MyMedicare

On 25 September the Department of Health and Aged Care announced the commencement date for Chronic Conditions Management MBS item changes have been deferred to 1 July 2025.

The additional time will support all practices and providers, including GPs and allied health providers, to be ready for the changes to these important services. Previously, these changes were due to come into effect from 1 November 2024.

The Department of Health and Aged Care has announced major changes to the Medicare Benefits Schedule (MBS) items for chronic disease management from 1 November 2024.

The changes recommended by the MBS Review Taskforce, are ‘the first major change to the framework in almost 20 years’ and include:

• Replacing the current GP Management Plan and Team Care Arrangements with a single GP Chronic Condition Management Plan.
• Supporting continuity of care by requiring patients enrolled in MyMedicare to access management plans through the practice where they are enrolled (patients who aren’t enrolled will be able to access management plans through their usual GP).
• Encouraging management plan reviews by equalising the fees for developing and reviewing plans and requiring patients to have their plan established or reviewed in the last 18 months so they can retain access to allied health and other services.
• Formalising referral processes for allied health services so they are more consistent with other referral arrangements.

Chronic conditions management activities make up a substantial proportion of general practice activity with 2022 -23 data from the Australian Institute of Health and Welfare identifying that:

• 60% of people (10.2 million) who visited a general practitioner (GP) in the last 12 months had a long-term health condition, and
• Almost 1 in 6 (16%; 4.1 million) Australians claimed a Chronic Disease Management service.

There are several steps your practice can take to prepare for these changes before 1 November:

1. Discuss what these changes mean with your practice team and identify any activities or processes you need to review or update.
2. Register your practice for MyMedicare if you have not done so already.
3. Engage your patients to encourage them to register with your practice, particularly those with a chronic condition or existing care plan.

See the latest information on the MBS Factsheet released 23 August 2024 - Upcoming Changes to Chronic Disease Management MBS Items – Overview.
 

To inform patients and their carers about MyMedicare the resources below can help explain the benefits and what it means for them.

Patient Brochures

• mymedicare-dl-brochure.pdf (health.gov.au)

Patient Videos

• Introducing MyMedicare | Australian Government Department of Health and Aged Care
• Registering in MyMedicare | Australian Government Department of Health and Aged Care

The following information outlines the eligibility requirements for general practices to register in MyMedicare.

To be eligible for MyMedicare, general practices must:

• provide Medicare-funded services or Department of Veterans’ Affairs (DVA) equivalent services.
• be registered in the following Services Australia systems:

o Provider Digital Access (PRODA)
o Health Professional Online Services (HPOS)
o the Organisation Register

• have at least one eligible GP linked to the practice in the Organisation Register – an eligible GP can be a vocationally registered GP, non-vocationally registered GP or a GP registrar.
• be accredited against the National General Practice Accreditation Scheme (NGPAS) – non-accredited practices will have 12 months to gain accreditation through a registered accreditation agency from the date they register in MyMedicare as a practice.

A temporary exemption from accreditation is available to mobile and outreach services (including sole providers) who do not meet the current RACGP definition of a general practice until 30 June 2025 if they deliver general practice services:

• in rural settings
• in residential aged care
• in disability residential settings
• to First Nations Australians
• to people experiencing homelessness.

You can find out more about the accreditation process by visiting the Australian Commission on Safety and Quality in Health Care website or by contacting our team through Practice Assist.

General practices will need to be accredited under the National General Practice Accreditation Scheme, including the requirement to meet the RACGP definition of a general practice, to participate in MyMedicare. Unaccredited practices will have 12 months to gain accreditation through a registered accreditation agency from the date they register in MyMedicare as a practice.
 
General Practices accredited under the National Safety and Quality Primary and Community Healthcare Standards and not accredited against the National General Practice Accreditation Scheme, are ineligible for MyMedicare.
 
A temporary exemption from accreditation is available to mobile and outreach services (including sole providers) who do not meet the current RACGP definition of a general practice until 30 June 2025 if they deliver general practice services in rural settings, residential aged care, disability residential settings, to First Nations Australians and/or people experiencing homelessness.

Services Australia has developed a practice registration checklist to guide practices through the MyMedicare registration process. This can be found here.

Practice Registration

To take part in MyMedicare, general practices need to register their organisation and link their participating providers to the organisation in PRODA.

Information on practice eligibility and registration can be found here.

