MyMedicare

For GPACI, the relationship between the 3 participants is critical (the practice, the patient, and the Responsible Provider). The assessment process looks for this relationship, and anything that can potentially break or remove any of those relationships will impact GPACI payments for eligible services.

If there is a change in the relationship (e.g. new responsible provider) it is important that the previous relationship is maintained in the patient’s MyMedicare profile. Removing or deleting relationships will impact past payments.  

*Note that the Responsible Provider may not be the same practitioner as the patient’s nominated Preferred GP (e.g. a registrar may be engaged to deliver RACH services).

Below are tips on managing GPACI correctly and some cautions on what not to do (also attached as infographics). *IMPORTANT: Using actions incorrectly can impact payments, including reassessment of past payments.

For the Incentive Period:

• DO select Set period and add a Start Date to add the Incentive to a patient’s MyMedicare profile.
• DO NOT add an End Date to the Incentive period. When a patient is withdrawn from the MyMedicare program, the system will automatically end the Incentive period.
• DO NOT Amend the Start Date for the Incentive period, unless it was incorrect and you understand the impact to payments.
• DO NOT Amend the Incentive period at the start of every new quarter.
• DO NOT Delete the Incentive unless it was added to the patient’s MyMedicare profile in error.

For the Responsible Provider:

• DO Add the Responsible Provider and add a Start Date.
• DO NOT add an End Date for the Responsible Provider. If a new Responsible Provider is added, the system will automatically end the previous Responsible Provider.
• DO NOT Amend the Start Date for the Responsible Provider, unless it was incorrect and you understand the impact to payments.
• DO NOT Remove the Responsible Provider unless they were added in error.

For the Patient:

• DO Register the patient for the MyMedicare program as soon as possible and no later than 28 days after receiving the consent form (or they can register themselves online).
• DO Add GPACI to the patient’s MyMedicare profile (as above).
• DO Add a new Responsible Provider if required (only add a Start Date, do not add an End Date). Adding a new Responsible Provider will automatically end the previous one.
• DO Add an Incentive period End Date if the Patient asks to no longer be part of GPACI (Note, this is very unlikely).
• DO Withdraw the patient if they ask to no longer be part of the MyMedicare program or are deceased. This will automatically end the Incentive.
• DO NOT Remove a Responsible Provider. It is important that previous relationships are maintained, even if the patient has a new Responsible Provider added, no longer wants to be involved in GPACI or MyMedicare, or is withdrawn from MyMedicare. Removing responsible providers will impact reassessment of past payments.
• DO NOT Move a patient to a new Organisation Site unless you understand the impact to payments. Moving a patient resets their MyMedicare registration date and restarts them in Quarter 1 for GPACI.
• DO NOT Delete GPACI from a patient’s MyMedicare profile unless the Incentive was added in error. If the patient is deceased, withdraw them from MyMedicare but do not delete the Incentive.

For support on MyMedicare, please contact [email protected]. 

The General Practice in Aged Care Incentive (GPACI) Quarter 4 (Q4) payment requirements are different to the requirements for Q1, Q2 and Q3.

Practices and providers must familiarise themselves with the below requirements, to ensure they meet Q4 eligibility.

Requirements:

Patients who had the GPACI added to their MyMedicare profile in the July-September 2024 quarter are [as at May 2025] in Q4 of their 12-month care period.

To receive Incentive payments for GPACI patients in Q4, practices and providers must deliver the GPACI quarterly servicing requirements AND the GPACI annual servicing requirements.

• Individual providers may have some patients in Q4 while other patients may be in Q1, Q2 or Q3.

o   This is dependent on when the patient had GPACI added to their MyMedicare profile; not when the practice registered for GPACI or when the practice linked the provider to the patient as the Responsible Provider.

o   It is the responsibility of the practice and the Responsible Provider to make sure they track which quarter each individual patient is in, and that all servicing requirements are met.

o   It is recommended that practices and providers run an Eligibility Forecast in HPOS, particularly for patients in Q4. This will identify any servicing requirements that have not been met.

• Both the quarterly and annual servicing requirements must be met by both the practice and the Responsible Provider for either of them to be eligible for the Q4 payment.
• If practices and providers were assessed as ineligible for Q1, Q2 or Q3 they must still meet the annual servicing requirements by the end of Q4 to be eligible for the Q4 payment.

o   Note that the Responsible Provider is required to deliver care to patients in line with the patient’s need. That is, all MBS services must be clinically relevant.

o   Meeting the annual servicing requirements (i.e. 8 regular services and 2 care planning services) contributes to eligibility for a Q4 payment. It does not trigger back-pay for any previous ineligible quarters.

Quarterly servicing requirements (for all quarters, including Q4):

Each quarter:

• the practice and provider must deliver at least 2 regular services to the patient, each in a separate calendar month.
• the Responsible Provider must deliver at least one of the regular services. The other regular service can be delivered by either the Responsible Provider or an Alternate Provider.

