Allied Mental Health Services - November 2011

Frequently Asked Questions

Page last updated: 31 October 2011

PDF printable version of Questions and Answers (PDF 56 KB)

1. Medicare Services Provided under the Better Access Initiative
1.1 What information is available about the allied mental health services Medicare items?
1.2 What allied mental health services can be provided under the Better Access Initiative?
1.3 What are Psychological Therapy services?
1.4 What are Focussed Psychological Strategies (FPS) services?

2. Patient Eligibility
2.1 Who can access services under this initiative?
2.2 How can an allied mental health professional check that a GP Mental Health Treatment Plan or a psychiatrist assessment and management plan is in place when a patient has been referred by their GP?
2.3 What requirements must a psychiatrist or paediatrician meet in order to refer a patient to the allied mental health Medicare services?

3. Provider Eligibility
3.1 Are publicly funded psychologists able to access the items?
3.2 How does a referring medical practitioner know whether an allied mental health professional is registered with Medicare Australia to provide Medicare rebateable services?
3.3 What are the provider eligibility requirements to provide Focussed Psychological Services (FPS) under this initiative?
3.4 What are the provider eligibility requirements to provide Psychological Therapy services under this initiative?

4. Referral
4.1 Do referring practitioners require a specific form to refer patients on to eligible allied mental health professionals for treatment?
4.2 When do patients need to get a new referral?
4.3 What are the requirements for allied mental health professionals to report back to the referring medical practitioner?
4.4 What if a patient has been referred inappropriately?

5. Claiming Restrictions
5.1 What are the Medicare rebates for the allied mental health items?
5.2 How many services can a patient receive under this initiative?
5.3 Must Medicare items for the relevant GP, psychiatrist or paediatrician services be claimed before a Medicare rebate can be paid for allied mental health services?
5.4 What about out-of-pocket expenses and Medicare safety net provisions?
5.5 What about patients with private health insurance cover?

6. Other initiatives
6.1 Are the GP Chronic Disease Management and individual allied health Medicare items still available?
6.2 Which items should I use if my patient has been referred using a CDM referral form?

7. Contact Details Top of page

1. Medicare Services Provided Under the Better Access Initiative

1.1 What information is available about the allied mental health services Medicare items?

Information on the allied mental health services items is available:
    • on the Department’s web site at www.health.gov.au (and use the ‘A-Z Index’ link to go to ‘Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS’ );
    • on the Department’s Mental Health and Well being web site at www.mentalhealth.gov.au (and use the ‘Programs and Initiatives’ link to go to ‘Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS‘);
    • under paragraphs M6.1 and M7.1 of the Explanatory Notes of the Medicare Benefits Schedule which can be found on-line at: http://www.mbsonline.gov.au/ and
    • by calling Medicare Australia on 132 150 (for providers) or 132 011 (for patients).
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1.2 What allied mental health services can be provided under the Better Access Initiative?

Allied mental health services that can be provided under this initiative include Psychological Therapy services provided by eligible clinical psychologists and Focussed Psychological Strategies services provided by eligible registered psychologists, social workers and occupational therapists.

Medicare items 80000, 80005, 80010, 80015 and 80020 are available to clinical psychologists providing psychological therapy services.

Medicare items 80100, 80105, 80110, 80115 and 80120 are available to registered psychologists providing focussed psychological strategies services.

Medicare items 80125, 80130, 80135, 80140 and 80145 are available to occupational therapists providing focussed psychological strategies services.

Medicare items 80150, 80155, 80160, 80165 and 80170 are available to social workers providing focussed psychological strategies services.

Medicare items 2721, 2723, 2725 and 2727 are available to general practitioners providing focused psychological strategies services.

1.3 What are Psychological Therapy services?

Psychological Therapy services offer a full intervention package for the patient’s condition. Clinical psychologists registered with Medicare Australia are able to provide Medicare rebateable Psychological Therapy services to eligible patients. In addition to psycho-education, it is recommended that cognitive behaviour therapy be provided. However, other evidence-based therapies, such as interpersonal therapy, may be used if considered clinically relevant.

1.4 What are Focussed Psychological Strategies (FPS) services?

A range of acceptable strategies has been approved for use by psychologists, occupational therapists or social workers (registered with Medicare Australia) using the FPS items. These are:
    • Psycho-education (including motivational interviewing);
    • Cognitive Behavioural Therapy (including behavioural interventions and cognitive interventions);
    • Relaxation strategies (including progressive muscle relaxation and controlled breathing);
    • Skills training (including problem-solving skills and training, anger management, social skills training, communications training, stress management, and parent management);
    • Interpersonal Therapy (especially for depression); and
    • Narrative therapy for Aboriginal and Torres Strait Islander people.

