Opioid Substitution Treatment - G.P. Shared Care (GPSC) Service Description The GP Shared Care Programme aims to achieve improvement in the physical and psychological health and wellbeing of people who are on Opiate Substitution Treatment (OST). Patients suitable for shared care will be identified by the OST Specialist Service. The GP or NP will be provided with case management support from the OST Specialist Service for individual patients.
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The GP Shared Care Programme has the benefits of: Improving social integration by normalising patients' treatment. Instigating more comprehensive health care for patients. Providing a patient pathway based on recovery principles.
Total payment available annually per patient - $768.85 This is made up of: • Annual Package of Care (PoC) $ 527.35 including GST per patient (annually) which is equal to 4 Extended Consults per patient and any repeat prescriptions. • Discretionary Funding Up to $241.50 including GST, per patient, per annum. This funding can be drawn down throughout the year. One off payment available for •
Reimbursement of Pneumococcal Conjugate Vaccine (PCV13) One-off payment of $273.00 including GST, per patient
Please Note: No patient co-payment is to be charged.
Patient Eligibility Criteria • Eligible patients are referred from the Te Whatu Ora Hauora a Toi OST Specialist Service. • Patients are enrolled with a WBOP PHO practice. • Each patient, eligible for transition into a GP Shared Care arrangement, will enter a Service Agreement with both their treating GP and Specialist Mental Health Services (SMHS). • Eligibility to continue within the funded GPSC programme depends on client’s attendance at regular reviews and ongoing stability and suitability for the Shared Care Programme Updated October 2023
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Please note – this service should include a minimum of 1 x face-to-face consult with the patient every 3-months.
Provider Eligibility Criteria: • Provider has a current Authority to Prescribe from BOPAS (renewed every 3 months) • The authorised lead clinician at the practice must be able to evidence OST specific mental health training which may be through support from a specialist OST or attendance at conferences/relevant workforce development either externally or through the WBOP PHO CME process. • Specific training is available through Te Pou: https://www.tepou.co.nz/initiatives/opioidsubstitution-treatment
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Referral Process Halcyon ‘Other Options’ Menu Once a patient is loaded in the Practice/Web Portal, they can be registered on the programme via the ‘New Registration’ link for the ‘Opioid Substitution Treatment’ programme under ‘Other Options’.
‘Current Programmes’ Menu Once registered on the programme the patient’s ‘Current Programmes’ menu will display: • • •
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Registration, expiry (defaults to 12 months from registration), and any exit date if applicable Previous consult type and date Number of Extended Consults, Repeat Prescriptions, and vaccinations remaining o Please note: Patients are only eligible for a single Pneumococcal Vaccine regardless if an option for it displays upon re-registration. Amount ($) of Package of Care and Discretionary funding remaining
A new consult can be entered via the “New Consult” link, or the patient can exit from the programme via the “Exit Patient” link.
If either consults or funding remaining reaches 0, the relevant item in the status will be Updated October 2023
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highlighted red.
A registration with no discretionary funding or vaccinations remaining is shown below:
Registration Form ‘Registration Details’ Tab There is a single eligibility checkbox to register the patient on the programme. Patients must be re-registered each year once their previous registration has expired to remain eligible to participate in this programme. The single eligibility checkbox must be ticked in order to submit the claim.
The resources link to the following websites: • • •
MOH: https://www.health.govt.nz/publication/new-zealand-practice-guidelinesopioid-substitution-treatment-2014 BPAC: https://bpac.org.nz/bpj/2014/october/opioid-addiction.aspx Opioid Substitution Treatment | Addiction | Te Pou: https://www.tepou.co.nz/initiatives/opioid-substitution-treatment
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•
GP Shared Care Manual (wboppho.org.nz): https://portal.wboppho.org.nz/images/documents/ost-gp-shared-care-manual.pdf
Registration Summary The Registration summary page is displayed once the Registration form is successfully submitted. The summary will be saved to patient inbox.
Please note - Registration will be rejected if the patient already has an active Registration.
Consult Form ‘Claim Details’ Tab
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The options for ‘Consult Type’ are shown below.
When ‘Extended Consultation’, ‘Repeat Prescription’, or ‘Discretionary Funding’ is selected from the ‘Consult Type’ dropdown – the following ‘Amount Claimed’ input will appear:
Practices must then manually enter the appropriate amount as relevant. When ‘Pneumococcal Vaccination’ is selected from the ‘Consult Type’ dropdown – the following ‘Vaccination Date’ input will appear. Practices must select the date appropriate. The ‘Amount Claimed’ box for this selection is non-editable and will auto-populate as $260 (GST incl.)
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Invoicing MedTech PMS: Once the claim form is complete, a New Invoice Window will appear in MedTech as per below. Please note – for claims with no fixed costs, you will need to update the “amount” column and then click OK for the invoice to appear on the Halcyon form.
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Required Fields The following fields must be completed in the form. If these are not completed, the form will not be accepted:
If shown on form - ‘Amount Claimed’ is required to be completed:
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If shown on form– ‘Vaccination date’ is required to be completed:
Consult Summary The Summary page is shown once the claim is successfully submitted, and an invoice will be generated in the PMS if applicable.
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The Claim will be rejected if it fails one or more of the business rules.
Also, any recall will be set, and screening activities will be written to the patient’s daily record (example from MedTech shown below).
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Please note, a new screening term may need to be added for this recall, using code “OST” (Example from MedTech32 shown below):
Exit Form The Exit form is accessed via the “Exit Patient” link on the ‘Current Programmes’ tab. One a date and reason are required to exit the patient.
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Exit Summary
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Payment Service Code WPOS01 WPOS02 WPOS03 WPOS04
Amount (GST Inc.) $0 $0 $273 $0
PMS Description
Notes
OpSubs Cons Extended OpSubs Cons RptScrpt OpSubs Cons PneumVac OpSubs Cons DiscFund
Extended Consultation Repeat Prescription Pneumococcal Vaccination Discretionary Funding
Please note: the $0 items reflect the variable nature of the claim amount. For these items, manual input will be required for appropriate amounts. Total Payment available annually per patient - $768.85 This is made up of: • Annual Package of Care (PoC) $ 527.35 including GST per patient (annually) which is equal to 4 Extended Consults per patient. • Discretionary Funding Up to $241.50 including GST, per patient, per annum. This funding can be drawn down throughout the year. One off payment available for •
Reimbursement of Pneumococcal Conjugate Vaccine (PCV13) $273.00 including GST, per patient
Please Note: No patient co-payment is to be charged. Medtech, MyPractice and Indici Practices An invoice will automatically be created in your PMS and a claim will be electronically sent to the PHO on completion of the Halcyon form.
Please Note: No patient co-payment is to be charged.
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Contact Info: For all accounts and payment queries please contact WBOP PHO Accounts team at: accounts@wboppho.org.nz For all other queries regarding program guidance and support, contact your Network Liaison directly or the Network Services Team at: NSAdmin@wboppho.org.nz
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