NDIS & Funding
Funding options to suit your needs
At Speech Pathology Australia, we understand the importance of easy access to services. We are also committed to promoting equity by ensuring that all individuals, regardless of their background or circumstances, have equal access to high-quality speech pathology services.
In this guide, we’ll walk you through the different funding options available to you, including the National Disability Insurance Scheme (NDIS), Medicare, and private health insurance to assist you or your loved one on a path to better communication.
National Disability Insurance Scheme (NDIS)
At Speech Therapy Australia, we partner with the NDIS to help you achieve your goals. We are able to work with self-managed and plan-managed participants. Please note that as a small business, we are not registered with the NDIS therefore cannot take on participants who are NDIA-managed.
Framework Categories
For National Disability Insurance Scheme (NDIS) participants, speech pathology supports fall under several specific categories within the NDIS framework. These categories include:1. Capacity Building Supports
- Improved Daily Living: This category includes funding for therapeutic supports such as speech pathology to improve daily living skills.
- Improved Relationships: Funding for interventions that enhance social skills and the ability to build and maintain relationships.
- Improved Learning: Supports to enhance learning outcomes, including communication skills necessary for education and training.
2. Core Supports
- Assistance with Daily Life: This can cover support related to communication needs that impact daily living activities.
3. Capital Supports
- Assistive Technology: Funding for communication devices and specialized software that assist with speech and communication. This includes augmentative and alternative communication (AAC) devices, speech-generating devices, communication boards, and relevant software.
Examples of Funded Supports
Therapeutic Supports
- Individual Assessments
- Individual Assessments
- Telehealth
- Group Therapy
Assistive Technology
- Communication Devices
- Specialised Software
Therapeutic Supports
- Capacity Building Supports
- Parent/Carer Training
- Social Skills Programs
NDIS funding is tailored to individual needs, with guidelines based on disability severity and required support. An annual review adjusts funding based on progress. Collaboration with an experienced NDIS planner or coordinator is recommended to navigate supports effectively.
Fees effective from the latest NDIS price guide
- Initial Consultation, Assessment, and Therapy (including telehealth) - $193.99 per hour
- NDIA requested report - $193.99 hourly rate
- Travel allowances: Allowances include up to 30 minutes against your appointment in MM1-3 areas and 60 minutes in MM4-5 areas. Return mileage may apply if you are the last participant of the day.
- Additional charges: Some instances may incur an extra 0.85c per kilometre (up to 50 kms) for vehicle maintenance and parking fees
- NDIS remote rates: For NDIS remote (MM6), the rate is $271.59 per hour, with up to 60 minutes against your appointment plus return mileage if you're the last appointment.
- For NDIS very remote (MM7), it's $290.99 per hour, with mileage as per remote rates.
We're here to clarify your applicable area and provide details on our current fee structures.
Medicare
Chronic Disease Management (Enhanced Primary Care plan)
While Medicare does not directly cover speech pathology services, you can access financial support through EPC plans. This plan caters to individuals with “chronic conditions”, defined as “medical conditions persisting for at least six months”. Medicare rebates extend to up to five eligible sessions per calendar year with a rebate of $52.95 per session. These sessions can consist of five of a single service type (e.g. speech pathology) or a mix of various services (e.g., 1 dietitian, 1 speech pathologist, and 3 OT sessions). A person who is of Aboriginal or Torres Islander descent may be eligible for an additional 5 sessions to make a total of 10 sessions in a calendar year.
Your GP can provide a referral for speech therapy services. Reporting procedures entail your therapist providing updates to the referring doctor following the initial and final sessions.
Private Health Insurance
Extras Coverage: Many private health insurance policies offer "extras" or "ancillary" coverage, which may include speech therapy services.
Providers
Here are a list of insurance providers offering benefits for speech therapy:- Bupa: Includes speech therapy in their 'Extras' cover with varying limits based on the chosen level of cover.
- Medibank: Covers speech therapy in many of its extras plans, with specific benefits depending on the plan.
- HCF: Offers comprehensive coverages that usually include speech therapy benefits.
- nib: Provides speech therapy coverage under various extras policies, with limits based on the policy level.
- Australian Unity: Their health covers typically offer benefits for a range of therapies, including speech therapy.
- AHM: Includes speech therapy benefits in their extras cover options.
This is not an exhaustive list so please check with your insurer to see if speech pathology is covered under your policy and inquire about any limits or waiting periods.
What to consider
If you are considering signing up for private health for benefits, here are some helpful points to consider when selecting a health insurance plan:
- Coverage Level: Verify that the policy includes speech therapy and check the annual limits on sessions or monetary coverage.
- Gap Payments: Understand how much the insurance will cover per session and any potential out-of-pocket expenses.
- Choice of Therapist: Ensure you can choose a therapist outside the insurance network without affecting your rebate.
- Waiting Periods: Check for any waiting periods before benefits for speech therapy become claimable.
- Policy Exclusions: Review the policy for any exclusions that might apply to specific therapies or treatments.
- Premium Costs: Balance the cost of premiums against the benefits, considering how frequently you will use the services to determine value for money.
