(Cth) Allow GPs and Eating Disorder Specialists to Conduct 20-Session Eating Disorder Reviews
Author: Bethany Roger, Kah Ying Fu, Jaye Lauder & Sureen Hasan | Publish date: 26/10/2026
Content Warning: Eating Disorders
P: In Australia, people on an Eating Disorder Management Plan (EDMP) cannot access Medicare-funded sessions beyond session 20 without sign-off from both a GP and a psychiatrist.
S: The Minister for Health should amend Division 2.31.9 of the Health Insurance (General Medical Services Table) Regulations 2021 (Cth) so the 20-session review can be conducted by the treating GP alone where progress is satisfactory, or by the treating team via case conference with an eating-disorder-experienced clinician where progress is slow or absent.
E: The Evaluation of the Eating Disorder Medicare Benefits Schedule Items (2024): ‘in the case of satisfactory progress towards goals ... the 20-session review is conducted by the GP’ and ‘in the case of slow/no progress ... specialist advice/review is sought in a case conference organised by the GP, with members of the multidisciplinary team and the specialist present’.
Problem Identification:
Division 2.31.9 of the Health Insurance (General Medical Services Table) Regulations 2021 (Cth) requires people on an Eating Disorder Management Plan (EDMP) to obtain a sign-off from both a GP and psychiatrist before they can access sessions 21 through 40. Reviews at the 10- and 30-session marks may be conducted by a GP alone. However, patients must obtain an additional formal review from a psychiatrist at the 20-session mark.
According to the Evaluation of the Eating Disorders Medicare Benefits Schedule Items (MBSI) Report (2024), the 20-session review may have created an access barrier as ‘it was difficult to access or complete’. They found that treatment dropout rates peaked at all session review points, with ‘the need to see a psychiatrist for [the 20-session review] cited as a reason for stopping services’.
Context:
The National Institute of Mental Health refers to EDs as ‘serious illnesses marked by severe disturbances in a person’s eating behaviours’, such as anorexia nervosa, bulimia nervosa and binge eating disorder. Deloitte and the Butterfly Foundation, Australia’s national ED charity, reported that ‘in 2023 more than one million Australians were living with EDs’.
According to the National Eating Disorders Collaboration, the EDMP provides patients with a Medicare subsidy for up to 40 psychology sessions and 20 dietetic services within 12 months.
The MBSI report (2024) identified a ‘lack of clarity around the purpose of the [20-session] review’ and ‘perceptions that [it was] punitive.’
Arguments:
The MBSI report (2024) found that the ‘cost of the specialist review at 20 sessions was often excessive, resulting in people … not getting the review’. Participants in a Butterfly Foundation study stated the requirement created a ‘huge out of pocket cost’.
The MBSI report (2024) stated the ‘reliance on psychiatrists (or paediatricians) for a 20-session review remains a considerable risk’, and health professionals reported ‘difficulties … in finding appropriate psychiatrists … with the knowledge, skills, and experience in [EDs] to conduct the review’. They found that 68.1% of treatment providers found access to appropriate psychiatrists ‘very difficult’. In a meeting with FORE Good, Dr Siân McLean, first author of the MBSI report (2024), noted that patients ‘couldn’t find a specialist.’
Patients cited a ‘lack of therapeutic relationship’ with the psychiatrist as a reason for discontinuing treatment. Dr McLean told FORE Good that patients also reported feeling ‘uncomfortable in trying to see a specialist who didn’t know them or wasn't part of their treating team’.
The MBSI report (2024) found that psychiatrists participating in the survey agreed that ‘a specialist review (by a psychiatrist or paediatrician) at 20 sessions was necessary’. However, the report also noted that an existing formal credential system for GPs, clinicians, and psychologists ‘recognises clinicians with the qualifications, knowledge, training, and experience … for delivery of safe and effective [ED] treatment’. Credentialed clinicians demonstrated ‘significantly higher [ED] confidence, knowledge, and skill’ than non-credentialed professionals.
Advice/Solution Identification:
The MBSI report (2024) called for GP-led 20-session reviews and stated that ‘reviews with external clinicians … provide less of a barrier to progress’.
Precedent:
There is domestic precedent for expanding the criteria of eligible reviewers to GPs. In Australia, GPs have reviewed mental health treatment plans without a psychiatrist’s sign-off since 2006 under the Better Access Initiative (BAI). The BAI covers any clinically diagnosed mental disorder, including EDs.
Public Support of the Solution:
(This list reflects publicly stated positions and should not necessarily be taken as endorsement of this specific brief.)
Broad Support
Australia and New Zealand Academy for Eating Disorders (ANZAED) - They have called for the recognition of credentialed ED clinicians within the existing workforce and supported improvements to the EDMP review process. They stated that credentialing enables ‘safe and effective eating disorder care’. However, they have not explicitly called for legislative change.
News Coverage:
InSight+ (Medical Journal of Australia) - “Democratising eating disorder treatment in Australia: removing barriers to care”. This article examined barriers to accessing eating disorder treatment in Australia and called for structural reforms to improve equity and continuity of care. By: Sarah Maguire and Sarah Barakat | 28 July 2025 - Read the article here.
National Eating Disorders Collaboration - “Findings from the evaluation of the Eating Disorder Medicare Benefit Schedule (MBS) Items”. This article outlined key findings and recommendations from the 2024 evaluation, including barriers to accessing the 20-session review. No author listed | No date listed - Read the article here.
