Medicare, FaHCSIA & Better Start Funding
The Sensory Gym is a registered Medicare provider. As such, there are a number of Medicare Schemes under which your child may be eligible for partial reimbursement for occupational therapy services. These schemes require enrolment by your GP or your paediatrician. The referral date provided by the physician marks the first date under which you would be eligible for reimbursement for services received.
Enhanced Primary Care Plan (EPC):
Under the Enhanced Primary Care Plan, you may receive partial reimbursement for up to 5 occupational therapy visits in a calendar year.
Mental Health Initiative (MHI):
Since November 2006, occupational therapy is a reimbursable service under the Mental Health Initiative. Under the MHI, you may receive partial reimbursement for up to 12 visits in a calendar year (6 visits are authorised initially, with the next 6 visits requiring a 2 referral). Only children with social-emotional challenges are eligible for this care plan. For a complete listing of concerns covered under the initiative, please review the mental health chapter in the current volume of the ICD (International Classification of Diseases) which can be accessed on-line.
PLEASE NOTE THAT AS OF NOVEMBER 2011, THE MAXIMUM SESSIONS CLAIMABLE UNDER THE MHI WILL DROP TO 10 PER CALENDAR YEAR.
Helping Children with Autism:
Since July 2008, families with children with autism who meet certain eligibility requirements may receive partial reimbursement for up to 20 occupational therapy sessions. To understand if your child is eligible for this plan, please talk with your paediatrician.
FaHCSIA Funding:
FaHCSIA funding is available to children under the age of 7 years who have a diagnosis of an ASD (Autism Spectrum Disorder). For more information please call the Autism Advisor Program 1300 978 61. FaHCSIA Funding can be used to pay for services at the Sensory Gym. Please note that a 5% admin charge will apply to all FaHCSIA claims.
Better Start Funding:
From 1 July 2011, eligible children diagnosed with Down syndrome, cerebral palsy, Fragile X syndrome, or a moderate or greater vision or hearing impairment, including deafblindness, will have access to funding and new Medicare items under the Better Start for Children with Disability (Better Start) initiative.
The initiative includes the following components:
- Funding for early intervention services and treatments for eligible children under the age of six
- Medicare items for the development of a treatment and management plan for eligible children under the age of 13
- Medicare items for up to four allied health diagnostic services and for 20 relevant allied health services (in total) for eligible children up to the age of 15 (provided the treatment and management plan is in place before the age of 13).
Information for familiesEarly Intervention Funding
From 1 July 2011, eligible children will be able to be registered to access early intervention funding of up to $12,000 (to a maximum of $6,000 per financial year).
The funding will be able to be used to pay for early intervention services including speech pathology, audiology, occupational therapy, physiotherapy, psychology and orthoptics. Families will have until their child turns seven to use the early intervention funding.
This targeted early intervention in the pre-school years is intended to complement existing Commonwealth and State and Territory services and to assist these children to have the best possible preparation for transition to school.
Please note that a 5% admin charge will apply to all Better Start claims.
