Planning

When a person has been approved for access and becomes a participant of the NDIS, the next step is a planning meeting. The NDIA will contact the participant to arrange a meeting to discuss their goals and support needs. Generally, these meetings are held by telephone, but a participant can request any adjustments they need to be able to participate, including video conference or face-to-face.

Once the meeting has been held, the NDIA aims to have a plan made available to the participant within 56 days.

• What can be funded under the National Disability Insurance Scheme?

  An NDIS plan includes funding for the disability-related support needs of the participant. The participant has the choice as to how to use this funding and what supports and services to access.

  For funding to be allocated in a plan, the NDIA must form a view that the supports meet the criteria outlined in section 34, namely:

  • it is necessary to address needs of the participant arising from an impairment accepted by the NDIA in the access decision (or subsequently);

  • it will assist the participant to pursue specific goals;

  • it will facilitate the participant’s social and economic participation;

  • the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;

  • it is likely to be effective and beneficial for the participant;

  • it is not something that it is reasonable to expect families and the community to provide; and

  • it is an ‘NDIS support’.

• National Disability Insurance Scheme supports

  There are two sources of definition of an NDIS support. Section 10(9) of the NDIS Act states that sexual services, alcohol and illegal drugs are not NDIS supports.

  The National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (NDIS Supports) Transitional Rules 2024 (Cth) (‘Rules’) provide significantly more detail including the following categories:

  National Disability Insurance Scheme supports:

  • Assistance animals;

  • assistance with daily life tasks, travel or transport arrangements, household tasks;

  • assistance in coordinating or managing life stages, transitions and supports;

  • assistance to access and maintain employment or higher education;

  • assistive equipment for recreation;

  • assistive products for household tasks and personal care and safety;

  • specialist positive behaviour support;

  • Communication and information equipment;

  • prostheses and orthoses;

  • hearing, mobility and vision equipment;

  • community nursing care; specialised hearing services, disability-related health supports;

  • early intervention supports for early childhood;

  • exercise physiology, therapeutic supports;

  • home modifications, design and construction;

  • vehicle modifications, specialised driver training;

  • specialist disability accommodation;

  • support coordination

  Not National Disability Insurance Scheme supports:

  The Rules also stipulate the following categories of items that are not NDIS supports:

  Day-to-day living costs:

  • Accommodation and household (including rent, purchase of property, home security and maintenance, utilities);

  • finance and payments (including donations, gifts, fines, penalties, insurances, superannuation, education costs, legal costs, child support);

  • food and groceries;

  • lifestyle (including cigarettes, gambling, internet devices, internet plans, computers, recreational equipment and fees, dating or relationship services, weddings and other social events, musical instruments, theme park entrance);

  • clothing and beauty (including jewellery, makeup, hair treatments, manicures, body piercing and tattoos);

  • travel and transport (including cruises, holiday packages, motor vehicles, mechanical repairs, vehicle registration, bikes and skateboards, petrol);

  • pets (including pets and companion animals, pet food, veterinarian costs, pet grooming, boarding and insurance);

  • reproductive health, surrogacy and fertility treatments

  Not evidence-based:

  • Alternative and complementary therapies (including crystal therapy, tarot card reading, reflexology, wilderness and animal therapy);

  • wellness and coaching (including massage that is not provided by an allied health professional for disability-related purposes, sports or athletic supplements, life coaches, hypnotherapy, gaming therapy and kinesiology);

  • energy and healing practices (including reiki, scalar lounger, frequency healing, shamanic healing)

• Supports that are provided under other systems

  The Rules include significant lists of matters which are the responsibility of the following mainstream systems:

  • health;

  • mental health;

  • child protection and family support;

  • early childhood development;

  • school education;

  • higher education and vocational education and training;

  • employment;

  • housing and community infrastructure;

  • transport;

  • justice;

  • aged care;

  • income replacement

• Replacement supports

  It is important to note that the NDIA can fund non-NDIS supports under certain circumstances. Section 10 (6) of the NDIS Act allows for the CEO to determine that a non-NDIS support can be funded in relation to a participant. The NDIA refers to these as ‘replacement supports’, and can only be funded if the NDIA is satisfied that:

  1. the support would replace one or more other supports that are NDIS supports for the participant;

  2. the cost of the support is the same or lower than the total of the costs of the supports it would replace; and

  3. the support would provide the same or a better outcome for the participant than the supports it would replace.

