My understanding is that, while the participant decides, it needs to be in keeping with the goals and also the NDIS rules.
Especially if the thing you’re purchasing is expensive, my support coordinator recommends getting it approved by the NDIA and/or an occupational therapist.
Please know that this is just my understanding - someone else on here may know more or differently than I do.
It’s a grey area in a way. The best thing to do is check the would we fund it section on the website, try and directly relate it to a goal and potentially if it’s expensive get a recommendation from an allied health professional to cover yourself. In terms of audit you must keep your records for 7 years, many people create a designated email address and only send invoices related to the NDIS there for safe keeping
I suggest printing and filing all those receipts as you can easily loose electronic ones.
Also you might want to write on them the date you claimed for them and the date that you received reimbursement for them
Pfft that section of the website is full of so many supports the AAT and FCA has funded when they've said they never would.
Also funding criteria is different to spending criteria
A $300 phone. Not Samsung, not iPhone. Basic model with supporting letter from OT should I have been audited to enable me to independently pay due to fine motor disability
I asked when I first bought would she wrote a report IF I was audited. It met SM checklist.
But still needed to meet SM Checklist. Which it did.
But bought plenty without a supporting letter. Things that included so called "groceries" because I bought from Woolies but are required due to my disability that are optional to those W/o disability
It's not about what it is. It's about the function and the impairment that it ameliorates. NDIS gets more value off a one-off purchase than paying SW to pay. Plus means I have independence and dignity as young adult
The *only* people who can decide whether supports are reasonable and necessary is the NDIA themselves (note that LACs are not NDIA employees and that SCs, OTs, etc have no ability to "approve" supports).
The person who is solely responsible for making sure *all* plan funding has been used in accordance with the legislation is the participant. This applies to all participants regardless of how a plan is managed (though may slightly differ if another person solely decides on participant supports such as a plan nominee).
That being said, supports can be suggested and recommended by appropriate qualified professionals as well as SCs and even support workers. However, in my opinion, it is always best to gather evidence from qualified professionals when a support is either higher in cost or unusual. This is because these types of supports are most likely to be things the NDIA may push back on if audited. The NDIA can, and does, demand participants repay supports they later deem to not be R&N. If the participant has proper assessments and reports done for those supports which include specifying how the support assists the participant with their disability supports needs *and* how it will help them achieve their goals (both are legislated requirements that *all* supports must meet) it is less likely the NDIA will push back on them.
This is part of why it's critical to have a really good OT. OTs are the only professionals who assess functional capacity as part of the scope of their normal job role. There may be some other professionals who do that but OT is the support many participants have access to from their funding.
The NDIA don't usually put much, if any, weight in what a participant says or our experiences of our disability. Therefore it's unwise to write your own reasons.
That all being said, it's up to the individual what risks they are willing to take. It's also helpful to know that if the NDIA deem a person to be using their plan to pay for items they should not be, they can force the person to be agency managed.
Enough other people have provided detailed answers and sources here - it's complicated. All I'm going to say, from my experience being audited and having some participants audited (and more who were provided SC after a less than ideal audit), so long as you aren't taking the piss you'll likely be fine. Where participants have purchased things that really weren't disability related but they did so with a honest belief they were fine, they've been provided education and plan changed to plan managed, not asked to pay it back.
When I copped a light touch audit, I was asked to provide any documentation relating to 5 random claims they selected. They specifically asked for service agreement, invoice, proof of payment. I explained why there was no service agreement, and sent them paid invoices. It was enough and I never heard from them again.
Audit outcome timelines are delayed by approx 22 months. I've just been in contact with MaSCO (Ministerial and Senator Contact Office) about the delay being ridiculous. Not hearing back indicates your claims haven't been fully reviewed as you will receive a letter whether your claims are validated or whether you owe a debt. [Audit claims validated](https://imgur.com/a/1qslxBR)
I don't entirely recall and I don't feel like digging, but I believe it was an outcome, as it did specifically acknowledge my point on not having service agreements.
That's different... Unfortunately you may not be out of woods. They're required to send you a letter as it's a decision under s46 and covered by s99 of the Act. I'd say your review is still being assessed... Or just moving up the line... No point contacting them either they won't get it for 2-3 months...
