Helping Children with Autism (HCWA): Medicare funded services

Under the government funded Helping Children with Autism (HCWA) initiative Medicare rebates are available for assessment and treatment services for children and young people with an Autism Spectrum Disorder (ASD). Assessment and treatment can be provided by a number of eligible allied health professionals under this initiative.

Under HCWA eligible health professionals include

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

Children who have, or are suspected of having, an autism spectrum disorder.

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

Before a psychologist can undertake an assessment, the young person must have been referred for assessment by a paediatrician or consultant psychiatrist.

Prior to providing treatment, the psychologist must have received a referral by a paediatrician or consultant psychiatrist, and the paediatrician or consultant psychiatrist must already have developed a treatment plan for that young person.

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 who may have an autism spectrum disorder. 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 paediatrician or consultant psychiatrist.

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

If your child is already seeing a psychologist and you would like to see if the services could be eligible for rebates under Medicare, 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 HCWA – 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, whose assessment sessions combined must not total more than four sessions in order for them to be eligible for Medicare rebates. 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, visit Medicare. 

You cannot use your private health insurance ancillary cover to top up 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.