Care plans: What is an Enhanced Primary Care Plan?

woman talking to her GP about an enhanced primary care plan

Care plans: What is an Enhanced Primary Care Plan?

An Enhanced Primary care plan, known as an EPC, was a Medicare scheme. It helped people claim some of the costs of their allied health service. This included physio, osteo, chiro, podiatrists, dietitians and more. Back in 2005, the Government removed EPC’s from the Medicare Benefits Schedule. They replaced it with something called a Chronic Disease Management Plan (CDM). Now us Australians are creatures of habit, and of course this new term never took off. So, everyone still refers to their care plan (or CDM) as an EPC (confusing right!). Here at St Leonards Physio, we call them EPCs. But for the sake of simplicity, in this blog, we’ll call them ‘care plans’. 

What is a care plan?

A care plan is a plan the GP puts in place to help manage your chronic or terminal medical condition. This includes patients that need a multidisciplinary approach – a team of care professionals that includes a GP and at least two other health or care providers. With a care plan, you are able to receive a Medicare rebate for the costs of some allied health services. In short, treatments will be cheaper for you. 

What qualifies as a chronic medical condition?

According to the Department of Health, a chronic condition is one that has been or is likely to be around for six months or longer. It includes but is not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, musculoskeletal conditions and stroke. Your GP is able to determine whether you qualify for a care plan.

Is the rebate the only benefit of a care plan?

While the rebate is of course beneficial, it’s not the only reason care plans are in place. Care plans help GPs plan and coordinate your care with other health professionals. They also encourage you to take an active part in your healthcare journey.

Can I see a different practitioner than the one listed on my form?

Yes and no! Now, let us explain… If your referral form includes the name AND practice location of an allied health professional then you can see any allied health professional at that practice. However, if your referral form contains the name of an allied health professional, but no practice location, then you must see the allied health professional who is specified on your form. In this case, if you want to see someone else, you need to get a new referral form from your GP. If the GP has only specified the type of allied health professional, then you are free to see any allied health professional you like, as long as that professional is registered with Medicare Australia to provide services.

So that is care plans in a nutshell (or EPCs, or CDMs)! Here at St Leonards Physio, we treat many patients with care plans. The first stop for a care plan is always your GP, so if you think you may qualify, chat to your GP and they’ll be able to advise whether a care plan is right for you.