Medicare not for Commonwealth funded aged care residents

In addition to the training I provide to aged care staff across Australia, I am a clinical psychologist  providing services under the Better Outcomes funding of Medicare items that allow up to 10 rebated sessions with a psychologist or other allied health professional per year. I provide services to a range of clients including aged care residents. I have had conflicting advice as to the eligibility of aged care residents for MBS Mental Health items.

My understanding is that as a clinical psychologist approved to provide MBS services, if a person has a Mental Health Treatment Plan (MHTP) in place I can provide an approved service under the MBS, conditional upon all other requirements being satisfied.

I believed for several years that recipients of Commonwealth funded aged care beds were not eligible and refrained from providing services to these people. I have received advice from GPs over the past two years that residents in aged care homes are now eligible for such services. I spoke with a BeyondBlue representative recently who stated that they had been advised that this was not the case and that residents in Commonwealth funded aged care beds are not eligible for such Medicare services. I also continue to receive referrals from GPs to see some of their residents and they have included a MHTP for which they have received a Medicare payment. The latest MBS (July 2012) is not clear on this issue.

I have now received written advice from the Department of Human Services which administers Medicare that if a resident of an aged care home is in a Commonwealth funded aged care bed they are not eligible for the Better Outcomes Medicare rebated services.

So for the future, two things become important:

1. It is necessary that aged care homes make clear to GPs whether or not a person is in a Commonwealth funded aged care bed or not before referring them to a psychologist or other allied health practitioner.

2. It is important that psychologists and other allied health professionals who provide services in aged care homes ask the question about the nature of the funding for the person’s bed so as to establish eligibility and to avoid being in receipt of an overpayment.