Funding at OTFC
Funding
Funding
Medicare Funding
Depending on the criteria your child meets, there are three (3) different Initiatives that can be accessed from Medicare.
Better Access to Mental Health Care Initiative
This can either be called:
Mental Health Care Plan –– if you have a referral from a GP or
FPS – if you have a referral from a Paediatrician
This initiative was introduced to improve the treatment and management of mental illness within the community by increasing community access to mental health professionals and team-based mental health care. This initiative allows the client to access ten (10) therapy sessions per calendar year. Those that are eligible can claim a maximum of six (6) Occupational Therapy sessions under one referral. A referral can be current for two (2) years. If the OT believes more therapeutic intervention would be of benefit they can write back to the referring practitioner requesting another 4 sessions. It is however, the responsibility of the client to go back to the referring practitioner to gain another referral for these extra sessions otherwise they will not be able to claim these under this initiative.
If any of your sessions are carried over to the following calendar year, as long as your date of the initial referral remains current (within 2 years) you can use the remainder of the sessions available under that referral. At the completion of the 10th session, the OT will write a completion summary back to the referring practitioner.
The MBS code used for this Initiative is 80135 with a rebate of $77.10 available.
For more information, please click on this link:
Better Access to Mental Health Care Fact Sheet – Department of Health & Ageing
Chronic Disease Management Plan (CDM)
Can sometimes still be referred to as an EPC (Enhanced Primary Care Plan)
The CDM is available for those clients with chronic or terminal medical conditions. Your eligibility is determined by your GP including those requiring multidisciplinary, team-based care from a GP and at least two other health care providers (such as an Occupational Therapist).
Those that are eligible can claim a maximum of five (5) allied health services in the period from 1st January to 31st December (MBS items 10950-10970), however your referral can remain current for two years. If any of your 5 sessions are carried over to the following calendar year as long as your date of the initial referral remains current (within 2 years) you can use the remainder of the sessions available under that referral.
The MBS item code for Occupational Therapy is 10958 with a rebate of $54.60. Once all 5 sessions have been completed, the OT will write a completion summary back to the GP.
For more information, please click on the link:
NDIS
National Disability Funding
NATIONAL DISABILITY SCHEME FUNDING (NDIS)
The National Disability Scheme is an Insurance Scheme provided by the National Disabilities Insurance Agency (NDIA). The National Disability Insurance Scheme originated to provide life time individualized support for people living with significant or permanent disability.
For OTFC clients, this means that each child who meets the criteria outlined below is eligible to acquire an individual plan and is allocated funds to access “reasonable and necessary supports” in order to achieve their individual goals. The funded supports are based on the client’s needs, therefore are individualised to each case.
The below criteria are taken directly from the NDIS website (“Participating in the NDIS in South Australia”)
Your child will meet the disability requirements if:
The disability is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to one or more impairments attributable to a psychiatric condition and
their impairment is, or likely to be, permanent and their impairment substantially reduces their ability to take part effectively in one or more activities (i.e., communication, social interaction, learning, mobility, self-care or self-management), or perform tasks or actions unless:
- They had assistance with their disability from other people on most days, or
- They had assistive technology, equipment (other than common items such as glasses) or
- They can’t take part effectively even with assistance or aides and equipment; and
- They are likely to require support under the NDIS (and not another service system such as the health system) for their lifetime.
- An impairment that varies in intensity, for example because the impairment is of a chronic episodic nature, may still be permanent, and the person may require support under the NDIS for the person’s lifetime, despite the variation.
Early intervention requirements
Your child may meet the early intervention requirements if they have one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent or they have one or more identified impairments that are attributable to a psychiatric condition.
Or are aged under 6 years with a developmental delay which results in substantially reduced functional capacity in one or more of the areas of self-care, receptive and expressive language, cognitive development or motor development and results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services which are of extended duration, and are individually planned and coordinated; and there is evidence that getting supports now (early intervention) will help them by:
- Reducing how much help they will need to do things because of their disability in the future
- Mitigating, alleviating or preventing the deterioration of their functional capacity or improving such functional capacity
- Helping their family and carers to keep helping them and those supports are most appropriately funded through the NDIS, and not through another service system (such as the health system).
If you believe your child meets the above criteria, has a diagnosis/disability, and is not currently receiving any support, you may be eligible to access support from this scheme.
The first step is to apply to the NDIS by lodging an NDIS access request through My Access Checker (www.ndis.gov.au/my-access-checker) or contact them on 1800 800 110.
