Who qualifies for Medicare’s natural disaster telehealth exemption?

It is not something a telehealth service can hold on your behalf, and it is not available Australia wide.

If you have been told you qualify for bulk billed telehealth because of a natural disaster, this page explains what has to be true for that to be correct, how to check your own area, and what to ask if you are not sure.

What does Medicare say?

Two sentences carry the whole rule. Medicare’s telehealth guidance says “patients in areas declared a natural disaster can access telehealth services from any medical practitioners in general practice”, and it defines the areas: “eligible regions are State or Territory Local Government Areas identified as a natural disaster at the time of the service.”

The Department’s advisory on telehealth eligibility says the same thing more briefly. A patient is exempt if they are “affected by natural disaster, defined as living in a local government area declared a natural disaster by a State or Territory Government.”

Both sentences do the same two jobs. They tie the exemption to a place, at local government area level, and to a time, the day of your consultation.

Who declares an area a natural disaster area, and how do I check mine?

A State or Territory Government makes the declaration, and a declaration covers named local government areas rather than a whole State, region or postcode. In Western Australia that means whether you qualify depends on the local government area your home address sits in.

Neither the Commonwealth nor a telehealth service makes these declarations. That is why two people in the same city can get different answers on the same day.

You can check your own area in about a minute.

1. Find out which local government area your address is in. It is your local council, so if you are in the City of Stirling or the Shire of Mundaring, that is your local government area.
2. Open DisasterAssist, the Australian Government site where these declarations are published, and search or use the map to find declared local government areas. Its own description is that it is updated “as each State and Territory makes these declarations”.
3. Check the dates. A declaration that has ended does not help you today, because Medicare’s test is the position at the time of your consultation.

Which situations qualify, and which do not

The two tests are your local government area and the date. Everything else follows from them.

Can a telehealth service use this exemption for all of its patients?

No, and the reason is in how the rules are written.

Every exemption in Medicare’s telehealth rules is written as a fact about a patient, or about a kind of consultation. Under 12 months of age. Experiencing homelessness. Living in a local government area declared a natural disaster area. An urgent video consultation between 11pm and 7am. Not one of them is written as a fact about a service.

So a service can bulk bill every patient who meets an exemption, and many do. What no service can do is make you meet one. If a claim is made in your name on the basis of this exemption, there has to be a factual connection between your own address and a current declaration, and the doctor has to have recorded that at the time of your consultation.

This is the same point that applies to every one of Medicare’s telehealth rules, and our bulk billed telehealth eligibility page sets out all three ways to qualify in full.

What does the doctor have to record?

Recording the exemption is a legislated requirement, not an administrative preference. Where an exemption is used, doctors “are required to document and specify the exemption in patient clinical notes at the time of service for post audit compliance”, and it is “a legislated requirement to record any relevant exemption to eligibility criteria used at the time of service in patient clinical notes.”

The practical consequence is that a doctor relying on this exemption has to have a factual basis for it at the time of your consultation, because they have to write it down then. It is not something that can be worked out afterwards.

What can I ask if I am told I qualify?

These four questions will tell you where you stand before a claim is made in your name.

• Which Medicare eligibility rule applies to me?
• If it is the natural disaster exemption, which local government area am I recorded as living in?
• Is that local government area declared a natural disaster area today?
• If that exemption does not apply to me, is there another way I qualify?

The last question is the useful one. There are several other ways to be eligible for bulk billed telehealth, and for most people they are far more likely to apply than this exemption is.

What if the exemption does not apply to me?

You may well be eligible another way. There are three, and they are set out in full on our bulk billed telehealth eligibility page.

• That doctor or practice has seen you face-to-face in the last 12 months, and the appointment was billed to Medicare. A home visit counts.
• You are registered in MyMedicare with the practice you are having the telehealth consultation with.
• You, or the kind of consultation you need, meets one of the other exemptions.

One of those other exemptions is an urgent consultation between 11pm and 7am, which has its own conditions, including that Medicare funds it as a video appointment only. Our after hours bulk billed telehealth page explains how that works in practice.

You can also be eligible through the after hours service that covers your own practice, where the two have a formal arrangement in place and your practice has seen you face-to-face in the last 12 months.

If none of them applies, you can usually still be seen by telehealth, with a fee to pay. See our fees on our telehealth page.

Our position on the natural disaster exemption

Medicare provides an exemption from the usual telehealth relationship requirements for patients who live in a local government area that is currently declared a natural disaster area by the relevant State or Territory Government.

The exemption originated as an emergency access measure, designed to maintain continuity of essential healthcare where disasters disrupted patients’ ability to reach their usual doctor.

The technical test is whether you live in a currently declared natural disaster area. We consider it most appropriate where the disaster is genuinely affecting a patient’s ability to access ordinary face-to-face medical care. This might include flooding, bushfires, cyclones, evacuation, road closures, damage to local infrastructure or disruption to local health services.

We do not consider the exemption to be a routine alternative to Medicare’s usual telehealth eligibility requirements. A patient may live inside an area covered by a current declaration even where the disaster is having little or no practical effect on their ability to attend a GP clinic. In those circumstances we do not believe it is appropriate to use the existence of the declaration simply as a mechanism to make an otherwise ineligible routine telehealth consultation bulk billable, because that would be inconsistent with the access to care purpose for which the exemption was introduced.

So please do not assume that Perth Home GP will bulk bill a telehealth consultation simply because your address happens to fall within a currently declared natural disaster area. We consider use of the exemption on an individual basis. Where a natural disaster is genuinely affecting a patient’s ability to access ordinary face-to-face medical care, our doctors may consider whether the exemption is appropriate in the circumstances.

Where we rely on it, we expect there to be a clear and identifiable basis for doing so, which means all three of the following.

• A current State or Territory Government natural disaster declaration applying to the patient’s local government area.
• A genuine connection between the disaster and the patient’s access to ordinary medical care.
• Documentation in the patient’s clinical record of the exemption and the reasoning for relying on it.

Where those circumstances do not exist, we use the ordinary Medicare telehealth eligibility pathways instead: an eligible telehealth practitioner relationship with our practice, the after hours service that covers us, MyMedicare where it applies, or another exemption the patient genuinely meets.

We recognise that our approach is more conservative than simply applying the technical eligibility test wherever a current disaster declaration exists. That is intentional. We believe Medicare exemptions should be used consistently with the circumstances they were created to address, rather than treated as a way of routinely bypassing the usual telehealth eligibility criteria.

Night Doctor is the after hours service that covers Perth Home GP patients, so a patient we have seen face-to-face in the last 12 months is eligible for a Medicare rebate there too.

If you are eligible, we bulk bill telehealth consultations of up to 15 minutes, and we tell you the fee before you book rather than afterwards. Billing policies differ between services, so check with whichever telehealth service you are booking with.