Published by Auckland, Counties Manukau and Waitematā DHBs on 7/03/2022 6:37:12 PM.

Changes to funding claiming process for COVID-19 Case Management

Thank you for the critical role you and your teams are playing to support over 100,000 people with COVID-19 across metro Auckland currently.

It had been planned that CCCM could be used to determine COVID-19 Case Management (Whānau HQ) activity in primary care.

However, there have been ongoing challenges with the use of CCCM meaning that some clinicians have needed to use their PMS to record care in some instances. We want to make sure that primary care can have confidence they will be paid correctly. Therefore, the decision has been made to instead use a POAC form to claim services provided under Whānau HQ.

We appreciate that this is a departure from previous communications and will cause additional administrative work, but we have made this decision based on strong feedback from practices and PHOs.

We are giving you two claiming options as a pragmatic solution to recognise the change in claiming approach and the additional administration that claiming will now require. Note, both options are in line with the national funding framework for COVID-19 Care in the Community (22 December and 22 February 2022).

For the period from 10 February 2022 onwards, practices can claim under either of the two options below:

1. Packages of Care

Four packages depending, acuity dependent:

Package 1

Acuity 1-4, not high need: $221.50 plus GST. Based on price of 1 initial assessment + 1 regular review conducted on average.

Package 2

Acuity 1-4, high need: $454.08 plus GST. Based on price of 1 initial assessment + 3 regular reviews conducted on average.

Package 3

Acuity 5-6, not high need:

• 10 February to 8 March 2022: $537.33 plus GST. Based on price of 1 initial assessment + 6 regular reviews + 1 GP/NP regular review + clinical discharge conducted on average.
• From 9 March 2022*: $474.83 plus GST. Based on price of 1 initial assessment + 6 regular reviews + clinical discharge conducted on average.

Package 4

Acuity 5-6, high need:

• 10 February to 8 March 2022: $698.53 plus GST. Based on price of 1 initial assessment + 6 regular reviews + 1 GP/NP regular review + clinical discharge conducted on average.
• From 9 March 2022*: $617.28 plus GST. Based on price of 1 initial assessment + 6 regular reviews + clinical discharge conducted on average.

* Change to price from 9 March 2022 in line with Ministry of Health change to national funding framework – see attached.

Plus itemised add-ons

Assessment out of hours, weekend review, clinical escalations, in home care and mileage. Rates as per fee for service schedule, see attached.

Claims should be sent as a summary at the completion of the COVID-19 illness care.

OR

2. Fee for service: Full selection of activities to select for episodic or extended care (see attached). Claims can be submitted at any time during the patient’s treatment episode.

We are developing an algorithm and guidance to provide further clarity. This will be loaded onto Auckland Regional HealthPathways > COVID-19 Funding and Supplies in the coming days.

Key things to note:

• Acuity score – please see Auckland Regional HealthPathways. Clinicians are requested to state the acuity score when doing COVID-19 assessments and record in CCCM where possible. If an acuity score has not been applied at the time of the care, and the claim is for Acuity 5-6 please ensure POAC claim attached notes contain enough information to substantiate the claim.
• An initial assessment does require a conversation with the person with COVID-19. It is not possible to determine acuity without this. Oximetry results are not required to confirm acuity.
• If acuity changes during the course of the illness from 1 to 4 to acuity 5 or 6 then Package 3 or 4 can be claimed as appropriate.
• Packages of care estimate the work required by acuity. Sometimes the work will be more, sometimes less.
• Most low risk cases (COVID-19 Triage Tool < 10% risk of hospitalisation) will not need an assessment or call. However, if an assessment is required then claim as per Acuity.
• Please use the blue flag in CCCM to indicate that you are providing the care.

Thank you for your ongoing support and adaptability in this changing landscape.

Remdesivir

PHARMAC criteria for access to Remdesivir have been updated twice in the last week. Even with the more restricted criteria from 4 March, there will be limited supply and constrained delivery channels across the country. Therefore, more people may qualify but only a small proportion of those at the highest risk will end up accessing it. The metro Auckland access criteria and referral pathway for Remdesivir are being worked on urgently by a regional group, and will be communicated as soon as possible.

Currently Remdesivir is a hospital only medicine. We will keep you updated about criteria and referral pathways when that information is available.

220222 Update to pricing schedule for CCiC clinical services.pdf [271.8 KB]

Summary of COVID-19 Primary Care Activity Funded via POAC 8 March 2022 V6 2 (2) – final.docx [40.9 KB]