Fee structure and statutory registration process for allied mental health care providers
Questions and answers
1. Why has DVA implemented a new fee structure?
The fee structure was implemented to align DVA with services provided under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (MBS) initiative. The new fee structure expanded the treatment options for veterans by introducing trauma-focussed therapy items and group therapy items.
2. What were the key changes of the new fee structure?
The key changes of the new fee structure included:
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the alignment of DVA fees with the MBS mental health items, with DVA fees to be paid at 100% of MBS fees;
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DVA service descriptors simplified from the current initial/subsequent consultations to reflect time based consultations;
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DVA service locations streamlined to ‘in rooms’ or ‘out of rooms’. Prior approval will still be required for services provided to veterans in a public hospital and to ‘high care’ veterans in a residential aged care facility;
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introduction of new trauma focussed therapy and group therapy items; and
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removal of prior financial approval for neuropsychology assessments of up to four hours.
3. Why was a statutory registration process introduced?
A statutory registration process was introduced to simplify the registration process for providers wishing to provide allied mental health care to entitled persons. Statutory registration removes the need for providers to enter into individual contracts with DVA, thus reducing time and paperwork. Statutory registration aims to reduce the administrative burden on busy providers and increase veterans’ access to and choice of qualified allied mental health care providers.
Statutory registration expanded the number and type of allied mental health providers able to treat veterans. This has given general practitioners and medical professionals more choice when referring veterans for mental health services.
4. How does statutory registration work?
Under statutory registration, when a provider registers as an allied mental health care professional with Medicare they will be automatically registered with DVA to claim benefits for allied mental health care services provided to entitled persons. When a new provider receives notification of their Medicare provider number they will be advised that they can now claim for services provided to entitled persons.
As of 1 November 2010, any provider who is registered with Medicare Australia as a psychologist, clinical psychologist, social worker (mental health) or occupational therapist (mental health) is able to claim for allied mental health services provided to entitled persons.
5. Is there anything else providers who are currently registered with Medicare have to do before they can claim for services provided to entitled persons?
Yes. For GST purposes, providers need to complete the Recipient Created Tax Invoice (RCTI) Agreement. The RCTI Agreement and instructions on how to complete this form are available from DVA’s website
Providers who are not registered for GST will need to advise Medicare of this on 1800 653 629. Failure to supply your GST information will result in rejection of your claims by Medicare.
6. Which providers are covered by statutory registration?
Statutory registration covers four provider categories:
7. Are neuropsychologists and general social workers covered by statutory registration?
No. The registration of neuropsychologists and general social workers is managed by DVA.
8. How will these arrangements affect clinical counsellors?
The clinical counsellor provider category was removed from DVA provider categories on 1 November 2011 as it is not recognised in the Medicare Benefits Schedule (MBS) provider categories.
Clinical counsellors already registered with Medicare Australia as a social worker (mental health) do not need to do anything and can claim for services from the DVA Social Work (Mental Health) Schedule of Fees using their Medicare provider number.
Providers can contact the Australian Association of Social Workers (phone: 03 9642 2519 or email: mentalhealth@aasw.asn.au to inquire about accreditation as a mental health social worker. Providers not registered with Medicare can contact Medicare on 1300 302 122 to enquire about the registration process.
Currently contracted social workers who do not wish to register with Medicare can continue to claim for services from the DVA Social Workers Schedule of Fees.
9. Can I still provide general social work services to veterans under these arrangements?
Yes, currently contracted social workers can continue to provide and claim for general social work services as per the DVA Social Workers Schedule of Fees. If they are registered with Medicare they can claim from the DVA Social Workers (Mental Health) Schedule of Fees.
A review of general social work services will be undertaken during 2012 to inform the future direction for this provider type.
10. Where can I find the new fee schedules?
The new fee schedules, which incorporate the annual indexation increase are available on the DVA website at www.dva.gov.au/service_providers/Fee_schedules/Pages/Dental_and_Allied_Health.aspx .
The new Notes for Allied Mental Health Care Providers (PDF 130KB | RTF 2320KB) are available on the DVA website.
11. Where can I find more information about the fee structure or statutory registration?
Providers can contact DVA on 1800 550 457 (non-metropolitan callers) or 1300 550 457 (metropolitan callers) for more information.
12. Do these arrangements apply to VVCS contracted providers?
No. VVCS has separate contract and fee arrangements with their providers.
13. Who are ‘entitled persons’?
Entitled persons will hold a Repatriation Health Card issued by DVA, or have written authorisation on behalf of the Repatriation Commission or the Military Rehabilitation and Compensation Commission. The cards entitling treatment are the Gold Card and the White Card.
14. Are there limits on the number of services that can be provided in a calendar year as under the Better Access initiative?
There is no annual limit on the number of services that can be provided in a calendar year. The type, frequency and duration of services required to meet the clinical need of the entitled person is determined by the allied mental health care provider. The exception to this is group therapy (limited to 12 per year) and trauma focussed therapy (financial authorisation required after eight sessions).
15. Do I have to provide a review to the referring health provider after six consultations?
At the end of the 12 month referral period or as clinically appropriate, the allied mental health care provider should provide a report to the referring health provider. There is no requirement for a review after 6 consultations as under the Better Access initiative.
16. Is prior financial approval required to provide more than 10 psychology consultations?
No. There is no requirement to seek prior financial approval after 10 consultations. There is no annual limit on the number of services that can be provided. The type, frequency and duration of services provided is determined by the allied mental health care provider based on the clinical need of the entitled person.
17. Does an entitled person still need to have a referral from the LMO, GP etc to see an allied mental health care provider?
Yes. A referral is required from one of the following:
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a Local Medical Officer (LMO)/a general practitioner;
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a medical specialist;
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a hospital discharge planner;
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another allied mental health care provider with a current referral who is transferring the entitled person; or
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VVCS – Veterans and Veterans Families Counselling Service .
18. Does the referring LMO or GP have to prepare a mental health care plan when referring an entitled person to an allied mental health provider?
A mental health care plan is not required to be prepared as part of a referral. The referral must either be written on a ‘DVA Request/Referral Form (Form D904 or on the provider letterhead. The referral must include:
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name and DVA file number of the entitled person;
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the treatment entitlement of the person, i.e. Gold Card or White Card;
if the entitled person is resident in a residential aged care facility (RACF), the level of care that they are funded to receive and the date that the funding began;