Organisation Registration resources

• Services Australia Organisation Register eLearning module
• MyMedicare practice registration FAQ
• MyMedicare Registration Steps and Tips - step by step guide on registering your organisation*

*Created by East Melbourne Primary Health Network
 

Link your organisation to the MyMedicare program

Once the organisation is registered in HPOS and the Organisation Register tile is visible, you will need to link your organisation to the MyMedicare program. This step is essential for patients to be able to register with your practice.

In PRODA:

1. Log in to PRODA and go to ‘services’
2. Choose the practice, go to the green organisation tile, and then associated sites
3. Click on blue link to the chosen practice, then program registration, add program
4. Select new program, drop down box, and choose ‘MyMedicare’
5. Submit and save
6. Choose MyMedicare preferences. These preferences are about how the practice wants to work with patient registrations.

Prompts will assist you with the steps to add the MyMedicare program.

For additional support with practice registration, email ORGANISATION.REGISTER.SUPPORT@servicesaustralia.gov.au or phone 1800 700 199 and select option 1.

For more information on registering your practice, visit the Services Australia Health Professional Education website. This website has a range of eLearning modules to guide you through the registration process.

Patient Registration

Patients Registration is now available.

Information on patient eligibility, potential benefits to patients and patient resources can be found on the Information for MyMedicare patients page of the Australian Government Department of Health and Aged Care website.

Patients can be registered in three ways;

• Patients can commence the registration process in their Medicare online services (Medicare Online Account or the Express Plus Medicare mobile application) and then practice staff can then accept or decline the registration in MyMedicare system.
• Practice staff can commence the patient registration process in MyMedicare and patients can then complete the registration and provide consent in their Medicare online services.
• Patients can fill out a registration form at the practice and practice staff will then complete the registration in the MyMedicare system with the patient’s consent captured on the form. Note that DVA patients must use this method of registration.

Australian Government Patient Registration Resources

• Patient Registration FAQs
• Patient Registration Brochures and posters
• Patient Registration Form
• Services Australia MyMedicare - Managing patient registration eLearning module
• Registering in MyMedicare - Factsheet for patients

For additional support with MyMedicare actions in PRODA contact the PRODA helpline 1800 700 199 and select option 1.

You can visit health.gov.au/MyMedicare for more information, including Frequently Asked Questions (FAQs) on registration and the benefits of MyMedicare.

Practices and providers are encouraged to contact their local Primary Health Network if they need further information on eligibility or registration.

Information on patient registration will be made available on the Department of Health and Aged Care website in the coming months.

• Department of Health and Aged Care website – health.gov.au/MyMedicare
• Services Australia Health Professional Education website – hpe.servicesaustralia.gov.au

Information on patient registration, resources for patients and practices
can be found on the Australian Government Department
of Health and Aged Care MyMedicare page.

The Resources for general practices and healthcare providers page includes:

• GP Toolkit
• Patient Registration form
• Brochures and posters
• FAQs
• Fact sheets
• and webinars

For information regarding the changes to Bulk Billing in General Practice from 1 November 2023 please visit our Medicare Benefits Tool Kit page.

The Royal Commission into Aged Care Quality and Safety recommended the development of a new model of primary care to 'encourage the provision of holistic, coordinated and proactive health care for the growing complexity of the needs of people receiving aged care' (Recommendation 56).

The General Practice in Aged Care Incentive aims to improve access to quality, proactive general practice care for older people who live in aged care homes by incentivising proactive visits, regular, planned reviews and coordinated care planning.

Primary care providers and practices registered in MyMedicare and participating in MyMedicare GPACI will receive incentive payments for providing their MyMedicare registered patients who live in aged care homes with care planning services and regular visits.

Practices are able to register for the General Practice in Aged Care Incentive through the MyMedicare program, provided they meet the eligibility criteria.

Practice registration requirements

To be eligible to receive the incentive, practices must be:

• a general practice or practice eligible for an exemption under MyMedicare – see MyMedicare eligibility criteria
• registered in the Organisation Register
• registered in the MyMedicare program (with banking details added)
• registered in the General Practice in Aged Care Incentive sub-program

Responsible Providers

A ‘Responsible Provider’ is a provider who is responsible for coordinating the delivery of eligible services to the registered patient as part of the General Practice in Aged Care Incentive. This includes services provided by other health professionals at the practice as part of the servicing requirements of the incentive.
 

Responsible Providers eligibility

To be eligible for payment, Responsible Providers must:

• an eligible primary care provider as outlined in the Program Guidelines 
• linked to their eligible practices
• declared as the responsible provider of eligible services to the registered patient, including coordinating services provided by the care team or practice.  

