Autism and SN Guides Qld and beyond

One of the incredibly resourceful ladies I’ve had the privilege of “meeting” through Facebook has put together two very indepth resource guides that she is keen for people to share wherever they would be useful.

A Resource Guide & Ideas for Therapists, Teachers, Parents and Carers working with people with Special Needs- covers a multitude of topics, and is well worth checking out.

The Queensland Autism Parents Handbook is 101 pages and is a comprehensive guide to autism services, support, tips and ideas for Qld. The book is most relevant to Qld but is a valuable source of info wherever you live.

Pharmaceutical Benefits Scheme (PBS)

PBS Safety Net means that after you’ve spent above a certain amount on PBS scripts, any remaining scripts for that calendar year are reduced (for general patients) or free (for concession card holders – pension/senior/health care/DVA).  A pharmacist can provide the necessary forms to register for PBS Safety Net.

Families can combine their expenditure to reach the PBS thresholds – though there are many different options for doing so, as outlined in these pages:

PBS medicines are subsidised by the Australian government.  Where two or more brands of the same medicine are listed under the PBS, the Australian government subsidises each brand up to the same amount – but the supplier may request a surcharge, which is called a brand surcharge.  If you choose the more expensive brand, that price difference (brand surcharge) does not count towards your PBS Safety Net.

There are also rules for how many repeats per prescription are covered by the PBS.  You can browse by the A-Z listing by generic name only, but the PBS Medicine Search box will accept either generic or brand name.

If your doctor writes a prescription exceeding the allowed number of repeats for that medicine, it is considered a private prescription, and is not subsidised by the PBS.  Pharmacists can dispense the medicine and the permitted number of repeats under the PBS, and cancel the remaining repeats, upon request.

Prescriptions that are not covered by the PBS are called private prescriptions, which are not subsidised at all, nor are they included in PBS Safety Net calculations.  Pharmacies may charge different prices for non-PBS medicines, so shop around to find the best price.

The Therapeutic Goods Administration classifies medicines in a scheduling system, where Schedules 2 and 3 are often called “over-the-counter” medicines, and Schedule 4 can only be purchased with a prescription, and includes most items on the PBS.  Some compounded medicines (eg liquid melatonin) are not covered by the PBS, but can be subsidised through some private health funds’ Extras cover – with a pharmacist’s signed receipt stating that the dispensed item is Schedule 4.

Many pharmacies have reward schemes available, and every little bit helps!

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.