Delivering disability-related health supports - a guide for providers

The Commonwealth, state and territory governments have endorsed a new policy that clarifies the interaction between the National Disability Insurance Scheme (NDIS) and the health system, to deliver supports to Australians living with disability and who are eligible for the NDIS.

Effective 1 October 2019, more than 90 disability-related health supports will now be funded under the NDIS including (but not exclusively):

  • Dysphagia
  • Respiratory conditions
  • Nutrition
  • Diabetes
  • Continence
  • Wound & Pressure Care
  • Podiatry & Foot Care
  • Epilepsy

An extensive list of approved supports is on the Department of Social Services webpage , through the Disability Reform Council Communiqué dated 28 June 2019, and the associated fact sheet.

There are five types of disability-related health supports to deliver on these needs:

  1. Provision of disability-related health supports by disability support workers after appropriate training
  2. Allied health assessment, planning and the provision of, or training of disability support workers in the provision of, disability-related health supports
  3. Assessment, planning and the provision of disability-related health support by nurses or training of support workers to deliver these services  
  4. Consumables related to disability-related health supports
  5. Assistive technology related to disability-related health supports.

For a participant to be eligible to claim disability-related health supports, the need must be ongoing and directly related to a significant and permanent functional impairment.

Further detail is also available in an Information Pack for providers (DOCX 215MB).

Prices and related policy information for disability-related supports have been included in the NDIS Price Guide and Support Catalogue 2019–20

Current arrangements will stay in place until 1 October 2019, when these supports will start becoming part of participant plans.

State and territory health systems will continue to be responsible for all diagnostic, palliative and acute/post-acute treatment and management of chronic health conditions not related to a participant’s disability.

Details of more than 90 new or updated disability-related health support items now claimable under NDIS have been added to the NDIS Price Guide and Support Catalogue 2019–20.

The majority of these items have been identified to fall into one of five disability-related health support types:

  1. Provision of disability-related health supports by disability support workers
    • This includes three different price limits for disability support workers (standard, high and very high intensity).
  2. Assessment, planning and the provision of disability-related health supports by therapists.
  3. Assessment planning and the provision of disability-related health supports by nurses
    • This includes five new classifications of nurses.
  4. Consumables related to disability-related health supports
    • This includes options for high cost consumables where the price is not set and for low cost consumables where a maximum price applies. 
    • Two additional supports will also allow providers to claim for the delivery of equipment and consumables and for the set up and training in the use of disability-related health equipment and consumables. 
  5. Assistive technology (AT) related to disability-related health supports
    • This includes a support option for high cost AT where the price is not set and a support option for low cost AT. 

In addition, there has been a price update to a pre-existing nursing support line item to bring this in line with similar support items. 

  • Participant plans and service bookings will not be updated to reflect this change. 
  • Providers who want to charge the higher price for this item will first need agreement from the participant.

The NDIA is also monitoring participant plans to determine where plan reviews may be required and prioritising these as needed.

Participants can start accessing therapy (including early childhood intervention) and nursing disability-related supports immediately (from 1 October 2019), without a plan review.  

This means providers registered for these supports can start delivering supports to these participants immediately. Non-registered providers may also deliver such supports where a participant is self-managing.

If an NDIS participant already has therapy and disability-related health supports in their plan, they can continue to purchase these supports as usual.

If an NDIS participant does not have therapy and/or nursing for disability-related health supports in their plan and they are eligible, they can access these supports through one of two ways:

  1. Participants can use their plan budget flexibly to purchase disability-related therapy and nursing health supports 
    • Transitional arrangements are in place to expedite the ability for participants to access disability-related therapy and nursing health supports using NDIS funding without the requirement of a plan review.
    • Traditionally therapy and nursing supports have been purchased through a participant’s capacity building budget. However, participants will have temporary access to claim disability-related therapy and nursing health supports from their core budget.
    • The transitional arrangements allow participants to access these supports from their existing budget immediately (from 1 October 2019), without the need for a plan review, meaning providers can deliver and start claiming for these supports if the participant has budget available. (Refer claiming section below for more detail).
    • To be able to acquire disability-related low cost AT or consumable items participants must have at least $1 in their consumables budget. This allows them to use their budget flexibly to access their core support budget to purchase low cost AT and/or consumable items.
    • The ability to pay for disability-related therapy and nursing health supports from a participant’s core support budget will cease when participant plan reviews are completed. 
    • At this time, these supports will revert to only being accessible through a participant’s capacity building budget. The NDIA will provide further information when this arrangement is due to end. 
    • The NDIA is monitoring participant plans to determine when plan reviews may be required and prioritising these as needed.
    • Participants can also request an earlier plan review if they determine their funds may be exhausted prior to their next scheduled plan review.
  2. Where participant supports are not able to be transferred to the NDIS immediately, state and territory health services will continue to deliver disability-related health supports ensuring participants continue to receive these supports. 
    • In these situations states and territory health services will work with the NDIA to request a plan review and transfer the delivery of these supports to the NDIS as soon as practicable.