 

Care team registration requirements

Other members of a patients care team can deliver services that contribute to the patients' eligible services. These services must be delivered under the direction of the Responsible Provider and be in line with the quarterly servicing requirements for the patient’s care team.
Eligible care team members include an alternative provider within the same practice, including:

• another GP or GP registrar
• a nurse practitioner, and/or
• practice nurse, Aboriginal and Torres Strait Islander health practitioner or Aboriginal health worker.

 

Alternative provider eligibility

To be eligible to participate in the General Practice in Aged Care Incentive, an alternative provider must:

• be linked to the same eligible practice as the patient’s Responsible Provider.
• deliver eligible services under the direction of the patient’s Responsible Provider.

 

Practice nurse, Aboriginal and Torres Strait Islander health practitioner and Aboriginal health worker eligibility

A practice nurse, Aboriginal and Torres Strait Islander health practitioner and Aboriginal health worker can also contribute to the patient’s servicing requirements under the direction of the Responsible Provider. Any services delivered by these care team members must be billed through the eligible practice.
 

Patients eligibility:

Patients must: 

• permanently live in a residential aged care home, not including respite care  or supported living
• register with MyMedicare and link to an eligible practice and responsible provider 
• have the General Practice in Aged Care Inentive indicator seleted on their MyMedicare profile by their practice 

Note: People who live in a residential aged care home are exempt from the MyMedicare eligibility requirement for one face-to-face visit for practices in remote locations, or two face-to-face visits for practices in other locations in the previous 24 months recorded with the same practice

It is the responsibility of both the provider and practice to ensure a patient is eligible for the General Practice in Aged Care Incentive. The provider and practice must declare their patient meets the eligibility criteria as part of the patient registration process.

Practices need to

• link GPs and thier myMedicare patients to their practice 
• select the General Practice in Aged Care Incentive indicator (Shown on slide 27 in the link) on their patients MyMedicare profiles. 
• link patients to responsible providers in their practice

 

Eligible providers and practices are required to meet the servicing requirements to receive the incentive payments, including delivering:

• 2 eligible care planning services over a 12-month period; and
• 2 eligible regular visits per quarter; each in a separate calendar month, delivering at least eight regular services in a 12-month period.

There are several things you may consider prior to registering the GP ACI. The GP and Practice Information Kit provides information to help you understand the General Practice in Aged Care Incentive, eligibility, service requirements and responsibilities, helping you better understand the implications for your practice, GP, and care team.
Instructions on how to register for the GPACI can be found below:

• Services Australia Aged Care Incentive
• MyMedicare eLearning
• New and Improved GPACI MBS User Guide

New resources have been published on the Services Australia page to support providers and practices to forecast payments and eligibility for the General Practice In Aged Care Incentive. There are separate resources for practices and for providers:

Practices

• Forecast eligibility for MyMedicare Incentives for an Organisation site/Practice
• Search for and view eligibility assessments for MyMedicare Incentives for an Organisation site/Provider

Providers

• Forecast eligibility for MyMedicare Incentives as a Provider
• Search for and view eligibility assessments for MyMedicare Incentives as a Provider

There is a range of resources available to assist with implementing the MyMedicare GPACI program in your practice.

• Program Guidelines 
• GP and Practice Information Kit
• Services Australia Aged Care Incentive
• MyMedicare eLearning
• Fact Sheets and Patient journeys
• Patient monitoring and tracking tool
• Patient front sheet template
• GPACI Incentive Payment Structure

• MyMedicare is a new voluntary patient registration model that aims to build a stronger relationship between patients and their primary care teams.
• MyMedicare will drive improvements in primary health care for all Australians and deliver new funding packages to primary care providers.
• Registration in MyMedicare is voluntary for patients, practices and providers.

• Patients can register with their general practice and nominate their usual doctor.
• MyMedicare patients will have access to greater continuity of care with their registered practice, improving health outcomes.
• Registered patients will be able to access longer MBS-funded telephone calls with their usual general practice.
• Registered patients under 16 years old, pensioners and other Commonwealth concession card holders will have access to triple bulk-billed longer telehealth consultations.
• Patient registration will be available from 1 October 2023 to Australians with a Medicare card or Department of Veterans’ Affairs (DVA) Veteran Card. Patients will be able to register at their practice or online through their Medicare Online Account.

