Community Services Card and zero fees for under-14s programme

Here's information to help DHBs, Primary Health Organisations (PHOs) and General Practices implement the new subsidies for Community Services Card holders and 13 year olds.

What are the changes?

On 1 December 2018, several changes took place to provide people with greater access to primary care. The changes are part of Budget 2018 and include extending:

• access to low-cost General Practice visits to all Community Services Card (CSC) holders. This includes injury-related visits to the Accident Compensation Corporation (ACC)
• CSC eligibility to all people receiving the accommodation supplement or who are tenants in social housing
• zero-fee general practice visits and exemption from the standard prescription co-payment charge (usually $5 per item) on subsidised prescription items for children under the age of 14. This includes after-hours services and injury-related visits to ACC.

These initiatives are included within the Primary Health Organisations Services Agreement.

The following bulletins have information for General Practices, PHOs and DHBs regarding the new primary care initiatives from 1 December 2018.

More information about these changes, including previous bulletins, can be found on the Ministry of Health website and in the below PHO Services Agreement (version 6).

The changes provide additional subsidies so General Practices can charge patients low co-payments who need a standard day-time nurse or GP consultation. From 1 July 2019 these co-payments are no more than:

• $19.00 for enrolled adults
• $13.00 for enrolled youths aged 14-17

Access to low-cost general practice visits for Community Services Card holders

The Community Servcices Card (CSC) initiative applies to a standard daytime consultation with a GP or nurse at the usual practice where the patient is enrolled. After-hours and casual consultations are excluded from this policy.

Dependents of people with a CSC will also be able to access low-cost visits. This includes young people aged 14-17. Practices will be funded for dependants of CSC card holders aged 14-17 identified in the National Enrolment Service (NES).

VLCA practices

VLCA (very low cost access) practices will be paid on a capitated basis for enrolled CSC holders at the same rates as non-VLCA practices.

On 1 December 2018, all Access VLCA practices became Interim practices, which equalised the funding across VLCA practices. If you are an Access VLCA practice you do not need to do anything.

VLCA resources

Changes to Practice Management Systems (PMS)

As a result of extending access to primary care services, it will become more important for practices to have access to accurate information on the CSC entitlement status.

That's because more patients will present their cards and expect to receive discounted services. While most CSC cards will be linked to a patient in NES, practices will be able to link CSC cards to patients under some conditions.

 Zero fees for under-14s

The zero fees initiative applies to a standard daytime visit to a GP or nurse at the usual practice where the child is enrolled, or to a participating after-hours clinic.

DHBs are responsible for putting local arrangements in place to ensure after-hours services are available to 95 percent of the enrolled population within 60 minutes travel time to General Practice and pharmacy services. 

ACC-related primary care initiative changes

All practices will receive extra contributions from ACC to encourage them to provide zero fee visits for injured children aged under 14 and low-cost visits for CSC holders and their dependents aged 14-17.

Changes to ACC’s Cost of Treatment Regulations required public consultation and Cabinet approval.

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