The Annual Health Assessment: MBS Item 707 and the CHAP

The annual health assessment: the one appointment that catches what everything else misses

There is a Medicare item that funds a doctor to spend more than an hour, once a year, systematically going through the health of a person with intellectual disability. It is item 707. There is a free, Australian, evidence-based tool designed to structure that hour. It is called the CHAP. There is Easy Read material to help the person prepare for it.

It is funded. It is available at any GP practice. It does not require a referral, a diagnosis of anything new, or anybody’s approval.

And a great many people who are eligible for it have never had one.

This is the single highest-value thing in this entire library, and it has almost nothing to do with cancer specifically — which is precisely why it works. The reason cancers get found late in people with intellectual disability is that symptoms get absorbed into the disability, screening invitations do not land, and nobody reviews the whole person. The annual health assessment is the appointment where none of those failures apply, because the clinician is not working from a presenting complaint. They are working through a list.

We are a disability provider in New South Wales, not a medical practice. We cannot do this assessment and we do not bill Medicare. We wrote this guide because booking it is a support task, not a clinical one, and because the reason it does not happen is almost never medical.

What the item actually is

MBS item 707 is a health assessment for people with intellectual disability. The assessment runs more than 60 minutes and can be claimed annually.

There are other health assessment items in the same family — 701 (brief, under 30 minutes), 703 (standard, 30 to 45 minutes) and 705 (long, 45 to 60 minutes) — but those are directed at other target groups. For people with intellectual disability, 707 is the item, and the duration is the point of it. An hour is not generosity. It is roughly how long it takes to assess somebody properly when communication takes longer, the history is long, and the person has not been examined systematically in years.

There is a second annual item worth knowing: MBS item 699, a Heart Health Assessment running more than 20 minutes, claimable annually, with people with intellectual disability among the eligible groups. Cardiovascular disease is one of the major contributors to the life expectancy gap, so this is not a side issue.

For ordinary appointments, the longer consultation items also exist and are worth asking for by name: item 36 (Level C, 20 to 40 minutes) and item 44 (Level D, over 40 minutes). Items 3 and 23 are the brief and standard consultations most appointments default to.

The CHAP, and how it actually works

The Comprehensive Health Assessment Program is the tool built for this assessment. It is free, Australian, evidence-based, and updated annually. There is an adult version, released in 2023, and a version for young people aged 12 to 18, released in 2024.

The design is the clever part, and it is why it works where a normal appointment does not. The CHAP has two parts:

Part 1 is completed before the appointment, by the person themselves with support, or by a family member or supporter. It gathers history: what conditions the person has, what medications they take, what has changed, what screening they have had, what the people around them have noticed. This is information the GP cannot get in a consultation, because it lives across years and across several people’s heads.

Part 2 guides the health professional through the assessment itself. The GP reviews Part 1, asks follow-up questions, and works through a structured examination. At the end, there is an action plan — tests to order, referrals to make, things to follow up.

That structure solves the two problems that make ordinary appointments fail. The history problem is solved by doing the history before the appointment rather than during it. The systematic problem is solved by having a checklist, so the clinician is not relying on what the person or the worker thought to mention.

Department of Health material describes the assessment as taking up to an hour, with a practice nurse and the doctor potentially both involved, including blood pressure, height, weight and a whole-body examination, and a conversation about the person’s health priorities and goals.

What it should pick up

This is the list of things that get missed in fifteen-minute appointments and found in sixty-minute ones.

Cancer screening status. Which of the three national programmes the person is due for, and whether anything has been done. This is the cancer-specific reason the assessment matters: it is the appointment where the bowel kit gets ordered, the cervical screening gets booked or self-collection arranged, and the BreastScreen appointment gets made.

Unexplained weight change. Weighed, recorded, compared to last year. A documented 5kg loss over twelve months is a finding. The same loss spread through a year of shift notes is invisible.

Pain. Specifically asked about, in a way that works for the person’s communication, rather than waiting for them to raise it.

Vision and hearing. Both are commonly undetected and both are commonly mistaken for cognitive decline or behaviour change. Someone who stops participating may not be withdrawn; they may not be able to hear what is being said.

Dental and oral health. Routinely neglected, and a source of chronic pain that drives behaviour.

Swallowing and nutrition. Including whether a change has occurred.

Bowel function. Chronic constipation is near-universal in this population, which is why a change in a chronic pattern gets lost. The assessment is where the baseline gets written down so next year’s change is visible.

