Funding at OTFC - OTFC
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Funding at OTFC

Medicare Funding

Depending on the criteria your child meets, there are three (3) different Initiatives that can be accessed from Medicare.

 

  1. Better Access to Mental Health Care Initiative

This can either be called:

  • GP 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 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 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 $74.80 available.

 

For more information please click on this link:

Better Access to Mental Health Care Fact Sheet – Department of Health & Ageing

 

  1. 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 is10958 with a rebate of $52.95. 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:

CDM Fact Sheet – Department of Health & Ageing

 

 

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.

 

South Australia was a trial site for the NDIS which came into effect in 2013

 

  • By February 1st 2016 all children between the ages of 0-14 years of age will be eligible to receive funding under this scheme should they meet the criteria state-wide
  • By 1st January 2017 young people between the ages of 15-17 years of age will be eligible to access the funding should they meet the criteria state-wide
  • Between 1st July 2017 and 30th June 2018, people between the ages of 18-64 years of age will be eligible to receive funding should they meet the criteria. Roll out will be based on where they live.

For OTFC clients, this means that each child who meets the criteria outlined below has an individual plan and is allocated funds to access “reasonable and necessary supports” in order to achieve their individual goals. The funded supports are individual to the child and their requirements

Most of the families that access the services we offer at OTFC will now be eligible to receive NDIS funding.

 

The below criteria is taken directly from the NDIS website (“Participating in the NDIS in South Australia”)

 

“Disability requirements

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 (ie 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; or
    • mitigating, alleviating or preventing the deterioration of their functional capacity or improving such functional capacity or
    • 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 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: NDIS Participation Pack for South Australia

 

 

How is the support package determined?

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. OTFC cannot determine this package, however upon request OTFC can provide help with any documentation you may need or provide a treatment summary to date.

 

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. As of July 2016, the NDIS have begun rolling out the new phase of their documentation and funding criteria which expects a change in standard service expectations. This means as your key worker, OTFC 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 OTFC, we provide you with an NDIS Progress Report to take with you to your Review clearly outlining how each goal was worked on 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 (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 to that value. 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 supports 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. NDS 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 is charged at $175.57

 

Any documentation required to be completed by the OT will be charged at the NDIS fee of $175.57 per hour.

 

Making a Service Agreement with OTFC

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. OTFC 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 $175.57 per hour or part thereof 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 OTFC 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 and procedures and service delivery models so 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 Michelle at OTFC to gain a copy of their Service Agreement.

 

 

It is important you remember you have choice and control over how you use funded supports in your plan which includes choice of how the supports are given and which service providers you use. There are five ways a plan can be managed:

 

  1. Agency Managed – this is where providers claim directly from the NDIA.
  2. Plan Manager – funding in your plan is allocated to a third party so they can manage the financial transactions in your plan.
  3. Self Managed – you (or your nominee) directly manage the funds – all transactions are completed by the participant for services rendered.
  4. Automated Payments (transport only) – these funds can be deposited into an NDIS bank account weekly, fortnightly or monthly.
  5. 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).

 

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 OTFC 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 particular service.

 

The NDIS have set an hourly fee of $175.57 (FY 16/17) 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 NDIS pricing guide 2016/2017

 

Each Therapy Session at OTFC goes between 45 minutes – 60 minutes depending on the needs of the child and family. This normally comprises of 50 minutes one on one time with the child and up to 10 minutes in the room giving feedback to the parents, discussing issues that have arisen and any homework to focus on. This does not take into consideration the time it takes for the OT to plan for the session and write notes following the session, administration time to comply with legislation for those accessing Government Funds as well as any other correspondence required by them to other health professionals or teachers.

 

The fees are higher than for those currently accessing other Government Initatives due to the increased infrastructure OTFC has had to build to cope with the demands the NDIS has placed on it. Unlike other Government Programs, the NDIS underestimated the number of elgible children and thus did not have the processes and the infrastructre in place to support service providers in implementing the scheme. OTFC is still having to do a lot of work behind the scenes and because the portal is still in its infancy, we are unable to access all of the information We have also had to change the way we operate to support all of the legislative requirements demanded by the NDIS from both an administrative and therapeutic perspective with longer working days.  As a direct result of this as of January 2015, we have decreased the number of clients seen per day to increase the support we can offer each family.

 

As a way of ensuring our quality of service, we will also complete at the end of each block of therapy a Progress Report which addresses each of the goals in your NDIS plan and 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 OTFC there are some points that we recommend you consider to prepare for your child’s NDIS planning process. The goals we use at OTFC are functional and realistic goals that can be measured. The Assessment provided by the Assessment Team at OTFC are used as a baseline to measure the effectiveness of Occupational Therapy at OTFC.

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-think-about-preparing-for-your-childs-ndis-planning-process

Things to consider when thinking about your child’s needs

Your OTFC Assessment Report (as well as any other Assessment Reports you have from other service providers) is a good place to start to write your goals from as usually there is a list of recommendations suggested to provide a framework to work from. If you need help with this process, please ask your therapist.

 

Once you have your plan, sharing it with your service providers enables ease of access and transparency so everybody is on the same page working toward common goals. 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.

 

Since 2013, there have been a lot of resources and websites pop up to help families navigate their way through this time. Here are a few:

The NDIS Website has undergone many changes during this time and is a wonderful resource to help families understand what their rights are and how to access a level of insurance that is right for them.

The Raising Children Network Website is based on the philosophy that all children and families are individual and different, providing scientifically validated information to help parents and carers make informed decisions that work for them in relation to their NDIS funding.

The Disability Services Consulting Website (resource hub in early childhood and children) have some wonderful, recent resources to keep families and service providers informed about new decisions that are made by the NDIS that are difficult to find out about.

The Early Childhood Intervention Australia Website is the peak body for early childhood intervention in Australia representing professionals and organisations that provide services for young children with disability and developmental delays and their families.

 

The guidelines say the best providers have the following eight features and we are proud to say that Occupational Therapy For Children (OTFC) have all of these:

 

  1. We are Family centred
  2. We are Culturally sensitive
  3. We are Inclusive
  4. We are focused on everyday life
  5. We are focused on teamwork
  6. We are focused on building knowledge and skills
  7. They are qualified and evidence based
  8. We are Focused on outcomes

Occupational Therapy For Children focuses on identifying the skills you and your family need to achieve outcomes that you want for your child and family. OTFC have spent this time trying to come up with resources to help our OTFC families navigate this tumultuous yet exciting time within our Environment and we think our knowledge is relevant, accessible and current in relation to the service we provide for the families that access our service.