• Registration in MyMedicare is voluntary for patients, practices and providers.
• MyMedicare practices will have access to more information about regular patients, making it easier to tailor services to fit the patient’s needs.
• Registered practices will be able to deliver MBS funded longer telephone consultations (levels C and D) to registered patients.
• Registered practices will have access to the triple bulk-billing incentive for longer MBS telehealth consultations (levels C, D and E) for registered patients under 16, pensioners and Commonwealth concession card holders.
• The following new blended funding payments will be available to registered practices and providers:

      o   the General Practice in Aged Care Incentive from 1 August 2024, which will support regular health assessments, care plans and regular GP visits for people in residential aged care homes.
      o   new blended funding payments to support better care in the community for people with complex, chronic disease who frequently attend hospitals. These arrangements will roll out progressively across the country over three years from FY2024–25.
      o   Chronic Disease Management items linked to a patient’s registration in MyMedicare from November 2024, to support continuity of care for people with chronic and complex conditions. Patients who are not registered in MyMedicare will still be able to receive Chronic Disease Management items from their usual GP.

• Practices that provide services to patients who would benefit from the new MyMedicare-linked MBS long telehealth services or provide care to people in residential aged care are encouraged to register in MyMedicare as a priority.
• From 1 October 2023, patients will be able to register with their regular general practice and select their preferred general practitioner (GP).
• Practices will be able to generate and access a list of their registered patients through the MyMedicare system.

     o   Work is underway to integrate registration information with practice software to reduce administrative burden and allow GPs to access their registered patient lists directly.

 

Video 1   What should our practices be doing to prepare for the Medicare reform?	Preparing for the Medicare reforms: Insights from Dr. Walid Jammal In preparation for MyMedicare, it’s important for practices to come together as a team to understand why it is important for them and their patients.   In a recent interview, Dr Walid Jammal from Hills Family General Practice commented that every practice will have its own response to the reform, but by focusing on patients, practices can prepare for the changes to come.   “We’re moving to towards a cohort driven, patient centred model of care that involves in-reach and outreach to our patients and is funded by a blended funding model.”   Watch more as Dr Jammal shares his insights into what practices should be doing to prepare for the Medicare reform.
Video 2   What should our practices be considering to prepare for multidisciplinary team care?	Preparing for Multidisciplinary Team Care: Insights from Dr. Walid Jammal Watch part two of our video series with Dr Walid Jammal from Hills Family General Practice as he shares his thoughts on the importance of multidisciplinary team care. Every practice is different and there is no single answer that will work for all, however the need for multidisciplinary care is clear. Working as a team, with a common purpose and vision, can improve the care of patients and the sustainability of the practice. Dr Jammal also highlighted that teamwork can be built across sites, not just under the same roof. Practices should focus on what multidisciplinary team-based care means to them and put enablers in place to build trust and improve workflows. Watch more
Video 3   What’s within our reach with digital health that will transform our further with primary care?	Digital health and transforming primary care: Insights from Dr. Walid Jammal Watch the third part in our video series with Dr Walid Jammal from Hills Family General Practice, as we discuss the potential of digital health to transform primary care. Dr Jammal highlighted the importance of using existing data extraction and decision-making tools such as Primary Sense. He also discussed the potential for My Health Record, which is set to change with the government's commitment to making it more usable and friendly for both patients and providers. In addition, Dr Jammal mentioned the emergence of tools such as AI, transcription tools, and decision support tools, all of which are part of a big national digital strategy. Watch here
Video 4   Why is it important to be patient centred while we’re introducing these reforms	Health care reforms and patient centred care: Insights from Dr. Walid Jammal Watch the final part of our interview series with Dr Walid Jammal from Hills Family General Practice, as we discuss the importance of being patient centred. Dr Jammal challenges people to think about what patient-centeredness really means to them and their patients, emphasising the importance of understanding what patients want from their GP and general practice. He suggests focusing on three essential elements that patients want when asked: access, high-quality medicine, and convenience. By implementing changes and reforms with these three elements in mind patients can benefit from the convenience of telehealth, communication tools, and apps while receiving holistic high-quality care that is centred around their needs. Watch more

• All general practices providing Medicare-funded services or DVA equivalent services will be able to participate in MyMedicare.
• General practices must be accredited under the National General Practice Accreditation Scheme or have a valid exemption. Non-accredited practices will have 12 months to gain accreditation through a registered accreditation agency from the date they register in MyMedicare as a practice.
• Patients will be able to register with their regular general practice and select their preferred GP linked to that practice.
• General practices can start the MyMedicare registration process by ensuring they are registered in PRODA, HPOS and the Organisation Register and linking all their eligible providers so they are ready for patient registration.

