Medicare Rebates and National Disability Insurance Scheme

family-beach(For Medicare information please scroll down...)

 

National Disability Insurance Agency (NDIA, previously known as DisabilityCare and NDIS)

Update 5 Oct 2016

The NDIA is now rolling out across Australia over the next few years.  For more information about when NDIA is coming to your area, please refer to the NDIA information for your state or territory:

  • ACT locations
  • NSW locations
  • NT locations
  • QLD locations
  • SA locations
  • TAS locations
  • VIC locations
  • WA locations

If you are already receiving early intervention or disability services, check with your current provider whether your funding is in the process of being switched over to an NDIA plan.  For example, as NDIA rolls out, clients with DSS Early Intervention funding will be encouraged to switch over to an NDIA plan.  DSS Early Intervention funding should continue until the NDIA plan is in place.  For more information about the transition from DSS to NDIA, click here.  

If you are not already engaged with an early intervention or disability service, contact NDIA to start the eligibility and planning process on 1800 800 110.  You may need to complete an Access Request Form.  

The NDIA planning process can be confusing and stressful for some families.  NDIA has information sessions to help explain their processes.  To find information sessions in your local area, check the NDIA Events page for your state or territory:

The NDIA also runs a series of webinars, which may be helpful for families and service providers. Previous webinars can be accessed here.   

If you would like an advocate to help you to access supports through the NDIA, you may be interested in the National Disability Advocacy Program (NDAP).  You can use the NDAP Provider Finder to find your local advocacy service.  

If you live in NSW and you have a child eight years of age or younger, you may like to contact Ability Links, as they can assist you with the NDIA planning process and link you with local services.  Try their Find a Linker page, and search by region.  

Depending on your circumstances, you may choose to involve a case manager or broker who can help you manage your NDIA plan and liaise with service providers.  We would then bill NDIA directly for your sessions through the MyPlace Provider Portal at the rates NDIA sets for psychology services.  You will need to sign on the day to acknowledge that you received each session.  You will not have any out-of-pocket expenses for our sessions.  

Alternatively you may choose to self-manage your NDIA plan, and make your own claims through the MyPlace Participant Portal.  You would then need to pay for sessions on the day at the rate that NDIA sets for psychology services.  We will provide you with a tax invoice so you can be reimbursed in full by NDIA.  

If you would like to see us as part of your NDIA plan, please provide us with your NDIA number and Date of Birth so that we can check that psychology or behaviour support services are included in your NDIA plan.  If you are unsure if these services are included in your plan, you can also ask your NDIA planner, or your case manager or broker if you have one.  

Please note that we cannot access self-managed plans through the MyPlace Participant portal to check these details for you.  If you are self-managing your plan, please ensure that you have psychology or behaviour support in your NDIA plan before your session to avoid any difficulties with reimbursement.  

Update 5 Sept 2014

The NDIA Independent Evaluation Team has been set up through the Institute of Labour Studies at Flinders University.  You can sign up to receive email updates about the evaluation project at http://ndisevaluation.net.au/news-updates-events.cfm.  You can also read the flyer explaining their evaluation project.  

Update 21 July 2014

On 2 May 2014 NDIA released a document officially outlining the Disability Requirements for NDIA.  This confirms that people who have been "diagnosed by a multidisciplinary team, paediatrician, psychiatrist or clinical psychologist experienced in the assessment of Pervasive Developmental Disorders" with a DSM-5 diagnosis of Autism Spectrum Disorder Level 2 "Needs Substantial Support" or Level 3 "Needs Very Substantial Support" are included on "List A: Permanent Impairment/functional capacity - No further assessment required".  People with a moderate, severe or profound intellectual disability (IQ less than 55) are also included under List A.  

People with a mild intellectual disability, or who have been diagnosed with Pervasive Developmental Disorders not meeting the severity criteria in List A including  "Asperger's Disorder, Atypical Autism or Childhood Autism, and Autism Spectrum Disorder, Level 1" are included under "List B: Permanent Impairment/functional capacity variable - further assessment of functional capacity required".  In this case an Adaptive Assessment, like the ABAS-II can provide information about the individual's everyday level of functioning compared to other individuals their age.  In the case of people with an autism diagnosis, it may be worth reviewing their current behaviours to see if they now meet criteria for Autism Spectrum Disorder, Level 2 or Level 3.  

