Planning Operational Guideline - Is the support most appropriately funded or provided through the NDIS?

Is the support most appropriately funded or provided through the NDIS?

Mainstream and community supports are available to all members of the Australian community regardless of whether they have a disability or not. For example, supports provided or funded through the health, education or transport systems.

Before any support is added to a participant's plan, the NDIA must also be satisfied that the support is most appropriately funded or provided through the NDIS, and is not more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or systems of service delivery or support services offered:

  • as part of a universal service obligation; or
  • in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability (section 34(1)(f)).

Whether or not funding is available through other general systems is not the test of whether a support is most appropriately funded or provided under the NDIS.

For example, the fact that the health system does not fund entirely, or even at all, what is essentially clinical treatment, or some other form of support that is more appropriately funded through the health system, does not make it the responsibility of the NDIS (see Young and NDIA [2014] AATA 401 at [41] ) (external).

This principle reflects the statement of the Productivity Commission in its 2011 report (external), which states that:

“it will be important for the NDIS not to respond to problems or shortfalls in mainstream services by providing its own substitute services. To do so would weaken the incentives of government to properly fund mainstream services for people with a disability, shifting the cost to another part of government ... This ‘pass the parcel' approach would undermine the sustainability of the NDIS and the capacity of people with a disability to access mainstream services”.

The considerations that the NDIA must take into account when deciding whether a support is most appropriately funded through the NDIS, are outlined in Schedule 1 to the Supports for Participants Rules under the following headings:

  • Health (excluding mental health);
  • Mental health;
  • Early childhood development;
  • Child protection and family support;
  • School education;
  • Higher education and vocational education and training;
  • Employment;
  • Housing and community infrastructure;
  • Transport; and
  • Justice.

The considerations set out under these headings are derived from the Principles to determine the responsibilities of the NDIS and other service systems, agreed to by the Council of Australian Governments.

For the avoidance of doubt, while this information outlines the considerations relevant to whether a support should be considered to be more appropriately provided or funded through another service system, it does not purport to impose any obligations on another service system to fund or provide particular supports.

The information in this section should also be read together with the table located at Appendix 1, which provides further guidance on whether a support is most appropriately funded through the NDIS or by other parties.

In addition, please refer to the section, "what assistance is available where a support is not most appropriately funded by NDIS?"

Health (excluding mental health)

The NDIS will be responsible for supports related to a person's ongoing functional impairment and that enable the person to undertake activities of daily living, including maintenance supports delivered or supervised by clinically trained or qualified health practitioners where these are directly related to a functional impairment and integrally linked to the care and support a person requires to live in the community and participate in education and employment (rule 7.4 of the Supports for Participants Rules).

The NDIS will not be responsible for:

  • the diagnosis and clinical treatment of health conditions, including ongoing or chronic health conditions (rule 7.5(a) of the Supports for Participants Rules); or
  • other activities that aim to improve the health status of Australians, including general practitioner services, medical specialist services, dental care, nursing, allied health services (including acute and post-acute services), preventive health, care in public and private hospitals and pharmaceuticals or other universal entitlements (rule 7.5(b) of the Supports for Participants Rules); or
  • funding time-limited, goal-oriented services and therapies:
    1. where the predominant purpose is treatment directly related to the person's health status (rule 7.5(c)(i) of the Supports for Participants Rules); or
    2. provided after a recent medical or surgical event, with the aim of improving the person's functional status, including rehabilitation or post-acute care (rule 7.5(c)(ii) of the Supports for Participants Rules); or
  • palliative care (rule 7.5(d) of the Supports for Participants Rules)
  • supports that are more appropriately funded or provided by the health system
  • funding medical or clinical services, such as out of pocket expenses, gap payments and private health insurance fees.

NDIA plans are developed to cover the full cost of supports (e.g. physiotherapy or OT services to build function) where these are considered Reasonable and Necessary for the participant. As a result, there should not be a “gap” fee required to be paid.

Participants should not make claims under private health insurance policies for ‘Reasonable and Necessary’ supports in their plan that the participant will also claim from the NDIS. Participants may choose to use private health insurance to fund services and treatments that will not be funded under their NDIS plan. In the rare cases where a support being delivered may be claimable under either the participant’s plan or private health insurance, the participant may choose whether to use NDIS funds or make a claim under their private health insurance, but they cannot make a claim under both in respect to the same support.

Mental Health

The responsibility for which respective general system of service delivery is to take responsibility for different aspects of mental health support is subject to agreement between governments.

The NDIS will be responsible for supports that are not clinical in nature and that focus on a person's functional ability, including supports that enable a person with a mental illness or psychiatric condition to undertake activities of daily living and participate in the community and social and economic life (rule 7.6 of the Supports for Participants Rules).

