Information on the Chronic Disease Management (CDM) items that are available under Medicare to patients with a chronic medical condition.
The Chronic Disease Management (formerly Enhanced Primary Care or EPC) — GP services on the Medicare Benefits Schedule (MBS) enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers.
A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.
Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient’s medical condition and care needs, as well as the general guidance set out in the MBS.
Patients who have a chronic medical condition and complex care needs and are being managed by their GP under a GP Management Plan (item 721) and Team Care Arrangements (item 723) are eligible for Medicare rebates for certain allied health services on referral from their GP.
Summary
- There are two types of plans that can be prepared by a General Practitioner (GP) for Chronic Disease Management (CDM):
- GP Management Plans (GPMP); and
- Team Care Arrangements (TCAs)
- There are two types of plans:
- If you have a chronic (or terminal) medical condition, your GP may suggest a GPMP.
- If you also have complex care needs and require treatment from two or more other health care providers, your GP may suggest TCAs as well.
- Your GP or practice staff must obtain your agreement before providing these plans.
- If a provider accepts the Medicare benefit as full payment for the service, there will be no out-of-pocket cost. If not, you will have to pay the difference between the fee charged and the Medicare rebate.
- If you have both a GPMP and TCAs prepared for you by your GP, you may be eligible for Medicare rebates for certain allied health services. It is up to a GP to determine whether you are eligible for these allied health services which must be directly related to the management of your chronic condition.
- The practice nurse can provide support and monitoring between visits to your GP.
- Your GP will offer you a copy of your plan.
- You and your GP should regularly review your plan/s.
Page last updated: 02 April 2014
Source: http://www.health.gov.au/internet/main/publishing.nsf/content/mbsprimarycare-chronicdiseasemanagement