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Medicare Options

Chronic Disease Management Plan – GP Referral

This is a Medicare-rebated funding program for people who have a chronic medical condition. It consists of no more than five rebates per calendar year for Allied Health services (e.g. Speech Pathology, Occupational Therapy, Psychology). You can share the five rebated sessions across therapists, if desired, but are not entitled to five sessions of each service. To access this funding please ask your GP for a referral.

A Chronic Disease Management Plan (formerly known as an Enhanced Primary Care Plan or EPC) is established by your GP, and your therapist (e.g. Speech Pathologist, Occupational Therapist, Psychologist) is invited to participate in your child’s care under this plan. Your GP will either give the form to you to bring into Irabina, or send the form directly to us by mail, e-mail or fax. You are then entitled to claim under this program provided your GP has registered your plan with Medicare.

Sessions are paid for as usual, but you subsequently take your receipt to Medicare for the rebate. You are not able to pay for CDMP-funded sessions through your Private Health fund.

Better Access Initiative – Mental Health Care Plan – GP Referral)

The Better Access Initiative gives your child – irrespective of his/her age – better access to Mental Health practitioners through Medicare. If your child has an assessed mental health disorder such as anxiety or depression, he/she might be able to obtain Medicare rebates for up to 10 Allied Mental Health services each calendar year from Psychologists, Social Workers and Occupational Therapists. To get these rebates, your child must have:
  • A Mental Health Treatment Plan from a GP; Psychiatrist or Paediatrician, or
  • A referred Psychiatrist’s assessment and treatment plan, or
  • A referral from an eligible Psychiatrist or Paediatrician to eligible Allied Health professionals
Please note: Autism Spectrum Disorder itself is not covered under Medicare Mental health services. Anxiety, depression and other mental health conditions, however, are often present in children with autism (and their families) and these conditions are covered.

Source: Raising Children Network

Helping Children with Autism – Specialist Referral

The Helping Children with Autism Program funds Medicare items for children with autism. If the child is under 13 years, he/she can get Medicare rebates for a total of four diagnostic or assessment services across Allied Health professionals including Psychologists, Occupational Therapists, Speech Pathologists, Audiologists, Optometrists, Orthoptists, and/or Physiotherapists. A referral is required from a Paediatrician or Psychiatrist for these services.

In addition, a Paediatrician or Psychiatrist can refer your child for up to 20 treatment sessions, as long as he/she has a Helping Children with Autism treatment plan in place before turning 13. Your child must use the services by his/her 15th Birthday.

Sources: Raising Children Network The Department of Health

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