What is a Comprehensive Medical Assessment (CMAs)?

A CMA is a new Medicare item claimable by general practitioners. A Comprehensive Medical Assessment (CMAs) can be used for new residents of aged care homes, including veterans or existing residents if there is a clinical need.

The CMA item will focus on a medical assessment of the resident.  The CMA will usually occur in the aged care home but may be undertaken in the GP surgery.

The CMA entails:

• A detailed relevant medical history
• Comprehensive physical examination
• Current diagnosis
• Written summary of the outcomes of the assessment

What is the MBS Item number?

The item number is 712.

At what cost is the CMA funded?

The CMA is funded at $150.05. If the consult is bulk billed the rebate of $5.00 or $7.50 is claimable.

What are the benefits of CMAs?

Benefits to residents and their families
Comprehensive medical assessments can enhance the quality of medical care provided to residents of aged care homes by enabling the resident's GP to more exactly assess the resident's medical condition and identify what the resident requires for ongoing health care. CMAs can provide important information to assist in planning for the care of a resident and in reviewing a resident's medication management needs.

Benefits to GPs
Comprehensive medical assessments provide the opportunity for GPs to get to know the medical history of residents who may be new to them, to undertake a full medical examination, and to develop a good understanding of what care the resident will need. This work has not previously been remunerated as a separate Medicare item. CMAs provide the opportunity for closer working relationships between GPs and aged care homes and make it easier for GPs to contribute to care planning by the aged care home. CMAs can also contribute important information to medication management reviews for residents.

Benefits to aged care homes
The results of a CMA will feed into the ongoing care management of the resident including the resident's care plan.  The assessments will identify the resident's medical needs and provide important information, including diagnoses and problems, for planning individual care and medication management strategies.

Benefits to the community
Increased engagement of general practice with aged care can help prevent avoidable deterioration in health and functioning of residents, and help reduce emergency department visits and hospital admissions. Comprehensive medical assessments and other related initiatives for aged care homes including GP panel arrangements provide a more integrated approach to addressing current service gaps and greater incentive for GP involvement in aged care.

Is the resident's consent required before a CMA is done?

Yes, the resident's consent to a CMA should be obtained as per normal practice for obtaining consent to medical services.

How frequently can a GP conduct a CMA?

A CMA should be conducted for each new resident of an aged care home on admittance. A CMA can be conducted on a resident if a significant clinical change occurs due to medical, physical and / or psychological function. The need should be established by the treating GP. Examples of significant clinical changes might be discharge from acute care, medication change or falls in the last three months. Only one CMA can be claimed per resident in any twelve month period.

Over what time period does the CMA have to be completed?

The CMA should be completed over one or more visits. There is no definitive requirements except to state all components of the CMA are completed for each resident.

Who can identify the need for a CMA for an existing resident?

The resident, the resident's carer or a member of the resident's health care team, including staff of the aged care home, the resident's doctor, or the pharmacist providing medication management review services in the aged care home, can identify the need for a CMA. However, the resident's doctor must assess the resident and decide whether a CMA is necessary.

What is the role of a practice nurse in a Comprehensive Medical Assessment?

Practice nurses can assist GPs with the provision of CMAs in the same way that they assist with other GP consultation items. The CMA involves a personal attendance by the GP on the aged care resident, usually in the aged care home. Unlike the home visit component of the EPC health assessment, there is no specific component of the CMA that can be undertaken wholly by a practice nurse, in place of the GP. 

How do you determine if a CMA has been conducted in the last 12 months?

Where it is unclear whether the resident has had a CMA in the previous 12 months, the resident or their representative can ring the Medicare Enquiry Line on 13 2011 to verify the date of the previous CMA (if any).  The person will need to quote the resident's Medicare Number and the service (item 712).

Are residents on respite eligible for a CMA?

No, this MBS item is dedicated to permanent residents of aged care homes.

Are aged care person in the community eligible for a CMA?

No.This item number has been developed specifically for permanent residents of aged care homes.

How does it relate to EPC items?

The CMA is complimentary to the EPC items of case conferencing and care planning. Visit the EPC website at www.health.gov.au/epc.

Is there a cap on claiming the CMA?

No. However only $14.6m has been allocated over the first three years of this initiative.

When will the CMA be implemented?

From 1 July 2004.

Where can I find out more information about the CMA?

More information about the CMA can be found at the DoHA website. www.health.gov.au/medicareplus/agedcare.  Information on EPC items can be found at www.health.gov.au/epc.  The following link to the DoHA website has a frequently asked questions document http://www.seniors.gov.au./internet/wcms/publishing.nsf/Content/health-medicare-health_pro-gp-cmarach.htm.

Is there a set proforma for the CMA?

No. As part of supporting information for the CMA, the Department has developed a checklist and a form to assist GPs in meeting the requirements of the CMA. The checklist acts as a prompt for the activities to be undertaken in providing a CMA while the form can be used to record the results of the CMA. It is not mandatory to use these forms, or any other specific form, but it is important that any forms developed by Divisions and / or other organisations to assist GPs providing CMAs must enable GPs to meet the requirements of the MBS.

ADGP under the Complete Primary Care program has developed a CMA proforma. It is located on the CMA page of this website. This form was included in the Medical Directory update in August 2004.

ADGP has collated other approved CMA forms developed by the Department of Health and Ageing and various Divisions of General Practice.  Click here to view the forms.

Can a Locum provide a CMA?

Yes - provided the resident's usual GP has delegated the provision of this service to the Locum. The resident's usual GP should be given a copy of the written summary of the outcomes of the CMA.

What should the written summary of the CMA include?

The written summary of the outcomes of the CMA should contain sufficient information to serve as a communication tool from the GP to other health and care providers involved in the care of the resident. The GP may wish to include the list of diagnoses and/or problems and recommendations for the care of the resident. GPs can use this information to inform their contribution to a multidisciplinary care plan.

What is an Advance Care Directive?

The right to accept or reject any treatment or procedure ultimately resides with the patient. This includes the right to accept or refuse resuscitative and any other life-saving or sustaining measures should they become medically necessary.

An advance directive specifies the types of medical care a person would or would not want to undergo in the event of his or her becoming incompetent.  It allows a person to set out their wishes for the future, which can help reduce family conflict at a time of great trauma and stress. 

Why are Comprehensive Medical Assessments not available to people living in the community?

This Medicare item is specifically designed to meet the needs of people in aged care homes. Older people living in the community setting can access EPC health assessments available to people aged 75 years and over (55 years and over for Aboriginal and Torres Strait Islander people).  

What is a "Residential Aged Care Facility"?

A Residential Aged Care Facility is a facility in which residential care services are provided, as defined in the Aged Care Act 1997.  This includes facilities that were formerly known as nursing homes and hostels. This term is used in the Medicare Benefits Schedule, and encompasses aged care homes providing both high and low care to residents.

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