CIRCULAR 58 OF 2018 : BENEFIT DEFINITION SUBMISSIONS FOR SCHIZOPHRENIA, BIPOLAR MOOD DISORDER AND MENTAL HEALTH EMERGENCIES
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1 CIRCULAR Reference: Contact person: Mental Health PMB conditions Esnath Maramba Tel: Fax: Date: 13 December 2018 CIRCULAR 58 OF 2018 : BENEFIT DEFINITION SUBMISSIONS FOR SCHIZOPHRENIA, BIPOLAR MOOD DISORDER AND MENTAL HEALTH EMERGENCIES The Council for Medical Schemes (CMS) is hereby calling for submissions for benefit definitions for the following conditions: - Schizophrenia, - Bipolar mood disorder and - Mental health emergencies The applicable DTPs and list of ICD10 codes which will be discussed are tabled below. The CMS acknowledges the PMB review process that is currently underway but recognizes the urgent need to clarify funded benefits for mental health conditions listed above. These benefit definition guidelines will be updated and reviewed once the PMB review process is finalized as part of a revised new set of PMB regulations in future.
2 Applicable PMB code for bipolar mood disorder BIPOLAR MOOD DISORDER PMB Code 902T PMB Description Major affective disorders, including unipolar and bipolar depression Treatment Component Hospital-based management up to 3 weeks/year (including inpatient electro-convulsive therapy and inpatient psychotherapy) or outpatient psychotherapy of up to 15 contacts Applicable ICD 10 codes for bipolar mood disorder F31.0 Bipolar affective disorder, current episode hypomanic F31.1 Bipolar affective disorder, current episode manic without psychotic symptoms F31.2 Bipolar affective disorder, current episode manic with psychotic symptoms F31.3 Bipolar affective disorder, current episode mild or moderate depression F31.4 Bipolar affective disorder, current episode severe depression without psychotic symptoms F31.5 Bipolar affective disorder, current episode severe depression with psychotic symptoms F31.6 Bipolar affective disorder, current episode mixed F31.7 Bipolar affective disorder, currently in remission F31.8 Other bipolar affective disorders F31.9 Bipolar affective disorder, unspecified Page 2
3 Treatment algorithm for bipolar mood disorder as outlined in the Medical Schemes Act Page 3
4 SCHIZOPHRENIA Applicable PMB code for schizophrenia PMB Code 907T PMB Description Schizophrenic and paranoid delusional disorders Treatment Component Hospital-based management up to 3 weeks/year Possible ICD10 codes for identifying schizophrenia ICD10 code WHO description F20.0 Paranoid schizophrenia F20.1 Hebephrenic schizophrenia F20.2 Catatonic schizophrenia F20.3 Undifferentiated schizophrenia F20.4 Post-schizophrenic depression F20.5 Residual schizophrenia F20.6 Simple schizophrenia F20.8 Other schizophrenia F20.9 Schizophrenia, unspecified Page 4
5 Treatment algorithm for schizophrenia as outlined in the Medical Schemes Act Page 5
6 MENTAL HEALTH EMERGENCY CONDITIONS A mental health emergency is a life threatening situation in which an individual is imminently threatening harm to self or others, severely disorientated or out of touch with reality, has a severe inability to function, or is otherwise distraught and out of control. The following mental health conditions that are listed in the current PMBs qualify as mental health emergencies: PMB Code PMB Description Treatment Component ICD10 Code 910T Acute delusional mood, anxiety, personality, perception disorders and organic mental disorder caused by drugs Hospital-based management up to 3 days F06.- F07.- F09 F10.0 / F10.8 / F10.9 F11.0 / F11.3 F11.9 F12.0 / F12.3 F12.9 F13.0 / F13.3 F13.9 F14.0 / F14.3 F14.9 F15.0 / F F15.9 F16.0 / F16.3 F16.9 F17.- F18.0 / F18.3 F18.9 F19.0 / F19.3 F19.9 F24 901T Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse Hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts F43.0 / F43.8 / F43.9 T74.1 / T T Alcohol withdrawal delirium; alcohol intoxication delirium Hospital-based management up to 3 days leading to rehabilitation F10.3 / F10.4 / F10.5 Page 6
