Introduction to NDIS Supports

*See page 3 for the Can I buy it Checklist.

The NDIS funds reasonable and necessary supports that relate to a participants disability. NDIS planners decide what reasonable and necessary supports are funded in a plan. Once you have an NDIS plan, you can purchase supports that fit into the budget categories you have in your plan and are likely to be reasonable and necessary. 

This document is aimed to be a guide to help you decide whether the NDIS is likely to fund a support or service. The video below can help you to understand what are reasonable and necessary supports.

You have a choice about what supports you buy to achieve your goals. 

Once you understand your NDIS plan and support budget, you can choose the supports you will buy.

Your support budget is broken up into three separate budgets with multiple support categories. 

The Core Budget is flexible- 

The core budget includes direct practical help with activities and items purchased related to a participant's disability. 

Consumables funding from core can cover items under $1500 that are safe, off the shelf and directly relate to your disability. Useful everyday items that everyone uses may be purchased, though you will likely require proof that you need it directly due to your disability).

Core supports could include funding for Daily Activities helping with shopping, bathing, cleaning or cooking. This could also include Supported Independent Living funding (SIL) or Independent Living Options (ILO), where participants are provided with high levels of care in their home or a shared living environment.

Social Community Participation includes funding for outings and group activities.

The NDIS can fund help with Employment Related Supports while a person is at work with non-performance based tasks that assist participants in continuing working. An example could be a support worker helping with organising, planning, prompting or assisting with physical based tasks depending on the impairment caused by the participant's disability.

Participants can receive a Transport Allowance if they are unable to use public transport because of their disability. Payments can either be paid periodically into your bank account or be plan or agency managed. Choosing the latter two options allows you to use your whole core budget flexibly, enabling you to choose to use Taxis or transport providers with less restriction.

The good news is you can generally use Core budget funds allocated against one support category to purchase supports under another support category  unless funds have been set aside for a specific purpose; such as periodic payments for transport or any Core budget line item type that is:

• Affected by a compensation claim

• Specialised Disability Accommodation, i.e. accommodation for participants who require specialist housing solutions due to significant functional impairment and/or very high support needs

• In-kind, e.g. Government pre-paid supports such as school transport or some therapy supports.

• A "Stated item" (including Quotes for certain items allocated to a specific purpose), e.g. assistance in a shared living arrangement, meal preparation and delivery, live-in carers or linen services. A "Stated Support" will usually be written with an asterisk * next to it in your NDIS plan.

In these cases, the funds within a category must only be used for that specific purpose. For details about your Core supports, please refer to your NDIS plan.

The NDIS generally does not fund "everyday expenses" that everyone incurs, only costs directly related to a person's disability.

Capital items include Home Modifications, Vehicle Modifications and more complex or expensive assistive technology and repairs. These supports generally require a report requesting them from the NDIS. 

Assistive Technology can be requested at any time via emailing the request form and the supporting evidence to  enquiries@ndis.gov.au. Generally, more expensive items need to be trialled first before the NDIS will fund them.

You do not have to wait for a plan review. These items are requested via the  Assistive Technology Assessment and report process.

Once approved, the funds for items over $1500, those that require customisation, repairs or carry a risk, are added to this category.

To request Home Modifications or Specialised Disability Accommodation, it is best to contact an experienced Occupational Therapist and a Support Coordinator to help you.

Home modifications relate to changes required to your home that directly relate to your disability. This excludes structural repairs that relate to the deterioration of the building and generally changes that would alter the size or footprint of the building.

The Home and Living Supports Request Form is a great way to explain your need and be crucial evidence.

Capacity Building Supports help build your independence and skills to help you pursue your goals. Unlike your Core Supports budget, your Capacity Building Supports budget cannot be moved from one support category to another. Funding can only be used to purchase approved individual supports that fall within that Capacity Building category. 

Capacity Building supports are not treatments or interventions aimed at improving a condition; they teach skills and strategies and help prevent a participant's condition from deteriorating. Intensive capacity building supports not included in a clearly outlined and targeted program are often seen as a treatment. This is usually most appropriately the responsibility of the health system to support and wouldn't be funded by the NDIS.

Example:

Psychology- The NDIS will only fund non-clinical supports that are not aimed at treating a condition but are aimed at building skills and strategies to help manage the effects of a disability.

The Ndis do fund Psychology to discuss the impacts of a disability on a participant's life and develop coping strategies, to build social skills or help build and maintain relationships.

The NDIS does not fund ongoing counselling, psychotherapy, cognitive behavioural therapy, inpatient treatment, or supports relating to a co-morbidity with a psychiatric condition where the co-morbidity is the responsibility of another service system (for example, treatment for a drug or drug or alcohol issue).

*The NDIS does not cover medicare gap fees, medication costs or clinical services such as Psychiatry.

The Capacity Building categories are:

Some kinds of supports will not be funded or provided by the NDIS.

The NDIS Act and the Rules made under the NDIS Act also tell us which supports will not be funded by the NDIS.

The NDIS cannot fund support that is:

• the responsibility of another government system or community service

• not related to a person’s disability

• relates to day-to-day living costs that are not related to a participant's support needs, or

• is likely to cause harm to the participant or pose a risk to others.

Some expenses are the responsibility of other Government departments . An example would be a Student Learning Support Officer (SLSO), as it is the responsibility of the Department of Education to ensure reasonable adjustments are made at schools and universities. The NDIS will not fund assistance with education. Though the NDIS will fund support for personal care relating to essential activities of daily living whilst a participant is attending education or work. The NDIS can fund assistance with life skill development and skills training, advice, assistance with arrangements and orientation to assist a person with a disability moving from school to further education.

