MedicarePlus

MedicarePlus is the Federal Government’s program to strengthen Medicare. The aim of the MedicarePlus safety net is to help people cope with the costs of out-of-hospital procedures that have never been widely bulk-billed.

This initiative introduces a new MBS item that can be claimed by a GP for certain services provided by an allied health provider (excluding State or Commonwealth funded allied health providers).

Currently, GPs can involve at least two allied health professionals in developing a Multidisciplinary Care Plan for patients, through the Enhanced Primary Care (EPC) program.

Under the improvements, up to five allied health consultations delivered to patients with a chronic condition or complex care needs, for and on behalf of a GP, will qualify for MBS payments ($44 a session). The item will be for services delivered ‘for and on behalf of a GP’ along the lines of the practice nurse item that commenced on 1 February 2004.

It is estimated that GPs will prepare 150,000 Care Plans a year involving 680,000 allied health consultations.

To qualify, the allied health provider will need to be a recognised professional who is registered under relevant State or Territory law. These are minimum requirements.

The new allied health benefits will apply from 1 July 2004.

The new safety net benefits will be claimable from the day after legislation is passed and the benefits will be automatic once people have registered and passed the threshold. The cost of services received since 1 January, 2004, will count towards the safety net threshold.

Evidence suggests that the initiative will be of benefit to patients in the following ways:

• using professionals who complement GPs in care - such as with assessment, treatment management, self management support, and follow-up - improves patient satisfaction, clinical and health status, and use of health services; and
• self-management of chronic conditions, with help from GPs and allied health professionals, can significantly decrease self-reported hospital stays (one or more nights) and self-reported visits to GPs.

The MedicarePlus proposal to fund allied health providers achieves this as part of the Enhanced Primary Care program. This initiative provides GPs with the opportunity to collaborate with other primary-care providers to provide the best treatment for sufferers of chronic diseases.

The Better Outcomes in Mental Health Care Initiative (BOMHC), while also focused on primary care, is directed to mental health issues and is only available through those GPs who have been trained and accredited under the BOMHC training program. While these two initiatives might overlap at the margins, they are essentially different programs serving different patients through different processes. They are not seen as clashing or even duplicating but rather complementary to meet differing community demands and to hopefully relieve pressure form GPs.

As inferred above, you will be charged the full fee and claim back the gap between the rebate and your fee. 

The Enhanced Primary Care program (EPC) enables the GPs to seek payment for developing a patient care plan for which they can consult two or more allied health providers and refer to those allied health providers appropriate for treating the patient. If the GP feels that the patient's condition would benefit from the involvement of a psychologist, then he/she will select an appropriate or known psychologist in the area.

No. Only those patients referred by a GP to a psychologist within the Enhanced Primary Care program and where there is a developed patient care plan will be eligible for rebates under the new allied health item number.