Shared Care - Working Together for a Healthier Australia
Health Professional

QUICK GUIDE

Click on to a profession in one of the segments in the schematic below to see the services which may be provided by the selected health care professional to assist patients undergoing stroke recovery.

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Allied Health (Individual) Services and Medicare 

Medicare's CDM items program encourages the establishment of multidisciplinary team care arrangements to provide shared care for patients with a chronic medical condition (or terminal) and complex care needs. 

The program provides referral pathways for treatment services for patients with chronic disease by eligible allied health professionals with Medicare rebates for up to a total of  five individual sessions per calendar year.
The CDM Medicare items cover thirteen allied health professions:

  • Aboriginal health workers
  • Audiologists
  • Chiropractors
  • Diabetes educators
  • Dietitians
  • Exercise physiologists
  • Mental health workers*
  • Occupational therapists
  • Osteopaths
  • Physiotherapists
  • Podiatrists
  • Psychologists
  • Speech pathologists

*including Aboriginal health workers, mental health nurses, mental health social workers, occupational therapists and psychologists

Allied health professionals need to meet specific eligibility requirements, be in private practice and register with Medicare Australia. Registration forms are available from Medicare Australia at www.medicareaustralia.gov.au or can be obtained by phoning 132 150.
(Department of Health and Ageing, Allied Health Services under Medicare – Fact Sheet)

Patient Eligibility and CDM Medicare Items

The GP is responsible for determining patient eligibility for CDM Medicare items. Patients with chronic or terminal conditions and complex care needs may be eligible for Medicare rebates for certain allied health services on GP referral if their GP has provided the following Medicare Benefits Schedule (MBS) CDM services in the previous two years:

  • A GP Management Plan (GPMP) - Item 721 (or review item 725 -item 732 from May 1 2010) AND
  • Team Care Arrangements (TCA) - item 723 (or review item 727 - item 732 from May 1 2010) OR
  • For patients who are permanent residents of an aged care facility, their GP must have contributed to or reviewed a multidisciplinary plan prepared by the facility - item 731.

A chronic medical condition is one that has been (or is likely to be) present for six month or longer.  It includes conditions such as asthma, cancer, cardiovascular disease, diabetes mellitus, musculoskeletal conditions and stroke.

Patients have complex care needs if they require ongoing care from a multidisciplinary team, consisting of their GP and at least two other health or care providers, each of whom provides a different kind of treatment or service to the patient.

Referral Arrangements

GPs determine whether the patient’s chronic condition would benefit from allied health services.

GP referrals must be made using the referral form issued by the Department of Health and Ageing for individual health services under Medicare or a form containing all of its components. See www.health.gov.au/mbsprimarycareitems

Allied health services provided through these referrals must be directly related to the management of the patient’s chronic condition/s, and the need for allied health services must be identified in the patient’s care plan. MBS CDM item numbers for allied health services are from 10950 to 10970.

It is not appropriate for allied health professionals to provide part-completed CDM referral forms to GPs for signature, or to pre-empt the GP’s decision about the services required by the patient.

Service Length and Type

Services provided by an  AHP must be of at least 20 minutes duration and be provided to an individual patient. The allied health professional must personally attend the patient.
(Department of Health and Ageing,  Allied Health Services under Medicare – Fact Sheet)

Reporting Requirements

Following a single service to a GP referred patient, an AHP must provide a written report back to the referring GP. If multiple services are supplied to the same patient under one referral, AHPs are required to provide a written report back to the referring GP after the first and last service only, or more often if clinically necessary.

Written reports should include:

  • Any investigations, tests and/or assessments carried out on the patient
  • Any treatment provided
  • Future management of the patient’s condition or problem
    (Medicare Australia – quick reference guide for allied health professionals)

Receipt Requirements

For a Medicare payment to be made the account/receipt must include the following information:

  • Patient’s name
  • Date of service
  • MBS item number
  • Allied health professional’s name and provider number or name and practice address
  • Referring medical practitioner’s name and provider number or name and practice address
  • Date of referral
  • Amount charged, total amount paid and any amount outstanding in relation to the service.
    (Department of Health and Ageing, Allied Health Services under Medicare – Fact Sheet))

Review

The Medicare Benefits Schedule sets out requirements and recommendations for the review process for TCA and GPMPs (item 725 or 727).  Further information is on the MBS web site: www.mbsonline.gov.au

 See Medicare's Quick Reference Guides at:

www.medicareaustralia.gov.au/provider/business/education/quick-reference-guides.jsp


 

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FOLLOW-UP ALLIED HEALTH SERVICES FOR PEOPLE OF ABORIGINAL AND TORRES STRAIT ISLANDER DESCENT

People of Aboriginal and Torres Strait Islander descent who have had a health assessment may be referred by a GP for follow-up allied health services.  See www.health.gov.au/mbsprimarycareitems or www.medicareaustralia.gov.au

 

ALLIED HEALTH GROUP SERVICES

For more information on allied health group services for patients with type 2 diabetes (in addition to the five individual allied health services available to eligible patients), visit www.health.gov.au/mbsprimarycareitems