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Maximising use of the CHAP, a Comprehensive Annual Health Assessment Program: A Guide for the Disability Sector

Two men sit outisde. One is holding a notebook and wears a yellow top. The other man has Down Syndrome and is looking at the notebook.

Key benefits

  • A guide for the disability sector to maximise implementation of the CHAP tool with people with an intellectual disability
  • Supports disability providers to meet NDIS Quality and Safeguards Commission completion of annual health assessments with a person with an intellectual disability
  • Offers practical information on completion of the assessment by disability workers with a person with an intellectual disability and any family or carers involved in health management
  • Includes important information to support positive working relationships with General Practitioners to improve health assessments for a person with an intellectual disability
  • Includes links to the free CHAP tool and other relevant resources 

Who is this for?

This resource is for those in the providers and direct support workers supporting people with an intellectual disability to complete a comprehensive annual health assessment using the CHAP tool, Disability providers and workers delivering Supported Independent Living (SIL) supports, In home support workers and Support Coordinators.

Introduction

This guide has been prepared to maximise use of the CHAP (Comprehensive Health Assessment Program) to support people with an intellectual disability to have a comprehensive annual health assessment.

The information has been collated to assist disability sector managers implementing the CHAP with workers who are supporting people with an intellectual disability living in residential accommodation or receiving in-home support. Information can also be used with family or carers (referred to as natural supports) of a person with an intellectual disability with their health management needs.

The NDIS Quality and Safeguards Commission has identified completion of a regular comprehensive health assessment for people living with a disability as it improves detection of health needs, enables active management of those needs, and significantly reduces health risks and poor health outcomes. The Commission also states that disability providers are required to monitor participant health, safety and wellbeing, support participants to maintain their health and to access appropriate health services.

The CHAP tool supports this requirement to be completed thoroughly with a person with an intellectual disability and is recommended as an annual process. Completion of the CHAP each twelve months is also increasingly being identified by NDIS auditors as a focus for review in support of improved health outcomes for people with an intellectual disability.

Language: Throughout this guide there is an intentional reference to implementation of the CHAP tool with people with an intellectual disability. The CHAP is an evidence-based health assessment program that supports collaboration between the person with an intellectual disability, their workers or family and natural supports and their General Practitioner. The CHAP was not developed for use with people with other disabilities.

Acknowledgement

This guide has been developed with input from the CHAP developer, Professor Nick Lennox, Australian Government Department of Health and Aged Care, Janet McLeod, Outcomes Specialist Complex Health, Melba Support Services, Jayne Lehmann, Director of EdHealth Australia and Tamsin Gallie, Practice Advisor, Scope Australia.

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Overview of the CHAP

(Adult version)

The CHAP tool is free and available to download from the Australia Government Department of Health and Aged Care at: Adult Comprehensive Health Assessment Program (CHAP) – Annual Health Assessment for People with Intellectual Disability.

This version of the CHAP has been developed for use with adults with an intellectual disability. An adolescent version is currently in development.

The CHAP tool

  • Was developed by health professionals with people with a lived experience of intellectual disability, their families, carers, and the disability sector. It is an evidence-based tool that was developed, tested, and validated through research carried out by the Queensland Centre for Intellectual Disability for use with adults with an intellectual disability.
  • The CHAP tool has two parts, Part 1, and Part 2. These guide the person with an intellectual disability, their disability workers, family or natural supports, and their General Practice Doctor (GP) and Nurse Practitioner or Practice Nurse to gather information about the person’s health and wellbeing.

CHAP Part 1

  • Forms the preparation part of the assessment completed before the GP appointment.
  • It involves a conversation with the person with an intellectual disability by their disability worker, family, or natural supports to go through all the sections in Part 1 to gather information about their health and wellbeing.
  • Part 1 includes current medications, health history, past letters from specialist appointments, summaries from any accident and emergency presentations or any other health information the GP may not have.

CHAP Part 2

  • This is completed during the appointment with the GP, Nurse Practitioner or Practice Nurse using the information in Part 1 in conversation with the person with an intellectual disability. This conversation can include their disability worker, family, or natural supports, if needed to provide a thorough health overview.
  • Part 2 supports the GP to consider a comprehensive list of often unmet health needs or actions including identification of emerging health conditions, available immunisations, and early intervention health screening needs.
  • Part 2 also includes a section at the end for actions identified by the GP or Nurse Practitioner to be recorded. These form a plan for the person with an intellectual disability, their disability workers, family, or natural supports to address the needs identified.

