Question 1

What issues can be treated under a Medicare referral?

Accepted Answer

The Better Access initiative includes Psychological Therapy services provided by eligible clinical psychologists, and Focussed Psychological Strategies (FPS) services provided by eligible General Practitioners (GPs), registered psychologists, social workers and occupational therapists for the following issues:
- Alcohol Use Disorder 
- Anxiety disorders 
- Adjustment Disorder 
- Attention-Deficit Disorder
- Bereavement disorders
- Bipolar disorders
- Conduct Disorder
- Co-occurring anxiety and depression
- Depression
- Drug Use Disorder
- Eating disorders
- Obsessive-Compulsive Disorder (OCD)
- Panic Disorder 
- Phobic disorders
- Posttraumatic Stress Disorder (PTSD)
- Psychotic disorders
- Schizophrenia
- Sexual disorders
- Sleep problems

Question 2

Is there a difference between a Mental Health Treatment Plan (MHTP) and a referral?

Accepted Answer

Yes.

GP Mental Health Treatment Plan (MHTP):
A structured framework for GPs to undertake the management of patients with clinically diagnosed mental disorders. The MHTP is created at the start of treatment and allows the patient to access Medicare rebates for psychological services.

Referral for psychology: 
A formal recommendation from a GP, psychiatrist, or paediatrician to a psychologist, enabling their patient to access Medicare-subsidised psychological services. 
Under the Better Access to Psychiatrists, Psychologists, and General Practitioners through the Medicare Benefits Schedule (MBS) initiative, patients can receive access to rebates of:
 • up to 10 individual sessions per calendar year
 • Up to 10 group sessions per calendar year
A calendar year is 1 January to 31 December. Each year on 1 January, access resets to up to 10 of the above for the new calendar year.
The referral is typically for 6 sessions initially, with the possibility of additional sessions based on the patient's needs and the GP's assessment.
There is no standard form for allied mental health referrals. The referral should be in writing (signed and dated by the referring practitioner) and include: 
- the patient’s name, date of birth and address; 
- the patient’s symptoms or diagnosis; 
- a list of any current medications; 
- the number of sessions the patient is being referred for (the ‘course of treatment’); 
- a statement about whether the patient has an MHTP or a psychiatrist assessment and management plan.

Question 3

How do I obtain a referral?

Accepted Answer

MBS benefits for Better Access services are available to patients with a diagnosed mental health disorder who would benefit from a structured approach to the management of their treatment. An eligible health professional can provide a referral. This can be a General Practitioner (GP) once they have completed a MHTP, a psychiatrist or a paediatrician. We recommend that you book a long appointment with your doctor, to allow time for them to assess you and prepare referral documentation.

Question 4

Does a MHTP expire?

Accepted Answer

There is no fixed time limit on an MHTP. Many clients will not require a new plan after their initial plan has been prepared. As MHTPs do not expire, clients may still be referred for further mental health services for as long as the referral is consistent with what is in the MHTP and the referring practitioner has determined that further services are required. 
Ongoing management under a MHTP can be done by your doctor as often as necessary. Each referral for allied health services can be for a 'course of treatment' (up to 6 sessions), with a 10 session limit on rebate claims per calendar year. The only time a GP would need to create a new plan would be if your condition/diagnosis has changed. However, if you change doctors, your new doctor may prefer to create a new plan.

Referrals for psychology are valid for the number of services, not by time frame. If you have unused services on a referral at the end of the calendar year, you can continue to use them the next year.
Similarly, the referral is valid until the referred number of sessions have been completed, regardless of whether you choose to change allied health provider (although, it is recommended to advise your doctor if you have changed providers).

Question 5

How do Medicare rebates work?

Accepted Answer

A rebate is a partial amount paid back to you by Medicare, to help with the cost of medical and allied health services. Once you have paid your full session fee at the time of consultation, we can process your claim direct to Medicare. Medicare will process your claim and pay the rebate amount to your bank account.

Question 6

How many rebates can I claim?

Accepted Answer

Under a Mental Health Treatment Plan (MHTP), clients may be eligible for rebates of to 10 individual and 10 group therapy sessions with allied health professionals per calendar year (1 January - 31 December). 
MORE INFO: see the Services Australia fact sheet Better Access Mental Health Treatment Referred Allied Health Services.(https://hpe.servicesaustralia.gov.au/INFO/MBS/MBSM40INFO.pdf)

Under an Eating Disorder Treatment Plan (EDP), clients can claim up to 40 psychological sessions in a 12-month period. 
MORE INFO: see the Services Australia fact sheet Eligibility for Treatment Services under EDP.(https://hpe.servicesaustralia.gov.au/INFO/MBS/MBSM41INFO2.pdf) 
EDP referrals for psychology are created for a course of treatment (10 sessions) and are reviewed at the end of each course of treatment. When the EDP expires after 12 months, you will need a new EDP to continue to access psychological services under this scheme. 
MORE INFO: see the Services Australia fact sheet Eating Disorders Treatment and Management Plan Initiative Review Process.(https://hpe.servicesaustralia.gov.au/INFO/MBS/MBSM41INFO.pdf)

Question 7

Why is there a 'gap fee'?

Accepted Answer

The Medicare Benefits Schedule (MBS) is a list of the medical services for which the Australian Government will pay a Medicare rebate, to provide patients with financial assistance towards the costs of their medical services. 
Medicare rebates do not, and were never intended to, cover the full cost of medical services. The Government sets a Medicare Schedule Fee to determine the amount of the rebate that patients receive from the Government.
​Medicare rebates are paid as a percentage of the Medicare Schedule Fee (85% for allied health services). Unfortunately, since Medicare began many years ago, government indexation of Medicare Schedule Fees have not kept pace with real increases in practice costs. This is why clients will find there is a difference between the fee their therapist charges and their Medicare rebate. These are commonly called 'gap fees' or ‘out-of-pocket costs’, because the client must make up the difference out of their own pocket.
​

Question 8

Can I claim Medicare rebate and private health rebate for same session?

Accepted Answer

Medicare and private health funds stipulate that you can claim a rebate with either/or, not both.

Fees, rebates, and policies information

Our fees

Fees for other services:
letters, reports and completion of forms

Payment of fees

Medicare referrals and accessing rebates

Attendance Policy