Medicare chronic care cap may triple to 12 — here is what that means

Chronic condition management plans — the formal Medicare pathway through which GPs coordinate allied health care for people living with diabetes, arthritis, heart disease, autoimmune conditions, and other long-term diagnoses — are now carried by millions of Australians. The plan typically involves GP referral for allied health support: physiotherapy, podiatry, dietetics, occupational therapy, or others. What many patients do not know is that Medicare currently caps those subsidised visits at five per year.

A draft report released by the MBS Review Advisory Committee (MRAC) on 30 October 2026 proposes to change that cap to 12 — more than double, closer to triple. The report found that around one third of patients currently hit the five-session limit, and that peak bodies, providers, and patient groups across the consultation all supported increasing it.

This is a draft recommendation, not a done deal. But the breadth of support — and what the cap currently means for patients who exhaust it — is worth understanding.

What the CCM cap is and why it matters

The GP Chronic Condition Management Plan (GPCCMP) is the mechanism by which GPs formally coordinate chronic disease management. A GP assesses the patient, identifies what allied health input is needed, writes a management plan, and refers the patient to specific services. Medicare then funds up to five allied health sessions per calendar year per patient.

Five sessions is not a lot when you are managing a condition that does not go away.

The draft MRAC report notes that patients with complex chronic conditions or multimorbidity — multiple overlapping long-term conditions — commonly need several allied health providers, which quickly exhausts five sessions. The mismatch between typical session requirements and the annual cap means patients either pay out of pocket for additional sessions, go without, or compress care into inadequate intervals.

For reference: about 80% of GP management plans are used for physiotherapy or podiatry, and most are written for Australians over 60. But the picture is changing as chronic conditions occur at younger ages and conditions like type 2 diabetes, autoimmune disease, and chronic pain affect working-age Australians.

What the proposal includes

The draft MRAC report contains several linked changes, not just the cap increase.

Cap increase: five to twelve individual sessions per year. For Aboriginal and Torres Strait Islander patients, the proposed cap is seventeen, recognising higher chronic disease burden and the additional barriers to care that affect First Nations communities.

Time-tiered billing: the current CCM model funds sessions “of at least 20 minutes” under a single billing item. The MRAC report identifies this as a structural problem: a typical physiotherapy or dietetics session runs 40 to 44 minutes, so GPs and providers have been billing a 40-minute session at the 20-minute rebate, creating either a gap fee for patients or an absorbed loss for the service. The proposed fix is three time-tiered items at 20, 40, and 60 minutes with “proportional per-minute benefits” — matching the actual session duration to the actual rebate.

Broader eligibility: group services under the CCM scheme are currently available only to patients meeting a specific threshold. The report proposes expanding this to any patient with one or more chronic conditions, and expanding the provider types who can deliver group services to include mental health social workers, chiropractors, physiotherapists, and speech pathologists.

Both-and: the case for the change and the real constraints

The support in the consultation data is unusually broad. The MRAC report summarises that “peak bodies, providers and patients all support increasing the number of individual sessions available each calendar year” — a degree of consensus that is less common in health policy. The logic is straightforward: chronic disease management is, definitionally, ongoing. Capping it at five sessions a year undermines the plan’s own clinical rationale.

The constraint is cost. The CCM system already processes a large volume of plans — most for physiotherapy and podiatry — and increasing the cap means higher Medicare expenditure per patient in that cohort. The MRAC report points to GPs as “gatekeepers” in the system, implying that GP quality-checking of referral appropriateness provides some natural cost constraint. But the funding question ultimately goes to government through a Budget process, which is where proposals like this can stall.

There is also a question about whether increased sessions translate to improved outcomes, or whether the primary barrier is that patients who would benefit have not been identified and enrolled. Most management plans remain concentrated in a narrow age range and narrow services. Increasing the cap helps patients already on plans; it does not by itself address identification gaps.

2 cents: what to do with this information now

The CCM cap change is not in effect yet — it remains a draft consultation document and must pass through Budget before implementation. If you have a chronic condition and are not on a GP Management Plan, the current entitlement still exists: up to five subsidised allied health sessions a year, coordinated through your GP. That is worth knowing about and asking about if it has not come up.

If you are already on a plan and have hit the five-session cap, you are in the third of patients the report is specifically describing. The proposed change would be retrospective to the calendar year in some models — but that detail is not confirmed, and nothing changes until legislation passes.

The longer arc here: the Department of Health’s chronic conditions framework makes clear that general practice coordination of chronic disease care is a deliberate design feature of the Australian system. What the MRAC process is doing now is updating that design to better match how long-term conditions are actually managed — not well, in five sessions.

Verdict: yes — worth knowing about.

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Sources cited

1. CCM appointment cap could be boosted to 12 — The Medical Republic, 30 October 2026
2. MBS Review Advisory Committee — Department of Health
3. GP management plans and team care arrangements — Department of Health