Resources introducing CHAP

  • Overarching: Comprehensive Health Assessment Program (CHAP) for people with intellectual disability.
    This short video (just over 3 minutes) has been produced by the SPIDAH project team who are part of the Western Victoria Primary Health Network funded by the Commonwealth to develop resources for the primary health and disability sectors. SPIDAH received funding as part of the National Roadmap for Improving the Health of People with Intellectual Disability to improve health outcomes for people with an intellectual disability.

  • Introducing CHAP 2023
    NDS has a one-hour video recording of an online seminar held to introduce the 2023 release of CHAP. Professor Nick Lennox outlines how the original CHAP was developed and tested. Professor Lennox discusses his 30 years of insight, including direct experience as a GP working with people with an intellectual disability and how this informs his current role as a specialist disability advisor to Government promoting the importance of a comprehensive health assessment for a people with an intellectual disability. The video is a valuable resource for any disability worker or manager not familiar with CHAP and implementation with adults with an intellectual disability.

  • Yearly health checks - Easy Read 
    The Department of Health and Aged Care has published an Easy Read for people with intellectual disability. This resource helps explain what annual health assessments are, why they are important, and the CHAP tool.

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Taking a person-centred approach

  • The person with an intellectual disability should always be central in any conversation related to completion of the CHAP through disability workers communicating in a style appropriate to their needs and preferences. This supports the principal approach of ‘Nothing about me without me’ when completing Part 1 and again during the appointment process for completion of Part 2.

  • Family or natural supports involved in the person’s life are also encouraged to take part in the assessment, where appropriate, and in alignment with the person’s request or treatment decision making delegation.

  • Family members or natural supports involved in health appointments with a person with an intellectual disability living in supported residential accommodation can be advised by disability workers when a CHAP is due to be completed. The disability workers can also ask when appointment arrangements have been made and any follow up actions to ensure support can be implemented and the appropriate health information documented in the person’s organisation record.

The Commonwealth Department of Health and Aged Care will release guides to the CHAP for family or natural supports in 2024. However, until then this guide for workers can be used and shared.

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Preparation steps

Identify one or two disability workers to be responsible for CHAP completion and related health appointments

  • This improves the consistency of information and engagement with the health professionals. Other disability workers would still carry out their support of the person’s health management actions, documentation of support requirements and monitoring for any changes in their health or wellbeing.

Complete Part 1 of CHAP with the person with a disability

  • Completion of Part 1 involves working through a comprehensive set of questions with the person with an intellectual disability by disability workers, family, or natural supports to ensure all aspects of the person’s health and wellbeing can be checked for any changes or needs.

    It is important to remember the aim of the CHAP process is to complete a comprehensive review of the person’s health and wellbeing, so it needs to include emerging concerns and requirements for early intervention screening to reduce the risk of health conditions becoming more complex.

    The medication section of Part 1 needs to include all medications (prescribed and over the counter) the person takes, how often they are taken, the dose and delivery format, such as oral, patches, drops, suppositories etc. This is important as it provides an opportunity for the GP to review if any issues arising from the assessment will require a medication change.

  • If the CHAP Part 1 is being completed by family or natural supports with a person with an intellectual disability living in supported residential accommodation involvement of the disability team is highly recommended. Their involvement can assist in identifying any concerns or needs that the individual, their family or natural supports may not have considered.

Setting up the appointment with the person’s regular GP

  • A relationship with one General Practice and one Pharmacy has been identified by disability workers, family, natural supports, and people with a disability as a key step in health support. This is because the health professionals get to know the person their family, natural supports and/or disability workers involved. Where possible the relationship with the GP should have been established before requesting an annual health assessment appointment. The developers of CHAP have also identified this important relationship recommending the assessment appointment is booked with the usual GP caring for the person with an intellectual disability.

  • Please remember to ask the General Practice to identify when the person with an intellectual disability is due for the yearly comprehensive health assessment as this can only be billed using the MBS item number once every 12 months. The MBS item numbers available for a GP are written on the CHAP. There is a small exception where someone can receive multiple health assessments in the same year such as a person with an intellectual disability and aged 45-49 years who is at risk of developing chronic disease.

