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NDIS Legislation Changes

General

What supports can and cannot be claimed from NDIS funding?

The NDIS has published a list of Approved and Non-approved supports. 

The approved support list documents all supports claimable under the NDIS, not all supports will be included in your plan. Generally you can find more information about what types of supports you can access by looking at your plan document and your funding categories (components).

Items on the Non-approved support list are not able to be claimed from your plan. It is important to check if you are unsure to avoid being out of pocket for these expenses. 

You can read more on the NDIS website: Supports funded by the NDIS

What are Reasonable and Necessary Supports?

The NDIS only funds supports that meet the reasonable and necessary criteria.

A support will usually be funded if it meets all of the following:

  •     It relates to your disability or early intervention needs
  •     It helps you work towards your goals
  •     It supports your social and/or economic participation
  •     It is value for money
  •     It is effective and beneficial for you
  •     It helps maintain your informal supports
  •     It is considered an approved NDIS support under legislation

Even if you have funding available in your plan, a support must still meet these criteria to be claimable.

Can I use my funding to pay for something on the non-approved list if I think it is reasonable and necessary?

No, participants are unable to claim supports from the non-approved supports list unless one of the following situations apply.

  • It is a replacement support (please note, this has a set process to follow).
  • It is funded in your current plan or supported by a letter from the Administrative Review Tribunal (ART). 
  • You receive written permission from the NDIA to allow the purchase of the non-approved item.
What is a replacement support?

Some items are generally not approved NDIS supports, but in certain circumstances, you may be able to request them as a Replacement Support.

A replacement support:

  • Must be approved by the NDIA in writing
  • Is not automatic
  • Is not an extra support
  • Replaces an existing support in your plan

Important: Replacement supports usually only apply to items such as:

  • Standard commercially available household items (for example, a washing machine or dishwasher)
  • Smart watches
  • Tablet devices
  • Smartphones
  • An app for accessibility or communication

We cannot process payment unless written NDIA approval is provided. If you are unsure, please contact us before purchasing the item.

How can I ask for written permission to claim a non-approved support?

This request needs to be sent to the NDIA. You can contact the NDIA through:

If the NDIA or planner told me on the phone it was okay, can I purchase the item?

Unfortunately, the NDIA has confirmed that written authorisation or approval is required to support the claim of items that are no longer approved.

Until written approval from the NDIS is provided to your plan manager, we are unable to process the claim; this is to make sure that you are not asked to pay money back to the NDIS or face other compliance action.

My support coordinator, or provider has written a support letter for this non-approved item; can I purchase it?

Unfortunately, letters of support from providers, even therapists, is not sufficient evidence to claim a Non-approved item through NDIS funding. 

The NDIA or planner told me that my plan manager can decide if it is okay to be claimed. Why won’t you process the claim?

Plan managers are not able to approve a non-approved support claim. 

This is because these supports are not available from NDIS funding, and claiming the invoice can put the plan management organisation and the participant at risk of being asked to pay the money back. 

What happens if a non-approved support is claimed?

The NDIA is increasing their audits on invoices, and it is becoming more common for claims to be checked. If your invoice is checked and the NDIA decides it is not an appropriate use of NDIS funding, they can take compliance action.  

This can include:

  • Cancelling your claims before the money is sent to the provider.
  • Asking you to pay the money back.
  • Changing how your plan is managed (i.e. making your funding NDIA managed).
My plan manager has claimed this before; why not now?

The NDIA is increasing their audits on invoices and it is becoming more common for claims to be checked. If your invoice is checked and the NDIA decides it is not an appropriate use of NDIS funding they can take compliance action. 

 

This can include:

  • Cancelling your claims before the money is sent to the provider.
  • Asking you to pay the money back.
  • Changing how your plan is managed (ie. making your funding NDIA managed).
What if a support is not listed in my plan?

Your NDIS plan will list the supports included, some parts of your plan have more flexibility than others. 

 

You may be asked for a copy of the plan, or a new copy to allow your plan manager to review the supports and make sure that purchases are in line with your budget.

Other Claiming Rules

Gap fees - can providers charge above the NDIS price limit?

No, all providers providing services to a participant with a plan managed plan are only able to claim up to the maximum rate set by the NDIA.

 

Extra fees such as gap fees are not able to be claimed and are considered a breach of the NDIS rules.

Can family members be paid support workers?

No, typically the NDIS does not allow paid support from family members as this can impact the family relationship and the informal supports a participant receives.

 

The NDIA only supports relatives and family members being paid for services in very special cases and this needs to be confirmed in writing by the NDIA.

Can an invoice be submitted after 2 years?

No, all claims must be submitted to the NDIA within two years of the support date. After this, it is no longer claimable. 

What is a provider banning order?

A banning order is a formal order sent to a service provider by the NDIS Quality and Safeguards Commission. Providers with a banning order are not permitted to submit or claim invoices for services delivered to NDIS participants.

 

If you are concerned your provider may have been banned, you can search for banning orders on the NDIS Commission website.

What is a conflict of interest for providers and participants?

