Mental Health Case Conferences

Associated Items: 930, 933, 935, 937, 943, 945, 946, 948, 959, 961, 962, 964, 969, 971, 972, 973, 975, 986, 80176, 80177, 80178

Mental Health Case Conference service requirements

The purpose of a case conference is to establish and coordinate the management of the care needs of a patient.

A case conference is a process by which a multidisciplinary team carries out the following activities:

• discusses a patient's history;
• identifies the patient's multidisciplinary care needs;
• identifies outcomes to be achieved by members of the case conference team giving care and service to the patient;
• identifies tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team; and
• assesses whether previously identified outcomes (if any) have been achieved.

A Medicare benefit may not be claimed until all of these activities have been completed. 

Services attracting Medicare benefits

There are 21 Medicare Benefits Schedule (MBS) items for the provision of mental health case conferencing services. These services consist of:

Organisation and coordination of a mental health case conference:

• General Practitioner (GP items): 930, 933 and 935
• Psychiatrist and paediatrician items: 946, 948 and 959
• Prescribed medical practitioner (PMP) items: 969, 971 and 972.

Participation in a mental health case conference:

• GP items: 937, 943 and 945
• Psychiatrist and paediatrician items: 961, 962 and 964
• PMP items: 973, 975 and 986
• Eligible allied health professionals: 80176, 80177 and 80178.  

The requirements of case conference organisation, coordination and participation are set out below. It is expected that a patient would not normally require more than 4 case conferences in a 12-month period unless there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of additional services.

Patient eligibility

Mental Health Case conferences using these MBS items can be held for patients who have been referred for treatment under the Better Access Initiative by either a GP or PMP at the general practice in which the patient is enrolled in MyMedicare, or regardless of whether the patient is enrolled in MyMedicare, by the patient’s usual medical practitioner. GPs or PMPs, and eligible allied health professionals or other members of the multidisciplinary team (psychiatrists/paediatricians) do not need to have an existing relationship with the patient, however, they must have agreed to and must be able to provide advice on the treatment and care they can or will provide the patient for the management of their condition. For further information on the Better Access Initiative, refer to explanatory note AN.0.78 - Better Access Initiative.

In addition, Mental Health Case Conferences using these MBS items can be held for patients who have an active Eating Disorder Treatment and Management Plan. For further information on Eating Disorder Treatment and Management Plans, refer to explanatory note MN.16.1 - Eating Disorders General Explanatory Notes. 

Organising and Coordinating a Mental Health Case Conference

To organise and coordinate a mental health case conference, a provider must:

• explain to the patient the nature of a mental health case conference and ask for their agreement to the conference taking place;
• record the patient's agreement to the conference;
• record the day on which the conference was held, and the times at which the conference started and ended;
• record the names of the participants;
• offer the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees) a summary of the conference;
• provide this summary to other team members;
• discuss the outcomes of the conference with the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
• record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient's medical records.

The organising of a mental health case conference should generally be undertaken by the patient's usual medical practitioner. A patient’s usual medical practitioner is a prescribed medical practitioner, or a medical practitioner working in the same medical practice, that has provided the majority of services to the patient over the previous 12 months and/or will be providing the majority of services to the patient over the coming 12 months.

Participating in a Mental Health Case Conference

To participate in a mental health case conference, a provider must:

• explain to the patient the nature of a mental health case conference, and ask for their agreement to the prescribed medical practitioner's participation in the conference;
• record the patient's agreement to the prescribed medical practitioner's participation;
• record the day on which the conference was held, and the times at which the conference started and ended;
• record the names of the participants; and
• record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient's medical records.

Mental Health Case Conference members

A mental health case conference must be organised by a GP, PMP or consultant physician specialising in the practice of their field of psychiatry or paediatrics and involve at least 2 other members of the multidisciplinary case conference team providing different kinds of treatment to the patient. In some instances, 2 providers from the same profession may both participate in the case conference if they each provide different aspects of care to the patient – for example, if the providers have different specialisations which are both clinically relevant to the patient.

Other members of the case conference team may include allied health professionals, home and community service providers, and care organisers. Participating providers must be invited to attend by the organising practitioner.

During the provision of a mental health case conference service, at least 3 members of the multidisciplinary case conference team (including a medical practitioner, and at least 2 other members) must be present at the same time for the case conference to take place. Two providers from the same profession may both participate in the case conference if they each provide different aspects of care to the patient. For example, if the providers have different specialisations which are both clinically relevant to the patient.

The case conference must be arranged in advance, within a time frame that allows for all the participants to attend. The minimum of 3 case conference members as outlined above must be present for the whole of the case conference. All participants must be in communication with each other throughout the conference, either face to face, by telephone or by video link, or a combination of these.

Patient, Family and Carer participation

The patient should be given the option to attend the case conference, however, may choose not to do so. A family member or unpaid carer, as well as other individuals providing support to the patient (such as a close friend, counsellor, teacher, or peer worker) may also be invited to attend the case conference with the patient’s consent. However, these individuals do not count towards the minimum number of providers required to meet the regulatory requirements of these items (refer to section on mental health case conference members). 

Allied Health Professional Eligibility

Only eligible allied health professionals can claim participation in mental health conference services under these MBS items.

For the purpose of a mental health case conference, an eligible allied health professional means an allied health professional who meets the qualification requirements for providing the following types of treatment:

• psychological therapy services (refer to explanatory note MN.6.2 - Provision of Psychological Therapy); or
• focussed psychological strategies services (refer to explanatory note MN.7.4 - Provision of Focussed Psychological Strategies).
• dietetics health services.

Further information

For further information on the Better Access Initiative, refer to explanatory note AN.0.78 - Better Access Initiative.

For further information on Eating Disorder Treatment and Management, refer to explanatory note MN.16.1 - Eating Disorders General Explanatory Notes.

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

Further information is available for providers 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.