This Friday update is around Medicare changes and questions I've had come about this week with some of the practitioners I'm working with. Question 1: Does the client need to go back to their GP to change the referral name if the client changes providers? Answer 1: According to Psych alert in April, 2018, InPsych Magazine: Medicare clients can change practitioners. Recent correspondence from the Department of Health has clarified that clients can change Medicare providers while under the same Medicare referral without seeking a new letter of referral from a medical practitioner (e.g., GP). Medicare Australia states that the Medicare legislation does not require a referral be addressed to a named health professional. If a referral is addressed to one psychologist, the patient is not obliged to go to that psychologist but can see another psychologist of their choice. Our previous correspondence with the Department indicated that once the client had seen a psychologist for the initial consult, they were required to continue with the same provider. The new information received from the Department is that a patient can change providers (and this could be interpreted as having any number of providers) on the same referral. The choice rests with the client about which practitioner to see and for how many of the referred sessions. The specific information from the Department is: A referral is valid until the referred number of sessions have been completed, regardless of whether a patient chooses to change their allied mental health provider. This means that if for any reason the patient wants to change their allied mental health provider they can do this without a new referral. Medicare online checker allows for a clinician to check the client's benefits. Clients are sometimes not aware how many sessions they have had with other providers under the same referral. It is therefore important to check with clients the number of sessions already used. Medicare provides an online checking system that allows practitioners to monitor and check the number of sessions that clients have used under their referral. This will assist members to plan for treatment and avoid payment claims being rejected. The online checker can be accessed through the Government’s PRODA and HPOS platforms or by calling Medicare on 132 150. For information on the online checker see: bit.ly/2GsMVcv (www.humanservices.gov.au/organisations/health-professionals/enablers/using-mbs-items-online-checker-hpos) Previous emails encouraged you to sign up for PRODA. This is a good reason to have a PRODA account set up if you haven't already. Question 2: What information is required on the MHCP as it's our understanding that there isn't a required form for the GP to complete. Answer 2: (Please email me if you would like this reference material) Referral requirements • The referring practitioner should specify the number of services to be provided per course of treatment (up to a maximum of 6 services in any 1 referral). • A course of treatment means up to 6 services per referral, or the number of services specified on the referral. • There may be 2 or more courses of treatment within a patient's entitlement of up to 10 services per calendar year. A second referral is required after the first course of treatment (6 services) has been completed. Note: allied mental health professionals should not claim Medicare benefits in excess of the patient's entitlement or in excess of the number stated on a referral. Question 3: What diagnosis is eligible for the MHCP? Answer 3: This is interesting. In my search for the specifics, I found this website: http://www.health.gov.au/internet/main/publishing.... It states: "The GP Mental Health Treatment items are for patients with a mental disorder who would benefit from a structured approach to the management of their care needs. Mental 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. This list of mental disorders is informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. Dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders for the purposes of the GP Mental Health Treatment items." Also confirmed on this site: http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=80110&qt=item Where as the APS site is a bit more specific: "Mental disorder' is a term used to describe a range of clinically diagnosable disorders that significantly impact on a person's emotions, thoughts, social skills and decision-making. The Better Access initiative covers people with mental disorders arising from:
Alcohol use disorder
Anxiety disorders
Adjustment disorder
Attention deficit disorder
Bereavement disorder
Bipolar disorder
Conduct disorder
Co-occurring anxiety and depression
Depression
Drug use disorder
Eating disorders
Obsessive compulsive disorder
Panic disorder
Phobic disorder
Posttraumatic stress disorder
Psychotic disorders
Schizophrenia
Sexual disorders
Sleep problems"
https://www.psychology.org.au/for-the-public/Medic... Question 4: Does the MHCP need to be signed by the GP? Answer 4: In zero search results could I find that the MHCP was invalid if not signed by the GP. This link: http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=80110&qt=item I hope this helps answer some of your questions. Enjoy your weekend and thank you to those who sparked interesting conversation and debates with me this week!
Don't forget to stay compliant, you need to send an inactive letter to your GP when the client drops out of therapy. (Even if they cancel their last session. Check out this post for some ideas.)