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Gender Affirming Hormone Therapy

Funding for the initiation and subsequent maintenance of Gender-affirming Hormone Therapy (GAHT) in primary care is now available for extended consultations via POAC.

Funding Criteria

·       A single extended consultation per patient can be claimed for initiation.

- Initiation is considered as the first GAHT appointment or reinstatement of GAHT with clinical discretion.

·       Up to 4 subsequent follow-up (maintenance) appointments can be claimed within the first 12 months following the onset of GAHT initiation.

·       The GAHT initiation must occur in general practice to claim funding for subsequent follow-up appointments.

·       A patient co-payment may be charged at the practice’s discretion.

·       All clinicians within general practice can claim funding for the delivery of GAHT.

Eligibility

·       Patients must be 18 years and over.

·       Patient is eligible for publicly funded health services in New Zealand (as per Te Whatu Ora criteria) https://www.tewhatuora.govt.nz/our-health-system/eligibility-for-publicly-funded-health-services/guide-to-eligibility-for-public-health-services/

·       Funded follow-up appointments must occur within 12 months of the initiation appointment.

·       Enrolment with that, or any, practice is not a requirement.

·       Funding is available for all practices within the Auckland Metro Region (Te Toka Tumai Auckland, Counties Manukau, Waitematā districts).

Provider Claiming

·        Claiming will be made via the POAC PMS claiming portal.

·       Providers will submit a ‘New Referral’ using the date of initial consultation and select code ‘Gender Affirming Hormone Therapy.’

·       Following consultation, the provider will submit an ‘invoice’ via the claiming portal and select from the two consult options:

1.     Initial appointment: $100.00 (excl GST)

2.     Follow-up appointment: $50.00 (excl GST)

·       Clinical notes should not be provided - any clinical information will be immediately deleted from the POAC system.

·       Claims can be backdated to 1st December 2023.

Clinicians are encouraged to refer to: Gender Diversity and Transgender Health Pathway

Contact:

For service information:

Contact Emma Pickles, Auckland PHO

 emma@aucklandpho.co.nz 

For claiming queries:

Email: accounts@poac.co.nz

 

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