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Questions and answers: New transition arrangements for the allied mental health services available under the Better Access initiative

Questions and answers about transition arrangements for the allied mental health services available under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative.

Questions and answers: New transition arrangements for the allied mental health services available under the Better Access initiative (PDF 65 KB)

• Q1. How many allied mental health services can I receive under Better Access?
• Q2. Why did the Australian Government make changes to the Better Access allied mental health services in the 2011-12 budget?
• Q3. Why did the Australian Government decide to reinstate for the 2012 calendar year an additional six sessions for people in 'exceptional circumstances'?
• Q4. Why is the Australian Government reinstating the additional six allied mental health sessions under 'exceptional circumstances' for a limited period only?
• Q5. Why didn't the Australian Government reverse its 2011-12 budget decision and allow people to be able to access 12 individual allied mental health services (and up to 18 services in 'exceptional circumstances')?
• Q6. When will I be able to start to receive sessions under 'exceptional circumstances' and when will it end?
• Q7. What criteria do people need to meet to be eligible to receive an additional six allied mental health services under 'exceptional circumstances'?
• Q8. What does a GP have to do to refer an individual for an additional six allied mental health services under 'exceptional circumstances'?
• Q9. What provisions is the Australian Government making to meet the needs of people with more severe and complex mental disorders?
• Q10. Where can I get further information about the Better Access mental health Medicare items?

Q1. How many allied mental health services can I receive under Better Access?

Medicare rebates are available for up to 10 individual allied mental health services in a calendar year. These 10 services may consist of:

• GP focussed psychological strategies services and/or
• Psychological therapy services provided by clinical psychologists and/or
• Focussed psychological strategies services provided by appropriately trained psychologists, social workers and occupational therapists.

Individuals will also be able to access an additional six allied mental health services available under 'exceptional circumstances' for a limited period to a maximum of 16 services for the 2012 calendar year.

Individuals are able to receive Medicare rebates for up to 10 group therapy services per calendar year, on top of their individual allied mental health services. Top of page

Q2. Why did the Australian Government make changes to the Better Access allied mental health services in the 2011-12 budget?

In the 2011-12 budget, changes to the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (Better Access) initiative were announced as part of the Delivering National Mental Health Reform budget package. These included the reduction in the number of rebates available for allied health services from 12 (up to 18 in 'exceptional circumstances') to 10 for individuals each calendar year.

These changes took effect on 1 November 2011.

The government made these changes because it was concerned that while Better Access is a good program for those it is reaching, it is still not servicing hard to reach groups like young people, men, people living in rural and remote regions, Indigenous Australians and people living in areas of high socioeconomic disadvantage.

In rural Australia – and especially in remote areas – service levels drop off dramatically. The recent Better Access evaluation showed that use of services was approximately 12% lower for people in rural areas and approximately 60% lower for people in remote areas, compared to people living in capital cities.

In addition, the evaluation showed that people on lower incomes received both significantly less services and funding under Better Access than those on higher incomes: use of Better Access services was approximately 10% lower for people living in the most socio-economically disadvantaged areas (48.5 persons per 1,000 population in 2009) compared to people living in relatively more advantaged areas (between 52.4 and 53.6 persons per 1,000 population in 2009).

All the savings generated from the changes to Better Access are being reinvested in mental health, enabling additional mental health services to better serve some of the most disadvantaged people and their carers, through services provided at low or no cost to the consumer and through innovative and expanded services delivered in a primary care setting. This means more services for young people, more services for people living in the bush and coordinated care services for people who are living with severe and chronic mental illness.

Better Access commenced in 2006 at a (then) estimated cost of $442.5 million over the first four years. Actual expenditure totalled $2.02 billion in the first five years from its introduction in 2006 to June 2011.

Growth in outlays may slow down as a result of the 2011-12 budget changes, but uptake and costs of this demand driven program will continue to rise. In the context of the evaluation findings and other data about Better Access usage, and the current fiscal environment, the government will redirect a proportion of the more than $4 billion which is otherwise projected to be spent on this program over the next five years, to services that are targeted to those people most in need.

The government wants all Australians living with mental illness to be able to access the care and support that they need. The changes to Better Access strike the right balance and enable the government to invest in more services for more Australians.

For example, the Access to Allied Psychological Service (ATAPS) program is aimed at targeting those groups that Better Access does not reach very well and provides low to no cost services. Funding for ATAPS is being doubled over the next five years. Additional ATAPS services are already being rolled out across Australia with funding increasing by 87 per cent from 2010-11 to 2011-12.

The government is also investing in and expanding a range of mental health services, including:

• 30 more youth friendly headspace services
• 16 new early psychosis prevention intervention centres
• doubling the number of family mental health services and
• a new online mental health clinic and portal (e mental health) to provide a one stop online shop for information and support so that people can access evidence based services anytime and anywhere. Top of page

Q3. Why did the Australian Government decide to reinstate for the 2012 calendar year an additional six sessions for people in 'exceptional circumstances'?

Better Access was neither designed nor intended to provide intensive, ongoing therapy for people with severe and persistent mental illness. However, the Australian Government acknowledges that there are some people with more complex needs who are using the services provided under the Better Access initiative.

The government acknowledges that reducing the number of allied mental health services for which people can receive a Medicare rebate has caused some community concern, as evidenced by the large number of submissions to the Senate Community Affairs References Committee Inquiry into Commonwealth Funding and Administration of Mental Health Services. The government has listened to those concerns.

The government recognises that some of the new mental health services announced as part of the Delivering National Mental Health Reform 2011-12 budget package need time to build further capacity before they are able to provide support to people with more complex needs or people with severe and persistent mental illness.

Q4. Why is the Australian Government reinstating the additional six allied mental health sessions under 'exceptional circumstances' for a limited period only?

