Medical and Allied Health Rebates and Financial Assistance

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1 This fact sheet was compiled in August 2011 to assist carers of children and adults with a disability; some of the information will be relevant to others also. It contains a range of information gathered from public domains about the various medical and allied health rebates available, as well as some other forms of available financial assistance. As information changes regularly and the information provided here is limited, it is recommended that you check eligibility and program details with the respective Government office, relevant agency or their websites. Centrelink Financial Carer Allowance - Non income or assets tested, non taxed, supplement paid to carers who provide daily care and attention at home to a person or child with a disability or medical condition - A diagnosis of Autism Spectrum Disorder or Asperger s Syndrome will meet automatic eligibility criteria. Other conditions such as intellectual disability and developmental delay, rely on Treating Doctor s Report. - Payment of $110 per fortnight (currently) - Provides a Health Care Card to the child which is needed for eligibility to the lower Medicare Safety Net threshold - It is for children with higher than usual care needs 14 hours per week extra - Can be paid for 12 weeks prior to claim in some circumstances - Can lodge an intent to claim if in the process of diagnosis for the child. Carer Payment Pension type payment for carers of individuals with a disability Income and asset tested Further information: Contact Centrelink on , or read the internal fact sheet on the Centrelink website at: Medicare Initiatives 1. Medicare Safety Net - All couples and families should register for the Medicare Safety Net and should update their details annually. Each family member needs to be identified so their medical costs are counted towards the family s Medicare Safety Net. Individuals do not need to register but just keep their contact details up-to-date with Medicare. - The Medicare Safety Net operates on the calendar year. 1

2 - Thresholds - Out of pocket expenses paid by non-concessional family $ Out of pocket expenses for concessional family $ Out-of-pocket expenses are the difference between the Medicare benefit and what your doctor charges you. - Once the threshold is reached Medicare pays 80% of the gap. The gap is the difference between the Medicare Benefit and the schedule fee. - The concessional threshold applies if the family receives Family Tax Benefit Part A or if a child or other family member has a Health Care Card. - Services included in out-of-pocket expenses in reaching the safety net threshold: a range of doctor visits and tests covered by the Medicare Benefits Schedule (MBS) that you receive out-of-hospital. Examples include: GP and specialist consultations, blood tests, CT scans, pap smears, radiotherapy, tissue biopsies, ultrasounds, x- rays. Further information can be found on the Medicare website or at Medicare offices. 2. Pharmaceutical Benefits Scheme Safety Net Under the PBS, the government subsidises the cost of medicine for most medical conditions. The co-payment is the amount you pay towards the cost of your PBS medicine. From 1 January 2011, you pay up to $34.20 for most PBS medicines or $5.60 if you have a concession card. If you or your family need a lot of medicines in a year, the PBS Safety Net helps you with the cost of your medicines. Once you or your family reach a Safety Net threshold, you can apply for a PBS Safety Net card. Then your PBS medicine will be less expensive or free for the rest of the calendar year. On 1 January 2011, the Safety Net thresholds are $ (for concession card holders) and from $1, (for all other patients). The same Safety Net threshold is applied to a family unit regardless of whether the unit consists of an individual, a couple or a family with dependent children. After reaching the Safety Net threshold, general patients pay for further PBS prescriptions at the concessional co-payment rate and concession card holders are dispensed PBS prescriptions at no further charge for the remainder of that calendar year. In order to access the Safety Net arrangements, you need to maintain records of your PBS expenditure on a Prescription Record Form. These are available from all pharmacies. For further information, ask your pharmacist, contact the PBS Information Line on (free call), collect a brochure at your nearest Medicare office or see: 2

3 3. Enhanced Primary Care Plan - Provides a rebate of $50.05 per session for up to 5 sessions per calendar year. - Referral provided by GP for individuals with a chronic condition, defined as persisting for more than 6 months. Individuals from a family may have separate Enhanced primary Care Plans - Can be for: Speech Therapy Occupational Therapy Physiotherapy Social Work Dietician Psychology 4. Better Access to Mental Health Care Program (GP Mental Health Plan) Rebates for individuals with a mental health concern eg. depression, anxiety, conduct disorder, attention deficit disorder, obsessive compulsive disorder, sleep disorders. An individual may have such a condition in addition to a disability diagnosis. Under this program rebates can be obtained for the following professionals if they are registered for this scheme with Medicare for up to 12 sessions per calendar year. An additional 6 sessions may be obtained through your GP under extenuating circumstances. All have different scheduled fees. Psychologists Psychiatrists Mental Health Occupational Therapists Social Workers Eligible patients can also claim up to 12 rebates per calendar year for group services provided by clinical psychologists and/or other allied mental health professionals. Further information: 3

