Division 1.1Provisions related to individual chronic condition management services

Schedule 2—Allied health and other primary health care services

Part 1—Services and fees—general

Division 1.1 – Provisions related to individual chronic condition management services

1.1.1 Application provisions for items in Subgroup 1 of Group M3

(1) An item in Subgroup 1 of Group M3 applies to a service only if: (a) the patient is referred to the eligible provider by a medical practitioner; (b) the service is provided to the patient individually and in person; and (c) after the service, the eligible provider gives a written report to the referring medical practitioner mentioned in paragraph (a): (i) if the service is the only service under the referral—in relation to that service; or (ii) if the service is the first or last service under the referral—in relation to that service; or (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters. (2) An item in Subgroup 1 of Group M3 does not apply to a service if the patient has already been provided 10 services to which the item, any other item in Subgroup 1 of Group M3, any item in Group M11 or item 93000, 93013, 93048 or 93061 of the Telehealth Attendance Determination applies in the same calendar year.

1.1.2 Limitations on case conference items for chronic condition management

(1) This clause applies to items 10955, 10957 and 10959.

Eligible patients

(2) An item mentioned in subclause (1) only applies to a service if the patient who the service is provided to has at least one medical condition that: (a) has been (or is likely to be) present for at least six months; or (b) is terminal.

Frequency limitations

(3) An item mentioned in subclause (1) does not apply to a service if the service has been performed in the last 3 months, unless in exceptional circumstances. (4) For subclause (3), exceptional circumstances means there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service.

Additional requirements on the multidisciplinary case conference team

(5) An item mentioned in subclause (1) only applies to a service if the patient requires ongoing care from a multidisciplinary case conference team which includes at least one medical practitioner (including a general practitioner, but not a specialist or consultant physician).

Eligible allied health practitioners, nurse practitioners, Aboriginal and Torres Strait Islander primary health care professionals

(6) For the purposes of the items mentioned in subclause (1), eligible allied health practitioner, nurse practitioner, Aboriginal and Torres Strait Islander primary health care professionals means: (a) an eligible Aboriginal and Torres Strait Islander health worker; (b) an eligible Aboriginal and Torres Strait Islander health practitioner; (c) an eligible diabetes educator; (d) an eligible audiologist; (e) an eligible dietitian; (f) an eligible mental health worker; (g) an eligible occupational therapist; (h) an eligible exercise physiologist; (i) an eligible physiotherapist; (j) an eligible podiatrist; (k) an eligible chiropractor; (l) an eligible osteopath; (m) an eligible psychologist; (n) an eligible speech pathologist; or (o) a participating nurse practitioner.