Group Allied Health Services under Medicare for patients with type 2 diabetes
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As outlined by Medicare; patients who have type 2 diabetes are eligible for one individual assessment session and up to 8 group sessions per calendar year.
Note: these services are in addition to the five individual services for patients with a chronic or terminal medical condition and complex care needs
ELIGIBILITY
To be eligible for the group allied health services, the patient must have in place one of the following:
a GP Management Plan (GPMP) (MBS item 721); or
for a resident of an aged care facility, the GP has contributed to a multidisciplinary care plan prepared for the resident by the facility (MBS item 731
Note: Generally, residents of an aged care facility rely on the facility for assistance to manage their type 2 diabetes. Therefore, the resident may not need to be referred for allied health group services under these items, as the self-management approach offered in group services may not be appropriate.
Unlike the individual allied health services under items 10950 to 10970, there is no additional requirement for a Team Care Arrangements service (MBS item 723) in order for patients with type 2 diabetes to be referred for group allied health services under Medicare.
Assessment for group services (MBS items 81100, 81110 and 81120)
The purpose of the assessment service is to undertake an individual assessment of the patient preparing him/her for an appropriate group services program. The service involves taking a comprehensive patient history, identification of individual goals and preparing the patient for the group service. This may also provide an opportunity to identify any patient who is likely to be unsuitable for group services. An assessment service has to be of at least 45 minutes duration. It can be provided by a diabetes educator, an exercise physiologist or a dietitian on referral from a GP.
Group services (MBS items 81105, 81115 and 81125)
These services are provided in a group setting to assist with the management of type 2 diabetes. Group services have to be of at least 60 minutes duration. They can be provided to the patient by a diabetes educator, exercise physiologist or dietitian on referral from a GP.
Number of services per year
Patients are eligible for a maximum of one assessment for group services (MBS items 81100, 81110 or 81120) per calendar year. If more than one assessment service is provided in a calendar year, the subsequent service/s will not attract a Medicare rebate and the MBS safety net arrangements will not apply to costs incurred by the patient for the service/s.
Patients are eligible for up to eight group allied health services in total per calendar year. Each separate group service must be provided to the patient by only one type of allied health professional (i.e. by a diabetes educator or an exercise physiologist or a dietitian). However, the overall group services program provided for the patient could be comprised of one type of service only (e.g. eight diabetes education services) or a combination of services (e.g. three diabetes education services, three dietitian services and two exercise physiology services).
An eligible allied health professional with more than one Medicare provider number (e.g. for the provision of diabetes education and dietetics) may provide separate services under each of these provider numbers.
Allied health group service providers are strongly encouraged to deliver multidisciplinary group services programs that allow patients to benefit from a range of interventions designed to assist in the management of their type 2 diabetes. If a patient with type 2 diabetes also has complex care needs and the GP has coordinated their care using Team Care Arrangements (MBS item 723) and a GP Management Plan (MBS item 721), the patient may also be eligible for up to five individual allied health services per calendar year (MBS items 10950 – 10970).
If there is any doubt about a patient’s eligibility, Medicare Australia will be able to confirm the number of services already claimed by the patient during the calendar year. The allied health professionals or the patient can call Medicare Australia on 132 011 to check this information.
Click here to download a referral form If you are a medical centre requiring an RTF format please email manager@betterhnf.org
This information has been taken directly from Medicare Australia's Medicare Benefits Schedule Allied Health Services Information Manual last updated 01 November 2014.