  Additionally, the Rules provide that supports being requested must be either of the following:

  • standard commercially available household items that must:

    1. be necessary to address the needs of the participant arising from an impairment in relation to which the participant meets the disability requirements or the early intervention requirements; and

    2. increase whole task independence; and

    3. reduce or eliminate the need for a support worker or disability specific assistive technology; or

  • one of the below supports:

    1. smart watches;

    2. tablets;

    3. smartphones;

    4. an app used for accessibility or communication purposes

  The supports must be necessary to address the communication or accessibility needs of the participant arising from an impairment in relation to which the participant meets the disability requirements or the early intervention.

  It should be noted that specific conditions must be met before a replacement support determination can be made in relation to either of these supports. These conditions are set out in column 2 of the table in section 7 of the Rules:

  A person may not apply for a replacement support determination in relation to a particular support or supports more than once in a twelve-month period or, if a plan has a reassessment date less than twelve months after the plan comes into effect, before the plan’s reassessment date.

  It is anticipated that these Rules will be further clarified in the coming months. Participants seeking to understand replacement supports should check the NDIS website for latest versions of these rules.

• Impact of impairment on funding and use of funds

  Changes to the NDIS Act in 2024 incorporated the requirement that funding can only be provided, and spent, for supports related to impairments which have met the access criteria.

  From 1 January 2025, new participants to the scheme will receive an ‘impairment notice’ advising them of any impairments which the NDIA have accepted, and for which funding can be provided and spent.

  Existing participants are expected to receive this notice in future, but no timeframe has been specified at the time of writing.

  In the interim, participants can request this information from the NDIA by contacting their planner, or by submitting either a freedom of information request or participant information access request.

• How does funding work?

  An NDIS plan states the amount of funding available to the participant in different categories as summarised below. The plan will state the duration of overall funding but may also include separate periods of funding for certain categories.

  Core supports

  Core supports help participants with everyday activities, and in most cases, funding can be used across any of the following sub-categories.

  • assistance with daily life: for example, assistance with everyday needs, household cleaning and/or yard maintenance;

  • consumables: for example, continence products or low-cost assistive technology and equipment to improve independence and/or mobility;

  • assistance with social and community participation: for example, a support worker to assist with participation participate in community activities;

  • transport.

  Capacity building supports

  Capacity building supports help build participant independence and skills. Capacity building supports funding cannot be moved from one sub-category to another. Examples of some of the supports that can be funded under this category include:

  • social and community participation to develop skills to participate in social and community activities;

  • improved relationships to support development of positive relationships with other (including behaviour support);

  • improved daily living to access assessment and therapies to identify support needs and increase skills or maintain function;

  • support coordination to help organise funded supports; and

  • plan management to help manage the plan and pay for supports.

  Capital supports

  This category is the least flexible and is used for specific items such as home modifications and specialised equipment.

• Management of funding

  An NDIS plan also stipulates how funding will be managed for each category of supports. There are three options:

  • Agency-managed: where service providers claim directly from the NDIA. Providers must be registered to do so, meaning that if a category is agency-managed the participant can only use registered providers for that category of funding.

  • Plan-managed: where an external provider manages the funding and pays for supports. The funding for this must be included in the plan.

  • Self-managed: where the participant manages the funding themselves and claims the funding directly from the NDIA.

Planning

Chapter: 8.2 Understanding the National Disability Insurance Scheme

Contributor: Naomi Anderson, Legal Practice Manager, Villamanta Disability Rights Legal Service, and Marcus Boere, Lawyer, Victoria Legal Aid; Elise Almond, Senior Lawyer, Villamanta Disability Rights Legal Service; John Morrissey, Professional Support Lawyer, Victoria Legal Aid

Current as of: 3 October 2024

Law Handbook Page: 711

Next Section: Home and living supports