Better Access Initiative for eligible health professionals

The Better Access initiative (Better Access) aims to improve access to mental health care especially for common conditions like depression and anxiety. To be eligible to receive services under Better Access, people must have a clinically diagnosed mental disorder which requires at least a moderate level of support. Under Better Access, Medicare benefits are available to eligible patients for selected mental health treatment services provided by eligible:

· GPs

· PMPs

· Psychiatrists

· Clinical Psychologists

· Psychologists

· Social Workers

· Occupational Therapists.

Eligible patients can receive a maximum of 10 individual and 10 group mental health treatment services per calendar year. A calendar year is from 1 January to 31 December.

MBS telehealth items can be substituted for equivalent individual face to face consultations where it’s clinically appropriate and safe to do so, noting these items have the same clinical requirements as the corresponding face to face consultation items. Group therapy mental health treatment services can be provided in certain circumstances.

Services under the Better Access initiative are distinct to the services that an eligible patient can access under their Chronic Condition Management Plan. Services under the Better Access initiative are different to the services an eligible patient can access under a GP Chronic Condition Management Plan. For further information on the Better Access Initiative, refer to MBS Note AN.0.78.

Medicare Mental Health Centres

The Australian Government is working in partnership with states and territories to establish Medicare Mental Health Centres across Australia. Medicare Mental Health Centres provide a place where everyone can access free mental health information, services and support. More information is available at Medicare Mental Health Centres | Australian Government Department of Health, Disability and Ageing.

Patient eligibility

Through Better Access, eligible patients can claim a Medicare benefit for up to 10 individual and 10 group therapy mental health treatment services per calendar year if they have been assessed with a clinically diagnosed mental disorder and have a:

· referral from a GP or PMP as part of a MHTP or,

· Psychiatrist Assessment and Management Plan (PAMP), or

· direct referral from a Psychiatrist, or

· direct referral from a Paediatrician.

It’s the responsibility of the referring MP to determine a patient’s eligibility for Better Access services. If a patient doesn’t need psychological intervention under Better Access, it’s worth considering other treatment options or pathways.

For more information, refer to MBS Note AN.0.78 or the resource collection at Better Access Initiative.

Mental Health Disorder

Mental Health Disorder is a term used to describe a range of clinically diagnosable disorders that significantly interfere with an individual’s cognitive, emotional or social abilities. Refer to the World Health Organisation: 1996, *Diagnostic and Management Guidelines for Mental Disorders in Primary Care, ICD-10 Chapter 5 Primary Care Version.

A mental disorder means a significant impairment of any or all of an individual’s cognitive, affective and relational abilities that:

(a) may require medical intervention; and

(b) may be a recognised, medically diagnosable illness or disorder; and

*Diagnostic and Management Guidelines for Mental Disorders in Primary Care (ICD-10, Chapter 5, Primary Care Version), developed by the World Health Organisation, 1996.

Mental health treatment plans, referrals, and reviews

A MHTP is developed through a structured consultation, where the patient will be asked a series of questions including a discussion of appropriate referral options. Consideration will also be given to other treatment interventions and pathways (e.g. digital mental health services, Medicare Mental Health Centres) should the patient’s level of support not require psychological intervention under the Better Access initiative. Eligible GPs and PMPs who have undertaken mental health skills training through the General Practice Mental Health Standards Collaboration can access specific MBS items that attract a higher Medicare benefit.

To be eligible for a Medicare benefit under Better Access, a patient must have had their MHTP, review of their MHTP and referral for treatment services undertaken by either their usual MP or a GP or PMP at the general practice they are enrolled in for MyMedicare. This includes a GP or PMP who is located at the medical practice that have provided the majority of a patient’s care over the previous 12 months or will be providing the majority of care over the next 12 months.

For telehealth services this includes the requirement to meet the established clinical relationship rule where a patient has had at least one face to face appointment in the previous 12 months with a GP or PMP at their usual medical practice. Some exemptions apply. For further information, refer to MBS Note AN.0.56 or MBS Telehealth Services.

