Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p30
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 30/38)
Character Range: 126895–131222

of General Treatment claims (excluding hospital-substitute and CDMP) that were processed within five working days in the current quarter.

(excluding hospital-substitute treatment and CDMP)

Retention index - Hospital Treatment policies       The retention index is designed to provide a performance indicator by showing the percent of policies that have remained active hospital treatment policies of the same fund for two years or more, over all states.

Part 8 Benefits Paid for Chronic Disease Management Programs

Chronic Disease Management Program (CDMP)  General Treatment cover for a Chronic Disease Management Program.

                                           A CDMP is intended to:

                                                * reduce complications in a person with a diagnosed chronic disease;
                                                * prevent or delay the onset of chronic disease for a person with identified multiple risk factors for chronic disease;
                                                * requires the development of a written plan that:
                                                  * specifies the allied health service or services and any other goods and services to be provided;
                                                  * specifies the frequency and duration of the provision of those goods and services;
                                                  * specifies the date for review of the plan;
                                                  * has been provided to the patient for consent;
                                                  * consent is given to the program, before any services under the program are provided; and
                                                * is coordinated by a person who has accepted responsibility for:
                                                  * ensuring the services are provided according to the plan; and
                                                  * monitoring the patient's compliance.
                                           (Private Health Insurance (Health Insurance Business) Rules 2018)

Allied Health Services                     Means a health service provided by any of the following allied health professionals who were eligible, at the time the service was provided, to claim a Medicare rebate for a service of that type:

allied health services                          * an Aboriginal health worker;
                                                * audiologist;
                                                * chiropodist;
                                                * chiropractor;
                                                * diabetes educator;
                                                * dietician;
                                                * exercise physiologist;
                                                * mental health worker;
                                                * occupational therapist;
                                                * osteopath;
                                                * physiotherapist;
                                                * podiatrist psychologist; or
                                                * speech pathologist.
                                           (Private Health Insurance (Health Insurance Business) Rules 2018)

Coordination                               Coordination ensures that the services are provided to the patient as planned. The plan should be reviewed and adjusted if necessary. Coordination may be undertaken by a health care provider, such as a practice nurse or other allied health professional and overseen by a medical practitioner. The medical practitioner would be involved in the review process.

                                           Services provided as part of a CDMP must be coordinated as described in the Private Health Insurance (Health Insurance Business) Rules 2018.

Planning                                   Planning commences with an assessment of the services needed to address the patient's condition and the agreed goals for the program. A plan is then made of the services or goods required and the frequency and duration of the services. Typically, a medical practitioner would undertake the assessment and formulate the plan.