GP Aged Care Access Incentive Guidelines
Introduction
The Practice Incentives Program (PIP)encourages general practicestocontinueprovidingquality care, enhancing capacity, and improving access and health outcomes for patients.
You can find more on the PIP incentives offered and overall eligibility in the PIP guidelines at humanservices.gov.au/pip
The PIP GP Aged Care Access Incentive
The PIP GP Aged Care Access Incentive (ACAI) aims to encourage GPs to provide increased and continuing services in Residential Aged Care Facilities (RACFs).
Eligibility
To be eligible for the PIP GP ACAI payments, GPs must:
- work from a PIP practice
- provide eligible Medicare Benefits Schedule (MBS) services to residents in RACFs
- reach the Qualifying Service Level (QSL) by providing the required number of MBS services in RACFs in a financial year, and
- use a Medicare provider number linked to a PIP practice when claiming MBS services in RACFs.
Payments and requirements
The PIP GP ACAI payments are based on a GP providing a required number of eligible MBS services in RACFs in a financial year. The PIP GP ACAI has 2 payment tiers-see Table 1.
Table 1: PIP GP ACAI payments and requirements
Tier / Qualifying Service Level (QSL) / Service Incentive Payment (SIP)Tier 1 / 60 services / $1,500
Tier 2 / 140 services / $3,500
To receive the:
- Tier 1 payment of $1,500, GPs must provide at least 60 eligible MBS services in RACFs in a financial year
- Tier 2 payment of $3,500, GPs must provide at least 140 eligible MBS services in RACFs in a financial year.
Eligible GPs can get2 payments totalling $5,000 for the financial year, in addition to the consultation fee.
Payments are automatically paid to GPs who reach the QSLs by providing the required number of eligible MBS services in RACFs. See Table 1.
For services to count towards the QSLs, GPs must claim the MBS services provided in RACFs using a Medicare provider number linked to a PIP practice.
Eligible MBS items
Eligible MBS services are those provided to residents in Commonwealth-funded RACFs and Multipurpose Services.
Multipurpose Services are integrated health and aged care services that provide flexible and sustainable service options for small rural and remote communities.
MBS services that count towards the QSLs include:
- attendances in RACFs
- contributions to Care Plans, and
- Residential Medication Management Reviews
The MBS items that count towards the QSLs are: 20, 35, 43, 51, 92, 93, 95, 96, 188, 202, 212, 232, 249,731,741,763, 772, 789, 903, 5010, 5028, 5049, 5067, 5260, 5263, 5265 and 5267.
We may update this list to include or remove MBS items.
For more information on the use and billing of MBS items call 132 150*.
Applying
GPs from PIP practices don’t need to apply for this incentive. If your practice isn’t in the PIP you can apply:
- through Health Professional Online Service (HPOS), at humanservices.gov.au/hpos, or
- by completing the Practice Incentives application form at humanservices.gov.au/pip
How payments are made
Once a GP has claimed the required number of MBS items, we’ll pay the SIPs in the next PIP quarterly payment into their nominated bank account.
If we don’t have the GP’s bank details, we’ll send thePractice Incentives Program Service Incentive Payment banking details form to the GPto complete. Once they’ve registered their bank details, all future payments will be paid into the nominated bank account after we process the MBS claims for services provided in RACFs.
Obligations
The practice must:
- give information to us as part of the ongoing audit process to verify that the practice has met eligibility requirements
- make sure the information given to us is correct, and
- tell us about any changes to practice arrangements:
- through HPOS. Most changes in HPOS are immediate and can be made up to, and on, the relevant point-in-time date
- by completing the Practice Incentives Change of practice details form
- by writing to us no later than 7 days before to the relevant point-in-time date.
Read more in the PIP Guidelines at humanservices.gov.au/pip
The point-in-time date is the last day of the month before the next PIP quarterly payment.
On joining the PIP, the practice must nominate an authorised contact person, who’ll confirm any changes to information for PIP claims and payments on the practice’s behalf.
Rights of review
The Practice Incentive Program has a review of decision process.This is separate from reviews relating to program audits. We base our decisions made under the program on the published guidelines as at the date of the event. To ask for a review of a decision, the authorised contact person or the owners of the practice must write to us using thePractice Incentives review of decision form. You must do this within 28 days of receiving the decision you want reviewed. We’ll review our decision against the PIP eligibility criteria, the payment formula, or both. We’llwrite to your practice to let you knowthe outcome of the review.
If you’re not satisfied, with the review decision you can ask our Formal Review Committee to reconsider it. The Formal Review Committee is the last avenue of appeal and its decision is final.
For more information
Online:humanservices.gov.au/pip
Email:
Call:1800 222 032** 8:30 am to 5:00 pm, Monday to Friday, Australian Central Standard Time (ACST)
*Call charges apply.
** Call charges apply from mobile and pay phones only.
Disclaimer
These guidelines are for information purposes and provide the basis on which PIP payments are made. While it’s intended that the Australian Government will make payments as set out in these guidelines, the making of payments is at its sole discretion.
The Australian Government may alter arrangements for the Practice Incentives Program or the Practice Incentives Program General Practitioner Aged Care Access Incentive at any time and without notice.
The Australian Government doesn’t accept any legal liability or responsibility for any injury, loss or damage incurred by the use of, reliance on, or interpretation of the information provided in these guidelines.