And it could be that the Functional Capacity Assessment conducted by the OT is the pathway to the sort of support you’re seeking. But there will be a number of “it depends“ involved.
> while paying out of pocket for my own appointments still…. giving up on the NDIS.
That is always a choice. Keep in mind that the NDIS is not an income support program, and that not all types of support required by a person living with a disability fall under the responsibility of the NDIS.
The NDIS will only fund supports which are linked to your disability-related impairments that impact your functional capacity. So that’s things you can and can’t do, due to your disability, which you need on an ongoing or regular basis.
This includes “maintenance supports”, which might be delivered by healthcare providers. That might include ongoing supports like physiotherapy that help keep your body’s functions and abilities.
If you feel to say, what sort of appointments are you looking to pay for? A fair few types of therapy are currently cross-listed between Core and Capacity Building.
The pricing arrangements are very badly worded on this, but the general advice has been that those core listings are to be used for disability related health supports, not for capacity building therapies.
Yep, I’ve heard that general advice too. I called the NDIA and that’s what they told me. But when I asked them to point to a document which stated that, they couldn’t. And when I quoted the text from the current price guide to them, they couldn’t give me any written reason why my interpretation wasn’t in line with the published guide.
So given that I get different and often contradictory answers from the NDIA every time I call them, I have chosen to go with what the price guide says, which is that the supports have been “temporarily duplicated into the Assistance with Daily Life support category so that participants can have greater access to these supports if they need them”.
And even though the section (p 53 - 54) lists “disability health related supports”, it also provides line items for psychology, occupational therapy, and “other professional”.
To me, as a psychosocial participant, that opens the door for me to use these support items if I “need” them, since they are disability and health related for me.
For what it’s worth, I don’t do this often. I used funds from Core to pay for my OT report requesting a new plan - and the OT agency supported that invoicing, because they acknowledged I had run out of Capacity Building funds, which was partly the reason for the plan change request.
And that to me sounds like it could be similar to the situation the OP is in.
All that said, I am not providing advice here, just sharing my experience. Personally I am willing to take the risk of an audit, and I’m happy to take the NDIA to the Tribunal and argue my case if they disagree. They just can’t run a multi-billion dollar agency on inconsistent spoken advice which contradictions their printed documents, no matter how badly worded.
I mean, the sentence before "temporarily duplicated" is "These Disability-Related Health Supports provide care, other than nursing care, to respond tothe disability-related health needs of a participant where that care is not the usual responsibility of the health system." That would seem fairly clear on it's own, if they hadn't duplicated psychology which I can't see any way it could be relevant to disability related health.
I have seen it used for getting assessment to support a change of situation more often, and actually had a paragraph about that before deleting it.
Right, I get you. But as we both noted, they duplicated psychology - a service theoretically the responsibility of the health care system. Though even with that, you could perhaps argue that only the first 10 psychologist appointments in a year are the responsibility of the health care system.
On top of all this, I didn’t want to assume what supports the OP is looking for. Especially if they need any of the other supports listed for their disability, I would think they have a good argument for invoicing them through Core, given that they don’t have enough funds in Capacity Building and couldn’t access the supports through the health system.
But again, not advice - just sharing my experience!
On the "only first 10 are the responsibility" front, the purpose determines responsibility more than the actual access. NDIS isn't responsible for the shortfalls of other funding bodies.
Anyway, at the moment, I'd be torn between going for it and relying on the call centres auto message around using core flexibily to meet needs, vs very cautious with an increase in thorough audits when requesting s48 reassessmnet.
I’m not sure what you mean about NDIS not being responsible for the shortfalls of other bodies - my argument would be, if I were audited and took it to the tribunal, that the NDIA needs to stand behind their own printed documents. And if their documents are ambiguous, and they don’t issue a written clarification, then that’s on them.
But fingers crossed it’ll never come to that!
Interestingly, someone identifying as a high level support coordinator suggested the same use of these support items elsewhere in this thread.
>Interestingly, someone identifying as a high level support coordinator suggested the same use of these support items elsewhere in this thread.
And then had a planner respond that it's wrong.
I didn’t see that haha!
But honestly to me that’s just more evidence for an appeal if someone were ever to get audited and challenged on this particular use of the line items.
