DOCUMENT 1
FOI 24/25-1418 | MR25/01325
Guide – Safeguarding the
participant’s interests
SGP KP Publishing
Exported on 2025-09-02 22:14:05
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Risks and safeguards .......................................................................................................... 6
4
Pre-planning ......................................................................................................................... 8
4.1
Streaming ........................................................................................................................... 8
4.2
Personal and environmental circumstances (PEC) ............................................................ 8
4.3
Functional capacity assessment ........................................................................................ 8
4.4
Participant profile ................................................................................................................ 8
5
Risk assessment and plan duration ................................................................................. 10
5.1
Planning conversation for complex needs ........................................................................ 10
6
Planning .............................................................................................................................. 11
6.1
General planning principles to safeguard the participant's interests ................................ 11
6.1.1
Reasonable and necessary support ............................................................................................ 11
6.1.2
Planning guidance for specialist areas ........................................................................................ 11
6.1.3
Stated supports ........................................................................................................................... 11
6.1.4
Core supports ............................................................................................................................. 11
6.1.5
Core flexibility .............................................................................................................................. 11
6.1.6
Low cost assistive technology ..................................................................................................... 11
6.1.7
Capacity building supports .......................................................................................................... 12
6.1.8
Support coordination ................................................................................................................... 12
6.1.9
Psychosocial recovery coach ...................................................................................................... 12
6.1.10
Specialist behaviour support ....................................................................................................... 12
6.1.11
Capital supports .......................................................................................................................... 13
6.1.12
Higher cost assistive technology and home modifications .......................................................... 13
6.1.13
Replacement assistive technology .............................................................................................. 13
6.1.14
Rental or hire of assistive technology.......................................................................................... 13
6.1.15
Assistive technology during the course of the plan period .......................................................... 13
6.1.16
Plan management ....................................................................................................................... 13
7
Next steps ........................................................................................................................... 15
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This article provides guidance for all NDIA staff and partners to understand:
• risks and safeguards
• pre-planning considerations
• planning considerations.
Note: For risk assessment and safeguarding practices for NDIS applicants, use these
resources:
• PACE - Access Pre-decision Quality Check Guide (DOCX 338KB)
• Request priority eligibility decision
• Our Guideline – Applying to the NDIS.
Recent updates – 3
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1 Recent updates
12 August 2024 Guidance updated to:
• change user roles to All NDIA staff and partners
• change Our Guideline and PACE – Access Pre-decision Quality Check Guide links
• change mention of article Understand the product catalogue to Support Categories
• change mention of article Add support coordination funding and Add psychosocial
recovery coach funding to Understand support coordination and psychosocial recovery
coach funding
• change mention of article Conduct the plan meeting to Conduct the plan meeting -
Complete the participant profile
• remove mention of retired article Add low cost assistive technology (AT).
Recent updates – 4
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2 Before you start
You have read and understood:
• Participant safeguarding policy (external)
• Guide – Safeguarding the participant's interests – Context and background
• Guide – Conversation style guide
• Identify risk factors and vulnerabilities
• Our Guideline – Creating your plan (external)
• Our Guideline – Your plan (external)
• Participant Critical Incident Framework (DOCX 64KB)
Before you start – 5
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3 Risks and safeguards
Risk and safeguard assessments happen during the planning process. Planner delegates look
at all the information to create a plan that meets the needs of the participant. This can include:
• reviewing participant information
• requesting further information or reports
• thinking about the budget and plan length
• making plan management decisions
• conducting the plan meeting
• assessing risks and safeguards.
A general principle which guides actions under the NDIS Act is to support people with disability
to exercise choice and pursue their goals during the planning process, and we deliver their
supports. This choice includes being able to take reasonable risks. You can learn more about
choice, control and dignity of risk in the Participant safeguarding policy (external).
An NDIA function is to make sure there's a reasonable balance between safety and the
participant's right to be part of activities that involve risk.
To manage the risk, the NDIA puts in place safeguards with a minimum of necessary
restrictions. This is to balance the safety of the participant with the risk of harm. This recognises
their ability to take reasonable risks and make reasonable mistakes, giving participants choice
and control over their life.
The participant's plan meeting is an opportunity for open conversation. While developing their
plan, you may identify actual and potential risks. Together with the participant, you can explore
a range of safeguards and support mechanisms to minimise or mitigate risk. These could be:
•
Choice and control – participant empowerment to make their own decisions about
their supports and how funding in their plan is managed.
