The Roll Out of the National Disability Insurance Scheme and What it Means for Participants

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After much legislative review, in July 2013 the Australian Government commenced rolling out the new National Disability Insurance Scheme (NDIS). The NDIS steers away from traditional ‘block-funding’ under the National Disability Agreement (NDA) and into a collaborative system where participants are encouraged and assisted in developing their own support plans.

In doing so, the NDIS aims to achieve a system where “choice and control” is fundamental and gives effect to the United Nations Convention on the Rights of Persons with a Disability. The NDIS is progressively replacing the former NDA

What does the new system look like?

Under the former NDA system, each State and Territory had an agreement with the Commonwealth for the funding and support of persons with disabilities. This system involved block-funding to support disability care providers who then provided support for individuals. In 2011, however, the Prime Minister released the Productivity Commission Inquiry Report, Disability Care and Support, and called for major reform of the NDA system. In the NDIS explanatory memorandum, the former system was criticised as being ‘underfunded, unfair, fragmented and inefficient‘.

Taking a ‘person-centred’ and ‘self-directed’ approach, the goal of the NDIS is to encourage individuals to develop their own funding plans. These plans are for the funding of ‘reasonable and necessary services and supports’ which are directly related to that eligible person’s ‘individual ongoing disability support needs’. This plan must include two statements:

• a Statement of Goals and Aspirations; and
• a Statement of Participant Supports.

When helping a participant to create a plan, delegates implementing the NDIS must (among other things), as far as reasonably practicable, encourage the plan to be individualised, directed by the participant, consider the role of family, carers or persons who are significant in the participant’s life, attempt to strengthen and build capacity of families and carers to support participants who are children, support communities to respond to the individual goals and needs of participants, and maximise the choice and independence of the participant.

Statement of Goals and Aspirations

Under the National Disability Insurance Scheme Act 2013 (Cth) (‘NDIS Act’) in order to receive support a participant must include a Statement of Goals and Aspirations which must also reference that person’s living arrangements, informal community supports, other community supports and social and economic participation. This statement is to be prepared by the participant as much as possible.
A participant’s personal goals or aspirations can fulfil (among other things) therapeutic, domestic, personal, career or transport purposes. The goals and aspirations, for example, can relate to independence or further integration into social or economic life.

Statement of Participant Supports

In addition to a Statement of Goals and Aspirations, participants must also include a Statement of Support which he or she seeks from the NDIS. The supports are broken down into two categories:

• The general supports (if any) that will be provided to, or in relation to, the participant; and
• The reasonable and necessary supports (if any) that will be funded by the NDIS and help the participant to fulfil his or her aspiration.
The Australian Department of Human Services has listed examples of supports which might be funded to include:
• daily personal activities;
• transport to enable participation in community, social, economic and daily life activities;
• workplace help to allow a participant to successfully get or keep employment in the open or supported labour market;
• therapeutic supports including behaviour support;
• help with household tasks to allow the participant to maintain their home environment;
• help to a participant by skilled personnel in aids or equipment assessment, set up and training;
• home modification design and construction;
• mobility equipment, and
• vehicle modifications.

In assessing what constitutes “reasonable and necessary” support, the CEO will consider whether the support meets considerations under the NDIS Operational Guidelines. These considerations include whether:

1. the support is related to the participant’s disability and will assist the participant to fulfill his or her goals or aspirations;
2. the support will help the participant to reach social or economic participation and doesn’t include day-to-day living costs that are irrelevant to the participant’s disability;
3. the support represents value for money; the support is likely to be effective and beneficial to the participant; and
4. whether the support cannot be fulfilled by another avenue such as by families, carers, networks, and the community.

Examples of Reasonable and Necessary Supports

What is reasonable and necessary will differ from person to person, depending on their disability, age, family situation, other community and informal supports available, cultural background and geographic location.

For children aged 0-5, examples of reasonable and necessary supports include: early intervention, support to coordinate health care needs, toy libraries, support to facilitate a functioning family, support for parents providing care, encouragement to use informal and family supports, playgroups, support for inclusion in early childhood settings, support to include the child in family, community, cultural and religious practices, behavior support, and support to contact families with similar needs.

For older children and adults, supports may include: learning support, personal care, support in making life plans, support in domestic assistance, travel, and communication and finance management.

Subject to review

Pursuant to the NDIS Act, all decisions by the CEO can be challenged and reviewed.

The participant may request the CEO to review the decision (internal review) and, if dissatisfied with the results of the internal review, the participant may seek external review with the Administrative Appeals Tribunal under section 103 of the Act. An application for reviewing the decision is available on the NDIS website.

Finally

The NDIS is being rolled out progressively across Queensland over a three year period.

If you or a family member are eligible for assistance under the NDIS, read more information on ndis.gov.au or contact our Business Development Team to make an appointment.
Call us on 07 3252 0011

This article was written by Kristel Winkler (Senior Associate).