• ACCHS and AMS practices and their providers can participate in MyMedicare if they provide Medicare-funded services or DVA equivalent services.
• Patients will be able to register with their regular ACCHS or AMS practice and select their preferred GP and care team within the practice.
• Additional flexibility is available for ACCHS and AMS practices that operate as a hub and spoke model in their region. They will be able to set up their practice in the MyMedicare system to reflect these arrangements.
• Patients registering at a “hub and spoke” ACCHS/AMS will be able to access linked MBS items and incentives at any of the sites identified as part of the hub and spoke business structure. It will also mean that their eligibility will be calculated from any MBS services rendered by linked providers at any of the identified sites.
• ACCHS and AMS practices can start the MyMedicare registration process by ensuring they are registered in PRODA, HPOS and the Organisation Register and linking all their eligible providers so they are ready for patient registration.
• A temporary exemption from accreditation is available until 30 June 2025 to ACCHS and AMS who do not currently meet the current RACGP definition of a general practice (due to not having a bricks and mortar practice).
• The RACGP is updating its definition of a general practice for the purpose of accreditation. The proposed definition includes mobile and outreach providers and those providing comprehensive, patient-centred, whole-person and continuous care based predominantly of a general practice nature. The RACGP Standards for General Practice Accreditation will be reviewed to enable alignment with the revised definition.
• Practices should ensure that they commence the accreditation process by registering with an accrediting agency approved under the National General Practice Accreditation Scheme with enough time to achieve accreditation before the exemption period ceases.

• Mobile and outreach services and their providers can participate in MyMedicare if they provide Medicare-funded general practice services or DVA equivalent services.
• Patients will be able to register with a mobile or outreach practice in MyMedicare and select their preferred GP and the care team within that service.
• Mobile and outreach services can start the MyMedicare registration process by ensuring they are registered in PRODA, HPOS and the Organisation Register and linking all their eligible providers so they are ready for patient registration.
• A temporary exemption from accreditation is available until 30 June 2025 to mobile and outreach services (including sole providers) who do not meet the current RACGP definition of a general practice, if they deliver general practice services in rural settings, residential aged care, disability residential settings, to First Nations Australians and to people experiencing homelessness.
• The RACGP is updating its definition of a general practice for the purpose of accreditation. The draft definition being considered includes mobile and outreach providers and those providing comprehensive, patient-centred, whole-person and continuous care based predominantly of a general practice nature. If the proposed definition is adopted, the RACGP Standards for General Practice Accreditation (the Standards) will need to be reviewed to ensure alignment with the revised definition.
• If mobile and outreach services are able to be accredited under a revised definition and Standards, practices should ensure that they commence the accreditation process by registering with an accrediting agency approved under the National General Practice Accreditation Scheme with enough time to achieve accreditation before the exemption period ceases.

• State-operated GP practices will be able to participate in MyMedicare if they:

o provide Medicare-funded services or DVA equivalent services, and
o are covered under the COAG Section 19(2) Exemption Initiative.

• State-operated GP practices will be required to be accredited under the National General Practice Accreditation Scheme. Non-accredited practices will have 12 months to gain accreditation through a registered accreditation agency.
• State-operated GP practices can start the MyMedicare registration process by ensuring they are registered in PRODA, HPOS and the Organisation Register and linking all their eligible providers so they are ready for patient registration by 1 October 2023.

• Urgent Care Clinics (UCCs) will not be able to participate in MyMedicare as their operating model is not designed for continuity of care.
• General practices that operate as both a general practice and UCC can only register the regular general practice business in MyMedicare.
• Providers linked to a general practice and UCC must not use or link their UCC specific speciality code when providing MyMedicare services through the regular general practice.
• All activities and claiming that occur through the UCC will not count towards MyMedicare patient eligibility, nor will MyMedicare linked items be claimable under the UCC operations.

• Nurse practitioner-led practices will be able to participate in MyMedicare if they have an eligible GP linked to their practice who is providing Medicare services or DVA equivalent services.
• Patients will be able to register with their regular nurse practitioner-led practice and select their preferred provider and care team within the practice.
• Nurse practitioner-led practices with an eligible GP must be accredited under the National General Practice Accreditation Scheme or have a valid exemption. Non-accredited practices will have 12 months to gain accreditation through a registered accreditation agency from the date they register in MyMedicare as a practice.
• Nurse practitioner-led practices can start the MyMedicare registration process by ensuring they are registered in PRODA, HPOS and the Organisation Register and linking all their eligible providers so they are ready for patient registration by 1 October 2023.