nursing home visits mbs

Connection denied by Geolocation Setting.

Reason: Blocked country: Russia

The connection was denied because this country is blocked in the Geolocation settings.

Please contact your administrator for assistance.

An official website of the United States government

Here’s how you know

The .gov means it’s official.

Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure.

The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Press Releases CMS Announces New Guidance for Safe Visitation in Nursing Homes During COVID-19 Public Health Emergency

• Nursing facilities

Today, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance providing detailed recommendations on ways nursing homes can safely facilitate visitation during the coronavirus disease 2019 (COVID-19) pandemic. After several months of visitor restrictions designed to slow the spread of COVID-19, CMS recognizes that physical separation from family and other loved ones has taken a significant toll on nursing home residents. In light of this, and in combination with increasingly available data to guide policy development, CMS is issuing revised guidance to help nursing homes facilitate visitation in both indoor and outdoor settings and in compassionate care situations.  The guidance also outlines certain core principles and best practices to reduce the risk of COVID-19 transmission to adhere to during visitations.

“While we must remain steadfast in our fight to shield nursing home residents from this virus, it is becoming clear that prolonged isolation and separation from family is also taking a deadly toll on our aging loved ones,” said CMS Administrator Seema Verma. “With the Trump administration’s unprecedented efforts to bolster testing resources and deploy infection control support, we believe nursing homes should be able to resume visitations reuniting residents with their families within the recommendations outlined in our guidance.”

The vulnerable nature of the nursing home population, combined with the inherent risks of congregate living in a healthcare setting, have required aggressive efforts to limit COVID-19 exposure, including limiting visitation.  As a result, in March 2020 , CMS issued guidance instructing facilities to restrict visitation except for certain compassionate care situations.  In May 2020, CMS released Nursing Home Reopening Recommendations , which provided guidance on visitation as nursing homes progress through the phases of reopening.  In June 2020, CMS also released a Frequently Asked Questions document on visitation, which expanded on previously issued guidance on outdoor visits, compassion care situations, and communal activities.

In the revised guidance issued today, CMS is encouraging nursing homes to facilitate outdoor visitation because it can be conducted in a manner that reduces the risk of transmission.  Outdoor visits pose a lower risk of transmission due to increased space and airflow. The guidance released today also allows for indoor visitation if there has been no new onset of COVID-19 cases in the past 14 days and the facility is not conducting outbreak testing per CMS guidelines.  Indoor visitation is subject to other requirements as well as indicated in the guidance.

The guidance also clarifies additional examples of compassionate care situations.  While end-of-life situations have been used as one example, there are other examples including: 

• When a resident who was living with their family before recently being admitted to a nursing home is struggling with the change in environment and lack of physical family support.
• When a resident who is grieving after friend or family member recently passed away.
• When a resident needs help and encouragement with eating or drinking, previously provided by family, is experiencing weight loss or dehydration.
• When a resident who used to talk to others, is experiencing emotional distress, seldom speaking, and crying frequently (when he/she had rarely cried in the past).

For additional details on the revised nursing home visitation guidance released today, visit here: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-visitation-covid-19

The full list of CMS Public Health Actions for Nursing Homes on COVID-19 to date is in the chart below.

Get CMS news at cms.gov/newsroom , sign up for CMS news via email and follow CMS on @CMSgov

• Previous Newsroom article
• Next Newsroom article

CMS News and Media Group Catherine Howden, Director Media Inquiries Form 202-690-6145

The Department of Health and Aged Care

• Conditions and Diseases
• All other topics (new site)
• Health Workforce
• PBS Approved Suppliers
• News and media
• Medical and professional indemnity
• All other program and campaigns (new site)
• Ageing & Aged Care
• You are here:
• For Health Professionals /
• Primary care (GP, nursing, allied health) /

Medicare Benefits Schedule (MBS) Comprehensive medical assessment for residents of residential aged care facilities

Page last updated: 17 April 2014

Components of a comprehensive medical assessment

Restrictions on providing a comprehensive medical assessment, other requirements, guidelines and resources, in this section.

• Disability — Better Start for Children with Disability initiative
• Pregnancy support counselling
• Primary care (GP, nursing, allied health)

Department of Health and Aged Care

© Commonwealth of Australia ABN: 83 605 426 759

health.gov.au sections

• For Consumers
• For Health Professionals
• Programs & Campaigns

Quick Links

• Consultations
• Grants and tenders
• Annual Reports
• Reporting Suspected Fraud
• Acronyms & Glossary
• Subscription
• X Feedback Complaints Enquiry
• Accessibility
• Senate Order Listings
• Google Plus

• Skip to main content
• Keyboard shortcuts for audio player

• Your Health
• Treatments & Tests
• Health Inc.
• Public Health

Most nursing homes don't have enough staff to meet the federal government's new rules

The Biden administration is establishing new standards for how much time each day a nursing home resident gets direct care from a nurse or an aide. picture alliance/Getty Images hide caption

The Biden administration is establishing new standards for how much time each day a nursing home resident gets direct care from a nurse or an aide.

The Biden administration finalized nursing home staffing rules Monday that will require thousands of them to hire more nurses and aides — while giving them years to do so.

The new rules from the Centers for Medicare & Medicaid Services are the most substantial changes to federal oversight of the nation's roughly 15,000 nursing homes in more than three decades. But they are less stringent than what patient advocates said was needed to provide high-quality care.

Spurred by disproportionate deaths from COVID-19 in long-term care facilities, the rules aim to address perennially sparse staffing that can be a root cause of missed diagnoses, severe bedsores, and frequent falls.

"For residents, this will mean more staff, which means fewer ER visits potentially, more independence," Vice President Kamala Harris said while meeting with nursing home workers in La Crosse, Wisconsin. "For families, it's going to mean peace of mind in terms of your loved one being taken care of."

When the regulations are fully enacted, 4 in 5 homes will need to augment their payrolls, CMS estimated. But the new standards are likely to require slight if any improvements for many of the 1.2 million residents in facilities that are already quite close to or meet the minimum levels.

'Established a floor'

"Historically, this is a big deal, and we're glad we have now established a floor," Blanca Castro, California's long-term care ombudsman, said in an interview. "From here we can go upward, recognizing there will be a lot of complaints about where we are going to get more people to fill these positions."

The rules primarily address staffing levels for three types of nursing home workers. Registered nurses, or RNs, are the most skilled and responsible for guiding overall care and setting treatment plans. Licensed practical nurses, sometimes called licensed vocational nurses, work under the direction of RNs and perform routine medical care such as taking vital signs. Certified nursing assistants are supposed to be the most plentiful and help residents with daily activities like going to the bathroom, getting dressed, and eating.

While the industry has increased wages by 27% since February 2020, homes say they are still struggling to compete against better-paying work for nurses at hospitals and at retail shops and restaurants for aides. On average, nursing home RNs earn $40 an hour, licensed practical nurses make $31 an hour, and nursing assistants are paid $19 an hour, according to the most recent data from the Bureau of Labor Statistics.

CMS estimated the rules will ultimately cost $6 billion annually, but the plan omits any more payments from Medicare or Medicaid, the public insurers that cover most residents' stays — meaning additional wages would have to come out of owners' pockets or existing facility budgets.

'Unfunded mandate'

The American Health Care Association, which represents the nursing home industry, called the regulation "an unreasonable standard" that "creates an impossible task for providers" amid a persistent worker shortage nationwide.

"This unfunded mandate doesn't magically solve the nursing crisis," the association's CEO, Mark Parkinson, said in a statement. Parkinson said the industry will keep pressing Congress to overturn the regulation.

Richard Mollot, executive director of the Long Term Care Community Coalition, a New York City-based advocacy nonprofit, said "it is hard to call this a win for nursing home residents and families" given that the minimum levels were below what studies have found to be ideal.

The plan was welcomed by labor unions that represent nurses — and whom President Joe Biden is counting on for support in his reelection campaign. Service Employees International Union President Mary Kay Henry called it a "long-overdue sea change." This political bond was underscored by the administration's decision to have Harris announce the rule with SEIU members in Wisconsin, a swing state.

Shots - Health News

Labor unions praise biden's plan to boost staffing at nursing homes.

The new rules supplant the vague federal mandate that has been in place since the 1980s requiring nursing homes to have "sufficient" staffing to meet residents' needs. In practice, inspectors rarely categorized inadequate staffing as a serious infraction resulting in possible penalties, federal records show.

Starting in two years, most homes must provide an average of at least 3.48 hours of daily care per resident. About 6 in 10 nursing homes are already operating at that level, a KFF analysis found .

