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What exactly are the changes to Medicare?

From November 1, a suite of new MBS items will be introduced to support a model of best practice, evidence-based care for eating disorders.

People living with an eating disorder will be able to get a Medicare rebate for up to 40 psychological session and 20 dietetics session within a 12 month period. They will also receive Medicare subsidies for regular session with their GP and a specialist appointment with a psychiatrist or paediatrician.

Previously people with eating disorders (and all other mental health disorders) have had access to rebates for just 10 psychological sessions and 5 dietetic sessions.

Under the new scheme, there will be 64 specific Medicare Benefits Schedule (MBS) item numbers for the treatment of anorexia nervosa, bulimia nervosa, binge eating disorder and atypical presentations. The new items cover both face-to-face and telehealth services.

For all the details, check out more information at MBS online.

Why are these changes being made?

The changes being made will bring the Medicare Benefits Scheme (MBS) into line with the research for eating disorder treatment. Evidence shows that this higher level of treatment services is correlated with a reduced rate of repeat hospitalisation and improved health outcomes.

The changes were recommended by the MBS Review Taskforce, which is doing a major review of the MBS more broadly, and recommending ways it can be modernised to improve outcomes.

The Taskforce consulted with key stakeholders and experts in the eating disorders field, including InsideOut, about how the Medicare system needed to be updated. Follow the links to read more about the Eating Disorder Working Group and the Medicare benefits Schedule (MBS) Review Taskforce here.

Am I eligible?

The eligibility criteria for these items has been updated on the Federal Register of Legislation, you can read it in full here (go to page 182).

You are eligible if you have a diagnosis of Anorexia Nervosa. If you have a diagnosis of Bulimia Nervosa, Binge Eating Disorder or Other Specified Feeding and Eating Disorders Eating Disorder you may also be eligible and your GP can assess if you meet the eligibility criteria.

The eligibility criteria includes an assessment on the Eating Disorder Examination Questionnaire (EDE-Q) and criteria relating to medical and mental health severity.

You can complete the EDE-Q on our website here and print out the results to take to your GP.

What if I’m not eligible?

Even if you don't meet the criteria for these items, you may still be able to access treatment under the existing Better Access to Mental Health scheme. Please discuss your eligibility and referral options with your GP

How can I access the rebated sessions? What’s the process?

While there is a maximum 40 rebated psychological sessions available each 12 months, you will require regular review by your GP, Psychiatrist or Paediatrician, who will be best placed to help determine the number of sessions and providers who can help a patient to manage their condition.

Your doctor will establish an Eating Disorders Treatment Plan which will enable access to MBS rebated sessions, and regular review will determine what is needed to help you.

For any particular patient, an eating disorder treatment and management plan expires at the end of a 12 month period following provision of that service. Eating Disorders treatment services are not available if the eating disorder treatment and management plan has expired or is no longer required/in place.

For a more extensive overview of the process. Please see the Medicare For Me page.

How regularly do I need to be reviewed by my GP?

Your Eating Disorders Treatment Plan will initially provide access to a course of up to 10 psychological sessions. For dietetic session you will get access from he outset to 20 sessions over a twelve month period.

To access the full 40 psychological treatment sessions you will need to be regularly reviewed by your GP and also attend a specialist review with a psychiatrist/paediatrician.

What is the specialist review?

Once you have accessed 20 sessions of psychological treatment you will to get assessed by a psychiatrist or paediatrician to access the final 20 sessions. This is in addition to be reviewed by your GP. This can occur at any point before session 20 provided your GP makes the referral.

The psychiatrist/paediatrician needs to confirm your diagnosis, evaluate your response to therapy so far and make a recommendation as to whether further session are needed.

It is very helpful for your psychologist or mental health practitioner to provide a report to the psychiatrist or paediatrician (and a copy to your GP) before you see them. Your psychologist will have a good understanding of the need for further treatment sessions. We have templates for these psychological reports on our website.

Do I still need to meet eligibility criteria when I attend a specialist review?

It is not necessarily that you meet the intake eligibility criteria at the time that you attend a specialist review. If you no longer meet the criteria this is because you are improving, and this alone does not affect your eligibility for a further 20 sessions. The psychiatrist/paediatrician only needs to confirm your diagnosis at the time of entry to the rebated sessions and confirm your need for further sessions.

Can I do all my sessions between November 1 and December 31, or are the sessions to be over a 12 month period from November 1?

The sessions are to be used over the 12 months from the beginning of the treatment plan, not calendar year. There will be no need for you to establish a new plan sooner than every twelve months from the beginning of your last Eating Disorders Treatment Plan.

If you receive a treatment plan in November 2019, you will not be eligible for another round of up to 40 psychological sessions and 20 dietetic sessions until November 2020, at which time your GP will discuss the need for a new plan, including any updates to your treatment goals and care.

Will I be able to continue seeing my current psychologist, dietitian or other healthcare provider?

Psychologists, dietitians and all other providers who are currently able to provide services through the MBS are eligible and have met registration requirements to deliver services for these new items In addition, the new items point to where these professionals can receive training and support in how to effectively care for people with a range of issues, including for people specifically with eating disorders. It is expected that all health professionals providing services under these items have the appropriate skills, knowledge and experience to provide eating disorders treatment and be treating eating disorders according to the evidence base. Also, your mental health professional needs to deliver one of the evidence based treatments listed under the items. If you have any concerns about your treatment delivered by your care team, talk to your GP.

To get the Medicare rebates, your treatment must be provided by an eligible, appropriately trained provider (Medicare practitioner in general practice, clinical psychologist, psychologist, occupational therapist, social worker or dietitian).

Check out our Treatment Service Database for health professionals near you.

If you are already seeing a specific provider, it is possible that your GP may be able provide a referral to this person. Talk to your GP.

The approved treatment are:

  • Family Based Treatment for Eating Disorders (EDs) (including whole family, Parent Based Therapy, parent only or separated therapy)
  • Adolescent Focused Therapy for EDs
  • Cognitive Behavioural Therapy (CBT) for EDs (CBT-ED)
  • CBT-Anorexia Nervosa (AN) (CBT-AN)
  • CBT for Bulimia Nervosa (BN) and Binge-eating Disorder (BED) (CBT-BN and CBT-BED)
  • Specialist Supportive Clinical Management (SSCM) for EDs
  • Maudsley Model of Anorexia Treatment in Adults (MANTRA)
  • Interpersonal Therapy (IPT) for BN, BED
  • Dialectical Behavioural Therapy (DBT) for BN, BED
  • Focal psychodynamic therapy for EDs

How much will it cost me to see a psychologist and dietitian?

Rebates through the new items will be the same as the existing rebates for mental health services. Medicare rebates depend on the type of health professional you are seeing and the length of the sessions. For example, If you see a clinical psychologist, Medicare will rebate $126.50 for a session that lasts 50 minutes or longer. A session that goes for 30-50 minutes will attract a rebate of $86.15.

Some providers will charge more than the Medicare rebate, and they should inform you of this before offering you an appointment.However, some providers will take into account your circumstances when deciding to charge you a fee – and, it never hurts to ask when making a booking if you are experiencing financial hardship. Whether or not they charge you more than the MBS rebate is up to the provider of the service.If the session costs more, you will have to pay the difference.

If you have private health insurance, you will need to talk with your insurer to identify what they will pay for.

More Questions?

Visit the MBS FAQ Page