Wellness & Lifestyles is fully equipped to service clients in the community or aged care facilities who are on Chronic Disease Management (CDM) Plans using our bulk-billing software Pracsoft.

Medicare benefits are available for a range of specified allied health services for certain patients.  To receive allied health services patients must be referred by a medical practitioner (including general practitioner, specialist or consultant physician).  Patients who have a chronic medical condition and complex care needs may be eligible for up to 5 individual allied health services.  Patients who have Type 2 Diabetes may be eligible for one individual assessment and up to 8 group sessions.  Patients with an assessed mental disorder may be eligible for 12 individual services and up to 12 group therapy services.

All Wellness & Lifestyles allied health professionals have Medicare provider numbers and are eligible to provide services under Medicare.

Psychological therapy services for patients with an assessed mental disorder

Provision of psychological therapy services by clinical psychologists (Items 80000 to 80020).

OVERVIEW
The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative commenced on 1 November 2006. Under the Better Access initiative MBS items provide Medicare benefits for the following allied mental health services:

• psychological therapy (items 80000 to 80020) − provided by eligible clinical psychologists; and
• focussed psychological strategies – allied mental health (items 80100 to 80170) − provided by eligible psychologists, occupational therapists and social workers (refer to Part 5).

PSYCHOLOGICAL THERAPY SERVICES ATTRACTING MEDICARE REBATES
Eligible psychological therapy services
There are five MBS items for the provision of psychological therapy services to eligible patients by a clinical psychologist. The clinical psychologists must meet the provider eligibility requirements set out below and be registered with Medicare Australia.

In these notes, ‘GP’ means a medical practitioner, including a general practitioner, but not including a specialist or consultant physician.

Services provided under the Psychological Therapy items will not attract a Medicare rebate unless:

• a referral has been made by a GP who is managing the patient under a GP Mental Health Care Plan (item 2710);
• a referral has been made by a GP who is managing the patient under a referred psychiatrist assessment and management plan (item 291); or
• a referral has been made by a psychiatrist or paediatrician from an eligible psychiatric or paediatric service (see Referral Requirements for further details regarding psychiatrist and paediatrician referrals).

Number of services per year
Medicare rebates are available for up to twelve individual allied mental health services in a calendar year. These twelve services may consist of: GP focussed psychological strategies services (items 2721 to 2727); and/or psychological therapy services (items 80000 to 80015); and/or focussed psychological strategies − allied mental health services (items 80100 to 80115; 80125 to 80140; 80150 to 80165; and/or Access to Allied Psychological Services (ATAPS) consultations under the Better Outcomes in Mental Health Care Program. Referrals should be provided, as required, in one or more groups of up to six sessions.

In addition, the referring practitioner may consider that in exceptional circumstances the patient may require an additional six individual psychological therapy or focused psychological strategies services above those already provided (to a maximum total of 18 individual services per patient per calendar year). Exceptional circumstances are defined as a significant change in the patient’s clinical condition or care circumstances which make it appropriate and necessary to increase the maximum number of services. It is up to the referring practitioner to determine that the patient meets these requirements. In these cases a new referral should be provided, and exceptional circumstances noted in that referral. Invoices for services provided under exceptional circumstances must state that exceptional circumstances apply.

Patients will also be eligible to claim up to 12 separate services within a calendar year for group therapy services involving 6-10 patients to which items 80020 (psychological therapy – clinical psychologist), 80120 (focussed psychological strategies – psychologist), 80145 (focussed psychological strategies – occupational therapist) and 80170 (focussed psychological strategies – social worker) apply. These group services are separate from the individual services and do not count towards the 12 services per calendar year maximum associated with those items.

Service length and type
Services provided by eligible clinical psychologists under these items must be within the specified time period within the item descriptor. The clinical psychologist must personally attend the patient.

It is expected that professional attendances at places other than consulting rooms would be provided where treatment in other environments is necessary to achieve therapeutic outcomes.

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.

Course of treatment and reporting back to the referring medical practitioner
Patients are eligible to receive up to twelve individual services (up to eighteen in exceptional circumstances) and up to twelve group sessions in a calendar year.

