Referral pathways for GPs

Referral pathways for GPs 2017-09-19T02:34:20+00:00

A. Medicare rebated referral to LifePsyche

1. Mental Health Care Plans

The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative aims to improve outcomes for people with a clinically-diagnosed mental disorder through evidence-based treatment. Under this initiative, Medicare rebates are available to patients for selected mental health services provided by GPs, psychiatrists, psychologists (clinical and registered) and eligible social workers and occupational therapists.

  • Referral has to be made by:

    • a GP who is managing the patient under a GP Mental Health Treatment Plan (GP MHTP) (Items 2715 or 2717), or
    • a review of a GP MHTP or a Psychiatrist Assessment and Management Plan (Items 2712)
    • a medical practitioner (including a GP but not a specialist or consultant physician) who is managing the patient under a referred psychiatric assessment or management plan (Items 132 or 133).
  • Psychiatrists and paediatricians are able to directly refer patients with mental health disorders for
    Medicare rebateable allied mental health services.

Frequency Limits for Mental Health Medicare Item Numbers
  • Items 2715 and 2717

    • Should not be prepared unless clinically required.
    • Item will NOT be paid within 12 months of previous claim
    • Item will NOT be paid within 3 months of a claim for item 2712
  • Item 2712

    • Item will NOT be paid within 3 months of a previous claim for item 2712
    • Item will NOT be paid within 4 weeks of a previous claim for item 2700, 2701, 2715 or 2717
Eligibility Requirements
  • For the purposes of these items, Dementia, Delirium, Tobacco-use Disorder and Mental Retardation are not regarded as a mental disorder.

  • 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. Conditions that are eligible
    include:
  • Alcohol use disorders
  • Adjustment disorders

  • Anxiety disorders

  • Attention deficit disorder

  • Bereavement disorder

  • Bipolar disorder

  • Conduct disorder

  • Depression

  • Eating disorders

  • Generalised anxiety disorder

  • Mixed anxiety and depression

  • Mood disorders

  • Obsessive Compulsive disorder

  • Panic disorder

  • Phobias

  • Post-traumatic stress disorder

  • Psychotic disorders including schizophrenia and drug-induced psychosis

  • Sexual disorders

  • Sleep problems

  • Unexplained somatic complaints

What services are provided under a Mental Health Treatment Plan?
  • Medicare rebates are available for up to 10 individual consultations in a calendar year by an allied mental health professional.

  • Allied mental health services under this initiative include psychological assessment and therapy services provided by clinical psychologists, and focused psychological strategies services provided by appropriately qualified GPs and eligible psychologists, social workers and occupational therapists.

  • Referrals are provided for an initial course of treatment commencing with a maximum of 6 sessions.

  • On completion of the initial course of treatment, the psychologist must provide a written report (within 4 weeks to 6 months of the date of referral) to the referring medical practitioner, which includes assessments carried out on the patient and recommendations on future management of the patient’s disorder.

  • At the discretion of the psychologist and referring GP, another 4 sessions can be assigned to the patient on review of the GP Mental Health Treatment Plan (Items 2712) and in accordance to the patient’s on-going management and treatment of their presenting mental disorder.

  • A written report must also be provided to the referring medical practitioner at the completion of any subsequent course(s) of treatments provided to the patient.

  • The 10 individual sessions in a calendar year can either be 50 minute sessions hour (Item 80010; Clinical Psychologist), or 30 minute sessions (Item 80000; Clinical Psychologist).

  • Patients will also be eligible to claim up to 10 separate services within a calendar year for group therapy (Item 80020, clinical psychologist). These group services are separate from the individual consultations. They can be on the same GP MHTP, but must be specified by the doctor.

  • Medicare rebates with a GP MHTP will be $124.50 for a one hour consultation with a clinical psychologist, and $84.80 for a 30 minute consultation with a clinical psychologist. Group sessions attract a $31.65 rebate with a clinical psychologist. This is rebated on the day of service into the patient’s bank account. To receive this rebate you must have an Eftpos card to accept the rebate into your bank account. Once you reach your safety net your rebate will increase to $184.90.

  • There will be an out-of- pocket payment for all clients who are not bulk billed.

  • Only clients experiencing financial hardship are bulk billed.

For a complete review of rebates refer to this table:

Table of Medicare Benefits

2. Chronic Disease Management (GP Team Management Plan, formerly Enhanced Primar Care or EPC)

  • The Chronic Disease Management enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers.

  • A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.

  • Referrals are provided for an initial course of treatment with a maximum of 5 sessions per referral in a calendar year (including any services to which the items 10950 to 10970 apply).

  • On the first and last service, the eligible allied health professional (e.g., Dietetics Item 10954; Psychology Item 10968) must provide a written report to the referring medical practitioner, which includes assessments carried out on patient, management plan, and recommendations on future management of the patient’s.

  • Medicare rebates on a Chronic Disease Management Plan are $52.95 per appointment, regardless of session length. This is rebated on the day of service into the patient’s bank account. To receive this rebate, you must have an Eftpos card to accept the rebate into your bank account. Out-of- pocket costs depend on the session length. Chronic Disease Management sessions ARE NOT bulk billed.

B. Private health referrals

Clients/patients accessing private health rebates do not require a referral.

C. DVA referrals are accepted

LifePsyche can process DVA clients through our HPOS facility via the Medicare online portal.

DVA issues health cards to veterans, their war widow(er)s and dependants to ensure they have access to health and other care services.

There are two types of DVA health cards available, Gold and White Cards. Both cards have different entitlements to access health services.

Gold Cards

A Gold Card entitles the holder to DVA funding for services for all clinically necessary health care needs, and all health conditions, whether they are related to war service or not. The card holder may be a veteran or the widow(er) or dependant of a veteran. Only the person named on the card is covered.

Generally, health services listed on the Medicare Benefits Scheme (MBS) (including Psychological/Dietetic services) are available to Gold Card holders and are consistent with the limits under the MBS.

For any other health services that are not listed on the MBS, the patient will require prior financial authorisation from DVA. To check if the patient is entitled to Psychological Therapy or Dietetic services the patient or you can call the DVA Health Provider Line
on 1300 550 457 (Metro) or 1800 550 457 (Non-Metro).

White Cards

DVA White Card entitlements are as follows:

  • accepted injuries or conditions that are war caused or service related;

  • malignant cancer, pulmonary tuberculosis, any mental health condition whether war caused or not; and
  • the symptoms of unidentifiable conditions that arise within 15 years of service (other than peacetime service).

Services covered by a DVA White Card are the same as those for a Gold Card but must be for the above conditions.

The card also entitles the holder to transport related to treatment of their accepted condition. Accepted conditions will have been outlined in a letter from the DVA to the veteran.

To check the patient’s entitlements, the patient or you can call the DVA Health Provider Line on 1300 550 457 (Metro) or 1800 550 457 (Non-Metro), and quote the file number on the White Card. The same limitations apply to White Card holders as do to Gold Card holders. With the exception of when a veteran needs treatment for a health condition that is not an accepted disability, LifePsyche will not bill DVA.

It is important that the patient or yourself check with DVA prior to the patient’s first consultation regarding the patient’s entitlements for treatment rebates. For White Card holders, the patient may need prior financial authorisation for Psychology and/or Dietetic services.

D. WorkCover referrals are accepted.