Eating Disorder Medicare Changes | Eating Disorders Victoria
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Eating disorder Medicare changes

Home ~ Find support ~ Eating disorder Medicare changes

Changes introduced by the Australian Government on November 1st 2019 mean that some people with eating disorders will have access to an evidence-based, best practice model of treatment. This will be known as an Eating Disorder Plan (EDP) and involves Medicare subsidies for 20 sessions with a dietitian and up to 40 sessions with a mental health clinician over a 12 month period. This page has been created to guide you step-by-step through these changes.

Are you a visual person? Download this A3 guide to navigating the process. 

Medicare Changes

 

See your GP

If you are concerned that you or someone you care about is experiencing an eating disorder, it’s important to make an appointment with a medical practitioner. For most people this will be a GP, but it also includes paediatricians and psychiatrists.

How to prepare for your appointment

  • It’s important that you find a GP who has an understanding of eating disorders. EDV can provide you with a list of GPs in your area and surrounds who may be suitable. Please get in touch with us if you require assistance in this area.
  • Ask for a double appointment when you book and mention that you are wanting an Eating Disorder Plan (EDP).

When you’ve made an appointment, it’s a good idea to start getting prepared for your appointment so you don’t feel put on the spot. It might be helpful to write down any symptoms or behaviours you’ve been experiencing, as well as any questions you might want to ask the doctor.

A useful tool in preparing to see the doctor this is the Reach Out and Recover Checklist (ROAR).  The ROAR Checklist outlines some behaviour, thoughts and feeling changes you may have noticed in yourself. Once the checklist is completed, the website will generate a personalized report with a summary of the information you have provided that you can take with you to the GP.

For parents / carers

If you are a parent or carer concerned about a loved one, another useful tool is the Feed Your Instinct (FYI) website. Feed Your Instinct (FYI) is an interactive tool designed to support parents of children and young people experiencing different types of eating and/or body image problems. A checklist is available for parents that outlines changes you may have noticed in your child. Once complete, the website will generate a personalized report with a summary of the information you have provided that you can take with you to the GP.

 

Your first appointment

What to expect at your first appointment

The doctor will assess your eating disorder symptoms using a range of measures to assess whether you are eligible for an Eating Disorder Plan (EDP). This will include:

  • Eating Disorder Examination Questionnaire (EDE-Q) (you may want to pre-fill this out before your appointment);
  • a mental state examination;
  • taking of relevant history (biological, psychological, behavioural, nutritional, social);
  • assessing associated risk and any co-morbidity; and
  • making a psychiatric diagnosis for conditions meeting the eligibility criteria
Psychiatrist or paediatrician referral

If you are given an Eating Disorder Plan (EDP), you will be required to see a psychiatrist or a paediatrician after 20 Eating Disorder Psychological Treatment (EDPT) sessions. Due to the availability of these specialists, it is important that your GP make this referral in your initial appointment or at your 10 session review.

Your appointment with a psychiatrist or paediatrician can happen any time before the 20 session review.

What if my doctor isn’t aware of the Medicare changes for eating disorders?

As these changes are very new, some doctors may not be fully informed yet. If this is the case, we advise you point your doctor towards this page or the National Eating Disorders Collaboration (NEDC) website.

Visit NEDC website

Eligibility criteria

According to the Medicare Benefits Scheduling Book (pg 182-195), the eligibility criteria for an Eating Disorder Plan is:

a. Patients with a clinical diagnosis of anorexia nervosa; or
b. Patients who meet the eligibility criteria (below), and have a clinical diagnosis of any of the following conditions:

a. bulimia nervosa;
b. binge-eating disorder;
c. other specified feeding or eating disorder.

The eligibility criteria, for a patient, is:

a. a person who has been assessed as having an Eating Disorder Examination Questionnaire score of 3 or more; and
b. the condition is characterised by rapid weight loss, or frequent binge eating or inappropriate compensatory behaviour as manifested by 3 or more occurrences per week; and
c. a person who has at least two of the following indicators:

a. clinically underweight with a body weight less than 85% of expected weight where weight loss is directly attributable to the eating disorder;
b. current or high risk of medical complications due to eating disorder behaviours and symptoms;
c. serious comorbid medical or psychological conditions significantly impacting on medical or psychological health status with impacts on function;
d. the person has been admitted to a hospital for an eating disorder in the previous 12 months;
e. inadequate treatment response to evidence based eating disorder treatment over the past six months despite active and consistent participation.

Initial course of treatment

If you are eligible for an Eating Disorder Plan (EDP) you will begin the initial course of treatment. This includes:

  • 20 sessions with a dietitian
  • 10 Eating Disorder Psychological Treatment (EDPT) sessions

Who can administer the dietetics sessions?

EDV advise that you see a dietitian who is experienced in treating eating disorders. Dietitians provide nutritional assessment, eating plans, and nutritional education. Dietitians are vital in the process of nutritional rehabilitation and the development of healthy eating patterns. They work with the person with the eating disorder to identify fears of food, and discuss the consequences of not eating well. They also work with the individual to recognize feelings of physical hunger and fullness and a healthy response to these.