•
Risk-based and person-centred approach – safeguards are proportionate to the
actual level of risk the participant faces. This is based on their functional capacity,
natural support network and available supports.
•
Capacity presumption – the participant is presumed to have the capacity to exercise
choice and control, with support to be provided to develop and exercise this capacity.
To reduce the participant's potential exposure to harm or to manage the exposure, they're
encouraged to develop their own strategies and safeguards. Use the following safeguard levels
to guide the development of appropriate measures:
•
Individual safeguard level – informal and formal – Informal safeguards recognise the
participant is more likely to be safe when they're actively involved with their family and
the community. The things that make people safe can be seen as the same things that
are needed to have a good life. For example, caring relationships and increased
chances to be part of daily life. Formal safeguards include restrictive practices and
serious incident reporting.
•
Service safeguard level – include quality frameworks, complaint mechanisms and
workforce requirements. For example, delivery of contracted goods or services,
appropriate qualifications, recruitment practices and performance standards. For many
providers, an appropriate service safeguard level will be a requirement for NDIA
registration.
•
System safeguard level – the NDIA will use existing system safeguard levels to
protect the participant. These include internal and external processes for complaints
and to review decisions by an independent body and statutory power.
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•
Community-based safeguards – the NDIA uses and operates with existing
safeguards that aren't part of the formal disability service system. These include
advocacy organisations, community visitor schemes, public advocates or guardians,
ombudsman offices and discrimination commissioners. People with disability can also
use a range of community safeguards including anti-discrimination and consumer
protection legislation.
Additional safeguards that can be included in the participant's plan are to:
• set a shorter period between plan reassessments
• establish arrangements for regular contact between the participant and NDIA
• provide funding for supports to assist the participant to manage their own plan – for
example, budget training.
Safeguards also include supporting the participant with their decision making and interactions if
they require that level of support. The participant may be appointed a plan nominee,
correspondence nominee, or be supported by a third party with authority and consent. For more
information, go to Our Guideline – Appointing a nominee (external).
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4 Pre-planning
Pre-planning is the time to discuss and develop safeguards to make sure the participant's
interests are considered, risks identified and mitigated where necessary.
4.1 Streaming
Streaming helps predict the support level each participant will likely need to deal with the NDIS.
Streaming won't affect the level of reasonable and necessary supports in the participant's plan.
Participant streaming levels safeguard them to make sure there's appropriate resources and
expertise.
The participant may also be referred to the Complex Support Needs pathway for extra support.
For more information, go to articles:
• Complete a streaming case (Streaming and Restreaming).
• Guide – Complex support needs (CSN) pathway.
• Submit a referral to the Complex Support Needs (CSN) Branch.
Note: The term 'streaming' is for internal use only. We don't use this term with a person
externally.
4.2 Personal and environmental circumstances (PEC)
When a person applies to the NDIS, we ask questions to help us understand:
• the person's support needs
• how the person manages daily life.
This information may highlight a participant risk and can help inform other areas of the planning
process. For more information, go to article Complete personal and environmental
circumstances case.
The PEC questions will be done again for children younger than 7 by the early childhood
partner during a check-in. For more information, go to article EC: PEC – Capacity Building –
Early childhood supports overview.
4.3 Functional capacity assessment
Functional capacity assessment information assesses the impact level the participant's disability
has on their daily activities. This information may highlight a participant risk and can help inform
other areas of the planning process.
For more information, go to article to Understand functional capacity assessments.
4.4 Participant profile
The participant profile captures their environmental and personal information. The participant's
interests guide the planning process, through talking about living arrangements, relationships,
daily life and strengths. The participant's goals and informal, community and mainstream
supports are also recorded. Where appropriate, safeguard information can be recorded in this
section. For example, referral to family support services and child learning programs may be
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needed to reach a family orientated goal. If any risks are identified, go to article Identify risks
and vulnerabilities.
For more information, go to Our Guideline – Creating your plan (external) and article Conduct
the plan meeting - Complete the participant profile.
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5 Risk assessment and plan duration
The risk assessment should be used to identify risks and record safeguards in the participant's
life when developing the plan. Do this by asking questions and recording the information from
the planning conversation and other available supporting evidence. For more information, go to
articles:
• Change plan duration
• Create and complete a participant risk assessment case.
Plan duration should be determined based on the criteria set out in Appendix A of Our
Guidelines – Creating your plan (external). We might give a shorter plan duration if the
participant is experiencing higher risk, until their condition stabilises.
For more information, go to:
• Change plan duration
• section
When will we give you a shorter plan? in Our Guideline – Creating your plan
(external)
• section
Appendix A: Plan duration guidance in Our Guideline – Creating your plan
(external).
