Funding & Payment Options for Occupational Therapy

At Sensory SMART OT, payment is required on the day of therapy intervention.

I offer a variety of funding and payment options to ensure that families can access the support their child needs.

Whether you’re using NDIS, Medicare, Private Health Insurance, or Private Payments.

Here’s how I can help you understand your options, so you can focus on your child’s progress.

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National Disability Insurance Scheme (NDIS)

The NDIS provides support for individuals with disabilities, including funding for Occupational Therapy services.

There are several ways to manage your NDIS funding:

    • Control: You have full control over your NDIS funding and can choose any provider that meets your needs.

    • Payment: You pay for services upfront and claim reimbursement from the NDIS.

    • Record-Keeping: You are responsible for maintaining records of all transactions.

    For more information, visit the NDIS Participants page: ndis.gov.au

    • Plan Manager: An NDIS-approved plan manager handles your funding, payments, and record-keeping.

    • Provider Choice: You can access both registered and non-registered NDIS providers.

    Learn more about plan management here: ndis.gov.au

  • Foundational Supports are specific supports designed to assist people with disabilities, their families, and carers outside of the National Disability Insurance Scheme (NDIS). These supports are intended to complement the NDIS by providing additional assistance through community and government programs.

    While Foundational Supports are separate from the NDIS, they are not directly associated with Medicare either. Instead, they encompass a range of services aimed at building a more inclusive society for individuals with disabilities. The Australian and state/territory governments are collaborating to design and implement these supports to ensure comprehensive assistance is available beyond the NDIS framework.

    In summary, Foundational Supports operate independently of both the NDIS and Medicare, serving as additional resources to support people with disabilities within the community.

    The Disability Reform Roadmap for 2024 and 2025 outlines the government's initial plans for crucial reforms to the NDIS and the broader disability ecosystem, including the design and implementation of Foundational Supports.

    The government is planning crucial reforms to the NDIS and disability ecosystem, including Foundational Supports.  Rollout dates are unannounced, but it is expected during 2025.  Individuals can explore existing NDIS, Medicare, and community-based programs while staying informed about the changing landscape of disability support.

Note: Sensory SMART OT does not offer services for NDIS Agency-Managed participants.

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Medicare Rebates

Medicare provides rebates for Occupational Therapy services under specific plans. To access these rebates, a referral from a GP, Paediatrician, or Psychiatrist is required before your first appointment.

    • Eligibility: Up to 5 sessions per calendar year for children with long-term conditions.

    • Referral: Requires a GP referral.

    • Eligibility: Up to 20 sessions (one-time use) for children with a formal autism diagnosis.

    • Referral: Requires a referral from a Paediatrician or Psychiatrist.

    • Eligibility: Up to 10 individual and 10 group sessions per year for mental health concerns.

    • Referral: Requires a referral from a GP, Psychiatrist, or Paediatrician.

    For more information on Medicare coverage for Occupational Therapy services, visit: medicare.gov

    Please Note: Medicare rebates do not cover the full cost of sessions, and out-of-pocket expenses (gap payments) do apply.

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Private Health Insurance

If you have private health insurance with extras cover, you may be eligible for rebates on Occupational Therapy services.

  • Vary depending on your health fund and policy.

  • Submit your receipt to your health fund for reimbursement.

Note: Please check with your private health fund for specific details on coverage and rebates.

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Private Payment (Self-Funded)

Families can choose to self-fund Occupational Therapy services.

  • No funding restrictions; just schedule sessions based on your child's needs.

  • Full control over the frequency and type of services accessed.

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