    If the person with an intellectual disability is a new patient of a clinic and the disability worker, family or natural supports do not have recorded a previous completed annual health assessment a prior assessment date can be identified. Please ask the new General Practice to check if a health assessment was charged to Medicare for the individual in the previous 12 months. This will support arranging the yearly assessment date within the GP’s rules for bulk billing.

  • Ask the Manager or Receptionist if the General Practice team would prefer the assessment appointment to start with a Nurse Practitioner or Practice Nurse to review Part 1 of the CHAP and complete sections in Part 2, relevant to their scope of practice. The involvement of nurses in the assessment process will vary from one General Practice to another and this will be determined by the individual practice.

  • Book a long appointment for the assessment when Part 1 has been completed. A copy of the CHAP can be emailed to the General Practice in advance, for the GP, Nurse Practitioner or Practice Nurse to read through and identify what they will be required to do.

  • Prior to the appointment, please identify with the Manager or Receptionist any mobility, communication, or sensory needs for the person with an intellectual disability. Advance discussion of these will assist the person to feel comfortable and the General Practice with any arrangements needed at their end. These may include:
    • waiting in the car until time to go in for their appointment turn
    • waiting in a quieter space
    • facilitating manual handling tools availability e.g., hoist or consulting bed or chair that can be raised or lowered

A person with an intellectual disability can be encouraged to take an activity to assist their concentration, relaxation or reduce anxiety while sitting in the waiting room or during appointment if needed. These may include headphones, mobile device, book, pencils, drawing paper, sensory toy.

Note: It is important the comprehensive annual health assessment appointment is not used for other health needs including review or replacement of scripts etc. These need to be discussed at a separate appointment.

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Assessment process

Disability workers, family, or natural supports can assist the assessment process to be as person centred as possible using suggested strategies below if needed.

  • Advocate with the person with an intellectual disability for health professionals to speak in an accessible manner and direct questions and explanations to the individual.Encourage the person with an intellectual disability to share their concerns. This may involve support during the appointment like the example below.

    GP asks; "Is anything of concern?"

    The person answers "No". This could be due to lack of confidence or other reasons.

    Disability worker, family or natural supports can encourage discussion such as: "What about the other day when you had stomach pains and did not feel like eating? How about you tell (GP/Nurse) more about that so they can work out if this needs to be checked out."

    OR

  • Develop a pre-appointment plan that includes a list of concerns the person with an intellectual disability has shared earlier. The list can be used to prompt discussion by the person themselves with the GP or if needed by their disability worker, family, or natural supports.

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Identifying follow up actions

At the end of the assessment the GP, with the person with an intellectual disability, their disability worker, family, or natural supports are recommended to discuss any follow-up actions, what is needed and who is responsible. The information below has been included to help with discussion of an action plan. This is an important step in completing the assessment to clarify if health actions have not been identified or to list any actions needed to address identified health requirements.

No health needs are identified

  • When no health needs are identified it is important to rebook the next CHAP appointment in 12 months’ time if the General Practice can do this or request a reminder for a booking to be made in 12 months' time.

  • It is recommended the reminder for the annual comprehensive health assessment is documented in the person’s organisation record, and any family, or natural supports calendars to prompt booking the next CHAP appointment.

  • Disability workers are recommended to record the date when the CHAP has been completed and document that no specific actions are required as a result of the assessment. Attaching a copy of the completed CHAP Part 1 and 2 to the person’s organisational record will also demonstrate this has been carried out. This is an increasing auditor focus for duty of care when the person lives in a disability residential accommodation setting.

Health needs and actions are identified

  • The person with an intellectual disability with their disability worker, family, or natural supports to make a record of all recommended actions. If the reason for any actions is not clear the GP can be asked to clarify these.

  • When the discussion about the follow up actions is finished the person with an intellectual disability, with their disability worker, family or natural supports can check with the GP the list of identified actions are included at the end of Part 2 of the CHAP and request a copy of the full assessment is printed and/or a copy sent to the email address of the individual and their disability provider, family, or natural supports as appropriate. This provides the details for follow up for the disability organisation record and family or natural supports reference.