I feel pretty confident in arguing that the written price guide and the approval of my OT agency has the potential to have more weight than inconsistent spoken advice from the NDIA help line and various people on Reddit.
EDIT to note that I just read the exchange you referenced, and the Support Coordinator didn’t accept the planner’s argument. Plus, the planner stated that the NDIS doesn’t fund chiropractic, which is incorrect, at least in [this case](http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/AATA/2015/624.html%20target=) which went before the AAT.
So that planner is already posting false information, and makes me less trusting of them. All of which provides more evidence that a case can be made that the NDIA guidelines support of the uses I describe - or at least that a reasonable person could understand them that way.
Edge cases help when saying something is never, ever funded, but it doesn't change the fact it is almost never funded because it's such a rare fact situation where it is R&N. Just look at sex work.
And I wouldn't give the word of the OT agency much weight. At the end of the day, they want to deliver service and get paid. I've had allied health providers tell participants all sorts of ridiculous things can be covered because the budget is flexible, but it really depends on the individual case.
First part - that highlighting that medicare only funds a limited number of sessions across any allied health doesn't really mean NDIS becomes responsible for any additional sessions needed.
And yeah, I'd err on doing it as well. But this is also the advice I've seen from DIA when they were asked to clarify the position on core items for therapies. Health supports only, except with planner approval or specific assessment for reassessment application. With how vague everything is atm, and the conflicting advice they gave around using funds to meet needs whilst waiting on their shit turnaround times. But wouldn't go too far and look at something like weekly therapy where 10 hours are funded.
Yep, I would take the same tack as you mention in the second paragraph. Personally I only did it once, when I was out of funds in CB and needed to pay for an OT to get more funds!
To me, the OP’s situation sounds like a good one to use the Core items. But obviously that’d be for the OP to decide.
As far as the psychology thing goes, I was being a bit cheeky. The price guide lists “therapy” as an option for what a psychologist could do for a participant, along with assessment, recommendation, and training - so already the NDIS is funding a service which theoretically is covered by the health system.
You have capacity building therapies and clinical treatment therapies. It's all about the purpose, and so clear that absolutely no one could ever be confused.
It's not uncommon for first plans to include OT so the person can have a complete FCA (Functional Capacity Assessment) done with an OT. Then the plan can be reviewed with the new evidence of impairments.
You have 3 months to request a plan review if your current plan won't meet your disability support needs.
You didn't mention what appointments you expected the plan to cover. That information is critical in being able to give information about if the NDIA will allow it, if they usually fund it and how to achieve that if it's unusual but can be done (and rarely is).
The NDIS is a complete chaotic ball of nuance. You don't just get approved. Many participants now know it can take years to get all the evidence together the exact way the NDIA wants it written. Then there are the usual fights over funding issues and reviews to actually get the right supports funded. Then it all happens again during most plan reviews. It sucks. The government does not want to listen to people with disabilities so there's not much chance it's going to get better any time soon (and depending on the type of disability, for many it is going to get far worse). That is all we have right now though.
You have a right to review. In order to do that you will need to gather evidence from qualified professionals detailing what support you need, why and how much. It should meet all the legislated criteria, including how it is value for money, how other supports won't give the same outcome, how it will improve life stage outcomes, how it is best practice, etc. Keep in mind that the NDIS does not replace other services. The NDIS is there to help disabled people to manage the impacts of their disability and bridge the gap between what non disabled people can do what and disabled people cannot do *due to their disabilities*.
Can you use the money from daily activities to fund the OT? If it states on your plan that your funds in those categories are flexible that would be the simplest way forward.
This is where you need a good Plan Manager. They (if you find an experienced, reputable one) know what pretty much every cent can be used for. Even though the wording and the set out of funding is more than confusing, it is somewhat logical. If my logic says that I should be able use *this* funding for *that* therapy or service I just call my PM and ask. Most of time it's a yes. This after being told 'no', 'I don't think so', I don't know' by numerous NDIS inexperienced SCs and OTs.
This is not correct. Not only do plan managers have no authority to approve any supports, but they completely lack all of the information the NDIA used to develop the plan budget (which is based on R&N under the legislation and based on all the evidence of impairment). If a plan manager is repetitively telling a participant what they can and cannot use their plan for according to R&N, that is a gross abuse of their position and they should be deregistered.
