Care Coordination

The Care Coordination Supplementary Service (CCSS) provides a culturally safe service for Aboriginal and Torres Strait Islander people with chronic health conditions.

Our care coordination team walks alongside you to access services, manage your symptoms, and empower you to make deadly choices about your wellbeing and care.

MATSICHS Care Coordination team member in car

Who can access CSSS?

CCSS is free for Aboriginal and Torres Strait Islander clients of all ages who:

are enrolled for chronic disease management in a mainstream general practice or Aboriginal Medical Service / ACCHO
have a care plan
have a chronic disease

Care coordination services

Our deadly team can support you with:

access and coordination of clinical care
assisting you to attend appointments
arranging services like allied health
ensuring medical records are complete and current
ensuring regular reviews are undertaken by your healthcare team
understanding your chronic health condition and how to best manage it
reminding you to attend regular review appointments with your GP and other health-related appointments
providing support to identify signs that your condition may need further management.

We can assist with the costs of:

fees for services by allied health providers (when MBS rebates are not available, for example. no bulk billing)
paying the gap payment (the difference between the MBS rebate and the fees charged) for specialist and allied health providers
transport to medical appointments
the purchase of medical aids including assistive breathing equipment (e.g. CPAP machines and accessories.

Who are we?

Our team of care coordinators include nurses, Aboriginal and Torres Strait Islander health workers and other team members who specialise in Indigenous health.

The team will support you to access services included in your care plans, and they will work with you and your GP to achieve the best health outcomes for you.

Where to start?

For Mob connected to an Aboriginal Medical Service, or mainstream practice, please contact your GP to yarn about a referral to the CCSS program. The GP is required provide the following:

a signed CCSS consent/referral form, available from IUIH’s CSS GP Information page.
GP management plan and team care arrangements (MBS 721 and 723)
Indigenous Health Assessment (MBS 715), with allied health follow-up.