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Full details of incoming CDM changes revealed
New MBS fees, transition arrangements and referral pathways have been unveiled. The RACGP President said he’s been left frustrated by the delay, but ‘at least we now have clarity’.
The fee for the preparation or review of a new GP chronic condition management plan will be $156.55 for specialist GPs.
The long-awaited details of Medicare chronic disease management (CDM) item changes have been revealed, but with just weeks left for GPs to prepare for the systemic shift, the RACGP says it has been left frustrated by the lack of warning.
Late on Thursday, the Federal Department of Health, Disability and Ageing (DoHDA) confirmed the change will go ahead on 1 July.
It follows repeated calls for clarity from the RACGP to help general practices prepare to implement the significant changes.
In a matter of weeks, existing items for the preparation of GP management plans, team care arrangements and reviews will cease and be replaced with a new GP chronic condition management plan.
The CDM changes were first announced in the May 2023 Federal Budget, originally scheduled to begin in November last year.
However, with details of the new item numbers still unconfirmed by last September and following RACGP advocacy, the start date was pushed back until 1 July 2025, with the Federal Election and caretaker period causing further uncertainty.
Under the new arrangements, the Medicare items will be simplified to have a single item for plan preparation and second item for plan review.
The MBS fee for the preparation or review of a plan will be $156.55 for GPs and $125.30 for prescribed medical practitioners.
Previously, the rebate for preparation of a GP management plan was $164.35, preparation of a team care arrangement was $130.25, and a review was $82.10.
But RACGP President Dr Michael Wright said he is frustrated the information has been kept from GPs ‘as the professionals who need to implement these changes’.
‘Chronic disease management is core business of what we do in general practice and these item numbers are crucial for the care of our patients and the viability of our practices,’ he told newsGP.
‘When these measures were delayed back in September, it was hoped that the extra time would have been used to inform practices and patients about the changes, so that they could be implemented smoothly without disruption.
‘Unfortunately, information has not been forthcoming, and we will be playing a lot of catch up.
‘We know these chronic condition item numbers are crucial to support the financial viability of many practices, and they are the most commonly bulk billed items.
‘We were worried that these changes would reduce funding for these important services. When we surveyed our members last year, 69% said if chronic disease funding was not increased, they would have to start charging a fee rather than bulk bill patients.’
Eligibility and access
According to the newly released information, the GP chronic condition management plan will be available to patients with at least one medical condition that has been, or is likely to be, present for at least six months, or is terminal.
Patients registered through MyMedicare will be required to access the plan and review items through the practice where they are registered, while other patients can access the items through their usual GP.
Where multidisciplinary care is required, patients can access the same services currently available through GP management plans and team care arrangements.
Practice nurses, Aboriginal and Torres Strait Islander Health Practitioners and Aboriginal health workers can assist GPs or prescribed medical practitioners to prepare or review the plans.
Transition arrangements
Patients that had a GP management plan and/or team care arrangement in place before 1 July can continue to access services that are consistent with those plans under transition arrangements.
From 1 July 2025, any new plans put in place must meet the requirements of the new GP chronic condition management plan, and any new referrals for allied health services must meet the new referral requirements.
Patients will need to have their GP chronic condition management plan prepared or reviewed in the previous 18 months to continue to access allied health services.
From 1 July 2027, a GP chronic condition management plan will be required for ongoing access to allied health services and to access domiciliary medication management reviews.
Referrals and allied health
GPs and prescribed medical practitioners will refer patients with a GP chronic condition management plan to allied health services in the same way as other referrals.
The requirement to consult with at least two collaborating providers will be removed and the current referral form for allied health services will no longer be required.
Given the significance of the changes, Dr Wright said he had hoped GPs would be given more notice.
‘We’ve been asking the Health Department to give us certainty around the timing,’ he said.
‘We have that now, but we wish it had come sooner.
‘I know that many patients will have been booked for these plans and reviews after the start date of the new process, and software providers are going to have to move quickly to get updates available in time for the start.
‘With nearly eight million Australians accessing these items last year, they are a crucial health service and crucial to the financial viability of many practices.
‘We have to make sure the funding from these continues to flow to the right practices.’
According to DoHDA, the shift is ‘the first major change to the framework in almost 20 years’ and follow shifts in that time in the burden of chronic disease, patient expectations and technology.
For more information, DoHDA has released detailed fact sheets covering:
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