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Community Services Card and Zero Fees for Under 14s

  • Information to support DHBs, PHOs and general practices implement the new subsidies for Community Services Card (CSC) holders and 13 year olds.

What are the Changes?

From 1 December 2018, several changes will take 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 CSC holders. This includes injury-related visits (ACC)
  • Extending CSC eligibility to all people receiving the accommodation supplement or who are tenants in social housing
  • Extending 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 (ACC).

These initiatives are included within the PHO Services Agreement. The changes provide additional subsidies to enable general practices to charge patients no more than $18.50 for enrolled adults and $12.50 for enrolled youth aged 14-17 for a standard day time nurse or GP consultation.

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

The 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 to 17. Practices will be funded for dependants of CSC card holders aged 14-17 identified in the National Enrolment Service (NES).

VLCA practices

VLCA practices will be paid on a capitated basis for enrolled CSC holders at the same rates as non-VLCA practices.

As of 1 December 2018, all Access VLCA practices will become Interim practices, which equalises the funding across VLCA practices. If you are an Access VLCA practice you do not need to do anything.

Changes to PMS systems

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, as more patients will be presenting their cards and expecting 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. Detail will follow in future updates.

PMS vendors are currently working on the changes required, and system updates are expected be available before 1 December 2018. 

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. Arrangements for zero fees for under-13s will be extended to include 13-year-olds.

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 dependants aged 14-17 years.

Changes to ACC’s Cost of Treatment Regulations require public consultation and Cabinet approval. PMS vendors will be contacted by ACC this month with the information required to update their systems in advance of implementation. Once Cabinet has approved the regulation changes, ACC will provide PHOs and practices with confirmation of rates and processes, so practices can invoice at the correct rates from 1 December 2018.

Bulletin links

Bulletin 2 - October 12, 2018

Bulletin 1 – October 5, 2018