What can be expected from the NDIS
Presented by Chris McCelland and Di Stracha
NDS, NDIS, Conference at Geelong, 16 October, 2015
- People with disability have the same right as other members of the community to realise their potential
- People with disability, their families and carers should have certainty they will receive the care and support they need
- People with disability should be supported to exercise choice in the pursuit of their goals and the planning and delivery of their supports
- The role of families and carers in the lives of people with disability is to be acknowledged and respected
Three key pillars underpin NDIS design:
- Insurance Approach
- Choice and Control
- Community & Mainstream
To access assistance from the NDIS a person must have permanent disability which has a significant impact on everyday life and on their ability to participate in the community, and will mean they will need ongoing supports.
Early intervention requirements:
Early Intervention is for both children and adults.
To meet the early intervention requirements a person must have an impairment that is, or is likely to be, permanent.
There is evidence that receiving supports now (early interventions) will help:
• Reduce the level of support needed, now and in the future OR
• Assist their family and carer to keep providing support
Each participant will have an individual plan
Facilitating a Plan
- Individual Goals & Aspirations.
- Informal, Mainstream & Community Supports (provided by other systems, family, friends & community).
- NDIS Funded Supports (reasonable & necessary).
Outcomes framework & support category:
Purpose Domain Support Category
Core Daily Living Assistance with daily life at home in the
community, education and at work Supported
independent Living Transport to access daily
Capacity Daily Living Improved daily living skills
Building Home Improved living arrangements
Health and Wellbeing Improved health and wellbeing
Lifelong learning Improved learning
Work Get and keep a job
Social, community participation Increased social and community activities
Relationships Improved relationships
Choice and Control Improved life choices
Capital Daily Living Assistive technology
Home Home modifications
Reasonable and necessary criteria
The NDIS Act (s34) sets out criteria for decisions. 'Supports for Participants' Rule expands the criteria:
(a) Whether there are comparable supports which would achieve the same outcome at a substantially lower cost.
(b) Whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long-term benefit to, the participant.
(c) Whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports).
A delegate must be satisfied of ALL of the following in relation to each support
• The support will assist the participant to pursue the goals' objectives and aspirations.
• The support will assist the participant's social and economic participation.
• The support represents value for money.
• The support will be, or is likely to be, effective and beneficial for the participant.
• The funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide.
• The support is most appropriately funded or provided through the NDIS.
Value for money
The delegate must be satisfied that supports represents value for money in that the costs of the support are reasonable, relative to both the benefits and the cost of alternative support.
• Are there comparable supports which would achieve the same outcome at a substantially lower cost, and
• Is there evidence that the support will substantially improve the life stage outcomes for, and be of long term benefit to, the participant, and
• Would funding or provision of the support be likely to reduce the cost of the funding of supports for the participant in the long term, and
• Will the support increase the participant's independence and reduce the participant's need for other kinds of supports (for example, some home modifications may reduce a participant's need for home care).
The support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice
In deciding whether the support will be, or is likely to be, effective and beneficial for a participant the delegate is to consider the available evidence of the effectiveness of the support for other people in like circumstances.
That evidence may include:
• Published and refereed literature and any consensus of expert opinion
• The lived experience of the participant or their carers, or
• Anything the NDIA has learnt through delivery of the NDIS (can seek expert opinion).
The support is most appropriately funded or provided through the NDIS
In deciding whether the support is most appropriately provided or funded through the NDIS the delegate must consider each of the matters set out in Schedule 1 of the Supports for Participants Rules.
There are a number of interfaces that need consideration including:
• Mental health
• Early childhood development
• Child protection and family support
• School education
• Higher education and vocational education and training
• Housing and community infrastructure
• Transport, and
What NDIS will not fund
Supports not related to the participants disability Supports related to day to day living costs
Supports that are likely to cause harm to the participant or pose risk to others
How the NDIS works with mainstream systems
• The NDIS is not intended to replace the supports or services provided by other mainstream systems
• Wherever possible we assist participants to access mainstream systems
Key principles determine whether the NDIS or another system is more appropriate to fund particular supports
A participant's plan may include a range of supports provided by informal, mainstream and community networks. Some of these may be funded by the NDIS.
Part 1: About me
This part of my Participant Statement is about me, my daily life, and the people in my life.
