POMHA: Mental health and addictions

All practices in Te Tairāwhiti region can claim for this service.

Each patient is placed on one of the following two pathways and packages of care.

The physical care pathway aims to provide the patient with free GP consultations to address any physical needs. Their mental health condition continues to be managed by secondary services. 

The transitional care pathway aims to support the transition of the patient from secondary care to primary care for the management of their mental health condition.  

The service focuses on collaboration between the patient, their GP and mental health providers. 

The goal is to remove barriers for these patients to access primary care, and to assist the patient to reach a stage where they are comfortable within the general practice environment and are able to self-fund their primary care.  

TDH Mental Health and Addiction Services will carry out selection of patients for this programme. Patient's need to meet the following criteria to be eligible for the service.

Must haves:

1. Be under the care and support of CMHAS
2. Beneficiary or low income

Along with :

1. Comorbidities = Mental health or addiction diagnosis with medical issues
2. Prescribed Clozapine, long acting IMI’s, OST (Methadone or Suboxone)
3. MH + AoD Diagnosis requiring increased GP support

The patient has given their consent and is eligible for New Zealand funded health care and is domiciled in Te Whatu Ora Tairāwhiti area.

TDH Mental Health and Addiction Services will advise the Primary Options team, as well as the practice, who the patient is, the name of their support worker and which pathway the patient is eligible for. Notification is received via email. 

The patient’s general practitioner assesses the patient as clinically safe and appropriate to manage the care in the community.

The patient’s general practitioner is able to take responsibility for the person’s care or has the option to hand over the patient to another clinician. 

Clinical responsibility  
The doctor who initially receives the discharge letter and handover from TDH’s clinician carries clinical responsibility. This doctor can hand over the patient’s care to another doctor by mutual agreement only.  

If you identify a patient who you believe meets the eligibility criteria listed above, please email the Primary Options team with the patient's NHI. The team will liaise with Community Mental Health and Addictions and reply to your email with the outcome. 

Patients not identified by TDH including those patients receiving ongoing depot injections at general practice.  

Patients not domiciled in Te Whatu Ora Tairāwhiti area.

Each package of care/pathway is available to the patient for one financial year (1 July – 30 June); starting from the date the patient is added to one of the packages of care. If the funding rolls over to the next financial year and the patient has not been removed from the list, the funding will continue, and the patient’s package of care renews for another financial year.  

Alternatively, the patient will exit the programme for the current financial year if they have used up their allocation of funded appointments (see claiming guidelines). 

Practices will be notified via email if the TDH Metal Health and Addictions Services remove a patient from either the transitional or physical care packages. 

There can be no co-payment charged to the patient. 

Please make your claim via Primary Options, select either MH Physical or MH Transitional and then attach the appropriate invoice(s). Please see below for further instructions on claiming

Prices are GST inclusive.  

Physical care pathway 

This pathway is for patients who are not being transitioned for discharge and are still under the care of TDH Mental Health & Addictions services. The physical care pathway is intended to support greater access to general practice for POMHA patients for their physical health needs.

POMHA GP standard consult
15 minute GP standard consultation x 6 - $77.25

Transitional care pathway 

This pathway is for patients who are being transitioned for discharge from TDH Mental Health & Addiction services. The transitional care pathway is intended to support greater access to general practice for POMHA patients for both their mental and physical health needs. 

POMHA GP standard consult: 15min GP standard consultation x 4 - $77.25

POMHA GP extended consult: 30min GP consultation x 4 - $115.88 

POMHA RN standard consult: 30min nurse consultation x 12 - $38.63

Some transitional patients may be eligible for the additional funding below. This funding covers the administration of their depot injections. Selection is made by TDH Mental Health & Addiction Services and they will clearly indicate those patients who are eligible for this in the initial notification to the practice manager. 

POMHA Depot injection: administration of Depot injection only x 26 - $18.54

Submitting your claim

Claims can be made via Primary Options. When you have the initial consultation with the patient lodge a new referral and select the appropriate category for the patient, either MH Transitional or MH Physical. The case number generated will be used for the remainder of the financial year.  

At each consultation lodge a singular invoice using the original case number, add the consult notes and select the appropriate invoice. For example, for a consultation with the GP claim a GP standard consult. 

Please be aware if you do not ‘outcome’ the case you will receive this case as part of the reminder email sent out on a regular basis. If you do not want to receive a reminder, please ‘outcome’ the case. You will still be able to lodge singular invoices for this case number regardless of whether this case has had an ‘outcome’ submitted or not. 

Please generate one case number per financial year. 

When the new financial year starts, generate a new case number if the patient remains eligible.  

Retrospective claiming 

A claim needs to be lodged by the referring clinician at the time the decision is made to use POMHA funding to provide a service. A clinician should ideally invoice for every consultation as it occurs. 

Eligibility for each patient 

It is recommended that an alert is put on the patient’s record, indicating which package of care (Transitional or Physical) they are eligible for and case number being used for claiming.  

Can I claim for additional consults that take more time than usual? 

This service only funds what is listed in the claiming section above. If the patient requires additional services such as ECGs, dressing changes as part of the consult please advise the patient there may be an additional cost.  

Practices are required to provide sufficiently detailed consultation notes to determine appropriate use of funding. 

No co-payment can be charged to the patient.

The service is funded by Te Whatu Ora