Medicare mental health treatment plan referrals can be challenging for psychologists to navigate. This guide outlines some of the key considerations to keep in mind.
Summary:
- The difference between a mental health treatment plan and a referral
- Things to communicate to clients in your first Medicare-subsidised sessions
- Psychologists’ obligations when it comes to reporting back to GPs
- Recent APS advocacy around changing rules to mental health treatment plans
In May this year, the Federal Government announced two proposed changes to the way GP mental health referrals would be conducted as of November 2025.
The original announcement cited that to continue receiving psychological care under the Better Access scheme, mental health plan referrals would need to be made at a person's MyMedicare-registered practice, or via their 'usual' GP if they aren't registered for MyMedicare.
However, following APS advocacy, the government altered its proposed policy. Now, current or prospective clients will no longer need to be registered with MyMedicare to be eligible for a Better Access referral.
"This would have made it much harder for Australians to access psychological support when they most need it," says Dr Catriona Davis-McCabe, APS President.
"We are still concerned, however, about the proposed change that requires a person to get a referral from their ‘usual GP’. Many people don’t have a ‘usual’ GP, particularly vulnerable groups in our community, such as young people, plus shift workers, those who are constantly moving and those living in rural and remote areas.
"We will continue to pressure the Federal Government to cancel this proposed policy in its entirety and scrap the requirement for clients to get referrals from their ‘usual GP’".
This means that for now, until November 2025, clients can continue to get mental health treatment plan referrals from any GP.
Under the Better Access Initiative, clients have access to 10 subsidised sessions per calendar year.
"We will continue to advocate for an increase back to 20 sessions per calendar year to support clients who are experiencing more complex mental health challenges, as well as pushing for access to three Medicare-funded sessions without a referral to make it easier for clients to access immediate care,” says Dr Davis-McCabe.
As psychologists, understanding the nuances of mental health treatment plans under this initiative is essential to maximising outcomes for your clients. (Note: requirements differ for other types of Medicare services psychologists provide subsidised services for, such as Chronic Disease Management Plans).
This article delves into the critical aspects of managing mental health treatment plans to help psychologists effectively navigate this system. From initial assessments to ongoing treatment and coordination with GPs, it outlines some of the key considerations to keep in mind.
GPs and mental health treatment plans
As psychologists will know, to access psychological services via the Better Access initiative, clients first must see a general practitioner (GP).
During this consultation, the referring doctor and client will identify treatment options and support services and agree upon specific treatment goals.
This information will help form the mental health treatment plan and should be accompanied with a referral. It's important to note that these are two different things.
"A mental health treatment plan is the referring physician's assessment and treatment plan for that client," says Dr Clair Lawson, clinical psychologist, practice owner and business consultant. "The [mental health treatment plan] has to include a request for services, such as 'Please see for assessment and treatment of X' for it to be considered a valid referral."
From a compliance perspective, it's important that psychologists don't offer Better Access services without a referral, as Medicare can require you to pay the funds back if you continue seeing the client without a valid referral.
“It’s not essential for the psychologist to have a copy of the mental health treatment plan. For the referring doctor to provide a copy of the MHTP, they must have client consent. This may not always be forthcoming,” says Dr Davis-McCabe. “However, the psychologist must have a referral from the doctor for the client to be seen under Better Access. If the client is referred by a psychiatrist or paediatrician, only a referral is required.”
A common misconception about referrals is that it needs to include the name of the psychologist who is conducting the sessions.
"It could just read "Dear psychologist", or it could even be addressed to another practitioner," says Dr Davis-McCabe. "What's more important is that the referral includes the number of sessions that the client is to receive, as this is often missed."
In urgent situations, a verbal referral provided via a phone call can suffice, if it's then followed up with a written referral.
"This can be useful if a psychologist receives an incomplete referral but needs to see the client urgently. They can speak to the referring GP on the phone for confirmation ahead of new paperwork being prepared," says Dr Davis-McCabe.
To determine if a referral may be incomplete, refer to the guidelines on the Medicare Benefit Scheme online information portal which state that it should include:
- The patient’s name, date of birth and address
- The patient’s symptoms or diagnosis and a statement on whether a mental health treatment plan has been prepared
- A list of any current medications
- The number of sessions the patient is being referred for (the ‘course of treatment’)
- A statement about whether the patient has a mental health treatment plan or a psychiatrist assessment and management plan.
“Importantly, referrals are valid for the stated number of services, not for a calendar year. Unused services can roll over to the next calendar year,” says Dr Davis-McCabe.
It’s important to keep copies of all written referrals for 24 months from the date of the first session in case you are audited by the Department of Health and Aged Care.
Navigating your first session together
It's best not to assume that referring GPs would have walked clients through the process thoroughly, so it's worth spending time at the start of your first session together clarifying some key factors, such as:
- GPs determine the number of sessions a client can have in a course of treatment. Following the final session in that course of treatment (commonly the sixth session) the client will need to see their doctor for a mental health review.
“It’s recommended that you remind clients of this at their second-to-last appointment, so it doesn’t come as a surprise at the final session in their current course of treatment,” says Dr Davis-McCabe.
- That they can continue their treatment following the completion of their 10 Medicare-subsidised sessions, but they will either need to pay the full costs out of pocket or access any psychology services available in their private health insurance, if available under their level of cover.
"Some insurance companies require that patients first utilise all 10 Medicare sessions before accessing their private health insurance support, others are more flexible. It's worth bringing this up with your client in the first session," says Dr Davis-McCabe.
While telehealth services have become more common since the pandemic – and are a great way to provide critical mental health support to those in remote areas in Australia – it’s important to note that Medicare benefits are only payable for services provided in Australia.
“Both the patient and the health professional must be physically present in Australia at the time of the service delivery for Medicare rebates to apply,” says Dr Davis-McCabe.
“Psychologists may choose to consider private billing options for services rendered while their client or they themselves are overseas.”
When a course of treatment ends
If the client requires ongoing support but is not in a financial position to cover the costs (and they don’t have health insurance that covers psychology sessions), Dr Lawson says one option might be to suggest group therapy.
"Clients have access to 10 individual sessions, but they can also access 10 group therapy sessions in a calendar year,” she says.
"OCD is an area that can be very effective in group therapy because clients have that feeling of 'Someone else gets this. I'm not the only one.' Group therapy can also be really effective for borderline personality disorder, insomnia, anxiety, depression and PTSD."
Once a course of treatment is completed, it’s important to provide a written report to the referring medical practitioner. While there are no official forms to fill out, the report should include information about:
- Any assessments carried out on the client and, where relevant, the progress made
- Any treatment that was provided
- Recommendations on future management of the client’s disorder.
“If your client hasn’t completed a course of treatment, you should write a report after the last service you provided,” says Dr Davis-McCabe. “If you then reinstate the sessions at a later date, you will need to provide another report to the referring GP.”
If a psychologist does not send a report and continues seeing the client and is then audited, they would potentially need to repay any rebates that have been paid for any sessions that have occurred past the sixth session, says Dr Lawson.
"Even though the client has received the rebate in their pocket, the psychologist is the one who needs to pay it back."
Finally, if a client is unsure of their remaining sessions – for example, if they started their sessions with a different psychologist – you can confirm the client's eligibility using the MBS Items Online Checker available through Services Australia's Health Professionals Online Service (HPOS).
For more useful Medicare guidance, APS members can access a range of resources here.