Continence. Changes in pattern, which can signal several things including bladder and bowel cancer.

Skin. Including sun-damaged areas and anything not healing — particularly relevant for people who spend long periods in the same position in the same light.

Medication review. Polypharmacy is routine and reviews are not. Medicare funds a Domiciliary Medication Management Review under item 900, annually, for community-dwelling patients with a chronic condition or complex medication regimen. For people in permanent residential aged care, item 903 is the equivalent.

Epilepsy management, where relevant. Seizure frequency, medication levels, whether the current regimen is still the right one.

Mental health. Distinct from behaviour.

Immunisation status. Including HPV vaccination, which is directly relevant to cervical cancer prevention.

Sexual and reproductive health. The area most likely to be skipped entirely, and the one where the assumptions that block cervical screening get made.

Bone health. Relevant for people with limited mobility, on long-term anticonvulsants, or with low body weight.

What has changed since last year. This is the question that an annual structure makes possible and that nothing else in the system asks.

Why this is the defence against diagnostic overshadowing

Diagnostic overshadowing — a new symptom being attributed to the pre-existing disability rather than investigated — is named in Australian health policy as a core problem. The National Centre of Excellence in Intellectual Disability Health’s State of Play in Intellectual Disability Health, published in March 2025, lists it alongside unconscious bias, miscommunication, the absence of the person’s usual support people from consultations, and poor supported decision-making.

Overshadowing happens when a clinician is reasoning from a presenting complaint. The person arrives with a symptom, the symptom maps onto a known condition, and the reasoning stops.

The annual health assessment inverts that. There is no presenting complaint. The clinician is working through a list of body systems, which means a weight loss that would have been attributed to dysphagia in a reactive appointment gets recorded as a number next to last year’s number. A pattern that was invisible in shift notes becomes a line in a document.

This is also the assessment where the structural problems get named and dated. If the person has never had a cervical screening test, the assessment records that. If the bowel kit has been going in the bin for six years, the assessment records that. The register does not know who has a disability — the scoping review by Koko and colleagues published in the International Journal for Equity in Health in 2026 identified exactly this, that registries not recording disability means people are not identified for accessible invitations — so the annual assessment is the only point in the system where somebody checks.

Why it does not happen

The honest answer is that nobody owns it.

Australia has a National Roadmap for Improving the Health of People with Intellectual Disability. The annual health assessment is a Roadmap priority, with $6.7 million allocated to this area. The Roadmap’s own position is that the health and disability sectors share responsibility for ensuring these assessments are completed.

Shared responsibility is the problem, not the solution. In practice:

• The GP waits for the patient to book. Practices do not generally run proactive recall for this item, and many have never claimed it.
• The person does not know it exists. If nobody has explained it in a format they can use, they cannot ask for it.
• The family assumes the GP will raise it.
• The group home assumes the coordinator handles health.
• The support coordinator assumes the family handles health.
• The NDIS does not fund it, because it is healthcare, so it does not appear in any plan as a funded item or a goal.

So it sits in the gap. The Roadmap Implementation Governance Group reported in November 2024 that of 72 short-term actions, 56 had commenced and nine were complete. Progress is real but slow, and it is not yet changing what happens in a Western Sydney general practice next Tuesday.

The consequence is in the mortality data. The NCEIDH report found the median age at death for people with intellectual disability in Australia is 54 — around 27 years earlier than the general population — with 38 per cent of deaths classified as potentially avoidable, more than double the general rate. People with intellectual disability use emergency departments at about 1.6 times the general rate and are admitted to hospital at roughly twice the rate, while using preventive healthcare less. That is the profile of a population whose health problems are found in crisis rather than in advance.

How to actually book it

Here is the script, because the practical obstacle is usually that the person making the call does not know what to ask for.

On the phone to the practice:

“I’d like to book an annual health assessment for [name], who has an intellectual disability. It’s MBS item 707 — it’s a prolonged health assessment, over an hour, and it can be claimed annually. We’ll be using the CHAP tool and we’ll complete Part 1 before the appointment. Can we book a long appointment, and can a practice nurse be involved?”

If the receptionist does not know what you are talking about, ask to speak to the practice nurse or the practice manager rather than explaining it to reception. Nurses are often the people who know these items best, because they frequently do the information-gathering component.

If the practice has never done one: that is common and not disqualifying. Point them to the Department of Health page on the annual health assessment for people with intellectual disability, which sets out what is involved and links to the CHAP. Most practices will engage once they know the item exists. If a practice declines or is dismissive, that is useful information about whether it is the right practice.

