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Reasonable and necessary in the NDIS START MODULE Image of Transition support Project logo Description This training is designed to provide an overview of how the NDIA makes decisions about the services and supports that can be included in a person's NDIS plan. The information in this module is general in nature. Every organisation does things differently and has different policies and procedures, so please interpret the content in this module with your organisation in mind and discuss any discrepancies with your line manager. Duration: Approximately 30-40 minutes (note. you can close the training and pick up where you left off at a later date). Last updated: 2 July 2020 Content and links in this training were correct at the time of publication. We check these regularly; however, if you find broken links or errors please contact transitionsupport@flinders.edu.au
Topic 1 of 8 Training objectives Image of a light bulb This training is designed to provide an overview of how the NDIA makes decisions about the services and supports that can be included in a person's NDIS plan. By the end of this training you will: • Understand the NDIS reasonable and necessary support principles • Know how the NDIS work with other service systems • Understand the types of supports and services that the NDIS might fund. Assumed knowledge Image of an open book This module assumes a general understanding of the NDIS. If you have no knowledge of the NDIS, we recommend completing our 'NDIS explained' training module. Resources Image of many colourful books stacked on top of each other Content in this training is based on information available on the NDIS website and in the National Disability Insurance Scheme Act 2013 (the NDIS Act).
Topic 2 of 8 Overview What does the NDIS fund? When working with people with a psychosocial disability, you may need to provide education about the NDIS. To do so, you need to have an understanding of which services and supports can and cannot be funded by the NDIS. This helps to manage participants' expectations about the NDIS, and to prepare for NDIS planning meetings. Revision What the NDIS is and what it is not...... Front of card Image of a tick Click to flip The aim of the NDIS is to increase the independence and social and economic participation of people living with a disability. It funds services and supports that specifically address these aims. In essence, the NDIS supports people with a disability to overcome barriers associated with their disability, so that they can participate in everyday life in the way that people without a disability can. Front of card Image of a cross Click to flip The NDIS is part of a broader health and disability system; it does not fund clinical treatments/interventions or medication for health or mental health conditions. It is also not a replacement for existing public services. Furthermore, the NDIS is not an income top up or replacement for people with disability, which means it doesn't fund everyday expenses and activities. Image of people standing in a queue The NDIS is an individualised scheme. Services and supports which are considered 'reasonable and necessary' for one person may be different for another. However, there are guiding principles (specified in the NDIS Act, Section 34) used when making decisions about what can and can't be included in NDIS plans. In this module we will summarise the principles for determining if a support is 'reasonable and necessary' and explore the support areas that are beyond the scope of the NDIS.
Topic 3 of 8 Reasonable and necessary support principles For a support to be considered reasonable and necessary it must meet each of the following criteria. Click on the information icon for each to learn more. Icon 1 of 6 Assist to pursue goals All services and supports must be linked to goals and aspirations. A person may have multiple goals in their NDIS plan, which can be short, medium or long term. Setting goals is important to focus efforts and increase the chance of success. Goals in NDIS plans don’t have to be achieved every time, sometime things go wrong or priorities change. This is OK, the NDIA just need to be satisfied that the support will assist the person to work toward their goal. Icon 2 of 6 Facilitate social and economic participation This is a key aim of the NDIS. The NDIA must be satisfied that supports or services included in a participant’s plans would assist the person to undertake activities that would facilitate social or economic participation. Simply put, there must be a connection between the support need and the capacity for it to increase a person’s independence and ability to participate in society in the way that people without a disability can. Icon 3 of 6 Represent value for money Supports must represent value for money. When determining if a support represents value for money the NDIA will consider: • the long term benefits for the participant • the potential of the support to reduce need for additional supports in the future • its value relative to similar supports Icon 4 of 6 Reasonable expectation of informal supports When deciding what to fund, the NDIA consider what is reasonable to expect families, carers, informal networks or the community to provide. Each individual situation is different, but some of the key considerations include: • the age and capacity of the carers and/or family • the intensity and type of support required, compared to someone of a similar age without a disability • the impact on the wellbeing of the informal support and the participant • the impact on the relationship between the informal support and the participant Icon 5 of 6 Effective and beneficial for the participant The NDIS will not fund supports or services that are likely to cause harm to the participant or pose a risk to others. The NDIA needs to be confident that the service is likely to be effective and beneficial for the participant, noting good practice. Icon 6 of 6 Most appropriately funded by the NDIS The NDIS does not replace or duplicate existing services. It will only fund supports related to the participant’s disability and does not pay for every day living costs eg groceries, rent. Before including any support or service in a participant’s plan, the NDIA will consider if the support is most appropriately funded through the NDIS, or whether it is the responsibility of another service system.
