Part Part 8 - Financial Sector (Collection of Data) (reporting standard) determination No. 1 of 2024 - Benefits Paid for Chronic Disease Management Programs

Part 8Benefits Paid for Chronic Disease Management Programs

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Part 8 Benefits Paid for Chronic Disease Management Programs

Chronic Disease Management Program (CDMP)	General Treatment cover for a Chronic Disease Management Program.A CDMP is intended to:reduce complications in a person with a diagnosed chronic disease;prevent or delay the onset of chronic disease for a person with identified multiple risk factors for chronic disease;requires the development of a written plan that:specifies the allied health service or services and any other goods and services to be provided;specifies the frequency and duration of the provision of those goods and services;specifies the date for review of the plan;has been provided to the patient for consent;consent is given to the program, before any services under the program are provided; andis coordinated by a person who has accepted responsibility for:ensuring the services are provided according to the plan; andmonitoring the patient's compliance.(Private Health Insurance (Health Insurance Business) Rules 2018)
Allied Health Servicesallied health services	Means a health service provided by any of the following allied health professionals who were eligible, at the time the service was provided, to claim a Medicare rebate for a service of that type:an Aboriginal health worker;audiologist;chiropodist;chiropractor;diabetes educator;dietician;exercise physiologist;mental health worker;occupational therapist;osteopath;physiotherapist;podiatrist psychologist; orspeech pathologist.(Private Health Insurance (Health Insurance Business) Rules 2018)
Coordination	Coordination ensures that the services are provided to the patient as planned. The plan should be reviewed and adjusted if necessary. Coordination may be undertaken by a health care provider, such as a practice nurse or other allied health professional and overseen by a medical practitioner. The medical practitioner would be involved in the review process.Services provided as part of a CDMP must be coordinated as described in the Private Health Insurance (Health Insurance Business) Rules 2018.
Planning	Planning commences with an assessment of the services needed to address the patient’s condition and the agreed goals for the program. A plan is then made of the services or goods required and the frequency and duration of the services. Typically, a medical practitioner would undertake the assessment and formulate the plan. The plan should include arrangements to review the program in order to assess whether the intended clinical outcomes are being achieved and that the patient is complying with the plan.Services provided as part of a CDMP must be planned as described in the Private Health Insurance (Health Insurance Business) Rules 2018.

Aboriginal Health Workers	Practising in the Northern Territory (NT) must be registered with the Aboriginal Health Workers Board of the NT; in other States and the Australian Capital Territory they must have been awarded a Certificate Level III (or higher) in Aboriginal and Torres Strait Islander Health from a Registered Training Organisation that meets training standards set by the Australian National Training Authority’s Australian Quality Training Framework.
Audiologists	Must be either a ‘Full Member’ of the Audiological Society of Australia Inc (ASA), who holds a ‘Certificate of Clinical Practice’ issued by the ASA; or an ‘Ordinary Member – Audiologist’ or ‘Fellow Audiologist’ of the Australian College of Audiology (ACAud).
Chiropractors	Must be registered with the Chiropractors (or Chiropractors and Osteopaths) Registration Board in the State or Territory in which they are practising.
Diabetes Educators	Must be a Credentialled Diabetes Educator (CDE) as credentialled by the Australian Diabetes Educators Association (ADEA).
Dietitians	Must be an ‘Accredited Practising Dietitian’ as recognised by the Dietitians Association of Australia (DAA).
Exercise Physiologists	Must be an ‘Accredited Exercise Physiologist’ as accredited by the Australian Association for Exercise and Sports Science (AAESS).
Mental Health Workers	‘Mental health’ can include services provided by members of five different allied health professional groups. ‘Mental health workers’ are drawn from the following:psychologists;mental health nurses;occupational therapists;social workers; andAboriginal health workers.
Psychologists, occupational therapists and Aboriginal health workers	Are eligible in separate categories for these items.A mental health nurse may qualify if they are:a registered mental health nurse in Tasmania or the Australian Capital Territory (ACT), if providing mental health services in Tasmania or the ACT; ora ‘Credentialled Mental Health Nurse’ as certified by the Australian and New Zealand College of Mental Health Nurses (ANZCMHN), if providing mental health services in other States or the Northern Territory.To be eligible to provide mental health services for the purposes of this item, a social worker must be a ‘Member’ of the Australian Association of Social Workers (AASW); and be certified by AASW as meeting the standards set out in AASW’s ‘Practice Standards 2023’ and ’Australian Social Work Education and Accreditation Standards’.
Occupational Therapists	In Queensland, Western Australia, South Australia and the Northern Territory must be registered with the Occupational Therapists Board in the State or Territory in which they are practising; in other States and the Australian Capital Territory, they must be a ‘Full-time Member’ or ‘Part-time Member’ of OT AUSTRALIA, the national body of the Australian Association of Occupational Therapists.
Osteopaths	Must be registered with the Osteopaths (or Chiropractors and Osteopaths) Registration Board in the State or Territory in which they are practising.
Psychologists	Must be registered with the Psychologists Registration Board in the State or Territory in which they are practising.
Physiotherapists	Must be registered with the Physiotherapists Registration Board in the State or Territory in which they are practising.
Podiatrists/Chiropodists	In all States and the Australian Capital Territory must beregistered with the Podiatrists Registration Board in the State or Territory in which they are practising. If practising in the Northern Territory, Podiatrists/Chiropodists must be registered with the Podiatrists Registration Board in any other State or the Australian Capital Territory, or be a “Full Member” of the Australian Podiatry Association (APodA) in any other State or the Australian Capital Territory.
Speech Pathologists	Practising in Queensland must be registered with the Speech Pathologist Board of Queensland. In all other States, the Australian Capital Territory and the Northern Territory, they must be a ‘Practising Member’ of Speech Pathology Australia.