Within this maximum service allocation, the clinical psychologist can provide one or more courses of treatment. For the purposes of the allied mental health items, a course of treatment consists of up to six services (but may involve less than six depending on the referral). This enables the referring medical practitioner to consider a report from the clinical psychologist on the services provided to the patient, and the need for further treatment.

On completion of the initial course of treatment, the clinical psychologist must provide a written report to the referring medical practitioner, which includes information on:

• assessments carried out on the patient;
• treatment provided; and
• recommendations on future management of the patient’s disorder.

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. Following receipt of this report, the referring practitioner will consider the need for further treatment, before further allied mental health services may be provided.

Out-of-pocket expenses and Medicare safety net
Charges in excess of the Medicare benefit for these items are the responsibility of the patient.  However, such out-of-pocket costs will count toward the Medicare safety net for that patient.  Any psychological therapy services and/or focussed psychological strategies − allied mental health services that are in excess of the entitlement of twelve (12) individual services (apart from where exceptional circumstances apply) and twelve (12) group sessions in a calendar year will not attract a Medicare benefit and the safety net arrangements will not apply to costs incurred by the patient for such services.

Eligible patients
Items 80000 to 80020 (inclusive) apply to people with an assessed mental disorder and where the patient is referred by a GP who is managing the patient under a GP Mental Health Care Plan (item 2710), or under a referred psychiatrist assessment and management plan (item 291); or on referral by a psychiatrist or paediatrician from an eligible service.

The conditions classified as mental disorders for the purposes of these services are informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. For the purposes of these items, dementia, delirium, tobacco use disorder and mental retardation are not regarded as a mental disorder.

Checking patient eligibility for psychological therapy services
Patients seeking Medicare rebates for psychological therapy services will need to have a referral from a GP, psychiatrist or paediatrician. If there is any doubt about a patient’s eligibility, Medicare Australia will be able to confirm whether a GP Mental Health Care Plan; and/or a psychiatrist assessment and management plan is in place and claimed; or an eligible psychiatric or paediatric service has been claimed, as well as the number of allied mental health services already claimed by the patient during the calendar year.

Clinical psychologists can call Medicare Australia on 132 150 to check this information, while patients can seek clarification by calling 132 011.

The patient will not be eligible if they have not been appropriately referred and a relevant Medicare service provided to them. If the referring service has not yet been claimed, Medicare Australia will not be aware of the patient’s eligibility. In this case the patient or the clinical psychologist (with the patient’s permission) should contact the referring practitioner to ensure the relevant service has been provided to the patient.

Publicly funded services
Psychological therapy items 80000 to 80020 do not apply for services that are provided by any other Commonwealth or State funded services or provided to an admitted patient of a hospital. 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 clinic, the items apply for services that are provided by eligible clinical psychologists salaried by, or contracted to, the service as long as all requirements of the items are met, including registration with Medicare Australia.

Private health insurance
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate paid for the services.

REFERRAL REQUIREMENTS (GPS, PSYCHIATRISTS OR PAEDIATRICIANS TO CLINICAL PSYCHOLOGISTS FOR PSYCHOLOGICAL THERAPY)
Referrals
Patients must be referred for psychological therapy services by a GP managing the patient under a GP Mental Health Care Plan (item 2710); or a referred psychiatrist assessment and management plan (item 291); or on referral from a psychiatrist or a paediatrician from an eligible service.

Referrals from psychiatrists and paediatricians must be made from eligible Medicare services.  For specialist psychiatrists and paediatricians these services include any of the specialist attendance items 104 through 109. For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 through 370; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133.

Referring practitioners are not required to use a specific form to refer patients for these services. The referral may be a letter or note to an eligible clinical psychologist signed and dated by the referring practitioner.

The clinical psychologist must be in receipt of the referral at the first allied mental health consultation. A clinical psychologist is required to retain the referral for 24 months from the date the service was rendered for Medicare Australia auditing purposes.

Referral validity
Medicare benefits are available for up to twelve (12) individual (up to 18 services where exceptional circumstances apply) and/or twelve (12) group psychological therapy services and/or focussed psychological strategies services per patient per calendar year. Referrals should be made in one or more groups of up to six sessions. If a patient has not used all of their psychological therapy services and/or focussed psychological strategies services under a referral in a calendar year, it is not necessary to obtain a new referral for the “unused” services. However, any “unused” services received from 1 January in the following year under that referral will count as part of the total of twelve services for which the patient is eligible in that calendar year.

