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Helping Children with Autism

Fact Sheet for Health Professionals - Helping Children with Autism Program

The Australian Government has committed $190 million for the Helping Children with Autism Package.

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The Australian Government has committed $190 million for the Helping Children with Autism Package. This package funds training for teachers and support playgroups, early intervention and individual assistance packages for children with autism or any other pervasive developmental disorder (PDD), their families and carers, and has created new items in the Medicare Benefits Schedule (MBS). The Helping Children with Autism package involves the Department of Health and Ageing, the Department of Families, Housing, Community Services and Indigenous Affairs and the Department of Education, Employment and Workplace Relations.

Medicare items for autism/ PDD

Items are available for:

• paediatricians and psychiatrists to diagnose and develop a treatment and management plan for a child aged under 13 years on referral from a general practitioner (GP);
• audiologists, occupational therapists, optometrists, orthoptists, physiotherapists, psychologists and speech pathologists to provide assessment services to collaborate with the paediatrician or psychiatrist on the diagnosis and development of the treatment and management plan (up to 4 services in total per child); and
• audiologists, occupational therapists, optometrists, orthoptists, physiotherapists, psychologists and speech pathologists to provide early intervention treatment services following diagnosis (up to 20 services in total per child).

Referral requirements

An eligible allied health professional can provide autism/PDD assessment services (items 82000, 82005, 82010 and 82030) to a child where:

• the child has previously been provided with any MBS service covering items 110-131 (inclusive), as provided by a paediatrician; or
• the child has previously been provided with any MBS service covering items 296-370 (excluding item 359), as provided by a psychiatrist.

An eligible allied health professional can provide autism/PDD treatment services (items 82015, 82020, 82025 and 82035) to a child where:

• the child has previously been provided with an autism/PDD treatment and management plan (item 135) by a paediatrician; or
• the child has previously been provided with an autism/PDD treatment and management plan (item 289) by a psychiatrist.

An allied health professional wanting to provide any of the items 82000-82035 must be in receipt of a current referral provided by a paediatrician or a psychiatrist.

Allied health items for assisting with diagnosis and/or contributing to the autism/PDD treatment and management plan

• 82000 – psychology
• 82005 – speech pathology
• 82010 – occupational therapy
• 82030 – audiology, optometry, orthoptics and physiotherapy

Description of assessment items

Professional attendance provided to a child aged under 13 years where:

• the child is referred by an eligible practitioner for the purpose of collaborating with the practitioner for the diagnosis of the child; and/or
• the child is referred by an eligible practitioner for the purpose of contributing to the child’s autism/PDD treatment plan, developed by the practitioner;
• the eligible practitioner is a consultant physician in the practice of his or her specialty of paediatrics or psychiatry;
• the allied health provider attending the child is registered with Medicare Australia as meeting the eligibility requirements for the provision of these services;
• the child is not an admitted patient of an hospital; and
• the service is provided to the child individually and in person, and lasts at least 50 minutes in duration.

Up to 4 services may be provided to the same child on the same day. These items are limited to a maximum of four services in total per child consisting of any combination of 82000, 82005, 82010 and 82030 provided by any combination of allied health professionals. A written report must be provided to the referring medical practitioner after providing the assessment services.

Allied health items for early intervention treatment of autism/PDD

• 82015 – psychology
• 82020 – speech pathology
• 82025 – occupational therapy
• 82035 – audiology, optometry, orthoptics and physiotherapy

Description of treatment items

Professional attendance provided for the treatment of autism/PDD for a child aged under 15 years where:

• an autism/PDD treatment and management plan has been prepared for the child by an eligible practitioner (under item 135 or item 289);
• the child has been referred by an eligible practitioner for services that are consistent with the autism/PDD treatment and management plan;
• the eligible practitioner is a consultant physician in the practice of his or her specialty of psychiatry or paediatrics;
• the allied health provider attending the child is registered with Medicare Australia as meeting eligibility requirements for the provision of these services;
• the child is not an admitted patient of a hospital; and
• the service is provided to the child individually and in person, and the service lasts at least 30 minutes in duration.

Up to 4 services may be provided to the same child on the same day. These items are limited to a maximum of twenty services in total per life time, consisting of any combination of items 82015, 82020, 82025 and 82035, provided by any combination of allied health professionals. Within the 20 services provided, a course of treatment will consist of the number of services stated on the child’s referral (up to a maximum of 10). A written report must be provided to the referring medical practitioner after completion of each course of treatment.

Who can access these services?

Children with autism/PDD can access these services:

• if their condition is being managed by an eligible paediatrician or psychiatrist under an autism/PDD treatment and management plan and that autism/PDD treatment and management plan is complete prior to the child's 13th birthday;
• if they are under 15 years of age for treatment services; and
• the child has not already accessed services under the Better Start for Children with Disability initiative.

What is considered autism or PDD for the purpose of these items?

The conditions classified as PDD for the purposes of these services are informed by the “American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorder”, Fourth Edition (DSM-IV-TR) and the World Health Organisations International Classification of Diseases (ICD-10).

More information

Further information on the autism/PDD items can be obtained by visiting the MBS Online website: http://www.mbsonline.gov.au/

Inquiries can be directed to mbsonline@health.gov.au or (02) 6289 1555.
Further information on the Helping Children with Autism package is available at www.health.gov.au/

Provider registration forms can be obtained from Medicare Australia on 132 150 or at www.medicareaustralia.gov.au