There will be limited circumstances in which a provider can claim for a payment after a participant unexpectedly leaves the supported independent living arrangement.
A payment for supported independent living supports may be made from a participant’s plan where the participant no longer occupies the supported independent living residence, and:
- the supported independent living supports were shared by 2 or more residents: and
- the participant either:
- dies; or
- exits the accommodation permanently where there is an irretrievable breakdown of supports/relationship which requires an immediate exit due to the participant’s personal health and safety, or that of others, is critically compromised.
Claiming processes vary, depending on the reason for the unplanned exit.
Unplanned exit (deceased) claiming process:
- if a participant dies, a provider must first notify us, and must comply with relevant NDIS Commission standards and the National Disability Insurance Scheme (Incident Management and Reportable Incidents) Rules 2018
- a provider can subsequently submit an invoice to us via a payment enquiry, with the subject line ‘Participant Exit Enquiry’. Along with the invoice, a provider must also submit the service agreement that authorises the unplanned exit payment from the participant’s funding in accordance with the NDIS Pricing Arrangements and Price Limits
- invoice requirements should be in accordance with the information found on the Getting paid page, invoices provided without the accompanying service agreement will be rejected.
Unplanned exit (irretrievable breakdown) claiming process:
- a provider can submit a claim through the portal:
- this claim will follow the standard claiming process, and the claim type ‘Assistance in Supported Independent Living – Unplanned Exits’ must be used.
This unplanned exit payment can be claimed (pending which option comes first):
- for up to 4 weeks/28 days; or
- until the open position in the supported independent living arrangement is filled (if this occurs within 4 weeks from the participant leaving).
A provider can claim this support weekly at the specified weekly rate in the participant’s plan and is subject to the following conditions:
- A service agreement between the provider and participant (or nominee) that details notice periods for any intention to claim for unplanned exit in accordance with the Pricing Arrangements in the specified circumstances; and
- If a participant provides notice to exit and then exits the SIL arrangement early, then only the remaining period of the notice period can be claimed during the planned notice period.
This item may not be claimed in circumstances where a participant chooses to change SIL providers or when a participant is within a notice period.
The price limit for this item is specified in the participant’s plan.
Only one claim for 28 days or 4 weekly claims are permissible per provider during a plan period. This does not apply to exits where there is no critical risk to participants.
Providers can refer to the claiming rules in the NDIS Pricing Arrangements and Price Limits to understand the conditions of unplanned exits and learn how to create a payment request for unplanned exits in the myplace provider portal step-by-step guides.
Providers cannot claim payments that do not meet the unplanned exit criteria specified in the NDIS Pricing Arrangements and Price Limits.
Providers must not increase the price of supports or claim additional funds from other participant’s plans to cover notice periods.
Service agreements should include how providers manage notice periods.
Programs of support
Providers of group-based supports like supported independent living can enter into a program of support agreement with the participant.
Please see the NDIS Pricing Arrangements and Price Limits for more information on programs of support.