Over the coming months, the NDIA will proactively contact participants who are likely to be eligible for disability-related health supports.

Providers who deliver disability-related health supports to NDIS participants will need to register as an NDIS provider- (excluding those providers delivering supports to self-managed participants. 

Providers in all states except WA should register through the NDIS Quality and Safeguards Commission

Providers who deliver services in WA must register directly with the NDIA and will need to meet state requirements first, as part of the registration process. 

To expedite the ability for participants to access disability-related therapy and nursing health supports using NDIS funding, temporary payment arrangements for these supports are in place.

Traditionally, therapy and nursing supports have been purchased through a participant’s capacity building budget. However, participants will have temporary access to claim disability-related therapy and nursing health supports from their core budget – assistance with daily living.

Line items and codes for disability-related therapy and nursing health supports have been developed under core support for this purpose.

The transitional arrangements allow participants to access disability-related health supports from their existing budget from 1 October 2019, without the need for a plan review.

This is a transitional arrangement only. The ability to claim for disability-related health supports from a participant’s core support budget will cease when a participant’s plan review is completed.

At this time, these supports will revert to only being claimable through a participant’s capacity building budget. The NDIA will provide notification when this arrangement is due to end. 

Under the transitional arrangements, providers can claim payment for disability-related therapy and nursing health supports as follows:

  • Providers must be registered in one or more of the following registration groups according to the supports they will deliver:
  • To claim nursing and/or therapy supports, providers should first confirm with the participant that they have funding in their core support budget to pay for the support.
  • If yes, a provider should create a service booking at the category level and, once the support is delivered, claim payment for this item through the participant’s core support budget.
  • If the participant does not have budget available in core supports, they are unable to purchase these supports and require a plan review. 

Providers must be registered for ‘0103 – Assistive products for personal care’ to claim for disability-related assistive technology and consumable health supports.

All AT products for personal care must be claimed under either assistive technology or consumable support line items.

Participants purchasing low cost AT or consumable items will generally self-manage their budget to purchase these items directly from a supplier.

To be able to acquire disability-related low cost AT or consumable items participants must have at least $1 in their consumables budget. This allows them to use their budget flexibly to access their core support budget to purchase low cost AT and/or consumable items.

If a participant does not have a consumable budget and needs to acquire low cost AT and/or consumable items they will need to request a plan review. 

Participants requiring higher cost disability-related AT and/or consumable health supports—those greater than $1,500—will also require a plan review (to include assessment, recommendations and quotations) to access these items.

Where participants require a plan review to access items, states and territory health services will work with the NDIA to request a plan review and transfer the delivery of these supports to the NDIS as soon as practicable.

Claiming for supports under the NDIS

Providers can claim payment for a support only after the support has been delivered. 

Providers should create a service booking for a support prior to delivering the support to ensure funds are set aside in a participant’s budget to pay for the support, otherwise providers may not get paid.

Providers should claim payments against a support item that most closely aligns to the service they have delivered. Refer to the NDIS Price Guide and Support Catalogue 2019–20.

Where price limits apply (as outlined in the NDIS Support Catalogue), providers must not charge more than the price limit prescribed for each support.

It is the responsibility of the provider to ensure their claims accurately reflect the supports delivered, including the frequency and volume of supports and the type of practitioner delivering the support.

Falsifying claims for any aspect of supports delivered is a serious compliance issue and may result in action against the provider. 

Providers are also required to keep accurate records of claims, which are subject to audit at any time.

NDIS support prices

Price controls and related policy information for disability-related health supports have been included in the NDIS Price Guide and Support Catalogue 2019–20

The price limits set out in the NDIS Support Catalogue are the maximum a provider can charge for certain supports.

The NDIA sets price controls for certain NDIS supports to ensure a balance between NDIS participants obtaining reasonable value for money and enabling providers to operate within a market of adequate size, quality and return.

Prices are set according to the needs of the market and are updated regularly to respond to trends and changes in costs. These are identified through an Annual Price Review. 

Providers seeking further information about the transfer of disability-related health supports to the NDIS should email provider.support@ndis.gov.au or phone 1800 800 110.

This page current as of
28 November 2019