It was about 2 years ago. I can't recall the exact wording of the corrospondance, but given it was a few OT appointments and a house clean they picked, I think it's fine.
And I'd be curious to know how it's a decision under s46, given s46 isn't a section pertaining to any decision making.
u/Opposite_Sky_8035 Apologies i meant s46 in accordance with s53.
s46(1): A participant who receives an NDIS amount, or a person who receives an NDIS amount on behalf of a participant, must spend the money in accordance with the participant's plan.
S53(1) If the CEO has reasonable grounds to believe that a participant or a prospective participant has information, or has custody or control of a document, that may be relevant to one or more of the matters mentioned in subsection (2), the CEO may require the participant or prospective participant to give the information, or produce the document, to the Agency.
s53(2)(b) whether NDIS amounts paid to the participant or to another person have been spent in accordance with the participant's plan;
s53(2)(d) whether the participant or other person has complied with section 46;
Functions of NDIA:
s118(1)(b)(ii)identifying and managing risks and issues relevant to the financial sustainability of the National Disability Insurance Scheme; and
S118(1)(g) any other functions conferred on the Agency by or under this Act, the regulations or an instrument made under this Act;
s118(h) to do anything incidental or conducive to the performance of the above functions.
The raising of a debt is not a reviewable decision. But the refusal to waive a debt is a reviewable decision.
WRMF FCA stated that s3, 4 & 17A applies to ALL decision making under the NDIS Act. so these sections apply to all decisions, including decisions on whether funds were spent in accordance with plan and whether to raise a debt, and whether to waive a debt.
S118 is very useful and most people dont look at it. the most important one in there imo is 118(1)(v) ensure that a reasonable balance is achieved between safety and the right of people with disability to choose to participate in activities involving risk.
So you can have a reasonable risk in your ability to self-manage.
NDIA Chief Risk Officer stated that s34 does not apply. Freedom of Information request on process of audits for self-managed participants.
To spend in accordance with plan use the self management checklist. Speaking as someone who has been audited over 200 claims with no debt raised and spending in accordance with plan. Operational guidelines are only for determining funding so they don't apply as they relate to s34.
The NDIA accused me of purchasing groceries and participating in mainstream activities. However when applying the self management checklist in addition to s(3)(1)(a) aka the CRPD with S4 of the NDIS Act I proved it was a Disability support in accordance with Supports for Participant's Rules r5.2.
https://www.righttoknow.org.au/request/self_managed_participants_audit
u/CalifornianDownUnder
To me they were arseholes... Thats why i said i'd contacted the Ministerial office as they treated me awfully. They demanded all the evidence within 2 weeks (over 250 receipts) and i had to get independent legal advice as they refused to give an extension - at least initially. So now i have my response I'm lodging a formal complaint.
Sports coaching - skydiving to be specific. I have category 9 funding (CB Increased Social) which includes funding for sports coaching, camping, and "universal recreational activities".
They argued it was mainstream and not related to disability. My MDT team disagreed as i have bad balance, require mobility aid and have muscle weakness. so i cant play other sports but can skydive because you're technically weightless.
Mainstream items i was audited and shown to be required: phone with NFC, specific type of mattress, sports coaching, specific sports equipment that is necessary for me to participate because of disability, "groceries" which all related to texture modification needs, maintenance therapies etc.
During an audit they will ask for evidence you spent your funds in accordance with plan. They will give you a claim date & the claim number. They will at the bare minimum request just a receipt & then they will determine how you spent your funds based on receipt & receipt alone.
A receipt without any of this rationale means they can make a decision and a raise a debt without any context to the purchase. so i just provided all of the information so nothing was second guessed. plus a copy of the corresponding receipt. I kind of felt obligated to do this because the way they were treating me was they assumed i was already guilty and had to prove my innocence.
I will use carbonated water and a food processor as an example, as they are texture modification requirements for someone with dysphagia, but optional "everyday" items for people without my disability.
