Medicare Benefits Schedule Project - Community Health

Page contents: Overview | Client services through Medicare: Opportunities & considerations for community health services | Key Messages about using MBS item numbers | What are the new MBS item numbers, and which clients are eligible for MBS-rebateable services?| Further information | Contact

Overview

This project aims to provide information and support to the community health sector looking to expand the range of services available to clients by utilising MBS item numbers.

Enhanced client access to services (public or private) can be a significant outcome of work by the community health sector to implement evidence-based models of care that involve GPs, general practices and other primary healthcare providers and that incorporate MBS item numbers.

Client services through Medicare: Opportunities & considerations for community health services

A new resource, Client services through Medicare: Opportunities and considerations for community health services, outlines what agencies need to consider in order to enhance client services through the MBS. It provides practical case studies about how community health services have used the MBS.

Client services through Medicare: Opportunities and considerations for community health services (498kb, pdf)

Key Messages about using MBS item numbers

Community health

Models supporting effective chronic disease care are of particular relevance to the Community Health sector.

• a high proportion of Community Health clients have chronic and/or complex and mental health conditions
• both State and Commonwealth governments have identified chronic disease management and mental health as high priorities

New MBS item numbers

Over the past eight years, a suite of new MBS item numbers have been progressively introduced to support optimal, evidence-based models of care. The new items:

• encourage a more integrated approach to health care provision.
• provide a catalyst for strengthening partnerships with general practice and other public and private primary health providers through the Primary Care Partnerships (PCP) planning framework and often involving Divisions of General Practice who have expertise in GP engagement
• provide impetus for agencies to reconfigure their services to increase client access to services, and maximise care options

Service models

Enhanced access to services (public or private) for CH clients can be a significant outcome of work by community health services to implement new models of care that involve GPs and incorporate appropriate MBS item numbers.

• models adopted should not result in a reduction of public allied health services
• the implementation of new multidisciplinary models of care that incorporate MBS services is relevant to all CHSs, whether or not they manage medical clinics
• community Health agencies need to ensure that any new service models are compliant with s19(2) of the Health Insurance Act 1973 (Commonwealth) by seeking legal advice
• Services funded through the Medicare Benefits Schedule are in addition to services funded by Primary Health Branch. If an agency is recording an MBS-funded service in the client management software, the funding source should be recorded as 'MBS-funded service'. As the funding source is different, MBS-funded services should not be included by CHSs as part of their reporting to Primary Health Branch for Branch-funded activities.
• CHSs will determine which models are likely to be best suited to their clients, often in collaboration with other providers and with the input of clients. These decisions should be based on a local analysis of client characteristics and needs, the prevalence of chronic disease, the availability of local services and providers with whom models of care can be built, and the likely future impact on currently funded client services, CH workforce and demand management strategies

What are the new MBS item numbers, and which clients are eligible for MBS-rebateable services?

The Commonwealth reviews the types of services it will fund through the Medicare Benefits Schedule annually, and releases a new Schedule every 1 November. New items are also sometimes introduced to the Schedule at other times. Since 1999, the Commonwealth has progressively introduced a suite of new MBS item numbers aimed at enabling primary care teams to invest more time in the prevention and management of chronic disease, and the management of mental health conditions.

These MBS item numbers, their applicability to clients and their business rules have been summarised and grouped into eight categories (below). There is also a summary of the practice nurse MBS item numbers that are currently available.

The MBS item number summaries have been reviewed and endorsed by the Commonwealth Department of Health and Ageing.

MBS Item Numbers – How to Use These Resources (41kb, pdf)

MBS Item Numbers – About Medicare (21kb, pdf)

1. Health assessment item numbers
2. Prevention item numbers
3. Care planning and case conferencing item numbers
4. Allied and dental health item numbers
5. Better Access to Mental Health item numbers
6. Service Incentive Payments (SIP) item numbers
7. Quality Use of Medicines item numbers
8. Bulk Billing Incentive item numbers

Summary of practice nurse MBS item numbers (22kb, pdf)

MBS Flipchart (218kb, pdf)
Please note: This download does not currently include the following items:

(i) Healthy Kids Check
(ii) Type 2 Diabetes risk evaluation
(iii) Follow-up allied health services for people of Aboriginal and Torres Strait Islander descent, who have had an MBS health check

Further Information

Further information will be provided to the community health sector about evidence-based5 October, 2009 practice incorporating MBS item numbers that have been successful in different kinds of community health settings will also be highlighted. The sector will be notified of additions and modifications to the MBS Project website and its resources through the Primary Care Bulletin.

If you would like more information about the Medicare system, access Medicare Australia’s Mediguide.

Contact

For more information, contact the General Practice Partnerships Team

The Department of Human Services Primary Health Branch acknowledges and thanks the Commonwealth Department of Health and Ageing, General Practice Victoria and many individual Divisions of General Practice for their input into and feedback about these resources.

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