Funding Options

Many of you may have heard that there have been some Medicare schemes started over the recent years that enable families to access some funding for Allied Health services such as Occupational Therapy, Speech Pathology and Psychology. The latest is the new “Helping Children with Autism” initiative. We get many questions regarding how families access these Medicare rebates and how much they get back.

Better Access to Mental Health
This program can accessed via a referral from a GP, Psychiatrist or Paediatrician. You must be diagnosed with a specific mental disorder (these include Anxiety, Depression, Conduct Disorders, Sleep problems, ADHD).

This program entitles you to up to 12 sessions rebated. Initially referrals are for 6 sessions to an Allied Health professional (e.g. Psychology, OT, Social Work) and then the health professional must write to the referrer following this, and then you may receive another 6.

Health professionals must be registered Psychologists or in the case of OTs, specially registered as a Mental Health provider with Medicare. These sessions are per calendar year.

Sprout’s Psychologists and one of our OTs (Monica Leo) are currently able to provide services under this scheme. It can be used for individual and group therapy sessions.

Rates of rebate depend on length and type of session. Again, you cannot also claim private health insurance for sessions for which you claim a Medicare rebate.

Enhanced Primary Care Plan
This program can be accessed through your GP if you meet the criteria for having a “chronic” condition that is likely to impact you for over 6 months and there are 2 other health professionals involved in providing services.

Your GP must co-ordinate the Care Plan and send out the appropriate referrals to the involved professionals. Most GPs prefer you to book a double session in order to do this.

Under this program you can access up to 5 sessions for individual therapy rebated by Medicare for Allied Health in total NOT for each professional.

You are eligible for 5 services per calendar year with health professionals that are registered providers with Medicare.

For OT, Speech Pathology and Psychology you get a rebate of $47.85 per session. You cannot also claim private health insurance for the same consultation.

All providers at Sprout are registered with Medicare under this scheme.

Helping Children with Autism.
This package began as of 1 July 2008 and entitles children with an Autism Spectrum Disorder to claim up to 4 sessions for assessment (until 13 years of age) and up to 20 sessions for treatment (up until 15 years of age). In order to be able to claim any of these, an initial consultation is required with a Paediatrician or Psychiatrist (NOT a GP) to register the diagnosis with Medicare to make the child eligible to receive these rebates.

It is important to note these consultations can only be used ONCE within the lifetime of a child, and not every calendar year. The sessions can be spread across years and across a range of professionals. It covers diagnoses of Autism, Pervasive Developmental Disorder, Rett’s Disorder, Asperger’s Syndrome and Childhood Disintegrative Disorder.

Amounts rebated differ for Psychology, Speech Pathology and OT but you cannot use private health insurance also for these consultations rebated under Medicare. All of Sprout’s OTs, Speech Pathologists and Psychologists are registered to provide services under this scheme.

Also, there is an additional package of funding for children 0-7 years to access Early Intervention services (up to $12000 but no more than $6000 within one financial year). These services are run by FaHCSIA and must be provided by approved providers. The Sprout Team is on this panel of providers.