CMS also mandated that within two years an RN must be on duty at all times in case of a patient crisis on weekends or overnight. Currently, CMS requires at least eight consecutive hours of RN presence each day and a licensed nurse of any level on duty around the clock. An inspector general report found that nearly a thousand nursing homes didn't meet those basic requirements.

The rules give homes breathing room before they must comply with more specific requirements. Within three years, most nursing homes will need to provide daily RN care of at least 0.55 hours per resident and 2.45 hours from aides.

Nursing homes in rural areas will have longer to staff up. Within three years, they must meet the overall staffing numbers and the round-the-clock RN requirement. CMS' rule said rural homes have five years to achieve the RN and nurse aide thresholds.

Rural nursing home operators say new staff rules would cause more closures

Under the new rules, the average nursing home, which has around 100 residents, would need to have at least two RNs working each day, and at least 10 or 11 nurse aides, the administration said. Homes could meet the overall requirements through two more workers, who could be RNs, vocational nurses, or aides.

Homes can get a hardship exemption from the minimums if they are in regions with low populations of nurses or aides and demonstrate good-faith efforts to recruit.

Democrats praised the rules, though some said the administration did not go nearly far enough. Rep. Lloyd Doggett (D-Texas), the ranking member of the House Ways and Means Health Subcommittee, said the changes were "modest improvements" but that "much more is needed to ensure sufficient care and resident safety." A Republican senator from Nebraska, Deb Fischer, said the rule would "devastate nursing homes across the country and worsen the staffing shortages we are already facing."

Advocates for nursing home residents have been pressing CMS for years to adopt a higher standard than what it ultimately settled on. A CMS-commissioned study in 2001 found that the quality of care improved with increases of staff up to a level of 4.1 hours per resident per day — nearly a fifth higher than what CMS will require. The consultants CMS hired in preparing its new rules did not incorporate the earlier findings in their evaluation of options.

Threats of closure, siphoned profits

CMS said the levels it endorsed were more financially feasible for homes, but that assertion didn't quiet the ongoing battle about how many people are willing to work in homes at current wages and how financially strained homes owners actually are.

"If states do not increase Medicaid payments to nursing homes, facilities are going to close," said John Bowblis, an economics professor and research fellow with the Scripps Gerontology Center at Miami University. "There aren't enough workers and there are shortages everywhere. When you have a 3% to 4% unemployment rate, where are you going to get people to work in nursing homes?"

Researchers, however, have been skeptical that all nursing homes are as broke as the industry claims or as their books show.

Nursing home owners drained cash while residents deteriorated, state filings suggest

A study published in March by the National Bureau of Economic Research estimated that 63% of profits were secretly siphoned to owners through inflated rents and other fees paid to other companies owned by the nursing homes' investors.

Charlene Harrington, a professor emeritus at the nursing school of the University of California-San Francisco, said: "In their unchecked quest for profits, the nursing home industry has created its own problems by not paying adequate wages and benefits and setting heavy nursing workloads that cause neglect and harm to residents and create an unsatisfactory and stressful work environment."

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF .

Update April 24, 2024

This article was updated with a statement issued by the Centers for Medicare & Medicaid Services to clarify when the minimum staffing thresholds for RNs and aides working at rural nursing homes will take effect. CMS said those minimum levels will begin in five years, in May 2029, not in four years as originally stated in the text of the regulation.

• health care worker shortage
• biden administration
• Centers for Medicare & Medicaid Services
• nursing homes

Medicare Benefits Schedule

• Create publication
• Fact Sheets
• MBS interpretation
• You are here:
• About the MBS /

Questions and Answers – New MBS urgent after-hours Items starting on 1 March 2018

Page last updated: 01 March 2018

In this section

• Exemption for flood affected patients
• MBS Online - Archive News
• MBS Online RSS
• Medicare Safety Net Arrangements
• News March 2021

Search the MBS

Problems with this form ?

• Previous Publications >>

© Commonwealth of Australia ABN: 83 605 426 759

• Accessibility

About the MBS

• Type 2 Diabetes
• Heart Disease
• Digestive Health
• Multiple Sclerosis
• COVID-19 Vaccines
• Occupational Therapy
• Healthy Aging
• Health Insurance
• Public Health
• Patient Rights
• Caregivers & Loved Ones
• End of Life Concerns
• Health News
• Thyroid Test Analyzer
• Doctor Discussion Guides
• Hemoglobin A1c Test Analyzer
• Lipid Test Analyzer
• Complete Blood Count (CBC) Analyzer
• What to Buy
• Editorial Process
• Meet Our Medical Expert Board

We independently evaluate all recommended products and services. If you click on links we provide, we may receive compensation. Learn more .

Best Visiting Nurse Services

AccentCare is the best visiting nurse service, with performance ratings above industry standards

One day you or a loved one might need a visiting nurse for medical care in your home. In the United States, it’s a relatively common experience. According to the Centers for Disease Control and Prevention (CDC), about 4.5 million Americans are treated in their homes every year by more than 12,000 home healthcare agencies. Many people prefer the ease of having medical care in their own home, rather than having to travel to a hospital or doctor's office.

When the time comes, you’ll need to do some research to find a visiting nurse service that fits your personal needs. With that in mind, we reviewed over 40 home healthcare companies to find the best visiting nurse services available.

Best Visiting Nurse Services of 2024

• Best Overall: AccentCare
• Best for Post-Operative Assistance: Elara Caring
• Best Technology: Enhabit Home Health & Hospice
• Best for Specialized Care: Interim HealthCare
• Best for Hospice (End-of-Life Care): ProMedica Hospice
• Our Top Picks

Elara Caring

• Enhabit Home Health & Hospice
• Interim HealthCare
• ProMedica Hospice
• See More (2)

Final Verdict

• How to Choose

Methodology

Best overall : accentcare.

• Services offered : Personal care, behavioral health, rehabilitation, medical assistance, hospice and palliative care, care management, health alert systems
• Number of locations : 260 locations across 31 states

We selected AccentCare as the best overall provider of skilled home health care based on its accessibility (there are over 260 locations) and performance ratings that are above industry standards.

Programs for chronic conditions

Specialized programs, including behavioral health and stroke

Tele-monitoring program for early intervention

Some locations have different names, which can be confusing

Website’s location search page is hard to find

All of AccentCare's agencies are accredited by Community Health Accreditation Partners (CHAP) and have earned an overall 4.6-star quality rating and recognition from the We Honor Veterans program. AccentCare treats over 140,000 patients a year. Along with skilled home health care and private duty nursing, it offers hospice care, personal care services, and care management.

AccentCare also uses technology to supplement visiting nurse home care visits with tele-monitoring that can deliver biometric data (blood pressure, pulse, blood glucose, etc.) in close to real-time to keep the medical support team informed and ready to take action if necessary. AccentCare is the fifth largest provider of skilled home health in the U.S.

Best for Post-Operative Assistance : Elara Caring

• Services offered : Home health care, hospice care, rehabilitation, recovery care, personal care, behavioral care
• Number of locations : 200+ locations across 16 states

Elara Caring focuses on recovery and rehabilitation, excelling in nursing, physical therapy (PT) , occupational therapy (OT), and speech therapy . 

Also offers hospice care and behavioral health services

Delivers proactive customized care (CAREtinuum)

Only available in 16 states

Elara Caring's CAREtinuum program, a system that uses predictive analytics to identify patients at risk, sets it apart from other companies for post-operative assistance. For example, Elara’s CAREtinuum Fall Risk Program patients are 72% less likely to return to the hospital due to falling.

Elara Caring offers a wide range of in-home clinical services, treating more than 65,000 patients a day. Along with skilled home health, Elara Caring offers hospice care, personal care, and behavioral care. Its behavioral care supports a wide range of conditions, including depressive/anxiety disorders, schizophrenia, bipolar, and other disorders.

Even though Elara only has locations in about one-third of the states in the U.S., it is the ninth largest provider of skilled home health in the country.

Best Technology : Enhabit Home Health & Hospice

• Services offered : Home health care, hospice care, post-operative care, transition program from hospital to home, long-term care
• Number of locations : 355 locations across 34 states

We chose Enhabit Home Health & Hospice for its easy-to-use technology that makes a customer’s online experience simple, with comprehensive information quickly available.

Locations in 34 states

Variety of programs to enhance skilled nursing, including skilled therapy, balance and fall prevention, and orthopedics

Not all locations offer hospice

Website offers Spanish translation, but only portions of the site are available in Spanish

The online software at Enhabit streamlines each step, from referral processing to scheduling to management of physician orders, in order to optimize patient care and attention. This connection between patients, doctors, and in-home care providers makes processes easier and more transparent.