There is nothing precluding a patient from having both a MHTP and a GP Chronic Condition Management Plan (GPCCMP) or an Eating Disorders Management Plan (EDP), provided they meet the relevant eligibility requirements for each plan. Patient eligibility for each plan remains at the clinical discretion of the treating MP. For further information, refer to MBS Note AN.0.56 or MBS Telehealth Services.

Many patients will not require a new plan after their initial plan has been prepared. Because a MHTP does not expire, a new plan should only be prepared in exceptional circumstances. An exceptional circumstance may be where the patient has had a significant change to their mental health and is unable to obtain a copy of their MHTP.

Medical Practitioner	Face to Face items	Video items
PMP	272, 276 (no mental health skills training)	92118, 92119 (no mental health skills training)
PMP	281, 282 (with mental health skills training)	92122, 92123 (with mental health skills training)
GP	2700, 2701 (no mental health skills training)	92112, 92113 (no mental health skills training)
GP	2715, 2717 (with mental health skills training)	92116, 92117 (with mental health skills training)

Review of a patient’s MHTP

A review of a patient’s MHTP is important as it ensures the treatment services are effective.

GPs and PMPs can use time-tiered general attendance items to review, refer and/or provide ongoing mental health consultation for a patient’s mental health.

This allows GPs and PMPs greater flexibility to determine the appropriate amount of time they need to spend with the patient based on their patient’s individual circumstances.

Reviews should not occur more than once every 3 months, or within 4 weeks of the MHTP being prepared unless there are exceptional circumstances.

It is recommended a MHTP be reviewed at least once during a course of treatment, with most patients not requiring more than 2 reviews in a calendar year.

For further information, refer to MBS Note AN.0.56.

Better Access mental health treatment services

Allied health treatment services

Medicare benefits are available for the following mental health treatment services:

· Psychological therapy - provided by eligible clinical psychologists

· Focussed Psychological Strategies (FPS) - provided by eligible GPs, PMPs, Registered Psychologists, Occupational Therapists, and Social Workers.

To provide mental health services under the Better Access initiative, health professionals must:

· meet the eligibility criteria

· have a Medicare provider number.

Learn more about health professional eligibility requirements on the Services Australia website.

Eligible allied health professionals can provide the following mental health treatment services.

Allied health professional	Individual Face to Face items	Individual Video items	Individual Phone items	Group MBS items (4 to 10 items)
Clinical Psychologist	80000-80015	91166, 91167	91181, 91182	80020-80022 and 80024
Registered Psychologist	80100-80115	91169, 91170	91183, 91184	80120-80122 and 80027
Occupational Therapist	80125-80140	91172, 91173	91185, 91186	80145-80147 and 80152
Social Worker	80150-80165	91175, 91176	91187, 91188	80170-80172 and 80174

MP FPS services

A GP or PMP who has the appropriate training recognised by the General Practice Mental Health Standards Collaboration can provide individual FPS services to a patient with a MHTP.

Eligible GPs and PMPs must be accredited and registered as a provider of FPS services before they can bill these services under Medicare. For further information refer to MBS Note MN.7.4.

Medical Practitioner

Face to Face items

Video items

Phone items

Claiming frequency

PMP

283, 285, 286, 287

91820, 91821

91844, 91845

FPS services count towards the patient’s limit of 10 individual treatment services in a calendar year.

2721, 2723, 2725, 2727

91818, 91819

91842, 91843

Telehealth (video and phone) options

Videoconference is the preferred alternative to a face to face service. However, some services can be provided via phone if video is not available. These have separate item numbers. The MBS telehealth attendance items are not payable if the patient is in hospital. This includes hospital in the home patients.

Further information on Better Access telehealth is available in the Better Access Initiative resource collection and MBS Telehealth Services.

Group therapy

Medicare benefits can be paid for telehealth (video) group therapy mental health treatment services for groups of 4 to 10 patients, if a patient meets the eligibility requirements.

For group therapy telehealth (video) services, patients must:

· have both a visual and audio link with the Allied Health Professional

· be located in an area within Modified Monash regions 4-7 at the time of the consultation

· be located at least 15 km apart by road from the Allied Health Professional when delivering the service.

The patient or allied health professional is not permitted to travel to an area outside the minimum 15 kilometres to claim a group therapy mental health treatment service.

