Application Package - Medicare Urgent Care Clinics

The purpose of this Application Package is to facilitate an assessment of your general practice’s capability, capacity and readiness to operate a Medicare Urgent Care Clinic (Medicare UCC). 

Closing Date:  

Closing date for applications is Tuesday, 9 May 2023 at 5pm.

Process:  

This is a two-stage process. 

Stage 1 – Medicare UCC Registration of Interest 

On 24 February 2023, General Practices and Aboriginal Community Controlled Health Services (ACCHSs) were invited to submit a Registration of Interest (ROI) to register their interest in the recently announced Medicare UCCs.  

General Practices that believed they met minimum requirements set out in the Operational Guidance for Medicare UCCs were encouraged to submit an ROI by 1.00pm Friday, 24 March 2023. 

Stage 2 – Medicare UCC Application 

Application Packages will be sent to practices and ACCHSs that submitted an ROI on Tuesday, 11 April 2023.  

Brisbane North PHN via ucc@brisbanenorthphn.org.au  

Overview

Background

Over the past decade, emergency department (ED) presentations across Australia have continued to increase. This, coupled with the impact of COVID-19 on the health care workforce, and reduced access to primary and specialty care, has resulted in significant challenges for the Queensland (Qld) health system. To improve access to urgent care options for the community and ease pressure on EDs from primary care type presentations, the Australian Government has committed to delivering 50 Medicare UCCs, 9 of those will be in Qld.

A Medicare UCC provides clinically appropriate community-based and patient-centred care to eligible patients with urgent non-life-threatening illnesses and injuries who may have otherwise attended a Qld ED to seek treatment.

Medicare UCCs uniquely distinguish their services from usual care general practices as they provide short term, episodic care for non-life-threatening urgent conditions requiring same day assessment or treatment. Once a patient has been treated at a Medicare UCC, they will be discharged, and ongoing management and clinical care will be handed over to the patient’s usual GP or GP Practice (or other appropriate service).

Medicare UCCs are required to have extended hours of operation, walk-in treatment availability, and adhere to the minimum standards as referenced in the Australian Government Department of Health and Aged Care (DOHAC) Operational Guidance for Urgent Care Clinics (the Guidance).

The Guidance details the minimum standard for the activity, infrastructure and staffing of Medicare UCCs. If your practice is unable to meet these minimum standards, you should not progress to complete a Medicare UCC application.

Funding

The Commonwealth has committed to the establishment of Medicare UCCs. Further information on indicative funding will be made available at the PHN market briefing on Friday 21 April 2023 (NB: before attending the PHN market briefing, your practice will be required to sign a non-disclosure agreement).

All eligible patients attending Medicare UCCs are to be bulk-billed under the Medicare Benefits Schedule (MBS). All services provided at a Medicare UCC will be free to the patient with no out-of-pocket expense, includes all required radiology and pathology testing as part of urgent care.

Providers operating a Medicare UCC will receive:

• A one-off upfront payment to support establishment costs at clinics. This may include minor fit out, medical and other equipment, beds, trolleys, hoists, wheelchairs, office chairs, drug fridges, IV pumps and monitoring systems.

• An annual grant is for operational costs including labour (to cover basic staffing e.g. general practitioners, nurses and administrative support staff sufficient to meet expected demand on the clinic) and non-labour costs (such as consumables, pharmaceuticals).

• Access to the Medicare Benefits Schedule (MBS) for claiming relevant items in the Medicare UCC.

Medicare UCC operators will be eligible for an exemption from subsection 19(2) of the Health Insurance Act 1973, which prohibits the payment of Medicare benefits where other government funding is provided for that service. The subsection 19(2) exemption will enable the Medicare UCC provider to receive Commonwealth Government grant funding in addition to MBS payments, provided the clinic meets the eligibility criteria outlined in the Guidance (Attachment A).

Medicare UCC providers will be required to apply to Services Australia for a secondary provider number and use their secondary provider number when billing MBS for Medicare UCC services. This is required to ensure the exemption to subsection 19(2) of the Act is applied only to urgent care services. There will be a mechanism in place to support clinicians who do apply for the provider number as normal through Services Australia. Full details will be confirmed with the Medicare UCCs at the appropriate time.

Attachments

A: Operational Guidance for Urgent Care Clinics

B: Design Principles 

Statement of Requirements

Essential Requirements

Medicare UCC operators will be expected to engage collaboratively with the Commonwealth, the local Hospital and Health Service (HHS), and the PHN throughout the Medicare UCC program including during establishment, operation and evaluation of Medicare UCC services.

Eligibility criteria for a subsection 19(2) exemption

To meet the Commonwealth definition of a Medicare UCC for the purposes of the subsection 19(2) Direction, the clinic must:

• Adhere to the Operational Guidance for Urgent Care Clinics (attached as Attachment A)

• Adhere to the Design Principles (attached as Attachment B)

• Adhere to data reporting requirements as per the minimum data set 

• Agree to provide all Medicare UCC services at no charge to patients.

• Have an escalation pathway agreed in writing with the nearest public emergency department and ambulance providers, where locally appropriate. PHNs can assist with developing these with the successful provider.

Design Principles 

The Commonwealth has worked with jurisdictions to develop a set of common design principles to provide clear and consistent requirements for Medicare UCCs throughout Australia. All Medicare UCCs will be required to adhere to the Design Principles which are intentionally broad enough to allow for flexibility, noting each Medicare UCC will operate differently to respond to the needs of their local communities. Further information is provided in the attached Design Principles (Attachment B).

Operational Guidance

The Commonwealth, jurisdictions and PHNs have developed an Operational Guidance for Urgent Care Clinics (the Guidance), which will apply to all Medicare UCCs across Australia. The Guidance specifies the minimum standard for activity, infrastructure and staffing of a Medicare UCC, while acknowledging that the specific operating model of clinics will vary across locations and is dependent on local conditions including workforce availability.

Full details are provided in the attached Operational Guidance for Urgent Care Clinics (Attachment A).

Data collection and sharing arrangements

Data collection from Medicare UCCs is essential to monitor implementation, report on impacts to stakeholders and the public, and to inform the evaluation of the Medicare UCC program. Each Medicare UCC will be required to enter into a data sharing agreement with the Commonwealth and the PHN ahead of opening and agree to participate in the Medicare UCC program evaluation. These arrangements will not interfere with any existing data sharing arrangements in place at the practice.

De-identified data will be collected on a specified basis from patient management systems. Data elements to be collected will include a subset of existing patient fields (e.g., age, gender) and several new fields specific to the Medicare UCC program. If you require further information in relation to data collection, please contact the PHN (ucc@brisbanenorthphn.org.au.)

Medicare UCCs will be required to seek patient consent for the collection and use of data for each patient episode. Insights from data collected will be regularly provided back to Medicare UCCs and to the PHN to guide continuous improvement of the program and better target necessary support for clinics and their staff.

Procurement process

Evaluation

Evaluation of applications received during the EOI process will be based on the following criteria:

Before completing this Application, please review the Operational Guidance for Urgent Care Clinics and the Design Principles attached with this Package.