General Practice in Aged Care Incentive

General Practice in Aged Care Incentive 

Developed in response to the Royal Commission into Aged Care Quality and Safety and the Strengthening Medicare Taskforce, 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. Eligible providers will receive payments for reviewing their patients in a Residential Aged Care Home, rather than at their practice. Eligible practices will receive funding to manage the care for registered patients living in a Residential Aged Care Home.

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. 

Providers will be able to participate in the General Practice in Aged Care Incentive from 1 July 2024. 

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.

It is the responsibility of providers and practices to ensure a patient is eligible. They must declare their patient meets eligibility criteria for the incentive as part of the patient registration process.

If these servicing requirements are met the incentive payments available are:

• $75 per patient per quarter for providers (up to $300 per patient, per year) 
• $32.50 per patient per quarter for the practice (up to $130 per patient, per year)

The payments will be 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. 

The first quarter of the GPACI ends on 30 September 2024.  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. 

Ceasing the current incentive programs - 

The Practice Incentives Program General Practitioner Aged Care Access Incentive (PIP GP ACAI) ceased on the 31 July 2024. GPs have three (3) payment quarters from the 31st of July 2024 to finalise outstanding payments. After this time, any outstanding payments are forfeited and will not be paid. 

Practices and providers may be eligible to receive payments under both the PIP GP ACAI and the MyMedicare General Practice in Aged Care Incentive for services delivered while both programs are active, if they meet the specific eligibility and servicing requirements of both programs.

What practices need to do - 

1. Register the practice with MyMedicare 
2. Register individual providers and ensure they are linked to the practice in PRODA
3. Encourage patients to register using one of these 3 methods: the practice initiates online registration, practice pre-fill paper registration forms, or promote patient self-registration via the Express Plus Mobile Medicare App.
4. Register the practice for GPACI. 
5. Link your RACH patients.  
6. Finalise outstanding payments from the previous program: PIP GP ACAI 

For assistance with patient registration, please visit our MyMedicare webpage.

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.