You can find more about what other government services are responsible for funding here.

More information on Support Costs and options can be found in the NDIS Pricing Limits and Funding Arrangements document.

Learn more about plan budgets and categories here . 

How The NDIS Pay For Your Supports

A person can be:

1. Agency Managed (where the NDIS pays NDIS registered providers directly).

2. Plan Managed (where a registered Plan Manager pays people with an Australian Business Number for the supports you receive).

3. Self-Managed (where the NDIS pays you directly for the supports you receive, then you pay your provider). 

*Plan and Agency-managed participants cannot pay more than the NDIS pricing arrangement amount. 

*Only Plan and Self managed participants can pay unregistered NDIS providers. Being Self Managed means that you can pay above the maximum hourly rate if needed as long as the support is still value for money and helps you to achieve your goals.

*You can have a combination of all three types in your NDIS plan.

Note: Support Coordinators and Recovery Coaches can help with budgeting but are not Plan Managers. They do not pay invoices or decide what funding is in your plan. They help you to navigate the NDIS, connect with providers and explore support options.

What is a Plan Manager?

A plan management provider is expected to manage activities and tasks to ensure the effective financial administration of a participant's NDIS plan. 

If you have Plan Management in your plan, a Plan Manager "manages" the Plan Managed budgets in your plan. They pay invoices relating to NDIS services on your behalf and help with NDIS financial administration responsibilities.

A plan management provider validates whether invoices received from providers of services are following the plan and in line with expected NDIS plan spend within no more than five business days. 

In circumstances where an invoice or receipt is received and found to be outside the scope of a participant’s funded supports, the plan management provider should discuss the invoice with a participant as soon as practicable and refer a participant to the provider for further discussion.

Tax invoices or receipts received by a plan management provider should contain precise details to enable accurate processing. Tax invoices must include enough information to determine the following details clearly:

• that the document is intended to be a tax invoice

• the provider’s identity, and their AustralianBusiness Number (ABN)

• date the invoice or receipt was issued• a description of service or support delivered

• the GST amount (if any) payable 

Where appropriate, many of the following details are also expected to be included in an invoice:

• the participant’s NDIS number, and their name

• quantity of service or support delivered

• the total cost of service delivered and invoicing amount date(s) of service or support delivered

• location of supports delivered

• NDIS support item name and number (if known)and

• details of how payment should be processed. 

Participants seeking reimbursement for services must provide a plan management provider with a receipt containing the same information as the tax invoice issued from their chosen provider of supports (as stated above).

Ultimately, all plan managers have a legal responsibility to ensure that NDIS funds (public monies) are spent following the participant's plan. 

In discharging this obligation, it is important for plan managers to consider that supports in a participant’s plan can be described generally or specifically. Where supports in a plan are generally described, the participant will have a high degree of flexibility over implementing their supports. 

In contrast, supports described specifically(known as ‘stated’ supports) will have to be purchased in the way described in the plan. 

To enable maximum choice and control, the NDIA tries to describe core supports generally to provide participants with greater flexibility surrounding the supports they can purchase to move them towards their goals. 

However, given each participant has an individualised plan, the plan manager will need to ensure that funds have been spent appropriately regarding the supports approved in each participant’s plan. 

To be clear, the role of a plan manager does not extend to determining whether supports or services purchased are reasonable and necessary. The participant's individualised plan will already have funding for the reasonable and necessary support that the Agency has approved at the planning stage. As stated above, the plan manager's role is to ensure that the participant's plan is being implemented as intended, including ensuring that funds are being spent following the plan and in line with expected NDIS plan spend. 

In addition, a plant manager's role does not extend to deciding what supports a participant can access. It may be the case that a participant is spending their NDIS plan funds faster than anticipated, and there is a risk that funds will be exhausted before the participant’s next scheduled review date. 

In these circumstances, a plan manager should engage early with the participant about the effective and efficient utilisation of the approved funding throughout the expected plan period. If a participant needs additional funding (for example, due to a change in circumstances), the participant can contact the Agency directly to discuss the available options. 

Inappropriate use of government funds or fraud is a serious matter. A plan manager may be liable to repay any amounts that have not been spent according to a participant’s plan. If they feel that the risk for processing a payment is too significant, and you choose to continue and take the risk, you may be liable to repay the money paid in the future.

• Plan managers cannot pay an invoice for support that exceeds the relevant price control, regardless of whether a provider seeking payment is registered or non-registered. 

• Plan managers cannot pay providers before supports and services have been delivered to a participant.
  

• Plan Managers can only claim services for the period they have managed your plan.

• Plan Managers can continue to claim for services delivered in a previous plan for 90 days after the end of that plan.

• Plan managers cant pay for things that don't relate to a participant's NDIS goals or disability.

If you are having difficulty filling out the form on the next page, one of the friendly support coordination team at Ability Links may be able to help you.

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What is Support Coordination?

They can help you:

• understand your plan and what supports and services you can pay for with your NDIS funding

• learn what is the responsibility of other services, such as the health or education systems, or your state or territory government

• connect with the community and other government services

• find providers who meet your needs and will help you achieve your goals

• put service agreements and service bookings in place with your providers

• as point of contact if you have questions, concerns or something in your life changes.

Below is a checklist, you must be able to answer YES to all questions for the NDIS to approve the payment of the support.

Click here to learn more about what the NDIS will fund.

If you would like exaples of what the NDIS will fund, or are unsure of what the NDIS will fund; you can visit the  Would We Fund It Website.

The information included in this form is true and corrrect and relates to my request to have the listed support paid for within my NDIS plan. Please submit this form and any attechments to be proceessed for payment.

Regards

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