Better Access Initiative

Summary

This explanatory note provides an overview of The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative (Better Access), which commenced on 1 November 2006. Under this initiative, Medicare benefits are available to patients for selected mental health treatment services provided by eligible general practitioners (GPs), eligible prescribed medical practitioners (PMPs), psychologists (eligible clinical and eligible registered), eligible social workers and eligible occupational therapists.

Further information on the eligibility requirements of a GP can be found at 2.20.7 (Restrictions on items in Subgroup 2 of Group A20 [focussed psychological strategies]) and a PMP can be found at 2.20.7A (Restrictions on items in Subgroup 9 of Group A7 [focussed psychological strategies]). The Health Insurance (General Medical Services Table) Regulations 2021 provides further information on the legislative requirements for eligible GPs and PMPs. For further information on the qualification requirements for Allied Health Professionals who are able to provide mental health services under Medicare, refer to Schedule 1 (Qualification requirements for allied health professionals) in the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024.

All Medicare Benefits Schedule (MBS) explanatory notes that are associated with the Better Access initiative are listed below:

Explanatory Note	Relevant item numbers
AN.0.56 - Mental Health Treatment Plans and Consultation	272, 276, 277, 282, 2700, 2701, 2715, 2717, 92112, 92113, 92116, 92117, 92118, 92119, 92122, and 92123.
MN.6.2 - Provision of Psychological Therapy	80000, 80005, 80010, 80015, 80020, 80021, 80022, 80023, 80024, 80025, 91166, 91167, 91181, and 91182.
MN.7.4 - Provision of Focussed Psychological Strategies	283, 285, 286, 287, 2721, 2723, 2725, 2727, 80100, 80105, 80110, 80115, 80120, 80121, 80122, 80123, 80125, 80127, 80128, 80130, 80135, 80140, 80145, 80146, 80147, 80148, 80150, 80152, 80153, 80155, 80160, 80165, 80170, 80171, 80172, 80173, 80174, 80175, 91818, 91819, 91842, 91843, 91820, 91821, 91844, 91845, 91169, 91170, 91183, 91184, 91172, 91173, 91185, 91186, 91175, 91176, 91187 and 91188.
MN.6.3 - Referral requirements for Better Access Treatment Services	272, 276, 281, 282, 283, 285, 286, 287, 2700, 2701, 2715, 2717, 2721, 2723, 2725, 2727, 80000, 80005, 80010, 80015, 80020, 80021, 80022, 80023, 80024, 80025, 80100, 80105, 80110, 80115, 80120, 80121, 80122, 80123, 80125, 80127, 80128, 80130, 80135, 80140, 80145, 80146, 80147, 80148, 80150, 80152, 80153, 80155, 80160, 80165, 80170, 80171, 80172, 80173, 80174, 80175, 91167, 91169, 91170, 91172, 91173,  91175, 91176, 91181, 91182,91183, 91184, 91185, 91186, 91187, 91188,  91818, 91819, 91820, 91821,  91842, 91843, , 91844, 91845, 92112, 92113, 92116, 92117, 92118 and 92119. Note: for specialist psychiatrists and paediatricians these services include any of the specialist attendance items 104 through 109 and items 91822, 91823 and 91833. For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 to 308, 310, 312, 314, 316, 318 or 319 through 349; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133.
AN.15.1 - Mental Health Case Conferences	930, 933, 935, 937, 943, 945, 946, 948, 959, 961, 962, 964, 969, 971, 972, 973, 975, 986, 80176, 80177 and 80178.
MN.7.5 - Family and Carer Participation	309, 311, 313, 315, 2739, 2741, 2743, 2745, 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162, 80166, 91859, 91168, 91171, 91174, 91177, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91861, 91862, 91863, 91864, 91865, 91866, and 91867.

Services provided under Better Access

Through Better Access, eligible patients can claim a Medicare benefit for up to 10 individual and 10 group therapy mental health treatment services per calendar year. These services consist of:

• psychological therapy provided by eligible clinical psychologists (refer to explanatory note MN.6.2 - Provision of Psychological Therapy); and
• focussed psychological strategies provided by eligible GPs, eligible PMPs, eligible psychologists, eligible occupational therapists, and eligible social workers (refer to explanatory note MN.7.4 – Provision of Focussed Psychological Strategies).

