NURSE PRACTITIONERS AND THE
MEDICARE BENEFITS SCHEDULE
(MBS)
MEDICARE REBATES AND RULES
Fifine Cahill
Assistant Secretary
...
Overview
• Expanding Medicare Support for Nurse
Practitioners Measure
• Understanding the frameworks in place
• Current fi...
Expanding Medicare Support for
Nurse Practitioners Measure
• $36.6 million over four years was allocated in
the 2009-10 Bu...
The measure was introduced to:
• Improve the flexibility and capacity of the
primary care health workforce;
• Advance the ...
An eligible nurse practitioner can:
• treat their own patients;
• provide Medicare rebateable primary care
services within...
Within their scope of practice, nurse
practitioners may also:
• refer patients to specialists and
consultant physicians;
•...
To access Medicare arrangements,
an eligible nurse practitioner must:
• have a Medicare provider number;
• be working in a...
Collaborative arrangements – nurse
practitioners
• Medicare benefits are only payable for
nurse practitioner services prov...
A collaborative arrangement between
a nurse practitioner and a medical
practitioner must always provide for:
• consultatio...
Forms of collaboration
• through an employment relationship; or
• referral to a nurse practitioner by a
medical practition...
An eligible nurse practitioner can
provide services at:

• Nurse practitioner’s private consulting
rooms;
• The patient’s ...
Referral requirements
• Referrals must be within the nurse
practitioner’s scope of practice.
• A referral made by an eligi...
Current figures

1 November 2010 to 31 January
2013
• 148 nurse practitioners;
• 144,177 general attendance
services;
• 76...
Current figures
1 November 2010 to 31 January
2013
• 130,807 PBS prescriptions;
• 2,178 diagnostic imaging requests;
• 35,...
Current figures
1 November 2010 to 31 January 2013
• $3,809,466 paid in MBS rebates;
• $3,843,230 paid in PBS prescription...
Nurse Practitioner Services by Selected Time
Periods, 1 November 2010 to 31 January 2013
Nurse Practitioner Services by MBS Item Number,
1 November 2010 to 31 January 2013
Nurse Practitioner Services by State/Territory,
1 November 2010 to 31 January 2013
Nurse Practitioner Services by Australian Geographical
Classification – Remoteness Areas, 1 November 2010 to
31 January 20...
Looking towards the future
• Aged Care Models of Practice
Program
• Collaborative Arrangements
Nurse Practitioner - Aged Care
Models of Practice Program
• In the 2010-11 Budget, the Government
provided $18.7 million o...
Nurse Practitioner - Aged Care
Models of Practice Program
The program aims to:
• identify effective, economically viable a...
Nurse Practitioner - Aged Care
Models of Practice Program
•
•
•
•
•
•
•

Funded organisations include:
Individuals/sole tr...
Nurse Practitioner - Aged Care
Models of Practice Program
Models tested include nurse practitioners
working in:
• Private ...
Nurse Practitioner - Aged Care Models
of Practice Program
• Projects are funded in all states and
territories.
• Projects ...
Nurse Practitioner - Aged Care
Models of Practice Program
National Evaluation:
• Undertaken by the University of Canberra....
Collaborative arrangements –
midwives
• More Choice for Women – Expanding
Medicare Support for Midwives measure
introduced...
Collaborative arrangements –
midwives
• Collaboration between providers is
pivotal to ensuring safe, high quality
care and...
Collaborative arrangements –

midwives
• The Commonwealth agreed to vary the
secondary legislation on collaborative
arrang...
Collaborative arrangements –
midwives
• Collaboration will continue to be
fundamental to midwifery care under
Medicare and...
Collaborative arrangements –
midwives
• There will still need to be pathways in
place for consultation, referral and
trans...
Questions and comments?
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Fifine Cahill, Department of Health and Ageing:Nurse Practitioners and the Medicare Benefits Schedule (MBS): Medicare Rebates And Rules

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Fifine Cahill, Assistant Secretary Primary Care, Diagnostics and Radiation Oncology Branch
Medical Benefits Division, Department of Health and Ageing
delivered this presentation at the 2013 Developing the Role of the Nurse Practitioner conference. The event is designed for organisations and managers looking to better understand, utilise and grow the role of the nurse practitioner in their health service. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/nursepractitionersconference

Published in: Health & Medicine, Education
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Fifine Cahill, Department of Health and Ageing:Nurse Practitioners and the Medicare Benefits Schedule (MBS): Medicare Rebates And Rules

