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 (External website) and NDIS Rules (External website). 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.