A Medicare benefit is also available for a patient to involve another person, such as a family member or carer, in their treatment. Medicare benefits are available to a patient for up to 2 services provided to another person per calendar year. Any services delivered using these MBS items count towards the patient's course of treatment and calendar year allocations under Better Access. For further information on involving another person in a patient’s treatment, refer to explanatory note MN.7.5 – Family and Carer Participation.

There are also MBS items for the provision of mental health case conferencing services to establish and coordinate the management of the care needs of a patient. For further information refer to explanatory note AN.15.1– Mental Health Case Conferences.

Patient eligibility for Better Access services

Better Access services apply to people with a clinically diagnosed mental disorder. For the purposes of Better Access services, a mental disorder is defined as a significant impairment of an individual's cognitive, affective and/or relational abilities which may require intervention and may be a recognised, medically diagnosable illness or disorder. This definition is informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. For the purposes of Better Access services, dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders.

When referring for treatment services under the Better Access initiative, services should be utilised for patients who require at least a moderate level of mental health support. Consideration should be given to other treatment interventions and pathways (e.g. digital mental health services, Medicare Mental Health Centres, etc) should the patient’s level of support not require psychological intervention under the Better Access initiative.

Referral requirements

Additionally, Better Access MBS treatment items will only attract a Medicare benefit where a patient has been referred for Better Access services by a GP or PMP at the patient’s MyMedicare registered practice or by their usual medical practitioner, or by a specialist or consultant physician specialising in the practice of their field of psychiatry or paediatrics. For the purposes of these services, referring practitioner means:

• usual medical practitioner, in relation to a patient, means a general practitioner or prescribed medical practitioner:

(a) who has provided the majority of services to the person in the past 12 months; or
(b) who is likely to provide the majority of services to the person in the following 12 months; or
(c) located at a medical practice that:

(i) has provided the majority of services to the person in the past 12 months; or

(ii) is likely to provide the majority of services to the person in the next 12 months.

• A GP or PMP at a MyMedicare registered practice means the registration program by that name administered by the department. A MyMedicare service means a service to which an item is provided:

(a) to a person enrolled in MyMedicare; and
(b) at the general practice at which the person is enrolled.

• a medical practitioner who has referred the patient as part of a GP Mental Health Treatment Plan (refer to explanatory note AN.0.56 – GP Mental Health Treatment Plans and Consultation) or a Psychiatrist Assessment and Management Plan (refer to explanatory note AN.0.30 - Consultant Psychiatrist – Referred Patient Assessment and Management Plan); or

• a specialist or consultant physician specialising in the practice of their field of psychiatry directly referring for Better Access services; or

• a specialist or consultant physician specialising in the practice of their field of paediatrics directly referring for Better Access services.

• the patient referral requirements, as part of a Mental Health Treatment Plan (refer to explanatory note AN.0.56 – Mental Health Treatment Plans and Consultation Items) or a Psychiatrist Assessment and Management Plan (refer to explanatory note AN.0.30 - Consultant Psychiatrist – Referred Patient Assessment and Management Plan), have been met.

Focussed psychological strategies are available to any patient from any GP or PMP who has the appropriate training recognised by the General Practice Mental Health Standards Collaboration. GPs and PMPs who provide focussed psychological strategies do so as part of an arrangement for the treatment of an assessed mental disorder under a Mental Health Treatment Plan.

For more information on referral requirements for Better Access services, refer to explanatory note MN.6.3 - Referral requirements for Better Access Treatment Services.

If there is any doubt about a patient's eligibility, Services Australia will be able to confirm whether a Mental Health Treatment Plan and/or a Psychiatrist Assessment and Management Plan is in place and claimed; or an eligible psychiatric or paediatric service has been claimed, as well as the number of Better Access services already claimed by the patient during the calendar year. Additionally, providers can also access the Health Professional Online Services (HPOS) to view a patient’s Mental Health Treatment Plan history.

Allied health professionals can call Services Australia on 132 150 to check this information, while unsure patients can seek clarification by calling 132 011 or view their care plan history in their Medicare online account through myGov to help track services that have been claimed.

A patient will not be eligible to receive a Medicare benefit if they have not been appropriately referred or if a relevant Medicare service has not been provided to them. If the referring service has not yet been claimed, Services Australia will not be aware of the patient's eligibility. In this case the treating practitioner or allied health professional should, with the patient's permission, contact the referring practitioner to ensure a relevant referring service has been provided to the patient.