NDIA plans are developed and approved to cover the full cost of supports (e.g. psychology services) where these are considered Reasonable and Necessary for the participant. The decision as to what capacity building supports or therapy would be deemed reasonable and necessary takes into account the responsibilities of the health system and services already available to the participant.

Once supports are approved in a plan the participant is able to use those supports as described in the plan. Therapy may be described generally (e.g. “Therapy up to the value of $X’) in a budget so supports can be used flexibly within that budget or may be described specifically (for example, 1 session of psychology/therapy per week).

Early childhood development

The NDIS will be responsible for personalised supports, specific to a child's disability (or developmental delay), which are additional to the needs of children of a similar age and beyond the reasonable adjustment requirements of early childhood development service providers (rule 7.8 of the Supports for Participants Rules).

The NDIS will be responsible for early interventions for children with disability (or developmental delay) which are:

  • specifically targeted at enhancing a child's functioning to undertake activities of daily living, but not supports which are specifically for the purpose of accessing a universal service such as school readiness programs that prepare a child for education (rule 7.9(a) of the Supports for Participants Rules); and
  • likely to reduce the child's future support needs, which would otherwise require support from the NDIS in later years, including through a combination and sequence of supports (rule 7.9(b) of the Supports for Participants Rules).

The NDIS will not be responsible for:

  • meeting the early childhood education and care needs of a child with a developmental delay or disability required by children of a similar age, including through inclusion supports that enable children to participate in early childhood education and care settings (rule 7.10(a) of the Supports for Participants Rules); or
  • supports, which are clinical in nature provided in the health system, including acute, ambulatory or continuing care (rule 7.10(b) of the Supports for Participants Rules); or
  • new-born follow-up provided in the health system, including child and maternal health services (rule 7.10(c) of the Supports for Participants Rules).

Please refer to Appendix 1 for further guidance on whether early childhood development supports are appropriately funded through the NDIS or more appropriately funded by other parties.

Child protection and family support

The NDIS will be responsible for:

  • supports for children, families and carers, required as a direct result of a child's disability, that enable families and carers to sustainably maintain their caring role, including community participation, therapeutic and behavioural supports and additional respite and aids and equipment (rule 7.11(a) of the Supports for Participants Rules); and
  • where a child is in out-of-home care - supports specific to the child's disability (or developmental delay), which are additional to the needs of children of similar ages, in similar out-of-home care arrangements. The diversity of out-of-home care arrangements is recognised and the level of reasonable and necessary supports will reflect the circumstances of the individual child (rule 7.11(b) of the Supports for Participants Rules).

The NDIS will not be responsible for:

  • statutory child protection services required by families who have entered, or are at risk of entering, the statutory child protection system (rule 7.12(a) of the Supports for Participants Rules); or
  • general parenting programs, counselling or other supports for families, which are provided to families at risk of child protection intervention and to the broader community, including making them accessible and appropriate for families with disability (rule 7.12(b) of the Supports for Participants Rules); or
  • funding or providing out-of-home care or support to carers of children in out-of-home care where these supports are not additional to the needs of children of similar age in similar out-of-home care arrangements (rule 7.12(c) of the Supports for Participants Rules).

Please refer to Appendix 1 for further guidance on whether child protection and family supports are appropriately funded through the NDIS or more appropriately funded by other parties.

School education

The NDIS will be responsible for supports that a student requires that are associated with the functional impact of the student's disability on their activities of daily living (that is, those not primarily relating to education or training attainment), such as personal care and support, transport to and from school and specialist supports for transition from school education to further education, training or employment that are required because of the student's disability. Any supports funded by the NDIS will recognise the operational requirements and educational objectives of schools (rule 7.13 of the Supports for Participants Rules).

The NDIS will not be responsible for personalising either learning or supports for students that primarily relate to their educational attainment (including teaching, learning assistance and aids, school building modifications and transport between school activities) (rule 7.14 of the Supports for Participants Rules).

Please refer to Appendix 1 for further guidance on whether school education supports are appropriately funded through the NDIS or more appropriately funded by other parties.

Higher education and vocational education and training

Supports for education and training are designed to assist the participant to develop new skills and qualifications and to find and retain employment. The NDIA encourages participants to participate in the Australian labour force to maximum extent they are able to in accordance with their goals, objectives and aspirations.

The NDIS will be responsible for supports that a student requires which are associated with the functional impact of the student's disability on their activities of daily living (that is, those not primarily relating to education or training attainment), such as personal care and support, transport to and from the education or training facility and specialist supports for transition from education or training to employment that are required because of the person's disability (rule 7.15 of the Supports for Participants Rules).

The NDIS will not be responsible for the learning and support needs of students that primarily relate to their education and training attainment (including teaching, learning assistance and aids, building modifications, transport between education or training activities and general education to employment transition supports) (rule 7.16 of the Supports for Participants Rules).

Please refer to Appendix 1 for further guidance on whether higher education and vocational education and training supports are appropriately funded through the NDIS or more appropriately funded by other parties.

