Education guide - Better Access to mental health care for eligible practitioners and allied health professionals - Australian Government Department of Human Services

Make sure you read the relevant Medicare Benefits Schedule (MBS) item descriptions and explanatory notes at MBS Online.

The purpose of the Better Access initiative is to improve treatment and management of mental illness within the community. The aim is to provide patients with access to mental health professionals and team-based mental health care. Under this initiative, Medicare benefits are available to patients for selected mental health services provided by:

general practitioners (GPs)
non-vocationally recognised medical practitioners (non-VR MPs)
psychiatrists
clinical psychologists
registered psychologists
appropriately trained social workers and occupational therapists.

Information for eligible Practitioners

GP and non-VR MP services under Better Access

GPs and non-VR MPs can claim these MBS items in general practice. Specialists or consultant physicians can’t claim them.

The term ‘GP’ in the item descriptions is used as a generic reference to medical practitioners eligible to claim these items.

Under Better Access, practitioners can provide and claim for the services in the table below.

Service	MBS items	Frequency practitioners can use it
Prepare a GP mental health treatment plan (GPMHTP)	272, 276, 281, 282, 2700, 2701, 2715 or 2717	Practitioners can use these items once every 12 months Practitioners can’t use these items within 3 months of using a review items 277 or 2712.
Review a mental health treatment plan	277 or 2712	Practitioners can use these items once every 3 months Practitioners can’t use these items within 4 weeks of claiming item 272, 276, 281, 282, 2700, 2701, 2715 or 2717.
Manage a patient’s mental health condition	279, 2713 or a general consultation item	Practitioners can use these items as often as necessary. There are no restrictions.
Provide GP focused psychological strategies (FPS) services*	283-287 or 2721 - 2727	Practitioners can use these items up to 10 times every 12 months.

*You should register with us if you have completed the mental health skills training accredited by the General Practice Mental Health Standards Collaboration. Once you have registered, you can provide GP FPS services.

Patient eligibility for mental health treatment

GPMHTPs and review services are available to:

patients in the community
private in-patients, including residents of aged care facilities being discharged from hospital.

To be eligible, a patient must both:

have a mental disorder
be likely to benefit from a structured approach to the management of their care needs.

Referred mental health services

Once you've completed a GPMHTP you can refer your patient for a range of mental health services, including:

psychological therapy services performed by a clinical psychologist
allied health FPS services performed by a registered psychologist, occupational therapist or social worker
GP FPS services performed by a GP with appropriate training.

You can also refer your patient for these services if you’re managing them under either:

a referred psychiatrist assessment and management plan - MBS item 291
a shared care plan.

Certain allied health services require that the patient’s care is being managed under a:

GP Management Plan and Team Care Arrangements
GPMHTP, or shared care plan.

A practitioner may develop a shared care plan for a patient enrolled under the Health Care Home trial.

Referral format and content

There's no standard form for referrals. Eligible medical practitioners can refer patients for allied mental health services with a signed and dated letter.

The referral should include:

the patient’s symptoms
the number of treatment services the patient needs to receive
a statement about whether the patient has a GPMHTP, shared care plan or a psychiatrist assessment and management plan.

Referral course of treatment

Medical practitioners can refer up to 6 services for a course of treatment. The number of services stated in the patient's referral is a course of treatment.

A patient can have 2 or more courses of treatment within their calendar year limit of 10 services.

Patients need a new referral for each course of treatment.

Referral validity

Referrals are valid for the number of services shown on the medical practitioner’s referral letter or note. If patients have unused services at the end of the calendar year, they can use them the next year without a new referral.

Allied health professionals must keep copies of referrals for 2 years.

Calendar year claiming limits for allied mental health services

In a calendar year, patients can receive psychological therapy and/or FPS services up to the limit of:

10 individual services
10 group services.

A calendar year is from 1 January to 31 December.

From 1 September 2018, the limit of 10 individual and 10 group services can be made up of:

face-to-face consultations
telehealth consultations
a combination of face-to-face and telehealth consultations.

Which item applies when you bill a GP mental health treatment service

To determine which item applies when billing a GP mental health treatment service either:

ask the patient if they have a copy of the previous GPMHTP
with the patient’s permission, ask their previous practitioner for a copy.

You can review a patient’s previous plan if it’s been in place for more than 4 weeks. Use MBS item 277 or 2712 to bill a review service.

Only prepare a GPMHTP if you are the patient’s usual practitioner and expect to continue to manage their condition.

Confirming mental health items and limits

You can use the MBS Online Items Checker in HPOS to:

view and check patient eligibility based on their MBS history
check your own eligibility for claiming MBS items
check claiming conditions for MBS items.

Or you can call us to check:

if a patient has claimed a GPMHTP
how many allied mental health services the patient has already received in the calendar year
which MBS item you can bill if your patient’s clinical condition or care circumstances have changed significantly.

