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Better Access to Metal health Care Program: Medicare rebates for mental health services

In November 2006, the Australian Government extended the Medicare Benefits Scheme to include mental health care treatments for adults and children experiencing mental health difficulties and problems (the Better Access to Mental Health Care Program). This extension provides those experiencing mental health problems with the ability to access a Medicare rebate for services provided by an eligible allied health care professional (including psychiatrists, psychologists, occupational therapists or social workers). Mental health problems that can be treated using the scheme are not limited to, but include:

  • Anxiety, phobias and depression
  • Behaviour problems
  • Difficulties in controlling emotions (including anger)
  • Sleep problems
  • Concentration and attention problems
  • Bed-wetting and other toileting problems
  • Obsessive Compulsive Disorder
  • Developmental Disorders including Autism Spectrum Disorder, Aspergers Disorder and Pervasive Developmental Disorder **

I’m concerned and would like to access the Mental Health Care Plan for my child, what do I need to do?Medicare has worked with health professionals to make the process of accessing a rebate as streamlined as possible.  Below is an indication of the steps you will need to take:

Step 1: Make an appointment

Make an appointment with your child’s General Practitioner (GP), paediatrician or psychiatrist as soon as possible:

  • If you have an existing appointment with your child’s paediatrician or psychiatrist, use this to discuss your concerns.
  • If you have made an appointment with your child’s GP, request that this appointment be a Mental Health Care Consultation (this is a specific appointment type that is longer than a typical appointment enabling your concerns to be heard and necessary forms to be completed).
  • In some cases, children will already be accessing the services of an eligible allied health practitioner however the rebate cannot be accessed without having a referral from an appropriate medical professional.

Step 2: Requirements of eligibility for a Medicare rebate

To ensure that your child is eligible for assistance, your chosen medical professional will discuss your concerns with you (and your child where appropriate) and the following will occur:

  • Your child’s GP, psychiatrist or paediatrician will assess your child as having a mental health problem that is covered by the extended Medicare rebates.
  • If your child’s GP is making the referral, a Mental Health Care Plan will be written and submitted to Medicare.
  • Your chosen medical professional can then refer you to an eligible allied health professional and you can begin seeking and receiving assistance.

Although any Australian citizen/resident with a Medicare card is eligible to apply for a Mental Health Care Plan, not all mental health care providers can provide services. The following requirements are made of providers:

  • Eligible allied health professionals include psychologists, occupational therapists and social workers who have specialised in the treatment of mental health problems.
  • The provider must have a Medicare number.

What exactly is the rebate and what are the costs incurred?

The Better Access to Mental Health Care Program provides individuals with the following:

  • 10 sessions of treatment with an appropriate allied health professional per year
  • 10 group therapy sessions where these services are available and are seen as appropriate by the referring doctor

The cost of services and the rebate available from Medicare varies according to the length of the session and the fee being charged. Fees are determined by the allied health professional. If there is a gap between the consultation fee and the Medicare rebate, you will be responsible for the additional payment. You cannot use private health insurance extras cover to cover the out of pocket expense.

What about confidentiality?

Similar to all medical and mental health information, the Mental Health Plan created by your medical team and submitted to Medicare is covered by the appropriate privacy of information acts. Medicare will have a record of your visit and the reason for your visit, however they are unable to give out this information without your permission (unless strict legal exemptions have been applied).

More information:

The Better Access to Mental Health Care Program is also available for many adolescent and adult mental health problems. Further information can be found by downloading:

**If your GP assesses your child as requiring assessment or treatment for Autism Spectrum Disorder, Aspergers Disorder or Pervasive Developmental Disorder your child may also be eligible for a Medicare rebate under the Helping Children With Autism Program. Your child may be eligible for up four assessment sessions and 20 treatment sessions with an eligible allied health professional across their lifespan. Eligible allied health professionals include psychologists, speech pathologists, occupational therapists, audiologists, optometrists, orthoptists and physiotherapists who specialise in assessing and/or treating developmental disorders. Eligible allied health professionals must have a Medicare provider number. Further information can be found by downloading: