SNAA Fee Schedules and Funding options to support Therapy
Different Medicare plans for rebates:
1. Better Access to Mental Health Care Plan: (can be offered with registered Occupational Therapists, Psychologists, Social Workers or Psychiatrists). This plan offers 10 sessions of individual therapy per calendar year. This plan can be used by anyone that requires assistance to improve their emotional wellbeing and whose mental health is affected. Either a General Practitioner or Paediatrician can make this referral.
2. Chronic Disease Management Plan: (can be offered with psychologists, O.T’s, Speech Pathologists, Social Workers, Dieticians, Podiatrists, Physiotherapists, Optometrists). This plan offers 5 individual sessions of individual therapy per calendar year. Your General Practitioner needs to write this plan.
3. Helping Children with Autism Plan:
- Assessment sessions: This plan offers up to 4 assessment sessions of Speech Pathology, Psychology or Occupational Therapy or a combination of all. (Once off in your child’s lifetime, and used by their 15th birthday). This referral needs to be written by a Paediatrician and written before your child’s 13th Birthday.
- Treatment sessions: This plan offers up to 20 sessions of Speech Pathology, Psychology or Occupational Therapy or a combination of all. (Once off in your child’s lifetime, and used by their 15th birthday). This referral needs to be written by a Paediatrician and written before your child’s 13th Birthday.
The Medicare threshold provides an additional payment back to families. When the threshold is reached, Medicare will pay 80% of the out-of-pocket costs on top of the rebate. The threshold is:
- $598.80 for Commonwealth concession cardholders, including those with a Pensioner Concession Card, a Health Care Card or a Commonwealth Seniors Card, and people who receive Family Tax Benefits (Part A)
- $1,198.00 for all other singles and families This means that once the threshold is reached the gap payment reduces to between $8.75 – $17.50 per session, depending on which plan is used.
SNAA Medicare support
We offer the following to help everyone to keep up to date with plans being used and number of sessions remaining:
- Emails – in the subject header we state the plan and session number
- Reminders in progress notes if plans are finishing or a doctor’s review is required
- SNAA Therapist’s GP letters can be taken to doctor’s appointments to explain the OT’s role as a Mental Health care provider (please ask Eva for a copy of this) SNAA will continue to forward request letters for new or review plans directly to your doctor and will also provide you with a copy for your own reference. We encourage you to take this along to your appointments just in case the letter does not reach your doctor in time for your appointment.
- We provide you with SNAA spreadsheets to keep track of plans being used, sessions remaining and when a doctor’s review appointment needs to be scheduled
Other ways in which SNAA can also support you
Discussion about your therapy plan with your SNAA Therapist can include:
- Work out the different therapists in your child’s life
- The plans that can be used for each therapist
- Timing of therapy and plans in place
- When that Dr. appointment needs to be scheduled to coincide with review plans / new plans
- Frequency of therapy
- Needs verses wants
- Goals formulated
How to go about organising these Medicare services for your child
Steps to take:
General Practitioners / Paediatricians
1. Make an appointment with your General Practitioner or Paediatrician depending on the plan to be used (you will need to book a long consultation to plan the care plans and to discuss your treatment options for your child). It is important to see somebody who has knowledge and understanding of ASD or Mental Health Care issues of concern
2. Discuss the difficulties that your child is having at school / home / kinder. For example:
- Behavioural issues
- Social difficulties
- Organisational problems
- Sensory processing difficulties
3. Ask for your child to be put on a Care plan (as stated previously). Your General Practitioner or Paediatrician will guide you and suggest which plan is best for your child, however it is recommended that you use the plans in the order that they are written to maximise funding
4. Get your General Practitioner or Paediatrician to write a referral to your Occupational Therapist (O.T.) or Psychologist for the “Better Access to Mental Health Care Plan’, or to the O.T., Speech Pathologist or Psychologist if accessing the other two care plan packages (remember your G.P can only refer the CDM plan and your Paediatrician, the Helping Children with Autism Plan)
Visit the Medicare website for further information