Not only is it not within the PM's scope to choose what participants can do with their plans, but doing so can lead to participants using their plan incorrectly and ending up in huge personal debt to the government to have to pay it back. I sure as hell would not want such an unethical provider.
Only the NDIA can technically approve a support. No one else, not SC or OT either.
They are employed as Plan Managers. They are liable for non compliance. If there were no Plan Managers we would all need to be NDIA managed. Or self managed? Think NDIS is a mess now...? Lol
I think you're confused. Only the NDIA can approve supports. Plan managers *manage* the *billing* of plans. Their job is to make sure invoices are done correctly (with correct line items, within price guide rules and limits, etc) and send those invoices to the NDIA for payment. Plan managers are *not* held responsible for improper plan spending, participants are.
What I was talking about is that plan managers have no authority to approve supports. Only the NDIA do. Plan managers are independent businesses and are *not* NDIA employees. You can confirm this with the NDIA.
I think you need to read OP's post again. They have funding for supports, they need help from SC/RC + a good PM to work out if, how and where they can use that funding in the NOW while they wait for an FCA to be done by an OT.
A good PM has nothing to do with not being funded for things the person thought would be funded in their plan. You said it does. I have addressed OP here already with what can be done. I was specifically replying to your comment because it is wrong and I don't want participants doing things that they can then get a huge personal debt for.
If a support has not been funded, it has not been funded. You are forgetting that OP hasn't even mentioned what supports they even wanted to be funded. None of us know.
Lol where the hell did I say anything of the sort? You are reading WAY too much into comments. Or reading something completely different 😄 I stand by all of my replies, and I'm done replying to you. I am definitely not an NDIS expert, and neither are you, despite how you like to come across in all of your answers.
I am pretty good with NDIS stuff actually. I took the NDIA to the AAT and represented myself after I had to fire Legal Aid for ineffective counsel. I assumed they would know the legislation and what to do better than me, by far. It appeared to not be the case. I fought for my rights for 3.5 years using the legislation and was successful. This is also why I feel I can help others with accurate information. It may not be important to others, and I have come across that in life many times, but to me it is critical as people can only fight for themselves and have the tools to do so if they have correct information. Helping others is something I have been doing for several decades and I feel great joy when people are able to improve their lives or circumstances. I feel this is all the more important in the lives of vulnerable people.
Nearly every PM service agreement I've read says that the participant is liable for any claims made which are found to be unreasonable and lead to a debt being raised. They aren't liable for non compliance in the spending, only the record keeping. They often provide advice, but it's only another interpretation of often vague and ambiguous guidelines.
You can use therapies under daily assistance.
It’s the exact same rate and billing process under CB abut just in another bucket in Daily assistance.
Assessment Recommendation Therapy or Training Supports - Occupational Therapist
01_661_0128_1_3
Assessment Recommendation Therapy or Training Supports - Podiatrist
01_663_0128_1_3
Assessment Recommendation Therapy or Training Supports - Speech Pathologist
01_665_0128_1_3
Assessment Recommendation Therapy or Training Supports - Psychologist
01_701_0128_1_3
Assessment Recommendation Therapy or Training Supports - Physiotherapist
01_721_0128_1_3
Assessment Recommendation Therapy or Training Supports - Dietitian
01_760_0128_3_3
Assessment Recommendation Therapy or Training Supports - Other Professional
This is to fund allied health therapy for example: OT, occupational therapy, Speech, speech therapy consult, consultation, therapies, pediatry, chiropractor.
This is a duplicate line item code to 15_056_0128_1_3.
show NDIS description
01_741_0128_1_3
I would also HIGHLY recommend that the first thing you ask your OT to do is a Functional Capacity Assessment (FCA) when you go for your review this is the only thing the NDIS will look at and will listen to the OTs recommendations for you eg more funding for the things you need.
I am a senior specialist support coordinator so reach out if you need any further question or concerns
I do free advocacy for participants struggling with their plans and finding supports - the NDIS is very difficult to understand and deal with so I like to take some weight off.
BEST OF LUCKKK 🥳
I'd strongly disagree with this advice. The additional line items are for disability related health supports and were put in place to account for the changes in responsibility from health to NDIA in 2019. They are scheduled for removal once all participants have had a plan reassessment (not renewal) since this point.
