Government Funding Options
There are a range of funding options available for many families, but knowing what options you may have is not always easy. At Talking Matters we help eligible families to access a range of funding options for their children, because we want to help families access any support they are entitled to. To help you on your way we have provided the following information and your speech pathologist, psychologist or occupational therapist can assist you in determining if you may be eligible for any of these options.
National Disability Insurance Agency Service Provision (NDIA)
Talking Matters are eligible providers for clients who have a care plan from the NDIA. More information about this program is available from the National Disability Insurance Agency (NDIA) website. The roll out of the National Disability Insurance Scheme commenced for children in South Australia in July 2013 and we have been providing services through the scheme since then.
To check whether your child may be eligible for support through this program please contact your local NDIA office. Once families complete the required paperwork and are determined to be eligible they are offered an appointment time with a planner. Families meet with a planner to discuss their aspirations for their children's future and to form a plan outlining the required supports. Families are best served to consider their needs carefully before attending the planning meeting, so they can request the most appropriate supports for their child.
Talking Matters are providers of speech pathology and occupational therapy supports under this scheme. We also offer a range of programs such as 'Transition to School', 'Handwriting & fine motor skills', 'Social Skills' group programs and intensive school holiday services. Remember to include your child's communication, behavioural, social emotional and occupational therapy needs in your plan where they are needed.
The Carers Allowance is a payment available through Centrelink for families with children who meet their criteria as a child with a disability. Many families use this payment to pay for their child's speech pathology or occupational therapy sessions. For further information about the payment and the process to apply please refer to the information published on the Centrelink information page.
Enhanced Primary Care Plan (CDM)
We are happy to work with clients who have an Enhanced Primary Care plan, written by their General Practitioner. There will however be a gap payment and therefore accounts will need to be paid on the day, with clients then claiming the rebate directly from Medicare. The Medicare rebate covers most, but not all of the consultation and there is a limit of a maximum of 5 sessions per annum. The gap payment paid will be counted towards your Medicare Safety Net total. For more information about this program please download and read this Chronic Disease Management Program provided by Speech Pathology Australia. Please advise us when booking of the care plan so that we can properly prepare for your visit. We are able to lodge claims for families on care plans on the day of their visit and rebates are paid back into their bank accounts, usually the next day. Alternatively we can provide a receipt to take to the Medicare office if clients would like their rebate the same day.
Mental Health Care Plan
GP's can make referrals to psychologists and occupational therapists who have Mental Health Care Provider status for 6 services per year under a Mental Health Care Plan. With this referral in place clients can receive a rebate from Medicare for a large portion of their service. Please note that these are not 'free' sessions as they are sometimes described by GPs. The entire fee will be billed to the client who is then able to receive a rebate, leaving an often small out of pocket expense. Please inform reception if you have a Mental Health Referral when booking so we can prepare. If you do not advise us before the session you may not be able to receive your rebate as we need to confirm the plan is in place.
Medicare items under the Helping Children with Autism & Betterstart programs
A Medicare item for the development of a treatment and management plan for children who meet the Helping Children with Autism or Betterstart criteria is also be available for eligible children up to the age of 13. Medicare items are available for up to four allied health diagnostic services and for a total of 20 relevant allied health services per eligible child. These items are available for children up to the age of 15 years, provided the treatment and management plan is in place before 13 years of age. To receive these items for a child on the autism spectrum you need a Medicare compliant referral from your child's paediatrician or child psychiatrist. GPs are able to refer for children who meet the Betterstart eligibility criteria. At Talking Matters we have a hicaps machine and are able to process Medicare payments with your Medicare card back into your account to save you a trip to the Medicare office. Accounts are paid at the time of service and the Medicare items enable a rebate to be processed for the session.
* Please note the Helping Children with Autism and Betterstart programs which provided up to $12,000 of supports for children who met the criteria no longer run in South Australia from the 1st of July 2015. The Medicare items above are currently still available.
Sessions with a speech pathologist or occupational therapist are usually claimable through your private health fund if you have cover for these services. Most funds cover approximately half of the cost for therapy sessions. There are sometimes larger gaps for assessment sessions. It is recommended you check your eligibility and the amount of your rebate with your health fund prior to your appointment. Sessions that have been paid a Medicare rebate can not also be claimed under private health. Clients need to consider which rebate is most beneficial for them to claim as Medicare state that only one can be used per session.