About EPC and CDM Plans
These plans are prepared by your General Practitioner (GP) when you have ongoing, complex care needs that need to be managed by a multidisciplinary team. This team would typically include your GP and 2 or more health care providers, one which may be your speech pathologist. This team would be responsible for managing and monitoring the client’s care needs such as a recently diagnosed expressive and receptive language delay or speech sound disorder that makes it difficult for the client to communicate effectively. Other health professionals that can provide services under a CDM/EPC program include (but are not restricted to):
- Occupational Therapists
Who is Eligible for a EPC/CDM Plan?
The following person’s can seek a referral from their GP*:
- Medicare card holders (including children) with ongoing, complex health conditions/needs
- Residents of aged care facilities
- Individuals of Aboriginal and Torres Strait Islander descent
*It is at the discretion of your GP at whether they issue you a CDM/EPC plan, despite meeting the above requirements.
What’s the Referral Process?
Your GP will prepare a GP Management Plan and Team Care Arrangements and make a referral to the speech pathologist using a CDM/EPC referral form. Your GP may recommend a local speech pathologist, OR you can provide them with the following details:
Full name of your therapist* from HDST
Our phone number: 9054 1996
Our Address: Solent Centre, Building A Level 3 Suites 301-303
1 Burbank Place, Norwest NSW 2153
The client must provide their therapist with a copy of the referral form prior to commencing their next session. This can be given in hand to reception or emailed to your therapist or firstname.lastname@example.org.
*If there is a change in the speech pathologist providing the service the GP should be notified of the change.
Your GP then nominates the number of sessions up to a maximum of 5 per calendar year**. The five sessions are per client, not five sessions per allied health professional, and may be across a number of allied health professionals (e.g., three with a speech pathologist and two with an occupational therapist). Each session must be at least 20 minutes long and provided as an individual session (i.e. you can not use your CDM/EPC plan for group therapy).The allocation of sessions is best discussed with your GP during the referral process.
** If all sessions are not used during the calendar year in which the client was referred, the unused sessions can be used in the next calendar year. However, those sessions will be counted as part of the five sessions with allied health professionals available to the client during that calendar year.
Clients continue to be eligible for rebates for speech pathology while they are being managed under a CDM plan as long as the need for eligible services continues to be recommended, by their GP, in their plan.
How much is the rebate?
The current rebate is $58 (as of July 2023). We do not bulk bill (i.e. only charge the Medicare rebate) for services at Hills District Speech Therapy. Our therapy and assessment fees are more than the rebate amount and need to be paid in full prior to making a claim. You will be left with an out of pocket expense from each CDM/EPC session, however these expenses will count towards your Medicare safety net.
How can I make a claim?
Upon having provided your therapist with a copy of the referral and paying the full session fee, you will be emailed a receipt with important information required by Medicare to make a successful claim. You can then provide Medicare with this receipt using the app or visiting your closest Medicare branch. The rebate will be deposited into your nominated bank account. If you lose track of how many speech pathology services you have claimed in a calendar year, please contact Medicare on 132 011.