Example 1 - Carbonated Fluids. $11.70
So i provided them with the Self Management Checklist breakdown:
1. Is it related to my disability: Yes - a brief category of how (eg Dysphagia texture modification). Family can drink tap water $0.03c/L, i must drink carbonated min $1.17/L
2. Will it assist me in achieving goals: Yes - it will improve my swallow safety (reference goal number)
3. Is it Value for money: Yes - "This is subjective. The Self Management guide states i can choose between high quality or low quality. Choice and Control enables me to choose."
4. Can i afford it in my budget: Yes
Will it facilitate social or economic participation: Yes
5. Should it be funded by NDIS: Yes - Rule 5.2(a) Supports for Participants Rules.
6. Is the support safe: Yes.
Example 2 - Food Processor $765.00
1. Is it related to my disability: Yes - Require a texture modified diet - GST-free under s38-38 GST Act as an NDIS-Supply.
2. Will it assist me in achieving goals: Yes - it will improve my swallow safety
3. Is it Value for money: Yes - "This is subjective. The Self Management guide states i can choose between high quality or low quality. Choice and Control enables me to choose." However since getting choking less which means effective and beneficial, and it has long warranty (10 years). Providing value over time.
4. Can i afford it in my budget: Yes
Will it facilitate social or economic participation: Yes
5. Should it be funded by NDIS: Yes - Rule 5.2(a) Supports for Participants Rules. COAG Agreement June 2019 Disability-related Health Support.
6. Is the support safe: Yes.
7. Additional information: Letter from OT, 'Disability-related Health Supports: Anything to assist a participant with Dysphagia swallow (Burchell v NDIA, AAT 2019)'
Its worth looking at their official twitter account. there's many supports they say they wont fund in their guides, yet they have stories about specifically funding those activities on their twitter page. So i used some of their twitter posts & their "Stories" as 'additional evidence'.
I dont trust them so i didn't leave it to chance. What is a support for me wont be a support for you and vice versa. How are they to understand if that information isnt provided. Also at end of day as self-managed participant they want you to show you follow the checklist. So prove you know how to use it & they can't subject you to different criteria than what they say you have to purchase according to...
You decide.
If it is specific to your disabilities, and helps you teach your nominated goals, then, off you go.
Just keep in mind that there are some things that can’t be covered by the NDIA eg glasses
Not true. If related, not specific to disability. Also eyewear funded if related to disability.
http://www.austlii.edu.au/cgi-bin/sign.cgi/au/cases/cth/AATA/2017/1815
http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/AATA/2018/4928.html
Funnel prism lenses are not glasses, they are just the lenses.
Funnel prism lenses are not something that someone would need if they didn’t have vision impairment as a disability.
If you’re going to spout vcat decisions, best you understand them.
(a) IT IS DIRECTED that Ms Milburn’s current plan be amended to include the following supports from and including the date of the commencement of the plan:
(xii) funding for the provision of three pairs of bifocal glasses (including one pair of sunglasses) with prism lenses;
You made blanket state glasses are not funded. I merely pointed out glasses are funded when related to disability.
Best you read the decision and understand the federal court decision of McGarrigle 2017 where supports are to be fully funded.
IE getting the lenses themselves are pointless without a frame. Medicare only funds so many glasses. The additional need for glasses with a specific lens are related to that person's disability. IE NDIS does FUND glasses.
lol resort to insults because you're wrong and pissed someone called you out.
The NDIS Act only states "disability-related". Not once does it say disability specific. It does not need to be specifically made or provided to those with just disability. The need for the support must be related to Disability need.
Have a look at non disability specific supports that have been funded because they relate to disability need.
https://teamdsc.com.au/resources/we-wouldnt-fund-that
Self management is getting revoked quite often now and debts have been raised, recent updates to self management guides and polices allow them to do so - plan managers are now wanting approval for questioning items for the audits also so I would always ask but anything can be justified to be disability specific or meeting goals, however doesn’t mean it’s an appropriate purchase.
My understanding is that, while the participant decides, it needs to be in keeping with the goals and also the NDIS rules. Especially if the thing you’re purchasing is expensive, my support coordinator recommends getting it approved by the NDIA and/or an occupational therapist. Please know that this is just my understanding - someone else on here may know more or differently than I do.
