New financial year changes for general practice

Morgan Liotta

30/06/2022 1:24:38 PM

Updates to PBS subsidies, prescribing and digital health services will come into effect from 1 July.

GP checking records
GPs should be aware of some changes to prescribing and PBS subsidies in the new financial year.

CLARIFICATION: This article was updated at 9.30 am on 15 July. The original article stated that it was mandatory for all doctors to have a Provider Digital Access (PRODA) account, but subsequent advice from Services Australia has confirmed that this is only required to access certain services.

In addition to changes being introduced to the MBS from 1 July, updates to other areas relating to general practice will be in place from the new financial year.
Closing the Gap PBS Co-payment Program
The new financial year marks the end of the grace period for the Closing the Gap (CTG) PBS script measure reform. The co-payment program was expanded in July 2021, before further grace periods were extended until January and July 2022.
The system for CTG registration for Aboriginal and Torres Strait Islander patients is run by Services Australia and operates online through the Health Professional Online Services (HPOS) portal.
To date, key benefits of the program have included:

  • one-off registration
  • registration to only occur through HPOS
  • any PBS prescriber (such as doctors, dentists, optometrists, midwives, nurse practitioners) or AHPRA-registered Aboriginal and Torres Strait Islander health practitioners registered with Medicare as a provider can register eligible Aboriginal and Torres Strait Islander people
  • people can be registered for the program regardless of where they live and their chronic disease status
  • prescriptions no longer need to be annotated with ‘CTG’.
However, the RACGP is concerned about some of the 1 July changes that mean patients who are not correctly registered will pay more for PBS medicines.
Dr Mary Belfrage previously told newsGP that the onus should not all fall on GPs to register patients.
‘Although the changes to the program are positive … it’s on the individual prescriber to check the eligibility,’ she said.
‘[But] the onus is also on the pharmacies to know because it’s actually at the point of dispensing that it becomes an issue, not at the point of prescribing.’
While many patients were successfully transferred from the old CTG registration system, currently there are potentially thousands of eligible clients not correctly registered on CTG, and GP clinical software systems may not provide a clear indication of a client’s CTG registration status.
In addition, writing or printing ‘CTG’ on a script or completing PIP forms does not ensure a patient will receive CTG scripts – this can only be done through HPOS.
To help maintain medicines access for Aboriginal and Torres Strait Islander patients, the college recommends GPs and practice teams should consider:
  • ensuring that workflow and systems support both check Aboriginal and Torres Strait Islander patients’ registration status and register all CTG eligible clients
  • asking patients if they have had problems accessing CTG medications when they present at a pharmacy
  • sending out a bulk SMS to Aboriginal and Torres Strait Islander patients with key information, if the practice software allows.
Because only ‘warnings’, not ‘rejections’ are issued at the pharmacy for clients who are not registered (prior to July 2022), GPs may also wish to contact their local pharmacies to check if they have received many PBS ‘warnings’ for their respective clients.
Health professional education resources are available via the Services Australia website, and NACCHO has developed a CTG information and FAQs document for Aboriginal Community Controlled Health Organisations to further address issues related to the new CTG reforms.
Provider Digital Access account requirements
Provider Digital Access (PRODA) is used to access a wide range of government services, including health professional services.
Doctors and medical practices who require access to services such as the Health Professional Online Service (HPOS) or third-party online claiming will need a PRODA account for authentication.
With the move to webservices on 1 July, accessing some digital health services such as Medicare Online (including AIR and DVA) and PBS Online can only be done via PRODA authentication.
Where independent contractor doctors work at a practice, each doctor should have their own PRODA account and issue invoices with their own ABN (not the practice’s). If the doctor uses the practice’s PRODA account, that doctor may not be viewed as an independent contractor.
However, the Australian Tax Office (ATO) has advised that employers need to consider ‘the entirety of the working arrangement’ to determine whether a doctor is considered an independent contractor for tax and superannuation purposes, rather than just whether or not they submit claims on behalf of the organisation.
As it’s a state-based tax issue, the ATO recommends contacting a tax professional to get individual advice.
Where doctors are employed by the practice, they can utilise the practice’s PRODA account and ABN when invoicing. At this stage e-invoicing via PRODA will not be mandatory.
If GPs have specific questions regarding PRODA and e-invoicing, they can contact Services Australia or a financial/tax professional.
PBS Safety Net thresholds
From 1 July, the Pharmaceutical Benefit Scheme Safety Net thresholds will be reduced by the equivalent of 12 full-priced scripts for concession card holders and the equivalent of approximately two fully priced scripts for non-concessional patients.
For concessional patients, the safety net threshold will be lowered from $326.40 to $244.80 – an $81.60 reduction for concessional patients. This means when a concession card holder reaches the safety net threshold, after 36 full-priced concessional scripts, they will receive PBS medicines at no charge for the rest of the year.
For other patients, the general safety net threshold will reduce from $1542.10 to $1457.10 – a maximum reduction of $85 for non-concessional patients, which means that after the equivalent of about 34 full-priced general co-payments, general patients pay only the concessional co-payment of $6.80 per PBS script (plus any applicable premiums) for the balance of the year.
Further information is available on the PBS website or Department of Health and Aged Care FAQs document.
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Dr David Zhi Qiang Yu   1/07/2022 6:19:28 PM

From 1 July 2022, the payments of many common item numbers have been decreased from Medicare !!! Those decreased payment item numbers including but no limiting to 2717, 2715, 2712, 2713, 721, 723, 732, 11607, 16500, 11306, 14206, 30062, 73806 ......
Dear Professor Karen Price, President and other College official, please talk to the Government immediately to stop the cutting of the essential fees/funding /service for already struggle for survive of all hardworking GPs.

Dr Lynette Dorothy Allen   2/07/2022 11:54:21 AM

The general safety net for non concessional patients with the reduction in cost for full priced scripts to $30 from 1/7/22 promised by the current government means that 49 full priced scripts would now be needed before reaching the concessional copayment so most will never reach it Government generosity seems to only happen if you qualify for a card.