2. Patient Eligibility

2.1 Who can access services under this initiative?

These MBS rebateable services are available to patients with an assessed mental disorder who are referred by:
    • A General Practitioner who is managing the patient under a GP Mental Health Treatment Plan (item 2700, 2701, 2715 or 2717), or
    • A General Practitioner who is managing the patient under a referred psychiatrist assessment and management plan (item 291), or
    • A psychiatrist or paediatrician.
Please note: GPs do not have to complete another GP Mental Health Treatment Plan using one of the new items (2700, 2701, 2715 or 2717) if they are already managing a patient’s care needs using one of the former GP Mental Health Treatment Plan items (items 2702 and 2710) and this plan is still appropriate to the patient’s needs.

2.2 How can an allied mental health professional check that a GP Mental Health Treatment Plan or a psychiatrist assessment and management plan is in place when a patient has been referred by their GP?
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If unsure, the allied mental health professional should contact the referring GP. The allied mental health professional can also call Medicare Australia on 132 150 to confirm patient eligibility, however if the Medicare rebate has not yet been claimed by the GP (if the patient was bulk billed) or by the patient (if the GP invoiced the patient), Medicare will not know that the patient is eligible for the services.

2.3 What requirements must a psychiatrist or paediatrician meet in order to refer a patient to the allied mental health Medicare services?

Psychiatrists and paediatricians are not required to develop a specific Mental Health Treatment Plan in order to refer patients for allied mental health services, though the preparation of a Plan can be useful for the ongoing management of the patient.

In order to refer patients for allied mental health Medicare services, psychiatrists and paediatricians must first assess that the patient has a mental disorder that would benefit from the specific allied mental health services that can be provided using the Psychological Therapy and Focussed Psychological Strategies services items. The psychiatrist or paediatrician is then required to provide a letter of referral to the allied mental health professional.

This referral must be made from a Medicare billed service (any of the items 104 to 109 for specialist psychiatrists or paediatricians, items 293 to 370 for consultant psychiatrists or items 110 to 131 for consultant paediatricians) in order for Medicare to recognise that the patient is eligible for Medicare rebates for allied mental health services. It is also important to note that when billing any Medicare item, the specific requirements of that item must have been met.

3. Provider Eligibility

3.1 Are publicly funded psychologists able to access the items?

No. The Medicare mental health care items are available for services provided by health professionals working in private practice. This means that the items are not claimable by health services or individual providers working under arrangements which are already funded by the Australian or State Governments.

For example, if an individual allied mental health professional is receiving payment from a Division of General Practice as part of the Division’s Government-funded role or function, or providing services funded under an Australian Government program, such as Access to Allied Psychological Services (ATAPS), they are not able to also provide and claim for Medicare items for services under such programs. If an allied mental health professional employed under a Government-funded program also accessed Government funding through Medicare as part of that employment this would involve double-dipping.

However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory Government health clinic, these items can be claimed for services provided by eligible allied health professionals salaried by, or contracted to, the service as long as all requirements of the items are met, including registration with Medicare Australia. In this case, these services must be direct billed (that is, the Medicare rebate is accepted as full payment for services).

3.2 How does a referring medical practitioner know whether an allied mental health professional is registered with Medicare Australia to provide Medicare rebateable services?

The referring practitioner may either:
    1. contact the allied health professional to check their Medicare Australia registration status for the items; or
    2. get the information from the relevant professional bodies on their website or by phone.
3.3 What are the provider eligibility requirements to provide Focussed Psychological Services (FPS) under this initiative?
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All providers wishing to provide Psychological Therapy or Focussed Psychological Strategies services – Allied Mental Health using the Medicare items must be registered with Medicare Australia as meeting the eligibility requirements of the items.

