Gp aged care pip guidelines june 2021 PDF

Preview

Summary

Info on aged care and PIP guidelines of 2021 in june....

Description

Practice Incentives Program General Practitioner Aged Care Access Incentive Guidelines Effective July 2021

Introduction The Practice Incentives Program (PIP) encourages general practices to continue providing quality care, enhance capacity, and improve access and health outcomes for patients. You can read more on the PIP incentives and eligibility criteria in the PIP guidelines, at servicesaustralia.gov.au/pip

The PIP General Practitioner (GP) Aged Care Access Incentive (ACAI) The PIP GP 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:    

be registered in the PIP at an approved PIP practice use a Medicare provider number linked to a PIP practice when claiming Medicare Benefits Schedule (MBS) services in RACFs provide eligible 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.

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 4 payment tiers - see Table 1.

Table 1: PIP GP ACAI payments and requirements Tier

Qualifying Service Level (QSL)

Service Incentive Payment (SIP)

Tier 1a

60 to 99 services

$2,000

Tier 1b

100 to 139 services

+ $2,500

Tier 2a

140 to 179 services

+ $2,500

Tier 2b

180 or more services

+ $3,000

To receive the:    

Tier 1a payment of $2,000, GPs must provide at least 60 eligible MBS services in RACFs in a financial year. Tier 1b payment of an additional $2,500, GPs must provide at least 100 eligible MBS services in RACFs in a financial year. Tier 2a payment of an additional $2,500, GPs must provide at least 140 eligible MBS services in RACFs in a financial year. Tier 2b payment of an additional $3,000, GPs must provide at least 180 eligible MBS services in RACFs in a financial year.

Eligible GPs can get 4 payments totalling $10,000 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. Services count towards the QSLs when GPs claim the MBS services provided in RACFs using a Medicare provider number linked to a PIP practice. Where a QSL is met after the processing of claims in May and June, an adjustment payment is made in August for the previous financial year.

Eligible MBS items Eligible MBS services are those provided to residents in Commonwealth-funded RACFs and Multi-Purpose Services. Multi-Purpose Services are integrated health and aged care services that provide flexible and sustainable service options for rural and remote communities. MBS services that count towards the QSLs include:   

attendances in RACFs, including those provided to DVA patients contributions to Care Plans Residential Medication Management Reviews.

The MBS items that count towards the QSLs are: 232, 249,731,741,763, 772, 789, 903, 5010, 5028, 5049, 5067, 5260, 5263, 5265, 5267, 90020, 90035, 90043, 90051, 90092, 90093, 90095, 90096, 90183, 90188, 90202 and 90212. We may update this list to include or remove MBS items. For more information on the use and billing of MBS items call Medicare Provider Enquiries on 132 150*.

How to Apply You do not have to apply for this incentive if your practice is already participating in the PIP. If your practice is not participating in the PIP, the practice can apply: 



online through Health Professional Online Service (HPOS), at servicesaustralia.gov.au/hpos using your Provider Digital Access (PRODA) account o read more about PRODA including how to create an account at servicesaustralia.gov.au/proda, by faxing a completed Practice Incentives application form (IP001) to 1300 587 696. Go to servicesaustralia.gov.au/hpforms to download the form.

How payments are made The PIP GP ACAI payment is made once a GP has claimed the required number of MBS items. The payment is made quarterly and paid into the GPs nominated bank account.

Table 2: Quarterly payment months and reference periods Quarterly payment month

Point in time assessment of eligibility

Reference period

February

31 January

1 November to 31 January

May

30 April

1 February to 30 April

August

31 July

1 May to 31 July

November

31 October

1 August to 31 October

If we don’t have the GP’s bank details, we’ll send them the Practice Incentives Program Service Incentive Payment banking details form (IP011). Once they’ve registered their bank details, all future payments will be paid into their nominated bank account.

Obligations The practice must:   

give information to the Department of Health and Services Australia as part of the ongoing audit process to verify that the practice has met eligibility requirements make sure the information given to the Department of Health and Services Australia is correct tell us about any changes to practice arrangements within 7 days of the change, or at least 7 days before the point-in-time date. The point-in-time date is the last day of the month before the next PIP quarterly payment (see Table 2).

Read more in the PIP Guidelines at servicesaustralia.gov.au/pip PIP practices must nominate an authorised contact person to act on behalf of the practice in relation to the program. They’ll be authorised to advise us of any changes and are the person we send all correspondence or enquiries to. We can only contact the current owner or authorised contact person.

Rights of review The PIP has a review of decision process that is separate to reviews relating to program audits. To ask for a review of a decision related to the PIP GP ACAI, the GP must write to Services Australia using the Practice Incentives review of decision form (IP027) and provide supporting documentation within 28 days of receiving the decision you want reviewed. Services Australia will review the decision against the published guidelines at the time of the event. The outcome of the review will be advised in writing. If you’re not satisfied with the 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: servicesaustralia.gov.au/pip Email: [email protected] 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 PIP GP ACAI 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....