National Disability Insurance Scheme

The NDIS is a new system of providing support and services to people with significant and permanent disability. It has been described as the most significant government initiative since Medicare and all sides of government have given their unanimous support to the NDIS.

The Commonwealth Parliament passed the National Disability Insurance Scheme Act 2013 in March 2013. To learn more about the Act click here.

Before the announcement of the NDIS, funding was given directly to service providers who in turn provided support to people with disability. The control of how support was provided lay with the service providers. The NDIS is about giving the funding directly to the person with disability. They will be able to choose what services they need and how, when and where they are provided.

It is anticipated that 460,000 people will benefit from the NDIS by 2019 at a cost of $22 billion. This is double what is currently being spent on disability services. Like Medicare, it will funded by the Australian community.

What does the term ‘Insurance’ mean in the name: ‘National Disability Insurance Scheme’?

The NDIS insurance approach is one that shares the cost of disability services and supports across the whole community. It is based on the principle that anyone is at risk of disability at any stage of their life. Therefore everyone should share the risk and responsibility of caring and supporting those who are born with, or acquire disability during their lifetime.

The NDIS is funded in part by increasing the Medicare levy by 0.5%. The money collected is being placed in a separate savings account for 10 years and can only be used for additional costs associated with funding for NDIS participants.

State and Territory governments are also gradually transferring their disability funding across to the Commonwealth. Disability funding will almost solely be the responsibility of the federal government by the time the NDIS is fully operational by 2019.

The job of changing from one system to another on such a large scale is enormous. It was decided that there would be a three-year trial period to test the new system and learn from early experiences and improve and strengthen its functions.

The National Disability Insurance Agency (NDIA)

The NDIA manages the NDIS. It does this by:

  • Delivering the NDIS including employing NDIS planners and Local Area Coordinators who work with the person with disability and their family carers to develop an individualised plan
  • Increasing community awareness of disability
  • Ensuring the NDIS is financially sustainable

The NDIS Rollout

The trials commenced in July 2013 in a number of different trial sites across Australia. The South Australian trial was state-wide and concentrated on children with disability from birth to 14 years of age.

From January 2017, the NDIS starts to become available to more people with disability in South Australia for 15 to 17 year old young people, followed by people aged 18 – 65 years (July 2017).

More information about when the NDIS will become available in your area can be found on the NDIS website or by clicking here.

People who are already receiving a service or funded activity will be the first ones to enter the NDIS.

Once the NDIS is fully operational it is anticipated that 32,300 South Australians with disability will be eligible for the NDIS.

What do these terms mean?

1. Eligibility

To be eligible for the NDIS the person with disability must:

  • Be an Australian citizen and live in Australia, or a permanent resident or hold a Special Category visa
  • Live in an area where and when the NDIS becomes available
  • Provide evidence that they have a permanent and significant disability
  • Be under 65 years of age at the time they access the NDIS

To find out more information on becoming an eligible participant you can:

  • Go to the NDIS website www.ndis.gov.au
  • Call on 1800 800 110 (8am to 8pm eastern standard time weekdays)
  • Email: enquiries@ndis.gov.au

2. Permanent and significant disability

The person has a disability that is likely to be permanent and significantly reduces their ability to function in one or more of the following activities:

  • communication
  • social interaction
  • learning
  • mobility
  • self-care
  • self-management

The person’s disability can be intellectual, cognitive, neurological, sensory or physical or a combination of more than one of these.

Examples of disability can include intellectual disability, genetic disorders such as Down Syndrome, autism spectrum disorders (ASD), cerebral palsy, hearing and/or sight impairment and acquired brain injury.

A disability that is likely to vary in intensity or occurs episodically but is expected to continue over a person's lifetime, is considered to be permanent and significant. Examples include, multiple sclerosis, motor neuron disease, muscular dystrophy and psychosocial disability (mental health issues).

3. Early Intervention

Children up to six years of age diagnosed with developmental delay in more than one area may be able to access NDIS funding. The focus will generally be on specific therapies such as physiotherapy, speech pathology and occupational therapy which is aimed at improving a child’s functioning capacity.

