A significant administrative challenge is emerging across the Australian aged care and primary healthcare sectors.
The Department of Health and Aged Care is moving to reinstate stricter Medicare requirements for patient consent and signatures for bulk-billed services as pandemic-era flexibilities are withdrawn, to a tighter system, not allowing any bulk-billing services without a signature, even for those who cannot sign.
While protecting the integrity of the Medicare system is important, the practical implications for Residential Aged Care Facilities (RACFs) are considerable.
Many aged care residents live with advanced dementia, cognitive impairment, or significant physical frailty. As a result, they may be unable to provide a signature at the time of a GP consultation, this means, the GP cannot bill until a legal guardian can sign.
Obtaining consent from substitute decision-makers is often equally challenging. Family members may live interstate, Enduring Guardians may not be immediately contactable, and some residents are represented by Public Guardians.
While a longer-term digital solution is reportedly being developed, implementation is not expected until 2027. This creates a significant gap where clinicians and providers may struggle to meet administrative requirements despite delivering essential care.
The concern is not theoretical.
I recently spoke one of our dedicated GP who provides care to more than 30 residents in a single facility. They are seriously questioning whether continuing regular RACF visits will remain viable under the proposed requirements. If even a small number of visiting GPs reduce services, the consequences will be felt quickly through increased hospital presentations, greater pressure on emergency departments, and reduced access to timely medical care for vulnerable older Australians.
Facilities are also considering whether clinical staff may need to divert time away from resident care to pursue signatures and manage additional administrative processes.
The message from the sector is clear: aged care requires a practical interim solution. Whether that is a delayed implementation, a RACF-specific exemption, recognition of existing consent arrangements, or another workable alternative, the current approach risks creating barriers to care without improving outcomes.
We must continue to address Medicare compliance and billing integrity. However, this should not come at the expense of access to healthcare for some of Australia’s most vulnerable people.
For those working in aged care, general practice, and primary healthcare: How is your organisation preparing for these changes, and what solutions do you believe would be most effective?
