Medicare and Payment Information

Medicare Information

1) New Better Access to Mental Health Care Rebates (12 sessions):

NEW PSYCHOLOGY MEDICARE ITEMS

The new Medicare scheme allows all Australians to have access to effective psychological treatments from experienced health professionals. Below are some further details.

Who do I have to be referred by?
Clients must be referred by a GP, psychiatrist or pediatrician.

Who is eligible for the Medicare rebate?
Any person with a mental disorder (excluding dementia, delirium, tobacco use disorder and mental retardation) who is being managed by a GP under a GP Mental Health Care Plan or a psychiatrist assessment and management plan. They may also be referred directly by a psychiatrist or pediatrician from an eligible Medicare Benefits Schedule (MBS) service. It is recommended that you speak to your referrer to ensure that you are eligible for the rebate. (Note: this is separate and in addition to your EPC Plan / 5 sessions rebated at $44 a session).

What sort of services will be provided?
Any Focused Psychological Strategy (FPS), including: psychoeducation, cognitive-behavioral therapy, relaxation strategies, skills training (e.g problem-solving, anger management) and interpersonal therapy (especially for depression).

How many sessions am I allowed?
Clients are allowed up to 12 individual sessions in one calendar year. These sessions are provided in two sets of six, with the need for the second set to be reviewed by the referring medical practitioner. There are also 12 group sessions allowed per calendar year.

What is my psychologist/social worker required to do?
Psychologists must provide a written report to the referring medical practitioner following the first six services and on completion of the treatment.

It is also important to note that your psychologist/social worker must have a Health Insurance Commission (HIC) provider number. 

From 01 November 2006

Details of Applicable Rebates:

	Rebate per Individual  Session	Rebate per Group Session
Psychologist	$75.00 (Item 80100-80120)	$19.10
Clinical Psychologist	$110.00 (Item 80000-80020)	$28.00
Social Worker	$66.05	$16.80

2) Enhanced Primary Care Plans (5 sessions):

People with chronic conditions and complex care needs who are being managed through an Enhanced Primary Care (EPC) multidisciplinary care plan may be eligible for up to 5 allied health services per year on referral from their GP. This is referred to as Item 10968 - services provided by a Psychologist (the rebate is only $44 per session).

Is it necessary for the GP to use the EPC Plan referral form?
Yes. The GP referral form is an important part of the referral, claiming and payment process. However, clinical patient notes should not be included on the form.

How do patients get a rebate for these services?
When the allied health professional has provided the service he/she must complete the allied health referral form, including providing their HIC registration number. The allied professional then attaches a receipt to the EPC plan which they signed. The patient then takes the completed allied health referral form and receipt from the allied health professional to Medicare to claim the Medicare rebate. Out of pocket costs will count toward the Medicare safety net. 

What about patients with private health insurance cover?
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients with such insurance can either:

• Access rebates from Medicare under the allied health items by following the claiming processes, or
• See allied health professionals of their choice and claim on their health insurance's ancillary benefits. No referral form will be required in this case.

Patients cannot use their private health insurance ancillary cover to "top up" the Medicare rebate. It is important for patients to check with their health fund which ancillary services are covered and what their out of pocket expenses are likely to be.

How do I find out more about EPC care planning?
More information about EPC care plans is contained in the notes to the Medicare Benefits Schedule book (pages 36-39, November 2003 edition). Detailed information is also available from the Department of Health and Ageing website at www.health.gov.au/epc

Some basic information about the EPC program is provided below. The Australian Psychological Society has released some further details concerning the benefits for clients undergoing psychological sessions; more information can be found HERE.

What is the Enhanced Primary Care Program?

There are 28 EPC items on the Medicare Benefits Schedule (MBS). These items cover:

• Multidisciplinary care planning
• Multidisciplinary case conferencing
• Multidisciplinary discharge care planning and case conferencing

The case conference is a tool for coordinating care across a multidisciplinary team. It is used by team members to identify and discuss the care needs and goals of patients with chronic or complex conditions

Those who stand to benefit most from the case-conference approach include patients who:

• have complex problems for which the GP has difficulty finding solutions (eg. patients with stroke or other physical or intellectual disabilities);
• are coping with complex psychosocial problems, such as child abuse;
• have cognitive problems that make them unable to coordinate their own care among providers;
• require case management across multiple services (eg. those with mental health problems);
• are managed by telemedicine or by visiting teams in rural areas; and
• need coordination of care after being discharged from hospital.

Healthcare workers other than GPs may initiate case conferences. GPs and private physicians are renumerated for their roles, but community and allied health professionals are not.