In addition, Enhabit’s web portal provides one-stop access to manage diagnoses, patient history, medications, and plan of care. Enhabit is also able to deliver better care for patients through predictive analysis, to identify potential risks.

Best for Specialized Care : Interim HealthCare

Interim Healthcare

• Services offered : Home health care, senior care, in-home nursing services, respite care, transitional care; at-home physical therapy, occupational therapy, and speech therapy.
• Number of locations : 300+ locations across 41 states

We chose Interim HealthCare for its focus on home care for adults or children with special needs due to an injury or illness.

Promotes a more engaged existence at home for patients and their families

Offers caregivers more than 300 continuing education units

Available in nearly 50 states

Independently owned franchises mean inconsistencies in customer satisfaction

Interim HealthCare's services include care for adults and children who are developmentally delayed or need to use a feeding tube. Specialized offerings include home care for arthritis, multiple sclerosis , joint replacement, hypertension , paraplegia and quadriplegia, and traumatic brain injury (TBI).

Interim also offers many specialized interactive online training courses and live webinars for specific needs, such as dementia care. Interim HealthCare University provides extensive training resources available for free to employees, including over 300 lessons for both clinical and non-clinical staff and management in areas such as fall prevention, home care technology, and transitioning from a facility.

Interim’s HomeLife Enrichment program looks beyond basic needs to address the mind, spirit, and family as well as the body. The focus is to add purpose, dignity, and self-worth to basic safety and independence.

Interim HealthCare has a network of more than 300 independently owned franchises (employing nurses, aides, therapists, and other healthcare personnel) serving about 173,000 people every year.

Best for Hospice (End-of-Life Care) : ProMedica Hospice

• Services offered : Home hospice care, pain management, spiritual support, comforting treatments, bereavement services
• Number of locations : In 26 states

ProMedica Hospice provides the comfort and quality of life that hospice is known for, with fast and effective responses to patient discomforts such as pain, shortness of breath, and anxiety.

Advance directive not required for hospice care

Fully accredited

Provides employees with training, continuing education, and tuition assistance

Only available in 26 states across the U.S.

ProMedica Hospice has locations in 26 states, offering services such as pain and symptom management therapies. Heartland can provide hospice care in any “home”—including a private home, an assisted living facility, or a skilled nursing center.

While some hospices require a do not resuscitate (DNR) order before providing care, ProMedica (formerly Heartland Hospice Care) doesn’t. In situations where Medicare will be paying for the care, a DNR is not required because the care is considered palliative (providing comfort, instead of a cure or treatment).

ProMedica Hospice develops talent by offering its employees training and education opportunities at many of its locations. For example, its nursing assistant training programs include assistance with the cost of taking a state certification exam.

ProMedica Hospice also offers bereavement services, advanced planning services, and the possibility to grant funds to help offset financial burdens created by terminal illness.

While each visiting nurse service on this list has its strengths, AccentCare is our top pick due to its wide variety of specialized programs and high quality rating. The caretakers at AccentCare are skilled and experienced. Plus, home care visits are supplemented with an advanced tele-monitoring system.

Guide to Choosing a Visiting Nurse Service

When it comes to selecting the best visiting nurse services for you or a loved one, there are several factors you should look for to help inform your decision.

• Accreditation : Home healthcare agencies and companies must be licensed in order to operate in a state. As you research the best visiting nurse services, ensure that the agency you select is licensed in the state you live. Consult with the Centers for Medicare & Medicaid Services (CMS) or the Joint Commission, which offers accreditation to home health providers.
• Insurance : Check your available coverage and what potential out-of-pocket costs may be by asking any potential visiting nurse service if it accepts your insurance. Often, services take Medicare, Medicaid, private insurance, or Veterans Administration benefits.
• Services needed : Depending on your needs, you may require more specialized nursing care. For example, visiting nurse services can be tailored to the patient if they need after-surgery care, rehabilitation therapy, medication administration, or personal care and companionship.
• Visiting hours : Many visiting home nurses operate between the hours of 8 a.m. and 5 p.m. However, depending on the needs of the patient, in-home hours can often be adjusted. Ask a home healthcare provider if they also arrange for evening or overnight visits, should you need them.

Frequently Asked Questions

What are the duties of a visiting nurse.

A visiting nurse is a skilled medical professional, usually a registered nurse, who oversees all aspects of the medical care you receive at home, as ordered by a physician. This might include evaluating your medical condition and health needs, monitoring your vital signs and assessing risk factors, and administering medication. A visiting nurse is also trained to care for specific conditions such as COPD, diabetes, dementia, and Alzheimer’s. They can change dressings for surgical incisions or wounds and provide hospice care .

When your visiting nurse leaves, they make sure that you and your caregivers have the necessary information and supplies to support the plan of care.

Is a Visiting Nurse the Same as a Home Health Aide?

A visiting nurse is a skilled medical professional, while a home aide typically has limited formal medical training and provides services such as help with personal hygiene, meals, and transportation. A home health aide may stay in your home for several hours providing care, while a visiting nurse will stay for a shorter time to perform specific tasks.

Does Medicare Cover Visiting Nurse Services?

If you have Medicare, home health care, such as that provided by a visiting nurse, is covered 100% by Medicare when your doctor certifies that you meet the required guidelines. If you do not have Medicare, consult with your healthcare insurance to determine your policy parameters for coverage, including necessary copayments, if any.

Hospice (including a visiting nurse, if one is on your team) is covered by Medicare, Medicaid, the Veteran’s Health Administration, and private insurance. Although most hospice care is provided at home, it is also available at hospitals, assisted living facilities, nursing homes, and dedicated hospice facilities.

Always double-check coverage with your insurance provider and ask the visiting nurse service if it accepts your insurance plan.

For this ranking, we looked at more than 40 home health providers. The primary criteria were the number of locations and national footprint, so the ranking would be useful to a large number of people. In addition to reviewing companies' areas of expertise, we also looked at their website interface, navigation, and usability and how they are ranked in areas such as quality care and patient satisfaction by services such as the U.S. government’s Centers for Medicare and Medicaid Services (CMS) Home Health Star and Home Health Compare .

AE Pictures / Getty Images

Centers for Disease Control and Prevention, National Center for Health Statistics. Home health care .

LexisNexis Risk Solutions. LexisNexis Risk Solutions ranks top home health and hospice providers .

MBS COVID-19 vaccine suitability assessment service

New items from march 2021.

From March 2021, 16 new MBS items will be available to enable GPs and suitably qualified health professionals to assess patients for their suitability to receive a COVID-19 vaccine. The MBS COVID-19 vaccine suitability assessment service is free to Medicare eligible patients and the MBS items must be bulk billed for all patients.

Bulk billing incentives (double for dose one, single for dose two) are incorporated into the value of the items, meaning the new items cannot be co-claimed with bulk billing incentive items 10990, 10991 or 10992. An accredited general practice that has completed two vaccine suitability assessment services for the same patient in a clinically appropriate timeframe is also eligible for a $10 payment under the Practice Incentives Program (payable only once per patient).

Detailed information on the new items is available on MBS Online . This fact sheet includes scenarios which offer examples of how the MBS items can be billed, what to do when patients present with multiple clinical matters, and guidance on issues such as co-claiming.

In situations where a COVID-19 vaccine suitability assessment service is provided and the patient elects to be vaccinated, but the vaccination cannot be delivered due to unforeseen circumstances, the patient may return to the medical practice at a later date to receive their vaccination. A further vaccine suitability assessment service would also need to be provided, to ensure that the patient can still receive the vaccine safely. Circumstances that may lead to this kind of delay include unanticipated staff absences leading to reduced capacity to vaccinate all patients on the day of service. For the most up to date rebates for MBS COVID-19 vaccine items, please refer to the RACGP's MBS online tool .

On 14 June 2021, a new MBS vaccine flag fall item was introduced. GPs administering COVID-19 vaccines to people at home or in a disability or residential aged care facility will be paid an additional fee for each visit they make.  Item 90005  pays $57.25 per visit, regardless of how many patients are vaccinated. The flag fall item must be bulk billed and can be claimed in addition to existing MBS items to assess a patient’s suitability to receive a COVID-19 vaccine. Visit  MBS Online  for more information

On 18 June 2021, the Minister for Health announced a new Medicare item for GPs to counsel patients and build confidence in the COVID-19 vaccine ( item 10660 ). The item is equivalent to a Level B consultation with a rebate of $39.10, can be claimed once per patient and must be bulk billed.

