5. What is taken into consideration by the NDIA when funding disability-related health supports?
The NDIA takes a ‘whole of person’ approach when funding disability-related health supports in a participant’s NDIS plan. This means a planner will determine funding for these supports based on the criteria in section 34 of the NDIS Act and NDIS Rules . When applying the NDIS Act and Rules, planners will have regard to the Guiding Statements (see above).
In funding disability-related health supports from 1 October 2019, the NDIA, states and territories have worked together to ensure a seamless transition for participants in which they continue to receive the disability-related health supports they require in a consistent manner.
To do this, planners will consider a range of issues, such as:
- Is the disability-related health supports directly related to the participant’s ongoing functional impairment; and required on an ongoing (regular) basis?
- Should the support be provided by the health system (i.e. acute/post-acute care, chronic health conditions not related to a participant’s disability, diagnostic, palliative or time limited (non-ongoing) conditions)?
- What disability-related health support is the participant currently receiving?
- What are the specific details of the disability-related health support the participant requires?
- Does the participant have any unmet needs?
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Where appropriate, a planner may ask a participant or another person to provide evidence to confirm the disability-related health support will be or will likely be effective and beneficial for the participant. This evidence may be:
- an expert opinion in the form of a written report from a suitably qualified health care practitioner detailing clinical reasoning and justification for the proposed disability-related health support, including the type of support recommended and the frequency and duration this support is required, and how the support is related to the participant’s functional impairment;
- lived experience of the participant; and
- anything the NDIA has learnt through the delivery of the NDIS.
A participant should talk to a planner to determine the evidence required for NDIS to fund a specific disability-related health support.