Aged Care Access Initiative

Background

Residents of Aged Care Facilities are amongst the most frail of Australians. They often have complex care needs requiring multidisciplinary healthcare providers. Some residents of Aged Care Facilities experience difficulties accessing GPs and allied health professionals.

The Aged Care Access Initiative began in July 2008 to improve access to primary care services (GPs and allied health) for residents of aged care facilities.

The initiative has two distict components:

• a GP Incentive component; and
• an allied health services component.

GP Incentive Payment

The GP Incentive Payment operates through the Practice Incentives Program (PIP), and is designed to encourage GPs to provide more services in Residental Aged Care Facilities (RACFs). The Incentive recognises some of the difficulties faced by GPs in providing care in these settings and encourages GPs to provide continuing and increased services in RACFs. The PIP payments are administered through Medicare Australia.

Operation

Incentive payments are based on a GP porviding a predetermined number of Medicare services in RACFs over a financial year. The Incentive payments are available to GPs in practices participating in the PIP. These practices are required to be accredited or registered for accreditation against the Royal Australian College of General Practitioners (RACGP) Standards for General Practices.

There are two payment levels under the GP component. Payments are calculated by Medicare Australia based on the number of relevant MBS items claimed in one financial year.

• Tier one provides a payment of $1,000 when the first qualifying service level (QSL1) of 60 services is claimed in 2009-10.
• Tier two provides a payment of $1,500 when the second qualifying service level (QSL2) of 140 services is claimed in 2009-10.

The maximum payment any one GP can receive in one financial year is$2,500. Once the prescribed number of MBS items has been claimed, Medicare Australia will make a payment automatically to the account nominated by the GP.

Eligible MBS Items

Eligible services are those provided to Aged Care Facility residents in Commonwealth funded RACFs and Mulitpurpose services. MBS Items that count toward the incentive are as follows:

25, 35, 43, 51, 92, 93, 95, 96, 712, 731, 734, 736, 738, 775, 778, 779, 903, 5010, 5028, 5049, 5067, 5260, 5263, 5265, 5267.

This list may be revised from time to time to include other items.

Allied Health Services Payment

The allied health services component is a payment for clinical care provided by Allied Health Professionals (AHPs) in RACFs, where these services are not currently covered by Medicare or other government funding arrangements. This component is managed at a state level by State Based Organisations which purchase allied health services from GP Networks.