4 5. Helping Children with Autism/PDD Plan (Pervasive Developmental Disorder Not Otherwise Specified) There are 3 parts to this DoHA (Dept of Health and Aging) funding: 1. Medicare items for paediatricians and child psychiatrists (item 135 or 289) to diagnose and develop a treatment and management plan for a child under 13 years on referral from a general practitioner (GP). 2. Allied Health assessment service, in collaboration with the paediatrician or psychiatrist on the diagnosis and development of a treatment and management plan (up to 4 services per child). The allied health specialties include psychologists, occupational therapists, physiotherapists, speech pathologists, audiologists, optometrists and orthoptists. 3. Allied Health early intervention treatment (up to 20 services in total per child) which can be used up to 15 th birthday. Further information re: Medicare benefits: Fact Sheet on Helping Children with Autism Program, FaHCSIA Helping Children with Autism Autism Advisor Program - If a child has a diagnosis of ASD before their 6 th birthday an application can be made to Autism Victoria for $6000 per financial year for a maximum of 2 years to pay for early intervention services. This funding can be used up until the 7 th birthday. - The funding supports the delivery of multidisciplinary early intervention to facilitate improved cognitive, emotional and social development prior to a child starting school. - An Autism Advisor will assist with the allocation of these funds. Eligible families can only access service providers from the panel of Early Intervention Service Providers. - These funds can be used to pay the gap between the cost of the service and private health fund rebates but not the gap between Medicare rebates and the full cost of the service. - Up to 35% of a child s early intervention funding can be used to purchase resources, eg. equipment that is essential to the child s therapy when ordered by an approved provider. Autism Advisor program, contact Autism Victoria , lt.aspx 4

5 FaHCSIA - Better Start for Children with a Disability Program - Supports families of children diagnosed with Downs Syndrome, Cerebral Palsy, Fragile X Syndrome, moderate or greater hearing or vision impairments including deaf/blindness. - Children under 6 years of age can access funding of up to $12,000 (to a maximum of $6,000 per financial year) for a range of early intervention services, including: Speech Therapy, Occupational Therapy, Psychology, Audiology, Physiotherapy, Orthoptics. - Applicants must be an Australian citizen or a permanent resident. - Equipment that is essential to the child s therapy when ordered by an approved provider (up to 35% of the early intervention funding) can be purchased. - Therapists must be chosen from the Government approved authorised provider panel. - Families will have until the child s 7 th birthday to use this early intervention funding. How to register: Call the Carer Advisory Centre on or betterstart@carersvictoria.org.au Further information also available at: or Net Medical Expenses Tax Offset - Rebate of 20 cents in the dollar for medical expenses over $2000 (from 2011 financial year). - Allowable medical expenses include therapeutic treatment under the direction of a doctor, (source: Australian Taxation Office website. Therefore, therapeutic treatment may include allied health services under the direction of a doctor. (Check with Taxation Dept or your taxation consultant). - Need to save medical, dental, optical, pharmaceutical receipts, if treatment is under direction of a doctor, for lodging of tax return. 5

6 Early Childhood Intervention Service (ECIS) Eligibility criteria - delays in development in at least 2 areas eg. Communication, social skills, play skills, physical skills. All children diagnosed with ASD would meet this criteria. - Child is under school age. Provides up to $5000 worth of goods and services: - Therapy services, eg. speech therapy, psychology, occupational therapy. - Aides and Equipment - Additional respite - In some regions, childcare To access ECIS contact Southern ECIS Central Intake on If access is delayed, you may directly contact the agency in your region which administers the funds: Eg. - Eastern Metropolitan Region Scope Ph Southern Metropolitan Region Yooralla Ph Western/Northern Metropolitan Region Abercare Ph Brokerage Funds Southern Region If you think your usage of funds will exceed Medicare/FaCSIA, consider applying for brokerage. The main agencies which assist with brokerage funds for disability are: DHS Intake and Response To apply for an Individual Support Package Ph Bayside, Glen Eira, Kingston, Port Phillip, Stonnington - Moira Early Choices program, Making a Difference program - Yooralla Breakaway Flexible Respite Mornington Peninsula, Frankston, Rosebud - Anglicare Family Centre Early Choices Program, Making a Difference program - Wresacare Flexible packages Greater Dandenong, Cardinia, Casey Windemere Early Choices, Making a Difference program Wresacare Adult Flexible Respite Options 6

7 Child Care Benefit (CCB) Child Care Benefit is a payment from the Australian Government that helps you with the cost of your child s care. Eligibility: - You are a parent, relationship parent, foster parent or grandparent with a child in your care - You or your partner must be an Australian citizen, a permanent resident living in Australia or be exempted from the Governments residency requirements. - You are responsible for your child s child care costs. If your employer contributes through salary sacrificing or packaging, you must discuss with your employer who is responsible for the child care costs. - Children under 7 must meet the government s immunisation requirements or have an exemption. Approved Care Services approved by the Government to provide child care because they meet certain high standards and operating requirements. They include: Long Day Care Family Day Care Outside School Hours Care (Before and after school care, and school holiday care) Occasional Care In Home Care Registered Care This is child care provided by grandparents or other relatives, friends or nannies for workrelated child care. The carer must be registered with the Family Office. The CCB is paid at the registered care rate. Work, Training, Study Test For Registered Care (see above) you and your partner must be working, training or studying, or have an exemption from this test, to get up to 50 hours of CCB per child per week. For Approved Care (see above) all families can get up to 24 hours of CCB per child per week. To get up to 50 hours, you and your partner need to be working, training or studying for at least 15 hours per week (or 30 hours per fortnight) or have an exemption from this test. 7

8 How much CCB can I get? This depends on your income, the type of care you use (approved or registered), the amount of care you use, the reason you are using the care and the number of children receiving child care. Child Care Rebate This relates to Approved Child Care and parents who are working, training or studying. It provides 50% of out-of pocket child care costs up to the annual cap, currently $7500 per child per year. To receive this you must be eligible for CCB, at a rate of zero or more. It can be paid weekly/fortnightly or quarterly or annually. Further information: Online: Phone: Visit: Family Office (located in Medicare Offices and Centrelink Customer Service Centres). 8