If I have diagnosed you or your child and you need a covering letter updating your diagnosis with the DSM-5 Autism Spectrum Disorder severity level to support your NDIA application, please contact our office on 02 4967 3363.  If you or your child have been diagnosed by another professional/team, you can contact that profesional/team for an updated diagnosis, or we can update the diagnosis as part of your next consultation.  Of course, if you are not happy with a previous diagnosis and would like a second opinion, please contact Kim on 02 4967 3363 to arrange a full diagnostic assessment.  

Update 14 March 2014

Autism Understanding Pty Ltd has been approved as a registered provider of supports to provide the following classes of supports in NSW effective from 19 July 2013:

  • Specialised assessment of skills, abilities and needs
  • Behaviour support
  • Early intervention supports for early childhood
  • Assistance to integrate into school or other educational program
  • Development of daily living and life skills
  • Therapeutic supports

If you would like to see Lydia Meem under NDIA, you need to have support items included in your plan to cover the sessions.  Depending on the needs of the client, some of our clients have found it helpful to consider adding one or more of the items below into their NDIA plan:

  • Specialist assessment of skills, abilities and needs
  • Psychology with an individual
  • Behaviour support/management plan
  • Intensive behavioural intervention support
  • Training for carers and others in behaviour management strategies
  • Specialised individual early childhood interventions
  • Communication equipment: assessment, set up and training
  • Transition to school and other education programs - program design, planning and implementation
  • Parenting training in behaviour support strategies 

Carers Australia has developed a Carer Checklist to help you prepare for your meeting with NDIA.  It includes a number of issues to consider regarding the needs of the person with a disability and you as their carer. 

The focus for families wanting to access support through NDIA will be to think about their goals and aspirations, and what supports they need to achieve those.  These supports will need to be deemed "reasonable and necessary" for NDIA to cover them.  Interventions with little to no empirical evidence of effectiveness are unlikely to be funded.  However evidence-based interventions like speech therapy, occupational therapy, behavioural interventions would be more likely to be covered by the funding.  

Once a plan has been made, it can be reviewed and further supports applied for if the person's needs change.  

 

Medicare Rebates

When you attend our service, you will need to pay your account in full (we have EFTPOS facilities).  We can then swipe your Medicare card, enter the details of one of the plans below, and then by swiping your Savings or Cheque account card, Medicare will  deposit any rebates directly into your account overnight (you need to have provided your bank details to Medicare for this to work).  Alternatively we can give you a tax invoice for your paid account so you can take or post it to Medicare to obtain your rebates.  Unfortunately Medicare rebates have not increased since 1 November 2012.    

If you are interested in obtaining rebates through your Private Health Fund, please contact them directly as rebates vary across plans and funds.  Some funds will only provide rebates for clinical psychology once all Medicare avenues have been exhausted.    

If your child has FaHCSIA Early Intervention funding, we suggest you use this to pay for our services as there is no out-of-pocket expense.  

If you have an NDIA plan, we suggest consulting with your planner or broker to see if psychology or behaviour support can be included in your NDIA plan (see above).  If we are able to bill NDIA directly, you would have no out-of-pocket expenses.  If you are self-managing your NDIA plan, you would need to pay for your session on the day at the rate set by NDIA. We would provide you with a tax invoice for you to show NDIA that you have paid for your session, so NDIA can reimburse you in full.   

There are three Medicare initiatives that can be used to obtain rebates for our services:

  1. Better Access to Mental Health (this provides the best rebates)
  2. Helping Children with Autism Assessment and Treatment items
  3. Chronic Disease Management (formerly known as Enhanced Primary Care)

1. The Better Access to Mental Health Medicare initiative provides the best rebates to families because it includes a higher level of rebate for clinical psychology services and allows for the most sessions.  

Clients attending our service under a Mental Health Care Plan can access rebates for six sessions: 6 X $124.50 = $747.  In some cases, an additional four rebates of $124.50 can be accessed, to give a total of 10 rebates in a 12 month period.  

