Primary healthcare news, information & resources


Changes to ACC consultation rate subsidies


  • (Rural contract holders - please scroll down for more information)

Further to the recent announcements of the extension of community services cards (CSC) cardholder subsidies, ACC has proposed to increase the consultation rate subsidies to all practices for the following population groups:

  • CSC holders
  • dependents of CSC holders (14-17 years)
  • under 14's.

These changes are designed to bring the funding associated with an ACC related consultation in line with medical consultations for CSC holders. Please see the tables below for more detail.

The expectation is the increased ACC consultation subsidy results in lower patient co-payments, however due to regulatory restrictions, they are unable to prescribe a price.

As with all ACC consultations, practices are able to stipulate a maximum allowable co-payment, however with the increased funding, Pinnacle supports reducing the co-payments for these priority groups to improve access.

The current increases are still at a proposal stage with final government sign-off due in November. We will keep you up to date as more information is released.

New rates for 1 December 2018

The rates in the tables below apply to both VLCA and non-VLCA practices.

Contribution rates for general practice visits for CSC holders (excl. GST)

Service

Current contribution for claimants 13 and over

Additional contribution for CSC holders

New contribution rate for CSC holders (including the proposed 1.56% increase)

GP consultation

$31.53

$21.80

$53.33

GP and nurse

$34.48

$21.84

$56.32

Nurse practitioner

$27.04

$22.02

$49.06

Nurse consultation

$14.77

$12.84

$27.61


Contribution rates for general practice visits for dependants of CSC holders (excl. GST)

Service

Current contribution for claimants 13 and over

Additional contribution for dependents of CSC holders (aged 14-17 years)

New contribution rate for dependents of CSC holders (including the proposed 1.56% increase)

GP consultation

$31.53

$27.01

$58.54

GP and nurse

$34.48

$27.06

$61.54

Nurse practitioner

$27.04

$26.82

$53.86

Nurse consultation

$14.77

$18.06

$32.83


Proposed GP visit contribution rates for under 14's (excl. GST)

Service

Current contribution for claimants under 13 years old

Current contribution for claimants 13 years old and over

Additional funding for claimants 13 years old

New contribution rate for all claimants under 14 years old (with 1.56% increase)

GP consultation

$56.07

$31.53

$25.41

$56.94

GP and nurse

$59.01

$34.48

$25.45

$59.93

Nurse practitioner

$51.57

$27.04

$25.33

$52.37

Nurse consultation

$19.88

$14.77

$17.16

$31.93


Changes to ACC consultation rates - rural general practice agreement update

We understand rural practices contracted by ACC have received a variation to their contract, effective 1 December 2018. 

This is to accommodate the new Community Services Card (CSC) rates and extending fee-free visits to under 14 year olds which will be implemented from 1 December 2018 (as per government initiatives in primary care).  

We've followed up with ACC on your behalf to clarify some points regarding this variation.

  • The ACC rural agreement has consult codes based on "levels" and does not differentiate based on provider (GP or nurse consult).
  • Based on recent claim information ACC believe 75 per cent of rural ACC work is completed by doctors with the remaining 25 per cent by nurses, and have taken this into account with the proposed adjustments to consult rates.
  • ACC has modelled the increased consultation rates based on an average of $42.50 for GP consults and $32.50 for nurse consults. Based on the 75/25 split (as above) this creates an average co-payment of $40. Please note, the average co-payment assumption has increased since the initial consultation phase with ACC.
 ServiceProposed subsidy
(ex GST)
 Fee free under 14s $24.96 per visit
 Community Services Card holders (to cap the co-payment at $18.50 including GST) (RPCS)
 $19.13 per visit
 Dependents of Community Services Card holders (to cap the co-payment at $12.50 including GST) (RPCD)
 $24.35 per visit

If your practice charges less than $42.50 and $32.50 for an ACC consult with a doctor and nurse respectively, then there is effectively an increase in funding for each ACC consult where the patient is either a CSC holder or a dependent of a CSC card holder.


New claim codes

  • ACC is providing two new codes which are claimable on top of the traditional rural consult codes to off-set the reduction in co-payments - RPCS and RPCD. These are claimed in a similar manner to the current RP07 code for free under 13s.
  • Please note, RP07 is being replaced with RP08 to take into account the expansion of the U13 programme to U14s.

For more information

If you have any further questions regarding this please contact your practice support.

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