Note AN.15.1 | Medicare Benefits Schedule

Category 1 - PROFESSIONAL ATTENDANCES

AN.15.1

Mental Health Case Conferences

Associated Items: 930, 933, 935, 937, 943, 945, 946, 948, 959, 961, 962, 964, 969, 971, 972, 973, 975, 986, 80176, 80177, 80178

Mental Health Case Conference service requirements

The purpose of a case conference is to establish and coordinate the management of the care needs of a 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.

A Medicare benefit may not be claimed until all of these activities have been completed.

Services attracting Medicare benefits

There are 21 Medicare Benefits Schedule (MBS) items for the provision of mental health case conferencing services. These services consist of:

Organisation and coordination of a mental health case conference:

GP items: 930, 933 and 935
Psychiatrist and paediatrician items: 946, 948 and 959
Prescribed medical practitioner items: 969, 971 and 972.

Participation in a mental health case conference:

GP items: 937, 943 and 945
Psychiatrist and paediatrician items: 961, 962 and 964
Prescribed medical practitioner items: 973, 975 and 986
Eligible allied health professionals: 80176, 80177 and 80178.

The requirements of case conference organisation, coordination and participation are set out below. It is expected that a patient would not normally require more than 4 case conferences in a 12-month period unless there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of additional services.

Patient Eligibility

Mental Health Case conferences using these MBS items can be held for patients who have been referred for treatment under the Better Access Initiative or have an active eating disorder treatment and management plan. For further information on the Better Access Initiative, refer to explanatory note AN.0.78 - Better Access Initiative.

Organising and Coordinating a Mental Health Case Conference

To organise and coordinate a mental health case conference, a provider must:

explain to the patient the nature of a mental health case conference and ask for their agreement to the conference taking place;
record the patient's agreement to the conference;
record the day on which the conference was held, and the times at which the conference started and ended;
record the names of the participants;
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;
provide this summary to other team members;
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.

The organising of a mental health case conference should generally be undertaken by the patient's usual medical practitioner. A patient’s usual medical practitioner 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.

Participating in a Mental Health Case Conference

To participate in a mental health case conference, a 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;
record the patient's agreement to the prescribed medical practitioner's participation;
record the day on which the conference was held, and the times at which the conference started and ended;
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.

Mental Health Case Conference members

A mental health 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. 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.

Other members of the case conference team may include allied health professionals, home and community service providers, and care organisers. Participating providers must be invited to attend by the organising practitioner.

During the provision of a mental health case conference service, a maximum of one other medical practitioner may be present, and they must be providing a different kind of service to 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 case conference members as outlined above 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.

Patient, Family and Carer participation

The patient should be given the option to attend the case conference, however, may choose not to do so. A family member or unpaid carer, as well as other individuals providing support to the patient (such as a close friend, counsellor, teacher, or peer worker) may also be invited to attend the case conference with the patient’s consent. However, these individuals do not count towards the minimum number of providers required to meet the regulatory requirements of these items (refer to section on mental health case conference members).

Allied Health Practitioner Eligibility

Only eligible allied health practitioners can claim participation in mental health conference services under these MBS items.

For the purpose of a mental health case conference, an eligible allied health practitioner means an allied health professional who meets the qualification requirements for providing the following types of treatment:

psychological therapy health services (refer to explanatory note MN.6.2 - Provision of Psychological Therapy);
focussed psychological strategies health services (refer to explanatory note MN.7.4 - Provision of Focussed Psychological Strategies); or
dietetics health services.

Further information

For further information on the Better Access Initiative, refer to explanatory note AN.0.78 - Better Access Initiative.

For further information about Medicare Benefits Schedule items, please visit the MBS online website at www.health.gov.au/mbsonline.

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

If you are a patient seeking advice about Medicare services, patient benefits, or your Medicare claims, please contact Services Australia on the Medicare General enquiry line on 132 011.

Related Items: 930 933 935 937 943 945 946 948 959 961 962 964 969 971 972 973 975 986 80176 80177 80178

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: $64.50 Benefit: 75% = $48.40 100% = $64.50