Chronic Disease Management (CDM), Medicare Benefits Schedule (MBS)

Chronic Disease Management (CDM), Medicare Benefits Schedule (MBS)

What is the policy issue?

The Australian Government has released new rules for Chronic Disease Management Plans for the Medicare Benefits Schedule, which take effect from 1 July 2025.

A number of areas in the new rules require clarification including:

  • Provider number of referrer - GPs don't have to include their provider number on the referral. Currently, payment is not received without the GP provider number.
  • Number of sessions - GPs don't have to stipulate how many sessions of podiatry they are requesting and this creates uncertainty on utilisation of up to 5 sessions, specifically:
    • If several allied health receives a referral, then the sessions may be used up by other allied health before podiatry is accessed. The patient then misses out on podiatry treatment.
    • A report is required after initial treatment and after final treatment. It is unknown when the final treatment is to be provided. GPs will end up chasing reports from allied health providers.
    • Payment can take up to 48 hours to be confirmed. This can be rejected if the 5 visits are used up and then the allied health professional is left to follow-up with patient for payment.
  • Nomination of providers on referral – GPs are not required to nominate a specific provider on a letter of referral. This allows flexibility for a patient to choose from many podiatrists in the same practice. The patient can also go to another practice which means that it is difficult to monitor the number of visits that are eligible for claiming through MBS. In other words, services may be split across practices that are not connected. Constant checking through proda will be required, adding administrative burden.

What is APodA advocating for?

Clarity on how to operationalise the new arrangements specifically in relation to reporting, payment, and monitoring of patient CDM visits.

What has APodA been doing?

  • Met with the Commonwealth Chief Allied Health Officer and raised the issues.
  • Written to Government Officials responsible for the CDM MBS changes.
  • Received advice that a resource will be provided to answer the questions raised and guide allied health.
  • Raised the issue with Allied Health Professions Australia.

What are the next steps?

As soon as APodA receives advice, then this information will be made available to the podiatry community. Communications will be via electronic direct mail and social media.