Funding | Occupational Therapy and Speech Pathology Services in Australia

Medicare rebates, and funded programs

Below is information about allied health rebates available through Medicare and funded programs

Rebates

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.

Referral process

The GP will prepare a GP Management Plan and Team Care Arrangements and make the referral to the Occupational Therapist, Speech Therapist or Physio Therapist using a CDM referral form. The client cannot claim the rebate from Medicare until the Occupational Therapist, Speech Therapist or Physio Therapist receives the referral form. The client may request to see a particular Occupational Therapist, Speech Therapist or Physio Therapist, or the GP may recommend one. Occupational Therapist, Speech Therapist or Physio Therapist must be registered with Medicare. (If the allied health provider is registered with Medicare, they will have a provider number.) The GP nominates the number of sessions up to a maximum of 5 per calendar year. The five sessions are per client, not five sessions per allied health professional, and may be across several allied health professionals (e.g., three with a speech pathologist and two with an occupational therapist)

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

Session

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.

Speech Therapy

Occupational Therapy

Physiotherapy

Medicare rebate

The current rebate is $56.00. (as of Sep 2022). Up to date information about the rebate can be found at MBS online. Please note: the allied health professionals are able to set the level of their fee. In most cases the fee will be more than the rebate and there is generally an out of pocket cost for clients who are seeing a speech pathologist under this program.allied health providers rarely bulk bill (i.e. only charge the Medicare rebate) for services that are eligible under Medicare items such as the Chronic Disease Management (CDM) Program. The client pays the full fee and then claims the rebate from Medicare. The out-of-pocket expense will count towards the Medicare safety net. See: Information regarding Medicare safety net on the following URL link: Medicare Safety Nets -Services Australia

Claims

Upon payment of the fee the allied health provider the client with a receipt. The receipt must include;

Client’s name
Date of service
MBS item number
Allied health professional’s name and provider number
Referring GP’s name and provider number
Date of referral
Amount charged
Total amount paid
Any amount outstanding in relation to the service

The rebate will be paid when this receipt is presented to Medicare. If you lose track of how many allied health services you have claimed in a calendar year they you contact Medicare on 132 011.

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;

Aboriginal Health Worker
Occupational Therapist
Audiologist
Osteopath
Chiropractor
Physiotherapist
Diabetes Educator
Podiatrist
Dietician
Psychologist
Exercise Physiologist
Mental Health Worker

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

Private Health

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.

You will also need to check with your allied health service providers that they are an eligible provider for your health fund. You may not claim a Medicare rebate and a private health insurance rebate for the same service. You may not claim a private health insurance rebate for a session where you have also used NDIS funds. You must choose which rebate they are going to claim for a 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