Understanding Medicare Rules for Mental Health Care Plans and Reviews
Mental health is a vital part of overall well-being, and Medicare in Australia provides support for people seeking treatment through Mental Health Care Plans (MHCPs). These plans, developed by a GP, enable eligible individuals to access subsidised mental health services under Medicare.
What is a Mental Health Care Plan?
A Mental Health Care Plan is a structured document created by a GP after assessing a patient with a mental health condition, such as anxiety, depression, PTSD, etc. The plan outlines the patient's mental health needs, treatment goals and the types of services required, including referrals to psychologists.To be eligible, a patient must be diagnosed with a mental disorder as defined by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Common qualifying conditions include depression, anxiety disorders, bipolar disorder and eating disorders.
How Many Sessions Are Covered?
Under Medicare, patients with an MHCP can initially access up to 10 individual therapy sessions per calendar year with eligible mental health professionals. The process is as follows:
- First referral: The GP can refer the patient for up to six sessions. This can be completed via an in-person consult or via video consults (if you have physically attended the clinic in the past 12 months).
- Review required: After those sessions, a review must be conducted by the GP to assess progress and determine if more sessions (up to four additional ones) are appropriate. This means that patients must return to their GP partway through treatment for a formal MHCP review. This can be completed via an in-person, video or telephone consult.
What Happens During a Review?
The MHCP review allows the GP to:
- Evaluate the patient’s response to treatment
- Update the goals in the care plan
- Decide whether to refer for more sessions
- Coordinate care with other health professionals if needed
Reviews are a Medicare requirement for accessing additional sessions beyond the initial six. Who Can Provide Services Under an MHCP?
The referred provider must be:
- A registered psychologist, clinical psychologist, mental health occupational therapist, or mental health social worker
- Approved by Medicare to provide services under the Better Access initiative
- Willing to accept referrals under the MHCP and bill the appropriate MBS item numbers