Note AN.7.32 | Medicare Benefits Schedule

Category 1 - PROFESSIONAL ATTENDANCES

AN.7.32

Mental Health Case Conferences - Prescribed Medical Practitioners

Last reviewed: 1 November 2023

Items 969, 971, 972, 973, 975, 986 provide rebates for a prescribed medical practitioner (see note AN.7.1), to organise and coordinate, or participate in, mental health case conferences. They apply for a patient who is being treated under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (MBS) initiative (Better Access) or an eating disorder treatment and management plan (EDTMP).

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 prescribed medical practitioner 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, prescribed medical practitioner, psychologist, social worker or occupational therapist, or
psychological therapy service delivered by a clinical psychologist

REGULATORY REQUIREMENTS

To organise and coordinate case conference items 969, 971 and 972, the provider must:

explain to the patient the nature of a mental health case conference and ask for their agreement to the conference taking place; and
record the patient's agreement to the conference; and
record the day on which the conference was held, and the times at which the conference started and ended; and
record the names of the participants; and
offer the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees) a summary of the conference and provide this summary to other team members; and
discuss the outcomes of the conference with the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient's medical records.

To participate in mental health case conference items 973, 975 and 986, the provider must:

explain to the patient the nature of a mental health case conference, and ask for their agreement to the prescribed medical practitioner's participation in the conference; and
record the patient's agreement to the prescribed medical practitioner's participation; and
record the day on which the conference was held, and the times at which the conference started and ended; and
record the names of the participants; and
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

Usual medical practitioner

Items 969-986 should generally be undertaken by the patient's usual medical practitioner. This is a prescribed medical practitioner, or a medical practitioner working in the same medical practice, that has provided the majority of services to the patient over the previous 12 months and/or will be providing the majority of services to the patient over the coming 12 months.

Mental health case conference team members

The case conference must be organised by a medical practitioner (GP, prescribed medical practitioner 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 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.

This item does not preclude the claiming of a consultation on the same day if other clinically relevant services are provided.

Claiming frequency

It is expected that a patient would not normally require more than 4 case conferences in a 12-month period.

This item does not preclude the claiming of a consultation on the same day if other clinically relevant services are provided.

Further sources of information

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

Category 1 - PROFESSIONAL ATTENDANCES

969

Attendance by a prescribed medical practitioner, as a member of a multidisciplinary case conference team, to organise and coordinate a mental health case conference if the conference lasts for at least 15 minutes, but for less than 20 minutes

Fee: $62.30 Benefit: 75% = $46.75 100% = $62.30