We suggest that parents discuss their concerns about their child with their GP, and see if a Mental Health Care Plan is appropriate for their situation.  Often GPs refer clients to us for a diagnostic review, treatment planning and behavioural strategies in relation to mental health concerns.  For example a child showing anxiety around changes in routine and social situations may need to be assessed to determine whether they have autism/Asperger's or whether they are experiencing symptoms of an anxiety disorder.  A child who engages in repetitive behaviours like lining things up or who needs to do things in a very set way or order may need an assessment to determine if they have Asperger's/autism or whether they are experiencing symptoms of obsessive compulsive disorder.  Many children on the spectrum also show signs associated with mental health difficulties, including difficulties around eating and sleeping.  Mental health care plans can be reviewed by your GP and renewed every 12 months.  

Please note: Research has found that PARENTS of children with autism are at higher risk for depression and anxiety.  They experience ongoing grief and loss, and can have difficulty adjusting to the demands of a child with autism.  As many children on the spectrum have sleep difficulties, their parents are often chronically sleep deprived.  Parents who may feel they are struggling with caring for a child on the autism spectrum can get their own Mental Health Care Plan from their GP, and use up to six sessions for individual sessions with a clinical psychologist (with the rebate of $747 shown above, and possibly another four rebates) to speak freely about their child and discuss strategies that will fit in with their family life.  Under the same plan they can also access rebates for up to six sessions of group therapy with a clinical psychologist, which can be used for our Parent Group Program evening sessions.

This means Parents attending individual sessions as part of their own Mental Health Care Plan can access six rebates: 6 X $124.50 = $747, with the possibility of another 4 rebates in a 12 month period.

In addition, Parents attending our Parent Group Program evening sessions as part of their own Mental Health Care Plan can access six rebates: 6 X $31.65 = $189.90

 

2. The Helping Children with Autism (HCWA) Medicare initiative provides rebates for four sessions with a psychologist (or OT or speech therapist) for the purposes of autism assessment. A referral is needed from a paediatrician or a child psychiatrist, which can slow down the process as it can take several months to see a paediatrician. When using this initiative, we recommend all four assessment session rebates be used for the psychology assessment, as this is central to the diagnosis.

Clients referred for Assessment under the Helping Children with Autism Medicare initiative can access rebates for four sessions: 4 X $84.80 = $339.20

On confirmation of the diagnosis by a paediatrician or child psychiatrist by the age of 13, the child can access 20 Treatment sessions of psychology, occupational therapy or speech therapy to be used before the child turns 15 years of age. The Helping Children with Autism rebates can only be used once in a child’s lifetime. You do not need to have used the Assessment items to be able to use the Treatment items.  If you are unsure if you have already obtained these rebates, please call Medicare on 132 011. For more information about the “Helping Children with Autism” items, please visit www.health.gov.au and select “Programs & Campaigns”, then “Programs & Initiatives”, then “Helping Children with Autism”.

Clients referred for Treatment under the Helping Children with Autism Medicare initiative can access rebates for twenty sessions: 20 X $84.80 = $1696.00

Note: The Helping Children with Autism Medicare items are a "once in a lifetime" package, and cannot be renewed.  

Note: If clients also qualify for a Mental Health Care Plan which has higher rebates for clinical psychology, we suggest that HCWA Treatment sessions be used for Occupational Therapy and Speech Therapy sessions.  

 

3. The Chronic Disease Management Medicare initiative (formerly known as Enhanced Primary Care) provides five rebates for allied health services for people with complex medical needs (including autism and other developmental disabilities).   Clients can ask their GP to create a Chronic Disease Management plan and discuss which allied health services they would like to access.  A client's Chronic Disease Management plan can be reviewed by a GP and renewed every 12 months.  Clients can use a Mental Health Care Plan and a Chronic Disease Management Plan in the same year.  

Clients referred under a Chronic Disease Management Plan can access five rebates: 5 X $52.95 = $264.75

Note: If clients also qualify for a Mental Health Care Plan, we suggest they use their Mental Health Care Plan first.  Alternatively they may choose to use their Mental Health Care plan for clinical psychology, and their Chronic Disease Mangement plan for other allied health services (i.e. speech therapy, occupational therpay, physiotherapy, podiatry, dietitian).  

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