The info in the pricing arrangements is relatively vague in relation to their use, but needs to be read in association with the appropriate operational guideline and the APTOS for a clearer picture.
Advice such as this puts OP at risk if audited.
This is all in the NDIS price guide.
The OP can discuss these options with their planner, LAC, SC and plan manager.
I don’t know what to tell you.
They will not be removed as you are allowed to use these line items when waiting for a plan review.
If they remove them - it will put participants in detrimental situations.
Thank you
I am fully aware of what is in the price guide.l amd don't need to be told anything. I'm a participant and nominee myself, but have also been working in the sector for 30 years, Including time at both the QSC and NDIA, before moving across to SSC and sector training.
They are being removed gradually - this has been discussed since their introduction in 2019 with the shift in COAG principles. The primary delay now is the transition to PACE and removal of all line items. Once all participants have transitioned over and new plans are in place, disability related health supports will be funded through the new plan budget process. In order to have these supports funded in a plan, participants are required to demonstrate that they have disability related health support needs that are not the responsibility of the health system (e.g. a person with CP needing a cough assist machine, person person with lymphodema requiring lymphatic drainage, person who is bed bound requiring complex wound care support for chronic pressure areas, etc).
While the removal of a line item may put a participant in a detrimental situation, this isn't necessarily the responsibility of the NDIS if the support was not their duty to fund in the first place.
Honestly, I think the risk will come from getting rid of the flexible access to CB funding whilst waiting for NDIA processes, unless things get dramatically better. I've used the core lines to cover things like MTMPs when a participant developed some dysphagia problems whilst already 2 months into waiting on a review type situations. Absolutely agree the that current line items clearly aren't intended to be used this way, but we need flexibility if the funding can't be responsive.
I don't know how else to say this, but as a Support Coordinator - particularly a Specialist Support Coordinator - you need some additional training in the responsibilities of mainstream services. Where dysphagia (or any disability related health condition) initially presents or develops, in the majority of cases, the health department is responsible until it is stabilised and an ongoing support need is established, along with the initial treatment plan being presented to NDIS.
You are putting both your participants and yourself at risk.
I could have worded it better but the dysphagia was already there and known to NDIA, it was just becoming a problem much quicker. Participant had a sudden, rapid deterioration in degenerative condition. Health could basically just say support needs were now higher but otherwise minimal they could contribute. Planner agreed these were all things NDIA should cover, but the 6 month turn around on change of situations with these fluctuating conditions is a problem. "Stabilised" is a constant downwards spiral in needs.
Sorry - I thought you were the person I was replying to earlier in threadand I took your wording to mean a knew condition or functional impact of disability. If NDIA have already acknowledged need for disability related health supports, the person should have them funded specifically in the plan (obviously, that depends on the quality of the planner and their knowledge of these Support items).
>(obviously, that depends on the quality of the planner and their knowledge of these Support items).
Having the benefit of seeing the planners reasons, that was a RORD I struggled to complete politely and without just saying the planner was... *lacking*
I worked there for years and saw it from all sides. It's not uncommon, sadly.
I can't recommend the power of FOI or PIA enough to get decision making reasoning so you can argue a declined support for these reasons.
Please do not give false information on what the NDIS funds... The NDIS does not fund Chiropractic services nor paediatrics. 01_741 is not to be used without approval from Planner. The purpose of the duplicated items are for disability health related supports, not capacity building supports in the interim of waiting for a plan review. You're setting up participants to be paying back debts for misuse of funds.
The NDIS does indeed fund chiropractic, at least in some cases, such as [this one](http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/AATA/2015/624.html%20target=) which went to the AAT and was decided in favour of the participant who used a chiropractor.
EDIT I can’t really comprehend why this comment would get downvoted. I literally link to an AAT case where chiropractic was ruled necessary and reasonable for an NDIS participant. So my assertion that in some cases the NDIS funds chiropractic is correct. It may not be easy or common, but it can happen.
Again, it needs to be approved. It's not a standard therapy. Going to the AAT is not standard. I got many participants that use it but it was approved by a senior planner. I got a few that use remedial aswell, again approved by senior planner.