Employment

The NDIS will be responsible for:

  • supports related to daily living that a person would require irrespective of whether they are working or looking for work (including personal care and support and transport to and from work) (rule 7.17(a) of the Supports for Participants Rules); and
  • frequent and ongoing supports that assist a person with disability to take part in work where the person has work capacity and is unlikely to be able to find or retain work in the open market, including with the assistance of employment services (rule 7.17(b) of the Supports for Participants Rules); and
  • individualised assistance to support a person with disability to transition into employment, where these support needs are additional to the needs of all Australians and specifically required as a result of a person's functional impairment, for example training on workplace relationships, communication skills, dress, punctuality and attendance, and travelling to and from work (rule 7.17(c) of the Supports for Participants Rules).

The NDIS will not be responsible for:

  • work-specific support related to recruitment processes, work arrangements or the working environment, including workplace modifications, work-specific aids and equipment, transport within work activities and work-specific support required in order to comply with laws dealing with discrimination on the basis of disability (rule 7.18(a) of the Supports for Participants Rules); or
  • the funding or provision of employment services and programs, including both disability-targeted and open employment services, to provide advice and support to:
    1. people with disability to prepare for, find and maintain jobs (rule 7.18(b)(i) of the Supports for Participants Rules) ; or
    2. employers to encourage and assist them to hire and be inclusive of people with disability in the workplace (for example support, training and resources, funding assistance to help employers make reasonable adjustments, and incentives for hiring people with disability, for example wage subsidies) (rule 7.18(b)(ii) of the Supports for Participants Rules).

Please refer to Appendix 1 for further guidance on whether employment supports are appropriately funded through the NDIS or more appropriately funded by other parties.

Housing and community infrastructure

The NDIS will be responsible for:

  • supports to assist a person with disability to live independently in the community, including by building their capacity to maintain a tenancy, and support for appropriate behaviour management (rule 7.19(a) of the Supports for Participants Rules); and
  • home modifications for accessibility for a person in private dwellings (rule 7.19(b) of the Supports for Participants Rules); and
  • home modifications for accessibility for a person in legacy public and community housing dwellings on a case-by-case basis but not to the extent that it would compromise the responsibility of housing authorities to develop, maintain and refurbish stock that meets the needs of people with disability (rule 7.19(c) of the Supports for Participants Rules); and
  • user costs of capital in some situations where a person requires an integrated housing and support model and the cost of the accommodation component exceeds a reasonable contribution from individuals (rule 7.19(d) of the Supports for Participants Rules).

The NDIS will not be responsible for:

  • the provision of accommodation for people in need of housing assistance, including routine tenancy support and ensuring that appropriate and accessible housing is provided for people with disability (rule 7.20(a) of the Supports for Participants Rules); or
  • ensuring that new publicly-funded housing stock, where the site allows, incorporates Liveable Housing Design features (rule 7.20(b) of the Supports for Participants Rules); or
  • homelessness-specific services including homelessness prevention and outreach, or access to temporary or long term housing for participants who are homeless or at risk of homelessness (rule 7.20(c) of the Supports for Participants Rules); or
  • the improvement of community infrastructure, for example accessibility of the built and natural environment, where this is managed through other planning and regulatory systems and through building modifications and reasonable adjustment where required (rule 7.20(d) of the Supports for Participants Rules).

Please refer to Appendix 1 for further guidance on whether housing and community infrastructure supports are appropriately funded through the NDIS or more appropriately funded by other parties.

Transport

The NDIS will be responsible for:

  • supports for a person that enable independent travel, including through personal transport-related aids and equipment, or training to use public transport (rule 7.21(a) of the Supports for Participants Rules); and
  • modifications to a private vehicle (for example not modifications to public transport or taxis) (rule 7.21(b) of the Supports for Participants Rules); and
  • the reasonable and necessary costs of taxis or other private transport options for those not able to travel independently (rule 7.21(c) of the Supports for Participants Rules).

The NDIS will not be responsible for:

  • ensuring that public transport options are accessible to a person with disability, including through the funding of concessions to people with disability to use public transport (rule 7.22(a) of the Supports for Participants Rules); or
  • compliance of transport providers and operators with laws dealing with discrimination on the basis of disability, including the Disability Standards for Accessible Public Transport 2002 (rule 7.22(b) of the Supports for Participants Rules); or
  • transport infrastructure, including road and footpath infrastructure, where this is part of a universal service obligation or reasonable adjustment (including managing disability parking and related initiatives) (rule 7.22(c) of the Supports for Participants Rules).

Please refer to Appendix 1 for further guidance on whether transport supports are appropriately funded through the NDIS or more appropriately funded by other parties.

Justice

Please see the Justice system guideline for more information.

This page current as of
15 June 2021
Indicates required field
Was this page useful?*
Why?
Why not?