Where I live and the people 1 live with
I live with my mum, Claire, my sister, Abbey and my brother Jack. The best thing about where I live is that I can walk to school with my mum.
People in my life who support me
Mum helps me. My teachers help me and so does my grandma. Grandma lives near us. i have a worker at headspace called Jo.
My daily life
I go to St Joseph's school, I am in grade 5.1 like my friends at school and my grandma, i also like my sister and brother, i would like to start girl guides and dance classes. I like Lego.
Claire and Julie report that Amy loves computers, maths, reading and drama. She has excellent ball skills and is very good at handling a ball in sports such as netball. They stated that in addition to Lego, Amy loves Starwars, Pokemon, and anything that is pink.
Part 2: My Goals
This part of my Participant Statement lists my goals and things i want to work towards during this plan.
1. My goal for daily living: I would like to get better at managing and organising myself in the mornings as this will make me feel better for rest of my day.
During this plan i war I to: Lean to be able to follow a routine in the mornings without much help from my mum.
2. My goal for social and community participation: I would like to have more friends so that I can have people to play with on the weekends.
During this plan I want to: learn communication skills so that I can initiate conversations in different social settings and feel confident when I am with my class mates.
During this plan I want to: start going to a new out school activity like girl guides or dance classes so that I can meet new friends.
3. My goal for learning: I would like to do well at school and not get overwhelmed by other kids in my class.
During this plan I want to: Work with my counsellor and my mum to get better at managing my emotions. Work with a speech pathologist to learn better social communication skills.
Part 3: My Supports
These are the supports that will help me to work toward my goals.
Family and Friends
This is what the NDiS call 'informal' supports.
Mum and Grandma
Support to implement strategies recommended by my therapists
Support to keep on track with my school work
Services and community groups
These supports might include things like health or mental health services, schools or education services, community groups, sporting or hobby clubs or other government services. This is what the NDIS call 'community and mainstream' supports.
Assistance to manage mood and anxiety whilst at school
Girl Guides activity
Mum will help me find a hip hop class
St Joseph's school
School support meetings to address learning needs
NDIS reasonable and necessary supports
I can choose how I spend the amount in each budget listed below by checking the ND1S price list and the matching supports on the NDIS website participant page (ndis.qov.au/participants).
Where a support is listed in my plan as 'stated' I must purchase this support as it is described In the plan. I cannot swap 'stated' supports for any other supports listed in the price list
Improved Daily Living Skills. Ref: 00 004. Budget: $4,056.00
How will the supports be paid: NDIA will pay my support provider directly This support budget can only be used from: 30/09/2015 to 30/09/2016
Purpose of Support
Amy will receive 12 hourly sessions of Occupational Therapy to support independence in self-care and organisational skills.
This support is to include a functional assessment, therapy program, resource development, recommendations for family to implement in the home/community & liaising with other professionals involved. To include 3x staggered progress reports. Reporting to include outcomes of functional improvement in relation goats and objectives. Any further functional goals, recommended strategies and clinical justification for further therapy to be provided in final standardised assessment report prior to plan review.
Amy will receive 12 hourly sessions of Speech Therapy to develop expressive, receptive and pragmatic language skills.
This support is to include a functional assessment, therapy program, resource development recommendations for family to implement in the home/community & liaising with other professionals involved. To include 3x staggered progress reports. Reporting to include outcomes of functional improvement in relation goals and objectives. Any further functional goats, recommended strategies and clinical justification for further therapy to be provided in final standardised assessment report prior to plan review.
Claiming for Services Delivered
• Connect to participant plan using DoB and NDIS Reference Number
• Enter details of service and cost -note maximum rates
• Claim as frequently as business requires
• Payment in two business days
Plan - Provider Claiming
Planner conversation relating to outcomes - Data entry into Siebel - (revised) Plan generated - Participant chooses their supports and provider to achieve their goals - Participant & Provider make service agreement to describe supports delivered - Provider delivers supports - Self –managed participant claims for cost of supports delivered or, Provider claims against (revised shorter) price list for service delivered (existing process).
Role of providers
Fostering Partnerships : Single greatest difference to participants : Best placed to advise Governments on design : Foster goodwill in the local community and Scheme participants : Innovators : Tailoring services to the needs of individuals : Holistic approach – supports to individuals across all systems (health, mental health, justice system) : Support to realise participants’ goals
Phone: 1800 800 110
Email: firstname.lastname@example.org or email@example.com