Actions that involve a GP providing information The list below includes actions a GP may recommend and the paperwork or details they will provide. This list has been included to prompt the person with an intellectual disability, their disability workers, family, or natural supports to check they have the appropriate information before leaving the appointment.

  • Health screening: This may be recommended to check for emerging conditions such as cancer. Paperwork may include a referral letter, a screening or blood test form or the contact details of the screening organisation including phone number or address.

  • Specialist health professional referrals: The GP will provide a referral letter and a copy will be given with the contact details so an appointment can be arranged.

  • Pathology tests, Xray's or Ultrasounds: These are printed by the GP on template forms with details of the provider. The template forms are supplied by one of the test providers and include a list of locations where the test can be accessed and contact numbers to arrange an appointment. The test requirements are printed on branded company forms; however, the appointment can be made with any pathology or Xray provider where the same test is available. The person with an intellectual disability, their disability workers, family, or natural supports can check with the GP if any of the tests are only offered by specific providers due to expertise or special equipment.

  • Vaccination needs: This may require a follow up appointment with GP, Nurse Practitioner, Practice Nurse, or a local pharmacy provider may be recommended. Details need to be clarified with the GP.

  • Medication changes: If the GP recommends medication changes these may include scripts to be printed or information about other medication options to be given.

    Disability workers will need to ensure they are provided with printed medication information from the GP and check it includes the details needed for authorisation and management by the disability organisation to support the person with their own medication management or for the disability workers to administer correctly.

    Family or natural supports with the person with an intellectual disability are recommended to check they have received any prescriptions identified during the appointment, and they understand the dosage, time to be given, route and possible common side effects.

    Medication changes may also prompt the GP to recommend a Home Medication Review as part of the action plan.

  • Home Medication Review: A Home Medication Review can assist in preventing or minimising the risk of medications errors, which are not uncommon and can cause distress and avoidable hospitalisation. The review is for anyone who is taking five or more medications including a person with an intellectual disability with their disability workers and family or natural supports to better understand how to use the medications correctly, and how to manage potential adverse effect. If needed, a further appointment will be recommended by the GP to provide enough time to focus on a referral for an accredited pharmacist to visit the person with intellectual disability in their home to review their prescribed and over the counter medications.

  • Development of Chronic Disease Health Plans or Mental Health Plans: If needed, a further appointment will be recommended to provide enough time to focus on the specific chronic disease or mental health condition. These plans support additional bulk billed appointments with allied health professionals relevant to the health need. For example, Diabetes Educator, Podiatrist, Physiotherapist, Exercise Physiologist, Dietician, Psychologist etc.

Additional health actions a GP may recommend
These may include:

  • Oral health assessments: Unless a specialist referral is identified by a GP oral health checks or appointments are arranged separately as indicated below.
    • The person with an intellectual disability manages their own appointments
    • Disability organisation assisting a person with an intellectual disability with their health management as part of service supports
    • Family member or natural supports when involved in assisting a person with an intellectual disability to manage their health needs

Establishing a relationship with one oral health practice will support the health professionals to get to know the person with an intellectual disability and the people who support them. Refer to the resource section of this guide for a link to NDIS Quality and Safeguards Commission Practice Alerts to locate oral health information.

  • Other lifestyle recommendations:
    This may include the GP recommending a need for increased exercise, changes to diet, ceasing smoking etc. Discussion of needs and actions may require an additional appointment with GP, Nurse Practitioner or Practice Nurse.

    Where other lifestyle needs are identified disability workers should discuss with the person and their managers how this is going to be addressed. A plan for action and monitoring progress to be documented in the individual’s record.

    Refer to the resource section of this guide for link to NDIS Quality and Safeguards Commission Practice Alerts to locate lifestyle risk factors information.

    Family or natural supports should be involved where appropriate to develop a plan with the individual to make the changes needed. The GP, Nurse Practitioner or Practice Nurse may also have suggestions about what to do or where to source ideas.

Responsibilities of disability, allied health, or nursing workers
These responsibilities apply to workers involved with a person with an intellectual disability, their family or natural supports.

All actions require discussion with the person with an intellectual disability regarding delegation to identified people involved in their life to support or complete follow-up steps appropriate to their self-management capability. Documentation of any identified self-management actions and other health support delegations are to be made in the organisational file of the person with an intellectual disability, including when actions are completed.