The item can only be claimed where a GP attends to a patient in person for more than 10 minutes, and must be provided in conjunction with a relevant MBS COVID-19 vaccine suitability assessment item. It cannot be billed with other MBS items.

On 29 June 2021, the Minister announced the vaccine counselling item, which previously only applied to patients aged over 50, will be expanded to all patients irrespective of age.

A separate item for other medical practitioners working in a general practice setting is also available ( item 10661 ).

Visit  MBS Online  for more information.

In October 2021 the federal government announced that individuals who are severely immunocompromised should receive a third dose of the COVID-19 vaccine. Assessment of suitability for these third doses are eligible for MBS reimbursement with the same rules as suitability assessments for second doses. The same second dose MBS items are used, including when a medical practitioner performs a suitability assessment for a patient and determines they are not suitable for a third vaccine dose.

Flag fall and in-depth patient assessments may also be claimed if all other eligibility requirements are met (in-depth patient assessments can only be claimed once per patient). The additional Practice Incentives Program (PIP) payment for administering COVID-19 vaccines is not claimable for a third dose. It remains payable only when the first and second vaccine doses are administered at the same general practice.

On 28 October 2021, the federal government announced funding arrangements for the wider vaccine booster program, which will commence on 8 November 2021. MBS rebates for boosters will stay at the existing level for administering a second dose, with no PIP payment included.

Funding for paediatric vaccine administration is as per adult populations. Eligible practices are able to claim the $10 Practice Incentive Payment if the child receives both vaccines at the same practice.

Additional funding announced for administration of third and booster doses 

Following National Cabinet on Wednesday 22 December 2021, Prime Minister Scott Morrison announced that general practices will receive an additional $10 per COVID-19 booster dose administered.   

As per MBS online :

• Commencing  23 December 2021 , a new temporary Medicare Benefits Schedule (MBS) item has been made available to support medical practitioners providing vaccine suitability assessment services to patients who require booster vaccinations.
• MBS item 93666 provides an incentive payment of $10 per eligible vaccine suitability assessment service to patients receiving a COVID-19 third dose or booster vaccination.
• The incentive will be paid in conjunction with COVID-19 vaccine suitability assessment services provided to patients receiving a third dose or booster dose of a COVID-19 vaccine.
• The item will not be paid for patients receiving a second dose service.
• The MBS item is available until 30 June 2022.

Two new MBS items will be introduced which allow qualified health professionals to provide vaccine suitability assessment services outside of a medical practice without on-site supervision by a medical practitioner. Item 93660 is for Modified Monash Model (MMM) 1 areas and item 93661 is for MMM 2-7 areas. These new items are intended to target the provision of COVID-19 vaccines to vulnerable people who may have difficulty travelling to a medical practice. Like all MBS COVID-19 vaccine items, the items must be bulk billed.

The medical practitioner retains responsibility for the health, safety and clinical outcomes of the patient. They must be satisfied that the relevant health professional is appropriately qualified and trained to provide the service.

Advertising

• Election 2024
• Entertainment
• Newsletters
• Photography
• Personal Finance
• AP Investigations
• AP Buyline Personal Finance
• AP Buyline Shopping
• Press Releases
• Israel-Hamas War
• Russia-Ukraine War
• Global elections
• Asia Pacific
• Latin America
• Middle East
• Election Results
• Delegate Tracker
• AP & Elections
• Auto Racing
• 2024 Paris Olympic Games
• Movie reviews
• Book reviews
• Personal finance
• Financial Markets
• Business Highlights
• Financial wellness
• Artificial Intelligence
• Social Media

The pandemic exposed staff shortages at nursing homes. A new White House push aims for a remedy

FILE - Vice President Kamala Harris speaks at the International Union of Painters and Allied Trades District Council 7, Monday, Jan. 22, 2024, in Big Bend, Wis. Harris plans to return to Wisconsin next week for her third visit to the battleground state this year. President Joe Biden’s campaign announced Thursday, April 18, that Harris plans to campaign in La Crosse on Monday at an event focused on abortion rights (AP Photo/Morry Gash, File)

• Copy Link copied

WASHINGTON (AP) — Vice President Kamala Harris on Monday said the first rule to set minimum staffing levels at federally funded nursing homes and require that a certain portion of the taxpayer dollars they receive go toward wages for care workers is a long-overdue “milestone” that recognizes their value to society.

Harris announced the rules in Washington before she flew to LaCrosse, Wisconsin to meet with nursing home care employees. In the battleground state, the Democratic vice president also held a campaign event focused on abortion rights.

“It is about time that we start to recognize your value and pay you accordingly and give you the structure and support that you deserve,” Harris told a small group of care workers.

The federal government is for the first time requiring nursing homes to have minimum staffing levels after the COVID-19 pandemic exposed grim realities in poorly staffed facilities . The change will mean more staff at these facilities, fewer emergency room visits for residents and peace of mind for caregivers, who will be able to spend more time with their patients, Harris said.

The vice president said that Medicaid, the federal-state health insurance program for lower-income people, pays $125 billion annually to home health care companies, which were not required to report on how they were spending the money. A second rule being finalized Monday will require that 80% of that money be used to pay workers, instead of administrative or overhead costs, Harris said.

“This is about dignity, and it’s about dignity that we as a society owe to those in particular who care for the least of these,” she said.

President Joe Biden first announced his plan to set nursing home staffing levels in his 2022 State of the Union address. Current law only requires that nursing homes have “sufficient” staffing, leaving it up to states for interpretation.

AP AUDIO: Vice President Harris announces final rules mandating minimum standards for nursing home staffing.

AP correspondent Donna Warder reports on new rules for U.S. nursing homes.

The new rules implement a minimum number of hours that staff members spend with residents. They also require a registered nurse to be available around the clock at federally funded facilities, which are home to about 1.2 million people.

Allies of older adults have sought the regulation for decades, but the rules drew pushback from the nursing home industry.

Mark Parkinson, president of the American Health Care Association, which lobbies for care facilities, said Monday in a statement that the organization was disappointed and troubled that the federal government was moving forward with what he said was an “unfunded mandate.”

“It is unconscionable that the administration is finalizing this rule given our nation’s changing demographics and growing caregiver shortage,” Parkinson said. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers.”

Wisconsin Republicans echoed the staffing concerns, noting shortages particularly in rural parts of the state. In Elroy, Wisconsin, for instance, an 80-bed nursing home would be required to hire six additional nurses, but “we simply don’t have the bodies,” said Wisconsin state Rep. Tony Kurtz.

Noting the added costs and requirements, Republican U.S. Sen. Ron Johnson bluntly insisted to reporters on a conference call that the rule “might sound good. It won’t work.”

Health and Human Services Secretary Xavier Becerra said the change is about setting a standard for quality of care.

“We believe, that with more and more Americans going to nursing homes, it’s time to make sure that quality is the standard that everyone strives for,” Becerra said in an interview.

He said the administration listened to feedback from the nursing home industry and is allowing the rule to be phased in with longer timeframes for nursing homes in rural communities and temporary hardship exemptions in places where it’s hard to find staff.

The care event marked Harris’ third visit to the battleground state this year and is part of Biden’s push to earn the support of union workers in his bid for reelection. Republican presidential challenger Donald Trump made inroads with blue-collar workers in his 2016 victory. Biden regularly calls himself the “most pro-union” president in history and has received endorsements from leading labor groups such as the AFL-CIO, the American Federation of Teachers and the American Federation of State, County and Municipal Employees.

Lisa Gordon, a certified nursing assistant who told Harris, “I’ve been doing this job for 29 years,” said she was grateful that Biden and the vice president were “finally getting something done.”

“I entered this field because I care about taking care of our elderly,” Gordon said during a talk with other care providers, Chiquita Brooks-Lasure, administrator of the Centers for Medicare and Medicaid Services, and April Verrett, secretary-treasurer of the Service Employees International Union.

“Being short-staffed is not taking care of them like they should be,” Gordon said. “They didn’t ask to be there. Your residents are your family. They’re your loved ones. We need these changes.”

The coronavirus pandemic, which claimed more than 167,000 nursing home residents in the U.S., exposed the poor staffing levels at the facilities and led many workers to leave the industry. Advocates for the elderly and disabled reported residents who were neglected, going without meals and water or kept in soiled diapers for too long. Experts said staffing levels are the most important marker for quality of care.

The new rules call for staffing equivalent to 3.48 hours per resident per day, just over half an hour of it coming from registered nurses. The government said that means a facility with 100 residents would need two or three registered nurses and 10 or 11 nurse aides as well as two additional nurse staff per shift to meet the new standards.

