General practice in aged care incentive

On 1 August 2024, the General Practice in Aged Care Incentive (GP ACI) replaced the Aged Care Access Incentive (ACAI) as a new way to incentivise primary care delivered to patients living in residential aged care homes (RACH). Eligible general practitioners (referred to as Responsible Providers) and practices registered in MyMedicare and the MyMedicare General Practice in Aged Care Incentive can now receive incentive amounts for providing regular visits and care planning to their registered patients living in residential aged care homes. The incentive supports GPs and practices to deliver more proactive, planned and continuous care for people living in aged care homes, and is an important part of the Australian Government’s response to the Royal Commission into Quality and Safety in Aged Care and Strengthening Medicare.

• Assessment periods

  Quarterly assessment periods
  The assessment quarters for GP ACI follow the financial year quarters:

  1 July to 30 September	1 January to 31 March
  1 October to 31 December	1 April to 30 June

  12-month care period
  The 12 month care period is based on each patient’s assessment start date.

  1 July to 30 June	1 January to 31 December
  1 October to 30 September	1 April to 31 March

• Eligible Regular Service Requirements and MBS Items

  For each patient:

  • two 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.
  • at least eight eligible regular visits in a 12-month period.
  • The MBS item numbers in the table below are those that are considered eligible regular services for the purposes of the General Practice in Aged Care Incentive.

  	Consultation at RACH			Non-urgent after hours
  	GP	Other medical practitioner		GP	Other medical practitioner
  		MP	PMP		MP	PMP
  Level B	90035	90093	90188	5028	776	5262
  Level C	90043	90095	90202	5049	788	5263
  Level D	90051	90096	90212	5067	789	5265
  Level E	90054	90098	90215	5077	2200	5267

   

  Practice nurse, Aboriginal and Torres Strait Islander health practitioner and Aboriginal health worker	Nurse practitioner
  Items	Items
  10987	82205
  10997	82210
  	82215

• Eligible Telehealth MBS Items
  • Practices located in MMM 4-7 can provide up to four regular visits (out of the eight required) per 12-month period via telehealth where they are unable to provide a face-to-face service. Telehealth services under any other circumstances do not qualify for the quarterly requirements.
  • Eligibility for telehealth is based on the location of the practice as recorded in the Organisation Register. The MBS item numbers in the table below are those that are considered eligible telehealth services for the purposes of the General Practice in Aged Care Incentive

  Telehealth items Level B-E
  	Telehealth video			Telephone
  	GP	Other medical practitioner	Other medical practitioner	GP	Other medical practitioner	Other medical practitioner
  		MP	PMP		MP	PMP
  Level B	91800	91803	91806	91891	91893
  Level C	91801	91804	91807	91900*	91903*	91906*
  Level D	91802	91805	91808	91910*	91913*	91916*
  Level E	91920	91923	91926	NA	NA	NA

   *Patients enrolled in MyMedicare only, MP= Medical Practitioner, PMP= Prescribed Medical Practitioner in an eligible area

• Eligible Care Planning Items
  • Two eligible care planning items delivered to each patient by the Responsible Provider over the 12 month care period.
  • The MBS item numbers in the table below are those that are considered eligible care planning services for the purposes of the General Practice in Aged Care Incentive

  Comprehensive Medical Assessment (CMA)		Contribution to or review of multidisciplinary care plan		Residential Medication Management Plan (RMMP)		Multidisciplinary care conference		Veteran Health Check
  GP	Other medical practitioner	GP	Other medical practitioner	GP	Other medical practitioner	GP	Other medical practitioner	Item
  701	224	731	232	903	249	735	235	MT701
  703	225					739	236	MT703
  705	226					743	237	MT705
  707	227					747	238	MT707
  						750	239
  						758	240

• Incentive payments

  Responsible Provider
  $300 per patient per year. Paid in quarterly payments based on meeting servicing requirements.
  = $75 per patient per quarter

  Practice
  $130 per patient per year. Paid in quarterly payments based on meeting servicing requirements.
  = $32.50 per patient per quarter

  Loadings are applicable for practices located in MMM 3-7 regions.

  The MMM region applied to the incentive payment will be determined by the location of the practice registered in MyMedicare.
  Partial payments will not be made. For example, if the resident has passed away, and servicing requirements have not been met for the quarter, the relevant quarterly payments will not be made.

  MMM region	Loading	Payment to the GP	Payment to the practice
  1-2	0	$300	$130
  3	20%	$360	$156
  4	30%	$390	$169
  5	30%	$390	$169
  6	50%	$450	$195
  7	50%	$450	$195

   

• Checking eligibility for payment

  You can forecast your eligibility in Health Professional Online Service (HPOS) to track whether the incentive requirements have been met for each patient.

  Services Australia has separate resources to guide providers and practices through the steps in HPOS. The resources are located at: MyMedicare – Health Professional Education Resources (servicesaustralia.gov.au).

  1. Practices
     a. Forecast eligibility for MyMedicare Incentives for an Organisation site/Practice
     b. Search for and view eligibility assessments for MyMedicare Incentives for an Organisation site/Provider
  2. Providers
     a. Forecast eligibility for MyMedicare Incentives as a Provider
     b. Search for and view eligibility assessments for MyMedicare Incentives as a Provider
• Checking payments

  MyMedicare incentive payments are paid quarterly and correspondence regarding payments (or failed payments, eligibility issues) is sent to practices and providers via their HPOS mailbox.

