Advocacy win to retain 85% Medicare rebate
11 September 2024
The Australasian Sleep Association has successfully advocated to retain the 85% Medicare rebate for attended sleep studies in non-hospital settings.
"In December 2023, we were contacted for comment as part of the Medicare Benefits Schedule Continuous Review process. A number of procedures had been identified by the Department of Health and Aged Care as suitable for hospital settings only but were eligible for both the in-hospital rebate (75%) and the non-hospital rebate of 85%. These items included attended overnight sleep studies," said ASA's CEO, Marcia Balzer.
"The Clinical Committee considered the issue and sought feedback from members about this proposal. A number of members provided compelling arguments against removing the 85% rebate for non-hospital attended sleep studies, and we recently received the news that the 85% rebate will be retained.
"Thank you to all the members who provided feedback to retain access to this vitally important public health funding," Marcia said.
Points raised in the ASA's response to the consultation included:
- Attended sleep studies can be performed in non-hospital settings, still meet the criteria for Medicare rebates and also meet the criteria in the relevant professional guidelines.
- Reclassifying sleep study items as hospital-only would disproportionately affect patients in regional and rural areas.
- Reducing the rebate would result in increased out-of-pocket expenses for uninsured people, which could lead to a decrease in access to sleep studies due to financial constraints.
- People with complex health needs, including physical and mental health comorbidities, often require more frequent and comprehensive sleep health services and this would limit their access to sleep studies.
- This measure would limit access to diagnostic and specialised vigilance testing for people with central disorders of hypersomnolence - who already experience long delays in diagnosis.
- Most services, particularly those in non-hospital settings, run on very narrow margins and a reduction in rebate runs the risk of these services becoming unviable. This is particularly of concern outside metropolitan centres, where non-hospital settings for attended sleep studies are often the only service available.
Read the full ASA submission including member feedback