  1. 1. NURSE PRACTITIONERS AND THE MEDICARE BENEFITS SCHEDULE (MBS) MEDICARE REBATES AND RULES Fifine Cahill Assistant Secretary Primary Care, Diagnostics and Radiation Oncology Branch Department of Health and Ageing
  2. 2. Overview • Expanding Medicare Support for Nurse Practitioners Measure • Understanding the frameworks in place • Current figures • Looking towards the future
  3. 3. Expanding Medicare Support for Nurse Practitioners Measure • $36.6 million over four years was allocated in the 2009-10 Budget. • Representatives of professional groups were members of the expert advisory group that helped to develop the Measure. • Medicare Benefits Schedule (MBS) nurse practitioner items introduced on 1 November 2010
  4. 4. The measure was introduced to: • Improve the flexibility and capacity of the primary care health workforce; • Advance the position of nurse practitioners in private practice; and • Provide a sustainable model of practice.
  5. 5. An eligible nurse practitioner can: • treat their own patients; • provide Medicare rebateable primary care services within their scope of practice under: - four time tiered attendance items; - six telehealth items; and - ten specific pathology items. • www.mbsonline.gov.au
  6. 6. Within their scope of practice, nurse practitioners may also: • refer patients to specialists and consultant physicians; • prescribe medicines under the Pharmaceutical Benefits Scheme; • request pathology and diagnostic imaging services.
  7. 7. To access Medicare arrangements, an eligible nurse practitioner must: • have a Medicare provider number; • be working in a private practice; • have professional indemnity insurance; and • have collaborative arrangements in place with a medical practitioner.
  8. 8. Collaborative arrangements – nurse practitioners • Medicare benefits are only payable for nurse practitioner services provided under a collaborative arrangement with specified medical practitioners. • Collaborative arrangements are covered under the Health Insurance Regulations 1975
  9. 9. A collaborative arrangement between a nurse practitioner and a medical practitioner must always provide for: • consultation; • referral of a patient; and • transfer of a patient’s care.
  10. 10. Forms of collaboration • through an employment relationship; or • referral to a nurse practitioner by a medical practitioner; or • a written agreement between a nurse practitioner and a medical practitioner; or • an arrangement acknowledged by the medical practitioner and patient and detailed in the nurse practitioner’s written records.
  11. 11. An eligible nurse practitioner can provide services at: • Nurse practitioner’s private consulting rooms; • The patient’s home; • Health clinics; • General practices; and • Aboriginal Medical Centres.
  12. 12. Referral requirements • Referrals must be within the nurse practitioner’s scope of practice. • A referral made by an eligible nurse practitioner is valid for 12 months.
  13. 13. Current figures 1 November 2010 to 31 January 2013 • 148 nurse practitioners; • 144,177 general attendance services; • 76,188 patients.
  14. 14. Current figures 1 November 2010 to 31 January 2013 • 130,807 PBS prescriptions; • 2,178 diagnostic imaging requests; • 35,886 pathology requests.
  15. 15. Current figures 1 November 2010 to 31 January 2013 • $3,809,466 paid in MBS rebates; • $3,843,230 paid in PBS prescriptions
  16. 16. Nurse Practitioner Services by Selected Time Periods, 1 November 2010 to 31 January 2013
  17. 17. Nurse Practitioner Services by MBS Item Number, 1 November 2010 to 31 January 2013
  18. 18. Nurse Practitioner Services by State/Territory, 1 November 2010 to 31 January 2013
  19. 19. Nurse Practitioner Services by Australian Geographical Classification – Remoteness Areas, 1 November 2010 to 31 January 2013
  20. 20. Looking towards the future • Aged Care Models of Practice Program • Collaborative Arrangements
  21. 21. Nurse Practitioner - Aged Care Models of Practice Program • In the 2010-11 Budget, the Government provided $18.7 million over four years to develop, test and evaluate a range of models of nurse practitioners in the aged care sector.
  22. 22. Nurse Practitioner - Aged Care Models of Practice Program The program aims to: • identify effective, economically viable and sustainable models of practice; • facilitate the growth of the aged care nurse practitioner workforce; and • improve access to primary health care for clients of residential and community aged care services.
  23. 23. Nurse Practitioner - Aged Care Models of Practice Program • • • • • • • Funded organisations include: Individuals/sole traders; Small providers; Peak bodies; Medicare Locals; Consortiums; and Universities
  24. 24. Nurse Practitioner - Aged Care Models of Practice Program Models tested include nurse practitioners working in: • Private practice; • Residential Aged Care Facilities; • General practice; • Specialist medical practice.
  25. 25. Nurse Practitioner - Aged Care Models of Practice Program • Projects are funded in all states and territories. • Projects are underway in rural, regional and remote areas. • Includes organisations providing Aboriginal and Torres Strait Islander and culturally specific care.
  26. 26. Nurse Practitioner - Aged Care Models of Practice Program National Evaluation: • Undertaken by the University of Canberra. • Evaluator collecting data on the cost, financial viability and economic sustainability of each model. • Results of the evaluation, including best practice models, available in 2015.
  27. 27. Collaborative arrangements – midwives • More Choice for Women – Expanding Medicare Support for Midwives measure introduced 1 November 2010. • The inclusion of legislative requirements for collaborative arrangements was central to the introduction of the midwifery and nurse practitioner measures.
  28. 28. Collaborative arrangements – midwives • Collaboration between providers is pivotal to ensuring safe, high quality care and to enable the seamless escalation of care if clinically required. • Midwives report ongoing difficulties in establishing collaborative arrangements with individual medical practitioners.
  29. 29. Collaborative arrangements – midwives • The Commonwealth agreed to vary the secondary legislation on collaborative arrangements to enable agreements between midwives and hospitals and health services.
  30. 30. Collaborative arrangements – midwives • Collaboration will continue to be fundamental to midwifery care under Medicare and Midwives will continue to be required to collaborate with doctors. • The proposed change will be to the way collaborative arrangements are demonstrated.
  31. 31. Collaborative arrangements – midwives • There will still need to be pathways in place for consultation, referral and transfer of care to a medical practitioner, where required. • Stakeholder consultation is underway to effect this change.
  32. 32. Questions and comments?

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