Community claiming-Flow chart-May-2022 (14.09.22)

COVID-19 ASSESSMENTS AND TESTING

Service

Description

COVID-19 Virtual Assessment COVID-19 In-person Assessment and Test (complex and/or symptomatic people)

COVID-19 virtual assessment by a nurse, nurse practitioner or general practitioner.

A COVID-19 clinical assessment by a nurse, nurse practitioner or general practitioner for complex cases, and COVID-19 test for symptomatic patients. The RAT can either be supervised at the practice or unsupervised if the patient is able to selfadminister the RAT themselves at home.

Test Type

Claim

No test

$69.00

RAT or PCR

$138.00

Notes • • •

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•

General practices will be funded to undertake a combined clinical assessment and provide a test (either a RAT or PCR).

In Phase 3, the test will predominately be a RAT and only PCR where clinically indicated.

The RAT can either be supervised at the practice or unsupervised if the patient is able to self-administer the RAT themselves at home. This includes the provision of RATs for symptomatic patients and household contacts. They should be provided with at least three RATs for each member of the household. This funding will be reviewed at the end of May 2022.

Once a case is confirmed COVID-19 positive (either via a RAT or a PCR), general practices will have access to the COVID-19 Care in the Community general practice funding. This includes funding for further assessments, reviews, and clinical escalation.

Large-scale drive through CBAC/CTC models, and isolation and quarantine facilities are excluded from the scope of the framework.

Initial Contact

Initial Assessment Standard/High Need ($215.63 - $462.52)

High Risk Active Care

Moderate Risk Active Care

Initial Assessment Standard/High Need ($215.63 - $462.52)

DAY 10 – 42 Post-Acute Phase: One per

One claim per day, per patient

Patient, per Episode of care

0-14 days

Regular review (Standard/High Need ($39.10 /$83.87)

Ongoing or Worsening Symptoms (Acute) • Clinically a continuation of recent infection Return to current CCiC Programme (Regular Review)

Clinical Escalation ($39.10 /$83.87)

Clinical Assessment (Post Transfer) Standard/High Need $143.75/$237.19

In-Home Care Standard/AHs ($250.62 /$412.50 per hr) + $0.71 per Km

In-Person Care in a Clinic Standard/Weekend ($287.50/$474.38)

14-42 days New Symptoms (Acute) Follow-up A single postCOVID-19 review within six weeks of Positive swab notification.

$71.88

Low Risk Active Care

Low Risk Self-Management MOH Txt only Self-Management

DAY 14 - 42

Or

Chart review & Contact (Text) (Standard/Weekend) ($39.10 /$56.10)

Hospital Discharge Active Care

DAY 2 – 9 (Acute Symptoms only)

Chart review & Contact (Text) (Standard/Weekend) ($39.10 /$56.10)

Clinical Discharge (Standard/High Need ($95.83 -$237.19)

Initial Assessment (Standard/High Need) ($215.63 - $462.52)

Non-Contact Quick Call (No response) $39.10

Chart review & Contact (Text) (Standard/Weekend) ($39.10 /$56.10)

(following previous recovery from infection)

• Clinically a re-infection: Assessment + Supervised RAT can be claimed for.

• Positive test → New CCiC POC (Initial Assessment) • Negative test → Process of elimination (see reinfection guidance)

42 + days Continuing Symptoms- Non Acute: Treat as: Long COVID – Patient self-funded

Re-infection guidance This can be found in the WBOPPHO portal under COVID resources.

Reinfection Guide 1

Click here: Reinfection Guide

COVID-19 CARE IN THE COMMUNITY All costs are GST incl.

Service Chart Review and Contact

Description

Standard Claim

For people requiring some, but not the full initial clinical assessment

After Hours Weekday Claim

Weekend Claim -

$39.10

$64.52

Initial Clinical Assessment

Standard

$215.63

$355.79

$355.79

Regular Review

High needs / unenrolled Standard

$280.31 $39.10

$462.52 -

$462.52 $64.52

$50.83

-

$83.87

High needs Clinical Escalation

As determined at regular review, when clinically indicated or by self-referral by a person $237.19

on the self-management pathway, includes transfer of care to hospital level services Clinical Assessment

Post transfer of care out of hospital to primary care

Clinical Discharge

$143.75

$237.19

$95.83 $124.58

-

$237.19 -

Follow-Up Check

Standard High needs A single post-COVID-19 review within six weeks of notification of positive test result

$71.88

-

-

In-Home Care

Per hour where clinically required

$287.50

$474.38

$474.38

-

$474.38

Mileage rate per kilometre In-Person Care in a Clinic

Notes • • • •

• • •

•

Full assessment where clinically required

$0.71 $287.50

The Pricing Schedule only applies to COVID-19 positive patients. The prices in the schedule include reimbursement of patient co-payments for COVID-19 positive patients.

