Medicare Benefits Information Sheet - Amaze

Information SheetMedicare BenefitsReviewed May 2013• The Chronic Disease Management Plan• The Better Access to Mental Health Plan• The Helping Children with Autism Access toDiagnosis and TreatmentMedicare is a national body that subsidises primaryhealth care in Australia. Generally, Medicare providesa rebate on the cost of seeing a doctor, but doctors canwrite special plans that mean you can claim a Medicarerebate for seeing other kinds of health professionals,like therapists. Some of the most relevant plans topeople with ASD are listed on this information sheet.For the most part, Medicare will only refund a limitedportion of the overall cost of service and this will usuallyleave you with a gap that you need to pay yourself. Ifyou end up paying a lot for medical services in oneyear, you may reach the Medicare Safety Net. Reachingthe Medicare Safety Net means you get a higher rebatefor Medicare-subsidised services.Individuals will be notified by Medicare when theyapproach the safety net, but families will need toregister with Medicare so that Medicare knows to tallytheir medical expenses together. For more information,call Medicare on 13 20 11 or read about it atwww.medicareaustralia.gov.au.Chronic Disease Management PlanPreviously called an Enhanced Primary Care (EPC) planThe Chronic Disease Management (CDM) Plan provides:• Five sessions with an Allied Health Professional percalendar year (see the list of professionals who areconsidered Allied Health Professionals).People with Autism Spectrum Disorder (ASD) areeligible for the CDM Plan because ASD is a chroniccondition.The CDM Plan can be written by your GP and peoplewith ASDs are eligible for five sessions every calendaryear. Once the initial plan has been made, the GP willnot need to write a new plan each year, but may reviewthe plan.Allied Health Professionals• Aboriginal Health Workers• Audiologists• Chiropractors• Diabetes Educators• Dietitians• Exercise Physiologists• Mental Health Nurses• Occupational Therapists• Osteopaths• Physiotherapists• Podiatrists• Psychologists• Speech PathologistsBetter Access to Mental Health PlanAlso known as Mental Health Care PlanThis plan provides:• Six sessions of individual therapy with aPsychologist, Occupational Therapist or Social Worker.Autism Victoria Trading as Amaze T: 1300 308 699 W: www.amaze.org.au Page 1

An additional four sessions are available following areview with the GP (a maximum of ten sessions percalendar year).• 10 Group Sessions of therapy with aPsychologist, Occupational Therapist, or Social Worker.The Better Access to Mental Health Care plan is anoption available for anybody (individuals with an ASD,parents, siblings, carers etc.) who feels that their overallwellbeing and mental health is at risk.Mental illness is common; around one in five Australianswill experience a mental illness at some stage in theirlives. Your mental health can be affected by a number ofthings; physical problems such as chemical imbalancesin the brain, as well as non-physical problems such asexposure to trauma, family environments, cumulativestress and difficult life events.We know that having a child with an ASD can bedifficult. Any members of the family who are feelingsad, confused, depressed or anxious about the personin the family who has an Autism Spectrum Disordershould see their GP to discuss other professionals whomay be able to support them, such as social workers orcounsellors.People who have ASDs can also have mentalhealth difficulties. They may be anxious about theenvironments around them; they may be depressedbecause they are having difficulty forming relationshipswith other people. There are many reasons why theywould be eligible to access the Better Access to MentalHealth Care Plan, and they should be encouraged toseek support from the appropriate professionals.Group sessions can be used for social skills groups,play therapy groups, anxiety groups, or any group thatbook a long consultation with your doctor to allow youand your doctor enough time to prepare a GP MentalHealth Care Plan and discuss your treatment options. APsychiatrist or Paediatrician can also write this referral.The Helping Children with Autism Accessto Diagnosis and Treatment PlanSometimes called “Medicare Item 135”This provides the following:• Four Appointments for Private Diagnosisreferred by a Paediatrician or Psychiatrist to aPsychologist, Speech Therapist, OccupationalTherapist, Audiologist, Optometrist, Orthoptist orPhysiotherapist. This is called the ‘Helping Childrenwith Autism Increased Access To Diagnosis’• 20 Sessions with a Psychologist, Speech Therapist,Occupational Therapist, Audiologist, Optometrist,Orthoptist or Physiotherapist. This is called the’Helping Children With Autism Treatment Plan’Families have the option of using the Medicare rebatesystem to help pay for private assessments. The family’spaediatrician or psychiatrist can diagnose the childwith autism, in collaboration with the allied healthprofessionals listed above. The rebate allows a totalof four sessions with these professionals (together noteach).With a diagnosis of ASD, the child will be eligible for 20sessions of therapy with one of the above listed alliedhealth professionals. Your paediatrician or psychiatristwill develop a treatment plan for your child with you.These rebates can only be used once in the child’s lifetime, they must be written by their 13th birthday, andused by their 15th birthday.Not every professional will have experience with andunderstanding of ASD. You can call Amaze for contactdetails of professionals who have registered to be onour Directory of Services.is run by the above listed professionals and is workingtowards building the confidence, self esteem andability of the person with ASD.People are eligible for up to 10 sessions under theBetter Access to Mental Health plan every calendaryear. You can get a referral from your GP. Make sure youFrequently Asked QuestionsQ. Can I use all these plans at the same time?A. Yes!Q. Can I use the 20 Sessions plan/Item 135 more thanonce?A. No, your child will receive this plan only once in theirlifetime.Q. Who can write the referrals?A. The Helping Children with Autism referrals need tobe written by a paediatrician or psychiatrist. The BetterAccess to Mental Health referral can also be written bya paediatrician or psychiatrist, but are more commonlyAutism Victoria Trading as Amaze T: 1300 308 699 W: www.amaze.org.au Page 2

written by a GP. The Chronic Disease Managementreferrals can only be written by your GP.Q. Are these sessions free of cost?A. No – you will receive a rebate from Medicare. Thisrebate does not cover the total cost of the service.Please check with Medicare the amount you willreceive.Q. Can an Allied Health Professional who is seeing mychild for some or all of the 20 HCWA Medicare sessionsalso work with my child through the FaHCSIA-fundedHCWA initiative for early intervention?A. If the therapist is on the FaHCSIA approved panel,you may use this therapist. If the therapist is not onthe approved panel, you will need to source a serviceprovider that is approved by FaHCSIA._________________________________________©2013 Autism Victoria trading as Amaze. Permission isgranted for the content of this information sheet to bereproduced in its entirety, provided Autism Victoria isacknowledged as the source and the website address isgiven.The Medicare Plans: at a glance...How manysessions?How often?SpeechTherapistCDM 1 BAMH 2 HCWA 3Eachcalendaryear5 10 Ind.+10 GroupEachcalendaryear20One-offItem 4 Psychologist Occ. Therapist Social Worker Audiologist Optometrist Orthoptist Physiotherapist Group Sessions GPs writereferralPaediatricianswrite referralPsychiatristswrite referral Adults eligible 1. Chronic Disease Management Plan2. Better Access to Mental Health Plan3. Helping Children with Autism Access Treatment Plan4. Paediatrician must write referral by child's 13thbirthday; sessions must be used by 15th birthdayAutism Victoria Trading as Amaze T: 1300 308 699 W: www.amaze.org.au Page 3