Rebates from Medicare Australia

MEDICARE REBATES

Chronic Disease Management (formerly Enhanced Primary Care)

  • Up to five visits per calendar year to an allied health professional (eg occupational therapist, speech therapist, psychologist, physiotherapist, dietitian, osteopath, chiropractor, audiologist etc).
  • Must be referred by GP.
  • Can combine sessions (eg two OT and three speech).

Better Access to Mental Health Professionals Plan

  • Up to ten individual visits, plus ten group sessions per calendar year to a mental health professional (psychologist, or an occupational therapist or social worker registered for Better Access to Mental Health).
  • Must be referred by GP, paediatrician or psychiatrist.
  • A diagnosis of an ASD is insufficient to access this plan, however some associated symptoms are eligible (eg anxiety, depression, ADD, OCD etc).

To find an occupational therapist registered for Better Access to Mental Health, go to Occupational Therapy Australia and click “Find an OT” (purple box in bottom left corner of page). Under Speciality, select “Autism Spectrum Disorders”, choose the appropriate geographical Region, and under Registered provider, select “Better Access to Mental Health”. Each OT’s page will list which services they provide eg ASDs, Fahcsia, Chronic Disease Management, Better Access to Mental Health.

The GP can refer for six visits initially, then review the Plan before making a referral for the remaining four visits. Any unused visits can be carried over to the next calendar year, but count towards the new year’s total. A new Mental Health Plan can only be made twelve months after the previous Plan.
Helping Children with Autism Paediatrician Treatment Plan

  • Up to twenty visits to allied health professionals, only valid until age 15, and only able to be claimed once in a child’s lifetime.
  • Must be referred by paediatrician or psychiatrist.
  • This funding ceases (regardless of age or how many sessions have been used) once the child is signed up for NDIS.

Medicare Safety Net

  • Families who have registered for Medicare Safety Net receive an additional rebate from Medicare for out-of-pocket costs for out-of-hospital services above the relevant annual threshold.
  • Threshold amounts can be found on the Medicare website.
    After the relevant threshold is reached, Medicare will reimburse 80% of out-of-pocket costs.

PBS Safety Net

  • Concession card holders who spend $360 (60 scripts), or general patients who spend $1421.20 per calendar year on prescription medicines (excluding private scripts), are then eligible for free scripts (concession) or $6 per script (general patients).
  • The PBS amounts can be combined for a family, however concession card holders are calculated separately from the rest of their family.
  • A Pharmacist can provide a PBS Safety Net form.

Recommendations:

  • Register for Medicare Safety Net.
  • Keep records of PBS expenditure, and register for PBS Safety Net.
  • Use Fahcsia’s Helping Children With Autism funding first (up to $6,000 per financial year, total $12,000 per child). Budget it to last until age 7, supplementing each year with the Chronic Disease Management and Mental Health programs.
  • The Chronic Disease Management and Mental Health programs are available every calendar year, regardless of age.
  • Save the HCWA Paediatrician Treatment Plan until after age 7, when there is less funding available – but this plan must be written before age 13, and used before age 15 – or before the child is signed up for NDIS.
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