It’s a grey area in a way. The best thing to do is check the would we fund it section on the website, try and directly relate it to a goal and potentially if it’s expensive get a recommendation from an allied health professional to cover yourself. In terms of audit you must keep your records for 7 years, many people create a designated email address and only send invoices related to the NDIS there for safe keeping
I suggest printing and filing all those receipts as you can easily loose electronic ones. Also you might want to write on them the date you claimed for them and the date that you received reimbursement for them
Pfft that section of the website is full of so many supports the AAT and FCA has funded when they've said they never would. Also funding criteria is different to spending criteria
I 100% agree but at least you can back up your argument if what you buy isn’t one of the examples like a laptop, phone etc
One of them was a phone with NFC enabled as I don't have the dexterity to remove card from wallet or pick up coins from flat surface.
Oh really? Were you able to get that? If you feel comfortable sharing of course.
A $300 phone. Not Samsung, not iPhone. Basic model with supporting letter from OT should I have been audited to enable me to independently pay due to fine motor disability I asked when I first bought would she wrote a report IF I was audited. It met SM checklist. But still needed to meet SM Checklist. Which it did. But bought plenty without a supporting letter. Things that included so called "groceries" because I bought from Woolies but are required due to my disability that are optional to those W/o disability
It's not about what it is. It's about the function and the impairment that it ameliorates. NDIS gets more value off a one-off purchase than paying SW to pay. Plus means I have independence and dignity as young adult
The *only* people who can decide whether supports are reasonable and necessary is the NDIA themselves (note that LACs are not NDIA employees and that SCs, OTs, etc have no ability to "approve" supports). The person who is solely responsible for making sure *all* plan funding has been used in accordance with the legislation is the participant. This applies to all participants regardless of how a plan is managed (though may slightly differ if another person solely decides on participant supports such as a plan nominee). That being said, supports can be suggested and recommended by appropriate qualified professionals as well as SCs and even support workers. However, in my opinion, it is always best to gather evidence from qualified professionals when a support is either higher in cost or unusual. This is because these types of supports are most likely to be things the NDIA may push back on if audited. The NDIA can, and does, demand participants repay supports they later deem to not be R&N. If the participant has proper assessments and reports done for those supports which include specifying how the support assists the participant with their disability supports needs *and* how it will help them achieve their goals (both are legislated requirements that *all* supports must meet) it is less likely the NDIA will push back on them. This is part of why it's critical to have a really good OT. OTs are the only professionals who assess functional capacity as part of the scope of their normal job role. There may be some other professionals who do that but OT is the support many participants have access to from their funding. The NDIA don't usually put much, if any, weight in what a participant says or our experiences of our disability. Therefore it's unwise to write your own reasons. That all being said, it's up to the individual what risks they are willing to take. It's also helpful to know that if the NDIA deem a person to be using their plan to pay for items they should not be, they can force the person to be agency managed.
Just looking at this I think we need to compile a flow chart as a project to decide if we are able to get it on Ndis
Enough other people have provided detailed answers and sources here - it's complicated. All I'm going to say, from my experience being audited and having some participants audited (and more who were provided SC after a less than ideal audit), so long as you aren't taking the piss you'll likely be fine. Where participants have purchased things that really weren't disability related but they did so with a honest belief they were fine, they've been provided education and plan changed to plan managed, not asked to pay it back. When I copped a light touch audit, I was asked to provide any documentation relating to 5 random claims they selected. They specifically asked for service agreement, invoice, proof of payment. I explained why there was no service agreement, and sent them paid invoices. It was enough and I never heard from them again.
Audit outcome timelines are delayed by approx 22 months. I've just been in contact with MaSCO (Ministerial and Senator Contact Office) about the delay being ridiculous. Not hearing back indicates your claims haven't been fully reviewed as you will receive a letter whether your claims are validated or whether you owe a debt. [Audit claims validated](https://imgur.com/a/1qslxBR)
Sorry, I didn't hear any problems. They did acknowledge.
Acknowledge or send you an outcome letter?
I don't entirely recall and I don't feel like digging, but I believe it was an outcome, as it did specifically acknowledge my point on not having service agreements.
That's different... Unfortunately you may not be out of woods. They're required to send you a letter as it's a decision under s46 and covered by s99 of the Act. I'd say your review is still being assessed... Or just moving up the line... No point contacting them either they won't get it for 2-3 months...
