Dose Administration Aids
For the purpose of this program a Dose Administration Aid (DAA) is defined as a well-sealed, tamper-evident device that allows individual medicine doses to be organised according to the prescribed dose schedule. There are a number of commercially available products on the market.
This program specifically relates to the DAA service delivery to patients living within the community and excludes patients who reside in Government funded Residential Aged Care Facilities (RACF) or correctional facilities.
To be eligible to receive payments under the DAA Program, a community pharmacy must:
- be approved under Section 90 of the National Health Act;
- be accredited by an approved Pharmacy Accreditation Program such as the Quality Care Pharmacy Program (QCPP);
- agree to publicly display and comply with the Community Pharmacy Service Charter and Customer Service Statement;
- abide by the 6CPA General Terms and Conditions;
- deliver DAA services in accordance with the current version of the 6CPA DAA Program Rules and relevant Professional Standards and Pharmacy Board Guidelines;
- register for the program via the 6CPA Registration and Claiming Portal;
- continue to meet the eligibility criteria outlined in clause 3.1 of the Program Rules while participating in the DAA Program.
To be eligible for a DAA service under the 6CPA, a patient must:
- is a Medicare Card and/or Department of Veterans’ Affairs (DVA) cardholder or a person who is eligible for a Medicare card;
- have a valid Government issued Concession Card; and
- live at home in a community setting; and
- have difficulties managing their medications due to literacy or language issues, physical disability or cognitive difficulties; or
- is taking five or more prescription medicines and is experiencing difficulties with medication management.
DAA services funded under this Program are not available to in-patients of public or private hospitals, day hospital facilities, transitional care facilities, residents of an Aged Care Facility or patients in a correctional facility.
DAA services funded under this Program are not available to patients receiving DAA services funded under other Federal or State and Territory Government Programs. Claims cannot be made for DAA Services provided as part of the DVA DAA Program or the 6CPA QUMAX Program.
Funding of $100 million is available in the 2017/18 financial year to allow DAA Service Providers to provide services. To ensure the funding remains within the budget allocation the following measures will apply:
a) All Approved DAA Service Providers will be allocated an individual cap based on previous DAA Service volumes recorded and claimed under the Pharmacy Practice Incentive Program prior to 30 June 2017 (the most recent 12 month claiming period will be used to calculate the cap).
b) Approved DAA Service providers who recorded and claimed greater than 200 DAAs patient per week under the Pharmacy Practice Incentive Program prior to 30 June 2017 will receive an upper limit cap of 200 DAAs.
Note: Special capping arrangements at a level of no more than 60% of previous DAA service volumes recorded and claimed under the Pharmacy Practice Incentive Program prior to 30 June 2017 may be put in place for Approved DAA Service Providers who previously recorded and claimed greater than 400 DAAs.
Caps will be monitored and may be modified to ensure the funding does not exceed $100 million.
Claiming and Payments
Pharmacy Practice Incentive (PPI) payments for Dose Administration Aids (DAAs) end on 30 June 2017. PPI claims for DAAs provided in June 2017 must be submitted between 1 July and 14 July 2017.
From 1 July 2017, DAA Services must be claimed by the end of the next calendar month (e.g. DAA services undertaken in March must be claimed by 30 April). Claims submitted outside this timeframe will not be paid and cannot be resubmitted.
From 1 February 2018, Service Providers participating in the DAA Program will be required to collect and provide patient data for five patients receiving a DAA service under the 6CPA Program to monitor the Program’s delivery of health outcomes for patients. This information will be collected and submitted in accordance with Attachment A of the Program Rules. This information will be required at the initial patient registration and at six monthly intervals. Service Providers will need to attach this to their claim as well as indicating the number of eligible DAAs provided during the claiming period.
Please note that there will be a template for the collection of patient data at the registration stage and a separate template for the collection of patient data at the six month follow up.
