Medicare & Health Fund Information

Medicare rebates and Private Health Fund rebates may be available to you when you receive psychological services. Please refer to the information below for more details.

Medicare
The Australian Government has introduced new Medicare rebates for psychological treatment by Registered Psychologists. This service provides considerable assistance to people living with mental heath problems, allowing them greater access to psychologists and providing more affordable mental healthcare.

Under the new Medicare scheme, all Registered Psychologists who are endorsed by Medicare Australia can provide treatment for mental health problems.

New Medicare services promote a team approach to mental health care, with general practitioners, psychiatrists and paediatricians encouraged to work with psychologists, and other allied mental health professionals as well as mental health nurses, to increase the availability of care.

Mental Health Care Plan
The Mental Health Care Plan is an option available to all Australians with a diagnosis of a specific mental health disorder that is being managed by a General Practitioner (GP) under a GP Mental Health Care Plan, or a psychiatrist assessment and management plan, or on direct referral from a psychiatrist or a paediatrician (for treatment of a child). Some examples of disorders are; Anxiety, Depression, Attention Deficit Disorder (ADHD), Conduct Disorders, Sleep Problems, Eating Disorders, and other mental health disorders.

Most GP’s will require you to book a long consultation to allow adequate time to co-ordinate the Mental Health Care Plan and discuss treatment options. Please speak with your own GP practice as to their booking requirements.

Medicare rebates of $84.80 are available for up to 10 individual psychological services in a calendar year (January to December). After an initial group of 6 services, the referring Medical Practitioner managing the client will conduct a review of the need for further services before a further 4 services may be provided.

Please note there will be an out-of-pocket amount payable by the person attending appointments with Active Psychology. This out-of-pocket amount represents the monetary difference between the Medicare rebate listed above, and the total cost of appointments with Active Psychology. Please also note that you cannot you cannot claim Private Health Fund insurance for sessions for which you claim the Medicare rebate.

Enhanced Primary Care Program (EPC)
Patients who have a chronic condition and complex care needs that are being managed by their GP under an Enhanced Primary Care (EPC) plan may be eligible to receive Medicare rebates for Psychologist services and certain other Allied Health Professionals. A chronic medical condition is one that has been (or is likely to be) present for 6 months or longer. Patients have complex care needs if they need ongoing care from a multidisciplinary team consisting of their GP and at least 2 other health care providers.

This program is initiated by your local GP. Your GP will determine if you are eligible, and if so, coordinate an Enhanced Primary Care Plan for the relevant allied health services. Some GP practices require a double session appointment to organise this, so it’s a good idea to check with the GP practice receptionist regarding these plans.

The EPC program provides:

  • Maximum of 5 services per patient each calendar year
  • Medicare rebate of $52.95 per service. Please note there will be an out-of-pocket amount payable by the person attending appointments with Active Psychology. This out-of-pocket amount represents the monetary difference between the Medicare rebate listed above, and the total cost of appointments with Active Psychology. Please also note that you cannot you cannot claim Private Health Fund insurance for sessions for which you claim the Medicare rebate.
  • Patient must have an Enhanced Primary Care (EPC) plan prepared by their GP
  • GP refers to Allied Health Professionals
  • Allied Health Professional must report back to the referring GP

Helping Children with Autism Package (HCWA)
The HCWA package provides for diagnosis and early intervention treatment for children with Autism, Asperger’s Syndrome, Pervasive Developmental Disorder (PDD), Rett’s Disorder, and Childhood Disintegrative Disorder. It is important that you take your child to see your General Practitioner (GP). Your GP will consider your child's condition and decide whether to refer your child to a psychiatrist or paediatrician. To access this Medicare funding a referral from psychiatrist or paediatrician is required.

If your child is seen by one of these specialist medical practitioners, they will assess your child's condition, develop an accurate diagnosis, and create a treatment and management plan if appropriate.

Only one HCWA treatment and management plan for PDD, with either a psychiatrist or a paediatrician, can be rebated by Medicare. However, after the plan is created, your child can still be seen by a psychiatrist or paediatrician and the services for their treatment claimed from Medicare.

The psychiatrist or paediatrician may need to see your child more than once, and may decide to seek assistance with either diagnosis or the treatment of your child. Under Medicare this may involve a consultation with one or more psychologists, speech pathologists or occupational therapists (Allied Health Professionals).

Under the HCWA treatment and management plan, Medicare provides rebates for up to 4 allied health diagnostic services with a psychologist, speech pathologist, and occupational therapist. The initial consultation with a paediatrician or psychiatrist is required so that the specific Medicare rebate item is generated and your rebate can be claimed.

Also under the HCWA treatment and management plan, Medicare provides rebates for up to 20 individual allied health treatment services per child with a psychologist, speech pathologist, and occupational therapist. Again, the initial consultation with a paediatrician or psychiatrist is required so that the specific Medicare rebate item is generated and your rebate can be claimed.

The HCWA treatment and management plan can only be used once in the child’s lifetime (not per calendar year), and the HCWA treatment and management plan must be written by the child’s 13th birthday and Medicare rebates claimed by the child’s 15th birthday. The sessions can be used all at once, or spread across the years prior to the child turning 15. Please note these sessions cannot be claimed through Private Health insurance funds.

Additional non-Medicare early intervention services
As part of the Helping Children with Autism Package (HCWA), the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) offers a number of additional programs to assist children and families of children with autism and any other PDD (also known as Autism Spectrum Disorders or ASD).

Details include:

  • Children must be aged between 0 and 6 years, and be diagnosed with ASD, and not yet commenced full time compulsory school (Prep in Victoria)
  • Funding of up to $12,000 over 2 years (maximum of $6,000 per year) is available
  • Eligibility documentation is required to be submitted when applying for this funding. This includes a copy of the child’s birth certificate, Centrelink number, a copy of rates/utilities’ notice, copy of Definitive Statement of Diagnosis given by a paediatrician or psychiatrist only, and this statement must be signed
  • Once the funding application is processed the family is assigned an Autism advisor. The advisor will provide details of local early intervention professionals who have satisfied the selection criteria to be recognised as service providers under this scheme.
  • You cannot claim Medicare rebates through this scheme, rather the scheme funding provides adequately for early intervention consultations
  • Other services offered under the HCWA package include ‘PlayConnect Playgroups’ for children with ASD or ASD symptoms (0-6 years), a program of workshops to support and educate families and carers of children with ASD, and an ASD website for parents, carers and professionals
  • For application forms go to www.autismvictoria.org.au/helping_children/ and download the forms under the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) link. You can also call Autism Victoria on 03 9657 1600, or the HCWA enquiry line on 1800 289 177.

Private Health Funds
Private Health fund rebates for registered psychological services are provided by most health funds under their ancillary/extra tables. These rebates differ depending on your health fund, and your level of cover. Please check with your health fund for further details.

National Disability Insurance Scheme (NDIS)
The National Disability Insurance Scheme (NDIS) is the new way of providing support for Australians with disability, their families and carers. The NDIS will provide about 460,000 Australians under the age of 65 with a permanent and significant disability with the reasonable and necessary supports they need to live an ordinary life. As an insurance scheme, the NDIS takes a lifetime approach, investing in people with disability early to improve their outcomes later in life. The NDIS gives all Australians peace of mind that if their child or loved one is born with or acquires a permanent and significant disability they will get the support they need.

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Psychologist, Dimitra Gina Arthur, Child Psychology, Counselling, Assessments, Registered Psychologist, Child Psychologist, Autism, Helping Children with Autism, Self Esteem, Learning Difficulties, Behavioural Problems, Family Relationships

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