Medicare Better Access Initiative
MBS benefits are available to people with
a diagnosed mental health condition, and
a valid Mental Health Treatment Plan (MHTP); or
under a referred psychiatrist assessment and management plan (PAMP); or
with a direct referral by a psychiatrist or paediatrician.
Referral validity
Referrals are valid for the number of services shown on the referral letter, even if the patient changes their treating allied health professional.
If your patient has unused services on their referral at the end of the calendar year, they can use them the next year, but they will count towards the new year’s claiming limit.
For a referral to be valid, it requires that the presenting concern is a diagnosed mental health condition —documented within the MHTP.
Calendar year claiming limits
In a calendar year (1 January to 31 December), your patient can get psychological therapy and FPS services up to the combined limit of:
10 individual services
10 group services
The yearly claiming limit is calculated on the date of service, not when the treatment was referred.
Once a patient has reached their service limit, they can continue to receive treatment if it is required - however Medicare benefits cannot be claimed once the limit is reached.
Family and carer participation
Better Access services allow eligible health professionals to deliver up to a maximum of 2 services per calendar year to a family member or carer of the patient. These 2 services are included within the maximum of 10 sessions per calendar year, not in addition to the maximum.
Referral details:
MHTP referrals must now be dated and signed (an electronic signature is acceptable), and include:
the patient’s name
date of birth
address
their symptoms or diagnosis
any current medications
the number of treatment sessions (‘course of treatment’) the patient is being referred for
include if a MHTP or PAMP has been prepared - a copy can be shared if the patient has consented