Important Information Regarding the Medicare and NDIS Systems

 

Many NDIS participants are coming to us saying their Psychology sessions are no longer being funded or funding has been reduced. Many have been told to pursue the mental health care plan pathway using the Medicare system. However, NDIS has never funded psychological therapy, it has always been under ‘capacity building’. 

So, what is the difference between these two options and what does this mean for our participants?  

Medicare services are provided for a specific diagnosed mental health illness where your General Practitioner makes a referral for psychological counselling. This is where the psychologist needs to use specific therapeutic models such as Cognitive Behavioural Therapy as an intervention.  

 

Capacity building, on the other hand, is about developing a person’s skills so that they no longer require those supports or require those supports in a more limited capacity. For example, under the Medicare system, we may have someone who has been diagnosed with anxiety who goes to a psychologist and is treated under the cognitive behaviour model for anxiety to treat the symptoms. Under the capacity building, we could have someone who has Autism and an anxiety diagnosis but if we can give them coping skills, education and understanding about anxiety, it will limit and reduce the impact of that anxiety or the behaviours of anxiety that it has for them so they may no longer need future funding.  

How to get the funding under ‘capacity building’ heavily relies on the correct wording in reports.  

If you need capacity building, to develop your skills, education or understanding so that you are able to function at a higher level or to develop independent living skills in the future it is more likely that the NDIS will fund you for that. However, if you need treatment for an anxiety disorder it is less likely that the NDIS will fund you.