5.1 Planning conversation for complex needs
The Complex Support Needs (CSN) branch works with participants with specific and unique
needs. The CSN branch supports participants who need a higher support level to use their plan
and pursue their goals.
For more information, go to article Guide – Complex support needs (CSN) pathway.
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6 Planning
6.1 General planning principles to safeguard the participant's
interests
6.1.1 Reasonable and necessary support
Appropriate reasonable and necessary funded supports are identified and included in the
participant plan. These supports are in the budget areas of core, capacity building and capital.
You must think about if any funded supports should not be provided or funded under the NDIS.
A support won't be funded under the NDIS if it is likely to cause harm to the participant or be a
risk to others.
For more information, refer to the Our Guideline – Reasonable and necessary supports
(external).
6.1.2 Planning guidance for specialist areas
You need to refer to guidance for participants with certain disabilities, in specific cohorts or with
specialist needs. For example, there's specific guidance for participants with motor neurone
disease to have supports in place for a quick response to a rapidly declining function as a
safeguard for the participant.
6.1.3 Stated supports
A stated support makes sure the funds are used for a vital service and can't be used flexibly for
an alternate support. An example of a stated support is support coordination. For more
information, go to article Support Categories.
6.1.4 Core supports
Core supports help the participant manage daily living areas such as self-care, community
access, and consumable items (such as daily adaptive equipment and transport). The
appropriate funding level is included in the plan to make sure needs are met and the participant
is safeguarded from risks. For more information, go to article Support Categories.
6.1.5 Core flexibility
Core support flexibility in the participant's plan assists them to vary levels of control over how
they use their support and responds to their changing needs. The flexible support will help
reduce the likelihood of risks that may come up during the plan duration. For more information,
go to article Support Categories.
6.1.6 Low cost assistive technology
For more information on assistive technology (AT), go to section
Capital supports in this
article.
Low cost AT is less than $1,500 in value and is generally low risk. These funds can be included
to allow the participant to purchase low-cost items. For example, a walking stick or basic shower
chair. Funds can also be for minor AT repairs or to help the participant to decide which AT to
purchase. This gives the participant immediate access and flexibility to purchase AT. This also
minimises the risks from waiting for an assessment or purchase approval.
For more information, go to:
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• Assistive technology – Guide for Low Cost support funding (DOCX 71KB)
• Our Guideline – Assistive Technology (external)
• article Support Categories.
6.1.7 Capacity building supports
Capacity building supports link to the participant's goals and aspirations. Funding is allocated to
the specific support areas needed by the participant in their daily life.
Including funded supports in the plan to build capacity for independence or to build skills in an
identified area can be in response to a risk, and therefore a safeguard.
For more information, go to article Support Categories.
6.1.8 Support coordination
Plan developers consider the support level the participant needs to build their capacity to
connect with supports and services. This includes informal and mainstream supports. Support
coordination helps the participant to understand their plan, and how to:
• use funded supports
• build capacity
• strengthen their ability to pursue their goals.
If multiple mainstream interfaces are involved, or there's a high-risk level, then specialist
support coordination may be included in the plan.
For more information, go to articles:
• Record support coordination information
• Understand support coordination and psychosocial recovery coach funding.
6.1.9 Psychosocial recovery coach
Participants with a primary psychosocial disability can have support from a recovery coach. A
recovery coach is a qualified mental health worker. From their own experiences and training,
understands the impacts of mental health. They can support the participant to build confidence
and motivation to achieve their goals and use their supports to live a fulfilling life. A recovery
coach will also support the participant to understand how the NDIS works with other supports
including mainstream and community supports.
For more information, go to articles:
• Guide – Psychosocial disability
• Understand support coordination and psychosocial recovery coach funding.
6.1.10 Specialist behaviour support
Some participants may need positive behaviour support to address behaviours of concern that
are a risk to themselves or to others. These supports are recommended to:
• support the participant's safety and wellbeing
• promote options for increasing the participant's capacity and community and
mainstream connections to pursue plan goals
• provide long term sustainability of the participant's plan and informal support systems.
Including specialist behaviour support in the plan is to identify and reduce behaviours of
concern, can improve the participant's quality of life, uphold their dignity and safeguard their
rights. As a further participant safeguard, positive behaviour support must be provided in
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accordance with the NDIS Quality and Safeguards Commission's requirements. This means
these support providers must be registered with the Commission and ensures the regulation of
restrictive practices.