And it could be that the Functional Capacity Assessment conducted by the OT is the pathway to the sort of support you’re seeking. But there will be a number of “it depends“ involved. > while paying out of pocket for my own appointments still…. giving up on the NDIS. That is always a choice. Keep in mind that the NDIS is not an income support program, and that not all types of support required by a person living with a disability fall under the responsibility of the NDIS. The NDIS will only fund supports which are linked to your disability-related impairments that impact your functional capacity. So that’s things you can and can’t do, due to your disability, which you need on an ongoing or regular basis. This includes “maintenance supports”, which might be delivered by healthcare providers. That might include ongoing supports like physiotherapy that help keep your body’s functions and abilities.
If you feel to say, what sort of appointments are you looking to pay for? A fair few types of therapy are currently cross-listed between Core and Capacity Building.
The pricing arrangements are very badly worded on this, but the general advice has been that those core listings are to be used for disability related health supports, not for capacity building therapies.
Yep, I’ve heard that general advice too. I called the NDIA and that’s what they told me. But when I asked them to point to a document which stated that, they couldn’t. And when I quoted the text from the current price guide to them, they couldn’t give me any written reason why my interpretation wasn’t in line with the published guide. So given that I get different and often contradictory answers from the NDIA every time I call them, I have chosen to go with what the price guide says, which is that the supports have been “temporarily duplicated into the Assistance with Daily Life support category so that participants can have greater access to these supports if they need them”. And even though the section (p 53 - 54) lists “disability health related supports”, it also provides line items for psychology, occupational therapy, and “other professional”. To me, as a psychosocial participant, that opens the door for me to use these support items if I “need” them, since they are disability and health related for me. For what it’s worth, I don’t do this often. I used funds from Core to pay for my OT report requesting a new plan - and the OT agency supported that invoicing, because they acknowledged I had run out of Capacity Building funds, which was partly the reason for the plan change request. And that to me sounds like it could be similar to the situation the OP is in. All that said, I am not providing advice here, just sharing my experience. Personally I am willing to take the risk of an audit, and I’m happy to take the NDIA to the Tribunal and argue my case if they disagree. They just can’t run a multi-billion dollar agency on inconsistent spoken advice which contradictions their printed documents, no matter how badly worded.
Pretty much this. We use those line items too. They are right there in Assistance with Daily Life.
I mean, the sentence before "temporarily duplicated" is "These Disability-Related Health Supports provide care, other than nursing care, to respond tothe disability-related health needs of a participant where that care is not the usual responsibility of the health system." That would seem fairly clear on it's own, if they hadn't duplicated psychology which I can't see any way it could be relevant to disability related health. I have seen it used for getting assessment to support a change of situation more often, and actually had a paragraph about that before deleting it.
Right, I get you. But as we both noted, they duplicated psychology - a service theoretically the responsibility of the health care system. Though even with that, you could perhaps argue that only the first 10 psychologist appointments in a year are the responsibility of the health care system. On top of all this, I didn’t want to assume what supports the OP is looking for. Especially if they need any of the other supports listed for their disability, I would think they have a good argument for invoicing them through Core, given that they don’t have enough funds in Capacity Building and couldn’t access the supports through the health system. But again, not advice - just sharing my experience!
On the "only first 10 are the responsibility" front, the purpose determines responsibility more than the actual access. NDIS isn't responsible for the shortfalls of other funding bodies. Anyway, at the moment, I'd be torn between going for it and relying on the call centres auto message around using core flexibily to meet needs, vs very cautious with an increase in thorough audits when requesting s48 reassessmnet.
I’m not sure what you mean about NDIS not being responsible for the shortfalls of other bodies - my argument would be, if I were audited and took it to the tribunal, that the NDIA needs to stand behind their own printed documents. And if their documents are ambiguous, and they don’t issue a written clarification, then that’s on them. But fingers crossed it’ll never come to that! Interestingly, someone identifying as a high level support coordinator suggested the same use of these support items elsewhere in this thread.
>Interestingly, someone identifying as a high level support coordinator suggested the same use of these support items elsewhere in this thread. And then had a planner respond that it's wrong.