A person is an allied health professional in relation to the provision of a focussed psychological strategies health services if the person meets one of the following requirements:
    1. the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in that State or Territory in which the service is provided;
    2. the person is a member of the Australia Association of Social Workers (AASW) and certified by AASW as meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008;
    3. the person:
      1. is a Full-Time Member, or a Part-time Member of Occupational Therapy Australia; and
      2. is, for a person who provides a focused psychological strategies health service in Queensland, Western Australia, South Australia or the Northern Territory, registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and
      3. has a minimum of 2 years experience in mental health; and
      4. has given an undertaking to Occupational Therapy Australia to observe the standards set out in the document published by Occupational Therapy Australia titled ‘Australia Competency Standards for Occupational Therapists in Mental Health’, as in force on 1 November 2006.
From 1 July 2011, new eligibility criteria for Better Access requires providers to have completed 10 hours FPS Continuing Professional Development (CPD) since 1 July 2009, and then annually, to remain eligible to provide FPS Medicare services.

A series of online one hour FPS CPD modules are available from the Australian Psychological Society, the Australian Association of Social Workers and Occupational Therapy Australia websites to assist providers complete their FPS CPD requirements. For more information visit http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-ba-focus

3.4 What are the provider eligibility requirements to provide Psychological Therapy services under this initiative?

All consultations providing psychological therapy services must be rendered by a clinical psychologist who is registered without limitation to provide clinical services under the applicable law in force in the State or Territory in which the service is provided, and be either:
    1. a member of the College of Clinical Psychologists of the Australian Psychological Society (APS) or;
    2. assessed by the APS as meeting the requirements for membership of that College and continues to meet those requirements; or
    3. endorsed by the Psychology Board of Australia to practice in clinical psychology.
The clinical psychologist must be registered with Medicare Australia.

4. Referral

4.1 Do referring practitioners require a specific form to refer patients on to eligible allied mental health professionals for treatment?

No. The referral may be a letter or note to an eligible allied mental health professional, signed and dated by the referring practitioner, but will preferably, and with the patient’s agreement, include a copy of the Mental Health Treatment Plan developed.
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4.2 When do patients need to get a new referral?

Patients need to get a new referral if they have a clinical need for additional services and:
    • they have used up all their referred services; or
    • they require further services in a new calendar year (not in the same course of treatment).
Referrals for allied mental health services do not become invalid at the end of a calendar year. These referrals remain valid for the stated number of services. If the services are not used during the calendar year in which the patient is referred, the unused services may be used in the next calendar year. However, they will be counted as part of the patient's calendar year limit for services in that calendar year.

Patients accessing Psychological Therapy services provided by clinical psychologists or Focussed Psychological Strategies services provided by GPs and allied mental health providers can still receive Medicare rebates for these services under former items 2702 and 2710 if these items are in place before
1 November 2011.

4.3 What are the requirements for allied mental health professionals to report back to the referring medical practitioner?

On completion of the initial group of up to six services, the allied mental health professional must provide a written report to the referring practitioner. The report must contain information on assessments carried out on the patient, treatment provided, and recommendations on future management of the patient’s disorder. Following receipt of this report, the referring practitioner will consider the need for further treatment, before further allied mental health services may be provided.

A written report must also be provided to the referring medical practitioner at the completion of any subsequent course(s) of treatment provided to the patient.

4.4 What if a patient has been referred inappropriately?

If an allied mental health professional considers that a patient has been referred to them inappropriately, they should advise the GP that in their clinical opinion the patient is not suffering from a mental disorder, and it would not be appropriate to claim the Medicare items.

They can however, continue to see the patient privately, but not access Medicare subsidies for their services.

5. Claiming Restrictions

5.1 What are the Medicare rebates for the allied mental health items?
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The patient rebates for the allied mental health items vary and are dependent on:
    • the professional providing the services;
    • the length of the service;
    • whether the service is provided in consulting rooms or at another location; and
    • whether the service provided is a group or individual service.
5.2 How many services can a patient receive under this initiative?

Eligible patients can receive up to ten individual services in a calendar year. The ten services may be made up of Psychological Therapy services or FPS (provided by allied mental health professionals or GPs) or a mix of both.

In addition, eligible patients may also be able to receive up to ten group therapy services in a calendar year where such services are possible and seen as appropriate by the provider. This maximum of ten group services may be made up of Psychological Therapy services, FPS allied mental health services, or a mix of both.

On completion of a course of treatment (which is a maximum of 6 individual or group services, but could cover less depending on the nature of the referral), the allied health professional is required to complete a report to the referring medical practitioner. Once this report has been received, the patient’s referring practitioner must assess the patient’s need for additional services before further services may be provided.