Aboriginal Health Workers

Practising in the Northern Territory (NT) must be registered with the Aboriginal Health Workers Board of the NT; in other States and the Australian Capital Territory they must have been awarded a Certificate Level III (or higher) in Aboriginal and Torres Strait Islander Health from a Registered Training Organisation that meets training standards set by the Australian National Training Authority’s Australian Quality Training Framework.

Audiologists

Must be either a ‘Full Member’ of the Audiological Society of Australia Inc (ASA), who holds a ‘Certificate of Clinical Practice’ issued by the ASA; or an ‘Ordinary Member – Audiologist’ or ‘Fellow Audiologist’ of the Australian College of Audiology (ACAud).

Chiropractors

Must be registered with the Chiropractors (or Chiropractors and Osteopaths) Registration Board in the State or Territory in which they are practising.

Diabetes Educators

Must be a Credentialled Diabetes Educator (CDE) as credentialled by the Australian Diabetes Educators Association (ADEA).

Dietitians

Must be an ‘Accredited Practising Dietitian’ as recognised by the Dietitians Association of Australia (DAA).

Exercise Physiologists

Must be an ‘Accredited Exercise Physiologist’ as accredited by the Australian Association for Exercise and Sports Science (AAESS).

Mental Health Workers

‘Mental health’ can include services provided by members of five different allied health professional groups. ‘Mental health workers’ are drawn from the following:psychologists;mental health nurses;occupational therapists;social workers; andAboriginal health workers.

Psychologists, occupational therapists and Aboriginal health workers

Are eligible in separate categories for these items.A mental health nurse may qualify if they are:a registered mental health nurse in Tasmania or the Australian Capital Territory (ACT), if providing mental health services in Tasmania or the ACT; ora ‘Credentialled Mental Health Nurse’ as certified by the Australian and New Zealand College of Mental Health Nurses (ANZCMHN), if providing mental health services in other States or the Northern Territory.To be eligible to provide mental health services for the purposes of this item, a social worker must be a ‘Member’ of the Australian Association of Social Workers (AASW); and be certified by AASW as meeting the standards set out in AASW’s ‘Practice Standards 2023’ and ’Australian Social Work Education and Accreditation Standards’.

Occupational Therapists

In Queensland, Western Australia, South Australia and the Northern Territory must be registered with the Occupational Therapists Board in the State or Territory in which they are practising; in other States and the Australian Capital Territory, they must be a ‘Full-time Member’ or ‘Part-time Member’ of OT AUSTRALIA, the national body of the Australian Association of Occupational Therapists.

Osteopaths

Must be registered with the Osteopaths (or Chiropractors and Osteopaths) Registration Board in the State or Territory in which they are practising.

Psychologists

Must be registered with the Psychologists Registration Board in the State or Territory in which they are practising.

Physiotherapists

Must be registered with the Physiotherapists Registration Board in the State or Territory in which they are practising.

Podiatrists/Chiropodists

In all States and the Australian Capital Territory must beregistered with the Podiatrists Registration Board in the State or Territory in which they are practising. If practising in the Northern Territory, Podiatrists/Chiropodists must be registered with the Podiatrists Registration Board in any other State or the Australian Capital Territory, or be a “Full Member” of the Australian Podiatry Association (APodA) in any other State or the Australian Capital Territory.

Speech Pathologists

Practising in Queensland must be registered with the Speech Pathologist Board of Queensland. In all other States, the Australian Capital Territory and the Northern Territory, they must be a ‘Practising Member’ of Speech Pathology Australia.