“High needs” is defined as Māori, Pacific peoples, people living in NZ deprivation quintile 4 and 5 areas, refugees, and people 75 years-old and over.

Initial assessment for those people who are not enrolled with a general practice are claimed at the high needs rate.

Subsequent regular reviews are claimed at the standard rate unless they meet the high need definition.

After-hours on weekday is between 8pm-8am Monday – Thursday. Weekend rate covers 5pm Friday- 8am Monday and any public holiday. Most regular reviews are intended to be undertaken during standard work hours (weekdays) with weekend reviews based on clinical need.

In-home care per hour rate includes travel time; the type of clinician is not prescribed.

A claim can be submitted for each person in a household who is COVID-19 positive.

Conditions of claiming: o No fee to patient and no claim for claw back. o Regular reviews that identify a clinical need for additional GP or Nurse Practitioner input are eligible for an additional ‘clinical escalation’ claim per day. o No simultaneous claiming against any other funding stream.

Chart review and contact does not cover bulk text messaging.

COVID-19 CARE IN THE COMMUNITY DEFINITIONS Funding eligibility: is it Long COVID? COVID-19 Care in the Community funding is intended to fund COVID-19 related care for those in the acute stage of their infection while they are isolating at home. Care for those patients in the acute stage of their infection is currently fully funded. to minimise barriers for accessing testing and treatment, to identify as many cases as possible, and to support isolation, thereby reducing the risk to the wider community. Based on current evidence, it is clinically appropriate to treat any presentations beyond that time as outside of the acute infection - for which the current funding is provided.

Once the acute phase of the COVID-19 infection is resolved, any longer-term presentations beyond the six-week check should be managed in the same way as other long-term conditions.

For patients reporting persistent symptoms beyond four weeks, the funded six-week review should be utilised to plan any ongoing care that may be clinically indicated. Normal co-payments for general practice appointments will apply, as well as part charges for emergency ambulance callouts, and prescription co-payments at community pharmacies. Specialist level treatment will be funded by DHBs, or self-funded if accessed privatelyi.

Term High Needs

Explanation Māori, Pacific peoples, people living in NZ deprivation quintile 4 and 5 areas, refugees, and people 75 years-old and over.

Virtual clinical care for COVID-19 positive patients includes telephone/video/text/patient portal.

Consult Type

In-person clinical care for COVID-19 positive patients includes in-home and in-person care in a health facility where appropriate streaming is available.

Chart review and contact

Initial Clinical Assessment

Chart review and contact (via text, email, patient portal) for patients who are higher risk but do not require a full initial assessment Initial clinical assessment can be undertaken by any clinical member of the general practice team where a care plan is agreed based on the patient’s clinical condition and risk factors. People may be placed on either an active clinical management or a self-management pathway.

Active clinical management: The frequency of regular reviews is determined according to clinical need based on risk and acuity.

Self-management pathway: Where clinically appropriate, people can self-manage while they have COVID-19. They will be provided with information that enables them to escalate their care to an appropriate provider should their clinical condition deteriorate, or they have a welfare need.

Regular Review

The frequency of regular reviews for those people under active management can be determined clinically. Guidance is available on Health Pathways. Regular review can be carried out by any clinical member of the practice team.

Clinical Escalation

Where a person identifies a new need or when a deterioration is found through regular review, clinical care should be escalated to an appropriately qualified clinician.

Clinical Assessment (post transfer)

Re-assessment following transfer of care from hospital to primary care.

Clinical discharge

Clinical team determines whether the patient has clinically recovered and can be discharged from clinical regular reviews.

Follow-up check

Where required the clinical team may provide a single follow-up review. Timing of follow-up will be clinically determined.

Quick Call – Non-Contact *DHB Arrangement*

Where a Patient is non-contactable for initial assessment or scheduled review. As per schedule

Management of Household Close Contacts *DHB Arrangement*

Rate per household, regardless of number of close household contacts.

i

https://www.health.govt.nz/covid-19-novel-coronavirus/covid-19-information-health-professionals/covid-19-primarycare/long-covid-funding-primary-care