  • Disability Service Providers to ensure an organisation policy and procedure is developed and followed by workers for the management of actions arising from any health-related reviews including CHAP appointment.

  • Disability workers require a clear procedure to implement the organisation’s duty of care regarding the health needs of a person with an intellectual disability. This needs to include how a person with an intellectual disability will be supported through follow up appointments, health plans, monitoring for new or emerging health needs and steps required to see any health professionals identified. It also needs to include what actions are expected when there are changes in the person’s health. All these steps are to be documented in the individual’s personal record, as part of a health and wellbeing plan by the organisation.

  • Support coordinators, allied health, and nursing professionals Where these workers are involved as key supports for health management or navigation with the person with an intellectual disability, they need to communicate with any other stakeholders involved. Communication needs to identify what is in focus, completion and monitoring needs or changes to existing health management requirements. This must be documented in the appropriate system and with the key disability workers, family, or natural supports.

  • Family or natural supports may be responsible for supporting health management needs and actions with a person with an intellectual disability. Where this occurs, an agreement needs to be developed identifying who is responsible for actions related to the person’s health needs and how information relevant to the disability care setting, especially residential accommodation, will be shared for appropriate duty of care support.

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Disability sector resources supporting health and wellness

NDS Resources

  • Health Professionals (nds.org.au): A list of NDS collated resources for workers and health professionals supporting people with a disability including intellectual disability.

  • People with Disability (nds.org.au): A list of NDS collated resources for individuals with a disability including an intellectual disability, family, or natural supports to support health related needs.

  • Tasmanian Healthy Eating Project: Cooking videos (nds.org.au): A series of videos to support skills and knowledge for improved eating. The video’s include budget friendly options with minimal ingredients, dietary modifications and alternatives and how healthy food can have a positive impact on mental health.

  • Health topics videos and podcasts for disability workers:
    • Falls Prevention:Professor Prue Morgan, Head of Physiotherapy at Monash University, talks about the importance of falls prevention, the consequences of falls, and the steps disability workers can take to reduce them.
    • Safe Mealtimes:  Professor Bronwyn Hemsley, Professor of Speech Pathology at the University of Technology, Sydney, discusses safe and enjoyable mealtimes and how to support NDIS participants who have difficulty swallowing.
    • Deteriorating Health: Reece Adams, Head of the Centre for Developmental Disability Health, Monash Health, talks about deteriorating health in disability care settings, what disability workers should look for, and how they can respond.
  • Oral hygiene for people with disability (NDS): This eLearning course supports disability support practitioners to provide effective oral hygiene for people with a disability.

NDIS Quality and Safeguards Commission

Other Resources

Primary Health Network CHAP resources for General Practice

These weblinks are included in the guide for disability workers, family, or natural supports to highlight with General Practice for further information where an interest in intellectual disability has been identified. Western Victoria Primary Health Network SPIDAH team are one of four primary health networks selected by the Commonwealth Government to develop and pilot local models to improve how primary health care services are delivered to meet the needs of people with an intellectual disability. You can learn more about this project here.

Digital Health Tools

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Australian Government Information

This information has been added in response to disability sector feedback indicating a need to understand the health system processes and funding to support improved access for people with a disability. Understanding of the Medical Benefit Scheme (MBS) funding available to General Practice and current government incentive programs to increase bulk billed appointment options is provided to assist disability workers, family, or natural supports to request a time length that is better suited to an individual’s needs.

MYMedicare

The information about MYMedicare can assist a person with a disability, their disability workers, family, or natural supports with their health management through the establishment of a key General Practice relationship. Participation in the program increases General Practice access to additional bulk billed health options for people who may need increased support.

MYMedicare is a new voluntary patient registration model. It aims to formalise the relationship between patients, their General Practice, General Practitioner (GP) and Primary Care Teams. MYMedicare has been developed to support ongoing care with an identified General Practice. This is recognised as important for people with a disability as this improves understanding of their disability, other health conditions, communication preferences etc. Signing on to MYMedicare does not prevent a person from attending another General Practice.

When a patient registers in MYMedicare, it will notify their general practice that they have chosen them as their regular care team. Additional funding will be available from the government to help them provide the care they need.

