Step 1: Check if you can still claim for supports
There are limited circumstances supported independent living (SIL) providers can claim for a payment after a participant unexpectedly leaves the SIL arrangement.
A payment for SIL supports may be made from a participant’s plan where the participant no longer occupies the SIL residence, and:
- the SIL supports were shared by 2 or more residents
- the participant either:
- dies
- leaves the accommodation permanently because of a relationship or support breakdown affecting the participant's health and safety or the health and safety of others.
Claiming processes vary, depending on the reason for the unplanned exit.
Service agreements should include what happens in an unplanned exit.
This could include notice periods, final payments and how you’ll handle a sudden unplanned exit.
Step 2: Follow the right claim process
Unplanned exit claiming process – deceased
You must let us know if a participant has died before submitting a claim.
You can claim following a participant’s death at the specified weekly rate in the participant’s plan for a period of up to 28 days.
For all claims of this type, you must submit an invoice to us via a payment enquiry, with the subject line ‘Participant exit enquiry’.
You must follow the relevant NDIS Quality and Safeguards Commission standards and the National Disability Insurance Scheme (Incident Management and Reportable Incidents) Rules 2018 .
More information on the support items you can claim after a participant dies can be found in the NDIS Bereavement Addendum of the NDIS pricing arrangements and price limits.
We strongly recommend service agreements include details about claiming for an unplanned exit.
Unplanned exit claiming process – irretrievable breakdown
You can submit a claim through the myplace provider portal following a participant’s exit if there has been an irretrievable breakdown. This could be due to a relationship or support breakdown, which is affecting the health and safety of the participant and others.
You should follow the standard claiming process, using the line item ‘Assistance in Supported Independent Living – Exit Accommodation Permanently’.
This unplanned exit payment can be claimed, pending which option comes first:
- for up to a maximum of 28 days
- until the open position in the SIL arrangement is filled.
You can claim this support at the specified weekly rate in the participant’s plan. Your claim is subject to an agreement being recorded between you and the participant detailing notice periods and any intention to claim for unplanned exits.
Only the remainder of the notice period can be claimed during the planned notice period if a participant provides notice to exit and then leaves the SIL arrangement early.
Only one claim for 28 days or 4 weekly claims are allowed per provider, per participant during a plan period. This doesn’t apply to exits where there is no critical risk to participants.
You can refer to the claiming rules in the NDIS pricing arrangements and price limits to understand the conditions of unplanned exits.
We strongly recommend agreements are clearly outlined in the form of a service agreement. This should include how you’ll manage notice periods, your roles and responsibilities and liabilities of costs.
This item can’t be claimed where a participant chooses to change providers, or when a participant is within a notice period.