Care Plans

Robina Doctors care plans. We provides EPC (Enhanced Primary Care) referrals to Allied Health providers as part of GP Chronic Disease Management Care Plans. Robina Doctors also provides Mental Health Care Plans, referrals to Psychiatrists and Psychologists as well as DVA Co-ordinated Care programmes.

CARE PLANS:

Medicare and DVA provide additional medical services through care plans. Below you will information on these plans. Please discuss your needs with our Doctors.

Medicare Chronic Disease Management Plan

People with a chronic medical condition may be able to get Medicare benefits to cover allied health services that help manage their condition. 

Chronic medical condition

A chronic medical condition is one that has been, or is likely to be, present for at least 6 months or is terminal. 

Eligibility

Anyone with a chronic or terminal medical condition can have a GP Management Plan in place. 

Chronic Disease Management Plan

If you have a chronic medical condition, your doctor may suggest a Chronic Care Management Plan.

This plan of action agreed between you and your GP:

  • identifies your health care needs
  • sets out the services to be provided by your GP and
  • lists the actions that you need to take

If you need treatment from 2 or more health professionals, your doctor may also put a Team Care Arrangement plan in place for you. This lets your doctor work with, and refer you to, at least 2 other health professionals who will provide treatment or services to you. This may include Allied Health Providers and Medical Specialists. 

Access to Allied Health

You may be eligible for Medicare benefits for specific allied health services if your doctor prepares both types of plans for you.

Further information can be found at http://www.humanservices.gov.au/customer/services/medicare/chronic-disease-management-plan

MEDICARE MENTAL HEALTH TREATMENT PLANS:

The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative aims to improve outcomes for people with a clinically-diagnosed mental disorder through evidence-based treatment. Under this initiative, Medicare rebates are available to patients for selected mental health services provided by general practitioners (GPs), psychiatrists, psychologists (clinical and registered) and eligible social workers and occupational therapists.

What Medicare services can be provided under the Better Access initiative?

Medicare rebates are available for up to ten individual and ten group allied mental health services per calendar year to patients with an assessed mental disorder who are referred by: 
• A GP managing the patient under a GP Mental Health Treatment Plan; or 
• Under a referred psychiatrist assessment and management plan; or 
• A psychiatrist or paediatrician.

What are the eligibility requirements?

The Better Access initiative is available to patients with an assessed mental disorder who would benefit from a structured approach to the management of their treatment needs. Mental disorder is a term used to describe a range of clinically diagnosable disorders that significantly interfere with an individual’s cognitive, emotional or social abilities. Dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders for the purposes of this initiative.

How can I access these services under Medicare?

Step 1: 
Visit your GP who will assess whether you have a mental disorder and whether the preparation of a GP Mental Health Treatment Plan is appropriate for you, given your health care needs and circumstances. If you are diagnosed as having a mental disorder, your GP may either prepare a GP Mental Health Treatment Plan, or refer you to a psychiatrist who may prepare a psychiatrist assessment and management plan. Alternatively, your GP may refer you to a psychiatrist or paediatrician who, once an assessment and diagnosis is in place, can directly refer you to allied mental health services. Whether a patient is eligible to access allied mental health services is essentially a matter for your treating health practitioner to determine, using their clinical judgement and taking into account both the eligibility criterion and the general guidance.

Step 2:
You can be referred for certain Medicare rebateable allied mental health services once you have: 
• a GP Mental Health Treatment Plan in place; or 
• are being managed by a GP under a referred psychiatrist assessment and management plan; or 
• been referred by a psychiatrist or paediatrician.

Your GP or psychiatrist/paediatrician can refer you for up to six individual or six group allied mental health services, which may comprise either psychological assessment and therapy by a clinical psychologist or focussed psychological strategies by an allied mental health professional. It is at the clinical discretion of your referring practitioner as to the number of allied mental health services you will be referred for (to a maximum of six in any one referral).

Step 3:
Depending on your health care needs, following the initial course of treatment (a maximum of six services but may be less depending on your clinical need), you can return to your GP or psychiatrist/paediatrician and obtain a new referral to obtain an additional four sessions to a maximum of ten individual and ten group services per calendar year. Whether you have a clinical need to access the additional allied health services which attracts a rebate is a decision for your treating health practitioner, taking into account the written report received from the allied mental health professional at the completion of a course of treatment. At this time, a review of your GP Mental Health Treatment Plan may also be undertaken.

Exceptional circumstances 
From 1 January 2013 the number of individual allied mental health services for which a person can receive a Medicare rebate will be ten services per calendar year. Exceptional circumstances apply when there has been a significant change in the patient’s clinical condition or care circumstances which necessitates a further referral for additional services. It is up to the referring practitioner (e.g. GP) to determine that the patient meets these requirements.

A Fact Sheet providing more detailed information on the arrangements for accessing further allied mental health services under exceptional circumstances can be found at: 
www.health.gov.au/mentalhealth-betteraccess
http://www.health.gov.au/internet/main/publishing.nsf/content/mental-ba-fact-pat

Further information on the Better Access initiative is available at 
http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-ba
http://www.health.gov.au/internet/main/publishing.nsf/content/0F792912834609B4CA257BF0001B74FA/$File/patients2.pdf

DVA COORDINATED VETERANS CARE (CVC) PROGRAMME

The Coordinated Veterans’ Care (CVC) Programme is a team-based programme designed to increase support for Gold Card holders with one or more targeted chronic conditions or complex care needs; and those who are at risk of unplanned hospitalisation. CVC focuses on improving the management of chronic conditions and quality of life for eligible Gold Card holders who are most at risk of unplanned hospitalisation. Gold Card holders can include veterans, war widow/widowers and dependants. The programme is aimed at Gold Card holders with the following chronic conditions:

  • congestive heart failure
  • coronary artery disease
  • pneumonia
  • chronic obstructive pulmonary disease
  • diabetes.

GPs are paid to enrol Gold Card holders onto the CVC Programme and to provide ongoing, comprehensive and coordinated care with the assistance of their practice nurse or a community nurse (from a DVA contracted provider).

Further information can be found at
http://www.dva.gov.au/providers/provider-programmes/coordinated-veterans-care

CVC is not for all Gold Card holders. The focus of the Program is on prevention and improved management of chronic diseases resulting in improved quality of life and reduced risk of hospitalisations. The Program is voluntary and is in addition to any existing DVA services and entitlements.

What does it mean for me?
If you are eligible and enrolled in the CVC Program, your ongoing and planned care will be based on a personalised Care Plan developed by your General Practitioner (GP) along with a nurse coordinator and in consultation with you. The GP and the nurse coordinator will work closely with you to help you understand your health needs, assist you in managing your conditions and to coordinate the various aspects of your care. All of this will be in your Care Plan.

Your Care Plan will be regularly reviewed and you will be given a patient friendly version of the plan to take home and keep handy as a reminder of your medications, appointments and health goals.

A brochure can be downloaded at 
http://www.dva.gov.au/sites/default/files/files/providers/cvc/info-veterans-brochure.pdf