Home > For Health Professionals > Services > MBS Primary Care Items

MBS Primary Care Items

Chronic Disease Allied Health Services in Residential Aged Care Facilities - Eligibility for Medicare Rebates

Fact sheet on Chronic Disease Allied Health Services in Residential Aged Care Facilities - Eligibility for Medicare Rebates

Downloadable version of Chronic Disease Allied Health Services in Residential Aged Care Facilities - Eligibility for Medicare Rebates (PDF 253 KB)

If you have any difficulty accessing the PDF, please contact the Medical Benefits Division webmaster

All Commonwealth-funded residents of aged care facilities, regardless of their classification as high or low care, are eligible for Medicare rebates for up to five (5) allied health services (MBS items 10950 – 10970) each calendar year, where their GP has contributed to a multidisciplinary care plan prepared by the aged care facility and referred them for services.

However, while Medicare does not discriminate between high- and low-care residents, approved providers of residential aged care have different service obligations depending on the resident’s classification. Medicare allied health services should not replace services already expected to be provided to residents by the facility as a requirement under the Aged Care Act (1997).

High-care residents

High-care residents should not be routinely referred for allied health services under Medicare.

Under the Aged Care Act (1997), approved providers of residential aged care have an obligation, where an assessed care need has been identified, to provide allied health services to high-care residents at no additional cost to the resident:

• - except for intensive long term rehabilitation services following serious injury, surgery or trauma (see Schedule 1 to the Quality of Care Principles 1997 and Residential Aged Care Manual 2005).

High-care residents should therefore be already receiving allied health services, at no cost to them, through the aged care facility. It is important that approved providers of residential aged care continue to meet their obligations under the Act.

Low-care residents

Aged care facilities are required to assist low-care residents to access health practitioner and therapy services, including arranging for the practitioner or therapist to visit the home if necessary. While this level of assistance must be provided at no cost to the resident, the resident may be asked to bear the actual cost of the service. Therefore, low-care residents are most suited for referral to chronic disease allied health services under Medicare, where their GP has contributed to a multidisciplinary care plan using MBS item 731 and identified the need for these services.

Referrals

The GP and the aged care facility should work together to assess and plan the care and service needs of the resident, and the GP is responsible for making referrals. Allied health providers should not partially complete referral forms for GPs to sign in a way that pre-empts the GP’s decision about the allocation of these Medicare referred services.

More Information

Further information can be found at the MBS Primary Care Items page .