Note: Allied health professionals can still claim group therapy MBS items if 4 patients were due to attend and one patient is unable to attend, regardless of the reason.

Accessing mental health treatment services

Patients referred for mental health treatment services can access up to:

· 10 individual services, and

· 10 group services (group services include 4 to 10 patients).

These limits apply per patient, per calendar year and can be undertaken via a combination of face to face and telehealth consultations.

Both psychological therapy and FPS services count towards the limit of 10 individual treatment services per calendar year.

Group and individual services count towards the service limits for a patient on an eating disorders treatment plan.

Where a patient is referred for both individual and group therapy services, a separate referral is required for each type of treatment.

Once a patient has accessed the maximum number of 10 individual or 10 group treatment services in a calendar year, the allied health professional can continue to treat them, however no further Medicare benefits are payable for those services.

If a patient has not used all their mental health treatment services covered by a referral within the calendar year, they don’t need a new referral. Unused services provided after 1 January will count towards that calendar years maximum service limit.

Referrals

A Medicare benefit will not be payable for mental health treatment services unless a referral has been made by a:

· GP or PMP managing the patient under a MHTP, or

· MP managing the patient under a PAMP

· Psychiatrist or Paediatrician from an eligible psychiatric or paediatric service.

The practitioner or Allied Health Professional providing the relevant treatment service must be in receipt of the referral at the first consultation.

For further information on referral requirements, refer to MBS Note MN.6.3 and the Better Access Initiative Resources collection.

Issuing a referral

Referring practitioners are not required to use a specific form to refer a patient. MBS note AN.15.6 outlines the referral requirements for referring a patient to MBS supported allied health services.

Note: A MHTP is not considered a referral.

The referral should be in writing, signed and dated by the referring practitioner (an electronic signature is acceptable) and include:

· the patient’s name, date of birth and address

· the patient’s symptoms or diagnosis

· any current medications

· the number of treatment services the patient is being referred for

· a statement about whether your patient has a MHTP or, PAMP prepared.

Course of treatment

A course of treatment is the number of services stated in the patient’s referral.

The referring MP decides how many services the patient will receive in a course of treatment, depending on the patient’s clinical need and within the maximum service limit. For example, if a patient received 6 services in their initial course of treatment, they could only receive 4 services in a subsequent course of treatment provided within the same calendar year.

The maximum service limits are:

Course of treatment	Service limit
Initial	6 individual services
Subsequent	Remaining individual services up to 10 per calendar year
Group therapy	Up to 10 per calendar year

Important: Referring MPs should be mindful of the limitations on the number of services a patient is eligible to receive in a calendar year when issuing referrals under Better Access.

Prerequisite MBS items for mental health treatment services

The prerequisite MBS item must be claimed before Medicare benefits are available for psychological therapy or FPS services. Refer to MBS Online to check which of these services can be performed via telehealth.

Referring service	MBS prerequisite items	Video items
PMP preparation of a MHTP	272, 276 (no mental health skills training)	92118, 92119
PMP preparation of a MHTP	281, 282 (with mental health skills training)	92122, 92123
GP preparation of a MHTP	2700, 2701 (no mental health skills training)	92112, 92113
GP preparation of a MHTP	2715, 2717 (with mental health skills training)	92116, 92117
Referred PAMP	291	92435
Specialist Psychiatrist and Paediatrician attendance	104-109	91822, 91823, 91833
Consultant Physician Psychiatrist attendance	293-308, 310, 312, 314, 316, 318, 319-349	N/A
Consultant Physician Paediatrician attendance	110-133	N/A

For further information, refer to MBS Note AN.0.56.

Reporting requirements

Allied Health Professionals must provide a written report back to the referring MP after a patient has completed each course of treatment.

The report informs on the patient’s progress, the treatments

provided and allows the referring MP to determine if additional services are required.

The report must include:

· assessments carried out on the patient

· treatment provided

· recommendations on the patient’s future management.

If a patient hasn’t completed a course of treatment, the report should be written after the last service was provided.

If the patient returns at a later stage and completes the course of treatment, a subsequent report will be required.

