These Guidelines supersede the Guidelines for Determining Benefits for Health Insurance Purposes for Private Patient Hospital Based Mental Health Care (2010 Edition). The 2012 Edition attached below, has been endorsed by the PMHA and was developed by its Collaborative Care Models Working Group. In this Edition, advice is included that is applicable, in some instances, to both the hospital–based and office–based settings. The Guidelines cannot be prescriptive and, at present, are primarily intended to provide guidance for hospitals and health insurers in determining health insurance benefits for private patient hospital–based mental health care. This includes same–day, half–day, overnight and approved outreach services as well as community and outpatient services, where applicable. The Guidelines may also be of assistance to State and Territory health authorities and their public hospitals in the treatment of Medicare and privately insured patients and to office–based practitioners. The 2012 Edition includes advice for services that substitute for traditional admitted hospital-based care in a new section titled, Alternatives to In Hospital Treatment.
Guidelines for Determining Benefits 2012 Edition.pdf