Mental Health Care Plans
Answers to Questions Frequently Asked by Doctors
There is often a lot of confusion about when to complete a review of a patient’s Mental Health Care Plan (MHCP), how many individual therapy sessions a patient is entitled to at different stages of the plan, and conditions of access to group sessions. The responses to the questions below aim to clarify any queries you have about patient MHCPs, and are based on multiple detailed conversations we have had with Medicare staff in regard to these matters, and information from the Australian Psychological Society.
How long is a patient’s MHCP valid?
Patient MHCP referrals are valid for 1 year from the date of the referral.
How many sessions of individual therapy is a patient eligible for under their MHCP?
Patients are eligible for up to 10 sessions per calendar year:
- Patients are eligible for 6 sessions under the initial plan.
- Patients are subsequently eligible for a further 4 sessions if they require additional treatment within the calendar year.
- You can request for patients to have access to these sessions by either:
- Conducting a review of the patient’s MHCP (if clinically appropriate/necessary); or
- Writing a letter to the treating psychologist requesting that the patient continue to be seen for the balance of their remaining sessions for the calendar year.
Is a patient with an existing MHCP eligible for another set of 10 sessions in the new calendar year, or only after their MHCP has expired?
It is a common misconception that patients may only access one set of 10 sessions within 12 months from the date of their initial referral, and must wait until this referral expires before accessing any further sessions during the following calendar year. As a result of this misconception, many patients experience unnecessary disruptions to the continuity of their psychological therapy. Please note that from the beginning of a new calendar year, the balance of a patient’s MHCP sessions resets to 10. A patient with a valid MHCP will be able to continue their treatment without requiring a new plan.
Case example: John is referred to a psychologist on 3rd March 2014. After having monthly sessions with his psychologist, he has used 10 sessions during 2014. He continues to require treatment in 2015. From 1st January 2015, he is able to begin accessing his 10 sessions for 2015. He does not have to wait until his referral expires on 3rd March 2015. The doctor does not need to review John’s plan at this stage, but writes the psychologist a letter stating that further treatment is required and stipulating the number of sessions requested. If John continues to attend monthly sessions, he will have used 3 of his 10 sessions by the time his referral expires. He will then require a review of his MHCP if he continues to require treatment, and will have access to 7 further sessions for the remainder of the year.
Medicare has provided an information sheet which further clarifies this aspect of the referral process.
When do I need to complete a MHCP review?
- A review only needs to be completed if something has changed clinically in regard to the patient’s mental health presentation, or if the plan is due to expire.
- If a review is required, the first review may be completed from 60 days after the patient’s initial referral date, and subsequent reviews may be completed from 90 days after the previous review date.
- If a patient is not due/eligible for a MHCP review but requires access to further sessions under their plan, you may write a letter to the treating psychologist requesting that the patient continue to be seen. Please be sure to stipulate the number of sessions you are requesting the patient have access to (e.g. “for the balance of their remaining sessions for the calendar year”).
How many group therapy sessions is a patient eligible for under their MHCP?
A patient with a valid MHCP is entitled to up to 10 group therapy sessions per calendar year, provided that participation in the group program is considered complimentary to their individual treatment.
Do the group sessions come out of the patient’s allocation of 10 sessions?
No. Patients are eligible for up to 10 individual sessions and 10 group sessions per calendar year. This allows patients with more complex needs to access additional treatment options, and can be a useful way to engage in skill-building outside their individual therapy.