Chronic condition management cap may rise from 5 to 12 visits per year

If you have a chronic condition and have ever hit a wall at five allied health visits in a year — been told your physiotherapy, dietitian or psychology sessions under the Medicare rebate are used up — this draft reform proposal is for you.

The MBS Review Advisory Committee (MRAC) has released a draft report recommending that the annual cap on individual chronic condition management services rise from 5 to 12 visits per patient per year. For Aboriginal and Torres Strait Islander patients, the proposal is to lift the cap from 10 to 17 services per year. Group services — currently restricted to type 2 diabetes — would be expanded to cover any chronic condition lasting six months or more. The draft is currently open for public consultation.

The existing scheme has not been materially updated in 22 years. The MRAC report is direct about why: the current structure “is no longer appropriate” for the millions of Australians living with chronic conditions.

What is actually being proposed

The five-visit cap under the existing scheme is a hard ceiling. For a patient managing, say, type 2 diabetes, heart disease and chronic low back pain, those five visits might be allocated entirely to one condition or split across three — in either case, the patient is left without funded support for large parts of their care by October. The report finds this is exactly what is happening: “patients with few services rarely see meaningful improvement and are left dissatisfied,” and those with complex or multiple conditions are routinely forced to prioritise one problem over others.

The 12-visit proposal is not simply a number change. Combined with expanded group eligibility, the ability to provide those services via telehealth, and a proposed new time-tier structure for consultation billing (20, 40 and 60 minutes, replacing the current flat 20-minute MBS minimum that doesn’t reflect actual consultation lengths), the full package would substantially restructure how allied health chronic condition management works in general practice.

The proposed group service expansion is particularly significant. Currently, an exercise physiologist, dietitian or diabetes educator can deliver group sessions under MBS only for type 2 diabetes. The proposal would open this to occupational therapists, physiotherapists, psychologists, accredited mental health social workers, speech pathologists, chiropractors and osteopaths — and cover a much wider range of conditions.

The honest complication

This matters, and it is not yet real.

RACGP President Dr Michael Wright welcomed the proposal while noting 12 visits “isn’t enough either” for the most complex patients. RACGP Specific Interests Diabetes Chair Dr Gary Deed flagged a practical concern: the proposal adds to GP workload at a time when reporting standards for allied health feedback in care plans are not nationally agreed. Coordination is not automatic — a 12-visit cap that generates 12 sets of communication back to the GP, with no agreed national standard for what that communication looks like, is a workflow challenge for general practice.

There is also the gap between recommendation and implementation. MRAC is an advisory committee — its draft recommendations inform the government, which decides whether and when to adopt them. The report on longer consultation billing that RACGP has called its “biggest priority” is a separate process still awaiting government action. These things move slowly.

None of that diminishes the significance of a formal advisory recommendation to more than double the annual cap. It is the clearest signal in 22 years that the five-visit ceiling is a policy artefact of its time, not a limit grounded in clinical evidence.

2 cents

If you manage a chronic condition and you currently plan your allied health care around hitting the five-visit limit by mid-year, this draft matters to you — both for what it proposes and for the feedback window that is now open.

Your GP is the best person to explain how your existing management plan works and what a change to 12 visits would mean for your care. If you feel the current cap falls short of what your condition requires, a submission to the public consultation is a direct line to the people making this decision.

For GPs, the RACGP’s framing is worth noting: the College supports the visit increase while calling for outcome measures and reporting standards to be built into every plan from the start. If the reform lands, the difference between it working and not will largely come down to care coordination infrastructure at the general practice level.

Verdict: yes — a significant draft policy reform that any Australian managing a chronic condition should know exists and can respond to.

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Sources cited

1. MRAC recommends lifting chronic care cap to 12 visits — newsGP, 5 November 2026