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Circular 17 of 2023: Revision of mental health Prescribed Minimum Benefit (PMB) definition guidelines

The Council for Medical Schemes (CMS) would like to inform stakeholders of the commencement of the process to revise the mental health Prescribed Minimum Benefit (PMB) definition guidelines.

The CMS is carrying out the benefits definition project to establish PMB entitlements and offer direction to relevant stakeholders in interpreting PMB provisions. The CMS is cognisant of the latest advancements in mental health management. With this aim in mind, PMB definition guidelines were published in 2020 for three mental health conditions, i.e., bipolar mood disorder, schizophrenia and acute mental health disorders.

Since the publication of the mental health definition guidelines, several stakeholder groups have advised regarding poor interpretation and application of the guidelines and have advised on the need for revisions. The CMS is preparing a discussion document to revise these previously published mental health benefit guidelines. The process to be outlined is outlined in Figure 1. The CMS, therefore, calls for submissions to revise the current mental health benefit guidelines for consideration by 23 June 2023.

The full version of the current (2020) PMB definition guidelines on mental health can be found below:

  • Click here for bipolar mood disorder
  • Click here for schizophrenia
  • Click here for acute mental health conditions

A Clinical Advisory Committee (CAC) will be set up and comprise Technical Experts selected from the CMS Technical Expert Selection Panel and other stakeholders with expertise in mental health with affiliation and representation of various interest groups within the field.

It should be noted that stakeholder representation in the CAC is on a volunteer basis to provide advice and representation of all stakeholder interests and, thus, are not remunerated positions.

All stakeholders who would like to be part of the CAC on mental health disorders can email their CVs to pmbreview@medicalschemes.co.za. The committee will consider all the submissions received and propose recommendations and revisions regarding the basket of benefits and care to be made available to manage the relevant mental health condition.

To protect the intellectual property of the CMS, stakeholders accepted to join the CAC will be required to complete a confidentiality agreement and non-disclosure agreement.

All PMB-related queries may be addressed to pmbreview@medicalschemes.co.za

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