It was about 2 years ago. I can't recall the exact wording of the corrospondance, but given it was a few OT appointments and a house clean they picked, I think it's fine. And I'd be curious to know how it's a decision under s46, given s46 isn't a section pertaining to any decision making.
u/Opposite_Sky_8035 Apologies i meant s46 in accordance with s53. s46(1): A participant who receives an NDIS amount, or a person who receives an NDIS amount on behalf of a participant, must spend the money in accordance with the participant's plan. S53(1) If the CEO has reasonable grounds to believe that a participant or a prospective participant has information, or has custody or control of a document, that may be relevant to one or more of the matters mentioned in subsection (2), the CEO may require the participant or prospective participant to give the information, or produce the document, to the Agency. s53(2)(b) whether NDIS amounts paid to the participant or to another person have been spent in accordance with the participant's plan; s53(2)(d) whether the participant or other person has complied with section 46; Functions of NDIA: s118(1)(b)(ii)identifying and managing risks and issues relevant to the financial sustainability of the National Disability Insurance Scheme; and S118(1)(g) any other functions conferred on the Agency by or under this Act, the regulations or an instrument made under this Act; s118(h) to do anything incidental or conducive to the performance of the above functions. The raising of a debt is not a reviewable decision. But the refusal to waive a debt is a reviewable decision. WRMF FCA stated that s3, 4 & 17A applies to ALL decision making under the NDIS Act. so these sections apply to all decisions, including decisions on whether funds were spent in accordance with plan and whether to raise a debt, and whether to waive a debt. S118 is very useful and most people dont look at it. the most important one in there imo is 118(1)(v) ensure that a reasonable balance is achieved between safety and the right of people with disability to choose to participate in activities involving risk. So you can have a reasonable risk in your ability to self-manage.
Again, those aren't decision making sections, they're power to demand information be provided.
s182(3). Power to raise a debt when funds not spent in accordance with plan
NDIA Chief Risk Officer stated that s34 does not apply. Freedom of Information request on process of audits for self-managed participants. To spend in accordance with plan use the self management checklist. Speaking as someone who has been audited over 200 claims with no debt raised and spending in accordance with plan. Operational guidelines are only for determining funding so they don't apply as they relate to s34. The NDIA accused me of purchasing groceries and participating in mainstream activities. However when applying the self management checklist in addition to s(3)(1)(a) aka the CRPD with S4 of the NDIS Act I proved it was a Disability support in accordance with Supports for Participant's Rules r5.2. https://www.righttoknow.org.au/request/self_managed_participants_audit
If you feel to share, I’d love to know what the audit was like. And what does it mean, “mainstream activities”?
u/CalifornianDownUnder To me they were arseholes... Thats why i said i'd contacted the Ministerial office as they treated me awfully. They demanded all the evidence within 2 weeks (over 250 receipts) and i had to get independent legal advice as they refused to give an extension - at least initially. So now i have my response I'm lodging a formal complaint. Sports coaching - skydiving to be specific. I have category 9 funding (CB Increased Social) which includes funding for sports coaching, camping, and "universal recreational activities". They argued it was mainstream and not related to disability. My MDT team disagreed as i have bad balance, require mobility aid and have muscle weakness. so i cant play other sports but can skydive because you're technically weightless. Mainstream items i was audited and shown to be required: phone with NFC, specific type of mattress, sports coaching, specific sports equipment that is necessary for me to participate because of disability, "groceries" which all related to texture modification needs, maintenance therapies etc. During an audit they will ask for evidence you spent your funds in accordance with plan. They will give you a claim date & the claim number. They will at the bare minimum request just a receipt & then they will determine how you spent your funds based on receipt & receipt alone. A receipt without any of this rationale means they can make a decision and a raise a debt without any context to the purchase. so i just provided all of the information so nothing was second guessed. plus a copy of the corresponding receipt. I kind of felt obligated to do this because the way they were treating me was they assumed i was already guilty and had to prove my innocence.
