Review of the Medicare Taskforce Mental Health Reference Group (MHRG) Report

“…what I am absolutely committing to is if the Medicare Taskforce, the finest body of professionals in the country, makes these recommendations, we will implement those recommendations.”
(Hon Greg Hunt, 2nd May 2019)

On 2nd May 2019 at the National Press Club Debate, the Hon Greg Hunt communicated his unequivocal commitment to implementing the recommendations of the Medicare Taskforce Review on Mental Health.

Below is a dot point summary of key considerations:
• The Medicare Taskforce formulated a suite of recommendations across all areas of Medicare through focused reference groups.
• The Mental Health Reference Group (MHRG) of the Medicare Taskforce has completed its report with 14 Recommendations for consideration.
• The Hon Greg Hunt has stated his commitment to implementing those recommendations.

Considering the significance of the 14 Recommendations of the Medicare Taskforce MHRG Report, it’s quite surprising that a lot of psychologists have confused this document with the APS white paper.

In order to clear this up, below is an excerpt from the Medicare Taskforce Mental Health Reference Group Report. It is a summary focused on 5 of the 14 recommendations proposed and their implications on mental health service provision through Medicare.

BELOW IS A SUMMARY DRAWING ATTENTION TO 5 of the 14 RECOMMENDATIONS
For a complete summary of all 14 recommendations, refer to page 70 of the Mental Health Reference Group Report.

Recommendation 1: Expand better access to at-risk patients

Recommendation 2: Increase maximum sessions per referral
• The Reference Group agreed that enabling up to ten sessions to be referred during the initial referral under a MHTP would simplify access to care for some patients

  • Requiring the patient to return to the referring practitioner (generally a GP) after the sixth session creates a barrier to accessing further sessions if the patient does not follow up with their GP (Figure 3).
  • Requiring the patient to return to the referring practitioner may also interrupt the therapeutic flow of a course of treatment if the patient has to wait several weeks to see their GP

WHAT DOES RECOMMENDATION 2 MEAN: No need for the patient to return to the GP for a follow up referral after 6 sessions. One referral can be for up to 10 sessions.

Recommendation 3: Introduce a 3-tiered system for access to Better Access sessions for patients with a diagnosed mental illness
• changing the item 80000–80015, 80100–80115, 80125–80140 and 80150–80165 descriptors to specify that instead of 10 planned sessions in a calendar year, patients can access up to three tiers of Better Access sessions, with each tier allowing a greater number of sessions with:

  1. each tier to provide access to a different maximum number of sessions within a 12-month period (for example, Tier 1 -10, Tier 2 – 20, Tier 3 – 40).
  2. access to, and progress through, the three tiers will depend on the severity of the patient’s condition requiring treatment, defined by a number of factors outlined below.
  3. a patient’s access to each higher level tier would require GP review. Thus, a GP would need to endorse, by way of a review, a patient’s need to progress from Tier 1 to Tier 2 at the completion of Tier 1, and from Tier 2 to Tier 3 at the completion of Tier 2. The intent is that the GP’s central stewardship role be maintained in the proposed tiered Better Access system.
  4. Patient session allocation should be determined based on clinical need, rather than arbitrary session limits. Evidence demonstrates the need for more than 10 sessions for specific disorders. See Appendix EE for detailed evidence
• The Reference Group did not align different levels of care with different professions or qualifications. Some members of the Reference Group, including Prof Lyn Littlefield (the GPPCCC ex-officio member) dissented from the part of the recommendation which states that the Reference Group did not align different levels of care with different professions or qualifications. Instead, they noted that their understanding was that a new working group or committee (see Section 5.2.3) would establish whether different levels of care should be associated with different professions or qualifications.

WHAT DOES RECOMMENDATION 3 MEAN:
• All treatment item numbers across tier one and tier two of psychology, social work and OT’s be made eligible to provide treatment across all three tiers of treatment.
• It is the condition being treated rather than the ‘type’ of mental health clinician that should be tiered in to three categories for optimum triaged care

Recommendation 4: Establish a new working group or committee to review access to, and rebates for, Better Access sessions delivered by different professional groups
• The Reference Group recommends establishing a new working group or committee to review access to, and rebates for, Better Access sessions delivered by different professional groups, (i) the group would need adequate time and resources to complete its mandate, (ii) government would need to carefully consider membership of the group to ensure unbiased, balanced and well-informed discussion and recommendations, and (iii) this new group should be established urgently to maximise value for the patient and the health system.

WHAT DOES RECOMMENDATION 4 MEAN: While recommendation three proposes that ALL item numbers across all psychologist, social workers and OT’s become eligible to provide treatment across all 3-tiers, the follow-up of Recommendation 4 highlights the need to address the discrepancy in the patient’s rebates across service providers.

Recommendation 9: Update treatment options
The Reference Group recommends updating treatment options by:

  • adding all therapies (items 80000–80171) with National Health and Medical Research Council (NHMRC) Level I or Level II evidence to the list of approved therapies under Better Access
  • updating the terminology for Better Access services for consistency across service providers, renaming items 80100–80171 as psychological therapy services

WHAT DOES RECOMMENDATION 9 MEAN: This recommendation highlights the need for all clinicians providing mental health treatment under Medicare to apply a comprehensive scope of evidence-based treatment options and that all providers are acknowledged as applying psychological therapies rather than the very narrow scope of focused psychological strategies.

Below is a summary of the Medicare Taskforce Mental Health Reference Group recommendations raised above:
1. Have 10 rebated sessions available for those considered ‘at risk’
2. Have up to 40 rebated treatment sessions available that is triaged to either 10, 20 or 40 treatment sessions according to the patient’s condition requiring treatment.
3. Set up a new working group to resolve the discrepancy in rebates for patients receiving treatment through Medicare
4. Abolish the ill-conceived restrictive scope of focused psychological strategies to ensure Medicare Better Access acknowledges that all treating clinicians apply a comprehensive scope of evidence-based psychological therapies.

Conclusion
It would be great to read thoughts on the recommendations highlighted through this post or on any of the 14 Recommendations proposed through the Medicare Taskforce Mental Health Reference Group. Please, become versed in the content of each recommendation and share your thoughts.

Remember, the Medicare Taskforce Mental Health Reference Group Report IS NOT the APS White Paper.