Running Out of Better Access Sessions? Two Things Worth Knowing Before the Year Ends

1 Oct

As the year winds down, plenty of clients have used up their rebated sessions, or are getting close. That’s usually when the questions (and the myths) start flying.

So we’ve done the digging for you. Below is a frequently overlooked option for topping up sessions once Better Access runs dry, plus written advice from Medicare on re-referrals that cross into the new year.

Topping Up with a GP Chronic Condition Management Plan

At this time of year, many clients on a Mental Health Treatment Plan (MHTP) have used all 10 of their rebated sessions, or are about to.

The good news is that some clients may be eligible for up to 5 additional sessions under a GP Chronic Condition Management Plan (GPCCMP). The rebate is lower than Better Access, but it can make a real difference for clients who’d otherwise pay full fees.

“But depression isn’t a chronic condition...”

It can be. A patient is eligible if they have at least one medical condition that has been (or is likely to be) present for at least six months. Mental health and neurodevelopmental conditions can qualify, and they don’t need to be secondary to a physical condition.

Whether a GPCCMP is right for an individual patient still comes down to the GP’s clinical judgement. Even so, it’s well worth raising with clients who are running low on sessions.

MHTP Re-Referrals: The Myth That Won’t Quit

You may have heard that GPs can only re-refer for the number of MHTP sessions a client has left in the calendar year. We had our doubts, so we went straight to the source.

Here’s the scenario we put to Medicare:

A client has used 9 rebated sessions this year and returns to their GP for a re-referral. Can the GP only refer for 1 session (the remaining cap for the year), or can they refer for, say, 4, with the remaining 3 to be used next year?

Medicare’s written response (via AskMBS) confirmed there’s no legislated restriction on a GP issuing a referral for up to 4 sessions, as long as the GP considers it clinically appropriate.

In short: a re-referral can include sessions that carry over into the new year, as long as the GP considers it clinically appropriate. Only the sessions within the remaining annual cap can be claimed before 31 December.