When patients have used all of their referred services they will need to obtain a new referral from the referring practitioner if they are eligible for further services. Where the patient’s care is being managed by a GP, the GP may choose to use this visit to undertake a review of the patient’s GP Mental Health Care Plan and/or psychiatrist assessment and management plan.

It is not necessary to have a new GP Mental Health Care Plan and/or psychiatrist assessment and management plan prepared each calendar year in order to access a new referral(s) for eligible psychological therapy services and/or focussed psychological strategies services. Patients continue to be eligible for rebates for psychological therapy services and/or focussed psychological strategies services while they are being managed under a GP Mental Health Care Plan and/or a psychiatrist assessment and management plan as long as the need for eligible services continues to be recommended in their plan.

CLINICAL PSYCHOLOGIST PROFESSIONAL ELIGIBILITY
Eligible clinical psychologists
All consultations providing psychological therapy services must be rendered by a clinical psychologist who is a member of the Australian Psychological Society’s College of Clinical Psychologists or meets the requirements for such membership, based on assessment by the Australian Psychological Society; and who is registered with Medicare Australia.

Registering with Medicare Australia
Advice about registering with Medicare Australia to provide psychological therapy services using items 80000-80020 inclusive is available from the Medicare Australia provider inquiry line on 132 150.

Further information
For further information about Medicare and the MBS, please go to the Department of Health and Ageing’s website at www.health.gov.au/mbsonline. For providers, further information is also available from the Medicare Australia provider inquiry line on 132 150.

FOCUSSED PSYCHOLOGICAL STRATEGY SERVICES FOR PATIENTS WITH AN ASSESSED MENTAL DISORDER
PROVISION OF FOCUSSED PSYCHOLOGICAL STRATEGIES SERVICES BY ALLIED MENTAL HEALTH PROVIDERS (ITEMS 80100 TO 80170)

OVERVIEW
The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative commenced on 1 November 2006. Under the Better Access initiative MBS items provide Medicare benefits for the following allied mental health services:

• psychological therapy (items 80000 to 80020) − provided by eligible clinical psychologists (refer to Part 4); and
• focussed psychological strategies – allied mental health (items 80100 to 80170) − provided by eligible psychologists, occupational therapists and social workers.

FOCUSSED PSYCHOLOGICAL STRATEGIES − ALLIED MENTAL HEALTH SERVICES ATTRACTING MEDICARE REBATES
Eligible focussed psychological strategies services
There are fifteen MBS items for the provision of focussed psychological strategies (FPS) − allied mental health services to eligible patients by allied health professionals:

• 80100, 80105, 80110, 80115 and 80120 for provision of FPS services by a psychologist;
• 80125, 80130, 80135, 80140 and 80145 for provision of FPS services by an occupational therapist; and
• 80150, 80155, 80160, 80165 and 80170 for provision of FPS services by a social worker.

The allied mental health professional must meet the provider eligibility requirements set out below and be registered with Medicare Australia.

In these notes, ‘GP’ means a medical practitioner, including a general practitioner, but not including a specialist or consultant physician.

Services provided under the focussed psychological strategies – allied mental health items will not attract a Medicare rebate unless:

• a referral has been made by a GP who is managing the patient under a GP Mental Health Care Plan (item 2710);
• a referral has been made by a GP who is managing the patient under a referred psychiatrist assessment and management plan (item 291); or
• a referral has been made by a psychiatrist or paediatrician from an eligible psychiatric or paediatric service (see Referral Requirements for further details regarding psychiatrist and paediatrician referrals).

Number of services per year
Medicare rebates are available for up to twelve individual allied mental health services in a calendar year. These twelve services may consist of: GP focussed psychological strategies services (items 2721 to 2727); and/or psychological therapy services (items 80000 to 80015); and/or focussed psychological strategies − allied mental health services (items 80100 to 80115; 80125 to 80140; 80150 to 80165) and/or Access to Allied Psychological Services (ATAPS) consultations under the Better Outcomes in Mental Health Care Program. Referrals should be provided, as required, in one or more groups of up to six sessions.

