Medicare Benefits Schedule - Item 80160

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Category 8 - MISCELLANEOUS SERVICES

80160

80160 - Additional Information

Item Start Date:
01-Nov-2006
Description Start Date:
01-Mar-2012
Schedule Fee Start Date:
01-Nov-2012

Group
M7 - FOCUSSED PSYCHOLOGICAL STRATEGIES (ALLIED MENTAL HEALTH)

Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a social worker registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.


These services are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply).


Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).  


(Professional attendance at consulting rooms)

Fee: $87.95 Benefit: 85% = $74.80

(See para M7.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $263.85


Associated Notes

Category 8 - MISCELLANEOUS SERVICES

M7.1

Provision of Focussed Psychological Strategies Services by Allied Health Providers - (Items 80100 to 80170)

OVERVIEW

The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative commenced on 1 November 2006.  Under the Better Access initiative MBS items provide Medicare benefits for the following allied mental health services:

 

·         psychological therapy (items 80000 to 80020) - provided by eligible clinical psychologists; and

  • focussed psychological strategies - allied mental health (items 80100 to 80170) - provided by eligible psychologists, occupational therapists and social workers.

 

FOCUSSED PSYCHOLOGICAL STRATEGIES - ALLIED MENTAL HEALTH SERVICES ATTRACTING MEDICARE REBATES

 

Eligible focussed psychological strategies services

There are fifteen MBS items for the provision of focussed psychological strategies (FPS) - allied mental health services to eligible patients by allied health professionals:

 

  • 80100, 80105, 80110, 80115 and 80120 for provision of FPS services by a psychologist;
  • 80125, 80130, 80135, 80140 and 80145 for provision of FPS services by an occupational therapist; and
  • 80150, 80155, 80160, 80165 and 80170 for provision of FPS services by a social worker.

 

The allied health professional must meet the provider eligibility requirements set out below and be registered with the Department of Human Services.

 

In these notes, 'GP' means a medical practitioner, including a general practitioner, but not including a specialist or consultant physician.

 

Services provided under the focussed psychological strategies - allied mental health items will not attract a Medicare rebate unless:

  • A referral has been made by a GP who is managing the patient under a GP Mental Health Treatment Plan (item 2700, 2701, 2715 or 2717);
  • A referral has been made by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan (item 291); or
  • A referral has been made by a psychiatrist or paediatrician from an eligible psychiatric or paediatric service (see Referral Requirements for further details regarding psychiatrist and paediatrician referrals). 

 

Number of services per year

Medicare rebates for up to ten individual allied mental health services in a calendar year.  These ten services may consist of: GP focussed psychological strategies services (items 2721 to 2727); and/or psychological therapy services (items 80000 to 80015); and/or focussed psychological strategies - allied mental health services (items 80100 to 80115; 80125 to 80140; 80150 to 80165.

 

In addition, the referring practitioner may consider that in exceptional circumstances the patient may require an additional six services above those already provided (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012). 

 

Note: Patients will be able to receive an additional six individual allied mental health services under exceptional circumstances from 1 March 2012 to 31 December 2012.  From 1 January 2013 the number of individual allied mental health services for which a person can receive a Medicare rebate will be ten services per calendar year.

 

Exceptional circumstances are defined as a significant change in the patient's clinical condition or care circumstances which make it appropriate and necessary to increase the maximum number of services. 

 

It is up to the referring practitioner to determine that the patient meets these requirements.  In these cases a new referral should be provided, and exceptional circumstances noted in that referral.  Invoices for services provided under exceptional circumstances must state that exceptional circumstances apply.

 

Referrals should be provided, as required, for an initial course of treatment (a maximum of six services but may be less depending on the referral and patient need) to a maximum of ten services per calendar year (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply).  For the purposes of these services, a course of treatment will consist of the number of services stated in the patient's referral (up to a maximum of six in any one referral).

 

Patients will also be eligible to claim up to ten separate services within a calendar year for group therapy services involving 6-10 patients to which items 80020 (psychological therapy - clinical psychologist), 80120 (focussed psychological strategies - psychologist), 80145 (focussed psychological strategies - occupational therapist) and 80170 (focussed psychological strategies - social worker) apply.  These group services are separate from the individual services and do not count towards the ten individual service calendar year maximum associated with those items.

 

After an initial group of up to six services, the allied mental health professional must provide a report to the referring practitioner.  Following receipt of this report, the referring practitioner will consider the need for further treatment, before further allied mental health services may be provided.

 

Services provided under the Access to Allied Psychological Services (ATAPS) should not be used in addition to the ten (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) psychological therapy services (items 80000 to 80020), focussed psychological services-allied mental health services (items 80100 to 80170) or GP focussed psychological strategies services (items 2721 to 2727) available under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative per calendar year. Allied mental health professionals delivering services under the ATAPS program should refer to the ATAPS Operational Guidelines.

