What rebates and funding options are available for speech therapy?
If you do not have speech pathology extras as part of Private Health Insurance, the funding options listed below apply to all allied health professions, including psychologists, speech pathologists, occupational therapists, audiologists, optometrists, orthoptists or physiotherapists.
Medicare
Chronic Disease Management Plan (CDMP)
Formerly known as the Enhanced Primary Care Plan, this rebate is available through GPs and provides eligible patients with a maximum of five allied health sessions in the period 1 January to 31 December. The rebate is approximately $50 per session, or sometimes higher if you have reached your Medicare safety net for the year.
Eligible patients for this plan must have difficulty in at least two allied health areas. For instance, a GP could arrange a plan so that the client can have one plan for audiology to assess hearing, and four sessions for speech pathology.
Better Start
The Better Start for Children with a disability Medicare initiative offers Medicare items to for assessment and some intervention for children with specific conditions. These include:
hearing and vision impairments
Cerebral palsy
Down syndrome
Fragile X syndrome
Prader-Willi syndrome
Willams syndrome
Angelman syndrome
Kabuki syndrome
Smith-Magenis syndrome
CHARGE syndrome
Cri du Chat syndrome
Cornelia de Lange syndrome
Microcephaly
Rett’s disorder.
Services include up to four diagnostic/assessment sessions (inc. speech pathology), and up to 20 treatment sessions (again inc. speech pathology), for a child under 15 years of age, providing a treatment and management plan is in place before their 13th birthday). These are the total number of services available to each child through the Better Start program until 15 years– not an annual entitlement. These Medicare initiatives are usually instigated by a paediatrician and allied health professionals will require a referral to use these Medicare numbers.
Helping Children with Autism (HCWA)
The Helping Children with Autism program operates much the same as the Better start program, where children undergoing diagnosis/assessment and treatment for autism or any other pervasive developmental disorder receive some Medicare rebates. Children can access the autism Medicare rebate, providing they have not already accessed the Better Start for Children with a Disability Medicare initiative.
The rebate includes up to four diagnostic/assessment sessions, and up to 20 treatment sessions, for a child under 15 years of age, providing a treatment and management plan is in place before their 13th birthday). These are the total number of services available to each child through HCWA until 15 years– not an annual entitlement. Like with better Start, these Medicare initiatives are usually instigated by a paediatrician and allied health professionals will require a referral to use these Medicare numbers.
National Funding Bodies
National Disability Insurance Scheme (NDIS)
The NDIS is a relatively new scheme intended to support people with a significant and lifelong disability. The aim is to assist these people to participate fully in the social and economic life of the community. The application process can be quite lengthy, and most likely require documentation to support the diagnosis of a disability. Families are encouraged to seek paediatrician and allied health professional assistance in completing applications. More information about client eligibility for the scheme, can be found at https://www.ndis.gov.au/applying-access-ndis/am-i-eligible.
Thanks for reading! Next time we will share info on the three ways NDIS funding can be accessed.