Coordinated Veterans’ Care Program Fees

LMOs and GPs only

Fees effective 1 November 2011

Fees for the provision of Coordinated Veterans’ Care Program (CVC Program) items (LMOs and GPs only).

The CVC Program pays LMOs/GPs to enrol eligible Gold Card holders in the Program and to provide quarterly periods of care to enrolled participants. The LMO/GP is responsible for the overall leadership of care which must be coordinated by  a Practice Nurse, an Aboriginal Health Worker employed by the practice or a Community Nurse provided by a DVA contracted community nursing provider. Where none of those are available, the LMO/GP may perform the coordination role.

Payments to an LMO/GP with a Practice Nurse or Aboriginal Health Worker coordinator are higher. Where a Community Nurse is the care coordinator, the DVA contracted community nursing provider is paid according to the DVA Community Nursing Coordinated Veterans’ Care Program Schedule.

The CVC Program items are DVA only items and do not appear in the MBS Schedule. Payments are 100% of the listed fee.

UP01

Initial Payment – LMO/GP with Practice Nurse Coordinator $408.00

Item Description Business Rules
The payment is to an LMO/GP, with a Practice Nurse coordinator, for enrolling a person in the CVC Program and having done all things necessary for the enrolment as described in the Guide for General Practice or Notes for CVC Program Providersand summarised as follows:

  • The LMO/GP has made any required changes to the Practice   before enrolling the participant in the Program.
  • The participant has been  assessed by the LMO/GP as meeting the eligibility criteria for participation in the Program.
  • The LMO/GP has explained the Program and the person has provided informed consent to being enrolled in the Program and to the sharing of health and medical information.
  • A care coordinator employed by the general practice has been appointed: either a Practice Nurse or an Aboriginal Health Worker.
  • A comprehensive needs assessment of the participant has been carried out by the care coordinator or the LMO/GP.
  • A care plan (GP Management Plan – GPMP) has been prepared and agreed with the participant and a patient friendly copy provided to the participant and any carer/ family as agreed.
  • This item will be claimed on enrolment of a participant in the CVC Program
  • Only one claim of either UP01 or UP02 will be paid per participant regardless of a change in LMO/GP or in Practice Nurse arrangements.
  • Where a person ceases to be a participant and later re-enters the Program, the initial incentive payment (UP01 or UP02)will not be payable.
  • The date of service is the date of enrolment in the Program which is the date that all  steps necessary for enrolment in the Program have been completed.

UP02

Initial Payment – LMO/GP  without a Practice Nurse Coordinator $255.00

Note: Prompt claiming of UP02 is very important, as the Community Nurse CVC claims (UP05 or UP06) will reject if a GP Initial Incentive payment has not been made

Item Description Business Rules
The payment is to an LMO/GP, without a Practice Nurse coordinator,  for enrolling a person in the CVC Program and having done all steps necessary for the enrolment as described in the Guide for General Practice or Notes for CVC Program Providersand summarised as follows:

  • The LMO/GP has made any required changes to the Practice   before enrolling the participant in the Program.
  • The participant has been  assessed by the LMO/GP as meeting the eligibility criteria for participation in the Program.
  • The LMO/GP has explained the Program and the person has provided informed consent to being enrolled in the Program and to the sharing of health and medical information.
  • A care coordinator has been arranged through referral to a DVA contracted community nursing provider or, the LMO/GP has determined that the care coordination role will be performed by the LMO/GP
  • A comprehensive needs assessment of the participant has been carried out by the LMO/GP.
  • A care plan (GP Management Plan – GPMP) has been prepared and agreed with the participant and a patient friendly copy provided to the participant and any carer/ family as agreed.
  • This item will be claimed on enrolment of a participant in the CVC Program.
  • Only one claim of either UP01 or UP02 will be paid per participant regardless of a change in LMO/GP or in Practice Nurse.
  • Where a person ceases to be a participant and later re-enters the Program, the initial incentive payment(Up01 or UP02) will not be applicable.
  • The date of service is the date of enrolment in the Program which is the date that all steps necessary for enrolment in the Program have been completed.

UP03

Quarterly Payment –LMO/GP with Practice Nurse Coordinator $425.85

Item Description Business Rules
This item enables an LMO/ GP with a Practice Nurse coordinator (including an Aboriginal Health Worker) to claim a fee for the ongoing  leadership and coordination of the clinical care of a participant in the CVC Program in quarterly periods of care. This item covers a period of care as opposed to  items that are for individual fee for service visits.  The payment is for having done all things necessary for the quarterly period of care as described in the Guide for General Practice or Notes for CVC Program Providersand summarised as follows:

  • The LMO/GP has ensured that the General Practice Nurse has coordinated treatment services under the care plan including:
     
    • Assist with making appointments with other health professionals.
    • Remind the participant of appointments and any documents they must take or restrictions beforehand e.g. fasting.
    • Monitor the participant’s condition and address any concerns.
    • Coach and assist in self management.
    • Provide regular feedback to the LMO/GP.
       
  • Where the participant lives within a reasonable time and distance from the practice, the LMO/GP has ensured that at least one home visit was undertaken by the Practice Nurse within the first month of the participant being enrolled in the Program and one home visit per year was undertaken.
  • The LMO/GP has ensured that the nurse coordinator has liaised with other care providers  and provided regular feedback to the LMO/GP, who has oversighted the overall provision of care to the participant during the quarterly period.
  • The LMO/GP has ensured that the care plan has been regularly reviewed, updated and renewed where necessary. 
  • Only one of either UP 03 or UP04 can be claimed in any quarterly period and only 4 of these items in any 12 month period.
  • The previous quarterly period of care must have expired before the commencement of the new quarterly period.
  • A claim will be rejected for a care period commencing after a participant’s date of death.
  • The date of service is the first day of the quarterly period of care.
  • The claim cannot be made until the quarterly period of care has expired.


UP04

Quarterly Payment –LMO/GP without Practice Nurse Coordinator $191.25

Item Description Business Rules
This item enables an LMO/ GP without a Practice Nurse coordinator (i.e. a Community Nurse from a DVA contracted community nursing provider or the LMO/GP is performing the care coordinator role) to claim a fee for the ongoing  leadership and coordination of the clinical care of a participant in the CVC Program in quarterly periods of care. This item covers a period of care as opposed to  items that are for individual fee for service visits.  The payment is for having done all things necessary for the quarterly period of care as described in the Guide for General Practice or Notes for CVC Program Providersand summarised as follows:

  • The LMO/GP has ensured that a Community Nurse or the LMO/GP has coordinated treatment services under the care plan.
  • Where the LMO/GP has coordinated and the participant lives within a reasonable time and distance from the practice, at least one home visit was undertaken within the first month of the participant being enrolled in the Program and one home visit per year has been undertaken.
  • The LMO/GP has obtained regular feedback from the community nurse coordinator and has supervised the overall provision of care to the participant for the quarterly period of care.
  • The LMO/GP has ensured that the care plan has been regularly reviewed, updated and renewed where necessary.  
  • Only one of either UP 03 or UP04 can be claimed in any quarterly period and only 4 of these items in any 12 month period.
  • The previous quarterly period of care must have expired before the commencement of the new quarterly period.
  • A claim will be rejected for a care period commencing after a participant’s date of death.
  • The date of service is the first day of the quarterly period of care.
  • The claim cannot be made until the quarterly period of care has expired.