Services provided under ATAPS should not be used in addition to the ten psychological therapy services (items 80000 to 80020), focused psychological services-allied mental health services (items 80100 to 80170) or GP focused psychological strategies services (items 2721 to 2727) available under Better Access per calendar year. Allied mental health professionals delivering services under the ATAPS program should refer to the ATAPS Operational Guidelines.

5.3 Must Medicare items for the relevant GP, psychiatrist or paediatrician services be claimed before a Medicare rebate can be paid for allied mental health services?

Yes. Psychological Therapy and FPS services provided by allied mental health professionals will not attract a Medicare rebate unless they are provided after the relevant GP, psychiatrist or paediatrician service is complete, and a rebate for these services cannot be provided until after the appropriate referral item has been claimed.
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This means that, before a Medicare rebate can be paid for allied mental health service, the patient must have already claimed a Medicare rebate for either:
    • MBS item 2700, 2701, 2715 or 2717 (Preparation of a GP Mental Health Treatment Plan from 1 November 2011),
    • MBS item 2702 or 2710 (Preparation of a GP Mental Health Treatment Plan prior to 1 November 2011),
    • MBS item 291 (psychiatrist assessment and management plan) or the relevant specialist psychiatrist or paediatrician items (104 – 109 inclusive), or
    • consultant psychiatrist items (293 - 370 inclusive) or consultant paediatrician items (110 - 131 inclusive).
Alternatively, if the referring practitioner bulk-bills the patient, the GP, psychiatrist or paediatrician must have already lodged a claim for direct payment from Medicare for the relevant item.

Where the referring practitioner bulk-bills patients, it may sometimes happen that a patient will have their first referred allied mental health service before the practitioner has actually lodged a Medicare claim for direct payment. When this happens, Medicare will be unable to process the patient’s claim (or allied mental health professional’s claim for direct payment) until after the referring practitioner’s claim is submitted.

5.4 What about out-of-pocket expenses and Medicare safety net provisions?

Charges in excess of the Medicare benefit for items under this initiative are the responsibility of the patient. However, such out-of-pocket costs will count toward the Medicare safety net for that patient.

5.5 What about patients with private health insurance cover?

Patients need to decide if they will use Medicare or their private health insurance to pay for these services. Patients with appropriate private health insurance can either: access rebates from Medicare under the allied mental health items by following the claiming process; or receive services from allied mental health professionals and claim, where eligible, on their private insurance, but not both.

Patients cannot use their private health insurance ancillary cover to top up the Medicare rebates paid for these services. It is important for patients to check with their health fund what services are covered by their private health insurance (if any) and what their out-of-pocket expenses are likely to be.
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When patients have accessed all available services under this initiative, provided they are eligible, they may claim on their private health insurance for services in excess of the maximum available under Medicare.

6. Other Initiatives

6.1 Are the GP Chronic Disease Management and individual allied health Medicare items still available?

Yes. The GP Chronic Disease Management (CDM) Medicare items (MBS items 721-732) continue to be available for patients with a chronic or terminal medical condition, including patients requiring multidisciplinary care. The CDM individual allied health items (MBS items 10950-10970) remain available to patients being managed under the relevant CDM items.

Allied health providers managing patients under the CDM Allied Health initiative should continue to manage their patients using the relevant items.

It is anticipated that patients with a mental disorder only, who require a GP Mental Health Treatment Plan to be prepared, will be managed under the GP Mental Health Treatment items.

6.2 Which items should I use if my patient has been referred using a CDM referral form?

If a patient is being managed through the CDM items and has been referred to you using a CDM referral form for individual allied health services under Medicare, there are specific item numbers that should be claimed (MBS items 10950 – 10970). You should refer to the Medicare Benefits Schedule for Allied Health Services for more detail on which item number is relevant to your professional group.

You cannot bill Medicare item numbers 80000 – 80170 where the patient has been referred to you through the CDM Medicare items.

7. Contact Details

MBS Online
www.mbsonline.gov.au

Medicare Australia
http://www.medicareaustralia.gov.au
Phone: 132 150 (provider enquiries)
Phone: 132 011 (public enquiries)

The Department of Health and Ageing
www.health.gov.au
(use the ‘A-Z Listing’ link to go to ‘Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS’ )
    Australian Psychological Society
    www.psychology.org.au
    Phone: 1800 333 497

    Australian Association of Social Workers
    www.aasw.asn.au
    Phone: 1800 630 124

    Occupational Therapy Australia
    www.ausot.com.au
    Phone: (03) 9415 2900

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