Medicare rebates, and funded programs
Medicare Items for Complex and Chronic Conditions Individuals may be eligible for rebates under the Medicare Items for Complex and Chronic Conditions. Clients have complex care needs if they need ongoing care from a multidisciplinary team consisting of their GP and at least two other health care providers, two of which may be an Occupational Therapist, Speech Therapist or Physio Therapist. Residents of aged care facilities may also be eligible for this program, but hospital in-patients are not eligible for the chronic disease management (CDM) program. If you are unsure as to you (or your child’s) eligibility, please discuss with your GP.
If all sessions are not used during the calendar year in which the client was referred, the unused sessions can be used in the next calendar year. However, those sessions will be counted as part of the five sessions with allied health professionals available to the client during that calendar year. Clients continue to be eligible for rebates for speech pathology while they are being managed under a CDM plan as long as the need for eligible services continues to be recommended, by their GP, in their plan
A session is a face to face consultation with an allied health professional. The consultation must be of at least 20 minutes duration and must be provided to an individual client. The Occupational Therapist, Speech Therapist or Physio Therapist named on the referral form should provide the service. If there is a change in the Occupational Therapist, Speech Therapist or Physio Therapist providing the service the GP should be notified of the change.
Medicare Benefits schedule links for Occupational, Speech and Physio therapies.
We provide face to face occupational, speech and physiotherapy services at your home, school, work, and local community whichever best suits you to achieve your short- and long-term goals.
We also provide telehealth occupational, speech and physiotherapy services which reduces travel time and costs. It also eliminates communicable diseases. Telehealth services can be provided via a desk top computer, tablet/iPad, or a mobile device with a good internet connection. Telehealth services are effective, and your privacy is protected as the therapists must abide by Australian privacy principles.
Other allied health professionals can provide services under the CDM program
There are a range of other allied health professionals, in addition to speech pathologists, who can
provide services under the CDM program. These include;
Other allied health programs under Medicare
Up to four (4) Medicare rebate services in total will be available for eligible allied health professionals, to collaborate with the referring practitioner in the diagnosis of a child (aged under 13 years) and/or the development of a child’s PDD treatment and management plan
A further twenty (20) Medicare rebate services in total will also be available for eligible allied health
professionals, to provide treatment to a child (aged under 15 years and who was under 13 years at the time of receiving their diagnosis from the specialist and the development of the PDD treatment and management plan).
The 20 services are for a lifetime, and may apply across a speech pathologist, psychologist and occupational therapist, as determined by the treatment and management plan prepared by the referring specialist.
See the information sheet from the Department of Health about the Medicare items available through this program Department of Health and Aged Care | Autism — Helping Children with Autism program.
Follow-up Allied Health Services for People of Aboriginal or Torres Strait Islander Descent
Additional assistance for people of Aboriginal and Torres Strait Islander descent who have had a health assessment to receive a Medicare benefit for follow-up allied health services. To access these items patients must be referred to an eligible allied health provider by their GP. Eligible patients can receive a maximum of five services -in addition to the five allied health services available each calendar year for patients who have a chronic medical condition and complex care needs. See: Department of Health and Aged Care | Follow-up Allied Health Services for People of Aboriginal or Torres Strait Islander Descent
Rebates for allied health services may be available through your private health fund (PHF). You will need to determine the rebates with your health fund provider prior to commencing the service.
National Disability Insurance Scheme (NDIS)
The NDIS is an Australia wide funding scheme for people with a disability. It is replacing many of the other funding schemes for children, including the Helping Children with Autism and Better Start packages.
In order to qualify to access the NDIS a person must be:
The NDIS is gradually rolling out across Australia and is due to be fully rolled out by 30 June 2023.People with a disability must meet certain criteria as determined on an individual basis to receive a package of funding for a 12 month period. The amount of funding that a person will be able to receive through the NDIS varies, as it is tailored to the individual following a needs based assessment. The NDIS is not means tested, and the package of funding, known as a ‘plan’. NDIS funds cannot be used with Medicare or private health fund rebates to pay for the same session. Please see the NDIS website National Disability Insurance Scheme (NDIS) for more information
Helping Children with Autism (HCWA)
The Helping Children with Autism package was a package that provided additional funding to ensure that children aged 0 to 6 years diagnosed with ASD have greater access to a range of early intervention services, including packages of individual assistance. For more information visit website: Department of Health and Aged Care | Autism — Helping Children with Autism program
Children with Autism or Autism like symptoms may also have access to PlayConnect Playgroups. For more information see following website: Home – PlayConnect
Better Start under DSS
Better Start is a package of funding similar to HCWA. This was available to children aged six and under who have a range of conditions listed on the Better Start initiative website You can also find more information on websites: Better Start Continuity of Support and Grants | Department of Social Services, Australian Government (dss.gov.au)
Other Funding Sources Carer Payment
This is a supplementary payment for carers who provide additional daily care and attention for someone with a disability or medical condition, or who is frail aged. See Carer Allowance – Carer Allowance – Services Australia
National Australian Defence Force Academy Family Health program
PACMAN | Pay and Conditions (defence.gov.au) https://pay-conditions.defence.gov.au/pacman