How does my child become part of the NDIS?
Once you have been told that you are eligible to participate in the NDIS, the following information package provides a good outline for your family about the NDIS and some of the next steps you will need to take.
How is the support package determined?
NDIS Participation Pack for South Australia
The NDIA will assess your child’s needs and work with you to develop an individualised plan and determine an allocation of funds for the supports your child and family requires. The OTFC Group cannot determine this package, however upon request we can provide recommendations towards funding allocation.
All supports funded by the NDIS are expected to assist the participant to attain their goals. When a participant’s plan is reviewed, the planner will consider whether there is evidence that a support has helped the participant to achieve measurable outcomes. Additional funding for continued supports will not be provided by the NDIS if there is no evidence that the support is helping to achieve these outcomes.
The NDIS have set criteria for documentation and funding within standard service expectations. This means as your key worker, the OTFC Group will need to provide NDIS will an Initial Assessment (the current service plan), a review Assessment (within 6 weeks of the plan review) and biannual progress reports to not only show funding allocation but to ensure all service providers contributing to a plan are working toward the said goals in that plan. At the completion of each block of therapy at the OTFC Group, we provide you with an NDIS Progress Report to take with you to your Review clearly outlining how each goal was worked towards during therapy.
The NDIS Pathway will help outline the path to follow.
What if I am not happy with the package I am allocated?
If you are unhappy with the plan that has been developed and the reasonable and necessary supports allocated, you can appeal their decision following the NDIS Appeals Process.
How can I get more information?
Please feel free to talk to any of the OTFC team if you would like more information and they can direct you to the best place to find it. Alternatively, please visit The NDIS website
Principles in relation to pricing
The NDIA sets the value for funded supports in participant packages. At present it also limits the price a provider may charge. The NDIA will continue striving to increase flexibility for participants by encouraging vibrant and responsive markets for disability supports. The more the market for disability support matures, the more choice participants will have over how they spend their individualised budget, consistent with the vision of the Productivity Commission.
The NDIA has set these support item prices believing they are similar to prices of equivalent supports in comparable schemes existing in trial site markets. This ensures that the NDIA does not compete with other purchasers, avoiding inadvertent market disruption. However, concerns have been raised by the NDS over hourly rates for two of the highest-volume supports – assistance with self-care activities and assistance to access the community. NDIS is concerned that pricing support below the real cost of delivery will reduce choice of the available providers for participants and lower service quality. These prices are renewed annually and changes come into effect each year on July 1st.
Each 60 min Occupational Therapy Session covered by NDIS is charged at $193.99.
Any documentation required to be completed by the OT will be charged at the NDIS fee of $193.99 per hour.
Making a Service Agreement with OTFC Group
Providers and participants are encouraged to enter into a written agreement to ensure that there is a shared set of expectations about the delivery of supports. The NDIA has developed A Service Agreement Template to assist in this process.
An agreement should establish the key arrangements for the delivery of the supports. This includes what the arrangements are for the payment of fees, what happens when either party cannot keep an appointment, and the service fee.
The payment and receipt of supports are commercial transactions between the participant and the provider. Any disputes will need to be resolved between the two parties, or through consumer law.
As it is an expectation that providers will work with the participant to establish a written agreement about the nature, quality and price of supports to be provided, all supports delivered will be in accordance with that agreement. Such agreements will accord with the National Disability Insurance Scheme Model Agreement and incorporate input from participants including internal management of complaints and cessation of supports. Service agreements need to be consistent with the National Disability Insurance Scheme’s pricing arrangements and guidelines. The OTFC Group is one such provider.
A Service Agreement is different from your NDIS plan. Your plan lists your NDIS supports, but a Service Agreement is about delivering those supports. To complete your service plan, a fee of $193.99 per hour or part there of depending on the complexity of the plan and the agreement will be charged.
When making a Service Agreement, please bring in a copy of your NDIS plan so that we can attach it to your Service Agreement(s). This will help the OTFC Group deliver you the right supports in the right way. Remember, you have choice and control in the delivery of your supports. This means having the choice over who provides your supports; however, each service provider will have their own policies/ procedures and service delivery models to ensure you know what these are before entering into an agreement with them. It also means being responsible and reasonable in your expectations and dealings with providers. Please contact admin@otfc.com.au gain a copy of your Service Agreement.
There are five ways a plan can be managed:
- Agency Managed – this is where providers claim directly from the NDIA.
- Plan Manager – funding in your plan is allocated to a third party so they can manage the financial transactions in your plan.
