Mental Health Nurse Incentive Program Guidelines

Transcription

1 Mental Health Nurse Incentive Prgram Guidelines April 2016 Intrductin The Mental Health Nurse Incentive Prgram (MHNIP) funds cmmunity based general practices, private psychiatric practices and ther apprpriate rganisatins s they can emply mental health nurses t help prvide crdinated clinical care fr peple with severe mental disrders. Mental health nurses must wrk with psychiatrists and general practitiners t prvide services like mnitring a patient s mental state, managing their medicatin and imprving links t ther health prfessinals and clinical service prviders. These services can be prvided in a range f settings, like clinics r patients hmes, and must be prvided at little r n cst t the patient. These guidelines prvide infrmatin t rganisatins that prvide MHNIP services. Supprt prvided under the MHNIP targets patients with severe mental disrders during perids f significant disability. A patient shuld exit the MHNIP when he r she des nt require the level f supprt as utlined in this dcument. Transitin arrangements frm 1 July June 2017 On 26 Nvember 2015 the Australian Gvernment annunced its respnse t the Natinal Mental Health Cmmissin s review f Mental Health Prgrammes and Services. The refrms utlined in the respnse will transfrm Cmmnwealth mental health funding and prgram delivery ver the next three years t achieve a mre efficient, integrated and sustainable mental health system and t imprve mental health services fr Australians. A key cmpnent f the refrm package is the transitin f primary mental health prgrams, such as the MHNIP, t Primary Health Netwrks (PHNs) frm 1 July PHNs will be respnsible fr planning and integrating services at the reginal level and better targeting services t meet individual and lcal need. The rle f the mental health nurse in the new primary mental health care mdel will cntinue t fcus n prviding and crdinating clinical care fr peple with severe mental illness, in cllabratin with GPs and psychiatrists.

2 In , MHNIP funding will transitin t the PHN primary mental health flexible funding pl. Hwever, it will be quarantined and PHNs will be required t cmmissin mental health nursing services frm the current netwrk f MHNIP prviders. The emphasis will be n ensuring service cntinuity t existing/cntinuing clients, and bedding dwn the rle f mental health nurses within a team based apprach t prvide clinical care t peple with severe and cmplex mental illness. Frm , mental health nurse funding will n lnger be quarantined and will fully transitin t the PHN flexible funding pl arrangements Funding is being prvided t maintain the MHNIP at existing service levels frm 1 July 2015 t 30 June This is cnsistent with the gvernment's annuncement t extend funding fr existing mental health prgrams fr 12 mnths. Cntinuatin f the funding will enable mental health nurses t cntinue t prvide crdinated clinical care fr peple with severe mental illnesses t keep them well in the cmmunity and reduce avidable hspitalisatins. Maintaining services at levels means that rganisatins and nurses must wrk tgether t manage client services and sessins within the rganisatin s allcatin service levels The annual service levels that rganisatins must maintain in are based n the prjected number f sessins cnducted in and paid by the Australian Gvernment Department f Human Services (the department). Existing MHNIP rganisatins were prvided with a sessin allcatin in June 2015 that was calculated n available data fr sessins cnducted and paid fr in T help rganisatins maintain their service levels, the department will mnitr levels and prvide rganisatins with a quarterly update. This is t make sure that allcated service levels are nt exceeded by 30 June Any claims submitted fr services prvided in in excess f an rganisatin s sessin allcatin will nt be paid. Review f service levels Where rganisatins fully r substantially utilised their sessin allcatin, they were prvided with the same allcatin fr Where rganisatins utilised less than their allcatin, they were prvided with a sessin allcatin fr based n actual service levels in Organisatins that received a reduced allcatin in were eligible t seek a review f their allcatin. Requests fr reviews f initial allcatin clsed n 31 July Organisatins were ntified f the utcme f their requests fr review in September Inactive rganisatins During , if an rganisatin has nt submitted any claims in the previus quarter, they will be asked t cnfirm that they are still prviding services and/r want t remain in the MHNIP. If they n lnger want t prvide services under the MHNIP, r d nt respnd within the required timeframe, the department

