Time-Tiered Health Assessment - Comprehensive Medical Assessment for care recipient in a residential aged care facility

Publication date: 1 July 2024

SUMMARY

Time-tiered health assessment items may be used to undertake a Comprehensive Medical Assessment for a care recipient of a residential aged care facility (RACF).

Note: The requirements below must be met in addition to common principles for time-tiered health assessment items, contained in AN.0.36.

USE OF THE ITEMS

The specific requirements of the Comprehensive Medical Assessment for care recipients in a RACF are set out in clause 2.15.7 of the Health Insurance (General Medical Service Table) Regulations 2021 (the Regulations).

The regulations require that a Comprehensive Medical Assessment for care a recipient in a RACF must include an assessment of the resident's health, physical and psychological function.

It must also include:

• a personal attendance by a general practitioner or prescribed medical practitioner
• taking a detailed patient history of the resident
• conducting a comprehensive medical examination of the resident
• developing a list of diagnoses and medical problems based on the medical history and examination, and
• making a written summary of the Comprehensive Medical Assessment.

ELIGIBLE PATIENTS

Patients eligible for a Comprehensive Medical Assessment are care recipients in a residential aged care facility. The Regulations define a care recipient as a person to whom residential care (as defined in section 41-3 of the Aged Care Act 2024) is provided.

A Comprehensive Medical Assessment may be provided on admission to a residential aged care facility, if a Comprehensive Medical Assessment has not already been provided to the patient in another residential aged care facility in the last 12 months.

A Comprehensive Medical Assessment may be claimed by eligible patients:

• on admission to a residential aged care facility, if a Comprehensive Medical Assessment has not already been provided in another residential aged care facility in the last 12 months, and
• at 12 month intervals after that assessment.

ELIGIBLE PRACTITIONERS

A Comprehensive Medical Assessment can be undertaken by a general practitioner (see GN.4.13) or a prescribed medical practitioner (see AN.7.1).

CO-CLAIMING RESTRICTIONS

A Comprehensive Medical Assessment may be performed in conjunction with a consultation for another purpose, but must be claimed separately.

To co-claim a Comprehensive Medical Assessment item and another item, both items must be clinically necessary and distinct services.

RECORD KEEPING AND REPORTING REQUIREMENTS

The Regulations state that a Comprehensive Medical Assessment must include:

• making a written summary of the Comprehensive Medical Assessment
• giving a copy of the summary to the residential aged care facility, and
• offering the resident a copy of the summary.

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document it created, the document must be retained for the period of 2 years. 

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au. Health assessment items are set out in the following regulatory instrument:

• Health Insurance (General Medical Services Table) Regulations 2021.