The average U.S. nursing home already has overall caregiver staffing of about 3.6 hours per resident per day, including RN staffing just above the half-hour mark, but the government said a majority of the country’s roughly 15,000 nursing homes would have to add staff under the new regulation.

The new thresholds are still lower than those that had long been eyed by advocates after a landmark 2001 study funded by the Centers for Medicare and Medicaid Services recommended an average of 4.1 hours of nursing care per resident daily.

Associated Press writer Scott Bauer in Madison, Wisconsin, contributed to this report.

What you and your Connecticut Oxford small business clients can expect in 2024

New and enhanced offerings in our 2024 Connecticut Oxford small business portfolio

Today’s rising costs, supply issues and labor shortages can deliver crushing blows to the small employer’s already tight bottom line. For decades, we’ve offered small businesses in the region smart options for health care benefits coverage, designed for affordability, to help lessen the economic squeeze. We would like to take the opportunity to remind you about new and enhanced offerings in our 2024 Connecticut Oxford small business (1–50) portfolio, designed to help today’s small business owners focus on managing costs in an increasingly challenging economic environment.

Making health care simpler

For clients and their employees: 

• National network access with all plans
• Advantage Prescription Drug List included with all plans
• Broad pharmacy access (including CVS ® , Walgreens ® and many more)
• Nearly 20% of prior authorizations eliminated for most commercial, Medicare Advantage and Medicaid business
• Oxford Benefit Management (OBM) continues to offer small businesses a simplified, bundled dental and vision solution — with a basic life coverage option; simplified quoting and installation processes
• Consolidated invoicing for Oxford clients who are currently still receiving separate, monthly premium invoices for multiple medical products 

For producers:

• Benefitter – This small group, multi-carrier sales enablement platform was built by and for producers; it’s available at no cost to help you simplify the quoting and enrollment process
• Communication Center in SAMx now includes functionality for alerting you to missing information on Level Funded pending submissions
• Employee Navigator – The direct application programming interface (API) connection allows producers to pull client and plan details into the platform to help fully automate the benefit enrollment process 

Helping make health care more affordable

• $0 cost-share for preferred short and long-acting insulins, and preferred emergency use medications for in-the-moment critical care
• $0 cost-share for one adult routine vision exam per year on all fully insured plans
•  $0 cost-share for 24/7 Virtual Visits; no deductible with a health savings account (HSA) plan
• Oxford Level Funded plans – many of the same benefits as traditional self-funding with limited risk; fixed monthly payments, exclusion from many state coverage mandates; lower health plan costs; potential year-end surplus refund; Mineral TM offers support with HR and compliance issues 

Making health care more supportive

• 5-year average small group single-digit rate increase: 6.8%
• Fully insured rate increase overall for 2024: 4.1%
• Consistent level funded historical trend
• Broad network access and stable product portfolio
• Emphasis on behavioral health solutions 

Consumer offerings that may help encourage healthier living, and provide additional savings

• Care Cash ® – Now available with all non-HSA fully insured plans. This pre-loaded debit card (annually: $200 Ind./$500 Family) helps subscribers pay for health care expenses; new funds added annually; balance carries over
• One Pass Select TM – Included with fully insured plans, members have discounted access to thousands of gyms, with no long-term contracts or annual registration fees
• Real Appeal ® – A lifestyle and weight management program that offers encouraging messaging, a Success Kit, online classes, digital support/tracking, personal Health Coach
• Sweat Equity ® – Included with fully insured plans, members can earn up to $400 subscriber/$200 covered dependent in a plan year for meeting program’s cardio-based fitness requirements
• UnitedHealthcare Rewards – Members earn rewards for reaching daily fitness goals and one-time activities; $300 with fully insured plans and $1,000 with Oxford Level Funded plans 

Broad network access and choice

The Oxford networks continue to be the stable foundation for our innovative plan designs and a driving force for transforming the health care delivery system to be simpler, more affordable and supportive. Choose fully insured and level funded plans from the following networks

• 147,558 NY, NJ, CT providers
• 1,713,257 Choice Plus (national network) providers and 7,031 hospitals
• 67,000 pharmacies, including CVS ® , Duane Reade™, Walgreens ® , Walmart ®
• 145,200 NY, NJ, CT providers
• 1,436,907 Core (national network) providers and 5,500 hospitals
•  67,000 pharmacies, including CVS ® , Duane Reade™, Walgreens ® , Walmart ®

Reminder about producer and client incentives ending Jan. 1

• New sales bonus – $60 bonus for each enrolled employee in a new fully insured or level funded plan with up to 50 eligible employees
• Benefitter bonus – $250 bonus for each new, sold case on up to 5 cases; applies to new level funded medical cases with up to 50 eligible employees submitted through Benefitter with utilization of the electronic individual medical questionnaire feature
• Conversion bonus – $60 bonus for each employee converted from a fully insured medical plan to a level funded plan with 50 eligible employees

For clients:

• Level funded implementation credits – New and migration clients eligible for a $150 one-time implementation credit for each enrolled employee, up to $7,500; credit is applied to client’s billing statement(s) 

More information

We are committed to helping employers, providers and members navigate the health care benefits system. With one of the largest datasets in the industry and a quality health care ecosystem under one roof, we’re working to help drive more informed decisions, better health outcomes, lower costs and healthier communities.

Please check our Connecticut-specific site and producer website for more details and other important information to support your 2024 client sales and support efforts. Contact your Oxford sales representative or our Client Services team at 1-888-201-4216 or [email protected] with questions.

Thank you for your continued business. We wish you a happy and healthy holiday season.

More articles

Broker - local markets page template - more news experience fragment, current broker or employer group client.

Access uhceservices to check commissions, manage eligibility, request ID cards and more.

VP Harris to unveil nursing home rules in battleground state of Wisconsin

• Medium Text

Sign up here.

Reporting by Andrea Shalal; Editing by Michael Perry

Our Standards: The Thomson Reuters Trust Principles. New Tab , opens new tab

World Chevron

Musk's X says posts of Australia bishop stabbing don't promote violence

Elon Musk's social media platform X defended publishing posts showing a bishop in Australia being stabbed during a sermon as "part of public discussion", rejecting a regulator's order to take down the content on grounds it is offensive and violent.

VP Kamala Harris talks abortion in La Crosse, announces minimum nursing home staff levels

LA CROSSE — In a visit to a purple region of Wisconsin on Monday, Vice President Kamala Harris announced new rules for nursing home staffing and rallied voters around abortion as the race for the presidency remains extremely tight in the battleground state.

"This is a moment where we must stand up for foundational, fundamental values and principles," Harris told supporters during a campaign event at the La Crosse Center. "Here's the other piece that I will say: When we think about what is at stake, it is absolutely about freedom."

The trip to La Crosse reflects Democrats' efforts to make abortion a key factor in motivating turnout for President Joe Biden, including among voters in purple areas or even the traditionally red Milwaukee suburbs.

Women affected by abortion bans in other states campaigned for Biden in Waukesha County last week , and Harris brought a similar message to the area in January . Biden administration officials have also made frequent trips to Milwaukee and Madison this year, both Democratic strongholds.

Democrats have focused blame on former President Donald Trump, who has so far visited Wisconsin once this election cycle. Trump held a two percentage point lead over Biden in the most recent statewide poll by the Marquette University Law School, 51% to 49%, well within the poll's margin of error.

Trump in a video statement earlier this month said abortion restrictions should be left up to the states . Abortions are currently being provided in Wisconsin, but the state Supreme Court could soon weigh in .

"There is a clear line between where we are now and who is to blame," Harris said. "The former president was very clear with his intention — he would fill and appoint three members of the U.S. Supreme Court with the intention that they would overturn the protections of (Roe v. Wade)."

More: Wisconsin abortion laws: What to know after Arizona ruling

Harris announces new rules for staffing levels at nursing homes

Before speaking at the campaign event, Harris met with home health care workers at the Hmoob Cultural & Community Agency, where she announced two new federal rules.

One sets minimum staffing levels in nursing homes that receive federal funding through Medicare and Medicaid — about 3 1/2 hours of staffing per resident per day, a requirement that will be phased in. A registered nurse will also be required on site at all times.

Another rule provides that more Medicaid payments for home care services go toward workers' wages.

"The two announcements that we are making today recognize that we owe you, those workers, so much more than applauding you," Harris said, referencing praise for health care workers during the beginning of the COVID-19 pandemic. "Let's recognize the gift that these talented professionals give to families and to all of us as a society."

