Notes on the data: MBS services

Services provided under the Better Access Program, 2009/10

Note that although these data are several years old, they have been retained in the atlases as the only small area data available for this topic. Efforts continue to get access to more up-to-date data.

Policy context: The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (MBS) initiative (Better Access initiative) is an element of the Australian Government's commitment to the COAG's National Action Plan on Mental Health 2006-2011. The purpose of the Better Access initiative is to improve early detection, treatment and management of mental illness within the community; and includes new financing mechanisms that integrate allied health and GP care to provide team-based mental health care [1]. The initiative increased community access to mental health professionals, with general practitioners encouraged to work more closely and collaboratively with psychiatrists, clinical psychologists, psychologists, social workers and occupational therapists.

The Better Access initiative offers a series of MBS item numbers that make patients eligible for a rebate for services of registered allied health professionals and consultations by psychiatrists, if they are referred by their GP directly or following the completion of a GP Mental Health Care Plan. The allied health professionals can directly bill Medicare Australia or can bill the patient, who can then obtain a partial rebate from Medicare Australia.

Reference

Department of Health and Ageing (DoHA). Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (Better Access) initiative [Internet]. [cited 2013 Oct 18]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-ba

Notes:

Background

Under the Better Access initiative, Medicare rebates are available for GPs to provide early intervention, assessment, treatment and management of patients with mental disorders as part of a GP Mental Health Care Plan (Item 2710). Under this item, GPs can refer patients for Medicare-rebated psychological services to:

Psychiatrists
Clinical Psychologists
General Psychologists
GPs who have completed the required training to provide focussed psychological strategies (FPS) services
Social Workers (precluded from 1 July to 12 November 2010)*
Occupational Therapists (precluded from 1 July to 12 November 2010)*

who are registered with Medicare Australia and have recognised training to provide this role.

Patients who have a GP Mental Health Care Plan, or who are being managed by a GP under a referred psychiatrist assessment and management plan (Item 291), have access to these mental health service items on the MBS.

In 2009/10*, there were three GP Mental Health Care MBS items:

Preparation of a GP Mental Health Care Plan (Item 2710)
- Involves the assessment of a patient and preparation of a GP Mental Health Care Plan.
- Enables referral of patients to psychiatrists, and for psychological therapy by clinical psychologists and psychologists, or FPS services by qualified GPs, or other allied mental health professionals.
- Recommended frequency was one plan per patient, with a new plan only being prepared when clinically required (generally not within 12 months of a previous plan), supported by continuing management through consultation and review services.
Review of a GP Mental Health Care Plan (Item 2712)
- Enables a review of the patient’s progress against the goals in the GP Mental Health Care Plan.
- Recommended frequency was an initial review between four weeks and six months after the completion of the GP Mental Health Care Plan and, if required, a further review at least three months after the first review.
GP Mental Health Care Consultation (Item 2713)
- An extended consultation (at least 20 minutes) with a patient where the primary treating problem is related to a mental disorder.
- May be used for continuing management of a patient with a mental disorder, including for a patient being managed under a GP Mental Health Care Plan.

Eligible patients could claim up to 12 Medicare rebates per calendar year (provided in one or more groups of up to six sessions) for individual services provided by clinical psychologists, appropriately trained GPs and/or other allied mental health professionals. Patients could also be referred for FPS services under Access to Allied Psychological Services (ATAPS), available through Divisions of General Practice. Eligible patients were also able claim up to 12 rebates per calendar year for group services provided by clinical psychologists and/or other allied mental health professionals.

All GPs, consultant psychiatrists and consultant paediatricians can refer their patients under the Better Access initiative to allied mental health professionals (clinical psychologists, generalist psychologists, social workers, occupational therapists) and GP providers of FPS services for psychological treatment. These professionals must be registered with Medicare Australia via their peak bodies to enable Medicare rebates for providing these services on appropriate referral.

All consultations conducted as part of the GP Mental Health Treatment items must be rendered by the GP and include a personal attendance with the patient. A specialist mental health nurse, other allied health practitioner or Aboriginal Health Worker with appropriate mental health qualifications and training may provide general assistance to GPs in provision of mental health care. A GP should generally only provide GP Mental Health Treatment items where they reasonably expect that they will be the patient’s ‘usual GP’ and have an ongoing role in the management of the patient and their mental health.

Chronic Disease Management (CDM) items continue to be available for patients with chronic medical conditions, including patients needing multidisciplinary care. If the patient has a mental health problem only, a GP Mental Health Treatment Plan is preferable. Where a patient has a mental disorder as well as significant co-morbidities and complex needs requiring team-based care, the GP is able to use both the CDM items and the GP mental health treatment items.

*Note that from 13 May 2010, as a result of the Federal Budget, a number of changes were made to the Better Access initiative. Occupational therapists and social workers were no longer eligible to treat ‘Better Access’ patients under Medicare. The relevant Medicare item numbers remained open until the end of 2010 to enable patients who had commenced treatment prior to 1 July 2010 to complete their sessions. However, on 12 November 2010, this decision was overturned, and these professional groups were again included as part of the initiative. Changes in the Budget also reduced the number of subsidised sessions of cognitive behaviour therapy (CBT) from 12 to 10 per year.

Indicator details

The data presented are limited to the following:

Preparation of Mental Health Care Plan by GPs - MBS Item Nos: 2702, 2710, 2712 and 2713
Services provided by Psychiatrists - MBS Item Nos: 291, 293, 296, 297 and 299
Services provided by Psychologists - MBS Item Nos: 80000, 80005, 80010, 80015, 80020, 80100, 80105, 80110, 80115 and 80120
- Services provided by Generalist Psychologists - MBS Item Nos: 80100, 80105, 80110, 80115 and 80120
- Services provided by Clinical Psychologists - MBS Item Nos: 80000, 80005, 80010, 80015, 80020
Services provided by Social Workers - MBS Item Nos: 80150, 80155, 80160 and 80170
Services provided by Occupational Therapists - MBS Item Nos: 80125, 80130, 80135, 80140 and 80145

Data excludes any such services provided by the Department of Veterans' Affairs.

Numerator: Attendances as part of the Better Access Program for the relevant service

Denominator: Total population

Detail of analysis: Indirectly age-standardised rate per 100,000 population; and/or indirectly age-standardised ratio, based on the Australian standard

Source: Compiled by PHIDU based on data from Medicare Australia, supplied by the Department of Health of Ageing, 2009/10; and average of ABS Estimated Resident Population, 30 June 2009 and 30 June 2010.