Information for allied health professionals

Allied mental health services and MBS items

To be an eligible allied health professional, you must both:

meet the eligibility criteria
have a Medicare provider number.

Under Better Access, eligible allied health professionals can provide the services in the table below.

Allied health professional	Mental health services	Individual items	Group items
Clinical psychologists	Psychological therapy services	80000-80015	80020-80021
Registered psychologists	FPS services	80100-80115	80120-80121
Occupational therapists	FPS services	80125-80140	80145-80146
Social workers	FPS services	80150-80165	80170-80171

Patient eligibility for allied mental health services

An eligible practitioner must assess the patient as having a mental disorder. The following practitioners can refer a patient:

an eligible practitioner who is managing the patient under a
- GPMHTP
- referred psychiatrist assessment and management plan, or
- shared care plan
a psychiatrist, or a paediatrician.

If you’re not sure if your patient is eligible you can contact the referring medical practitioner.

You can continue to see patients who aren’t eligible, but they can’t access Medicare benefits for the services you provide.

Referral items for claiming allied mental health services

The practitioner must claim the relevant referral item before Medicare benefits are available for psychological therapy and FPS services.

The table below explains the items that can be used as a referral pathway to allied health professionals.

Referring medical practitioner service	Medicare items
Preparation of a GPMHTP	272, 276, 281, 282, 2700, 2701, 2715 or 2717
Referred psychiatrist assessment and management plan	291
Specialist psychiatrist and paediatrician consultation	104-109
Consultant physician paediatrician consultation	110-133
Consultant physician psychiatrist consultation	293-370

Confirming allied health items and limits

Call us to check if that patient has:

claimed a referral service
reached the calendar year limit of their allied mental health services.

Once a patient has reached their service limit, you can keep seeing them but they can’t access Medicare benefits for your services.

Allied mental health professional reporting

Allied health professionals must provide a written report to the referring medical practitioner after completing each course of treatment.

The report should allow referring medical practitioners to assess the patient’s need for more treatment services. It must include:

assessments carried out on the patient and, where relevant, the progress made
treatments provided
recommendations on future management of the patient’s disorder.

Allied health professionals don’t need to use an approved form to write a report.

Reporting when a patient doesn’t complete a course of treatment

If a patient doesn’t complete treatment, the allied health professional should write their report after the last service. If the patient returns later and completes the course of treatment, they’ll need to write another report.

Telehealth focused psychological strategies services

New MBS items were introduced on 1 November 2017 to provide Medicare benefits for services provided via videoconferencing. Psychologists, occupational therapists and social workers can use these items.

Unlike other telehealth items, these items are stand-alone and do not have a derived fee structure.

The patient must:

have both a visual and audio link with the allied health professional
be located in an area within Modified Monash Model regions 4 to 7
be located at least 15km, by road, from the treating allied health professional at the time of consultation.

From 1 September 2018, allied health professionals can deliver all 10 eligible services in a calendar year via videoconferencing. These changes also remove the need for 1 face-to-face consultation within the first 4 videoconferencing sessions.

Group therapy services involve 6-10 patients and can be:

psychological therapy delivered via videoconference with a clinical psychologist - item 80021
FPS services delivered via videoconference with a psychologist - item 80121
FPS services delivered via videoconference with an occupational therapist - item 80146
FPS services delivered via videoconference with a social worker - item 80171.

Telehealth restrictions

Practitioners can’t claim telehealth attendance items for services provided to admitted hospital and hospital in-the-home patients.

To claim telehealth items there must be a visual and audio link between the patient and the practitioner. A practitioner can’t claim this rebate if they can’t establish both a video and audio link with the patient. Practitioners can’t claim telehealth benefits for telephone or email consultations.

Case study: Individual services provided in 2 calendar years

Under Better Access, a patient can claim a maximum of 10 allied mental health individual services each calendar year.

Services are counted towards the year when a patient attends the service, rather than the year they are referred. This is also the case when a patient completes 2 courses of treatment over consecutive calendar years.

Case study: services provided in 2 calendar years

For example, a medical practitioner refers a patient for a course of treatment of 5 individual allied health services.

The patient receives 2 services in calendar year 1. In calendar year 2 the patient receives the remaining 3 services. The patient has now completed the course of treatment as they have been to 5 services. The allied health professional who treated the patient will write a report back to the medical practitioner.

The medical practitioner decides to refer the patient for another course of treatment. The next course includes 4 individual allied mental health services.

The patient receives all 4 services for this course of treatment during calendar year 2. The patient has now completed the course of treatment as they have been to 4 services. The allied health professional who treated the patient will write a report back to the medical practitioner.

The patient has now received a total of 7 individual services during calendar year 2.

If the medical practitioner decides that a third course of treatment is necessary, the patient can claim 3 more individual services in calendar year 2.

Education guide - Better Access to mental health care for eligible practitioners and allied health professionals