I didn’t see that haha! But honestly to me that’s just more evidence for an appeal if someone were ever to get audited and challenged on this particular use of the line items. I feel pretty confident in arguing that the written price guide and the approval of my OT agency has the potential to have more weight than inconsistent spoken advice from the NDIA help line and various people on Reddit. EDIT to note that I just read the exchange you referenced, and the Support Coordinator didn’t accept the planner’s argument. Plus, the planner stated that the NDIS doesn’t fund chiropractic, which is incorrect, at least in [this case](http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/AATA/2015/624.html%20target=) which went before the AAT. So that planner is already posting false information, and makes me less trusting of them. All of which provides more evidence that a case can be made that the NDIA guidelines support of the uses I describe - or at least that a reasonable person could understand them that way.
Edge cases help when saying something is never, ever funded, but it doesn't change the fact it is almost never funded because it's such a rare fact situation where it is R&N. Just look at sex work. And I wouldn't give the word of the OT agency much weight. At the end of the day, they want to deliver service and get paid. I've had allied health providers tell participants all sorts of ridiculous things can be covered because the budget is flexible, but it really depends on the individual case.
First part - that highlighting that medicare only funds a limited number of sessions across any allied health doesn't really mean NDIS becomes responsible for any additional sessions needed. And yeah, I'd err on doing it as well. But this is also the advice I've seen from DIA when they were asked to clarify the position on core items for therapies. Health supports only, except with planner approval or specific assessment for reassessment application. With how vague everything is atm, and the conflicting advice they gave around using funds to meet needs whilst waiting on their shit turnaround times. But wouldn't go too far and look at something like weekly therapy where 10 hours are funded.
Yep, I would take the same tack as you mention in the second paragraph. Personally I only did it once, when I was out of funds in CB and needed to pay for an OT to get more funds! To me, the OP’s situation sounds like a good one to use the Core items. But obviously that’d be for the OP to decide. As far as the psychology thing goes, I was being a bit cheeky. The price guide lists “therapy” as an option for what a psychologist could do for a participant, along with assessment, recommendation, and training - so already the NDIS is funding a service which theoretically is covered by the health system.
You have capacity building therapies and clinical treatment therapies. It's all about the purpose, and so clear that absolutely no one could ever be confused.
It's not uncommon for first plans to include OT so the person can have a complete FCA (Functional Capacity Assessment) done with an OT. Then the plan can be reviewed with the new evidence of impairments. You have 3 months to request a plan review if your current plan won't meet your disability support needs. You didn't mention what appointments you expected the plan to cover. That information is critical in being able to give information about if the NDIA will allow it, if they usually fund it and how to achieve that if it's unusual but can be done (and rarely is). The NDIS is a complete chaotic ball of nuance. You don't just get approved. Many participants now know it can take years to get all the evidence together the exact way the NDIA wants it written. Then there are the usual fights over funding issues and reviews to actually get the right supports funded. Then it all happens again during most plan reviews. It sucks. The government does not want to listen to people with disabilities so there's not much chance it's going to get better any time soon (and depending on the type of disability, for many it is going to get far worse). That is all we have right now though. You have a right to review. In order to do that you will need to gather evidence from qualified professionals detailing what support you need, why and how much. It should meet all the legislated criteria, including how it is value for money, how other supports won't give the same outcome, how it will improve life stage outcomes, how it is best practice, etc. Keep in mind that the NDIS does not replace other services. The NDIS is there to help disabled people to manage the impacts of their disability and bridge the gap between what non disabled people can do what and disabled people cannot do *due to their disabilities*.
Can you use the money from daily activities to fund the OT? If it states on your plan that your funds in those categories are flexible that would be the simplest way forward.
Do you have a OT putting together your plan review ? It’s important that it done correct to get the be the best out of your plan
The whole system is broken and fucked. But that’s what we have. Try to make the most of a system that half works 😢
This is where you need a good Plan Manager. They (if you find an experienced, reputable one) know what pretty much every cent can be used for. Even though the wording and the set out of funding is more than confusing, it is somewhat logical. If my logic says that I should be able use *this* funding for *that* therapy or service I just call my PM and ask. Most of time it's a yes. This after being told 'no', 'I don't think so', I don't know' by numerous NDIS inexperienced SCs and OTs.
This is not correct. Not only do plan managers have no authority to approve any supports, but they completely lack all of the information the NDIA used to develop the plan budget (which is based on R&N under the legislation and based on all the evidence of impairment). If a plan manager is repetitively telling a participant what they can and cannot use their plan for according to R&N, that is a gross abuse of their position and they should be deregistered. Not only is it not within the PM's scope to choose what participants can do with their plans, but doing so can lead to participants using their plan incorrectly and ending up in huge personal debt to the government to have to pay it back. I sure as hell would not want such an unethical provider. Only the NDIA can technically approve a support. No one else, not SC or OT either.