Early intervention is also a term used under the NDIS for any person with disability when there is good evidence that an intervention would improve an area of functioning, or delay, or reduce a decline in functioning.

In conjunction with therapies, equipment, aids, specialised and behavioural interventions and home modifications may also be funded.

NDIS Access Check List

The NDIS Access check list will ask questions relating to the previous points identified as 1, 2, and 3. If a person with disability or their family carer answers yes to these, they can call the NDIS on 1800 800 110 and ask for an Access Request form and linked information to prepare for registration with the NDIS.

More information about eligibility and access to the NDIS can be found here.

If a person is already receiving support or services from a disability service provider, they can request the provider's support in finding out more about how to access the NDIS.

4. Reasonable and necessary supports

The NDIS will fund things that are related to the person's disability that will increase their independence, enhance their quality of life and promote social and economic participation.

Things that the NDIS will pay for include:

  • Assistance with self-care
  • Assistance with finding and maintaining employment
  • Therapies relating to the person's disability such as occupational therapy, physiotherapy and speech pathology
  • Social participation
  • Mobility equipment
  • Assistive technology
  • Continence aids
  • Vehicle and house modification
  • Transport involved in social, community and employment activities

The NDIA planner may also support people with disability to connect with mainstream services. The NDIS does not replace services and supports already accessible via mainstream services.

Things that the NDIS will not pay for include:

  • Rent
  • Household bills
  • Medical costs
  • Education
  • Transport costs that are normally paid for by the general community and are unrelated to the person's disability support needs.

More information about reasonable and necessary support can be found here.

The NDIS is NOT means tested and does not affect a person's Disability Pension. If a carer is receiving a carer's payment this is also not affected unless their caring role is substantially reduced due to NDIS funding for the person they are caring for.

Getting ready for the NDIS

The NDIA has developed a number of resources to assist people with disability and their families to prepare for the NDIS. These can be found at: www.ndis.gov.au/ndis-ready or by contacting them on 1 800 800 110.

If a person is eligible for the NDIS, a planner will contact them or their carer or nominated person (depending on individual circumstances) to set up a time to meet and develop the first plan.

One of the most important parts of the NDIS process is the pre-planning activity. Being well prepared for the meeting with a NDIA planner will enable the person with disability and their family carers to be clear about what they want and need today and into the future.

Things that are essential before meeting with a planner:

  • Having copies of all the information that was previously submitted to the NDIA
  • Collecting any relevant information (evidence) from healthcare professionals and others, such as support staff, teachers and aids, that support any request for funding
  • Developing a participant statement that describes what a person's life is like now. For example: their current living arrangements, current support provided now, whether this is paid or informal support, their relationship with others, and what future support needs may look like.

The NDIA can also send out a worksheet to assist in the pre-planning process.

The NDIA has also created a number of template forms which may also be beneficial to people with disability and their family carers. These are available at: www.ndis.gov.au/ndis-ready or by contacting the NDIA on 1 800 800 110.

The NDIS plan is for 12 months. While it can be reviewed at any time if there is a significant change to a person's circumstances. For any planning meeting or review, it is important to be fully prepared.

The planning meeting

People who may be present at the planning meeting will include the planner, the person with disability and family carers (if appropriate). If the planning meeting is for a child, the child many not always attend and this will be at the discretion of the family carers.

Planning meetings can be stressful for some people, particularly if they have not been part of such a process before. Therefore it is often a good idea to have a support person/advocate attend the meeting with them. The support person may also take notes of the meeting on behalf of the person with disability and/or family carer.

The NDIS plan may take some time to get right and this will depend on the person's disability and their support requirements. The planner will take into account the person's informal supports (family and friends) and access to mainstream services.

Each NDIS participant will have their own plan which reflects their needs and may look quite different from another person's plan, even though they may have similar disabilities.

The plan will set out agreed goals, what supports will be funded and how much money will be provided. The completed plan may include:

  • General supports
  • Reasonable and necessary supports which may include therapy, training and support to learn new skills, aids and equipment, communication devices and support to access social and recreational activities
  • Respite and in-home support

It will also state when the plan will be reviewed.

Once the person with disability and/or their family/carer is satisfied with the content of the draft plan it can be signed and returned to the NDIA. The next step is putting the plan into action.

