Speech Pathology Funding Information for Clients www.communicatespeech.com.au
Private Health Cover - All Ages Children and Adults Speech Pathology Assessment and Therapy sessions can be claimed through Private Health Cover under extras cover. The rebate amount per session and the number of sessions covered is dependent on the individual s level of cover. The rebate for assessments is usually higher than that for therapy sessions. A typical rebate would be somewhere between $30-$80 per therapy session for 10-16 sessions per calendar year. Before commencing therapy, please check with your health fund to ensure that Speech Pathology is included in your cover and the amount you are eligible to claim for each individual assessment and therapy session. Medicare - Chronic Disease Management (CDM) - All Ages Children and Adults Medicare provides a rebate for up to 5 Speech Pathology sessions per calendar year for individuals with chronic conditions and complex needs that require a multi-disciplinary approach (treatment from several health professionals). Eligible conditions are those that are likely to be present for 6 months or longer such as Autism, Dyspraxia, Learning Disorders, Down syndrome, ADHD, Cerebral Palsy, Cleft Lip and Palate, chronic middle ear infections, Intellectual Disability and severe speech or language impairments. For adults these may also include Stroke, Traumatic Brain Injury, Progressive Neurological Diseases (Motor Neurone Disease, Parkinson s Disease), stuttering, vocal cord pathologies and Dementia. Clients must obtain a CDM referral from their GP who will lodge and complete a GP Management Plan and Team Care Arrangements Plan. Referrals are valid for 12 months and must be in place prior to the commencement of therapy in order to claim. Unused services from the same referral can be used in the following calendar year.
The rebate is $52.95 (indexed on 1st November) per session. Please note that clients cannot claim a Medicare rebate and private health care rebate for the same service. Additional CDM Services for People of Aboriginal or Torres Strait Islander Descent People of Aboriginal or Torres Strait Islander Descent are eligible for another 5 sessions per calendar year in ADDITION to the 5 annual CDM services. Eligibility criteria is identical to the 5 CDM sessions. The rebate for these additional services is also $52.95 per session. Better Start for Children with a Disability (Better Start) - Ages 0-6yrs Better Start is an Australian Government initiative that provides up to $12,000 in funding (up to a maximum of $6,000 per financial year) which can be used to pay for early intervention services, including Speech Pathology for children with disabilities. Families living in outer regional or remote areas may be eligible for an additional one-off support payment of $2,000 to assist with additional expenses such as travel and home visits associated with accessing services. Better Start funding is for children with a confirmed diagnosis of the following conditions: Angelman syndrome, Cerebral Palsy, CHARGE syndrome, Cornelia de Lange syndrome, Cri du Chat syndrome, Down syndrome, including those with mosaic Down syndrome, Fragile X syndrome, Fragile X syndrome with full mutation includes mosaicism, Kabuki syndrome, Prader- Willi syndrome, Smith-Magenis syndrome, Williams syndrome and Rett s disorder. Also included, with the following thresholds: Hearing Impairment in both ears (a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies or permanent conductive hearing loss and auditory neuropathy) Microcephaly (a head circumference less than the third percentile for age and sex; and a functional level at or below
2 standard deviations below the mean for age on a standard developmental test, or an IQ score of less than 70 on a standardised test of intelligence) Vision Impairment (less than or equal to 6/18 or equivalent field loss, in the better eye with correction), Deafblindess (diagnosis made by a specialist multidisciplinary team which includes an ophthalmological and audiological evaluation). To access Better Start, children with an eligible diagnosis must meet all registration criteria and be registered prior to their 6th birthday. Families will have until the child turns 7 to access funding. To be registered with Better Start: Please phone the Registration and Information Service (RIS) on 1800 242 636. Your child s eligibility will be assessed and confirmed either face-to-face, via telephone, internet, email or a video link. The child s parent or carer will need to provide documents to the RIS: 1. Proof of the child s age, preferably their birth certificate or passport 2. Written confirmation of diagnosis (noting the necessary thresholds) 3. Proof of residential status (if applicable) 4. Proof of residential address (where applicable, to ensure outer-regional and remote access payment - this could be a recent bill or similar) 5. The child s Centrelink-generated customer reference number (CRN). You can obtain a CRN by attending your nearest Centrelink Customer Service Centre or by phoning Centrelink on 136 150. If the diagnosis is confirmed, you will receive a letter of confirmation of your child s registration with the Better Start initiative. Your child will then be able to access funded Speech Pathology sessions. Communicate will require your child s CRN and date of birth prior to commencement of sessions. Evidence shows that targeted early intervention for children with eligible disabilities better prepares them for the transition to school.
