Medicare Benefits Schedule - Item 80178

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in a mental health case conference if the conference lasts for at least 40 minutes

Fee: $153.45 Benefit: 85% = $130.45

(See para MN.7.6 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $460.35

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Items 80176, 80177 and 80178 provide rebates for eligible allied health professionals to participate in mental health case conferences. They apply for a patient who is being treated under the Better Access to Psychiatrist and paediatricians, Psychologists and General Practitioners through the Medicare Benefits Schedule (MBS) initiative (Better Access) or an eating disorder treatment and management plan (EDTP).

The purpose of a case conference is to establish and coordinate the management of the care needs of the patient. A case conference is a process by which a multidisciplinary team carries out the following activities:

• discusses a patient's history;
• identifies the patient's multidisciplinary care needs;
• identifies outcomes to be achieved by members of the case conference team giving care and service to the patient;
• identifies tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team; and
• assesses whether previously identified outcomes (if any) have been achieved.

PATIENT ELIGIBILITY

Case conferences using these new MBS items can be held for patients who have been referred for treatment under Better Access or have an active eating disorder treatment and management plan.

Patients can be referred for treatment under Better Access by a:

• GP or OMP under a mental health treatment plan or psychiatrist assessment and management plan,
• psychiatrist, or
• paediatrician.

Treated under Better Access means a patient has been referred for a:

• a focussed psychological strategies service delivered by a GP, OMP, psychologist, social worker or occupational therapist, or
• psychological therapy service delivered by a clinical psychologist

REGULATORY REQUIREMENTS

To participate in mental health case conferences using items 80176, 80177 and 80178, the allied health professional must:

1. explain to the patient the nature of a mental health case conference and ask for their agreement to the allied health professional’s participation in the conference; and
2. record the patient's agreement to the allied health professional’s participation; and
3. record the day on which the conference was held, and the times at which the conference started and ended; and
4. record the names of the participants; and
5. record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient's medical records. 

ADDITIONAL INFORMATION

Mental health case conference team members

The case conference must be organised by a medical practitioner (GP, OMP or consultant physician in their specialty of paediatrics or psychiatry) and involve at least two other members of the multidisciplinary case conference team providing different kinds of treatment to the patient. Participating providers must be invited to attend by the organising practitioner. The case conferencing team must include one medical practitioner (including a general practitioner, but not a specialist or consultant physician). 

The case conference must be arranged in advance, within a time frame that allows for all the participants to attend. The minimum of three care providers for a case conference must be present for the whole of the case conference. All participants must be in communication with each other throughout the conference, either face to face, by telephone or by video link, or a combination of these.

The patient should be given the option to attend the case conference, however may choose not to do so. Family members or carers, as well as other individuals providing support to the patient (such as a close friend, counsellor, teacher or peer worker) can also attend the case conference if the patient has agreed. However, these individuals do not count towards the minimum number of providers required.

Eligible Allied Health Professionals

Items 80176, 80177 and 80178 can only be provided by a person who is an allied health professional in relation to the provision of psychological therapy health services, focussed psychological strategies or dietetics health services in accordance with Schedule 1 of the Health Insurance (Allied Health Services) Determination 2014.

In some instances, two providers from the same profession may both participate in the case conference if they each provide different aspects of care to the patient – for example, if the providers have different specialisations which are both clinically relevant to the patient.

Psychological therapy health service

A person is an allied health professional in relation to the provision of a psychological therapy health service if the person:

   (a)  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; and

  (b)  is endorsed by the Psychology Board of Australia to practice in clinical psychology.

Until 31 October 2015, a person is also an allied health professional in relation to the provision of a psychological therapy health service if the person:

   (a)  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; and

  (b)  on 31 October 2014 was an allied health professional in relation to the provision of a psychological therapy health service because the person:

         (i)   was a member of the College of Clinical Psychologists of the Australian Psychological Society; or

        (ii)   had been assessed by the College of Clinical Psychologists of the Australian Psychological Society as meeting the requirements for membership of that College.   

Focussed psychological strategies health service

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

  (a)  the person 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 meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers 2014’ as in force on 25 September 2014;

 (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:

                (A)    having a minimum of two years experience in mental health; and

                (B)    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.

Dietetics health service

A person is an allied health professional in relation to the provision of a dietetics health service if the person is accredited by the Dietitians Association of Australia as an ‘Accredited Practising Dietitian’.

Claiming frequency

These case conferencing items can be accessed no more than once every 3 months. However, where there has been a significant change in the patient’s clinical condition, another case conference may be arranged earlier than the three months limitation. This would be for exceptional circumstances and the claim must be annotated with this advice to enable Services Australia to properly assess the claim. A change of care providers does not qualify as an exceptional circumstance.

Further information

Further information is also available for providers from the Services Australia provider enquiry line on 132 150.

Related Items: 80176 80177 80178