Changes to Medicare chronic disease management items
Changes to Medicare chronic disease management items for GPs came into effect on 1 July 2025.
The single GP Chronic Condition Management Plans (GPCCMP) replaces the current GP Management Plan (GPMP) and Team Care Arrangements (TCA). To encourage GP and prescribed medical practitioners to undertake regular plan reviews, the Medicare Benefits Schedule (MBS) fees for planning and review items will not change.
While the number of allied health sessions available under the plans have not changed, the requirement to consult with two providers has been removed and there is a focus on increasing patient choice.
It is important to note changes in how patients are referred. Allied health practitioners and patients will need to monitor the number of available sessions more closely.
The APA has worked with Allied Health Professions Australia to seek further detail about the changes.
Chronic Disease Management—what is changing?
Two provider requirement
The requirement for GPs to consult with at least two collaborating providers, as described under the current Team Care Arrangements, will be removed.
Referral
GP and prescribed medical practitioner referrals to allied health services will be made directly via letter of referral to align with specialist referrals. The Chronic Disease Management Plan referral form will no longer be used. There are minimum requirements which must be included in the referral letter. Please refer to the MBS Online Upcoming Changes to MBS Fact Sheet to identify these minimum requirements.
Referrals can be signed and transmitted electronically by the GP. Patients can choose any allied health practitioner.
There is no requirement for allied health providers to confirm acceptance of the referral or otherwise provide input into the preparation of the GPCCMP. However, the requirements for allied health providers to provide a written report back to the GP after the provision of certain services (eg. the first service under a referral) are unchanged.
GPCDMP referrals will be valid for 18 months from the first session, unless stated otherwise. The time validity does not impact the number of sessions available.
Referrals don’t need to specify the number of services to be provided. There is nothing preventing the referring medical practitioner from specifying the number of services to be provided under the referral. Under the new arrangements, referrals will no longer need to specify the name of the allied health provider to provide the services. As a result, patients and providers will need to monitor the availability of their MBS supported allied health services, noting that there has been an existing need to do this where, for example, a referral is used beyond a single calendar year.
For most patients, they can establish the number of services they intend to seek from a particular provider at the point of intake. Where the number of available services is less clear, providers can check a patient’s eligibility for services using the MBS items online checker in Health Professional Online Services Check (HPOS) under:
- MBS item numbers
- health professionals
- Services Australia
- or the care plan history in HPOS
– patient details
– health professionals
– Services Australia.
Patients can check their history using the care plan service history functions in their Medicare online account.
Indexation
Indexation will be applied to MBS allied health items from 1 July 2025 at the indexation rate of 2.4 per cent.
What remains the same
Number of sessions
The number of Medicare supported allied health services in a calendar year has not changed. Patients can receive up to five services in a calendar year (10 for Aboriginal and Torres Strait Islander patients), regardless of the date the plan was prepared.
Patient eligibility
Patient eligibility criteria has not changed. The GPCCMP will be available to patients with at least one medical condition that has been (or is likely to be) present for at least six months or is terminal. There is no list of eligible conditions. This will be determined by medical practitioner clinical reasoning. Providers can check a patient’s eligibility for services using the MBS items online checker in HPOS under:
- MBS item numbers
- health professionals
- Services Australia
- or the care plan history in HPOS
– patient details
– health professionals
– Services Australia.
Patients can check their history using the care plan service history functions in their Medicare online account.
Reporting
Reports must be provided following the first and last services. For most patients, it will be possible to establish the number of services the patient intends to access under the referral at the point of intake. This will be based on their need to distribute services amongst different provider types, as reflected in their GPCCMP. The reporting frequency will be clear, noting that allied health providers must also provide a report to the referring practitioner when there is a clinical need to do so. Associated changes to the GP items also promote more frequent reviews, allowing the GP to issue new referrals in response to the patient’s clinical needs. The 18-month validity for referrals mean that patients must return to their referring practitioner to obtain new referrals.
As has been the case under the existing items, there are occasions when the patient does not return for the planned number of services. The advice for these circumstances remains the same. If the provider suspects that the patient will not return, they should provide the final report to the referring provider. There is no consequence for over-reporting. If it is subsequently discovered that it was not the final visit there would be no consequence if another final report is written for the same patient. Referrals are required for MBS-supported allied health services regardless of how frequently the GP reviews the plan. Where there is a valid referral in place for a particular allied health service at the time the review is undertaken it is not necessary for the GP to issue a new referral at that time
GP planning item limitations
There are no restrictions or dependencies between these GP planning items. Providing a patient is eligible for more than one of these plans, they can have more than one without timing or other restrictions between them. The plans do not interact, rather they are individual treatment pathways.
Range of services
Patients will be able to access the same range of services currently available through GP management plans and team care arrangements.
Plan and review period
Consistent with current arrangements, unless exceptional circumstances apply. A GPCCMP can be prepared once every 12 months (if necessary), and reviews are conducted every three months. New plans don’t need to be prepared each year, existing plans can continue to be reviewed.
Multidisciplinary care items
The existing item numbers for multidisciplinary care plans will remain unchanged.
Assisting GPs
Practice nurses, Aboriginal and Torres Strait Islander Health Practitioners and Aboriginal Health Workers will be able to assist the GP or prescribed medical practitioner to prepare or review a GP chronic condition management plan.
Transition arrangements
There will be a transition period of two years to enable people currently on GPMPs to be transferred to GPCCMPs.
Any referrals for allied health services written prior to 1 July 2025 will remain valid until all services under the referral have been provided.
Individual and group allied health services can be accessed under existing GPMPs and TCAs until 30 June 2027. Medical practitioners can continue to write referrals under these plans.
From 1 July 2025, any new plans put in place will need to meet the requirements of a GPCCMP. Any new referrals for allied health services should meet the new referral requirements that come into effect on 1 July 2025, regardless of whether the referral is made under a GPMP, TCA or GPCCMP.
There will be no changes to the way payments for allied health practitioners are processed.