1. Client Eligibility

    i. Client Eligibility - Who can refer a client for care coordination?

    The client must be referred by a GP from the practice that is responsible for providing the majority of care for the client and developing the client’s care plan. This can be in a mainstream general practice or Aboriginal Medical Service. 

    ii.Can clients with a high risk of chronic disease be included in the ITC Program even though they have not yet developed a chronic disease?

    No. High risk clients are not eligible. The care coordination component of the ITC Program is not aimed at tackling risk factors for chronic disease. The aim of the Program is to contribute to improved health outcomes for Aboriginal and Torres Strait Islander people already diagnosed with chronic conditions through better access to coordinated and multi-disciplinary care. 

    iii. What is considered a chronic disease for the purposes of the ITC Program

    The ITC Program uses the Medicare Benefits Schedule (MBS) definition of a chronic disease, which is: a disease that has been, or is likely to be, present for at least six months. 

    Dental is not an eligible condition for the purposes of the ITC Program. 

    Priority should be given to clients with complex chronic care needs who require multidisciplinary coordinated care in order to manage their chronic disease/s.  This includes, but is not limited to, clients with diabetes, eye health conditions associated with diabetes, mental health conditions, cancer, cardiovascular disease, chronic respiratory disease and chronic renal disease. 

    iv. Can children access the ITC Program?

    Yes. Children must be referred by their usual practice GP and have a care plan for their chronic disease. 

    v. Can ITC clients seek treatment across PHN regions?

    Yes. Where clients enrolled on ITC seek treatment across PHN regions, the relevant PHNs and commissioned organisations should work together to develop processes that best meet local circumstances. 

2. Care Coordinator Eligibility

    i. Can a non-clinical person work in the Care Coordinator role?

    Wherever possible, Care Coordinator positions should be filled by an individual with relevant clinical skills. In specific circumstances and in consultation with the Department of Health, consideration may be given to people who have other appropriate qualifications, training, skills and personal attributes.

3.Travel

    i. Can Supplementary Services funding be used for a health care provider to travel to a client (e.g. a home visit) rather than the client travelling to visit them?

    Supplementary Services funds can be used to allow a health care provider to visit the client’s home. For example, if a client is unable to leave their home, or if it is clinically necessary to deliver the service in the client’s normal home setting (e.g. for Activities of Daily Living, mobility, and falls prevention assessments). 

    ii. Can Supplementary Services funding be provided for a client to travel out of town to visit a health care provider, rather than arranging for the provider to travel to the client’s location?

    When it is necessary for a client to access required health care in a clinically appropriate timeframe, Supplementary Services funding can be used to support a client’s travel to the closest regionally available health care provider (i.e. GP, specialist or allied health practitioner). 
    In such cases, the manager of the Supplementary Services fund must ensure that all other funding options (e.g. Patient Assisted Travel Schemes) have been exhausted and that the most cost effective means of transport (and any essential accommodation) is used. For example, Supplementary Services funds may be used to fund the difference between the full cost of travel and any funds provided through alternative funding mechanisms. 
    Note: Managers of the Supplementary Services fund are encouraged to liaise with the relevant fund holder for the Medical Outreach - Indigenous Chronic Disease Program 
    (MOICDP) and/or the Rural Health Outreach Fund (RHOF) and/or the Visiting Optometrists Scheme (VOS) regarding opportunities to access outreach specialist services. 

    iii. Can Supplementary Services funds be used to support travel and accommodation costs of the client’s parent, carer or other support provider?

    If this is required to enable a care coordination client access to a health care appointment and all other options have been explored and excluded, Supplementary Services funds can be used for this purpose. Only the number of client transports should be recorded. Do not record the parent or carer’s transport in the number of transport services used. 

    iv. Can Supplementary Services be used to cover parking for a care coordination client attending a health care appointment?

    Yes.

    v. Should Primary Health Networks contact the Department’s Health State Network Office to discuss options when travel beyond the closest available regional service has been requested due to an urgent need to access treatment?

    No, this is not necessary. Travel beyond the closest available regional service is acceptable when there is no regional solution. Decisions regarding an individual client’s care needs should be made at the Primary Health Network level

4. Medical Aids

    i. Can Supplementary Services funding be used to provide medical aids?

    Yes. See the ITC Program Implementation Guidelines Section 10.2.2 for information on medical aids. 