Ron Johnson says nursing home rules should be handled locally

In Madison, Republican U.S. Sen. Ron Johnson spoke to reporters about Harris' visit following a roundtable discussion hosted by the state's largest business lobby, Wisconsin Manufacturers & Commerce.

"Anybody who's following me realizes I'm not a real fan of the federal government," Johnson said when asked about the new federal rules for nursing homes.

"So I would much rather allow or have the state government and local governments in charge of the requirements of nursing care facilities, and — anything to do with the citizens of this state, I'd rather have state governments and local governments handle that than some dictate from the federal government that causes more problems or exacerbates more problems than it solves."

New Marquette poll shows abortion is top issue for Democratic voters

In the latest Marquette University Law School poll released last week , 24% of Democratic voters said they consider abortion their most important issue in deciding who to vote for, followed by the economy. For independent and Republican voters, 5% of those groups saw abortion as their top issue.

"People will say to me, 'Well, Sarah, aren't folks just over that whole abortion issue? Haven't they just moved on?" Secretary of State Sarah Godlewski said before Harris' speech. "I am just as mad today as when I heard about the Supreme Court overturning Roe, and I know that I'm not alone."

While abortion was the leading issue among Democratic participants, the economy was the No. 1 issue for all respondents in the survey, followed by immigration and abortion policy. Voters saw Biden better at handling abortion and health care, and Trump better on the economy and immigration.

A majority of registered voters in Wisconsin, 54%, also said they favor a national ban on abortion after 15 weeks of pregnancy with exceptions for rape, incest and the life and health of the mother.

Johnson, in comments to reporters at the Wisconsin Manufacturers & Commerce, again called for a statewide referendum that would put the question of when to ban abortion to voters.

Democrats campaigning on abortion outside of blue strongholds

While Democrats have also highlighted abortion access in suburban Milwaukee, the La Crosse area is much more purple and voted for Biden in 2020. In 2020 , La Crosse County voted 56% for Biden, compared to Trump's 42%.

While Biden officials have stopped in Milwaukee and Madison most frequently, they've also visited Superior on the Minnesota border , Green Bay and the Menominee Nation in northeastern Wisconsin.

More: Did the 2020 presidential election in Wisconsin really come down to a few votes per ward?

La Crosse is located in the 3rd Congressional District, one of two truly competitive U.S. House districts in Wisconsin. The seat is currently held by Republican Rep. Derrick Van Orden. Democrats are focusing more energy on the race compared to the last cycle.

Van Orden has raised much more money than his prospective Democratic challengers, small-business owner Rebecca Cooke and state Rep. Katrina Shankland from Stevens Point.

Neither were spotted at the campaign event, though Democratic U.S. Rep. Mark Pocan from Madison praised Shankland alongside other state legislators from the area in his remarks at the campaign event. Pocan has endorsed Shankland in the race.

Pocan called Van Orden a "chauvinist" and said western Wisconsin is "represented in Congress by someone who has been endorsed by the most extreme groups on abortion."

Jessie Opoien contributed to this report from Madison.

Trump to visit mid-Michigan next week

FREELAND, Mich. (WNEM) - Former president Donald Trump will be returning to mid-Michigan.

According to his website, he will be rallying in Freeland on Wednesday, May 1 at 6 p.m. It will take place at the Avflight Saginaw Hangar at MBS International Airport. The doors open at 2 p.m.

The last time Trump visited Michigan was on April 2 , when he made a stop in Grand Rapids to talk about the Biden administration’s handling of immigration issues.

To register for tickets, click here . According to Trump’s website, you will only be able to register up to two tickets per mobile number for the event, and all tickets are subject to first come first serve basis.

Subscribe to the  TV5 newsletter  and receive the latest local news and weather straight to your email every day.

Copyright 2024 WNEM. All rights reserved.

Three Swartz Creek High School students hospitalized following crash

FTC refunds over $5 million to Ring doorbell camera users

Deathbed confession leads to a solved 24-year-old cold case of a missing woman and 10-year-old girl

Parents speak of heartache after baby dies at day care

Flint Twp. apartments ‘total loss’ after early morning fires, chief says

Latest news.

Freeland apple farm gets creative to protect crop from potential freeze

Solidarity forum held on 10-year mark of Flint Water Crisis

Vikings take QB J.J. McCarthy from national champ Michigan after sliding up a spot in swap with Jets

Fans in Detroit stocking up on NFL merch for the draft

Medicare Benefits Schedule

• Create publication
• Fact Sheets
• MBS interpretation

Medicare Benefits Schedule - Item 37

Search Results for Item 37

Category 1 - PROFESSIONAL ATTENDANCES

37 - additional information.

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation-an attendance on one or more patients at one place on one occasion-each patient

The fee for item 36, plus $29.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 36 plus $2.30 per patient. Ready Reckoner

(See para AN.0.9 , AN.0.11 , AN.0.13 , AN.0.74 , MN.1.3 , MN.1.4 , MN.1.5 , MN.1.6 , MN.1.7 , MN.1.8 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500, whichever is the lesser amount

• Previous - Item 36
• Next - Item 44

Associated Notes

Using time-tiered professional (general) attendance items

Last reviewed: 1 November 2023

This note sets out the key common principles that apply when using the time-tiered professional attendance (also referred to as general attendance, time-tiered attendance, and Level A-E attendance) MBS items for general practitioners (GPs), medical practitioners (who are not GPs) and prescribed medical practitioners (i.e. medical practitioners who are not GPs, specialists or consultant physicians). These items are usually claimed in a general practice setting.

Unless otherwise stated these principles apply to all general attendance items, regardless of location (in consulting rooms, out of consulting rooms or residential aged care facilities), time (business or after-hours), or mode (face to face or telehealth). For some categories of attendances (e.g. telehealth) additional requirements may apply.

Note: that within the general practice context, prescribed medical practitioners and medical practitioners who are not GPs are sometimes referred to as Other Medical Practitioners (OMPs) or non-vocationally registered (non-VR) GPs. References to OMPs in this Explanatory Note include both prescribed medical practitioners and medical practitioners who are not GPs.

Information on the definition of a GP for Medicare purposes is available in GN.4.13 and prescribed medical practitioners in AN.7.1 .

Tables setting out the item numbers for the various time-tiers and locations, times of day and modes are available in Note AN.0.74 for GPs, and AN.7.2 for OMPs.

USE OF THE ITEMS

General attendance items are claimed for a professional attendance when no other MBS item applies. It is a general principle of the MBS that the item that best describes the service is the item that should be claimed. This means that where a more specific MBS items exists (for example a skin biopsy under MBS item 30071), the more specific item should be claimed. If no other MBS item accurately reflects the service provided, and the requirements of a general attendance item are met, the general attendance item is claimed.

General attendance items generally require that the medical practitioner attends the patient and does at least one of the following:

• taking a patient history
• performing a clinical examination
• arranging any necessary investigation
• implementing a management plan
• providing appropriate preventive health care.

Appropriate and contemporaneous records must be kept.

The time-tiers range from Level A short consultation for straightforward tasks to 60+ minute Level E consultations.

General attendance items are both professional and personal attendances.

What is a professional attendance? The Regulations state that a professional attendance includes the " provision, for a patient, of any of the following services:

• evaluating the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19(5) of the [Health Insurance] Act
• formulating a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions
• giving advice to the patient about the patient’s condition or conditions and, if applicable, about treatment
• if authorised by the patient—giving advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment
• providing appropriate preventive health care
• recording the clinical details of the service or services provided to the patient.”

Further information on professional attendances is at AN.0.3 .

What is a personal attendance? The Regulations specify that personal attendance items “apply to a service provided in the course of a personal attendance by a single medical practitioner on a single patient on a single occasion.” This means that:

• the patient must be present and only time spent with the patient counts towards the attendance
• another health practitioner (e.g. a practice nurse) cannot provide the service on behalf of a medical practitioner
• benefits are not payable if more than one medical practitioner provides an attendance on the same patient at the same time.

In the case of telehealth (video) and telephone attendances this requirement is modified to be “a service that is an attendance by a single health professional on a single person”.

A guide on substantiating a patient’s attendance is available on the Department of Health and Aged Care’s website .

Further information on personal attendances is at AN.0.1 .

How do I choose which general attendance item to use? The correct general attendance item will depend on:

• practitioner type – GP, medical practitioner (excluding GPs) or prescribed medical practitioner
• length of time spent with the patient (i.e. the personal attendance time)
• location of the consultation – in consulting rooms, out of consulting rooms or residential aged care facility
• time of the consulting – business or after-hours
• mode of the consultation – face to face, telephone or telehealth (video), and
• for prescribed medical practitioners only – the location (by Modified Monash area) of the practice.