In addition, the referring practitioner may consider that in exceptional circumstances the patient may require an additional six services above those already provided (to a maximum total of 18 individual services per patient per calendar year). Exceptional circumstances are defined as a significant change in the patient’s clinical condition or care circumstances which make it appropriate and necessary to increase the maximum number of services. It is up to the referring practitioner to determine that the patient meets these requirements. In these cases a new referral should be provided, and exceptional circumstances noted in that referral. Invoices for services provided under exceptional circumstances must state that exceptional circumstances apply.

Patients will also be eligible to claim up to 12 separate services within a calendar year for group therapy services involving 6-10 patients to which items 80020 (psychological therapy – clinical psychologist), 80120 (focussed psychological strategies – psychologist), 80145 (focussed psychological strategies – occupational therapist) and 80170 (focussed psychological strategies – social worker) apply. These group services are separate from the individual services and do not count towards the 12 service per calendar year maximum associated with those items.

Service length and type
Services provided by eligible allied health professionals under these items must be within the specified time period within the item descriptor. The allied mental health professional must personally attend the patient.

It is expected that professional attendances at places other than consulting rooms would be provided where treatment in other environments is necessary to achieve therapeutic outcomes.

A range of acceptable strategies has been approved for use by allied mental health professionals utilising the FPS items.

These are:
1. Psycho-education (including motivational interviewing)

2. Cognitive-behavioural Therapy including:

• Behavioural interventions (behaviour modification, exposure techniques, activity scheduling)
• Cognitive interventions (cognitive therapy)

3. Relaxation strategies

• Progressive muscle relaxation
• Controlled breathing

4. Skills training

• Problem solving skills and training
• Anger management
• Social skills training
• Communication training
• Stress management
• Parent management training

5. Interpersonal Therapy (especially for depression)

There is flexibility to include narrative therapy for Aboriginal and Torres Strait Islander people.

Course of treatment and reporting back to the referring medical practitioner
Patients are eligible to receive up to twelve individual services (up to eighteen in exceptional circumstances) and up to twelve group sessions in a calendar year.

Within this maximum service allocation, the allied mental health professional can provide one or more courses of treatment. For the purposes of the allied mental health items, a course of treatment consists of up to six services (but may involve less than six depending on the referral). This enables the referring medical practitioner to consider a report from the allied mental health professional on the services provided to the patient, and the need for further treatment.

On completion of the initial course of treatment, the allied mental health professional must provide a written report to the referring medical practitioner, which includes information on:

• assessments carried out on the patient;
• treatment provided; and
• recommendations on future management of the patient’s disorder.

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.

Out-of-pocket expenses and Medicare safety net
Charges in excess of the Medicare benefit for these items are the responsibility of the patient. However, such out-of-pocket costs will count toward the Medicare safety net for that patient. Any psychological therapy services and/or focussed psychological strategies services that are in excess of the entitlement of twelve (12) individual services (apart from where exceptional circumstances apply) and twelve group sessions in a calendar year will not attract a Medicare benefit and the safety net arrangements will not apply to costs incurred by the patient for such services.

Eligible patients
Items 80100 to 80170 (inclusive) apply to people with an assessed mental disorder and where the patient is referred by a GP who is managing the patient under a GP Mental Health Care Plan (item 2710), or under a referred psychiatrist assessment and management plan (item 291); or from an eligible psychiatrist or paediatrician.

The conditions classified as mental disorders for the purposes of these services are informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. For the purposes of these items, dementia, delirium, tobacco use disorder and mental retardation are not regarded as a mental disorder.

Checking patient eligibility for focussed psychological strategies – allied mental health services
Patients seeking Medicare rebates for focussed psychological strategies – allied mental health services will need to have a referral from a GP, psychiatrist or paediatrician. If there is any doubt about a patient’s eligibility, Medicare Australia will be able to confirm whether a GP Mental Health Care Plan; and/or a psychiatrist assessment and management plan is in place and claimed; or an eligible psychiatric or paediatric service has been claimed, as well as the number of allied mental health services already claimed by the patient during the calendar year. Allied Mental Health Professionals can call Medicare Australia on 132 150 to check this information, while patients can seek clarification by calling 132 011.