For more information go to Guide – Behaviour support.
6.1.11 Capital supports
Capital supports include AT, repairs and AT maintenance, vehicle modifications and home
modifications (HM). The following AT processes make sure the participant's interests and risks
to them are looked at to minimise delay in vital equipment needs.
6.1.12 Higher cost assistive technology and home modifications
There's a higher risk of injury, hospitalisation or even death if appropriate assessment, setup or
construction isn't done for higher cost or complex AT.
Specialised and complex AT requires an assessment and supporting evidence from a qualified
AT assessor. For more information, go to article Understand high-cost assistive technology (AT)
funding.
Home modifications will require assessment usually by an occupational therapist. In more
complex cases, a building professional is also involved. For more information, go to article
Support categories or Our Guideline – Home modifications (external).
6.1.13 Replacement assistive technology
Replacement AT involves a streamlined process to avoid delays and provide a like-for-like
equipment replacement. This needs to follow specific criteria to make sure there are no
unreasonable risks to the participant.
6.1.14 Rental or hire of assistive technology
Funding for rental of AT may be included in a participant's plan, for example if there's a supply
delay, or if AT requirements are still being decided. This will usually be for a specific time
period. This will make sure there's no risk to the participant's safety while the AT is obtained.
For more information, go to article Support Categories.
6.1.15 Assistive technology during the course of the plan period
AT supports are included in the plan based on the available information at that point-in-time.
If we get an AT assessment recommendation during the plan period, the delegate must
determine if:
• there are any risks to the participant in delaying access to the AT supports
• the recommended AT is reasonable and necessary.
A planner delegate must consider if the AT needs to be funded immediately to mitigate risks, or
it can be funded at the next plan change.
For more information, go to Our Guideline – Assistive Technology (external).
6.1.16 Plan management
Plan management is how the support budget is managed by the participant or their
representative. The plan can be self-managed, plan-managed, agency-managed or a
combination. In the applying, planning and implementation stages, the benefits and
responsibilities of each plan management option are discussed with the participant.
For self-management, we need to decide if this approach is an unreasonable participant risk.
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We will only decide a risk is unreasonable if there are no suitable safeguards or supports
available to manage the risk of harm to the participant.
For more information, go to Our Guideline – Creating your plan (external).
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7 Next steps
Related knowledge articles:
• Record risks and vulnerabilities during a check-in
• Identify risks and vulnerabilities
• Create and complete a participant risk assessment case.
Related external guidance:
• NDIS Safeguards (external)
• Our Guideline – Your plan (external)
• Guide to self-management (external)
• Providing assistive technology (external)
• Understand assistive technology evidence, advice, assessments and quotes (DOCX
67KB).
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Discuss funded supports
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Confirm the participant understands their funded supports and how to use them ..... 6
3.1
Complete funded supports information .............................................................................. 6
4
Explain plan changes and review of the decision ............................................................ 9
5
Next steps ........................................................................................................................... 10
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This article provides guidance for a planner delegate, planner (non-partnered area), participant
support officer, local area coordinator or early childhood partner to:
• confirm the participant understands their funded supports and how to use them
• explain changes to the participant's plan
• explain how we review our decisions.
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1 Recent updates
25 November 2024 Updated guidance to correct link to article Record and action a request for a budget breakdown.
3 October 2024 Updated guidance to:
• advise participants that their plan letter and included supports will look the same until
PACE updates are completed for new legislative change
• add replacement support reference.
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2 Before you start
You have read and understood:
• Our Guidelines – Your plan (external)
• Our Guidelines – Supports you can access (external)
• article Guide – Conversation style guide
• article Support Categories.
You have reviewed and completed the:
• participant's plan approval letter, plan and goals
•
Handover Notes to make sure any notes about the participant's wishes are considered
and to help implement the plan
•
Update Profile screen, using article Implement community and mainstream supports.
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3 Confirm the participant understands their funded
supports and how to use them
Talk with the participant or their authorised representative about how they can use NDIS
supports funded in their plan. This is an opportunity to support the participant to make the most
of their funded NDIS supports to pursue their goals. You may want to talk with the participant
about tools and resources available to help them manage their funds, like the Budget calculator
(external) or Factsheet: Using your NDIS plan (external).
Note: In July 2024 we updated the plan letter and supports to include comments to help the
participant understand how to use their plan. We're now updating our computer system for new
legislative changes. Until these changes are finalised, you
must advise the participant their plan
letter and supports included will look similar.
