Nurse practitioners will need an existing clinical relationship with a patient to bill the MBS for telehealth items from November and an NP level E consult will be introduced from March.
From November, nurse practitioners will be required to establish a clinical relationship with a patient before billing the MBS for a telehealth consult, bringing the requirements in line with those for GPs.
The Department of Health and Aged Care has told the Australian College of Nurse Practitioners that from 1 November 2025, MBS rebates for telehealth with a nurse practitioner will only apply if the patient has been seen face to face in the preceding 12 months.
Exemptions will include children under 12 months old, homeless people, those isolating due to covid or another public health order, people affected by a natural disaster in a local area and consultations about blood borne virus and sexual or reproductive health.
Patients at Aboriginal Medical Service and Aboriginal Community Controlled Health Service will also be exempt.
DoHAC told The Medical Republic that there would be two additional changes to NP MBS items including the introduction of a level E (over 60 minute) video and face-to-face consultation item and that level B items would be amended to include consultations lasting six minutes from March 2025.
Speaking to TMR, chair of the RACGP expert committee for funding and health system reform Associate Professor Rashmi Sharma said the college welcomed the change to the existing relationship requirement for nurse practitioners as its absence promoted inconsistent regulatory oversight.
“It has opened the door to the establishment of nurse practitioner telehealth services that are able to access the MBS without the pre-existing clinical relationship requirement,” she said.
“These services are operating under a different care standard than that enforced by the Medical Board.
“In real terms it means a situation where nurse practitioners have been able to set up telehealth services and patients receive an MBS rebate, while a patient consulting with a GP would not have access to an MBS rebate in a similar situation, if there was no pre-existing clinical situation.
“This inconsistency is also confusing for patients in an already complex system, risking fragmentation of care.”
Related
Concerns over inconsistency were also raised by the MBS Review Advisory Committee in its telehealth post-implementation review last year.
The Committee noted pushback from nursing representatives, “with the changes seen as having detrimental impacts on nurse practitioner business and scope of practice”, read the report.
Following the recent removal of the requirement for collaborative arrangements for nurse practitioners, the RACGP had raised concerns about nurse-led telehealth-only clinics.
The changes allow nurse practitioners to bill through the MBS and prescribe through the PBS without the approval of a GP.
When asked about concerns over a potential rise in nurse-led telehealth-only clinics between now and 1 November 2025, when the existing relationship rule comes into effect for NPs, Professor Sharma said, “this is a business decision for nurse practitioners as to whether they wish to commence new ventures in a changing funding environment”.
“We hope that nurse practitioners will want to work with GPs in a collaborative fashion to improve health outcomes for our patients.”
ACNP said it was in discussions over the changes to seek clarification and would advocate for “better access to health care via telehealth”.
The nursing college said it expected “a celebratory response from the usual medical groups and medical media, as they support further restricting patient access to nurse practitioners, who often work with the most vulnerable people in Australia”.
“As always, I recommend for your own health and wellbeing not to engage in negative dialogue, or rise to the bait,” it told its members.
“ACNP and its members are collectively focused on better access to health care for all people.
“Engaging with predictable negative dialogue will not achieve anything to change their views.
“We do acknowledge as fellow health professionals that these responses are deeply disappointing.”