3 will remve them frm the MHNIP. Once remved frm the MHNIP, rganisatins will need t reapply t jin the MHNIP and will be placed n a waiting list. Patient entrance criteria General practitiners (GPs) and psychiatrists will determine which patients are eligible fr services under the MHNIP. T be eligible, all f the fllwing criteria must be met: the patient has been diagnsed with a mental disrder accrding t the criteria defined in the Wrld Health Organisatin Diagnstic and Management Guidelines fr Mental Health Disrders in Primary Care: ICD 10 Chapter V Primary Care Versin, r the Diagnstic and Statistical Manual f Mental Health Disrders - Fifth Editin (DSM-5) the patient s disrder is significantly impacting their scial, persnal and wrk life the patient has been t hspital at least nce fr treatment f their mental disrder, r they are at risk f needing hspitalisatin in the future if apprpriate treatment and care is nt prvided the patient is expected t need nging treatment and management f their mental disrder ver the next 2 years the GP r psychiatrist, emplyed t treat the patient by the rganisatin participating in the MHNIP, will be the main persn respnsible fr the patient s clinical mental health care, and the patient has given permissin t receive treatment frm a mental health nurse. When an rganisatin is the primary care prvider Sme private rganisatins and state r territry health rganisatins participating in the MHNIP may already have agreements where shared care health plans are in place fr their mental health patients. In these instances, MHNIP incentive payments are available t these rganisatins if the rganisatin is the primary care prvider fr the patient. Patient exit criteria A patient is n lnger eligible fr services under the MHNIP when: their mental disrder n lnger causes significant disablement t their scial, persnal and ccupatinal functining they n lnger need the clinical services f a mental health nurse, r the GP r psychiatrist, emplyed t treat the patient by the rganisatin participating in the MHNIP, is n lnger the main persn respnsible fr the patient s clinical mental health care. Eligible rganisatins T be eligible t participate in the MHNIP, rganisatins must be cmmunity based and have a GP r a psychiatrist with a Medicare prvider number. Eligible rganisatins include: general practices private psychiatry practices Primary Health Netwrks (in the circumstances as utlined in these guidelines under Medicare Lcals/Primary Health Netwrks Transitin), and Abriginal and Trres Strait Islander Primary Health Care Services funded by the Australian Gvernment thrugh the Indigenus Health Divisin

4 In additin, frmer Medicare Lcals that cntinue t exist as new entities, and Divisins f General Practice, can cntract the services f mental health nurses t GPs and psychiatrists wh have a Medicare prvider number, r ther medical fficers (as apprved by the Australian Gvernment Department f Health) wrking within their regin. State and territry health rganisatins are nt eligible fr MHNIP payments but they can make the services f their mental health nurses available t participating private rganisatins n a fee fr service basis. The nurses remain emplyees f the state r territry gvernment rganisatin and these arrangements are referred t as shared emplyment arrangements. The participating private rganisatin may claim MHNIP payments fr sessins prvided by these nurses. Frmal prtcls fr managing patients Eligible rganisatins must have a frmal prtcl in place fr managing a patient s mental health care under this measure. Where state r territry health rganisatins and participating private rganisatins have patient shared care health plans in place, the participating private rganisatin must: be the primary care giver, and bserve frmal prtcls described within the mental health patient shared care health plan in rder t be eligible fr payments under the MHNIP Mental Health Treatment Plan Tgether with the mental health nurse, a GP Mental Health Treatment Plan must be develped by GPs r an equivalent plan must be develped by psychiatrists. These plans must include specific reference t the rles and respnsibilities f bth the nurse and the treating GP. Treatment must be prvided accrding t the plan and the relevant clinical guidelines fr the treatment f that disrder. A GP r psychiatrist must regularly review the plan tgether with the mental health nurse. The review shuld include, where apprpriate, input frm a clinical psychlgist, registered psychlgist r ther allied health prfessinal. The steps in preparing a GP Mental Health Treatment Plan are the same as thse defined in Item 2700, 2701, 2715 and 2717 f the Medicare Benefits Schedule fr GP Mental Health Treatment itemssee: Explanatry Ntes A.46 f the Medicare Benefits Schedule. Examples f clinical practice guidelines can be fund at the Ryal Australian and New Zealand Cllege f Psychiatrists website. Health f the Natin Outcmes Scale Mental health nurses must use the Health f the Natin Outcmes Scale fr each patient as they enter the MHNIP. They must then measure changes t a patient s symptms and functining using these tls every 90 days, and as the patient exits the MHNIP. These measures include the child and adlescent, adult, and lder persn tls.