Before the appointment:

• Download and complete CHAP Part 1. Do it properly — this is where the value is. Pull the history together from whoever holds it: family, the house, the previous GP, old discharge summaries.
• Gather the medication list, current and accurate, including over-the-counter and PRN.
• Write down what has changed in the last twelve months, with dates. Weight, eating, sleep, mobility, continence, mood, behaviour, pain.
• Find out what screening has and has not been done. A GP can check the National Cancer Screening Register.
• Get the Easy Read material and go through it with the person, more than once. The Department of Health publishes Easy Read information about annual health assessments and the CHAP, and Inclusion Australia runs an initiative called “It’s Doctor Time!” with resources for people with intellectual disability, families, supporters and health professionals.
• Decide who is attending with the person. The NCEIDH report names the absence of the person’s usual support people as a problem; send somebody who actually knows them, not whoever is on shift.
• Ask whether the appointment can be at a quiet time — first or last of a session.

At the appointment:

• Let the person speak for themselves as much as they can. Direct communication with the person, rather than over their head, is one of the consistently identified enablers in this field, and the research notes clinicians often report lower comfort communicating with people with intellectual or cognitive disability.
• Raise cancer screening explicitly if it is not raised.
• Ask for the action plan in writing, with who is doing what and by when.
• Book next year’s appointment before you leave, if the practice will let you.

After the appointment:

• Follow up on every referral and test. This is where assessments die — the plan is made and nothing in the system chases it.
• Put the action items into whatever system the person’s support actually runs on, with dates and a named owner.

What follows on from the assessment

The assessment produces findings, and Medicare funds several things that come next.

Care planning. Items for chronic condition management and care coordination exist, and they were restructured from July 2025 — the long-standing GP Management Plan (721), Team Care Arrangement (723) and review (732) items were part of that change. Ask the practice which current items apply. There is also item 729, for a GP contributing to or reviewing a multidisciplinary care plan prepared by somebody else, and item 10997, which funds a practice nurse or registered Aboriginal health worker to deliver care plan services on the GP’s behalf, up to five times a year.

Case conferences. Where a person has a chronic or terminal condition and complex needs, Medicare funds multidisciplinary case conferences. Items 735, 739 and 743 cover a GP organising, coordinating or participating, at 15 to 20 minutes, 20 to 40 minutes and over 40 minutes respectively, with up to five claimable per year for the shorter items. Where the conference involves the GP plus at least two other health professionals, items 747, 750 and 758 apply instead.

This matters for cancer specifically, because when an NDIS participant is diagnosed with cancer, a case conference is the mechanism that gets the oncology team, the GP and the disability supports into the same conversation. Cancer Council Australia’s policy priorities include clarifying roles between health and disability supports, and note that a cancer diagnosis and hospitalisation can disrupt existing disability supports. A funded case conference is the closest thing currently available to a forum where that gets sorted out.

Medication review. Items 900 and 903, as above.

The gap nobody talks about

Item 707 is for people with intellectual disability. There is no equivalent annual, hour-long, structured assessment item for people with physical disability, acquired brain injury, cerebral palsy without intellectual disability, or degenerative neurological conditions.

That is a real gap and it is worth naming, because a person with severe cerebral palsy and normal cognition faces almost every physical access barrier in the cancer screening pathway — inaccessible examination tables, imaging equipment that cannot accommodate them, transport problems — and has no funded annual review in which any of it gets checked.

What is available instead:

• Item 44 (Level D consultation, over 40 minutes) for a long appointment, which can be booked for an annual review by agreement with the GP even without a dedicated assessment item.
• Chronic condition management planning, where the person has a chronic condition.
• A GP willing to run a structured annual review as a matter of practice.

None of that is as good as a funded, structured, prompted annual assessment. But a long appointment booked deliberately once a year, with a written list of what to cover brought by the person or their supporter, delivers a substantial share of the benefit. The CHAP itself is freely available and, while it is designed for intellectual disability, the systems-review logic of it is not proprietary.

If you do one thing

Find out whether the person you support has had an annual health assessment in the last twelve months. If they have not, ring the practice this week.

Everything else in this library — the screening barriers, the self-collection option, the ultrasound alternative, the symptom logs, the consent frameworks — is downstream of somebody sitting down with that person for an hour once a year and working through a list. The single most common reason a cancer in this population is found at stage four is that nobody ever did.