The Australian Government is making some changes to the Medicare Chronic Disease Management Program to streamline items codes and referral arrangements. New requirements apply for referrals to allied health providers.

Occupational therapists who treat patients for chronic conditions under Medicare should familiarise themselves with the changes to ensure that they can continue to provide valid services under the new arrangements.

What is changing?

From 1 July 2025, GP Management Plans (GPMPs) and Team Care Arrangements (TCAs) will be replaced with a single GP Chronic Condition Management Plan (GPCCMP).

Requirements for the GP or prescribed medical practitioner to collaborate with other members of the team when preparing or reviewing a patient’s plan have been removed. Patients will be referred directly to services. Allied health providers do not need to confirm their agreement to participate in the patient’s multidisciplinary team.

The nature of the individual and group allied health services that can be provided are not changing as part of these reforms. However, there are changes to the item descriptors for these items because of the removal of GPMPs and TCAs, and commencement of GPCCMPs

Patients with a GPCCMP will be able to access individual allied health services, and for patients with type 2 diabetes only, group allied health services.

Referrals for allied health services written on or after 1 July 2025 must meet new minimum referral requirements (see below).

All other MBS requirements of the existing allied health services are unchanged, including requirements to provide written reports to the referring medical practitioner.

New minimum requirements for allied health referrals

Referrals for allied health services written on or after 1 July 2025 must meet the new minimum referral requirements:

• includes the name of the referring practitioner
• includes the address of the practice, or the practitioner’s provider number at that practice, of the referring practitioner
• includes the date on which the referring practitioner made the referral
• the validity of the referral (if relevant)
• NB for referrals to individual or group allied health services (Group M3 Subgroup 1, Group M9 and Group M11) referrals will be valid for 18 months from the date of the first service provided under the referral, unless otherwise specified by the referring practitioner
• be in writing
• be signed by the referring practitioner (which may be by electronic signature)
• be dated
• explain the reasons for referring the patient, including any information about the patient’s condition that the referring practitioner considered necessary to give the allied health professional.

Referrals do not need to:

• Specify the name of the allied health provider to provide the services. For example, a patient can take a referral to physiotherapy services under their GP chronic condition management plan to a physiotherapist of their choice. Note that acceptance of a referral is at the discretion of the individual practitioner, subject to anti-discrimination legislation.
• Specify the number of services to be provided. However, nothing prevents the referring medical practitioner from specifying the number of services to be provided under the referral, if they choose to do so.

Referrals can be signed and transmitted electronically. Where the intended allied health provider is known, referring practitioners are encouraged to send referrals electronically where possible to minimise the risk of lost referrals.

Unless otherwise specified by the referring medical practitioner, referrals to allied health services for patients with a chronic condition will be valid for 18 months.

To remain eligible for allied health services, patients (other than those covered by the transition arrangements) will have to have had their GPCCMP prepared or reviewed in the previous 18 months.

What about existing patients?

Patients with a GPMP and/or TCA in place prior to 1 July 2025 can continue to access these services under those plans until 30 June 2027 (read more about transition arrangements).

Referrals written prior to 1 July 2025 remain valid until all services under the referral have been provided.

What do I need to do to prepare?

• Read the Medicare CDM Allied Health fact sheet.
• From 1 July, be aware that you may begin to receive referrals to treat patients under a GP Chronic Condition Management Plan (GPCCMP).
• Ensure that any new referrals received on or after 1 July 2025 meet the new minimum referral requirements (as outlined above and in this fact sheet.
• Continue to provide services to existing patients (referred prior to or on 30 June 2025) under old referral arrangements until all services under the original referral have been provided, or up until 30 June 2027.
• Continue to provide written reports at the frequency requested by the referring GP.