GPRIP – Stage One Trial of Health Care Homes Factsheet – October 2017

This factsheet provides information to practice locations that are participating in the stage one trial of Health Care Homes and are in a Modified Monash (MM) 3 to 7 area. This advice is to support medical practitioners in these practice locations to access General Practice Rural Incentives Program (GPRIP) incentive payments.

Page last updated: 03 October 2017

PDF version: GPRIP - Health Care Homes Factsheet (PDF 95KB)

Stage One of Health Care Homes

From 1 October 2017, practice locations across Australia will commence participation in the stage one trial of Health Care Homes.

How will the Stage One Trial of Health Care Homes impact the GPRIP?

As the Health Care Homes model replaces fee-for-service billing with bundled payments for the management and care of enrolled patients with chronic conditions, this may result in some activity no longer being captured by the Department of Human Services (Human Services), for the purposes of GPRIP eligibility assessment and payment calculations.

Who will be impacted in your practice?

Medical practitioners who are participating in the stage one trial of Health Care Homes in a MM 3-7 location, and who may be eligible for a GPRIP Central Payment System (CPS) payment could be impacted. These are medical practitioners who bill Medicare for eligible services and receive automated GPRIP payments.

Will medical practitioners who require assessment under the Flexible Payment System (FPS) be affected?

No. Medical practitioners who already provide some non-Medicare services and require assessment under the FPS will not be affected. From 1 July 2017, medical practitioners applying through the FPS are required to account for all time spent providing GPRIP eligible services, regardless of whether the services were Medicare Benefits Schedule (MBS) billed. This will include services to Health Care Homes patients.

Medical practitioners are required to apply directly to the Rural Workforce Agency (RWA) in the state or the Northern Territory in which they have provided the majority of services, to be assessed under the FPS.

What mechanism has been put in place to ensure medical practitioners receiving GPRIP CPS payments are not disadvantaged by their Health Care Homes participation?

For medical practitioners primarily billing the MBS for services and accessing payments only through the CPS, there is a simple opt-in review mechanism available to ensure that a medical practitioner’s Health Care Home services are included in GPRIP eligibility assessments and payment calculations.

Medical practitioners can complete a simple form that self-reports the number of hours per week, on average, that they spend providing eligible primary care services from all MM 3-7 locations, across the relevant quarters. After having this form signed off by their employer or practice manager, medical practitioners will need to submit it to the Department of Health via gprip@health.gov.au. Information provided on this form will be assessed, and if the medical practitioner is deemed eligible for a full payment or a ‘top-up’, the Department of Health will request Human Services to make a payment directly to their nominated bank account.

Further information (including Frequently Asked Questions and the GPRIP – Health Care Homes Review Form) is available on the GPRIP webpage.

What can practice managers / employers do to support the medical practitioner involved?

Medical practitioners who are seeking a review based on their Health Care Homes participation are required to have the activity recorded on their GPRIP – Health Care Homes Review Form endorsed by a practice manager or employer.

It is the responsibility of the medical practitioner to ensure that the information provided is true and accurate. Practice managers or employers can support this through provision of service records etc.

What if I have any further queries?

Please contact the Department of Health at gprip@health.gov.au.

What if I claim other incentives?

Further information and updates for other incentive programs will be made available on the Health Care Homes webpage.