We received some very welcome communication from the Department of Health today regarding referral requirements for Better Access services. We have had numerous communications from members about the excessive demand and administrative burden of ensuring that referrals had the number of sessions referred for on them. AAPi has advocated strongly regarding this and we are happy to share the below communication received today:
The Department of Health (the Department) has received contact from a number of organisations within the mental health sector with questions about referrals for treatment under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (MBS) initiative (Better Access). The key issues that have been raised are:
- whether a referral for Better Access services needs to specify the number of sessions covered by the referral, and
- how to manage referrals that do not specify the number of sessions in a course of treatment.
The purpose of this email is to clarify the Department’s position on this issue, and help address any questions or concerns your members may have around complying with MBS requirements. As such, please feel free to provide the information in this email to your membership.
Does a referral for Better Access services have to specify the number of sessions?
A referral for Better Access services should specify the number of sessions a patient is being referred for – that is, the Department considers it is best practice to specify the number of sessions on a referral for Better Access treatment, as this helps:
- ensure the treating practitioner can treat the patient in line with their clinical need as assessed by the referring practitioner,
- provide certainty and clarity for both patients and treating practitioners in relation to the course of treatment to be delivered, and
- support the policy intent behind Better Access since the number of sessions are capped per calendar year.
What to do if the referral does not specify the number of sessions
If a Better Access provider receives a referral that does not specify the number of sessions, they can use their clinical judgment to provide sessions up to the maximum amount allowed for that particular course of treatment. The maximum number of sessions allowed in a calendar year for each course of treatment is as follows:
- Initial course of treatment – a maximum of 6 sessions.
- Subsequent course of treatment – a maximum of 6 sessions up to the patient’s cap of 10 sessions (for example, if the patient received 6 sessions in their initial course of treatment, they can only receive 4 sessions in a subsequent course of treatment).
- Additional 10 COVID-19 sessions (only available until 30 June 2022) – a maximum of 10 sessions.
The Department’s Better Access communications materials as well as the explanatory notes on MBS online are currently under review to determine whether any changes are required to accurately convey this position.
Importantly, the terms of reference for the Better Access evaluation currently underway specifically mention the appropriateness and effectiveness of current treatment planning mechanisms and referral pathways. This provides an opportunity to examine referrals for treatment and their role in achieving the best outcomes for patients and practitioners involved in providing Better Access services. I encourage those of you that are part of the evaluation’s Clinical Advisory Group or Stakeholder Engagement Group to express any views on referrals and the types of information that you consider should be included on these through these forums.
In the meantime, if you, or any of your members, have any questions about the MBS claiming requirements for services delivered under Better Access please do not hesitate to email [email protected].
Australian Government Department of Health
AAPi will be updating all our resources with this new information and re-releasing them. We thank all our members that raised this with us or with the Department. It seems our collective communication has brought about this welcome outcome. As always - we are stronger together.