 

Service length and type

Services provided by eligible allied health professionals under these items must be within the specified time period within the item descriptor.  The allied mental health professional must personally attend the patient.

 

It is expected that professional attendances at places other than consulting rooms would be provided where treatment in other environments is necessary to achieve therapeutic outcomes. 

 

A range of acceptable strategies has been approved for use by allied mental health professionals utilising the FPS items.

These are:

1.       Psycho-education

(including motivational interviewing)

2.       Cognitive-behavioural Therapy including:

·              Behavioural interventions

-      Behaviour modification

-      Exposure techniques

-      Activity scheduling

·              Cognitive interventions

-      Cognitive therapy

3.      Relaxation strategies

-      Progressive muscle relaxation

-      Controlled breathing

4.      Skills training

-      Problem solving skills and training

-      Anger management

-      Social skills training

-      Communication training

-      Stress management

-      Parent management training

5.       Interpersonal Therapy (especially for depression)

6.       Narrative therapy (for Aboriginal and Torres Strait Islander people).

 

Course of treatment and reporting back to the referring medical practitioner

Patients are eligible to receive up to ten individual services (up to 16 services from 1 March 2012 to 31 December 2012 when exceptional circumstances apply) and up to ten group sessions in a calendar year.

 

Within this maximum service allocation  the allied mental health professional can provide one or more courses of treatment.  For the purposes of these services, a course of treatment consist of the number of services stated in the patient's referral (up to a maximum of six services in any one referral).  This enables the referring medical practitioner to consider a report from the allied mental health professional on the services provided to the patient, and the need for further treatment.

 

On completion of the initial course of treatment, the allied mental health professional must provide a written report to the referring medical practitioner, which includes information on:

¿       assessments carried out on the patient;

¿       treatment provided; and

¿       recommendations on future management of the patient's disorder.

 

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

 

Out of pocket expenses and Medicare safety net

Charges in excess of the Medicare benefit for these items are the responsibility of the patient. However, if a service was provided out-of-hospital, any out-of-pocket costs will count towards the Medicare safety net for that patient. The out-of-pocket costs for mental health services which are not Medicare eligible do not count towards the Medicare safety net.

Eligible patients

Items 80100 to 80170 (inclusive) apply to people with an assessed mental disorder and where the patient is referred by a GP who is managing the patient under a GP Mental Health Treatment Plan (item 2700, 2701, 2715 or 2717), referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan (item 291); or from an eligible psychiatrist or paediatrician.

 

The conditions classified as mental disorders for the purposes of these services are informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version.  For the purposes of these items, dementia, delirium, tobacco use disorder and mental retardation are not regarded as a mental disorder.

 

Checking patient eligibility for focussed psychological strategies - allied mental health services

Patients seeking Medicare rebates for focussed psychological strategies - allied mental health services will need to have a referral from a GP, psychiatrist or paediatrician.  If there is any doubt about a patient's eligibility, the Department of Human Services will be able to confirm whether a GP Mental Health Treatment Plan; and/or a psychiatrist assessment and management plan is in place and claimed; or an eligible psychiatric or paediatric service has been claimed, as well as the number of allied health services already claimed by the patient during the calendar year.

 

Allied Mental Health Professionals can call the Department of Human Services on 132 150 to check this information, while unsure patients can seek clarification by calling 132 011.

 

The patient will not be eligible if they have not been appropriately referred and a relevant Medicare service provided to them. If the referring service has not yet been claimed, the Department of Human Services will not be aware of the patient's eligibility.  In this case the clinical psychologist should, with the patient's permission, contact the referring practitioner to ensure the relevant service has been provided to the patient.

 

Publicly funded services

Focussed psychological strategies (FPS) services items 80100 to 80170 do not apply for services that are provided by any other Commonwealth or State funded services or provided to an admitted patient of a hospital.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory clinic, the FPS services items apply for services that are provided by eligible allied mental health professionals salaried by, or contracted to, the service as long as all requirements of the items are met, including registration with the Department of Human Services.  These services must be direct billed (that is, the Medicare rebate is accepted as full payment for services).

 

Private health insurance

Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to 'top up' the Medicare rebate paid for the services.

 

REFERRAL REQUIREMENTS (gPs, PSYCHIATRISTS OR PAEDIATRICIANS TO ALLIED MENTAL HEALTH PROFESSIONALS)

 

Referrals

Patients must be referred for focussed psychological strategies - allied mental health services by either a GP managing the patient under a GP Mental Health Treatment Plan (item 2700, 2701, 2715 or 2717), or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan (item 291); or on referral from a psychiatrist or a paediatrician.

 

Referrals from psychiatrists and paediatricians must be made from eligible Medicare services.  For specialist psychiatrists and paediatricians these services include any of the specialist attendance items 104 through 109.  For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 through 370; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133.

