General Practice in Aged Care Incentive

General Practice in Aged Care Incentive 

The MyMedicare General Practice in Aged Care Incentive focuses on improving and enhancing continuity of care for patients living in aged care through regular visits; care planning and health assessment and medication review services.

Each quarter, providers and practices registered with MyMedicare, meeting the General Practice in Aged Care Incentive eligibility and servicing requirements, will receive an incentive payment. 

Read more about the value of working as a GP in residential aged care.

Practice eligibility  criteria:

To be eligible to receive the incentive, practices must be: 

• a general practice or practice eligible for an exemption under MyMedicare – see MyMedicare eligibility criteria
• registered in the Organisation Register
• registered in the MyMedicare program (with banking details added)
• registered in the General Practice in Aged Care Incentive sub-program

Provider eligibility  criteria:  

• an eligible provider
• linked to their eligible practice   
• declared as the responsible provider of eligible services to the registered patient, including coordinating services provided by the care team. 

Patient eligibility criteria:

• permanently live in an aged care home, not including respite care.
• be registered in MyMedicare with the eligible registered practice.
• have the General Practice in Aged Care Incentive indicator selected on their MyMedicare profile by their practice
• have a Responsible Provider identified by the practice when a General Practice in Aged Care Incentive indicator has been selected in the Organisation Register. 

 - It is the responsibility of both the provider and practice to ensure a patient is eligible for the General Practice in Aged Care Incentive. The provider and practice must declare their patient meets the eligibility criteria as part of the patient registration process. Practices need to: 

• link providers and their MyMedicare-registered patients to their practice
• select the General Practice in Aged Care Incentive indicator on their patients’ MyMedicare profiles
• link patients to the Responsible Provider at the practice

Servicing requirements:

To meet the servicing requirements of the General Practice in Aged Care Incentive, providers and practices must deliver at least 10 eligible services, from eligible MBS and Department of Veterans’ Affairs (DVA) funded services, over a 12-month period including: 

• 2 eligible care planning services delivered by the Responsible Provider - see appendix 10.3 of the general practice in aged care incentive guidelines
• 8 eligible regular services comprising of at least 2 per quarter, each in a separate calendar month

Eligible services must be claimed using the Medicare Provider Number linked to the registered practice.

Quarterly servicing requirements 

Each quarter providers and practices will be required to meet the following criteria: 

• 2 eligible regular services per quarter are delivered, each in a separate calendar month
• at least one of the regular visits is provided by the Responsible Provider
• a second visit is provided by the Responsible Provider or another member of the patient’s care team. 

Providers and practices must complete the quarterly requirements by the end of each quarterly assessment period to be eligible for any quarterly payment. 

12-month servicing requirements

To ensure patients have received regular care over a 12-month period, providers and practices must complete the 12-monthly requirements by the end of the 12-month assessment period. This will ensure they are eligible for the 4th quarter payment. The 12-month requirements consist of the Responsible Provider delivering: 

• 2 eligible care planning services over a 12-month period, and
• at least 8 eligible regular visits in a 12-month period. 

Eligible services that contribute towards quarterly assessments contribute towards 12-monthly servicing requirements. Care planning items can be delivered at any point in the 12-month period.

Payments will be made quarterly, in addition to existing Medicare Benefits Scheme (MBS) and Department of Veterans’ Affairs (DVA) rebates for services delivered. Rural loadings will apply to provider and practice incentive payments for Modified Monash Model (MMM) regions MMM 3 to MMM 7. 

Assessment for the quarters GPACI will be performed by Services Australia 5 days after the end of the assessment period.  Once Services Australia are satisfied that the service criteria have been met payments will be paid to the bank account nominated in MyMedicare. 

Payment advice will be sent via HPOS.  Practices or providers will be notified via HPOS if a payment fails due to missing or incorrect bank account details and will receive this payment once the details are updated. 

Two infographics (one for practices and one for providers) which provide a quick summary of how to search for and view payment information are now available. 

Managing the GPACI in HPOS 

For the Responsible Provider: 

• Add the Responsible Provider and their Start Date. There is not need to an End Date for the Responsible Provider. If a new Responsible Provider is added, the system will automatically end the previous Responsible Provider.
• Do not amend the Start Date for the Responsible Provider, unless it was incorrect.  Changing this can impact payments.
• Do not Remove the Responsible Provider unless they were added in error. Remember - the Responsible Provider may not be the same practitioner as the patient’s nominated Preferred GP (e.g. a registrar may be engaged to deliver RACH services).  

For the Patient: 

• Register the patient for the MyMedicare program as soon as possible and no later than 28 days after receiving the consent form (or they can register themselves online).
• Add GPACI to the patient’s MyMedicare profile
• If adding a new Responsible Provider add a Start Date but there is no need to add an End Date. Adding a new Responsible Provider will automatically end the previous one.
• Withdraw the patient if they ask to no longer be part of the MyMedicare program or are deceased. This will automatically end the Incentive.
• Do not Remove a Responsible Provider. It is important that previous relationships are maintained, even if the patient has a new Responsible Provider added, no longer wants to be involved in GPACI or MyMedicare, or is withdrawn from MyMedicare. Removing responsible providers will impact reassessment of past payments. 

Please visit our general practice education webpage for training resources for MyMedicare and GPACI.

For more information, please visit the Department of Health and Aged Care website.