The reintroduction of 'exceptional circumstances' up to 31 December 2012 provides more time for allied mental health professionals and consumers to adapt to the new arrangements. It also provides time for the new mental health services to be able to build capacity to effectively respond to the needs of people with more complex needs.

The government did not take the decision to make the 2011-12 budget changes to Medicare services lightly, but identified that given the tight fiscal environment it had a responsibility to ensure that its investments were appropriately targeted to best meet the needs of the community.

Funding from Better Access is being redirected to services for some of the most disadvantaged in the community. This means more services for young people, more services for people living in the bush and coordinated services for people who are living with severe and chronic mental illness.

At the same time, as a demand driven program, Better Access will continue to grow and will continue to benefit an increasing number of people with mild to moderate illness.

Consistent with the current fiscal environment, the cost of the transition arrangements for the Better Access allied mental health services is also required to be offset through adjustments to government expenditure. Top of page

Q5. Why didn't the Australian Government reverse its 2011-12 budget decision and allow people to be able to access 12 individual allied mental health services (and up to 18 services in 'exceptional circumstances')?

The standard number of allied mental health services for which people can receive a Medicare rebate will continue to be 10 individual services per patient per calendar year as the services provided under Better Access are targeted at people with diagnosed mental disorders of mild to moderate severity where short term evidence-based interventions are most likely to be useful.

The findings of the Better Access evaluation showed that almost three-quarters of people who access services used between one and six sessions a year and the majority (87 per cent) of current Better Access users received between one and 10 sessions.

This means that the vast majority of people who benefit from Better Access services will continue to get the treatment they need, and in the longer term the funding is still available for other services.

Q6. When will I be able to start to receive sessions under ‘exceptional circumstances’ and when will it end?

From 1 January 2012, people are eligible for 10 Medicare rebatable individual allied mental health services if required.

From 1 March 2012 until 31 December 2012, individuals will be eligible for an additional 6 sessions in 'exceptional circumstances'. This means that eligible individuals will be able to access up to 16 services in the 2012 calendar year.

Legislative changes to enable this are currently being prepared. Further information and details of the legislative changes will be available early in 2012.

Q7. What criteria do people need to meet to be eligible to receive an additional six allied mental health services under 'exceptional circumstances'?

The definition of 'exceptional circumstances' is the same as applied before the reforms to Better Access that took effect from 1 November 2011.

'Exceptional circumstances' are defined as a significant change in the patient's clinical condition or care circumstances which makes it appropriate and necessary to increase the maximum number of services.

As was the case previously, it is up to the referring medical practitioner to determine that the individual meets the requirements for 'exceptional circumstances' and to provide a referral for the additional services. Top of page

Q8. What does a GP have to do to refer an individual for an additional six allied mental health services under 'exceptional circumstances'?

For the 2012 calendar year, a further referral can be made for up to an additional six services in 'exceptional circumstances' (to a maximum of 16 individual allied mental health services per calendar year).

As was the case previously, it is up to the referring practitioner (e.g. GP) to determine whether a patient meets the 'exceptional circumstances' requirements. The number of services that the patient is being referred for is at the discretion of the referring GP.

Where referrals are provided in 'exceptional circumstances', both the patient's mental health treatment plan and referral should be noted by the GP to indicate why the additional services were required. The referral may be a letter or note to an eligible allied health professional signed and dated by the referring GP.

Invoices for services provided under 'exceptional circumstances' must state that 'exceptional circumstances' apply.

Q9. What provisions is the Australian Government making to meet the needs of people with more severe and complex mental disorders?

It is important that people get the right care for their needs. People who currently receive more than 10 allied mental health services under Better Access are likely to be people with more complex needs and would be better suited to referral to more appropriate mental health services.

GPs can continue to refer those people with more severe ongoing mental disorders to Medicare-subsidised consultant psychiatrist services, where 50 sessions can be provided per year, or state/ territory specialised mental health services.

To help make psychiatrist services available in more areas, from 1 July 2011 the government has been providing new Medicare rebates for video psychiatrist consultations for patients living in regional, remote and outer metropolitan areas. GPs, specialists and other health professionals will be provided with financial incentives to help deliver these online services and funding will also be provided to support training and supervision for health professionals.

The Australian Government has announced an investment of $549.8 million over five years in the Partners in Recovery: Coordinated Support and Flexible Funding for People with Severe, Persistent Mental Illness and Complex Needs initiative. This will provide eligible individuals with a single point of contact, a care facilitator, and will assist about 24,000 people and their families.

The government has also announced $200 million over five years (2011-12 to 2015-16) for a national partnership (NP) with states and territories. This will assist people with severe and persistent mental illness and complex care needs who need stable accommodation and support to keep well and break the hospital cycle, and to improve presentation, admission and discharge planning and support for people with a mental illness who frequently present at emergency departments.

The government is also expanding proven community support services like the Day to Day Living and Personal Helpers and Mentors programs, which target people with severe and persistent mental illness.

Individuals are encouraged to discuss their ongoing mental health care needs with their GP and allied mental health professional and discuss what other options might be available to them. Top of page

Q10. Where can I get further information about the Better Access mental health Medicare items?

Information on the allied mental health Medicare items is available on the Department of Health and Ageing's Better Access web page.

Further information in relation to the transition arrangements to the Better Access initiative will be made available in early 2012. If you have any queries, please email Better Access at betteraccess@health.gov.au

For more detailed information about MBS item descriptors and explanatory notes, visit the Department of Health and Ageing's MBS Online website.

Information regarding eligibility, claiming and payment processes can be obtained from Medicare Australia on 132 150 (providers) or 132 011 (patients) or by visiting the Department of Human Services website.

February 2012