5. Other Services

    i. an Supplementary Services funding be used to provide care coordination clients with services such as ‘Meals on Wheels’?

    Supplementary Services funding may be used for services other than those detailed in the Implementation Guidelines, e.g. meals on wheels, if that service will assist with the management of the client’s chronic disease and is detailed in the client’s care plan. All other funding options need to be explored prior to using Supplementary Services funds. 
    The allocation of priorities within limited funding is at the discretion of the fund holder / fund manager. 

    ii. Can Supplementary Services funding be used to pay for health services that clients accessed prior to being enrolled in the ITC Program?

    No. Supplementary Services funds cannot be used to pay for costs incurred by clients prior to being referred to and accepted into the ITC Program. 

    iii. Can Supplementary Services funds be used to access dietary resources such as nutrition information and healthy recipes needed to aid healthy eating and the management of chronic disease?

    Yes, provided a relevant health professional has advised that the client should use these resources and they have been included on the client’s care plan under consultation with the client’s primary care provider. 

    iv. Can Supplementary Services funding be used to pay for food-related dietary supplements e.g. Sustagen?

    Yes, provided a relevant health professional has recommended that the client should use dietary supplements and they have been included on the client’s care plan under consultation with the client’s primary care provider. This is not intended to cover vitamins or other similar products. 

6. Client Consent and Confidentiality

    i. Does client consent need to be obtained for participation in the ITC Program?

    Yes. To ensure privacy requirements are met, Care Coordinators must obtain and record written informed consent from each client, or the client’s legal guardian. This will include consent for both the provision of ITC services and for the collection of information for the minimum data set. 
    Care Coordinators should confirm that the client wishes that the practice recorded on the client consent form to be their usual care provider and be responsible for their chronic disease management. 

7. Medicare Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS) – Gap Costs

    i. Can Supplementary Services funding be used for a client to undergo surgery?

    No. Supplementary Services funds cannot be used for surgery in acute or sub-acute settings. Use of Supplementary Services funding is restricted to funding primary care follow-up services. 

    ii. Can Supplementary Services funding be used for services performed by a specialist or allied health practitioner in their private rooms?

    Yes. Supplementary Services funds can be used for specialist or allied health services, including those in private rooms, as long as the services are detailed in the client’s care plan. Rooms that are located within hospital grounds but are privately leased by the specialist or allied health professional are considered to be private rooms. This advice does not supersede Section 8.1 

    iii. Can Supplementary Services funding be used for treatments provided at a hospital outpatient clinic?

    No. Any treatments or procedures that occur in a hospital (public or private) cannot be funded under the ITC Program. 
    However, Supplementary Services funds can be used for treatments or procedures that occur in rooms that are located within a hospital but are privately leased by a specialist or allied health professional (refer to Section 10). 

    iv. Can Supplementary Services funding be used to pay the gap between the MBS rebate and the fee charged for diagnostic tests e.g. MRI, blood tests and x-ray?

    Yes. To pay the gap between the Medicare benefit and the fee charged by the health practitioner, the Primary Health Network/commissioned organisation must follow the claiming advice provided below.  Primary Health Networks/commissioned organisations can call 132 150 (Medicare Provider enquiry line) if they have any further questions. 
    Note: The Primary Health Network/commissioned organisation accounts cannot be submitted electronically. 

    v. Can Supplementary Services funding be used to cover the gap which may remain after the subsidy is provided through the PBS Co-payment?

    No. Supplementary Services funding cannot be used to pay the PBS Co-payment gap.

    vi. Can Supplementary Services funding be used to pay for non-PBS listed medications?

    No. Supplementary Services funding cannot be used for the purchase of non-PBS medications. 

    vii. Can Supplementary Services funding be used to pay the full amount of the health care provider fee upfront?

    Yes. However, if the organisation providing care coordination services decides to pay the full cost of the service up front, the Medicare rebate for the service cannot be claimed. 

    viii. Can Supplementary Services be used to pay the gap between the Medicare rebate and a health practitioner’s fee?

    Yes. To pay the gap between the Medicare benefit and the fee charged by the health practitioner, the Primary Health Network/commissioned organisation must follow the claiming advice provided below.  Primary Health Networks/commissioned organisations can call 132 150 (Medicare Provider enquiry line) if they have any further questions. 
    Note: The Primary Health Network/commissioned organisation accounts cannot be submitted electronically.