Reference tables setting out the relevant general attendance items are available at AN.0.74 for GPs and AN.7.2 for OMPs.

Can I address more than one issue in a general attendance? Yes. All general attendance items can be claimed to address multiple issues with a patient.

When multiple issues are addressed in a single consultation, and more specific MBS items do not apply for any of these issues, medical practitioners should use the appropriate MBS general attendance item for the total time of the consultation. In these circumstances, medical practitioners should not claim each issue as a separate attendance.

What activities count towards the consultation time?

Only time spent with the patient (or on the telephone/video call with the patient in the case of telehealth) performing clinically relevant tasks can be included in the consultation time. Clinically relevant tasks include, but are not limited to:

• undertaking any of the activities described in the item descriptor
• communicating with the patient (and where relevant their carer)
• writing clinical notes, prescriptions or referrals, completing forms, reports or other paperwork relating to the patient while the patient is present
• reviewing, creating or updating entries in the patient’s My Health Record while the patient is present.

Time taken to write clinical notes, complete forms, reports or other paperwork, upload records in My Health Record (or other systems), or talk to carers or relatives when the patient is not present cannot be included in the consultation time.

If the patient has particular needs that mean good communication takes longer than average can this time be included? Yes, communicating effectively with patients is crucial to achieving clinical outcomes and a key part of a clinical service. A wide range of factors may affect the time needed to communicate effectively with a patient during a consultation. These include, but are not limited to, situations where a language barrier exists between the medical practitioner and patient (including when an interpreter is required), or when a patient has hearing problems, difficulty with speech, an intellectual disability, and/or dementia.

When claiming for time-tiered MBS items, the total consultation time includes the time required to communicate effectively with the patient. Where more time than usual is required to communicate effectively with a particular patient, it is considered reasonable to claim a longer attendance item than might otherwise be expected for the service. This applies to both face to face and telehealth services.

In such situations, medical practitioners and other providers should make a brief record in the patient’s notes including details about why the additional time was required. For example, stating ‘consultation extended due to use of interpreter’ and, if relevant, citing the Translating and Interpreting Service (TIS) job number.

Can I provide another medical service that is not a general attendance (e.g. a procedure or diagnostic test) and a general attendance to the same patient on the same day? In general, yes. However, there are some limitations including:

• both services must be clinically relevant and distinct services
• the other item must not have restrictions on same day claiming as a general attendance item, and
• the other item is not listed in MBS Group T6 (Anaesthetics) or T9 (Assistance at Operation).

Where more than one service is provided to a patient on the same day, the time taken for the second service (e.g. a procedure) must not be included in the consultation time for the general attendance.

Procedural items include all necessary components required to provide the service. This would include obtaining informed procedural and financial consent, the procedure itself, a discussion of the results of the procedure and (unless stated otherwise) the provision of routine aftercare.

Where the results of a procedure inform a further consultation on management, the consultation may be eligible for a Medicare benefit.

Can I provide more than one general attendance service to the same patient on the same day? Yes, provided that the subsequent attendance is not a continuation of the first attendance, both services are clinically relevant and distinct, and the item requirements are met for both attendances. Further information is available in AN.0.7 .

Are there specific requirements for any of the general attendance items? Yes, several general attendance items have additional, specific requirements:

• Telephone and telehealth (video) – patients can only access these services through their “usual medical practitioner” with limited exemptions. See AN.1.1 for further information. Some longer telephone items also require the patient to be registered with MyMedicare and can only be claimed at their registered practice.
• After-hours attendance items – can only be claimed in specific time periods. See AN.0.19 (GPs) and AN.7.24 (OMPs) for further information.
• Out of consulting rooms attendance items – have derived fee structures that vary with the number of patients attended or, in the case of some residential aged care facilities items, may be co-claimed with a flag fall item. See AN.0.11 (derived fees) and AN.35.1 and AN.35.2 (flag falls) for further information.
• Residential aged care facility items – See AN.0.15 , AN.35.1 and AN.35.2 for further information.
• Items 179, 185, 189, 203, 301, 91906, 91916, 19794, 91806, 91807, 91808, 91926 – can only be claimed when the service is provided at a practice located in a Modified Monash 2-7 area. Practice locations can be checked on the Health Workforce Locator .

Can I claim a general attendance for providing aftercare? No, you cannot claim a general attendance item if you performed the procedure that resulted in the need for aftercare.

However, the Health Insurance (Subsection 3(5) General Practitioner Post-Operative Treatment) Direction 2017 allows a medical practitioner working in general practice to use a general attendance item to provide aftercare provided that they did not perform the initial service that caused the need for aftercare. See AN.0.71 for further information.

ELIGIBLE PATIENTS

Any patient who is eligible to receive Medicare benefits is eligible for face to face (in consulting rooms and out of consulting rooms) general attendance items (business hours or after-hours).

Residential aged care facility-specific items are only available to Medicare-eligible patients that are residents of a residential aged care facility.

Patients must meet the “usual medical practitioner” requirement to access telehealth (video) and telephone items, unless an exemption applies (see AN.1.1 for more information). In the case of telephone items 91900, 91903, 91906, 91910, 91913, 91916, the patient must also be registered with the practice providing the service through MyMedicare.

ELIGIBLE PRACTITIONERS

General attendance items are available for different practitioner types:

• general practitioner items can be claimed by general practitioners only (see GN.4.13 ).
• medical practitioner items can be claimed by any medical practitioner that is not explicitly excluded in the relevant item descriptor.
• prescribed medical practitioner items can be claimed by prescribed medical practitioners only (see AN.7.1 ).

CO-CLAIMING RESTRICTIONS

To co-claim a general attendance item and another item both services must be clinically relevant and distinct services.

General attendance items and chronic disease management items 229, 230, 233, 721, 723 and 732 cannot be claimed on the same day for the same patient. This restriction is set out in clause 2.16.11 of the Health Insurance (General Medical Services Table) Regulations 2021. Further information on co-claiming of general attendance items and other MBS items is available in the AskMBS Advisory – General Practice Services #2 .

RECORD KEEPING AND REPORTING REQUIREMENTS

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 .

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item(s) can be found on the Federal Register of Legislation at www.legislation.gov.au . Attendance items are set out in three regulatory instruments:

• Health Insurance (Section 3C General Medical Service – Other Medical Practitioner) Determination 2018 – items 733, 737, 741, 745, 761, 763, 766, 769, 772, 776, 788, 789, 2197, 2198, 2200
• Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 – telehealth (video) and telephone attendance items.
• Health Insurance (General Medical Services Table) Regulations 2021 – all other attendance items.

Related Items: 3 4 23 24 36 37 44 47 52 53 54 57 58 59 60 65 123 124 151 165 179 181 185 187 189 191 203 206 301 303 733 737 741 745 761 763 766 769 772 776 788 789 2197 2198 2200 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067 5071 5076 5077 5200 5203 5207 5208 5209 5220 5223 5227 5228 5260 5261 5262 5263 5265 5267 90020 90035 90043 90051 90054 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215 91790 91792 91794 91800 91801 91802 91803 91804 91805 91806 91807 91808 91890 91891 91892 91893 91900 91903 91906 91910 91913 91916 91920 91923 91926

Derived fee items for general practice

Derived fees apply to a range of attendance items that are used when services are provided outside of consulting rooms, including some MBS items used in residential aged care facilities.

An item is a derived fee item if the MBS benefit payable depends on the number of patients that are seen at the location. Not all out of consulting rooms items are derived fee items. Some out of consulting rooms items attract a flag fall, instead of using a derived fee. See AN.35.1 , AN.35.2 and AN.44.1 for further information on flag falls.

To facilitate assessment of the correct Medicare rebate in respect of a number of patients attended on the one occasion at one location, it is important that the total number of patients seen be recorded on each individual account, receipt or assignment form. For example, where ten patients were visited (for a brief consultation) in the one facility on the one occasion, each account, receipt or assignment form would show "Item 4 - 1 of 10 patients" for a general practitioner. 

The number of patients seen should not include attendances which do not attract a Medicare rebate (e.g. public in-patients, attendances for normal after-care), or where a Medicare rebate is payable under an item other than these derived fee items (e.g. health assessments, care planning, emergency after-hours attendance - first patient).  