Butterfly Foundation - “New Report Reveals Alarming Growth in Both Prevalence and Cost of Eating Disorders”. This article reported on the findings of Deloitte Access Economics’ Paying the Price 2024 report, highlighting the increasing prevalence and economic cost of eating disorders in Australia. No author listed | 29 February 2024 - Read the article here.
Where to go to learn more:
(2024) Evaluation of the Eating Disorders Medicare Benefit Schedule Items | Department of Health and Aged Care, Deakin University and La Trobe University - This evaluation assessed the implementation and impact of the ED MBS items introduced in 2019, making 46 recommendations, including that the 20-session review be conducted by the treating GP alone where progress is satisfactory, or by the treating team via case conference with an eating-disorder-experienced clinician where progress is slow or absent, as indicated by the treating clinician. It was the primary evidence base for this brief. View the evaluation here.
(n.d.) Medicare Eating Disorder Plans FAQs | Butterfly Foundation - This resource provided a plain-language explanation of the EDMP structure, review requirements, and common barriers experienced by patients and clinicians. View the resource here.
(2024) Paying the Price: The economic and social impact of eating disorders in Australia | Butterfly Foundation and Deloitte Access Economics - This report outlined the prevalence and economic cost of eating disorders in Australia. View the report here.
(n.d.) Eating Disorder Treatment and Management Plans | National Eating Disorders Collaboration - This resource outlined the structure of the EDMP, including the review process and the role of GPs, mental health professionals, and dietitians in coordinating treatment. View the resource here.
(2021, updated 2024) Health Insurance (General Medical Services Table) Regulations 2021 (Cth) - This instrument contains Division 2.31.9, which governs the review requirements under the Eating Disorder Management Plan, including the mandatory psychiatrist sign-off for sessions beyond 20. View the regulations here.
Human Perspective:
CW: Eating Disorders
Jess is a 24-year-old university student who was referred to a psychologist by her GP after months of struggling with an eating disorder. Her GP established an Eating Disorder Management Plan, and Jess began weekly psychology sessions. For the first time in years, she felt she was making real progress, and she and her psychologist had developed a strong therapeutic alliance built on trust and consistency. As she approached her 20th session, Jess's GP explained that she would need a review from a psychiatrist before continuing. Still, neither Jess nor her GP had an existing relationship with a psychiatrist who specialised in eating disorders. After several weeks of searching, the earliest available appointment was months away and cost several hundred dollars out of pocket, an amount Jess could not afford while studying part-time. Rather than pay privately, she let her Eating Disorder Management Plan lapse. Jess had been working hard to stay engaged with treatment, and the sudden barrier of a single mandatory review she could not access made her question whether she could stay in treatment at all.
To protect the anonymity of those involved, this is a fictionalised account drawn from an amalgamation of real-life stories, experiences and testimonials gathered during the research process for this brief. Any resemblance to actual individuals is purely coincidental.
Conflict of interest/acknowledgment statement:
Dr Siân McLean (Senior Lecturer, Department of Psychology, Counselling and Therapy, La Trobe University) confirmed her support for this recommendation, specifying that ‘slow/no progress’ should be as indicated by the treating clinician, and that specialists used for advice/review are defined as health practitioners experienced in eating disorders. She shared quotes for this brief in a meeting with FORE Good held on 7 July 2026. Shared with her permission.
Support
If your organisation would like to add your support to this paper or suggest amendments, please email hello@foregood.org.au.
Disclaimers
Please review all FORE disclaimers here.
Reference list:
Australia and New Zealand Academy for Eating Disorders. (n.d.). The ANZAED Eating Disorder Credential. https://connected.anzaed.org.au/About
Butterfly Foundation. (2020). Medicare Item Numbers for Eating Disorders. https://butterfly.org.au/wp-content/uploads/2022/08/Medicare-Scheme-for-ED_FINAL.pdf
Butterfly Foundation & Deloitte Access Economics. (2024). Paying the Price, Second Edition: The economic and social impact of eating disorders in Australia. https://butterfly.org.au/wp-content/uploads/2024/10/deloitte-au-eco-paying-the-price-second-edition-180724-new-Oct-24.pdf
Department of Health, Disability and Ageing. (n.d.). Medicare Benefits Schedule - Item 80110. Australian Government. Retrieved August 7, 2026, from https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=80110
Department of Health, Disability and Ageing. (2026). Medicare Benefits Schedule (MBS) Eating Disorders Fact sheet for Health Practitioners [Fact sheet]. Australian Government. https://www.health.gov.au/sites/default/files/2026-01/medicare-benefits-schedule-mbs-eating-disorders-fact-sheet-for-health-practitioners_1.pdf
Health Insurance (General Medical Services Table) Regulations 2021 (Cth). https://www.legislation.gov.au/F2021L00678/latest/text
McLean, S. (2026). Chat regarding the 20-session psychiatrist review under the Eating Disorder Management Plan [Video interview with Senior Lecturer, Department of Psychology, Counselling and Therapy, La Trobe University]. 7 July 2026.
McLean, S., Fuller-Tyszkiewicz, M. (2024). Evaluation of the Eating Disorders Medicare Benefit Schedule Items. La Trobe University and Deakin University for the Department of Health and Aged Care. https://www.health.gov.au/sites/default/files/2024-10/evaluation-of-the-eating-disorders-medicare-benefit-schedule-items-2024_0.pdf
National Eating Disorders Collaboration. (n.d.). Eating disorder treatment and management plans. https://nedc.com.au/eating-disorder-resources/medicare-items/ed-treatment-and-mangement-plans
National Institute of Mental Health. (n.d.). Eating disorders. Retrieved August 7, 2026, from https://www.nimh.nih.gov/health/statistics/eating-disorders
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