- Self-Managed – you (or your nominee) directly manage the funds – all transactions are completed by the participant for services rendered.
- Automated Payments (transport only) – these funds can be deposited into an NDIS bank account weekly, fortnightly or monthly.
- Combination – A combination of the above four options can be used together to meet your individual needs.
No matter which option you choose for the payment of providers, you remain in control of which providers you select. Each Service Provider will have their own Service Delivery Models and you can choose which provider you would like to use. The NDIA has a role in ensuring that participants are not put at risk in managing the funding for supports in their plan and therefore the NDIA can determine which plan management option can be agreed upon with the participant (see s44 NDIS Act). And
Will my child receive the same services as they are receiving now?
You will have control over selecting the services that your child receives. Once an NDIS plan is in place, you may choose to use the allocated funds to purchase services from the OTFC Group that you are currently receiving now or depending on your child’s package and needs, you may be able to access different services. It is important to remember to familiarize yourself with each service providers terms and conditions as they will each have their own operational models.
Payment for Service
Providers who are working with participants whose plans are managed by the NDIA will be able to access the Provider Portal called myplace- an information technology (IT) system which supports electronic claiming and payment for supports. At the completion of your child’s OT session at OTFC, the admin team will ask you to sign an NDIS Personal Client Form. This signature gives OTFC the authorisation to access your funds on the NDIS provider portal myplace, to claim for services rendered on that particular day for that service.
Those who are self-managed will be required to pay for services obtained on a ‘same-day’ basis. The admin team at the OTFC Group will help you navigate this.
If you are plan managed, your nominated plan manager will be invoiced and they will pay the OTFC Group on your behalf.
The NDIS have set an hourly fee that OT’s are eligible to charge for the provision of their services. OTFC has altered their service model to align with the recommendations of the NDIA National Pricing Structure Framework. Please view the current NDIS pricing guide for more information.
Your OTFC Group therapist will also complete a NDIS Progress Report for each block of therapy, which addresses each of the goals in your NDIS plan and comments on attainment of these. This will be charged at the NDIS hourly rate. Once payment is received, the OTFC Group will provide yourself and NDIS with a copy of this.
Things to think about preparing for your child’s NDIS planning process
The NDIS provide a checklist that prompts you to think about things that will help you begin developing your child’s participation statement.
At the OTFC Group there are some points that we recommend you consider to prepare for your child’s NDIS planning process. The goals we use at the OTFC Group are functional, realistic and measurable. The Assessment provided by the Assessment Team at the OTFC Group are used as a baseline to measure the effectiveness and outcomes of Occupational Therapy at the OTFC Group.
All supports funded by the NDIS are expected to assist the participant to attain their goals. When a participant’s plan is reviewed, the planner will consider whether there is evidence that a support has helped the participant to achieve measurable outcomes. Additional funding for continued supports will not be provided by the NDIS if there is no evidence that the support is helping to achieve these outcomes. It is therefore very important to take the necessary time in determining the goals you wish for your child.
Things to consider when thinking about your child’s needs
Your OTFC Group Assessment Report (as well as any other Assessment Reports you have from other service providers) is a good reference point for goal development as usually there is a list of recommendations suggested. If you need help with this process, please ask your occupational therapist.
Once you have your plan, sharing it with your service providers enables ease of access and transparency. If you decide that you want to give your consent to the NDIA to share your NDIS plan and/or your contact details on the Provider Portal, ask your local office for a consent form. You can also use this form to cancel your consent at any time. When you consent, your most up to date plan will be available to all of your registered providers.
Please note that if you wish to share your plan in full to some but not all of your registered providers, you can do this yourself by downloading it from your Participant Portal or asking the NDIA for a copy. You will need to do this anytime your plan changes. Please feel safe in the knowledge that providers are required to comply with the NDIA privacy policy.
OTFC Group and NDIS
At OTFC Group we believe our purpose to; Influence Lives – Create Possibilities – Make a difference showcase the following eight features as described by the NDIS guidelines:
- We are family centred
- We are culturally sensitive
- We are inclusive
- We are focused on everyday life
- We are focused on teamwork
- We are focused on building knowledge and skills
- They are qualified and evidence based
- We are focused on outcomes
OTFC Group works hard to ensure we abide by the NDIS code of conduct when working with families who require additional support.
Being a registered NDIS provider allows the OTFC Group to service all clients funded by NDIS and provide best quality care and outcomes for the incredible clients we work with.
