Better Start for Children with Disability: Medicare funded services

Under the government funded Better Start for Children with Disability (Better Start) Medicare initiative rebates are available for assessment and treatment services for children and young people with an eligible disability. Assessment and treatment can be provided by a number of eligible allied health professionals under this initiative.

Under Better Start eligible health professionals include

• psychologists
• speech pathologists
• occupational therapists
• optometrists
• orthoptists
• physiotherapists
• audiologists.

The early intervention component of the Better Start initiative has been identified for transition to the NDIS and will have fully transitioned by 2018. Once children transferring from Better Start have a plan approved under the NDIS, their access to Better Start funding will cease as they will then be eligible to receive funding under the NDIS. For more information on this transition and to find out if the NDIS has replaced this funding in your location, refer to the NDIS website.

Children with one of the following conditions are eligible for Medicare rebates:

• Sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction
• Hearing impairment that results in one of the following:
  • a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies
  • permanent conductive hearing loss and auditory neuropathy
• Cerebral palsy
• Down syndrome
• Fragile X syndrome
• Rett’s disorder
• A range of genetic disorders.

For the full range of eligible disorders go to www.betterstart.net.au

Speak to your GP or paediatrician to see if your child is eligible for Medicare rebates under Better Start.

Assessment sessions are available up until the child turns 13 years of age, and treatment sessions are available up until a child turns 15 years of age, provided their treatment plan was in place before their 13th birthday.

The child must first have been seen by a specialist or consultant physician, or a GP before commencing assessment sessions with the psychologist. A treatment plan developed by a specialist or consultant physician, or a GP, must also be in place prior to the commencement of treatment.

Psychologists are highly knowledgeable in human development and behaviour. This means that they are able to assist not only those who have mental health problems, but children and young people with a disability.

Psychologists can help establish a diagnosis and can provide therapeutic input to support the child or young person’s social, emotional and academic development.

To provide Medicare services a psychologist must be registered with Medicare and have a Medicare Provider Number.

In addition, for treatment sessions with a psychologist to be eligible for Medicare rebates under this initiative, the referral must have come from a specialist or consultant physician, or a GP.

Finally, the psychologist the child sees should be someone with training and experience in working with children with a disability.

If your child is already seeing a psychologist and you would like to see if these could be eligible for Medicare rebates , discuss this with your doctor.

Under this initiative, up to four assessment sessions provided by a psychologist and other allied health professionals are available to assist the referring practitioner with diagnosis, or to contribute to a child’s treatment and management plan.

In addition, up to 20 treatment sessions provided by a psychologist and other allied health professionals are available.

It is important to note that these are the total number of services available to each child through Better Start – not an annual entitlement.

It is also important to note that these are the total number of services available for all allied health service providers, not the number of services provided by a psychologist alone. For example, an assessment might involve a speech pathologist, a psychologist and an audiologist which may require more than the four sessions funded under Medicare.  If additional sessions are required, these would not be eligible for Medicare rebates under this initiative.

It is the responsibility of the referring medical practitioner to allocate these services in keeping with the child’s individual needs.

The cost to you will vary depending on the length of the session and the fee being charged by the psychologist.

The cost for a psychological assessment or therapy session is usually greater than the Medicare rebate, so it is likely that you will need to pay the difference between what the psychologist charges you and the Medicare rebate.

In some instances a psychologist may choose to bulk bill (e.g. health care card holders), in which case you will not have to pay anything.

The payment arrangements will vary and you should check these with the psychologist before commencing assessment or treatment sessions.

Yes. You are responsible for paying any charges in excess of the Medicare rebate for treatment under this initiative. However, these out-of-pocket expenses will count towards the Medicare Safety Net. The Medicare Safety Net is designed to protect high users of health services from large out-of-pocket expenses. For more information on the Medicare Safety Net, go to www.medicareaustralia.gov.au.

You cannot use your private health insurance ancillary cover to pay any additional fee above the Medicare rebates for these services.

You need to decide if you will use Medicare or your private health insurance ancillary cover to pay for psychological services you receive.