5 Eligible rganisatins must ensure mental health nurses participating in the MHNIP have successfully cmpleted training in undertaking Health f the Natin Outcmes Scale assessments. Eligibility requirements fr mental health nurses Eligible rganisatins must engage the services f a mental health nurse credentialed with the Australian Cllege f Mental Health Nurses. Visit the Australian Cllege f Mental Health Nurses website fr mre infrmatin n the credentialing prgram, r call Eligible rganisatins can engage mre than 1 mental health nurse. Eligible rganisatins are able t enter int shared emplyment arrangements with state r territry health rganisatins fr mental health nursing services. Under these arrangements, rganisatins can use the services f state emplyed mental health nurses, n a fee fr service basis, and still receive MHNIP payments fr sessins prvided by thse nurses. Functins f the mental health nurse Mental health nurses engaged under the MHNIP will wrk clsely with psychiatrists r GPs t prvide crdinated clinical care and treatment fr peple with severe mental disrders. Services will be prvided in a range f settings, such as in clinics r at a patient s hme. Mental health nurse functins will include, but are nt limited t, the fllwing: Prviding clinical nursing services fr patients with severe mental disrders: establishing a therapeutic relatinship with the patient liaising clsely with family and carers as apprpriate regularly reviewing the patient s mental state administering, mnitring and ensuring cmpliance by patients with their medicatin; and prviding infrmatin n physical health care t patients. Crdinating clinical services fr patients with severe mental disrders: maintaining links and undertaking case cnferencing with GPs, psychiatrists and allied health wrkers such as psychlgists (health prfessinals may be eligible t claim case cnferencing items under the MBS) crdinating services fr the patient in relatin t GPs, psychiatrists and allied health wrkers, including arranging access t interventins frm ther health prfessinals as required cntributing t the planning and care management f the patient liaising with mental health persnal helpers and mentrs, thrugh establishing links with the Mental Health Persnal Helpers and Mentrs Prgram as apprpriate and where available, and liaising with supprt facilitatrs, thrugh establishing links with rganisatins that prvide services under ther prgrams, such as Partners in Recvery and Persnal Helpers and Mentrs Service, as apprpriate and where available. Mental health nurse caselads