 

Referring practitioners are not required to use a specific form to refer patients for these services.  The referral may be a letter or note to an eligible allied mental health professional signed and dated by the referring practitioner.

 

The allied mental health professional must be in receipt of the referral at the first allied mental health consultation.  It is recommended that the allied health professional retain the referral for 24 months from the date the service was rendered (for the Department of Human Services auditing purposes).

 

Referral validity

Medicare benefits are available for up to ten individual (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) and ten group psychological therapy services and/or focussed psychological strategies services per patient per calendar year.

 

Referrals should be provided, as required, for an initial course of treatment (a maximum of six services but may be less depending on the referral and patient's clinical need) to a maximum of ten services per calendar year (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply).  For the purposes of these services, a course of treatment will consist of the number of services stated in the patient's referral (up to a maximum of six in any one referral).

 

If a patient has not used all of their psychological therapy services and/or focussed psychological strategies services under a referral in a calendar year, it is not necessary to obtain a new referral for the "unused" services. However, any "unused" services received from 1 January in the following year under that referral will count as part of the total of ten services for which the patient is eligible in that calendar year.

 

When patients have used all of their referred services they will need to obtain a new referral from the referring practitioner if they are eligible for further services.  Where the patient's care is being managed by a GP, the GP may choose to use this visit to undertake a review of the patient's GP Mental Health Treatment Plan and/or psychiatrist assessment and management plan.

 

It is not necessary to have a new GP Mental Health Treatment Plan and/or psychiatrist assessment and management plan prepared each calendar year in order to access a new referral(s) for eligible psychological therapy services and/or focussed psychological strategies services.  Patients continue to be eligible for rebates for psychological therapy services and/or focussed psychological strategies services while they are being managed under a GP Mental Health Treatment Plan and/or a psychiatrist assessment and management plan as long as the need for eligible services continues to be recommended in their plan.

 

ALLIED MENTAL HEALTH PROFESSIONAL ELIGIBILITY

 

Eligible allied health professionals

A person is an allied health professional in relation to the provision of a FPS service if the person meets one of the following requirements:

a)          the person is a psychologist who holds general registration in the health profession of psychology under the applicable law in force in the State or Territory in which the service is provided;

b)          the person is a member of the Australian Association of Social Workers (AASW) and certified by AASW as the meeting the standards for mental health set out in the document published by AASW titled 'Practice Standards for Mental Health Social Workers', as in force on 8 November 2008;

c)          the person:

i)                    is an occupational therapist who is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and

ii)                  is accredited by Occupational Therapy Australia as:

·       having a minimum of two years experience in mental health; and

·       having undertaken to observe the standards set out in the document published by Occupational Therapy Australia 'Australian Competency Standards for Occupational Therapists in Mental Health' as in force on 1 November 2006.

 

Continuing professional development (CPD) for Occupational Therapists and Social Workers providing focussed psychological strategies (FPS) services

 

Occupational Therapists and Social Workers providing FPS services are required to have completed 10 hours FPS CPD. 

 

A CPD year for the purposes of these items is from 1 July to 30 June annually.

 

Part-time allied mental health professionals are required to have 10 hours of FPS related CPD, the same as full-time allied mental health professionals.

 

Occupational Therapists and Social Workers who are registered during the course of the CPD year, their obligation to undertake CPD will be on a pro-rata basis.  The amount of units will be calculated from the 1st of the month immediately succeeding the month they obtained initial registration.  The obligation will be one-twelfth of the yearly requirement for each month.

 

CPD activities must be relevant to delivering FPS services.  Acceptable CPD activities where the content is related to FPS can include formal postgraduate education, workshops, seminars, lectures, journal reading, writing papers, receipt of supervision and peer consultation, and online training. 

 

There is flexibility in the CPD activities that can be undertaken to meet individual professional needs and their practice/client base and client needs.  For example, activities could also include assessment and treatment of specific disorders and client types such as youth, or different modalities and delivery such as working with groups.

 

Registering with the Department of Human Services

Advice about registering with the Department of Human Services to provide focussed psychological strategies - allied mental health services using items 80100-80170 inclusive is available from the Department of Human Services provider inquiry line on 132 150.

 

Further information

For further information about Medicare Benefits Schedule items, please go to the Department of Health's website at www.health.gov.au/mbsonline

 

For providers, further information is also available for providers from the Department of Human Services provider inquiry line on 132 150.

 

The Department of Human Services (DHS) has developed a Health Practitioner Guideline to substantiate that a valid Allied Mental Health service has been provided (for allied health professionals)which is located on the DHS website.

 

Related Items: 80100 80105 80110 80115 80120 80125 80130 80135 80140 80145 80150 80155 80160 80165 80170


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change