Please contact us if you need help finding a suitable dietitian in your local area.

Note: The 20 dietetics sessions can be used at any point throughout the 12 month period.

Who can administer the EDPT sessions?

Mental health clinicians who can administer the EDPT sessions include psychologists, mental health social workers, mental health occupational therapists.

It is advised you see a mental health clinician who is experienced in treating eating disorders. Please contact us if you need help finding a suitable mental health clinician in your local area or learn more about EDV’s psychology services here. 

Did you know?

Mental health practitioners must use specific psychological treatments to claim the Medicare rebate for their services. The approved psychological treatments are:

  • Family Based Treatment for Eating Disorders (EDs) (including whole family, Parent Based Therapy, parent only or separated therapy)
  • Adolescent Focused Therapy for EDs
  • Cognitive Behavioural Therapy (CBT) for EDs (CBT-ED)
  • CBT-Anorexia Nervosa (AN) (CBT-AN)
  • CBT for Bulimia Nervosa (BN) and Binge-eating Disorder (BED) (CBT-BN and CBT-BED)
  • Specialist Supportive Clinical Management (SSCM) for EDs
  • Maudsley Model of Anorexia Treatment in Adults (MANTRA)
  • Interpersonal Therapy (IPT) for BN, BED
  • Dialectical Behavioural Therapy (DBT) for BN, BED
  • Focal psychodynamic therapy for EDs

10 session review - GP

After 10 EDPT sessions, you will need to see your GP or other managing practitioner to review your EDP. Your doctor will review your progress against the EDP and recommend whether you should continue with the plan.

If recommended, you will be referred for another 10 EDPT sessions.

20 session review - GP & psychiatrist/paediatrician

After 20 EDPT sessions you will need to see both your GP and a psychiatrist or paediatrician. It is recommended that this specialist referral is made at your initial appointment or at the latest at your 10 session review.

Should both practitioners recommend more intensive treatment, you will be referred for another 10 EDPT sessions.

Note: The psychiatrist/paediatrician appointment does not need to take place after the completion of 20 EDPT sessions. It can happen any time before the 20 session review. 

30 session review - GP

After 30 EDPT sessions you will need to see your GP or other managing practitioner to review the EDP.

If recommended, you will be referred for a final 10 EDPT sessions under the plan for that year.

What if I already have a Mental Health Care Plan?

If you still have sessions left on a Mental Health Care Plan, you will be required to use the remaining sessions before commencing an Eating Disorder Plan (EDP). You may still want to visit your GP in the lead up to the completion of your Mental Health Care Plan to prepare for potentially moving onto an EDP.

The sessions used on the Mental Health Care plan will come off your total entitlement to EDPT sessions on the Eating Disorder Plan (EDP). Ie. If you have used 10x MHCP sessions, you would only get a maximum of 30 EDPT sessions in that 12-month period.

How much will I pay?

Rebateable service fees will remain the same as the existing Mental Health MBS item numbers.

For most services, you will be required to make a ‘gap’ payment. Gap payments are dependent on the fees set by your treating clinicians.

For more information about item numbers and fees, please see see the Eating Disorders MBS item numbers Quick Reference Guide from the Department of Health.

At EDV, we understand that it can be difficult to afford ongoing therapy, and our fees are lower than those recommended by the Australian Psychological Society. Fees vary from $135 to $185 per session, depending on the type of psychologist you see and whether you have a valid health care card. If you have an Eating Disorder Plan (EDP) or a Mental Health Care Plan, you may be eligible for a Medicare rebate of up to $84.80 per session.

What if I'm not eligible?

An Eating Disorder Plan (EDP) will not be a suitable treatment approach for everyone. If your doctor does not recommend an EDP, there are a number of options that may be more suitable for you.

  • Your GP may decide you that will be better treated in the public health system. You will be referred to the appropriate services, such as a hospital, in your local area. EDV can help connect you with these services.
  • Your GP may refer you to the existing Better Access model, which entitles you to 10 subsidized sessions with a mental health clinician. EDV can help you find a psychologist who specialises in eating disorders.
  • Your GP may recommend another course of action that does not fit into any of of the above models.

Getting a second opinion

Unfortunately, not everyone has a good experience when seeking help for an eating disorder. If your doctor does not diagnose an eating disorder or does not recommend an EDP but you are still concerned about warning signs and symptoms, it’s a good idea to get a second opinion.

This may be another GP, or a mental health professional such a psychologist. For help finding a health professional with experience treating eating disorders, please contact the EVD Hub.

More information

If you require more information or would like help finding practitioners who specialise in eating disorders, please don’t hesitate to contact the EDV Hub on 1300 550 236 Mon-Fri 9.30am – 4.30pm or email edv@eatingdisorders.org.au.

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