Annual servicing requirements:

In each 12-month annual care period:

• 2 care planning services must be delivered by the Responsible Provider.
• 8 regular services must be delivered. For the annual assessment, these services do not have to be delivered:

o   in separate months or quarters.

o   by the Responsible Provider. They need to be delivered by an eligible provider linked to the same practice as the patient receiving the services.

Failure to meet the annual servicing requirements:

If the Responsible Provider does not deliver the 2 care planning services by the end of the 12-month care period:

• the practice and the Responsible Provider will not get the Q4 payment.
• the Responsible Provider must deliver at least 1 care planning service in Q1 of the following 12-month care period.

If the requirements are not met, the practice and provider will be ineligible for the Incentive payments for that patient for the remainder of the patient’s new 12-month care period.

HPOS sends notifications to the practice and Responsible Provider:

• if they did not meet the annual servicing requirements for a patient by the end of Q4, to notify them of the requirements to maintain eligibility.
• if they fail to meet this requirement in Q1 of the following 12-month care period, to notify them that the practice and Responsible Provider are not eligible for assessment for that patient for the remainder of the patient’s new 12-month care period.

Additional information regarding servicing requirements, including for Q4, can be found in the GPACI program guidelines here.

From 1 July 2025, a new framework for chronic disease management will be introduced. Under this updated system, the existing GP Management Plans (GPMP) and Team Care Arrangements (TCA) will be replaced by a single, consolidated plan known as the GP Chronic Condition Management Plan (GPCCMP).

Changes to Chronic Disease Management Framework - MBS Items for GP Chronic Condition Management Plans

This change to the Medicare Benefits Schedule (MBS) is designed to simplify, streamline, and modernise chronic disease management arrangements for health professionals, reducing administrative complexity and improving consistency of care.

Eligibility for the GPCCMP

• The GPCCMP is intended for patients with chronic or terminal medical conditions who would benefit from a structured and coordinated approach to their care.
• Specifically, a patient is eligible if they have at least one medical condition that has been (or is expected to be) present for six months or more, or is terminal.
• Eligibility will be determined at the clinical discretion of a GP or Prescribed Medical Practitioner (PMP), who will assess whether the patient is likely to benefit from the plan.
• Patients living in residential aged care facilities are not eligible for a GPCCMP.
• To access a GPCCMP and associated review services, patients must be registered with MyMedicare and receive these services through the practice where they are registered.

This change consolidates existing planning tools into a single, more efficient mechanism for managing chronic conditions and aims to better support both patients and healthcare providers in delivering long-term care.

Changes to Chronic Disease Management Framework - Overview

To support the implementation of the new GP Chronic Condition Management Plan (GPCCMP) framework from 1 July 2025, transition arrangements will be in place for two years, until 30 June 2027.

What’s Changing from 1 July 2025

• From this date, all new chronic disease management plans must be created using the GPCCMP.
• This applies to:
• New patients with a chronic condition requiring a structured care plan.
• New referrals written under either:
• Existing GP Management Plans (GPMPs) and Team Care Arrangements (TCAs), or
• The new GPCCMP.

For Patients with Existing GPMPs and/or TCAs (Before 1 July 2025)

• No immediate action is required.
• Patients can continue to access allied health and other relevant services under their existing GPMPs and TCAs until 30 June 2027.
• Referrals written before 1 July 2025 remain valid and may continue to be used until all services under that referral have been delivered, even if this extends beyond 1 July 2025.

For further details on the transition process, please refer to the transition arrangements fact sheet.

From 1 July 2025 the following MBS items will cease:

• GP management plans - 229, 721, 92024, 92055
• Team care arrangements - 230, 723, 92025, 92056
• Reviews - 233, 732, 92028, 92059

These changes do not affect multidisciplinary care plan items (231, 232, 729, 731, 92026, 92027, 92057, 92058). 

The new GPCCMP and review items commencing 1 July 2025 can be conducted in person or via telehealth.  

Changes to Chronic Disease Management MBS Items – Transition Arrangements for Existing Patients

Items for the preparation or review of a GPCCMP cannot be co-claimed on the same day as general attendance items.  GPCCMP items may be claimed with single bulk billing incentives when eligible patients are bulk billed and will be included in the Bulk Billing Practice Incentive Program from 1 November 2025.

Effective from 1 July 2025

Preparation of a GPCCMP

From 1 July 2025, a GP Chronic Condition Management Plan (GPCCMP) can be prepared for eligible patients with a chronic or terminal medical condition. The preparation of a GPCCMP is led by the patient’s General Practitioner (GP), with support allowed from:

• Practice Nurses
• Aboriginal and Torres Strait Islander Health Practitioners
• Aboriginal Health Workers

A GPCCMP can be prepared once every 12 months, unless exceptional circumstances justify more frequent preparation.