Further information on what is required from Allied Health Professionals on the completion of a course of treatment is outlined in MBS Notes MN.6.2 and MN.7.4.

Mental Health Case Conferences

The purpose of a MHCC is to establish and coordinate the management of the care needs of a patient.

A MHCC is a process where a multidisciplinary team carries out the following activities:

· discusses a patient's history;

· identifies the patient's multidisciplinary care needs;

· identifies outcomes to be achieved by members of the case conference team giving care and service to the patient;

· identifies tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team; and

· assesses whether previously identified outcomes (if any) have been achieved.

A Medicare benefit may not be claimed until all of these activities have been completed.

The organising of a MHCC should generally be undertaken by the patient's usual MP and involve at least 2 other members of the multidisciplinary case conference team providing different kinds of treatment to the patient. Only eligible Allied Health Professionals can claim participation in a MHCC. The requirements of MHCC organisation, coordination and participation are set out in MBS Note AN.15.1.

Patients are eligible for a MHCC if they’re being managed under either:

· the Better Access initiative, or

· an eating disorders treatment and management plan.

A patient would not normally require more than 4 case conferences in a 12-month period unless there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of additional services.

Below information lists the MBS items for MHCC.

Health professional	Attend, organise and coordinate case conference	Attend and participate in case conference
GP	930, 933, 935	937, 943, 945
PMP	969, 971, 972	973, 975, 986
Psychiatrist or Paediatrician	946, 948, 959	961, 962, 964
Eligible allied health professional	n/a	80176, 80177, 80178

Below information lists the health professional groups for MHCC.

Group	Health professionals eligible for MHCC team
MP	Patient's GP or PMP
MP	Consultant Physicians in the practice of their specialty of psychiatry or paediatrics
Allied health professional	Dieticians, Occupational Therapists, Psychologists, Clinical Psychologists, Social Workers

Better Access services for Family and Carers

MBS items are available for eligible GPs, PMPs, Clinical Psychologists, Psychologists, Occupational Therapists and Social Workers to deliver up to 2 Better Access mental health treatment services per calendar year to a patient’s family and/or carer.

These Better Access services can be provided to a person other than the patient, where the:

· patient has been referred for Better Access mental health treatment services as part of a MHTP, PAMP or by direct referral from a Psychiatrist or a Paediatrician

· treating or referring practitioner determines it is clinically appropriate

· patient consents to the service to be provided to the family member or carer as part of their treatment

· patient is not in attendance.

Any services delivered using these MBS items count towards the patient’s Better Access calendar year allocation of individual services. These services are claimed on the patient’s Medicare account.

These changes recognise the important role family members and carers play in supporting patients with mental illness, and the benefit of involving family members and carers in treatment and the impact this has on patient outcomes.

For further information refer to MBS Note MN.7.5.

Below information includes face to face and telehealth items.

Eligible Medical Practitioner	MBS items	Video items	Phone items
PMP	309, 311, 313, 315	91862, 91863	91866, 91867
GP	2739, 2741, 2743, 2745	91859, 91861	91864, 91865

Additional resources

Use the MBS items online checker to check eligibility. Alternatively, you can call Medicare provider enquiries to check eligibility for mental health treatment items that you intend to use.

Eligibility for treatment services under treatment services under eating disorders treatment and management plan (EDP) Infographic

Eating Disorders Treatment and Management Plan (EDP) Infographic

Eligibility for mental health treatment services infographic

Better Access Mental Health Treatment Referred Allied Health and other primary care services infographic

MBS items online checker infographic

View patient care plan history infographic

MBS items online checker simulation

View patient care plan history simulation

Additional information

Additional education resources are available from the Health Professional Education Resources website, including more information on the Medicare Benefits Schedule.

Glossary

Ahpra Australian Health Practitioner Regulation Agency

EDP Eating Disorders Management Plan

FPS Focussed Psychological Strategies

GP General Practitioner

GPCCMP GP Chronic Condition Management Plan

MBS Medicare Benefits Schedule

MHCC Mental Health Case Conference

MHTP Mental Health Treatment Plan

MP Medical Practitioner

PAMP Psychiatrist Assessment and Management Plan

PMP Prescribed Medical Practitioner

Feedback

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