Topic 4 of 8 Daily living costs First and foremost, the NDIS will only fund supports that are related to the person's disability. It does not cover daily living expenses or social/incidental expenses that everyone in the community is expected to pay for. Front of card Everyday living costs Click to flip Everyday living costs include things like groceries, rent, running a car and so on. They also include lifestyle-related costs like university attendance fees, holidays and childcare. Front of card Costs associated with disability Click to flip The NDIS can fund services and supports which make daily activities more accessible for people with a disability (e.g., support to address anxiety accessing public transport). It can also provide funding when daily living activities cost more because of the person's disability (e.g., modifications to a car that are necessary for the person with a disability to drive it). Example: Study and the NDIS Some people may want to use their NDIS plans to participate in study or training courses. The everyday costs associated with studying (e.g., course fees and text books) are costs that everyone has to pay for, regardless of whether they have a disability, and are generally not funded by the NDIS. However, if the person faces significant barriers because of their disability in participating in education (e.g., extreme anxiety prevents social interaction and thus course attendance) the NDIA may fund time-limited services to build the person's capacity to attend (e.g., support to improve social skills, assistance with communication, behaviour management strategies). Image of male person standing wearing his graduation gown and square graduation cap A simple way to consider if a support is likely to be funded by the NDIS is to ask yourself, 'Would this cost exist if it weren't for the person's disability?' Your turn Michael has an NDIS plan and one of his goals is to go out with his friends more often; however, he has severe social anxiety and currently cannot leave the house without his support worker. He lives alone and doesn't have any family to help him. He has a small group of friends who go to the movies once a month and he wants to be able to go with them. Michael's NDIS plan may be able to pay for...... • His movie ticket • His popcorn • His support worker SUBMIT TRY AGAIN Complete the content above before moving on.
Topic 5 of 8 Responsibility of other services The NDIS will not duplicate services or fund services which are the responsibility of other systems. Image of map of Australia It will be important for the NDIS not to respond to problems or shortfalls in mainstream services by providing its own substitute services. To do so would weaken the incentives of government to properly fund mainstream services for people with a disability, shifting the cost to another part of government ... This ‘pass the parcel' approach would undermine the sustainability of the NDIS and the capacity of people with a disability to access mainstream services. Extract from the inquiry into disability care and support in Australia which was used to develop the NDIS. What are mainstream services? One of the most common areas of confusion regarding what the NDIS can pay for and what it can't relates to mainstream services. Mainstream services are the public systems that are available to everyone (e.g., medical, dental, education and schooling, justice, housing). These systems aren't always perfect. Sometimes there are long waiting lists, or the system may only fund a portion of the total service that a person needs. The NDIS is not a 'get out of jail free card' for these services; addressing issues with the mainstream system is a whole-of-government responsibility. Image of many people walking across a pedestrian crossing Working together Image of many scrambled jigsaw pieces The NDIS will work with mainstream services. It will help people with a disability to access these services (through information, linkages and referrals) and it will help these services to become more inclusive and accessible for people with a disability. In addition, state/territory and federal governments have a responsibility to review their services and address concerns as part of an overall sector reform, detailed in the Fifth National Mental Health and Suicide Prevention Plan. You will likely work with people who require support from various mainstream systems (e.g., education, justice etc). The 'COAG principles to determine responsibilities for NDIS and other systems' document includes a list of services to be offered by the NDIS and those to be offered by mainstream services. You can download this document from the COAG website. Mental health supports The public mental health system is responsible for the diagnosis and treatment of mental health conditions. The NDIS is responsible for psychosocial recovery supports that focus on reducing the daily impact of mental health conditions (e.g., functional capacity). The NDIS definition of treatment is: activities associated with stabilisation and management of mental illness including crisis, symptom and medication management and establishment of pathways for longer term recovery. Front of card NDIS is responsible for... Click to flip Services that help people with mental illness to participate in daily life, including support with: decision making, self-management, household tasks, community connections, social skills development, medication management, communication development, accessing mainstream services and engaging with the community. Front of card The mental health system is responsible for... Click to flip Anything to do with diagnosis and treatment of mental health conditions including acute care services, hospital services and early intervention therapies. Your turn: psychology services and the NDIS People who are using government rebates to access psychological treatment (e.g., through the Better Access Initiative) can use the NDIS to pay for more psychology sessions when the rebate runs out. • True • False SUBMIT TRY AGAIN Complete the content above before moving on.