A conflict of interest occurs when a provider or organisation has competing interests that may influence their decisions or actions.

 

NDIS providers should avoid situations where their personal, financial or professional interests could affect the supports provided to participants.

 

Providers must act in the best interests of participants and be transparent about any potential conflicts of interest.

What notice do I need to give to my service providers to not have to pay a cancellation fee?

If a participant cancels a support at short notice or does not attend a scheduled support (no show), the provider may still be able to claim the cost of that support from the participant’s NDIS funding, in line with the NDIS Pricing Arrangements and the service agreement.

 

Generally, this applies when less than 2 clear business days’ notice is provided (or 7 days for some support work supports).

 

Providers can only claim if they were unable to find alternative work for that time and the worker still needed to be paid. Providers may choose to waive cancellation fees depending on the circumstances

Short Term Respite (STR)

What is STR?

STR (formerly known as Short Term Accommodation) allows you to have time apart, for at least one night, from your primary informal supports such as family and friends who give you the majority of your unpaid, active, disability-related support. 

 

This provides the opportunity for you to be supported by someone else, while giving your family or friends a short break from their usual caring responsibilities. It lets you try something else and helps you pursue your goals like increasing your independence or building your skills.

Can everyone access 1 on 1 STR?

Some participant plans have been funded for STR in a group setting. 

 

While there is some flexibility within your core supports, continuing to claim at a lower group ratio or even one on one will likely impact the amount of time you can access STR or impact funding available for other supports. This is because your budget is calculated based on the STR rate for the ratio of support that is listed.

 

For more information you can speak with your NDIS planner about what has been included. 

When is SRT not funded?

STR is not typically funded by the NDIA if:

  • If you live alone independently and don’t have drop-in supports. 
  • You get more than 18 hours paid supports in your home each date, regardless of who you live with. 
  • You’re not having a break from your family or friends who you live with, or give your significant daily drop-in support. 
  • It’s a day-to-day living cost that anyone is expected to pay, for example your mortgage, rent or utilities. 
  • You’re waiting for home modifications to be done. 
  • You’re living in a supported independent living (SIL) arrangement. 
  • You have funding for primary or supplementary individualised living options.
  • You’re in a housing crisis situation (if you are homeless or need somewhere to live you can contact homeless services in your State or Territory).
Can I use STR if I live alone or in supported independent living (SIL)?

The NDIA has published more information regarding the use of STR for participants living alone or in SIL. 

 

This shows that participants who live alone or in SIL are unable to use STR supports. This is because if a participant is living alone or in a supported independent living arrangement, they already have time apart from family and informal supports.

What can’t I use STR to do?

Holidays - You can’t use it to go on a cruise or tour or holiday. You can’t use it for accommodation on holidays or airfares or other holiday or travel items, including interstate and overseas travel for holidays. It’s also not for your family or friends to stay in accommodation or to attend programs. 

 

Transport - you can’t use your STR funding to pay for transport to get to your respite accommodation or activity if you can travel or use public transport independently. If you need specialised transport this may be paid for. If your plan includes separate funding for Transport, you can continue to use this funding to travel to and from your STR. The NDIS will not fund a claim for Activity Based Transport where your carer did not stay and support you in your activity in the community. 

 

Meals - If your meals are an extra cost while you’re staying in short term respite, you can’t use your NDIS funding for this. These are day-to-day living costs and are not NDIS supports. 

 

Activities - You can’t use your NDIS funding to pay for activities, such as tickets, entry fees, equipment, or membership fees for yourself, your support worker or your family or friends

Community Support & Activities

My goal is to attend lessons/activities/groups, can the NDIS pay for my classes?

The general costs of your social and recreation activities are considered an everyday cost. This means you’ll pay for things like membership, basic equipment or entrance fees.

 

If you need extra help to participate in social and recreation activities because of your disability, the NDIS may be able to fund this. This might include: support to attend and participant in the activities, some specialised equipment


More information can be found in the Operational Guidelines for Social and recreational supports.

Can specialised equipment be claimed?

If you need modifications or specialised equipment to participate in an activity, the NDIS may be able to claim this.  

 

Typically, if you are participating as a professional, for example competitive sports, this is not able to be claimed. 

Therapy

What therapy supports can be claimed?

There are a number of therapy supports that can be claimed. This may depend on your plan and what supports have been included. 

 

Therapy should be delivered by professionals with an allied health registration and qualification. 

 

A few examples of therapy supports that may be able to be claimed include: occupational therapy, speech therapy, physiotherapy, psychology etc.

What about other therapies that the NDIS does not include as ‘evidence based’?

The non-approved support list provides some examples of therapies that the NDIS believes are not evidence based. These are unable to be claimed. 

 

A few examples include: animal therapy, cuddle therapy, hair therapy, yoga therapy etc.

Are art and music therapy NDIS supports?

The NDIS has determined that art and music therapy remain allowed however there has been a change to the maximum rate these providers can charge. 

 

Providers of these supports must meet minimum qualification requirements to be eligible to claim as a therapy support.