Medicare Care Plans

On 1 November 2019, the Australian Government introduced a suite of new MBS items for people living with eating disorders. 

People eligible for the EDP will be able to access comprehensive treatment and management services for a 12-month period, including:

• Assessment and treatment planning
• Up to 40 sessions of evidence-based psychological treatment from a mental health professional eg psychologist or eligible occupational therapists/social workers
• Up to 20 sessions of dietetic services from an Accredited Practicing Dietitian 
• Review and ongoing management services to ensure the person accesses the appropriate level of intervention

An EDP can be created by a GP, Pediatrician or Psychiatrist. These are the people who can step the person through the plan, including reviews.

There are two cohorts of eligible patients who can access EDPs:

• People with a clinical diagnosis of anorexia nervosa; or
• People who meet the eligibility criteria (below) and have a clinical diagnosis of bulimia nervosa, binge eating disorder (BED) or other specified feeding and eating disorders (OSFED).

People living with anorexia nervosa are eligible for an EDP without any further criteria needing to be met.

The eligibility criteria that need to be met for a person with a clinical diagnosis of bulimia nervosa, BED and OSFED, are:

• Eating Disorder Examination Questionnaire (EDE-Q) scores ≥ 3 and
• 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
• Two of the following indicators are present:
  • Clinically underweight with a body weight less than 85% of expected weight where weight loss is directly attributable to the eating disorder
  • Current or high risk of medical complications due to eating disorder behaviours and symptoms
  • Significant functional impairment resulting from serious comorbid medical or psychological conditions
  • Admission to a hospital for an eating disorder in the previous 12 months
  • Inadequate treatment response to evidence-based eating disorder treatment over the past 6 months despite active and consistent participation. 

An EDP is valid for 12 months from the date the EDP was created by the medical practitioner and not based on a calendar year. 

The person’s count of EDP psychological and dietetic services should start from the date of the EDP and apply to all services provided within that 12-month period.

Once this time has lapsed, a new EDP will need to be created and new referrals made for psychological and dietetic treatment. Sessions that were not used in the preceding 12 months cannot be carried over into the new plan.

If the 40 psychological and/or 20 dietetic sessions are used in under a 12 month-period, the person will need to wait until the 12-month period has lapsed before accessing further sessions under a new EDP if eligible.

If you are unsure about your eligibility, or are wanting to pursue an EDP via your GP, you can complete the Eating Disorder Examination Questionnaire (EDE-Q) here.

Please note when booking to see a GP to obtain an EDP,  a double session to generally required to create or review a treatment plan.

Your GP will likely get you to complete the EDE-Q in your appointment, which can take around 10-15mins. Therefore, I usually suggest completing it beforehand and bringing to your GP appointment to make the process smoother.

Unsure how to create an EDP for your client?

Access the template here https://insideoutinstitute.org.au/resource-library/eating-disorder-care-plan

More info about the EDP can be found at https://insideoutinstitute.org.au/medicare/