MYMedicare patients will have access to:

  • greater continuity of care with your registered practice, improving health outcomes
  • longer MBS funded telehealth consultations with your GP
  • triple bulk billing incentive for longer MBS telehealth consultations for children under sixteen, pensioners, and concession card holders, from 1 November 2023

MYMedicare General Practices’ can access:

  • more information about regular patients, making it easier to tailor services to fit the patient’s needs
  • new longer telehealth items linked to MyMedicare outlined above, including:
    • longer MBS-funded telephone calls (Levels C and D) with their usual general practice
    • triple bulk billing incentive for longer MBS telehealth consultations (Levels C, D and E) for children under sixteen, pensioners, and concession card holders.

MY Health Record

This information has been added as the existing MY Health Record system is being revised for improved use as a tool to reduce the need for individuals to repeat their health history each time a General Practice or health professional appointment is needed or in emergency circumstances. MY Health Record is a secure online personal summary of key patient health information like immunisations, pathology and diagnostic imaging reports, prescription and dispensing information, and hospital discharge summaries. Healthcare providers can access the system to view and add information.

Patient benefits:

  • prompt access to key health information in an emergency
  • secure, convenient access to health information
  • safer, faster more efficient care
  • less need to remember key aspects of their medical history and medications
  • improved management of health information
  • informed self-management of health conditions

Healthcare provider benefits:

  • provides immediate access to key health information
  • facilitates the validation and verification of clinical information
  • avoid adverse medication events, provides access to allergy information
  • avoids duplication of tests and diagnostic imaging
  • provides immunisation details
  • improves continuity of care, informs end of life care

GP appointment needs, time involved and Medicare funding

When booking any appointment with a GP it assists the staff with the appointment process if the person with an intellectual disability, their disability worker, family, or natural supports can identify very briefly the reason for the request. Some examples are listed below.

  • CHAP appointment
  • Chronic Disease Management Plan or Mental Health Management Plan
  • Medication script review or renewal
  • A return appointment to discuss tests results
  • Discussion of a known health need, concern, or injury
  • Experiencing symptoms but the cause is unknown
  • Immunisation
  • Wound management

GP MBS rebates for bulk billed appointments are identified according to the reasons for the visit and how long the consultation takes.

  • Level A is for consultations not lasting more than 6 minutes focused on an obvious issue where the GP completes an examination of the affected part if required, and notes the action taken.
  • Level B: is used for a consultation lasting less than 20 minutes for one or more health needs that are not obvious or straightforward.
  • Level C is for a consultation lasts at least 20 minutes to focus on one or more health related issues.
  • Level D is used for a consultation lasting at least 40 minutes for a focus on one or more health related issues.

Other MBS options allow for longer consultations - at least 60 minutes.

These include completion of an comprehensive annual health assessment with a person with an intellectual disability. At the end of the CHAP tool is information for the GP to identify the appropriate MBS rebate items for the appointment. Information has also been included to assist the GP with MBS items applicable for appointments needed for chronic or terminal medical conditions or Mental Health Treatment Plans.

Increased bulk billed incentive payments for GPs

On the first of November 2023, the Department of Health and Aged Care increased the Medicare Benefits Schedule (MBS) bulk billing incentive payments for Commonwealth concession card holders and children under 16 years of age for a range of MBS consultation items. These payments are triple the amount of existing standard bulk billing incentive payments. Doctors can use these when bulk billing the following types of consultations:

  • All face-to-face general attendance consultations that are longer than 6 minutes (that is Levels B, C, D and E)
  • in any location (in and out of consulting rooms, residential aged care facilities) at any time (business and after-hours items)
  • MBS Level B video and telephone general attendance consultations
  • Video and telephone consultations that are longer than 20 minutes (Levels C, D and E (video only)) and the patient is registered with the practice through MyMedicare

The standard bulk billing incentive payments will continue to be available for doctors to co-claim when bulk billing with:

  • MBS Level A (and equivalent) general attendance consultations
  • Level C, D and E video and telephone general attendance consultations where the patient is not enrolled in MyMedicare
  • all other relevant MBS unreferred services, for example
    • chronic disease management items
    • Better Access Mental Health items
    • eating disorder items
    • health assessments
    • minor procedures

You can find more information on their website.

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Related Resources

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Contact information

For any enquiries, please contact Heather McMinn, Disability Sector Consultant, submit enquiry/feedback, show phone number