Question Number: 198
PDR Number: SQ22-000153
Date Submitted: 24/02/2022
Department or Body: Department of Health
165. Since March 2021, the former government has introduced 22 Medicare Benefits Schedule (MBS) COVID-19 items to support GPs in administering vaccines. These items must be bulk-billed, and no other items should be billed in relation to COVID vaccines. Medicare payments are made by Services Australia, not the Department of Health.
The COVID-19 MBS vaccine items include vaccine suitability assessments, in-depth assessments, a flag fall item for suitability assessments conducted outside consulting rooms and a vaccine booster incentive payment.
MBS items to support GPs to administer COVID-19 vaccines range in total payments to a GP of from $31.05 per patient depending on the circumstances, and how many doses are administered by the GP. Full details are available in published Medicare fact sheets.
In February 2021, a Practice Incentives Program (PIP) COVID-19 Vaccine General Practice Incentive was introduced to support the national vaccination effort. The Incentive encourages continuity of care and appropriate follow-ups by providing a $10 payment to general practices that deliver vaccine suitability assessment services for both the first and second doses of a COVID-19 vaccine to a patient at the same practice.
A time-limited incentive payment backdated from 29 April has also been introduced for general practices and pharmacies that undertake in-reach COVID-19 vaccination services for residential aged care and disability support workers in their workplace. From 1 November 2021, the COVID-19 In-reach Vaccination Payment was expanded to also support vaccinations to residents via an in-reach vaccination clinic until 30 June 2022.
Funding for community pharmacies to administer COVID vaccines is provided on a fee for service basis. This approach reflects consultations with the community pharmacy sector and is in line with other existing community pharmacy funding arrangements.
Nominally the claimable fee by pharmacies for administering a primary course of COVID-19 vaccine – Dose 1 and Dose 2 – and booster dose will attract a fee of $16 for pharmacies in metro areas (Modified Monash 1), and $19 for pharmacies in regional, rural and remote areas (MM2–7). Further, a payment of $26 in MM1 or $29 in MM2–7 is claimable for administration of second doses where the same provider administered the first dose.
From 23 December 2021, a $10 incentive payment was made available per booster vaccine administered through a General Practice, Aboriginal Community Controlled Health Service, Commonwealth Vaccination Clinic or Community Pharmacy.
The $10 incentive payment is on top of the payment for the booster dose. This means a payment for boosters will be $26 for pharmacies in metropolitan areas (MMM 1), $29 for pharmacies in regional, rural and remote locations (MMM 2-7) in total. This is for booster and third doses only.
166. As at 20 February 2022, more than $758 million in Medicare benefits have been paid by Services Australia under the former government across the 22 MBS COVID-19 items to support GPs in administering vaccines.
There has been $67,356,270 in expenditure on the Vaccine General Practice Incentive to 31 January 2022. This reflects the provision of both a first and second dose assessment service to 6,735,627 patients at the same PIP practice.
To date, there has been $190,120 in expenditure for the in-reach incentive for aged and disability care residents and workers. Payments were made to 45 PIP practices in November 2021 for in-reach vaccination services provided until 31 October 2021.
As of 20 February 2022, almost $130 million has been claimed for COVID-19 vaccinations by participating pharmacies in the COVID-19 Vaccination in Community Pharmacy (CVCP) Program.
167. The former government has invested more than $17 billion in COVID-19 vaccine and treatment supply. The specific details of these agreements are commercially confidential.
