The NDIA announced a long list of changes and updates late last month. Here is an overview in case you have missed these:
New Price Guide and Support Catalogue valid from 1 October 2019
Disability-related health supports
The new NDIS Price Guide (version 1.2) introduces disability-related health supports as agreed by the COAG Disability Reform Council meeting in June. The NDIS will now fund health supports where the supports are a regular part of the participant’s daily life and result from the participant’s disability. Funded disability-related health supports include dysphagia supports, respiratory supports, nutrition supports, diabetic management supports, continence supports, wound and pressure care supports, podiatry and foot care supports and epilepsy supports. More information about these supports can be found in the Price Guide (page 20). The NDIS Support Catalogue lists more than 90 disability-related health supports line items. Supports should be claimed if:
- provided by disability support workers – as standard core support items
- provided by therapists – as standard ECEI and therapy support items
- provided by nurses – as nursing support items (NEW, more information below)
- consumables – as low-cost or high-cost disability related health consumables (e.g. thickeners, wound care dressings and catheter bags)
- assistive technology – as disability related health assistive technology support line items (e.g. ventilators, epilepsy monitoring devices).
From 1 October, NDIS participants can access these supports through their NDIS plan. Individuals do not have to wait for a plan review and can use unspent core support budgets to purchase reasonable and necessary disability-related health supports (except for Assistive Technology items over $1,500). Participants are not permitted to claim for health supports from their plans when those supports do not relate to their disability, if supports needs become acute or if they do not require theses supports on a regular basis. To allow for a seamless transition, state and territory health services should continue to provide disability-related health supports where such supports are not yet accessible through the NDIS plan. State and territory health services can assist to escalate urgent and priority cases with the NDIA for early plan review.
New Nursing support items
Community nursing care (registration group 114) can be delivered by five levels of nurses: enrolled nurse, registered nurse, clinical nurse, clinical nurse consultant and nurse practitioner. Supports can be provided under core (Assistance with daily life) or capacity building (Improved daily living skills) to allow for flexibility during the transition stage. There are 30 new support line items in each category. Different price limits apply, depending on the level of the nurse, and the time and day of the support. The definition of nursing levels is summarised in the Price Guide (page 47). Providers should always confirm with the participant that they have funding in core or capacity to pay for the support. In the long term, nursing supports will be funded through the capacity building budget.
Changes for Therapeutic supports
- Therapeutic supports (registration group 128) are now also available through core funding (Assistance with daily life) including assessment, recommendation, therapy and/or training by a psychologist, physiotherapist, other therapist or a dietician consultation. We suspect that this is a transitional arrangement so participants can use core funding to access disability health supports. As done previously, other therapeutic supports should be provided under the capacity building line items (Improved daily living skills).
- Exercise physiology (individual or in a group) in Improved health and wellbeing (support category 12) and in Improved daily living skills (support category 15) can also be delivered by therapeutic supports (registration group 128). Previously, these supports were restricted to registration group 126 (physical wellbeing). The support catalogue lists four new item numbers 12_027_0128_1_3, 12_028_0128_1_3 and 15_200_0128_1_3, 15_201_0128_1_3.
- Improved daily living skills (support category 15) also includes dietician consultation and diet plan development (individual or in a group) both of which can be delivered by therapeutic supports (registration group 128). The support catalogue lists two new item numbers 15_060_0128_3_3 and 15_061_0128_3_3.
- In light of these changes, registration group 126 (physical wellbeing) is only required for the delivery of personal training.
Changes for Early Childhood Early Intervention supports
Early Childhood Early Intervention (ECEI) supports are now also accessible through core funding (Assistance with daily life) as an alternative to capacity building funding (Improved daily living skills). We believe this is also a transitional arrangement. The ECEI support description is in the Price Guide (page 46) and the support line items have been updated to introduce the supports via the key worker model.
More changes from the October Price Guide and Support catalogue
- The price limit for Capacity Building and Training in Plan and Financial Management has been increased to $60.16 (14_031_0127_8_3).
Support items relating to supports in residential age care facilities that were previously removed from the Price Guide have been reintroduced (01_049_0115_1_1 and 01_050_115_1_1).
- Providers delivering quotable items and non-price controlled items cannot charge separately for travel, non-face-to-face, report writing and cancellation. Costs should be included in the quote to the participant.
- A new list and definition of isolated towns that are now classified as remote locations is published in the Price Guide (page 11).
- SIL providers must use the latest SIL tool template and can no longer submit quotes in the previous format (see page 25 of the Price Guide).
- The Price Guide gives examples how providers should claim for participant transport (page 15).
Other changes for providers and participants
Removal of plan gaps
The end date of NDIS plans will now be automatically extended in case of delays with the plan review process. A plan that expires within seven days will receive an extension for a period of 28 days. Participants will be able to spend remaining funds, with core and capacity funding increasing in line with the days in the extension. The end date of existing service bookings will extend as well if the service booking end date is the same as the plan end date. Providers and participants will receive a notification about the extension in the portal. Providers will need to monitor the value of the service booking and communicate with clients as the allocated amount might have been used up towards the end of the plan. Service agreements do not automatically extend (unless specified in the service agreement). Providers and participants will need to communicate if the participant would like to continue existing support, if necessary funds are available and if the allocated amount in the service booking needs to be modified.
Plans that receive periodic transport supports cannot be automatically extended. If this is the case, the old plan will only be extended once the new plan is approved. Service bookings will also be extended once the new plan is approved. Providers can request payment under the old plan if services have been provided in the gap (however this is only if sufficient funds are available).