Related Items: 4 24 37 47 58 59 60 65 124 165 181 187 191 206 303 761 763 766 769 772 776 788 789 2198 2200 5003 5010 5023 5028 5043 5049 5063 5067 5076 5077 5220 5223 5227 5228 5261

Attendances at a Hospital (Items 4, 24, 37, 47, 124, 58, 59, 60, 65, 165)

These items refer to attendances on patients admitted to a hospital. Where medical practitioners have made arrangements with a local hospital to routinely use out-patient facilities to see their private patients, items for services provided in consulting rooms would apply.

Related Items: 4 24 37 47 58 59 60 65 124 165

General Attendance Items - General Practitioners

GENERAL ATTENDANCE ITEMS – GENERAL PRACTITIONERS

1 Residential Aged Care Facility 2 Use on: public holiday; Sunday; before 8am or after 1 pm on Saturday; before 8am or after 8pm on any other day 3 Use on: public holiday; Sunday; before 8am or after 12 noon on Saturday; before 8am or after 6pm on any other day 4 Patients enrolled in MyMedicare only

Related Items: 3 4 23 24 36 37 44 47 123 124 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067 5071 5076 5077 90020 90035 90043 90051 90054 91790 91800 91801 91802 91890 91891 91900 91910 91920

Category 8 - MISCELLANEOUS SERVICES

Bulk Billing Incentives for Eligible Patients in Modified Monash Area 1

General Practitioners 1

Bulk billing incentives for eligible patients 2  – Modified Monash 1 (Metropolitan Area) 3

1 For the definition of GP for MBS purposes see GN.4.13

2 Bulk billing incentives can be claimed when you bulk bill a child under 16 or a Commonwealth Concession Card holder www.servicesaustralia.gov.au/concession-and-health-care-cards

3 Practice located in Modified Monash area www.health.gov.au/resources/apps-and-tools/health-workforce-locator/app

4 If service is provided in an MM 2 – 7 area by a GP whose practice is located in an MM 1 area, then BBI item number 10992 is claimed

5 If service is provided in an MM 2 – 7 area by a GP whose practice is located in an MM 1 area, then BBI item number 75872 is claimed

6 Bulk billing incentives cannot be claimed for the provision of COVID vaccine support services

Medical Practitioners 1

1 Items in italics can only be claimed by prescribed medical practitioners, that is, medical practitioners that are not GPs, specialists or consultant physicians. Other items can be claimed by medical practitioners that are not GPs.

4 If service is provided in an MM 2 – 7 area by a OMP whose practice is located in an MM 1 area, then BBI item number 10992 is claimed

5 If service is provided in an MM 2 – 7 area by a OMP whose practice is located in an MM 1 area, then BBI item number 75872 is claimed

Related Items: 3 4 23 24 36 37 44 47 52 53 54 57 58 59 60 65 123 124 151 165 733 737 741 745 761 763 766 769 772 776 788 789 2197 2198 2200 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067 5071 5076 5077 5200 5203 5207 5208 5209 5220 5223 5227 5228 5260 5261 5262 5263 5265 5267 10990 10992 75870 75872 75880 90020 90035 90043 90051 90054 90092 90093 90095 90096 90098 91790 91792 91800 91801 91802 91803 91804 91805 91890 91891 91892 91893 91900 91903 91910 91913 91920 91923

Bulk Billing Incentives for Eligible Patients in Modified Monash Area 2

Bulk billing incentives for eligible patients 2  – Modified Monash 2 (Regional Centre) 3

4 Bulk billing incentives cannot be claimed for the provision of COVID vaccine support services

Related Items: 3 4 23 24 36 37 44 47 52 53 54 57 58 59 60 65 123 124 151 165 179 181 187 189 191 203 206 301 303 733 737 741 745 761 763 766 769 772 776 788 789 2197 2198 2200 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067 5071 5076 5077 5200 5203 5207 5208 5209 5220 5223 5227 5228 5260 5261 5262 5263 5265 5267 10991 75871 75881 90020 90035 90043 90051 90054 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215 91790 91792 91794 91800 91801 91802 91803 91804 91805 91806 91807 91808 91890 91891 91892 91893 91900 91903 91906 91910 91913 91916 91920 91923 91926

Bulk Billing Incentives for Eligible Patients in Modified Monash Area 3 and 4

Bulk billing incentives for eligible patients 2  – Modified Monash 3 and 4 (Medium and Large Rural Towns) 3

Related Items: 3 4 23 24 36 37 44 47 52 53 54 57 58 59 60 65 123 124 151 165 179 181 185 187 189 191 203 206 301 303 733 737 741 745 761 763 766 769 772 776 788 789 2197 2198 2200 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067 5071 5076 5077 5200 5203 5207 5208 5209 5220 5223 5227 5228 5260 5261 5262 5263 5265 5267 75855 75873 75882 90020 90035 90043 90051 90054 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215 91790 91792 91794 91800 91801 91802 91803 91804 91805 91806 91807 91808 91890 91891 91892 91893 91900 91903 91906 91910 91913 91916 91920 91923 91926

Bulk Billing Incentives for Eligible Patients in Modified Monash Area 5

Bulk billing incentives for eligible patients 2  – Modified Monash 5 (Small Rural Towns) 3

1 Items in italics can only be claimed by prescribed medical practitioners, that is, medical practitioners that are not GPs, specialists or consultant physicians. Other items can be claimed by medical practitioners that are not GPs. 2 Bulk billing incentives can be claimed when you bulk bill a child under 16 or a Commonwealth Concession Card holder www.servicesaustralia.gov.au/concession-and-health-care-cards 3 Practice located in Modified Monash area www.health.gov.au/resources/apps-and-tools/health-workforce-locator/app 4 Bulk billing incentives cannot be claimed for the provision of COVID vaccine support services

Related Items: 3 4 23 24 36 37 44 47 52 53 54 57 58 59 60 65 123 124 151 165 179 181 185 187 189 191 203 206 301 303 733 737 741 745 761 763 766 769 772 776 788 789 2197 2198 2200 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067 5071 5076 5077 5200 5203 5207 5208 5209 5220 5223 5227 5228 5260 5261 5262 5263 5265 5267 75856 75874 75883 90020 90035 90043 90051 90054 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215 91790 91792 91794 91800 91801 91802 91803 91804 91805 91806 91807 91808 91890 91891 91892 91893 91900 91903 91906 91910 91913 91916 91920 91923 91926

Bulk Billing Incentives for Eligible Patients in Modified Monash Area 6

Bulk billing incentives for eligible patients 2  – Modified Monash 6 (Remote Communities) 3

Related Items: 3 4 23 24 36 37 44 47 52 53 54 57 58 59 60 65 123 124 151 165 179 181 185 187 189 191 203 206 301 303 733 737 741 745 761 763 766 769 772 776 788 789 2197 2198 2200 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067 5071 5076 5077 5200 5203 5207 5208 5209 5220 5223 5227 5228 5260 5261 5262 5263 5265 5267 75857 75875 75884 90020 90035 90043 90051 90054 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215 91790 91792 91794 91800 91801 91802 91803 91804 91805 91806 91807 91808 91890 91891 91892 91893 91900 91903 91906 91910 91913 91916 91920 91923 91926

Bulk Billing Incentives for Eligible Patients in Modified Monash Area 7

Bulk billing incentives for eligible patients 2  – Modified Monash 7 (Very Remote Communities) 3

2 Bulk billing incentives can be claimed you bulk bill a child under 16 or a Commonwealth Concession Card holder www.servicesaustralia.gov.au/concession-and-health-care-cards

Bulk billing incentives for eligible patients 2  – Modified Monash 7 (Very Remote communities) 3

Related Items: 3 4 23 24 36 37 44 47 52 53 54 57 58 59 60 65 123 124 151 165 179 181 185 187 189 191 203 206 301 303 733 737 741 745 761 763 766 769 772 776 788 789 2197 2198 2200 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067 5071 5076 5077 5200 5203 5207 5208 5209 5220 5223 5227 5228 5260 5261 5262 5263 5265 5267 75858 75876 75885 90020 90035 90043 90051 90054 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215 91790 91792 91794 91800 91801 91802 91803 91804 91805 91806 91807 91808 91890 91891 91892 91893 91900 91903 91906 91910 91913 91916 91920 91923 91926

• Assist - Addition/Deletion of (Assist.)
• Amend - Amended Description
• Anaes - Anaesthetic Values Amended
• Emsn - EMSN Change
• Fee - Fee Amended
• Renum - Item Number Change (renumbered)
• New - New Item
• NewMin - New Item (previous Ministerial Determination)
• Qfe - QFE Change

© Commonwealth of Australia ABN: 83 605 426 759

• Accessibility

About the MBS