Medicare

Some therapeutic services provided by an Allied Health professional can be claimed at Medicare. Services need to be referred by either a General Practitioner, Paediatrician or Psychiatrist under one of the follow plans:

GP Management Plan (also known as Enhanced Primary Care Plans)

See your General Practitioner to prepare a management plan. It will require a longer consultation which may be bulk billed if the individual holds a Health Care Card (see Centrelink benefits). The GP will specify referral to relevant Allied Health Professionals including psychologists, speech pathologists, occupational therapists or physiotherapists. The referral is limited to 5 referred services in any 12 month period. Services claimed at Medicare pay a $50.05 rebate, more if the Medicare Safety Net Threshold has been reached. See http://www.medicareaustralia.gov.au/public/services/msn/index.jsp

Better Outcomes for Mental Health (BOHM) referrals

A General Practitioner can also prepare a BOHM plan to refer patients for psychological services. These may be 1:1 and/or group psychological services. Generally the plan includes referral for 6 services, and after follow up can be extended to 12 claimable visits. In exceptional circumstances this may be extended for subsequent 6 services, ie. 18 in total. Medicare pays a rebate of $80.20 for one to one services and $20.45 for group services, more if the Medicare Safety Net Threshold has been reached.

Helping Children with Autism referrals

Newly introduced Medicare item codes exist for use in the diagnosis and treatment of individuals with Autism Spectrum Disorder. These codes allow paediatricians and psychologists to refer patients for the purpose of collaborative diagnosis and, where diagnosis is confirmed, for treatment of ASD. Medicare pays a rebate of $80.20 for psychologist services and $70.65 for speech pathologist and occupational therapist services, more if the Medicare Safety Net Threshold has been reached.

Medicare Safety Net

The Medicare Safety Net provides financial assistance for high out-of-pocket costs for out-of-hospital Medicare Benefits Schedule (MBS) services. Once you meet a Medicare Safety Net threshold, you may be eligible for additional Medicare benefits for out-of-hospital MBS services for the rest of the calendar year.

The standard Medicare Safety Net Threshold is $1,198.00 per family, however if an individual with an Autism Spectrum Disorder holds a Health Care Card from Centrelink their threshold is reduced to $598.80.

Read about the Medicare Safety Net at http://www.medicareaustralia.gov.au/public/services/msn/index.shtm

To find out the current amount of Medicare rebates and other details visit Medicare Benefits Schedule Online: http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Medicare-Benefits-Schedule-MBS-1

To access your Medicare records online go to: http://www.medicareaustralia.gov.au/public/online-services/index.jsp