Topic 6 of 8 Carers and informal support networks The NDIA will take into account a person's informal support networks when deciding what is 'reasonable and necessary' to fund in a plan. The NDIA also recognises the importance of supporting carers in their role. Image of hands clasped over each other What is reasonable to expect from informal networks? The NDIA will consider a person's support network when determining what is reasonable and necessary to fund in an NDIS package. Everyone has different families and support networks. Some people may need fewer services because they have a strong support network. Other people without these connections may require different services and supports to fill this gap. When determining if it is reasonable to expect support to be provided by friends, family or carers the NDIS will consider: • The age and capacity of carers and family • The intensity and type of support required • The impact on the wellbeing of the carer (e.g., do their caring duties prevent them from pursuing education or work opportunities?) • The impact on the wellbeing of the participant (e.g., will it increase reliance on informal support networks as opposed to build independence?) Remember: the NDIS aims to increase a person's capacity to participate in society. This includes developing and maintaining relationships with friends and family. For this reason, it is important that NDIS services build relationships - rather than replacing them with paid supports and services. Sustaining informal supports Ensuring that carers, families and friends are supported in their role is also taken into consideration when establishing reasonable and necessary supports in NDIS packages. The NDIS does not provide funding for carers specifically, but it can include reasonable and necessary supports in a participant's plan that will benefit carers. Examples include: family support and counselling, services that increase the participant's independence (e.g., personal care and maintaining their household), activities for the participant which enable carer respite (e.g., day trips with community groups). Image of three ladies laughing together Want more? The Australian Government is continuing to work closely with carers outside of the NDIS which includes the development of a Integrated Carer Support Service to be introduced in October 2018 . You can read more about services for carers on the Supporting Carers page of the Department of Social Services website.
Topic 7 of 8 QUIZ Below are some examples of services and supports that people with an NDIS package may want to access. Using what you know about the principles for determining reasonable and necessary supports, sort these examples according to whether you think they are likely or unlikely to be included in a person's plan. Don't worry if you don't get them all correct the first time - this is a learning exercise. After you are finished we will go through the answers in more detail.
Topic 8 of 8 Quiz feedback and finish Here is the list of services and supports from the quiz and why they are likely or unlikely to meet reasonable and necessary criteria . Remember that details about a person's life, and their goals and aspirations, are very important when making decisions in the NDIS. This activity is a guide only. Likely to meet reasonable and necessary criteria Therapy to build social skills: to improve capacity for social interaction which is an aim of the NDIS. Public transport training: to improve capacity for independence and or social/economic participation. Behaviour management training: to improve capacity for social interaction or capacity for engaging in work or volunteer opportunities (e.g., economic participation). Financial management support: to build capacity for self-management and financial independence. Art classes: where these facilitate community participation or other NDIS goals, for example through a community centre or day activity centre. Computer programs or apps for learning assistance: where these are related to a person's disability and are therefore necessary to enable effective learning. Disability needs training for carers: builds the capacity of carers to provide informal support related to the disability. Assistance with meal preparation: when the person's disability prevents them from being able to prepare meals independently (cost of food not funded). Cleaning assistance: when the person's disability impacts their capacity to maintain their home. Parental advice or training: for people who need support or assistance with their parenting responsibilities as a result of their disability. Unlikely to meet reasonable and necessary criteria DBT treatment: treatment for mental health conditions is the responsibility of mainstream mental health services. Bus ticket: a bus ticket would be considered an everyday cost; however, the person may be able to access some transport assistance and use this to pay for travel related costs. Crystal healing therapy: this is unlikely to be funded because it is not known to be an effective or beneficial therapy. Plane tickets to go on holiday: the NDIS can help people to build capacity to go on holiday (e.g., through support with financial management, support with social interaction) but the costs of going on holiday are something that everyone in the community has to pay for and therefore would not be covered. Gym membership: this is an everyday cost for everyone who wants to join a gym. The NDIS can provide support that can assist a person to attend the gym, such as support to develop an individualised exercise plan. Money for groceries for people on low income: the NDIS cannot pay for everyday expenses like groceries, even if the person is on a low income. An iPad to assist with university studies: most students would benefit from an iPad however unless it is specifically required because of the person's disability it is unlikely to be NDIS funded. A visit to a day spa for relaxation: spa, massage and other similar services are something that many people pay for regardless of ability. This is considered an everyday cost. Child care so a participant can go to work: most working parents need child care; this is not disability related and therefore unlikely to be covered. The NDIS can, however, fund services that build people's capacity to manage their parenting responsibilities. Complete our feedback survey and download a certificate of completion for your records. Button: go to survey