- Assistance to coordinate supports and assistance with daily personal activities – assistance to engage with the health system such as decision making support and making appointments, (except where this is provided as part of a coordinated health care package), including a continuation of any support for complex communication needs or challenging behaviours while accessing health services, including hospitals
- Prosthetic limbs, orthotics or splints for ongoing functional performance (but not any medical or surgical procedures) – see separate Operational Guideline Planning and Assessment – Supports in the Plan - Prosthetic Limbs.
- Community re-integration– which enables the participant to live in the community such as personal support and home modifications and delivery of routine, non-clinical care to enable activities of daily living
- Training of NDIS funded support staff on a participant’s individual needs by nurses or allied health professionals, including training for new service providers and retraining as the participant’s needs change (with service providers being responsible for training new staff)
- Assistance with transport– specialist transport to and from medical appointments required as a result of the participant’s disability (where no other transport option is appropriate
- Assistance in managing life stages, transitions and supports, can be funded by the NDIS or by the health/mental health system. In determining which system is more appropriate, the system that is delivering the majority of supports is usually more appropriate to assist in the coordination of these supports.
- NDIS: assistance where the majority of the coordination and transition supports relate to supports funded by NDIS, or to non-clinical supports,
- Other parties: assistance where the majority of the coordination and transition supports relate to supports funded by the health system.
- Therapeutic support, including assistance by allied health professions such as speech and language pathology, physiotherapy, occupational therapy, audiology and therapy delivered by a therapy assistant under the supervision of the therapist:
- Maintenance care where the primary purpose is to provide ongoing support for a participant in order to maintain a level of functioning including long term therapy/support required to achieve small incremental gains or to prevent functional decline,
- To improve functioning in an early intervention context
- Other parties: where it is a time limited intervention to improve functioning following an acute event, medical treatment or accident (e.g. to improve functioning immediately following a stroke or acquired brain injury)
- Care and supervision by clinically trained staff, including delegated care
- NDIS: where this is required because of the participant’s functional impairment and integrally connected to the participant’s support needs to live independently and to participate in education and employment (e.g. supervision of delegated care for ongoing high care needs, such as PEG feeding, catheter care, skin integrity checks or tracheostomy tube changes) (see Decision Tree below)
- Other parties: where the primary purpose is to treat or manage a medical condition or recovery after medical treatment
- Assistance with daily personal activities and participation in community activities
- NDIS: where the assistance is related to an ongoing functional impairment (however not in hospitals, except where a continuation of any assistance for communication and challenging behaviours),
- Other parties: where the participant’s need is temporary to recover from a medical condition or event through post-acute care
- Aids and equipment
- NDIS: aids and equipment which are permanent and for the purpose of improving functioning and related to a participant’s self-care needs (including continence aids and catheters), except for medical or surgical procedures (e.g. the NDIS would not be responsible for providing continence aids and catheters for participants undergoing treatment within hospital settings),
- Other parties: aids and equipment which are for the permanent or temporary purpose of regulating or treating a medical or health condition or aids and equipment associated with medical or surgical procedures and post-acute recovery
- Diagnosis and assessment of health conditions, including ongoing or chronic health conditions (e.g. aged care, developmental delay)
- Clinical treatment and supports, including:
- Acute and emergency services, general practitioner, medical specialists, dental care,
- Care as an admitted patient in public and private hospitals,
- Medicines and pharmaceuticals including items listed and not listed on the Pharmaceuticals Benefits Scheme (PBS) and oxygen and Botox,
- Services listed on the Medicare Benefits Schedule, and
- Temporary or interim prosthetics.
- Subacute care services that are delivered under the management of a clinician, including:
- Palliative care where the primary clinical purpose or treatment goal is optimisation of the quality of life of a patient with an active and advanced life-limiting illness,
- Geriatric evaluation and management which aims to improve the functioning of a patient with multi-dimensional needs associated with medical conditions related to ageing, such as tendency to fall, incontinence, reduced mobility and cognitive impairment,
- Psychogeriatric care where the goal is improvement in the functional status, behaviour and/or quality of life for an older patient with significant psychiatric or behavioural disturbance, caused by mental illness, an age-related organic brain impairment or a physical condition
- Post-acute care – including clinical supports that are delivered to a participant in their home following an acute episode (such as nursing care and medical supplies).
- Assistance to increase functioning (rehabilitation) specialist allied health, rehabilitation and other therapies for people with recently acquired conditions such as newly acquired spinal cord injury or brain injury, until the participant has achieved the maximum level of achievable functioning and the remaining allied health support is for the purpose of maintenance
- General hearing, vision and podiatry services where these are unrelated to the participant’s disability as determined in the NDIS access requirements and/or required by other Australians of a similar age without a disability (e.g. prescription glasses, orthotics to realign posture)
- Preventive health designed to improve general health or prevent illness, injury and chronic disease through education, promotion and incentives, including addressing obesity, smoking and alcohol use.
- Private health insurance fees
- Medical costs normally met through disposable income such as gap fees with doctors or chemist costs or prescription medicines.