Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020
11Application provisions for contribution to multidisciplinary care plan items for care recipients in residential aged care facilities
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11 Application provisions for contribution to multidisciplinary care plan items for care recipients in residential aged care facilities
Application provision
(1) Items 93469 and 93475 do not apply to a service unless the person with the multidisciplinary care plan suffers from at least one medical condition that:
(a) has been (or is likely to be) present for at least 6 months; or
(b) is terminal.
Claimining limitation
(2) Items 93469 and 93475 do not apply to a service if:
(a) the service is associated with a service to which items 235 to 240, 735 to 758, apply; or
(b) the person has received a service to which item 229 to 233, 721, 723, 729, 731 or 732, 92024, 92025, 92026, 92027, 92028, 92055, 92056, 92057, 92058, 92059, 92068, 92069, 92070, 92071, 92072, 92099, 92100, 92101, 92102, 92103 applied in the previous 3 months;
unless there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service for the patient.
Meaning of terms
(3) In items 93469 and 93475:
multidisciplinary care plan means a a written plan that:
(a) is prepared for a care recipient by a collaborating provider (other than a general practitioner), in consultation with at least 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient; and
(b) describes, at least, treatment and services to be provided to the patient by the collaborating providers.
In this subclause, a collaborating provider is a person, including a medical practitioner, who:
(a) provides treatment or a service to a patient; and
(b) is not an unpaid carer of the patient.