Mental Health Treatment Plan review requirements

After a patient has used the allocated number of services in the initial individual course of treatment (a maximum of 6 services on the initial referral), a review of the patient’s Mental Health Treatment Plan and a new referral must be obtained from the referring practitioner for further treatment. The review will assess the patient’s progress and consider further treatment options. A review is not to be undertaken more than once in a 3 month period or within 4 weeks following the preparation of a Mental Health Treatment Plan unless exceptional circumstances exist. It is recommended a Mental Health Treatment Plan be reviewed at least once during a course of treatment, with most patients generally not requiring more than 2 reviews in a calendar year.

GPs and PMPs are to use time tiered professional (general attendance) items for the specific purpose of reviewing a Mental Health Treatment Plan. A Mental Health Treatment Plan does not expire. A new Mental Health Treatment Plan should not be created unless exceptional circumstances exist. An exceptional circumstance may be where the patient has had a significant change to their mental health or the treating practitioner or treating allied health professional is unable to obtain a copy of their Mental Health Treatment Plan.

In addition to the 10 individual services, a patient can be referred up to a maximum of 10 group therapy mental health treatment services each calendar year on any one referral. Patients will be required to have a review of their Mental Health Treatment Plan and obtain a new referral from their referring practitioner after they received the number of group therapy mental health treatment services stated on the referral (if less than 10).

The referring practitioner will use their clinical discretion when undertaking a review to determine the number of allied mental health services their patient will be referred for and if the patient requires additional MBS mental health services. Medicare benefits are only available for a maximum of 10 individual and 10 group therapy mental health treatment services each calendar year. Patients can privately fund or use other funding sources they are eligible for to access further services.

Under MyMedicare and usual medical practitioner requirements, GPs and PMPs will be able to access time-tiered professional (general) attendance items to review and provide mental health care to patients recognising the time spent with patients to provide quality care. There will be no limitation on the number of health-related issues that can be addressed as part of a general attendance consultation, as long as the requirements of the service are met, and adequate and contemporaneous records are maintained. Key principles for using time-tiered professional (general) attendance items and any specific requirements is available at AN.0.9 | Using time-tiered professional (general) attendance items. 

Out-of-pocket expenses and Medicare safety net

Charges in excess of the Medicare benefit for Better Access MBS items are the responsibility of the patient. However, any out-of-pocket costs will count towards the Medicare safety net for that patient. The out-of-pocket costs for mental health services which are not Medicare eligible do not count towards the Medicare safety net (refer to explanatory note GN.10.27 | Medicare Safety Nets.

Publicly funded services

Better Access MBS items do not apply for services that are provided by any other Commonwealth or state funded services or provided to an admitted patient of a hospital. Unless an exemption under subsection 19(2) of the Health Insurance Act 1973 applies for a Medicare benefit to be payable, all requirements of the service must be met, including registration with Services Australia.

Private health insurance

Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to 'top up' the Medicare benefit paid for the services. If a patient has exhausted their services for which a Medicare benefit is payable for the calendar year, and if they have appropriate private health insurance which covers psychological services, they may claim from their private health fund. The benefit payable to members of private health funds will vary based on the level of their ancillary cover.

Record keeping and reporting requirements

The Department of Health, Disability and Ageing undertakes regular post payment auditing to ensure MBS items are claimed appropriately. All practitioners providing Better Access services should ensure they keep adequate and contemporaneous records, including documenting the date, time and people who attended. Only clinical details recorded at the time of attendance count towards the time of the consultation. Other notes or reports added at a later time are not included. For information on what constitutes adequate and contemporaneous records, refer to explanatory note GN.15.39 - Practitioners should maintain adequate and contemporaneous records.

Relevant Legislation

Details about the legislative requirements of the Better Access initiative MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au.

Attendance items are set out in 3 regulatory instruments:

• Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024 - Eligible psychologist (clinical and registered), eligible social worker, and eligible occupational therapist items.
• Health Insurance (General Medical Services Table) Regulations 2021 – General practitioner, prescribed medical practitioner and psychiatrist items, including items related to Focussed Psychological Strategies for eligible general practitioners and eligible prescribed medical practitioners.
• Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021 - telehealth (video and phone) items – General practitioner, prescribed medical practitioner, eligible psychologists (clinical and registered), eligible social worker, and eligible occupational therapist items. In addition, items related to focussed psychological strategies for eligible general practitioners and eligible prescribed medical practitioners are included in this instrument.

Further information

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

For providers, further information is also available 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.