Medicare referral process

As a result of the 2006 Council Of Australian Governments’ (COAG) mental health package, Medicare rebates are now available for people experiencing a mental health disorder for up to 12 individual psychology sessions per calendar year.

The procedure to be considered for the new Medicare psychology rebates follows.

*** Note you can check your current eligibility status for medicare psychology rebates by calling Medicare on 132 011 during office hours (have your medicare card handy). ***

Step 1. You need a ‘GP Metal Health Care Plan’ from your General Practitioner (Medicare item number 2710). Note the following:

¨ Eligible patients are those with a mental disorder (see table below) who would benefit from a structured approach to the management of their care needs.

Acute psychotic disorders

Depression

Panic disorder

ADD / ADHD

Dissociative / conversion disorder

Phobic disorders (eg, lifts, heights, spiders…)

Adjustment disorder

Drug use disorders

Sexual disorders

Alcohol use disorders

Eating disorders

Sleep problems

Bereavement disorders

Enuresis

Unexplained somatic complaints

Bipolar disorder

Generalised anxiety

or

Chronic psychotic disorders (eg, schizophrenia)
Mixed anxiety and depression (eg, social phobia, PTSD, trauma, OCD...)

Mental Disorder, not otherwise specified

Conduct disorders (children & adolescents)

Neurasthenia (fibromyalgia, chronic fatigue syndrome)

Excludes: Dementia, delirium, tobacco use disorder and mental retardation.

¨ The time required to prepare a Mental Health Care Plan can be considerably longer than a standard GP consult. Therefore, it is suggested in order to obtain a GP Mental Health Care Plan, that you either:

(1) Make a standard GP appointment and ask your GP if they are willing to prepare a plan for you at a subsequent longer appointment, or,

(2) Ask the practice reception staff if you can have a long enough appointment with a practice GP who is able and willing to complete a GP Mental Health Care Plan for you.

¨ The paper work involved for GPs with these plans can be somewhat onerous at times, and in busy practices it may not be practical for GPs to complete such plans. In which case you may have to consider approaching another GP. While Medicare prefer your ‘usual GP’ to write the plan, they will accept plans from other GPs.

¨ The mental health care plan is meant to name a specific psychologist to provide the psychology sessions (so you do not need to hunt through the Yellow Pages for a psychologist). GPs generally select a psychologist by matching the needs of their patient with the skills and experience of available local psychologists. As a GP's patient, you may wish to inform your GP of any preferences you have regarding choice of psychologist.

Step 2. Medicare rebates are then approved for an initial six psychology sessions. N ote the following:

¨ The GP Mental Health Care Plan has to be lodged and approved by Medicare before patients are eligible for psychology rebates. The time for this can vary tremendously, from the same day the plan is created, to up to two or more weeks later in some bulk-billed practices. Beware, you are not eligible for rebates for any psychology sessions that occur prior to lodgement and acceptance of the GP Mental Health Care Plan with Medicare.
If you wish to see if your GP Mental Health Care Plan is lodged with Medicare and therefore am eligible for a Medicare rebate, phone Medicare on 132-011, give your medicare number to the medicare worker and ask if your GP Mental Health Care Plan is in place.

¨ The Medicare rebate may not cover the complete fee the psychologist charges for the session. In which case a gap-fee may be payable. As different psychologists have different charges, payment methods and pay by dates, you will need to discuss with your psychologist their payment requirements. (See ‘Fees and rebates’ page.)

Step 3. If more psychology sessions are required you need to attend a review of your GP Metal Health Care Plan with the GP that created it. (Medicare item number 2712).

¨ This can occur from 4 weeks to 6 months from the date the care plan was created. At this review meeting your GP decides whether your mental health issues justify further medicare psychology rebates.

Step 4. Medicare rebates may be approved for a further six rebateable psychology sessions.

¨ Again, the Mental Health Care Plan Review needs to be lodged and accepted at Medicare before you are eligible for your next - the seventh - psychology session. Again, sessions that take place after the review date but before the review is lodged and accepted by Medicare will not be eligible for a Medicare rebate.

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After patients have had 12 psychology rebates in one calender year they are no longer eligible for any further Medicare rebateable psychology sessions unless 'exceptional circumstances' are present. Patients though are eligible for a further 12 rebateable sessions when the next calender year commences (eg, if in 2008 you required 12 medicare rebateable psychology sessions, then as of 1st January 2009 you may be eligible for up to a further 12 medicare rebateable psychology sessions in 2009).