Speech Pathology Funding

National Disability Insurance Scheme (NDIS)

The NDIS is a Federal Government funding scheme to assist individuals aged 65-years and under diagnosed with a disability or chronic health conditions. To receive funding, you must be assessed to determine your eligibility. Talkshop is a registered NDIS provider. Below is a list of requirements for the Access checklist. Your or your child must:

1. Meet Australian residency requirements
2. Meet age requirements (less than 65)
3. Live in a NDIS designated state
4. Usually need support from a person or equipment to do everyday things for yourself because of an impairment or condition that is likely to be permanent. For example, you usually need support from a person or assistive equipment so you can:
   – understand and be understood by other people
   – make and keep friends and cope with feelings and emotions
   – understand, remember and learn new things
   – do daily jobs, handle money and make decisions
5. Need some supports now to reduce your support needs in the future. To meet the NDIS early intervention rules, you need to:

• have an impairment or condition that is likely to be permanent (lifelong); or

• be a child under 6 with a developmental delay and the delay means you usually need more help with your self-care, communication, learning or motor skills than another child of the same age.

Early intervention supports provided by the NDIS are those not provided by any other services such as health and education. For example, funding would:
– reduce the impact of your impairment or condition or developmental delay
– stop the impact of your impairment or condition from getting worse
– strengthen your family/carer to keep supporting you

Useful links:

NDIS Access Checklist: https://www.ndis.gov.au/ndis-access-checklist

NDIS Contact Number: 1800 800 110

Chronic Disease Management Plan (CDM)

If you or your child has a ‘chronic’ condition (a condition that is present for a minimum of six months) requiring speech pathology, you may be eligible for a Chronic Disease Management Plan (CDM). This is a GP managed plan that provides a Medicare rebate for allied health services.

The CDM plan provides a maximum of 5 total rebates per calendar year for all allied health services. If you are accessing more than one type of allied health service, you are entitled to 5 rebates across all of the services combined, not 5 rebates per clinical service.

How do I access a CDM plan?
You need to visit your GP to have this discussion. At Talkshop, we can give you a CDM referral form for your GP to complete. Your GP will decide if you are eligible for these services and will refer you where appropriate. GPs will have a CDM checklist. For further information, please contact your GP.

Can I get a CDM for speech pathology?

Yes, speech pathology is an allied health service. If you need to access us along with one other service, you may be eligible.

Our most common co-providers are audiology, ear nose & throat (ENT) and occupational therapy (OT). If you are already seeing one of these health professionals, you are likely to be eligible for a GP CDM plan.

All Talkshop speech pathologists are registered as certified practising speech pathologists with Speech Pathology Australia, which means if you have a CDM plan you can claim with any of our clinicians.

When can I use a CDM?

You can use a CDM at any time. Some of our clients use it at the end of the year to get 5 sessions with a rebate. They can re-apply in January for a new plan as they are only issued once per calendar year. This allows another 5 sessions with Medicare rebate. This effectively creates a 10-week block of therapy with Medicare rebate.

Is my child eligible if they have delayed speech or language?

A GP must make up their mind as to whether they consider a condition to be chronic (lasting more than 6 months), requiring at least two allied health professionals. In some cases, it is obvious that a CDM is needed. For example, a child with a diagnosed hearing impairment due to glue-ear or repeated ear infections impacting speech and language development will need to see both Audiology and ENT alongside Speech Pathology for ongoing management.

Some GPs will want an initial assessment report first before a CDM especially if they are unsure how significant the speech or language concern may be. This means that you will not be able to use a CDM to claim for the initial assessment but will be able to use it to claim against the therapy sessions.

I have been referred to you on a CDM plan, how does it work?
You will need to provide us with your referral form. We will write back to your GP along with our assessment results and plan of intervention. You will be eligible to claim up to a maximum offive rebated sessions per calendar-year, provided that your GP has registered your plan through Medicare. We will notify your GP once you have used the five Medicare rebated sessions.

Therapy provided by Talkshop Speech Pathology will need to be paid in full. You can immediately load your receipt to the Express Plus Medicare app on your mobile device. Alternatively, you can claim your rebate online or in person.

The Medicare rebate is $52.95 per service as of 30/12/2018.

Useful links:

General CDM information: http://www.health.gov.au/internet/main/publishing.nsf/content/mbsprimarycare-chronicdiseasemanagement

CDM for GP to complete: http://www.health.gov.au/internet/main/publishing.nsf/Content/DFEEB1B5AAEA0158CA257BF0001CAD67/$File/Referral-Form-for-Allied-Health-Services-under-Medicare(2).pdf

How to claim Medicare Rebate:

https://www.humanservices.gov.au/individuals/subjects/medicare-claiming

Claiming the Medicare Rebate on the Express Plus App:

https://www.humanservices.gov.au/individuals/services/medicare/express-plus-medicare-mobile-app

Health Insurance & Private Health Cover

Private speech pathology is covered under many health fund plans. Check with your health insurance to see if your specific level of cover entitles you to a rebate.

You will see these item numbers if you have cover:

320 is the item number for a Speech Pathology Assessment.
340 is the item number for a Speech Pathology therapy consultation.

If you wish to add speech pathology to your cover, this can take up to eight weeks to come into effect. In the meantime, you may be eligible for a Medicare rebate for five sessions with a GP Chronic Disease Management Plan (CDM).
My health fund has asked for all Medicare numbers to be removed
We issue all receipts with Medicare and health fund codes to allow clients to make claims with wherever they need to.

Bupa and Teachers Health require special amendments to their receipts to allow them to be claimed. If your health fund is with either of these, please let us know so your receipts can be specifically amended.

My health fund says you’re not registered?
All speech pathologists at Talkshop Speech Pathology are registered as providers for health fund rebates with Australian health funds. We make every effort to register with all health funds. However, on occasion, a new health fund will start or merge, or their registration requirements may change without our knowledge. If you do find that we aren’t registered with your specific fund, please contact us. It usually only takes a phone call for us to register with them allowing you to access the rebate according to your health cover.