Chronic Disease Management / Enhanced Primary Care Plan (GP Referral)

The Chronic Disease Management (formerly Enhanced Primary Care or EPC) — GP services on the Medicare Benefits Schedule (MBS) enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers.

A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.

Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient’s medical condition and care needs, as well as the general guidance set out in the MBS.

Patients who have a chronic medical condition and complex care needs and are being managed by their GP under a GP Management Plan (item 721) and Team Care Arrangements (item 723) are eligible for Medicare rebates for certain allied health services on referral from their GP.

 

Medicare Enhanced Primary Care Plan Enhanced Primary Care Program (EPC) is a government incentive which allows individuals with a chronic medical illness/condition to receive Medicare rebates for allied health services,

such as Podiatry.

 

What is a Chronic Medical Illness/Condition?

 

A chronic medical condition is an illness and/or condition which have been present, or likely to be present for more then six (6) months.  Such illnesses/conditions include cardiovascular disease, stroke, diabetes and
musculoskeletal conditions.

 

What are the benefits of an Medicare EPC Plan?

 

A Medicare EPC plan is put in place to assist you and your GP manage your chronic medical illness/condition by identifying and managing your needs and planning the best method of treatment.

 

A Team care arrangement is then made between your GP, other allied health professional/s and you, which provide an organized approach to your care.
This approach allows the coordination and collaboration of your treatment plan with at least two other health care providers.

 

Eligible Allied Health Professionals:

Aboriginal Health Workers
Occupational Therapist
Audiologists
Osteopaths
Chiropractors
Physiotherapists
Diabetes Educators
Podiatrists
Dietitians
Psychologists
Exercise Physiologists
Speech Pathologists
Mental Health Workers

How do I apply for the Medicare EPC Program?

 

You need to consult your GP who will perform a health assessment to determine whether you would benefit from a Medicare EPC program.  Once a Medicare EPC plan is agreed upon, then you can be referred to up to five
(5) allied health services each calendar year.

 

Please note that the five (5) services can be either provided by one allied health professional or shared between multiple allied health professionals. Also, keep in consideration that the allied health professional/s needs to meet specific eligibility criteria and be registered with Medicare Australia.

 

For Further Information:

 

Consult your GP or Specialist to see if you're eligible

Alternatively 


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Visit the Department of Health and Ageing website at https://www1.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-chronicdiseasemanagement

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