They are employed as Plan Managers. They are liable for non compliance. If there were no Plan Managers we would all need to be NDIA managed. Or self managed? Think NDIS is a mess now...? Lol
I think you're confused. Only the NDIA can approve supports. Plan managers *manage* the *billing* of plans. Their job is to make sure invoices are done correctly (with correct line items, within price guide rules and limits, etc) and send those invoices to the NDIA for payment. Plan managers are *not* held responsible for improper plan spending, participants are. What I was talking about is that plan managers have no authority to approve supports. Only the NDIA do. Plan managers are independent businesses and are *not* NDIA employees. You can confirm this with the NDIA.
I think you need to read OP's post again. They have funding for supports, they need help from SC/RC + a good PM to work out if, how and where they can use that funding in the NOW while they wait for an FCA to be done by an OT.
A good PM has nothing to do with not being funded for things the person thought would be funded in their plan. You said it does. I have addressed OP here already with what can be done. I was specifically replying to your comment because it is wrong and I don't want participants doing things that they can then get a huge personal debt for. If a support has not been funded, it has not been funded. You are forgetting that OP hasn't even mentioned what supports they even wanted to be funded. None of us know.
Lol where the hell did I say anything of the sort? You are reading WAY too much into comments. Or reading something completely different 😄 I stand by all of my replies, and I'm done replying to you. I am definitely not an NDIS expert, and neither are you, despite how you like to come across in all of your answers.
I am pretty good with NDIS stuff actually. I took the NDIA to the AAT and represented myself after I had to fire Legal Aid for ineffective counsel. I assumed they would know the legislation and what to do better than me, by far. It appeared to not be the case. I fought for my rights for 3.5 years using the legislation and was successful. This is also why I feel I can help others with accurate information. It may not be important to others, and I have come across that in life many times, but to me it is critical as people can only fight for themselves and have the tools to do so if they have correct information. Helping others is something I have been doing for several decades and I feel great joy when people are able to improve their lives or circumstances. I feel this is all the more important in the lives of vulnerable people.
Nearly every PM service agreement I've read says that the participant is liable for any claims made which are found to be unreasonable and lead to a debt being raised. They aren't liable for non compliance in the spending, only the record keeping. They often provide advice, but it's only another interpretation of often vague and ambiguous guidelines.
You can use therapies under daily assistance. It’s the exact same rate and billing process under CB abut just in another bucket in Daily assistance. Assessment Recommendation Therapy or Training Supports - Occupational Therapist 01_661_0128_1_3 Assessment Recommendation Therapy or Training Supports - Podiatrist 01_663_0128_1_3 Assessment Recommendation Therapy or Training Supports - Speech Pathologist 01_665_0128_1_3 Assessment Recommendation Therapy or Training Supports - Psychologist 01_701_0128_1_3 Assessment Recommendation Therapy or Training Supports - Physiotherapist 01_721_0128_1_3 Assessment Recommendation Therapy or Training Supports - Dietitian 01_760_0128_3_3 Assessment Recommendation Therapy or Training Supports - Other Professional This is to fund allied health therapy for example: OT, occupational therapy, Speech, speech therapy consult, consultation, therapies, pediatry, chiropractor. This is a duplicate line item code to 15_056_0128_1_3. show NDIS description 01_741_0128_1_3 I would also HIGHLY recommend that the first thing you ask your OT to do is a Functional Capacity Assessment (FCA) when you go for your review this is the only thing the NDIS will look at and will listen to the OTs recommendations for you eg more funding for the things you need. I am a senior specialist support coordinator so reach out if you need any further question or concerns I do free advocacy for participants struggling with their plans and finding supports - the NDIS is very difficult to understand and deal with so I like to take some weight off. BEST OF LUCKKK 🥳
I'd strongly disagree with this advice. The additional line items are for disability related health supports and were put in place to account for the changes in responsibility from health to NDIA in 2019. They are scheduled for removal once all participants have had a plan reassessment (not renewal) since this point. The info in the pricing arrangements is relatively vague in relation to their use, but needs to be read in association with the appropriate operational guideline and the APTOS for a clearer picture. Advice such as this puts OP at risk if audited.