6 Fr the purpses f the MHNIP, a sessin is 3.5 hurs. Eligible rganisatins can engage mental health nurses frm between 1 and 10 sessins per week, per nurse, with an average nurse caselad f at least 2 individual services t patients with a severe mental disrder per sessin. As a guide, an eligible rganisatin engaging the services f a full-time mental health nurse shuld have a current minimum case lad f 20 individual patients with a severe mental disrder per week, averaged ver 3 mnths. When taking int accunt patient turnver, the expected annual caselad managed by a full-time mental health nurse is 35 patients with a severe mental disrder, mst f whm will require nging care ver the curse f the year. It is expected that a full-time mental health nurse engaged fr 10 sessins per week wuld prvide an average 25 hurs f clinical cntact time per week, with the balance f time spent in related tasks. Related tasks include interagency liaisn, case planning and crdinatin, clinical briefings t relevant GPs r psychiatrists and travel. Under the MHNIP, the typical caselad f a full-time mental health nurse will cmprise f patients with different levels f care requirements that fall bradly int three grups: Lw care - patients in this grup include individuals with severe mental disrders whse clinical symptms are well cntrlled but wh wuld be at risk f relapse withut nging clinical supervisin. Medium care - patients in this grup will have active symptms which can nly be well cntrlled with regular clinical cntact (e.g. frtnightly) and need clse mnitring t prevent deteriratin. High care - patients will have persistent r fluctuating clinical symptms, despite active treatment. They are at risk f hspitalisatin r being lst t care if nt actively managed. Patients in this grup, n average, require frequent clinical cntact. Requirements fr eligible rganisatins T be eligible fr the MHNIP, rganisatins must be able t verify the fllwing when requested: sufficient caselad f eligible patients t engage the services f a mental health nurse fr at least 1 sessin per week apprpriate insurance cverage, including: wrker s cmpensatin in accrdance with relevant state r territry legislatin public liability insurance f $10 millin r mre prfessinal indemnity insurance f $10 millin r mre fr clinical and nn-clinical wrk vicarius liability cver f $1 millin r mre, where the mental health nurse is an emplyee f the rganisatin and is carrying ut medical prcedures r prviding medical advice where the mental health nurse is nt an emplyee f the eligible rganisatin, the same minimum. levels f insurance cverage must be maintained, althugh sme r all f the plicies may be maintained by the mental health nurse

7 nging maintenance f the required insurance cverage adherence t relevant prfessinal standards, and t the Natinal Practice Standards fr the Mental Health Wrkfrce 2013 the presence and use f patient reminder and recall systems the apprpriate qualificatins and experience f mental health nurses engaged - see Eligibility requirements fr mental health nurses the cnsistency f terms and cnditins fr the engagement f mental health nurses with relevant state r territry legislatin the maintenance f minimum levels f cntact with patients with a severe mental disrder that meet their individual clinical requirements (this may include telephne cntact) the presence f frmal prtcls fr managing a patient s mental health care under the MHNIP, including: a GP Mental Health Treatment Plan fr general practitiners r equivalent plan fr psychiatrists, develped in cllabratin with the mental health nurse (these plans must include specific reference t the rles and respnsibilities f bth the nurse and the treating medical prfessinal) mental health nurse assessment f eligible patients at entry, every 90 days and when a patient exits the MHNIP using the Health f the Natin Outcmes Scale, including the child and adlescent, adult, and lder persn tls, and the apprpriate training f mental health nurses engaged in using Health f the Natin Outcmes Scale. agreement t ntify the department f any changes t eligibility f the rganisatin within 14 calendar days fr incentive payments - see Payments t Eligible Organisatins the presence f clear and agreed rle descriptins fr mental health nurses engaged, which are cnsistent with the rle and functins f a mental health nurse and the legislative framewrk f the eligible rganisatin s state r territry the presence f clear lines f clinical accuntability (specified in writing), including the respnsibilities f the mental health nurse and participating GP and the cmmunicatin prtcls between the 2 health practitiners the presence f prtcls in relatin t the safety f staff in all service prvisin settings (e.g. clinic, patient s hme, traveling) the availability f dedicated wrking spaces within the clinic r as apprpriate fr engaged mental health nurses during wrking hurs the availability f clinical care versight, including regular reviews f care prvided by mental health nurses the presence f supprt systems fr mental health nurses, such as access t training and peer mentring pprtunities the maintenance f recrds relating t mental health nurse engagement the maintenance f case recrds by engaged mental health nurses that recrd activities undertaken Imprtant: these activities must be cnsistent with the rles described under Functins f the mental health nurse the services prvided by mental health nurses will be at little r n cst t the patient, and agreement t prvide the department with reprting data as detailed in Mnitring and Reprting