Better Start Medicare - 0-13yrs Children with an eligible disability can be referred by a GP (item number 139) or specialist or consultant physician (item number 137) for the following allied health services: 1. Up to four diagnostic/assessment services from allied health professionals including Speech Pathologists to assist the referring practitioner with diagnosis or to contribute to a child s treatment and management plan (for a child under 13 years of age). - item number 82005 for Speech Pathologist 2. Up to twenty treatment services from an allied health professional including a Speech Pathologist (for a child under 15 years of age, providing a treatment and management plan is in place before their 13th birthday). NB: These are the total number of services available to each child through the Better Start Medicare program not an annual entitlement. - item number 82020 for Speech Pathologist The referral may be a letter or note to the Speech Pathologist, signed and dated by the referring practitioner. Each referral is valid for a maximum of 10 sessions. Following the completion of sessions, the Speech Pathologist will provide a report to the practitioner who will then deicide on the need for further treatment. Please note that clients require a separate referral for each allied health provider and each separate course of treatment. Helping Children with Autism (HCWA) - 0-6yrs Helping Children with Autism is an Australian Government initiative that provides up to $12,000 in funding (up to a maximum of $6,000 per financial year) which can be used to pay for early intervention services, including Speech Pathology for children with the following confirmed diagnoses: 1. Autism 2. Autism Spectrum Disorder 3. Autistic Disorder
4. Asperger s Disorder/Syndrome 5. Childhood Disintegrative Disorder; or 6. Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) 7. Please note that having similar characteristics to autism is not a conclusive diagnosis. Families living in outer regional or remote areas may be eligible for an additional one-off support payment of $2,000 to assist with additional expenses such as travel and home visits associated with accessing services. To access HCWA funding, children must be diagnosed and be seen by an Autism Advisor prior to their 6th birthday. Families will have until the child turns 7 to access funding. The contact numbers for Autism Advisors in each state are as follows: State/ Territory Association Contact Number NSW VIC WA QLD ACT Autism Spectrum Australia (Aspect) AMAZE (Autism Victoria Inc) Autism Association of Western Australia Autism Queensland Inc Autism Aspergers ACT Inc 1300 978 611 or (02) 8977 8345 1300 424 499 or (03) 9657 1608 1800 636 427 or (08) 9489 8900 1800 428 847 or (07) 3273 0000 (02) 6176 0515 SA Autism SA 1300 288 476 or (08) 8379 6976 NT Managed through Autism SA (08) 8947 4800 or Fax: (08) 8947 4811 TAS Autism Tasmania Inc 1300 288 476 or (03) 6278 9985 Communicate will require your child s CRN and date of birth prior to commencement of sessions.
HCWA Medicare - 0-13yrs Children undergoing assessment or treatment for Autism can be referred by a consultant paediatrician or psychiatrist for the following allied health services: 1. Up to four diagnostic/assessment services from allied health professionals, including Speech Pathologists, to assist the referring practitioner with diagnosis or to contribute to a child s treatment and management plan (for a child under 13 years of age). - item number 82005 for Speech Pathologist 2. Up to twenty treatment services from an allied health professional including a Speech Pathologist (for a child under 15 years of age, providing a treatment and management plan is in place before their 13th birthday). NB: These are the total number of services available to each child through the Better Start Medicare program not an annual entitlement. - item number 82020 for Speech Pathologist The referral may be a letter or note to the Speech Pathologist, signed and dated by the referring practitioner. Each referral is valid for a maximum of 10 sessions. Following the completion of sessions, the Speech Pathologist will provide a report to the practitioner who will then deicide on the need for further treatment. Please note that clients require a separate referral for each allied health provider and each separate course of treatment. Department of Veteran Affairs (DVA) Clients (and their dependents) who have Gold Department of Veterans Affairs cards are eligible for rebates on Speech Pathology services Clients (and their dependents) who have White Department of Veterans Affairs cards are eligible for rebates on Speech Pathology services in some circumstances The rebate for mobile Speech Pathology assessment and therapy services is at full cost per session.
Our point of difference We differentiate ourselves from other Speech Pathology practices through the quality of our offering, our highly trained staff, value for money services, reliability and unique vision. We are mobile speech pathology experts with a tried and tested approach to speech therapy that ensures excellent outcomes for those under our care. Our team of highly experienced therapists with their wealth of knowledge always strive to go above and beyond for our clients. The information in this pamphlet is a collective summary of potential funding options as at 8.12.2014. For up to date accuracy, please consult your healthcare professional or the appropriate funding mechanism website. www.communicatespeech.com.au E: info@communicatespeech.com.au P: 02 9328 3444 PO Box 506, Double Bay NSW 1360