Chronic Disease Management Plan
A chronic medical condition is one that has been, or is likely to be, present for at least 6 months or is terminal.
What are the chronic disease management Medicare items?
The chronic disease management (CDM) Medicare items are part of a Government initiative that assists people living with a chronic and/or complex medical illness. Medicare rebates are available for treatment from allied health professionals who are assisting in managing the illness. Your GP is required to prepare a management plan (called a GP Management Plan and Team Care Arrangements) so that your illness can be better managed with the assistance of allied health professionals. The initiative allows a person with a complex and/or chronic illness to claim a Medicare rebate for up to five visits (in total) to certain allied health professionals within a calendar year. Within Better Health Nutrition and Fitness, these allied health professionals include:
Chronic medical conditions that may be covered by the scheme must have been present, or are likely to be present, for six months or more. The conditions include, but are not limited to:
Medicare is Australia’s universal public healthcare system. Medicare Provider Numbers are issued by Medicare Australia to practitioners who are able to provide services for which a Medicare rebate can be claimed.
If I am already seeing an Allied Health Professional, can I access Medicare benefits?
In order to receive a Medicare rebate under this initiative, you must be referred to a Dietitian, Exercise Physiologist or Physiotherapist by your GP under a specific management plan to assist in managing your chronic/complex medical illness. If you are already seeing an Allied Health Professional, discuss this with your doctor.
What about my private health insurance?
You cannot use your private health insurance ancillary cover to top up the Medicare rebates for these services. You need to decide if you will use Medicare or your private health insurance ancillary cover to pay for Allied Health services you receive. You can either access rebates from Medicare by following the claiming process or claim where available on your insurer’s ancillary benefits.
How many sessions with a Better Health Nutrition & Fitness Allied Health Professional (AHP) am I entitled to?
The chronic disease management scheme only provides payment for a total number of five visits per calendar year to all allied health professionals that are specified in your Team Care Arrangements (TCA) that your GP has prepared. This means the number of sessions with one of our AHP's that will be paid for by Medicare under this scheme will depend on how many sessions with other Allied Health Professionals you have had or will require. For example, your TCA may state that you need two sessions with a Podiatrist, one with a Physiotherapist, one session with a Dietitian, and one session with an Exercise Physiologist. The combination of services can only add up to five sessions in a year, otherwise you will be required to pay for any additional services.
This information has been obtained from the Medicare website which outlines the requirements for referral under this program.
The chronic disease management (CDM) Medicare items are part of a Government initiative that assists people living with a chronic and/or complex medical illness. Medicare rebates are available for treatment from allied health professionals who are assisting in managing the illness. Your GP is required to prepare a management plan (called a GP Management Plan and Team Care Arrangements) so that your illness can be better managed with the assistance of allied health professionals. The initiative allows a person with a complex and/or chronic illness to claim a Medicare rebate for up to five visits (in total) to certain allied health professionals within a calendar year. Within Better Health Nutrition and Fitness, these allied health professionals include:
- Dietitian (Diet management, weight loss and treatment of medical conditions)
- Exercise Physiology (Weight loss through exercise interventions, and treatment of chronic health conditions)
- Physiotherapy (Injury management, rehabilitation, dry needling, clinical pilates and manual therapy)
Chronic medical conditions that may be covered by the scheme must have been present, or are likely to be present, for six months or more. The conditions include, but are not limited to:
- Asthma
- Cancer
- Cardiovascular illness
- Diabetes
- Musculoskeletal conditions
- Stroke
Medicare is Australia’s universal public healthcare system. Medicare Provider Numbers are issued by Medicare Australia to practitioners who are able to provide services for which a Medicare rebate can be claimed.
If I am already seeing an Allied Health Professional, can I access Medicare benefits?
In order to receive a Medicare rebate under this initiative, you must be referred to a Dietitian, Exercise Physiologist or Physiotherapist by your GP under a specific management plan to assist in managing your chronic/complex medical illness. If you are already seeing an Allied Health Professional, discuss this with your doctor.
What about my private health insurance?
You cannot use your private health insurance ancillary cover to top up the Medicare rebates for these services. You need to decide if you will use Medicare or your private health insurance ancillary cover to pay for Allied Health services you receive. You can either access rebates from Medicare by following the claiming process or claim where available on your insurer’s ancillary benefits.
How many sessions with a Better Health Nutrition & Fitness Allied Health Professional (AHP) am I entitled to?
The chronic disease management scheme only provides payment for a total number of five visits per calendar year to all allied health professionals that are specified in your Team Care Arrangements (TCA) that your GP has prepared. This means the number of sessions with one of our AHP's that will be paid for by Medicare under this scheme will depend on how many sessions with other Allied Health Professionals you have had or will require. For example, your TCA may state that you need two sessions with a Podiatrist, one with a Physiotherapist, one session with a Dietitian, and one session with an Exercise Physiologist. The combination of services can only add up to five sessions in a year, otherwise you will be required to pay for any additional services.
This information has been obtained from the Medicare website which outlines the requirements for referral under this program.