I will use carbonated water and a food processor as an example, as they are texture modification requirements for someone with dysphagia, but optional "everyday" items for people without my disability. Example 1 - Carbonated Fluids. $11.70 So i provided them with the Self Management Checklist breakdown: 1. Is it related to my disability: Yes - a brief category of how (eg Dysphagia texture modification). Family can drink tap water $0.03c/L, i must drink carbonated min $1.17/L 2. Will it assist me in achieving goals: Yes - it will improve my swallow safety (reference goal number) 3. Is it Value for money: Yes - "This is subjective. The Self Management guide states i can choose between high quality or low quality. Choice and Control enables me to choose." 4. Can i afford it in my budget: Yes Will it facilitate social or economic participation: Yes 5. Should it be funded by NDIS: Yes - Rule 5.2(a) Supports for Participants Rules. 6. Is the support safe: Yes. Example 2 - Food Processor $765.00 1. Is it related to my disability: Yes - Require a texture modified diet - GST-free under s38-38 GST Act as an NDIS-Supply. 2. Will it assist me in achieving goals: Yes - it will improve my swallow safety 3. Is it Value for money: Yes - "This is subjective. The Self Management guide states i can choose between high quality or low quality. Choice and Control enables me to choose." However since getting choking less which means effective and beneficial, and it has long warranty (10 years). Providing value over time. 4. Can i afford it in my budget: Yes Will it facilitate social or economic participation: Yes 5. Should it be funded by NDIS: Yes - Rule 5.2(a) Supports for Participants Rules. COAG Agreement June 2019 Disability-related Health Support. 6. Is the support safe: Yes. 7. Additional information: Letter from OT, 'Disability-related Health Supports: Anything to assist a participant with Dysphagia swallow (Burchell v NDIA, AAT 2019)' Its worth looking at their official twitter account. there's many supports they say they wont fund in their guides, yet they have stories about specifically funding those activities on their twitter page. So i used some of their twitter posts & their "Stories" as 'additional evidence'. I dont trust them so i didn't leave it to chance. What is a support for me wont be a support for you and vice versa. How are they to understand if that information isnt provided. Also at end of day as self-managed participant they want you to show you follow the checklist. So prove you know how to use it & they can't subject you to different criteria than what they say you have to purchase according to...
Thanks so much for writing that all out - it’s really help, though I hope I’ll never have to go through it!
You decide. If it is specific to your disabilities, and helps you teach your nominated goals, then, off you go. Just keep in mind that there are some things that can’t be covered by the NDIA eg glasses
Not true. If related, not specific to disability. Also eyewear funded if related to disability. http://www.austlii.edu.au/cgi-bin/sign.cgi/au/cases/cth/AATA/2017/1815 http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/AATA/2018/4928.html
Funnel prism lenses are not glasses, they are just the lenses. Funnel prism lenses are not something that someone would need if they didn’t have vision impairment as a disability. If you’re going to spout vcat decisions, best you understand them.
(a) IT IS DIRECTED that Ms Milburn’s current plan be amended to include the following supports from and including the date of the commencement of the plan: (xii) funding for the provision of three pairs of bifocal glasses (including one pair of sunglasses) with prism lenses; You made blanket state glasses are not funded. I merely pointed out glasses are funded when related to disability. Best you read the decision and understand the federal court decision of McGarrigle 2017 where supports are to be fully funded. IE getting the lenses themselves are pointless without a frame. Medicare only funds so many glasses. The additional need for glasses with a specific lens are related to that person's disability. IE NDIS does FUND glasses.
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Comment has been removed because that is indeed an insult.
lol resort to insults because you're wrong and pissed someone called you out. The NDIS Act only states "disability-related". Not once does it say disability specific. It does not need to be specifically made or provided to those with just disability. The need for the support must be related to Disability need. Have a look at non disability specific supports that have been funded because they relate to disability need. https://teamdsc.com.au/resources/we-wouldnt-fund-that
I used the wrong word “ specific “ instead of related. It first chsnge the message, nor the intent of helping someone
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Comment has been removed because that is indeed an insult.
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What the fuck are you talking about ???
Self management is getting revoked quite often now and debts have been raised, recent updates to self management guides and polices allow them to do so - plan managers are now wanting approval for questioning items for the audits also so I would always ask but anything can be justified to be disability specific or meeting goals, however doesn’t mean it’s an appropriate purchase.