8 If requested, the rganisatin must prvide evidence f the abve t the Department f Health under the MHNIP audit. Medicare Lcals/Primary Health Netwrks Transitin MHNIP services that have been prvided by Medicare Lcals will cntinue t be prvided in the regin. There are sme circumstances where frmer Medicare Lcals may deliver MHNIP services in : Where Medicare Lcals transitined t a PHN frm 1 July 2015, the PHN was ffered a MHNIP sessin allcatin in , and Frmer Medicare Lcals that cntinued t perate as viable eligible new entities frm 1 July 2015 were ffered a cntinued MHNIP allcatin in Fr Medicare Lcals that ceased t perate as an entity frm 1 July 2015, all effrts were made t ensure the prvisin f MHNIP sessins cntinued fr existing patients in the regin, nting the rle f the GP r psychiatrist as the main persn respnsible fr the patient s clinical mental health care. PHNs will cmmissin services frm existing MHNIP Organisatins in , and will cmmissin services mre bradly frm , fllwing a cmprehensive needs assessment prcess in Mnitring and reprting Eligible rganisatins must prvide the fllwing data t the Department f Human Services with each sessin claimed until 30 April Organisatinal infrmatin: Mental Health Nurse Incentive Prgram identificatin number name f rganisatin number f mental health nurses engaged Sessinal infrmatin: sessin number date f sessin sessin start time full 8 digit prvider number prvider name mental health nurse name and date f birth shared emplyment arrangement mental health nurse engagement date mental health nurse credential number, as issued by the Australian Cllege f Mental Health Nurses lcality/suburb f service utlets pstcde f service utlets number f sessins prvided per nurse Patient infrmatin: Medicare card number r Department f Veterans Affairs Veteran file number patient name

9 sex date f birth patient s current residential pstcde shared care health plan number f face-t-face cnsultatins per patient Frm 1 May 2016, the Department f Health will prcess all claims fr payment by eligible rganisatins. Eligible rganisatins must prvide the fllwing data t the Department f Health fr each new claim: Mental Health Nurse Incentive Prgram identificatin number name f rganisatin rural and remte categry number f mental health nurses engaged mental health nurse name and date f birth sessin number date f sessin sessin start time full 8 digit prvider number lcality/suburb f service utlets pstcde f service utlets number f sessins prvided per nurse Ttal amunt f sessins Cst per sessin The eligible rganisatin must submit a crrectly rendered tax invice with the claim frm (guidance is included n the claim frm). Payments t eligible rganisatins Claim incentive payment Frm 1 May 2016 the fllwing timeframes and arrangements apply: Organisatins must submit claims fr all utstanding sessins t the Department f Human Services by clse f business, 30 April Nrmal payment eligibility rules will apply. T ensure claims are received by 30 April 2016, claims shuld be faxed t Frm 1 May 2016, rganisatins must submit all claims fr sessins t the Department f Health at MHNIPclaims@health.gv.au r via pst t MHNIP Claims, MDP 11, GPO Bx 9848, Canberra, ACT, Claims must be submitted using the new claim frm, available n the Department f Health website. New claims and previusly rejected claims submitted n the Department f Human Services claim frm will nt be able t be paid. All claims fr sessins must be received by the Department f Health by clse f business Friday 15 July Payment fr sessins claimed will be made apprximately 30 days after the receipt f a crrectly rendered tax invice.

10 All claims will be paid at the rate f $240 (GST free) per sessin. This amunt is intended t be applied t mental health nurse salary and n-csts, including persnal and recreatinal leave entitlements. Fr services in rural and remte areas f Australia, a 25% lading (GST free) will be applied t the sessinal payment. Rural and remte services are thse lcated in very remte, remte and uter reginal areas as defined by the Australian Standard Gegraphic Classificatin Remteness Areas. The lading will apply in respect t the lcality f a nurse s service utlet fr that day (that is the physical lcatin f the ffice r clinic where the nurse is based). Services prvided at the patient s hme are cnsidered t be services prvided frm the nurse s service utlet fr that day. Establishment payment The Establishment payment is n lnger applicable as n new rganisatins will be accepted t the prgram fr the remainder f Further infrmatin until 30 June 2016 Fr further infrmatin, please visit: Phne: (call charges may apply) between 8.30 am and 5.00 pm, Mnday t Friday, Australian Central Standard Time Frm 1 July 2016, all enquiries fr the MHNIP are t be directed t the Department f Health. Please call (call charges may apply).