Plan management

A number of options are available to the NDIS participant and/or their family carer about how to manage the plan.

Financial management options are:

  1. Self-managing – this means the money from the NDIS is paid directly to the person with disability or family (depending on circumstances) and payment for services will be made by the person or their family
  2. Nominating another person to manage the funding and pay providers – this is called a plan nominee
  3. Using a plan management provider – the planner will help find one. Payment for this service does not come out of a participant's support funding, but is an additional amount of money which is earmarked for this activity
  4. The NDIA can manage the plan
  5. There can be a combination of two or more of the above options

The Managing Your Plan section on the NDIS website outlines the various options available to people with disability and their family carers.

This can be found here.

Carers and the NDIS

The NDIS is primarily for people with significant and permanent disability. Family carers receive no funding in their own right unless it is to improve their ability to support a family member with disability.

When preparing for the NDIS planning meeting, it is worth putting together a Carer's Statement which outlines:

  • Their caring role, their ability to care and to sustain that care
  • If they are able/willing to continue caring in the same way and the impact this has on the carer
  • Any information about the carer and family life that the carer wants the planner to know

The Carer's Statement allows the carer to state what support they may need.

For carers supporting a family with psychosocial disability (mental illness) a useful resource is the Guide for Mental Health Carers on the National Disability Insurance Scheme which can be found at the Mental Health Australia www.mhaustralia.org and Carers Australia www.carersaustralia.com.au websites.

Things that may be funded for carers include:

  • Training for carers/parental strategies
  • Behaviour support/management plans
  • Group therapy and family therapy
  • Transition planning
  • Coordination of supports that are in the plan
  • Assistance with decision making, daily planning and budgeting

It is also worthwhile to keep a note book close by while you are waiting to meet or speak with the planner and jot down your daily routines and caring responsibilities. It is often difficult to remember all the things you do each and every day because it is something that you just do!

Depending on the circumstances, a carer can request a separate meeting with the planner. This can be either a face-to-face meeting or via a phone call.

The role of parents, carers, guardians and nominees

Family carers of children and young people up to 18 years of age are considered their legal guardians. After a person’s 18th birthday, they are considered by law to be able to make decisions on their own behalf. A nominee will only be appointed if it is not possible for a person with disability to make decisions for themselves.

There are two types of nominees:

  • A plan nominee can act on behalf of the person with disability that includes the preparation, and review of a person’s plan. It may also include the management of funding allocated to the plan.
  • A correspondence nominee is able to make requests to the NDIA and receive NDIA correspondence on behalf of the person with disability.

Nominees may be appointed at the request of the person with disability, or by the Chief Executive Officer of the NDIA.

Further information about this can be found on the NDIS website or directly via this link.

Review of decisions

There may be times when a person with disability and/or their family member(s) do not agree with what is in a plan. There are a number of things that can be done to appeal a decision.

  1. An internal review – this is undertaken by an authorised person in the NDIA. The reviewer is a person, who was not involved in developing of the plan. But before going through this process the person with disability and/or their family carer(s) will be encouraged to discuss their concerns with the original planner; particularly if they believe that an important matter was overlooked or ignored or if new information is now available. The NDIA must provide written notice of its decision. The person with disability and/or their family carer(s) then has up to three months to request a review of the decision. The reviewer can confirm, vary or set aside the original decision.
  2. External review – is an application to the Administrative Appeals Tribunal (AAT) for an external review of the decision. The application must be made within 28 days after you receive the appeal decision. This can be extended if the AAT deems it reasonable to do so.

The person with disability and/or their family carer(s) can receive support with this process from the External Review Service provided by to the Brain Injury Network of SA.

This service is a free service that helps people who have grievances with the decisions made by the NDIA. This service also provides impartial and confidential help and can also assist once an appeal has been lodged with the AAT.

Brain Network Network can also provide advocacy and support at the internal review stage.

More information can be found on the Brain Injury Network of SA website at: www.binsa.org.au or follow the link: www.braininjurysa.org.au/support-and-services/external-merits-review-support-service

Contact can be made by calling on 08 82177600 and country callers on 1300 733049.

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