Medicare Safety Net Changes and Item 316
The Australian Government’s changes to new Medicare Safety Net announced in the 2014-15 Budget that will take effect from 1 January 2016 have implications for MBS Item 316 and patient access to longer term intensive psychotherapy, in a submission received from AMA Psychiatrist-Psychotherapist members. The enabling legislation (yet to be introduced) will need to be considered and passed by the Parliament before the changes can take effect.
The AMA Psychiatrist-Psychotherapist members indicated that under the existing arrangements, once the patient has received 50 sessions under MBS Item 306, Medicare subsidy continues, but with a different MBS item number (316) and a reduced rate. The current Safety Net arrangements mean that the impact of the reduced fee on patients is minimal, so concerns about costs to patients after reaching the 50 session limit are currently negligible. Based on average fees charged, patients who have qualified for the current safety net would have an out-of-pocket cost of around $13 per service for item 306, which would increase to around $33 for services under item 316.
AMA Psychiatrist-Psychotherapist members have expressed concern that this system is about to change. From 1 January 2016, once the patient has exhausted their 50 sessions (item 306) and moves to using item 316, the operation of the new Safety Net arrangements will mean that if the psychiatrist charges the same average fee, the patient will have a total out-of-pocket cost per service for item 316 of around $107, an increase of $74 compared to the current safety net arrangements.
This means that from 1 January 1 2016, only wealthier patients will be able to afford this treatment after 50 sessions, effectively denying access to a vulnerable group of patients, many of whom have suffered abuse or have histories of complex trauma that require treatment with Item 316.
The RANZCP will raise this issue as well as the other implications of the Medicare Safety Net for patients with support of the AMA. The RANZCP is in the process of obtaining detailed costing and calculations. Dr Bill Pring from the AMAPG is also assisting with that work as he was involved with the original MBS 319 Item negotiations.
Published: 31 Aug 2015