Access to MBS-Supported Services Under a GPCCMP

Once a GPCCMP is in place, patients may access the following services under the Medicare Benefits Schedule (MBS), where these are clinically relevant and consistent with the care plan:

• Up to 5 individual allied health services per calendar year.
• Up to 10 individual allied health services per calendar year for patients of Aboriginal or Torres Strait Islander descent.
• Up to 5 services delivered on behalf of the medical practitioner by a Practice Nurse or Aboriginal and Torres Strait Islander Health Practitioner.
• For patients with type 2 diabetes:
• An assessment of suitability for group services (dietetics, diabetes education, or exercise physiology).
• If assessed as suitable, up to 8 group services for diabetes management per calendar year.

Note: The previous requirement for at least two collaborating providers as part of the care plan has been removed under the new GPCCMP model.

Review of a GPCCMP

Reviews of a GPCCMP can also be supported by Practice Nurses, Aboriginal and Torres Strait Islander Health Practitioners, and Aboriginal Health Workers.

• A GPCCMP can be reviewed every 3 months, if clinically necessary.
• It is not mandatory to create a new plan annually. An existing GPCCMP can be reviewed and updated as required, ensuring continuity of care.
• Patients must have had their GPCCMP either prepared or reviewed within the previous 18 months to maintain eligibility for allied health services under the MBS.

If a patient with a GPMP or TCA created before 1 July 2025 requires a review after that date, they must first have a new GPCCMP prepared to access continued services.

MBS Online has recently published the Upcoming Changes to Chronic Disease Management Framework confirming the new framework for chronic condition management from 1 July 2025. 

The changes simplify, streamline, and modernise the arrangements for health care professionals and patients.

Allied health professionals providing MBS services should be aware of the changes to plan and referral requirements.

Requirements for the GP or prescribed medical practitioner to collaborate with other members of the team when preparing or reviewing a patient’s plan have been removed. Patients will be referred directly to services. Allied health providers do not need to confirm their agreement to participate in the patient’s multidisciplinary team.

The nature of the individual and group allied health services that can be provided under the chronic condition management arrangements are not changing.

Transition arrangements will be in place for 2 years to ensure current patients do not lose access to services.

From 1 July 2025:
 

• GP Management Plans (GPMPs) and Team Care Arrangements (TCAs) will be replaced with a single GP Chronic Condition Management Plan (GPCCMP).
   

• Requirements for the GP or prescribed medical practitioner to collaborate with other members of the team when preparing or reviewing a patient’s plan have been removed. Patients will be referred directly to services. Allied health providers do not need to confirm their agreement to participate in the patient’s multidisciplinary team.
   

• Patients with a GPCCMP will be able to access individual allied health services, and for patients with type 2 diabetes only, group allied health services.
   

• Patients with a GPMP and/or TCA in place prior to 1 July 2025 can continue to access these services under those plans until 30 June 2027. Referrals written prior to 1 July 2025 remain valid until all services under the referral have been provided (see separate factsheet on transition arrangements).
   

• Allied health providers should be aware that referrals for allied health services written on or after 1 July 2025 must meet the new referral requirements (see separate factsheets on referrals and allied health services).
   

• All other MBS requirements of the existing allied health services are unchanged, including requirements to provide written reports to the referring medical practitioner.

For more information, MBS Online has released a selection of Factsheets here: 
MBS Online - Upcoming changes to the MBS Chronic Disease Management Framework

For support on MyMedicare and CCM Changes, please contact Country SA PHN on [email protected].

Referrals for allied health services issued prior to 1 July 2025 will remain valid until all services specified under the referral have been delivered.

Where possible, referrals can be signed and transmitted electronically. There is no requirement for allied health providers to confirm receipt or acceptance of the referral, nor to contribute to the preparation of the General Practitioner Chronic Condition Management Plan (GPCCMP).

When referring a patient to a multidisciplinary team member, the GP or Primary Medical Provider (PMP) must obtain the patient's ongoing consent to share relevant health information with that team. If the patient consents, the GP is responsible for providing both:

• A referral to the multidisciplinary team member, and
• Any updated, relevant sections of the GPCCMP to support coordinated care.

Referrals do not need to:

• Specify the name of the allied health provider. For example, a patient referred for physiotherapy under a GPCCMP may choose their preferred physiotherapist.
• Specify the number of services to be provided.

Please note that the new referral requirements do not apply to other MBS-supported allied health services, including:

• Better Access psychological therapy services
• Focussed psychological strategies (allied mental health)
• Eating disorder-related allied health services
• Diagnostic audiology services

For more detailed guidance, please refer to the fact sheet on referral arrangements for allied health services, which outlines the updated referral guidelines.