Chronic disease management: Medicare funded services

The chronic disease management (CDM) Medicare items are part of a government initiative that assists people living with a chronic or complex medical illness to get the support and help they need from allied health professionals.

Medicare rebates are available for up to five visits (in total) within a calendar year, to certain allied health professionals assisting in the care and management of a chronic disease from a range of allied health professionals including:

• Aboriginal Health Workers
• Audiologists
• Chiropractors
• Chiropodists
• Diabetes Educators
• Dietitians
• Exercise Physiologists
• Mental Health Workers
• Occupational Therapists
• Osteopaths
• Physiotherapists
• Podiatrists
• Psychologists
• Speech Pathologists

Your GP is required to prepare a management plan (GP Management Plan and Team Care Arrangements) so that your illness can be better managed with the assistance of allied health professionals.

Chronic medical conditions that may be covered by the scheme must have been present, or are likely to be present, for six months or more. The conditions include, but are not limited to:

• Asthma
• Cancer
• Cardiovascular illness
• Diabetes
• Musculoskeletal conditions
• Stroke

To be eligible to claim rebates under this initiative, you must have a chronic medical condition that has been present, or is likely to be present, for six months or more.

Psychologists are experts in human behaviour. This means that they are able to assist not only those people who have mental health problems, but also people who need help in adjusting to a chronic or complex illness.

Often chronic or complex illnesses require a number of lifestyle changes such as changes to diet, exercise, smoking and alcohol intake, changes in time management strategies to help with scheduling regular appointments, changes to medication, as well as changes to work, family and living arrangements.

Psychologists can often assist with making some of these changes and adapting to the challenges of having a chronic or complex illness. Being confronted with a long-term or complex illness can also be a very emotional time, and people may feel anxious or depressed, angry, helpless or confused.

Psychologists can provide support and assistance at these times to help with the emotional adjustment that occurs when confronted with an illness.

To provide Medicare services a psychologist must be registered with Medicare and have a Medicare Provider Number. In addition, you must have a referral from a GP who has completed a GP Management Plan and Team Care Arrangements.

In order to receive a Medicare rebate under this initiative, you must be referred to a psychologist by your GP under a specific management plan to assist in managing your chronic/complex medical illness. If you are already seeing a psychologist, discuss this with your doctor.

The chronic disease management scheme only provides payment for a total number of five visits per calendar year to all allied health professionals that are specified in your Team Care Arrangements (TCA).

This means the number of sessions with a psychologist that will be paid for by Medicare under this scheme will depend on how many sessions with other allied health professionals you have had or will require. For example, your TCA may state that you need two sessions with a podiatrist, one with a physiotherapist, one session with a dietitian, and one session with a psychologist.

The combination of Medicare-funded services under this initiative can only add up to five sessions in a year. You will be required to pay for any additional services. You could have up to five sessions with a psychologist, but this would mean that Medicare would not pay for any other allied health visits that are required to manage your chronic/complex illness or any other chronic/complex illness.

The cost to you will vary depending on the fee being charged by the psychologist. If the psychologist decides to bulk bill you will not have to pay anything.

However if the psychologist does not bulk bill then you will need to pay the difference between what the psychologist charges you (a fee set by the psychologist) and the Medicare rebate. This will vary and you should check this with the psychologist before commencing your treatment.

Yes. You are responsible for paying any charges in excess of the Medicare rebate for treatment under this initiative. However, these out-of-pocket expenses will count towards the Medicare Safety Net. 

The Medicare Safety Net is designed to protect high users of health services from large out-of-pocket expenses. Visit the Medicare website for more information on the Medicare Safety Net.

You cannot use your private health insurance ancillary cover to pay any additional costs above the Medicare rebates for these services.

You need to decide if you will use Medicare or your private health insurance ancillary cover to pay for the psychological services you receive.