Everything we know about the big changes coming to Chronic Disease Management items
- Chronic Disease Management, MyMedicare
- Bryn Tardent-Powell
- August 28, 2024
The Strengthening Medicare Taskforce was established in 2022 with the objective of improving patient access to care, improving healthcare affordability and most notably today, improving prevention and management of ongoing and chronic conditions. Now, in late August of 2024, we receive news of the next round of changes proposed for the MBS.
These changes have been proposed by the Department of Health and Aged Care and are a couple of months away from taking effect on 1 November 2024. This means there is potential for change, subject to industry feedback. We’ll be keeping this article up to date as new information is released.
Understanding Chronic Condition Management
Subject to passing legislation, from November 1st 2024, the way Chronic Disease Management services are accessed will see several big reforms.
Chronic Condition Management is the new term for the structured approach to managing long term medical conditions. These plans aim to simplify care for both patients, General Practitioners and Allied Health Professionals, ensuring continuity of care and easier access to necessary services, especially when multidisciplinary care is required.
The upcoming changes, effective from November 1st 2024 achieve this by introducing new MBS items under the Chronic Condition Management Plan (CCMP) which replace the existing GP Management Plans (GPMP) and Team Care Arrangements (TCA) items.
What are the biggest changes we can expect from November 1st?
Based on the latest information from the Department of Health and Aged Care, we’ve put together this timeline for practices.
If the legislation passes successfully, four new MBS items will be billable from November 1st. These items replace the items currently used for GP management plans (229, 721, 92024, 92055), team care arrangements (230, 723, 92025, 92056) and reviews (233, 732, 920278, 92059).
The 965 and 92029, will be accessible from November 1st for the development of a chronic condition management plan face to face or through telehealth, replacing the GPMP and TCA items 721, 723 and their telehealth equivalents.
The item 732, used for the review of a GP management plan or team care arrangement is also planned to “cease and be replaced” come November 1st, however, the department also goes on to say that patients with a GP management plan or team care arrangement in place will be able to access services consistent with those plans for two years after November 1st 2024.
This leaves us with two possible interpretations of the fate of the 732 review item.
- The item 732 will still be billable as a review for any existing GPMP or TCA created prior to November 1st, for two years after.
- The item 732 will cease from November 1st and replaced with the item 967, which will be used to review historical GPMPs, TCAs as well as the new CCMP.
Having spoken to many throughout the industry on their interpretations of this particular change, we don’t think there is a clear enough answer to provide today, and are seeking more information from the department.
Additionally, the department have not provided any details on the value of the new MBS items – only that the MBS fees for planning and review items will be “equalised”. We know many are eager to see what the new fees will be for the chronic condition management items, and we’ll return with updates as soon as it’s known.
The original update from the department can be found here
What about the patients who are already on a GPMP or TCA?
The goods news is, any patient that has an existing GPMP or TCA prior to November 1st will be able to continue accessing care under that plan or arrangement for the following two years. This is fantastic news for GPs who have historically been very thorough with their chronic disease management, as those plans won’t have to be interrupted or redone due to the new CCMP framework.
Patients who are not currently on a GPMP or TCA on November 1st will be able to make use of the new CCMP item numbers, while patients on a GPMP or TCA prior to November 1st can continue to access care as they normally would for the following two years.
How does MyMedicare interact with the new chronic condition management plans?
Last year’s big change to General Practice was MyMedicare, a scheme commenced with the objective of enhancing the continuity of care between patients and their GPs. The chronic condition management plan is really the latest and final of the MyMedicare deliverables we shared last year.
From November 1st 2024, patients who are registered with a practice through MyMedicare, will only be able to access chronic condition management plans through their registered practice. Patients who are not registered with a practice can continue to access care through their usual GP.
Overall, this seems to be a step in the right direction for improving continuity of care, while also reducing the likelihood of the billing rejections we saw frequently with the item 721 when patients moved between practices due to availability or other reasons.
Changes coming to Medication Management Reviews
From November 1st 2026, patients will be required to have a valid chronic condition management plan to access the Item 900 Medication Management review. This is in addition to the existing criteria of the items 900 & 245.
Updates in Cubiko for identifying patients eligible for chronic condition management items
The Cubiko team are already making quick work of the latest changes, adding in plenty of support for the new chronic condition management items across a variety of metrics in Cubiko.
Identifying patients potentially eligible for CCMPs and reviews
From November 1st, Cubiko’s item optimisation metrics will display lists of patients potentially eligible for the item 965, 967 as well as 92029 & 92030 telehealth equivalents based on historical billings. Historical billings include previous GP management plans and team care arrangements. We’ll also be continuing support for historical CDM items, such as reviews for the two year’s following the introduction of chronic condition management items.
Identifying new chronic conditions management plans
Potential eligibility for the new CCMP will be available in Item Optimisation, Possible Service Opportunities Today, and MyCubiko. For patients who have never received a CCMP, GPMP or TCA, Cubiko will also use clinical indicators to flag patients who may be eligible for chronic condition care within the “New CCM patients” metrics. This metric is an update to the existing “Potential new CDM patients” metric.
Chronic condition management added to benchmarking and billing metrics
Finally, the new CCM billings will be taken into account on all benchmarking and billing metrics. Come November 1st, everything in Cubiko will seamlessly take into account these new items, ensuring you and your practice can continue to provide the best possible care for your chronic condition patients without interruption.
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