Requirements of care plans and case conferences

There are eligibility requirements to prepare care plans and coordinate case conferences.

Eligibility for General Practitioner Management Plan (GPMP) or Team Care Arrangements (TCAs)

To be eligible for a GPMP your patient must have a chronic or terminal medical condition.

If they need ongoing treatment from a multidisciplinary team, they’re also eligible for TCAs.

While many patients will be eligible for both a GPMP and TCAs, you can provide the services independently.

Your patient’s usual medical practitioner, or someone at the same practice should provide GPMP and TCAs items. You’re a patient’s usual medical practitioner if you:

• have provided the majority of services to your patient in the past 12 months
• will provide the majority of services in the following 12 months.

You must consult with a multidisciplinary team when developing TCAs. A multidisciplinary team includes:

• your patient’s usual medical practitioner
• at least 2 other collaborating health or care providers, one of whom may be another medical practitioner.

Each person in the team must provide a different type of ongoing treatment or service. Not all members need to be Medicare eligible health professionals. Your patient’s informal or family carer isn’t counted as part of this team.

Eligibility for a Mental Health Case Conference (MHCC)

Your patient is eligible for a MHCC if they’re being managed under either:

• a GP Mental Health Treatment Plan (GPMHTP)
• an Eating Disorder Treatment and Management Plan (EDP).

You must consult with a multidisciplinary team for a MHCC.

Allied health professionals are eligible if they meet qualification requirements and offer any of the following:

• psychological therapy health service
• focused psychological health service
• dietetics health service.

Each person in the team must provide a different type of ongoing treatment or service.

Your patient’s informal or family carer isn’t counted as part of this team.

Claiming frequency

You can claim the following once every 12 months:

• preparation of a GPMP
• coordination of the development of TCAs for chronic disease management (CDM)
• coordination of the development of TCAs for mental health (MH) or eating disorder (ED).

You can claim for each of the following once every 3 months:

• review of a GPMP
• review of TCAs for CDM
• review of TCAs for MH or ED
• contribution to a Multidisciplinary Care Plan or to a review for a patient who isn’t in a residential aged care facility
• contribution to a Multidisciplinary Care Plan or to a review for a resident in an aged care facility.

You can provide these services more frequently in exceptional circumstances. For example, when there’s a significant change in a patient’s condition.

You can claim the review items 3 times on the same day, once for a review of each:

• GPMP
• TCAs for CDM
• TCAs for MH or ED.

Reviews

We suggest practices call and encourage their patients to attend an appointment to review their care plan.

Make a note on the patient’s account or include service text for electronic claims. This includes:

• exceptional circumstances
• significant change in clinical condition
• GPMP review, TCAs CDM review or TCAs MH or ED review.

This helps us to assess the claim.