1. What is the purpose of this operational guideline?
This Operational Guideline provides guidance in relation to making a decision on funding disability-related health supports in a participant’s plan.
2. What is the relevant legislation?
The Disability-related Health Supports decision was announced at the Council of Australian Government (COAG) Disability Reform Council (DRC) Meeting on 28 June 2019. The relevant legislation underpinning this policy is:
- Section 34 (1) (a)-(f) of the National Disability Insurance Scheme Act 2013 (NDIS Act); and
- National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Supports for Participants Rules) – in particular Schedule 1 – Health (excluding Mental Health) and Part 5 – General Criteria for Supports.
3. Disability-related health supports and the NDIS
The new Disability-related Health Supports Policy clarifies that the NDIA will now fund some disability-related supports that were previously provided by state and territory health systems.
Consistent with the NDIS Act and Rules, the policy provides that disability-related health supports will be most appropriately funded by the NDIS where the supports are:
- directly related to the participant’s ongoing functional impairment; and
- required on an ongoing (regular) basis.
The health system will continue to be responsible for the diagnosis and clinical treatment of health conditions (acute/post-acute care), chronic health conditions not related to a participant’s disability, palliative care, other activities that aim to improve the health status of Australians or funding time-limited, goal-oriented services and therapies, including rehabilitation and post-acute care.
In implementing the Disability-related Health Supports Policy the NDIA will have regard to the objects and principles in the NDIS Act and the following ‘Guiding Statements‘ adopted by the NDIA Board and Health Senior Officials Working Group (SOWG):
- put the participant experience at the centre and provide for choice and control
- identify the nature of a participant’s disability and the functional impacts as a key determinants of supports;
- wrap supports around the participant’s needs so they receive seamless support from multiple service systems;
- provide these supports in the context of appropriate quality and safeguarding frameworks;
- enable NDIS participants to choose the most appropriately qualified person to provide their supports, within the funding available in their NDIS plan;
- ensure the support is provided by the most appropriate and cost effective service provider.