disorder items, but NPs, despite being qualified to provide these services cannot utilise these exemptions because they are not eligible to bill these MBS items, meaning people who must or choose to use NP services are penalised and potentially paying more for these services.”
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ACN CEO, Adjunct Professor Kathryn Zeitz, said Medicare settings have not kept pace with the changing structure of the health workforce or the evolving needs of rural populations.
“In many rural and remote areas, GP wait times exceed three months, or there is no GP service at all,” she said.
“Evidence shows underfunding nurse-led care has stark consequences – including avoidable hospital presentations.
“In rural and remote Australia, where demand far exceeds supply, this gap is devastating. The current system is failing the communities that need it most.”
Professor Kathryn Zeitz said nurses and NPs were providing the only available primary care in many communities across rural and remote Australia.
“Their work should not be structurally excluded from public funding. We need reforms that reflect the workforce we have, not the workforce we had.”
The ACN said nurse-led models should be eligible for Medicare funding instead of having to operate through block funding, government incentives or private billing.
NPs are also excluded from aged care and after-hours incentives that are available to GPs, which restricts their access in residential aged care, the ACN said.
The ACN’s submission said the Medicare Benefits Schedule continued to rely heavily on GP‐centred fee‐for‐service arrangements, which limited the ability of other health professionals – including nurse practitioners, nurses and allied health practitioners – to practise to their full scope without consumers having to pay a gap or full fee.
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“These constraints are amplified in rural and remote areas where multidisciplinary and nurse‐led models are often the only viable way to ensure access to continuity of regular and preventive care,” the submission said.
“Reforms intended to strengthen continuity of care or support in‐person services, while well intentioned, have at times produced unintended consequences that further restrict access for communities already facing significant disadvantage.
“The introduction of new Medicare telehealth requirements on 1 November 2025 must therefore be understood within this broader context of rural health inequity, structural funding limitations and unmet workforce needs.
“While policy changes may be effective in metropolitan regions with higher clinician density, their impact can be markedly different in rural and remote settings where service availability is constrained, reliance on telehealth is high, and NP‐led models often function as the primary or sole point of care.”