7 903T Attempted suicide, irrespective of cause Hospital-based management up to 3 days or up to 6 outpatient contacts X60.- to X T Brief reactive psychosis Hospital-based management up to 3 weeks/year F10.5 / F11.5 / F12.5 / F13.5 / F14.5 / F15.5 / F16.5 F17.5 / F17.7 F18.5 / F18.7 F19.5 / F19.7 F23.- R44.0 / R44.1 / R44.2 / R T Delirium: Amphetamine, Cocaine, or other psychoactive substance Hospital-based management up to 3 days F11.4 / F11.5 F12.4 / F12.5 F13.4 / F13.5 F14.4 / F14.5 F15.4 / F15.5 F16.4 / F16.5 F17.4 / F17.5 F18.4 / F18.5 F19.4 / F T Major affective disorders, including unipolar and bipolar depression Not an emergency unless severely suicidal Hospital-based management up to 3 weeks/year (including inpatient electro-convulsive therapy and inpatient psychotherapy) or outpatient psychotherapy of up to 15 contacts F20.4 F25.- F30 1 / F30.2 F31.- All mania is an emergency F32.- Page 7
8 F33.- F53.1 / F53.8 / F T Schizophrenic and paranoid delusional disorders Not an emergency unless accompanied by aggression Hospital-based management up to 3 weeks/year F20.- F22.- F23.1 / F23.2 / F23.2 F25.- F28 F29 The following mental health conditions that are NOT listed in the current PMBs qualify as mental health emergencies: Delirium due to other causes Panic attacks The process for the PMB definition process is once again outlined below: Page 8
9 Publish circular for stakeholder submissions CMS collates submissions and submits to clinical advisory commitee (CAC) CAC meeting Draft write up Publish draft for stakeholder comments Final draft compilation Council apprval Publication Please note: Submissions from different stakeholders should follow the template provided below and ed to by the date indicated below. Any submissions for mental health conditions which are not currently listed as PMBs will be addressed with the PMB review project. Submissions should be limited to the ICD10 codes mentioned above. The CMS would also like to extend an invite to all stakeholders who would like to be part of the clinical advisory committee (CAC) meeting to their CVs to The committee will consider all the submissions received and propose recommendations regarding the basket of benefits and care to be made available in the management of the mental health conditions mentioned earlier. In order to protect the intellectual property of stakeholders, submissions will be treated as anonymous and distributed to committee members only. Page 9
10 Please take note of the following dates: Due date for submissions Due date for CVs CAC meeting date Schizophrenia 31 January January February 2019 Bipolar mood disorder 31 January January February 2019 Mental health emergencies 31 January January February 2019 Dr S. Kabane Acting Chief Executive & Registrar Council for Medical Schemes Page 10
11 TEMPLATE FOR SUBMISSION FOR SCHIZOPHRENIA, BIPOLAR MOOD DISORDER AND MENTAL HEALTH EMERGENCIES Please make a separate submission for bipolar mood disorder and schizophrenia. For mental health emergencies, please make a separate submission for each emergency for all relevant categories shown below. 1. Entry criteria 2. Diagnostic basket 2.1. Consultations and disciplines for diagnosis Discipline Frequency e.g. psychiatrist 2.2. Lab investigations for diagnosis Description Comment (if necessary) e.g. FBC 2.3. Other investigations for diagnosis Description Comment (if necessary) e.g. EEG Page 11
12 3. Medical management 3.1. In hospital medical management Please list medicine classes required with examples and the route of administration if necessary. Do not use any brand names. Medicine First line e.g Out of hospital Medical management Please list medicine classes required with examples and the route of administration if necessary. Do not use any brand names. Medicine 1 st line 2 nd line 3 rd line 4 th line Relapse 4. Follow up 4.1. Consultations and disciplines Please list all providers the patient needs to see out of hospital Page 12
13 Discipline Frequency/ annum e.g. psychologist e.g. psychiatrist 4.2. Lab investigations Please list all follow up investigations that are required out of hospital. These are not diagnostic tests. Description Frequency e.g. Aspartate aminotransferase Please list all drug related investigations that are required out of hospital Medicine name Lab investigation Frequency e.g. Quetiapine Aspartate aminotransferase (AST) Alanine aminotransferase(alt) Full Blood count (FBC) 5. Any other comments Page 13
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