HCWA - Assessment & Treatment Medicare items

The Federal Government has committed $190 million for the Helping Children with Autism Package. This package provided funds to assist children with autism and their families. Your family may be able to access this funding to assist with costs associated with attending appointments at Minds and Hearts. The new Autism and Pervasive Developmental Disorder (PDD) Medicare items do not replace any existing programs, but provide parents and caregivers with another way of accessing health services under Medicare. The Autism/PDD items focus on early intervention for children with a new diagnosis. To be eligible for this funding, certain initial steps need to be followed, as outlined below.

Assessment

These items can only be claimed for children under 13 years old.

1. Make an appointment for the child to see a GP for PDD behaviours to be identified. If identified, the GP will then refer the child to a paediatrician or a psychiatrist.

2. The paediatrician/ psychiatrist will collect history and take some initial observations / assessment data.

3. If the paediatrician / psychiatrist feels that a PDD diagnosis should be considered, the child is referred to the therapist that he/she feels is appropriate, for eg a psychologist, speech pathologist, or occupational therapist. The family can claim four assessments with any combination of these therapists.

4. The therapist/s then send their report/s back to the referring paediatrician/ psychiatrist, giving a summary of their results and clinical opinion. If the paediatrician/psychiatrist feels that a diagnosis of PDD is warranted, then he/she meets with the family to advise of the diagnosis and development of a treatment plan.

Treatment

Where a diagnosis of PDD has been given, a paediatrician or psychiatrist can refer children under 15 years old for treatment sessions to a psychologist, speech pathologist, or occupational therapist.

1. A paediatrician or psychiatrist is required to write the treatment plan either at the consultation when the results of the diagnostic assessment are shared, or, for children already diagnosed, during a scheduled appointment to discuss the child’s current needs.

2. Ten therapy sessions can be initiated before a review is required, and these can be made up by a combination of the three professionals (psychologist, speech pathologist, occupational therapist, audiologists, optometrists, orthoptists, physiotherapists). The paediatrician/ psychiatrist, in consultation with the therapists and the family, decide how these sessions are to be divided up.

3. After ten sessions a review of the treatment plan is required. At this time, the paediatrician/ psychiatrist may wish to schedule a direct consultation with the family, prior to writing to the therapists advising how the next ten sessions are to be distributed.

For further information contact the Medicare Helpline: 132 150