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The PHI (Private Health Insurance) Reforms on Pilates 1

In 2018, the Federal Government announced its plans to make certain natural therapies ineligible for private health insurance (PHI) rebates. Among these was Pilates. The Government’s original position was that Pilates would not be rebatable, regardless of who delivers it or how it is delivered.

However the Department considers that an insurer may lawfully pay benefits if a physiotherapist, providing services to a patient within the accepted scope of clinical practice, uses exercises or techniques drawn from Pilates as part of that patient’s treatment, as long as the exercises or techniques are within the accepted scope of clinical practice.

As long as the group exercise class is performed within the scope of physiotherapy, it does not need to change. It should be underpinned by individualised assessment, treatment and follow-up, and backed by thorough notes. The Department and private health insurers agree that physiotherapy is physiotherapy, and therefore fundable through private health insurance.

These changes are to take place as of 1st April, 2019.

For more information from the Department of Health in regards to these reforms, please click here.

For more information from the Australian Physiotherapy Associate regarding these reforms, please click here.

 

How does this affect clients of Body Mind Wellness Physiocare?

At Body Mind Wellness Physiocare have always conducted Initial Assessments to formulate individualised client treatment plans and backed this up with our clinical notes.

However to assist us to comply with the new legislation, we are asking that if you have not had an assessment in the last 8 weeks, that you schedule an individual assessment with Marika prior to April 1st, 2019.  This will ensure we have an updated physical assessment with patient specific goals.  We have also asked all of you to complete a Patient-Specific Functional Questionnaire which will tie in your goals and help us to assess and document your improvements as a result of your participation in our Group Physio Rehab Sessions/Classes.

Our classes will now be referred to as Group Physio Rehab Sessions, with the subtitle being, Core Strengthening and Stretching Class (CSSC).  Each client will be prescribed an individualised program which will be covered in the Physio Group Rehab Session. Each client will have their own modifications and elements to focus on.

Historically, my classes have always been conducted based on a combination of my physiotherapy knowledge and expertise, my Pilates training and my understanding and awareness of each client’s individual conditions and goals.  Small groups, individual modifications and individual guidance have always been key features of my classes.  These aspects and features will continue under the Physio Group Rehab Sessions or CSS Classes.

A review assessment will be required every 3 months, if not before, depending on the client’s needs, to reassess client outcomes and formulate/address any new goals.

Our Physio Group Rehab Sessions or CSS Classes continue to be claimable under the code 560 with the new PHI Reform, and after the 1st April, 2019.  If you are not prepared to participate in completing the above requirements you can still attend the classes, however, you will no longer be able to claim under your Private Health Insurance.

Our Group Physio Rehab Sessions/Classes will continue to be held at the following times….
Mondays 6:30pm and
Wednesdays 6:00pm

The Pricing structure of our Group Physio Rehab Sessions/Classes is as follows…..
$30 per class OR
$24.50 with purchase of a Ten Session Block ($245).

 

In a nutshell…
  • If you have not had an Individual assessment in the last 8 weeks, you need to schedule an appointment with Marika prior to April 1st, 2019
  • Complete a Patient-Specific Functional Questionnaire which will tie in your goals and help us to assess and document your improvements
  • Our classes will now be referred to as Group Physio Rehab Sessions, with the subtitle being, Core Strengthening and Stretching Class (CSSC)
  • Each client will be prescribed an Individualised program which will be covered in the Physio Group Rehab Session.  Each client will have their own modifications and elements of focus.
  • A review assessment will be required every 3 months, if not before, depending on the client’s needs, to reassess client outcomes and formulate/address any new goals.
  • Our Physio Group Rehab Sessions or CSS Classes continue to be claimable under the code 560 under the new PHI Reform, after the 1st April, 2019.
  • Same Class Format
  • Same Class Days & Times – Mondays 6:30pm and Wednesdays 6:00pm
  • Same Pricing Structure – $30 per class OR
    $24.50 with purchase of a Ten Session Block ($245).

I look forward to continue working with you on your health goals in 2019.
Should you require any further clarification, please do not hesitate to email me directly at marika@bmwphysio.com.au.

Kindest regards,

Marika Scicluna
Physiotherapist/Director Body Mind Wellness Physiocare