Guide to the NEW MEDICARE EATING DISORDER TREATMENT and MANAGEMENT PLAN (EDP)
The introduction of the Eating Disorders MBS items, valid for use from 1st November 2019, is a significant and welcome change, allowing eligible patients to access rebates for up to 20 dietetic and up to 40 psychological treatment services within a 12-month period.
This communication contains an overview and flow chart of the referral and review process for Eating disorders treatment and management plans (EDP).
We have also included the NEDC GP Guide to the new item numbers and a copy of the Eating Disorders Examination – Questionnaire, which is required for the development of an EDP (see eligibility criteria below).
The Stepped Model of Care of Eating Disorder Plans and Reviews
Eligibility for an eating disorders treatment and management plan (EDP)
For the development of an EDP a patient must:
1.Have a clinical diagnosis of anorexia nervosa(AN); OR
2.Meet the eligibility criteria (below), and have a clinical diagnosis of bulimia nervosa(BN), binge-eating disorder(BED), or other specified feeding or eating disorder (OSFED).
The eligibility criteria for a patient are:
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 eatingor 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:
- clinically underweight with a bodyweight 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;
- serious comorbid medical or psychological conditions significantly impacting on medical or psychological health status with impacts on function;
- the person has been admitted to a hospital for an eating disorder in the previous 12 months;
- inadequate treatment response to evidence-based eating disorder treatment over the past six months despite active and consistent participation.
The Eating Disorders items provide a Medicare rebate for a GP, psychiatrist or paediatrician to develop an eating disorders treatment and management plan (EDP).
An EDP can be developed for patients with a diagnosis of anorexia nervosa and patients with other specified eating disorder diagnoses who meet the eligibility criteria (see details above). It is expected that there will be a multidisciplinary approach to patient management through these items.
An EDP is valid for 12 months and allows patients to access clinical services including up to 20 dietetic services, up to 40 eating disorder psychological treatment services (EDPT service), and review and ongoing management services to ensure that the patient accesses the appropriate level of intervention.
The Eating Disorders items are distinct from a Chronic Disease Management Plan (CDM) or a Mental Health Care Plan (MHCP).
The EDP operates on a stepped model, where a course of treatment is defined as 10 EDPT (eating disorder psychological treatment) services.
The referrer (managing practitioner) must review the EDP with the patient to assess progress against the EDP or update the EDP, as the patient is approaching the end of each course of treatment before they can access the next course of treatment.
Additionally, it is expected that the managing practitioner will be reviewing the patient on a regular, ongoing and as required basis.