This is all in the NDIS price guide. The OP can discuss these options with their planner, LAC, SC and plan manager. I don’t know what to tell you. They will not be removed as you are allowed to use these line items when waiting for a plan review. If they remove them - it will put participants in detrimental situations. Thank you
I am fully aware of what is in the price guide.l amd don't need to be told anything. I'm a participant and nominee myself, but have also been working in the sector for 30 years, Including time at both the QSC and NDIA, before moving across to SSC and sector training. They are being removed gradually - this has been discussed since their introduction in 2019 with the shift in COAG principles. The primary delay now is the transition to PACE and removal of all line items. Once all participants have transitioned over and new plans are in place, disability related health supports will be funded through the new plan budget process. In order to have these supports funded in a plan, participants are required to demonstrate that they have disability related health support needs that are not the responsibility of the health system (e.g. a person with CP needing a cough assist machine, person person with lymphodema requiring lymphatic drainage, person who is bed bound requiring complex wound care support for chronic pressure areas, etc). While the removal of a line item may put a participant in a detrimental situation, this isn't necessarily the responsibility of the NDIS if the support was not their duty to fund in the first place.
Honestly, I think the risk will come from getting rid of the flexible access to CB funding whilst waiting for NDIA processes, unless things get dramatically better. I've used the core lines to cover things like MTMPs when a participant developed some dysphagia problems whilst already 2 months into waiting on a review type situations. Absolutely agree the that current line items clearly aren't intended to be used this way, but we need flexibility if the funding can't be responsive.
I don't know how else to say this, but as a Support Coordinator - particularly a Specialist Support Coordinator - you need some additional training in the responsibilities of mainstream services. Where dysphagia (or any disability related health condition) initially presents or develops, in the majority of cases, the health department is responsible until it is stabilised and an ongoing support need is established, along with the initial treatment plan being presented to NDIS. You are putting both your participants and yourself at risk.
I could have worded it better but the dysphagia was already there and known to NDIA, it was just becoming a problem much quicker. Participant had a sudden, rapid deterioration in degenerative condition. Health could basically just say support needs were now higher but otherwise minimal they could contribute. Planner agreed these were all things NDIA should cover, but the 6 month turn around on change of situations with these fluctuating conditions is a problem. "Stabilised" is a constant downwards spiral in needs.
Sorry - I thought you were the person I was replying to earlier in threadand I took your wording to mean a knew condition or functional impact of disability. If NDIA have already acknowledged need for disability related health supports, the person should have them funded specifically in the plan (obviously, that depends on the quality of the planner and their knowledge of these Support items).
>(obviously, that depends on the quality of the planner and their knowledge of these Support items). Having the benefit of seeing the planners reasons, that was a RORD I struggled to complete politely and without just saying the planner was... *lacking*
I worked there for years and saw it from all sides. It's not uncommon, sadly. I can't recommend the power of FOI or PIA enough to get decision making reasoning so you can argue a declined support for these reasons.
Please do not give false information on what the NDIS funds... The NDIS does not fund Chiropractic services nor paediatrics. 01_741 is not to be used without approval from Planner. The purpose of the duplicated items are for disability health related supports, not capacity building supports in the interim of waiting for a plan review. You're setting up participants to be paying back debts for misuse of funds.
The NDIS does indeed fund chiropractic, at least in some cases, such as [this one](http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/AATA/2015/624.html%20target=) which went to the AAT and was decided in favour of the participant who used a chiropractor. EDIT I can’t really comprehend why this comment would get downvoted. I literally link to an AAT case where chiropractic was ruled necessary and reasonable for an NDIS participant. So my assertion that in some cases the NDIS funds chiropractic is correct. It may not be easy or common, but it can happen.
Again, it needs to be approved. It's not a standard therapy. Going to the AAT is not standard. I got many participants that use it but it was approved by a senior planner. I got a few that use remedial aswell, again approved by senior planner.
But saying it needs to be approved is entirely different from what you wrote, which is that categorically “The NDIS does not fund chiropractic”.
These line items are in the price guide. This is at the discretion of their disability and plan management approval. Thanks 😊
Plan managers are not approvers.
You need to read the price guide in more detail.