AT ESP, Pragashni Pillay is :

• is a Medicare approved provider
• belongs to one of Victoria’s largest FaHCSIA approved consortiums, Irabina Childhood Autism Services
• is a registered Better Start Provider

MEDICARE

Medicare provides a rebate on the cost of seeing a doctor, but doctors can write special plans that mean you can claim a Medicare rebate for seeing other kinds of health professionals, like Speech Pathologists.

For most part, Medicare will only refund a limited portion of the overall cost of service and this will leave you with a gap that you need to pay yourself.

AT ESP we are happy to provide therapy to clients with the following plans

1. Chronic Disease Management (CDM) Plan
Previously Enhanced Primary Care (EPC) plan
People with a chronic medical condition may be able to get Medicare benefits to cover allied health services that help manage their condition.

The Chronic Disease Management Plan is initiated by your General Practitioner and available to both children and adults. The CDM plan provides five sessions with an Allied Health Professional per calendar year. CDM plans are also only allowed to be used for individual therapy sessions. The CDM Plan does not allow for group therapy sessions, including social skills groups, to be claimed by Medicare.

For more information about the CDM program you can download Information Sheets from Medicare

2. The Helping Children with Autism Access to Diagnosis and Treatment Plan
This provides the following:

• Four Appointments for Private Diagnosis referred by a Paediatrician or Psychiatrist to an Allied Health Professional such as a Speech Pathologist/Therapist.

This is called the ‘Helping Children with Autism Increased Access To Diagnosis’
Families have the option of using the Medicare rebate system to help pay for private assessments.
The family’s paediatrician or psychiatrist can diagnose the child with autism, in collaboration with the allied health professionals.
The rebate allows a total of four sessions with these professionals (together not each)

• 20 Sessions with a Speech Pathologist or other allied health professionals
  This is called the ‘Helping Children with Autism Treatment Plan’
  With a diagnosis of a Pervasive Developmental Disorder, the child will be eligible for 20 sessions of therapy (together not each) with one or more allied health professionals
  Your paediatrician or psychiatrist will develop a treatment plan for your child with you.
  These rebates can only be used once in the child’s life time, they must be written by their 13th birthday, and used by their 15th birthday.

HELPING CHILDREN WITH AUTISM FUNDING: FaHCSIA

The Helping Children with Autism (HCWA) package is an Australian Government initiative providing support for children aged 0 – 6 years with Autism Spectrum Disorder (ASD), their families and carers. The package covers a range of initiatives and services, including funding for therapies. Families of children diagnosed with Autism Spectrum Disorder have a maximum of $12,000 to spend on early intervention services, including accredited Private Speech Therapy, Occupational Therapy and Behavioural Therapy services. The funding can only be used with Speech Pathologists, Occupational Therapists and Psychologist who have been approved by the government. FaHCSIA has established a panel of multi-disciplinary providers to provide these early intervention services.

Families cannot spend more than $6,000 in any financial year (from 1 July to 30 June each year) and have access to the funding until the day before their child’s seventh birthday, unless they have spent the funding before then.

If you think your child may be eligible for this program, you will need to do the following:

1. Phone Amaze (formerly Autism Victoria) on 1300 308 699 to make an appointment with an Autism Advisor. At this appointment the child’s eligibility and needs will be discussed.
2. When your Autism Advisor has processed your application, they will contact you to organise a time to discuss the funding, and answer any questions you might have.
3. If your child is eligible you will receive a ‘Letter of Introduction’ from the Autism Advisor – you could consider the letter your “ticket” to using the funding.

Once your child has been approved for funding you will need to bring this letter with you to your initial HCWA funded session at ESP.

We will make a copy of this letter so that we can then begin billing the government directly for any services provided through the HCWA funding. At your child’s first FaHCSIA funded session you will also need to complete FaHCSIA Client Consent Forms prior to the commencement of services

At the completion of each session, FaHCSIA requires you to sign a form that acknowledges provision of the service. Invoices for Speech Therapy services will be sent directly to FaHCSIA for payment. You will be issued with a copy of the invoice. Further information can be found at AMAZE

BETTER START FUNDING

The Better Start for Children with Disability initiative provides funding for early intervention services. A child must be under the age of six years and have been diagnosed with one of the following disabilities to be eligible for Better Start funding.

• Cerebral palsy
• Deafblindness
• Down syndrome, including mosaic Down syndrome
• Fragile X syndrome with full mutation.
• Hearing impairment
• Sight impairment
• Prader-Willi syndrome
• Williams syndrome
• Angelman syndrome
• Kabuki syndrome
• Smith-Magenis syndrome
• CHARGE syndrome
• Cornelia de Lange syndrome
• Rett’s Disorder
• Cri du Chat syndrome; or
• Microcephaly
• Down Syndrome
• Cerebral Palsy
• Fragile X Syndrome
• Vision Impairment
• Hearing Impairment
• Prader Willi Syndrome
• Williams Syndrome
• Cri Du Chat Syndrome
• Angelman Syndrome
• CHARGE Syndrome
• Cornelia de Lange Syndrome
• Kabuki Syndrome
• Smith-Magenis Syndrome
• Microcephaly

Each disability included in the Better Start program is subject to an eligibility threshold. These thresholds have been determined by the Department of Social Services. Children with an eligible diagnosis must register for Better Start before they turn 6 years old. A child will have until they turn 7 to access funding. Children registered with Better Start can access up to $12,000 (maximum $6,000 per year) to pay for early intervention services. These services include: audiology, occupational therapy, orthoptics, physiotherapy, psychology and speech pathology. Families living in outer regional or remote areas may be eligible for an additional one-off payment of $2,000.This payment is to assist with additional expenses associated with accessing services. To access the Better Start program in Victoria program, further information can be obtained from Carers Victoria. Contact the Carer Advisory Service on 1800 242 636 or email betterstart@carersvictoria.org.au and ask about the Better Start program.
betterstart.net.au

PRIVATE HEALTH INSURANCE

If you have private health insurance and have taken out ‘extras’ you may be eligible for a rebate. It is our understanding that you are not able to use both medicare and private health rebates for the same session. You may wish to check with your health fund and compare the amount of the private health rebate you would receive with that provided by Medicare under the initiatives listed above.