The patient will not be eligible if they have not been appropriately referred and a relevant Medicare service provided to them. If the referring service has not yet been claimed, Medicare Australia will not be aware of the patient’s eligibility. In this case the allied health professional (with the patient’s permission) or patient should contact the referring practitioner to ensure the relevant service has been provided to the patient.

Publicly funded services
FPS items 80100 to 80170 do not apply for services that are provided by any other Commonwealth or State funded services or provided to an admitted patient of a hospital. 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 clinic, the FPS items apply for services that are provided by eligible allied mental health professionals salaried by, or contracted to, the service as long as all requirements of the items are met, including registration with Medicare Australia.

Private health insurance
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate paid for the services.

REFERRAL REQUIREMENTS (GPS, PSYCHIATRISTS OR PAEDIATRICIANS TO ALLIED MENTAL HEALTH PROFESSIONALS)
Referrals
Patients must be referred for focussed psychological strategies – allied mental health services by a GP managing the patient under a GP Mental Health Care Plan (item 2710), or a referred psychiatrist assessment and management plan (item 291); or on referral from a psychiatrist or a paediatrician.

Referrals from psychiatrists and paediatricians must be made from eligible Medicare services.

For specialist psychiatrists and paediatricians these services include any of the specialist attendance items 104 through 109. For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 through 370; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133.

Referring practitioners are not required to use a specific form to refer patients for these services. The referral may be a letter or note to an eligible allied mental health professional signed and dated by the referring practitioner.

The allied mental health professional must be in receipt of the referral at the first allied mental health consultation. An allied mental health professional is required to retain the referral for 24 months from the date the service was rendered for Medicare Australia auditing purposes.

Referral validity
Medicare benefits are available for up to twelve (12) individual (up to 18 services where exceptional circumstances apply) and/or twelve (12) group psychological therapy services and/or focussed psychological strategies services per patient per calendar year. Referrals should be made in one or more groups of up to six sessions. If a patient has not used all of their psychological therapy services and/or focussed psychological strategies services under a referral in a calendar year, it is not necessary to obtain a new referral for the “unused” services. However, any “unused” services received from 1 January in the following year under that referral will count as part of the total of twelve services for which the patient is eligible in that calendar year.

When patients have used all of their referred services they will need to obtain a new referral from the referring practitioner if they are eligible for further services. Where the patient’s care is being managed by a GP, the GP may choose to use this visit to undertake a review of the patient’s GP Mental Health Care Plan and/or psychiatrist assessment and management plan.

It is not necessary to have a new GP Mental Health Care Plan and/or psychiatrist assessment and management plan prepared each calendar year in order to access a new referral(s) for eligible psychological therapy services and/or focussed psychological strategies services. Patients continue to be eligible for rebates for psychological therapy services and/or focussed psychological strategies services while they are being managed under a GP Mental Health Care Plan and/or a psychiatrist assessment and management plan as long as the need for eligible services continues to be recommended in their plan.

ALLIED MENTAL HEALTH PROFESSIONAL ELIGIBILITY
Eligible allied health professionals
Allied mental health professionals providing services under the items must be registered with Medicare Australia. To be eligible to register with Medicare Australia to provide these services, an allied mental health professional must be:

• A psychologist registered with the Psychologists Registration Board in the State or Territory in which they are practising. (Psychologists whose State/Territory registration includes any limitation, for example, where marked ‘provisional registration’, are not eligible to register with Medicare Australia to use the FPS item); or
• A full or part-time member of OT AUSTRALIA with a minimum of two years of experience in mental health and an undertaking to abide by The Australian Competency Standards for Occupational Therapists in Mental Health; or
• A member of the Australian Association of Social Workers (AASW), including certification by the AASW as meeting the standards for mental health set out in the AASW’s ‘Standards for Mental Health Social Workers 1999’.

Registering with Medicare Australia
Advice about registering with Medicare Australia to provide focussed psychological strategies − allied mental health services using items 80100-80170 inclusive is available from the Medicare Australia provider inquiry line on 132 150.

Further information
For further information about Medicare Benefits Schedule items, please go to the Department of Health and Ageing’s website at www.health.gov.au/mbsonline. For providers, further information is also available from the Medicare Australia provider inquiry line on 132 150.

Contact our office by phone on 08 8331 3000 or via email for more information on how you may be able to save money by utilising these Medicare rebates for psychology services.