  Resources are available to assist practices and providers in accessing and viewing GP ACI payments and related correspondence:

  • An e-learning module on how to access detailed payment information in HPOS.
  • Two infographics (one for practices and one for providers) to provide a quick summary of searching for and viewing payment information.
  • An infographic regarding MyMedicare Incentive failed payment notifications
    It is important that practices and providers keep their banking details (recorded for the MyMedicare program and its incentives) up to date to receive payment promptly.
• Supporting residents to register in MyMedicare

  For residents of aged care homes to receive services under the General Practice in Aged Care Incentive, they will first need to be registered with their chosen practice in MyMedicare.

  If your practice is considering the practicalities of how to obtain consent for MyMedicare registration for patients living in an aged care home, options include:

  • Option 1 – Practice initiated online registration (where your patients have an Medicare Online Account or Express Plus Medicare Mobile app). This allows your practice to start patient registration through HPOS, which can then be finalised by the patient or appropriate carer/family member. For more on how to complete these steps, go to Services Australia e-learning package: Managing patient registrations (pages 15-18).
  • Option 2 – Practice initiated registration forms. If you need to pre-complete a large number of patient registrations forms, consider a mail merge process. This allows your practice to partially complete a MyMedicare registration form with details from your practice software for patients, carers or guardians to then sign to consent to MyMedicare registration with your practice.
  • Option 3 – Patient initiated registration. Patients can register themselves, or their family or carer can also support them in completing a MyMedicare registration form or registering online through Medicare Online Account or the Express Plus Medicare Mobile app. Once registered in MyMedicare, you can add the General Practice in Aged Care Incentive indicator to your patients’ MyMedicare profile (see page 27 of Managing patient registrations).

  Important: MyMedicare registration is voluntary for patients and practices. Patients are not automatically linked to your practice, nor can they be added without their initiation and/or consent. Registration for MyMedicare should only be completed in HPOS for patients who have initiated the registration process and/or completed and signed the Registration Form.

  Resources for preparation of bulk MyMedicare registration forms:

  • Mail merge process -details of how to create an excel sheet list of practice patients living in Residential Aged Care from practice software and instructions for using the list to create MyMedicare Registration Forms for all patients.
  • MyMedicare Registration Form – a word document for download (to be used for mail merge process)
  • Sample cover letter to the RACH to include with MyMedicare Registration forms
• Registration for general practices

  To access incentive amounts, practices, responsible providers, and patients all need to registered in MyMedicare and the General Practice in Aged Care Incentive.

  • Step 1: Practices and providers first need to be registered in MyMedicare. Follow the step by step guide: How to register for MyMedicare
  • Step 2: Adding banking details for the MyMedicare Program for your practice in the Organisation Register – slide 11
  • Step3: Adding the MyMedicare GP ACI program for your organisation – slide 10
  • Step 4: Adding banking details for Responsible Providers
  • Step 5: Once your patients are registered in MyMedicare you can add the GP ACI indicator and responsible provider for each patient Managing patient registration in MyMedcare and GP ACI – slides 27-28
• Resources

  The Department of Health and Aged Care has a range of resources to support the implementation of the General Practice in Aged Care Incentive, for these go to https://www.health.gov.au/our-work/gpaci?language=en

  Resources include:

  • fact sheet
  • program guidelines July 2024
  • frequently asked questions for GPs and practices
  • frequently asked questions for aged care residents and carers
  • frequently asked questions for residential aged care providers
  • GP and practice information kit provides a range of resources for business owners and principals, clinical directors, GPs, practice managers and nurses, managers, administrators, and other team members to help you understand and participate in the General Practice in Aged Care Incentive: General Practice in Aged Care Incentive GP and practice information kit
  • Template for contribution to a care plan: General Practice in Aged Care Incentive care planning template
  • Individual patient front sheet template: patient-front-sheet-template.docx
  • Patient monitoring and tracking template: patient-monitoring-and-tracking-tool.xlsx
  • Payment structure: gpaci-incentive-payment-structure_0.jpg (3429×1522)
  • Patient Information booklet: General Practice in Aged Care Incentive patient journeys
  • Guide to using MBS items for delivering care under the General Practice in Aged Care Incentive (version 3)
  • GPACI MBS item spreadsheet
  • Murray PHN GP Aged Care Connect brochure
  • GP-RACH agreement template
  • RACH and general practice collaboration MOU template
• Webinars
  • Responses to questions from systems webinars Oct 2024
  • Systems overview for practices and providers to register with MyMedicare 3 Oct 2024
  • Systems overview for practices and providers to register their patients with MyMedicare 10 Oct 2024
  • Webinar RACGP: General Practice in Aged Care Overview 13 Aug 2024
  • Presentation slides from RACGP/DoHAC 13 Aug 2024
  • Webinar recording Murray PHN 16 July 2024
  • Response to questions from Murray PHN webinar 16 July 2024
  • Presentation slides from AAPM/DoHAC webinar 4 July 2024
  • Responses to questions from AAPM/DoHAC webinar 4 July 2024

For further support