Better Start and Audiology Services

• Audiology services, Better Start Early Intervention and Medicare items; CDM Medicare items - how do they interact?
• Case studies
  

Audiology services, Better Start Early Intervention and Medicare items; CDM Medicare items - how do they interact?

	Better Start Early Intervention funding	Better Start Medicare items	Chronic Disease Management Medicare items
Entitlement/s	$12,000 that can be used until the child turns 7. Max of $6,000 in one year Up to 35% can be spent on resources (max $2,100 in one year)	Items for development of a treatment and management plan 4 allied health diagnostic items Up to 20 allied health services in total Must meet diagnostic and age criteria to access the items	5 claims per year, across a range of identified allied health professions
Hearing loss of 40+dB over four frequencies in better ear or ANSD	Eligible	Would be rare to claim for children who are under the care of Australian Hearing. May be used for cochlear implant audiology services if not covered through other Medicare items.	Eligible
Vision impairment, Down Syndrome, Cerebral Palsy, Fragile X (and not known whether hearing loss present or not)	Eligible	Can claim audiology assessment to help with planning program. May be used to monitor children whose hearing is normal but who are at risk of developing hearing loss.	Eligible
Disability other than specified for Better Start initiative	Not eligible	Not eligible	Eligible
Apply for funding by age...	Age 6	Must have treatment and management plan developed by age 13	No age restriction
Funding must be used by age...	Age 7	Age 15	No age restriction
Services	Some audiology services can be claimed from Better Start if the provider is a member of the Better Start Provider Panel Services must not be already covered by Australian Hearing or existing Medicare funding. Most commonly this includes support services for cochlear implantees or services that are part of a multidisciplinary team approach to early intervention management Sound field systems and Assistive Listening Devices can be purchased with the Better Start resources component if recommended by Better Start panellist.	According to medicare items	Can be used to assist planning. In reality, all such services are undertaken through Australian Hearing for children with permanent hearing loss

• An audiologist (or audiology service) must be a member of the Better Start Early Intervention Service Provider Panel in order to claim for services provided to clients who are registered for the Better Start Early Intervention Funding.
  
• An audiologist (or audiology service) does not need to be registered with FaHCSIA to claim Better Start Medicare Items and Chronic Disease Management Medicare items – but they will need a Medicare provider number. 

Case studies

Permanent sensorineural hearing loss
Julia is diagnosed at birth with a severe bilateral hearing loss and no other disabilities (4 FAHL left and right = 65dBHL). She is referred to Australian Hearing for device fitting and ongoing audiological management, and also enrols in an early intervention service for hearing impaired children.

Better Start Early Intervention Funding can be used to pay for programs delivered by her early intervention provider. This may include charges for Educational audiology services provided as part of a multidisciplinary approach and related to:

• Support and ongoing education of educators and therapists who are delivering services to the child.
• The collection of clinical and observational information related to the child’s hearing and communication ability in real life which provides a meaningful addition to the child’s hearing and communication improvement program with Australian Hearing or their cochlear implant clinic.

If Julia attends an early Intervention service that is fully funded by the State Government, she could use her Better Start Early Intervention funding to purchase additional services - e.g.from a private speech therapist.

Cochlear implant candidate
At the age of 3, Julia suffers a sudden deterioration in her hearing levels, so that she now becomes a cochlear implant candidate.

Better Start Medicare items may be used to cover Cochlear Implant candidacy evaluation where this is not already covered by Medicare.

Better Start Early Intervention funding may be used to cover audiological services related to the ongoing cochlear implant program where this is not otherwise covered by Medicare, as long as the provided the Cochlear Implant program provider has registered as a provider with the Better Start Initiative.

Child who has Down syndrome
Nicholas is 9 months old and has Down syndrome. He passed his newborn hearing screening test but is at risk for developing a long term conductive hearing loss.

His GP develops a Chronic Disease Management program, which allows up to 5 services a year from designated allied health services, including audiology.

The CDM Medicare item may be used to assess his hearing.

Because Nicholas has a condition that entitles him to Better Start Early Intervention funding which can be used to supplement his overall early intervention needs, he could use the Better Start Medicare items to cover monitoring of his hearing, if that is planned as part of his program.

Vision impairment
Maria is 4 years old and has a vision impairment that meets Better Start entry criteria. The Early Intervention Service that she attends wants to get her hearing tested to help with planning her intervention program.

Her hearing could be tested

• using the Better Start Medicare items, if her GP has developed a Better Start treatment and management plan; or
• if her GP develops a CDM management plan which includes a hearing assessment the test could be claimed via the CDM items; or
• using the Better Start Early Intervention funding if she goes to an audiology provider who is on the Better Start Early Intervention Service Provider Panel.
  

Multiple disabilities
Errol is 4 years old and has a profound bilateral hearing loss so is eligible for Better Start Early Intervention funding. He also has lost the use of his right arm due to a tractor accident.

Errol could access physiotherapy services using his Better Start Early Intervention funding, or using the Better Start Medicare Items; or using the CDM items.

His parents want to devote all their Early Intervention funding to managing his hearing needs. His GP develops a CDM care plan which allows him to attend 5 physiotherapy sessions per year.

Child older than 5 years
James is 5 years and 9 months old. He has a hearing loss that meets Better Start criteria and so is eligible for the Better Start Early Intervention funding.

James’ parent must register him for the Better Start initiative before he turns 6 by contacting Carers Australia. Once James is registered, he can use the Better Start funding until he turns 7. However, as there is a limit of $6,000 in any one financial year he may not be able to use the entire $12,000 in Better Start funding before his 7th birthday.

After James turns 7, he will continue to have access to the Better Start Medicare items to cover costs of allied health services until he turns 15 – provided there is a Better Start treatment and management plan in place before he turns 13.

He can also access the Medicare Chronic Disease Management items if his GP has developed a CDM management plan. James’s family decide that they will use these options to provide him with speech therapy after he no longer has access to the Better Start Early Intervention funding.

Information provided by Australian Hearing




Reproduced with permission.
Date reviewed: September 2011