Medicare Items Under the "Helping Children with Autism" Package
Information for Speech Pathologists
The “Helping Children with Autism” package created new items in the Medicare Benefits Schedule. Medicare items were introduced for speech pathologists (and psychologists and occupational therapists) to provide up to:
(a) four services (sessions) to assist in the diagnosis of the child and / or development of the child’s treatment plan,
(b) twenty services (sessions) to provide early intervention treatment.
- Speech pathologist must be registered with Medicare
- GP refers the child to a Paediatrician or Psychiatrist who makes the referral to the speech pathologist
- Client must be under 13 years of age at time of diagnosis and under 15 years of age when receiving treatment
- Total of four assessment sessions and 20 treatment services per lifetime for the client
- Speech pathologist must provide the client with receipt with all required details (including appropriate item number)
- Speech pathologist must report to referring practitioner at completion of the assessment or treatment cycle
Registration with Medicare
For clients to be able to claim a Medicare rebate, the treating speech pathologist must be registered with Medicare Autralia.
Speech pathologists who are working in private practice, and who meet the specific eligibility criteria, can register with Medicare. Upon registration Medicare will issue the speech pathologist with a provider number.
If a speech pathologist changes the location of their work or commences work in an additional location they must notify Medicare of these changes. A new or additional provider number will be issued.
Provider numbers may be closed if no longer required
A Paediatrician or Psychiatrist determines the client’s eligibility for the program.
The client will need a referral from his/her GP to see the Paediatrician / Psychiatrist.
Clients who are eligible include children with autism or any other Pervasive Developmental Disorder (PDD) such as Rett’s Disorder, Aspergers Syndrome or Childhood Disintegrative Disorder.
The following describes the referral pathway under the “Helping Children with Autism” Medicare Items package.
Specifics of referral
After the Paediatrician / Psychiatrist determines that a client is eligible for the program they will send a referral letter to the speech pathologist. The patient cannot claim the rebate from Medicare until the speech pathologist receives the referral letter.
The referring professional nominates the number of services, up to a maximum of 4 in total per lifetime, for assessment and / or collaboration in the development of a PDD treatment and management plan. The four sessions may be provided by one eligible allied health professional (e.g., speech pathologist) or a combination of eligible allied health professionals (e.g., one service with a psychologist) and two services with a speech pathologist).
The child must be under 13 years of age at the time of assessment and / or preparation of the treatment and management plan.
The referring professional nominates the number of services, up to a maximum of 20 in total, per lifetime, for treatment. The treatment sessions may be provided by one eligible allied health professional or by a combination of eligible allied health professionals.
The treatment sessions must be completed before the child turns 15 years of age.
Each session must be of at least 50 minutes duration (assessment) and 30 minutes duration (treatment) and be provided to an individual client. The speech pathologist named on the referral letter must be the person providing the service and they must personally attend the client. If the client sees an alternative speech pathologist, to the one named on the referral letter, the referring professional should be notified on the change.
Reporting to referring professional
Whilst not required, acknowledgement of the referral is recommended.
At completion of the assessment sessions, the speech pathologist is required to provide a written report to the referring professional.
At the completion of a course of treatment, the speech pathologist must provide a written report to the referring professional. A course of treatment will consist of the number of services stated on the child’s referral (up to a maximum of 10). A written report must also be provided to the referring professional at the completion of any subsequent course(s) of treatment provided to the client.
The treatment report should include information on:
- treatment provided,
- recommendations on future management of the child’s disorder;
- any advice provided to third parties (e.g., parents, schools).
A Medicare rebate of $69.10 per session is available.
The rebate is indexed on 1st November each year.
The speech pathologist may set his/her own fees.
Speech pathologists can contact Medicare Australia on 132 150 to confirm how many allied health services have been claimed by a client within a calendar year.
At the completion of each service and / or upon payment of the invoice the speech pathologist provides the client with a receipt.
The receipt must include:
- client’s name
- date of service
- MBS item number (ITEM NUMBER 82005 – ASSESSMENT)( ITEM NUMBER 82020 - TREATMENT)
- treating speech pathologist’s name and Medicare provider number
- referring professional’s name and Medicare provider number
- date of referral
- amount charged, total amount paid, and any amount outstanding in relation to the service
- speech pathologist’s signature
Private Health Insurance
Clients with private health insurance cannot claim a rebate from their health fund in addition to the rebate from Medicare for a service.
Medicare Safety Net
Out of pocket expenses for these services count towards the extended Medicare safety net.
Other eligible allied health professionals
Developmental psychologists and occupational therapists can also provide services under the Helping Children with Autism program.
Other Allied Health Initiative (Medicare) programs
There are a number of other funding programs available under Medicare. They include;
Specific Details and a Frequently Asked Questions & Answer guide can be found at FAQs
General information regarding the “Helping Children with Autism Package” can be found at Department of Health and Ageing.
The Department of Health and Ageing has prepared a questions and answers document for practitioners Providers Q&A.
Medicare Item Numbers
Click here for a complete copy of the Supplement to Medicare Benefits Schedule Allied Health Services, effective 1 July 2008.
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