Medicare

Management Plans

Chronic Disease Management Plan (Previously named Enhanced Primary Care Plan (EPC plan)) - Item no. 10958 (OT). The Chronic Disease Management Plan provides clients with 5 allied health sessions per calendar year. This plan is issued by your GP or your Paediatrician. To be eligible for this plan a child's medical condition needs to be considered chronic, meaning it has been present for at least 6 months or is likely to be or be terminal. This plan provides a rebate of $52.95 per session.  

Mental Health Care Plan (MHCP) - Item no. 80125 - under 50 minutes; 80135 - 50+ mins clinic session; 80140 - 50+ mins outside clinic; 80145 - group session. The Mental Health Care Plan provides clients with 10 individual allied health sessions. In addition to this clients are entitled to 10 group allied health sessions. After 6 sessions the allied health professional is required to request the additional 4 sessions from the referring GP, Paediatrician or Psychiatrist and you will need to attend an appointment with them to complete a review and receive the additional sessions. The benefit for a 1 hour individual clinic session is $74.80. If individual sessions are outside the clinic for 1 hour the benefit amount is $96.35. Group session rebates are $19.00

Helping Children with Autism Plan - 82010 - assessment sessions (OT); Item no. 82025 (OT). The Helping Children with Autism plan provides children  with 4 sessions in total from any health professional to assist in the diagnosis of Autism Spectrum Disorder or a Pervasive Developmental Disorder. The rebate for the assessment sessions are $74.80. After Diagnosis children with a diagnosis of a Pervasive Developmental Disorder (PDD) or Autism access up to 20 rebated sessions from an allied health professional. Clients will be issued with 10 sessions at one time before the allied health professional will need to request the additional 10 sessions if required from the referring GP, consultant physician or Paediatrician. You will need to attend a review with the referring doctor and it will be determined if your child is eligible for the additional 10 sessions. This plan must be in place before the child's 13th birthday and completed before the child turns 15 years old. Each child is only entitled to this plan once in their lifetime. The rebate is the same as the assessment sessions at $74.80. 

Follow up Allied Health Services for Aboriginal and Torres Strait Islander descent Plan - item no. 81330 (OT). The Follow up Allied Health Services for Aboriginal and Torres Strait Islander descent is available to Aboriginal and Torres Strait Islander descent with 5 additional individual Allied Health Services per calendar year.  A referral from your GP or Paediatrician is required to access this plan. The rebate is $52.95 for this plan. 

Private Health Insurance

Private Health Insurance

Please check with your health insurer, if you have extras cover you may be able to claim, this depends on your provider. If you wish to claim with private health insurance please let accounts know ASAP as receipt structure may need to be altered.

Depending on your private health cover will depend on whether you are eligible for a rebate for Occupational Therapy Services. It is important to talk directly to your Private Health Insurance company to work out what your child is entitled to on an individual basis.

As noted above you cannot claim a Medicare rebate as well as claiming through your private health insurance for the same visit. 

DSS Funding

NDIS (National Disability Insurance Scheme)

Connecting OT is currently accredited with the NDIS. We are able to see both self managed and case managed families if you reside within a current geographic roll out area. Further roll outs within Melbourne Metro are November 2017 and April 2018. We suggest you look on the NDIS website for more information and to access the pre application process.

Helping Children with Autism (HCWA). Helping Children with Autism provides children with a diagnosis of Autism Spectrum Disorder aged between 0 and 7 years with $12,000 funding. The application for funding must be completed to Better Start before the child's 6th birthday. This funding is to be spent over a minimum of a 2 year period with the maximum per financial year available being $6,000. The funding is available to use with OT services as well as being available to purchase equipment or resources through. A maximum of $2,100 can be used towards equipment and resources per financial year.   

Better Start

Better Start for Children with a Disability. Better Start for Children with a Disability provides children with a diagnosis of Cerebral Palsy, Deaf blindness, Down Syndrome, Fragile X Syndrome, Hearing Impairment, Sight Impairment, Prader-Willi Syndrome, Williams Syndrome, Angelman Syndrome, Kabuki Syndrome, Smith-Magenis Syndrome, CHARGE Syndrome, Cornelia de Lange Syndrome, Rett's Disorder, Cri du Chat Syndrome or Microcephaly aged between 0 and 7 years with $12,000 funding. This funding is to be spent over a minimum of a 2 year period with the maximum per financial year available being $6,000. The funding is available to use with OT services as well as being available to purchase equipment or resources through. A maximum of $2,100 can be used towards equipment and resources. 

Families are required to provide Connecting OT with a copy of their funding letter to allow them to use their DSS funding. A service agreement will be signed in the first sessions and families will then sign each session to allow claims to be made. Families can keep track of their funding via statements that are sent out quarterly by AMAZE or Better Start.