An Approved DAA Service Provider may submit claims on monthly basis for providing DAA Services which meet the patient eligibility criteria and the following criteria:
- the patient’s medicine/s in the DAA are dispensed and packed in the pharmacy by the claiming Approved DAA Service Provider in accordance with the relevant quality standard; or
- the patient’s medicine/s in the DAA are dispensed by the claiming Approved DAA Service Provider but are packed at another site which meets the pharmacy approval authority requirements in the relevant State or Territory as well as the relevant quality standard.
DAA services must be claimed by the end of the next calendar month (e.g. services undertaken in March must be claimed by 30 April). Claims submitted outside this timeframe will not be paid and cannot be resubmitted.
Note – for the purposes of claiming, a DAA service is the provision of DAA for an eligible patient for a week, irrespective of the number of packs a patient may require in a week. For clarity:
- if a patient returns home from hospital mid-week and is provided a DAA for the remaining half of the week, this is equivalent to one service
- if a pharmacy supplies a DAA and is then notified by the prescriber mid-week about a medicine change with a request for urgent re-packing for the remainder of the week, this is equivalent to one service.
From 1 July 2017, the following information must be provided to the 6CPA Administrator in order to claim a payment under this Program for the provision of a weekly DAA service:
a) Section 90 approval number;
b) Pharmacy Accreditation ID;
c) Number of eligible DAA services provided; and
d) A declaration by the claiming Approved DAA Service Provider that the patient satisfies the eligibility criteria outlined in clause 3.2 of the Program Rules, including confirmation of patient consent, as required.
From 1 February 2018, the following information must be provided to the 6CPA Administrator in order to claim a payment under this Program for the provision of a weekly DAA service:
a) Section 90 approval number;
b) Pharmacy Accreditation ID;
c) Patient’s Medicare/DVA Card Number;
d) Date(s) of provision of the DAA; and
e) A declaration by the claiming Approved DAA Service Provider that the patient satisfies the eligibility criteria outlined in clause 3.2 of the Program Rules, including confirmation of patient consent, as required.
All information collected in Attachment A must be provided to the 6CPA Administrator in order to claim a payment under this program for the collection of data for five (5) patients at Patient Registration and Six Month Follow Up.
Claims for payment under the 6CPA DAA scheme will utilise an assumption that there are a maximum of 5 weeks of DAA packing in any month (depending on the pharmacies individual circumstances). This methodology will be referred to as the 5x cap method.
When processing claims under this program, the assumption will be that the maximum amount of DAAs
that can be claimed in any one month would be 5 times the weekly cap.
There will be a six monthly reconciliation process undertaken to ensure that payments to Service Providers remain within individual caps. The reconciliation process will take place in January and July of each year (the reconciliation process includes the periods 1 July–31 December and 1 January–30 June).
Further information about this process can be found in the Reconciliation Process for DAAA Program factsheet.
Claims that are submitted with incomplete information or incorrect patient details will be required to be amended within thirty (30) days of the amendment notification. Claims that are not amended within thirty (30) days of the amendment notification will not be paid.
Claims that are submitted outside the required timeframe (by the end of the following calendar month) cannot be resubmitted.
From 1 July 2017, participating Service Providers are eligible to receive the following payments as part of the 6CPA DAA Program:
|$6.00||Provision of weekly DAA service for all eligible patients who receive a DAA service.|
From 1 February 2018, participating Service Providers may claim additional fees for the collection and provision of health outcome data provided to the 6CPA Administrator in accordance with Attachment A of the DAA Program Rules:
|$31.90||Collection of data at Patient Registration (for five patients)|
|$31.90||Collection of data at six month follow up (for five patients)|
Record Keeping and Auditing
Service Providers participating in 6CPA Programs must keep all relevant records for seven (7) years, inclusive of service records, claim records and patient information for Program evaluation. The records may be electronic or hard copy.
The Department of Health is responsible for auditing 6CPA Programs. Anomalies observed by the 6CPA Administrator will be reported to the Department. If an audit is conducted, the Service Provider will be required to produce supporting documentation within a specified timeframe. Service Providers found to be in breach of the Program Rules may be subject to harsh penalties.