Medicare Items for Allied Health Services for people with chronic conditions and complex care needs

To be eligible to access Medicare rebates:

.                 patients need to have a chronic condition and complex care needs which are being managed by their GP under an Enhanced Primary Care (EPC) multidisciplinary care plan

.                 the need for diabetes education must be identified in the care plan

.                 the GP must refer the patient to an eligible CDE using an EPC Program referral form for allied health service  and

.                 CDEs must be registered with the HIC.

Patients may access a maximum of 5 Medicare rebateable allied health services in a 12 month period (from the date of their first visit).

CDEs may charge patients the Medicare rebate.  Alternatively, if the patient has any out of pocket expenses, they will count towards the Medicare safety net.

The rebate for each of the 5 services will be $55.10 (85% of the schedule fee of $64.80).

The new Medicare Benefits Schedule (MBS) diabetes education item (item 10951) will operate in same way as existing allied health MBS items.  As well as the requirements outlined above, the provision of diabetes education services must meet the following requirements:

.                  the patient is not an admitted patient of a hospital or day-hospital facility

.                  the service is provided to the patient individually and in person

.                  the service is of at least 20 minutes duration

.                   after the service, the eligible CDE gives a written report to the referring GP.

Copies of the current allied health fact sheet, allied health professional eligibility criteria, and EPC referral form may be downloaded from the HIC website at:

http://www.hic.gov.au/providers/incentives_allowances/medicare_initiatives/allied_health.htm

CDEs in private practice can apply to the HIC in their State for registration.  The application form must be accompanied by a certified copy of their Credentialling Certificate.  This Certificate has been modified to meet HIC requirements and will be issued as a matter of course from now on for newly credentialled or re-credentialling CDEs.  If you are an existing CDE in private practice who wants to register, you can request a new Certificate in the required form from the National Office by emailing inquiries@adea.com.au.  Include in your email the address you want the Certificate mailed to.

CDEs are encouraged to contact the HIC provider enquiry line on 132 150 for advice about requirements for billing and claiming.

These are early days and we will keep you informed of developments and provide advice on issues like the definition of private practice.

Alternatively give Chris Thorpe a call on 02 6287 4866 or email him on executive@adpo.com.au.