3.1 Complete funded supports information
In the
Plan Implementation case, at the
Funded Supports screen:
1. At
Discuss with the participant if they require any clarifications, they are
comfortable with what has been included in their plan and how to use their
funded supports, select:
o
Further discussion or clarification required, go to step 2.
o
No further discussion or clarification required, go to step 5.
2. At
Confirm the following topics have been discussed and understood by the
participant, select all the options you've discussed with the participant. The options
are:
o
The plan funding included in the participant's plan. Talk about what the
different budgets in their plan mean. Talk about how the supports can help the
participant pursue their goals and help them to find and connect with providers.
To learn more, go to article Connect with providers.
o
Any changes from their previous plan. Talk about what funded NDIS
supports have changed since their previous plan.
Note: If you've changed the duration of the participant's plan tell the participant
we're updating our computer system for the new legislative changes. Until we
complete these updates, new and reassessed plans will generally be 12
months (1 year) in length.
o
The different support categories and their flexibility. Talk with the
participant about the different support categories. Check that the participant
understands which of the core supports in their plan are flexible and what
supports they can buy more generally. This means they have more choice
about how to use their funding between these flexible support categories. To
learn more, go to article Support Categories.
o Talk with the participant about spending in line with their plan budget. This will
make sure their funding will last the full length of their NDIS plan. Advise the
participant if they'd like more details about the supports that make up their
plan's total budget amount, we can send this to them. They can contact us and
ask for a Budget Breakdown. To learn more, go to article Record and action a
request for a budget breakdown.
o You may also want to talk about their provider relationships, both now and in
the future.
Note: If the participant's plan includes Agency-managed NDIS supports such
as home and living, behaviour support or specialist disability accommodation
(SDA), you must make sure these support categories have been added. This is
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so provider relationships can be added or updated, and the provider can
access funds in the plan. If the provider is not yet known, make sure you add it
as soon as it is. This is important so the provider can submit a claim to access
funds. To learn more, go to article Add or update a provider relationship.
Participants with Agency-managed funds to pay for NDIS supports, can accept
or decline provider relationship requests in the my NDIS participant portal. They
can also change the information they consent to share with providers. To learn
more, go to article my NDIS portal – Understand provider relationships and
consent to share information. You can provide the participant a copy of, or a
link to, Factsheet: Support categories (external).
o
The value and importance of service agreements. Explain how important
service agreements are. Talk to the participant about how they can negotiate
their supports to make sure the service provided meets their support needs and
helps to pursue their goals. To learn more, go to article Discuss service
agreements.
o
If any supports have been stated in the plan, the participant knows who
can deliver the support and how it may need to be provided. Talk about
which supports in their plan are stated. If capital supports are included, talk
about when to get a quote. To learn more, go to article Understand high-cost
assistive technology (AT) funding.
o
Organising and planning supports over the life of the plan. Talk to the
participant about how to use and make the most out of their plan. Talk to them
about tools and resources to help keep track of their funding and supports. For
example, how they can use the Budget calculator or the Support Organiser
(external).
o
Entering and ensuring bank account details are up to date. Check the
participant's bank details are correct. To do this, go to article View bank
account details. If they have a plan nominee or authorised representative with
manage plan funding authority, make sure their bank details are correct and
assigned to the participant. To learn more, go to article Before you update bank
account details.
Note: You must record bank details within 2 weeks of the plan
being approved in PACE. This is to make sure the participant automatically
receives recurring payments for NDIS funded supports and services. They can
give us bank details through their my NDIS contact or any of the contact
(external) options listed on the NDIS website. If bank details aren't recorded on
the person account within 2 weeks, a
Claim and Payment Enquiry case will
have to be created. To learn more, go to article Create a new claim and
payment enquiry case.
3. If you make a referral on behalf of the participant, you must log an activity using article
Log an activity or internal note. To learn more about how to support the participant to
connect with providers and how to make a referral, go to article Make a referral.
4. Record what you've talked about and what support you've given the participant at the
implementation meeting in the
Supporting Notes screen of the
Plan Implementation case. This means the participant doesn't have to retell their story or repeat information
they've already told us.
Note: Don't record information in the
If any of the above topics were not able to be
discussed, use the notes section to describe why and any alternative strategies
being used free text field. This is because you may not be able to view this information
once this case is closed.
5. Select
Yes or
No at
Has funding been included for supports to assist the
participant implement their plan i.e., Support Coordination or Psychosocial
Recovery Coach support?. If you select:
o
Yes, and the participant needs a new or updated request for service, you'll
need to create a
Request for Service case. To learn more, go to article
Complete the request for service. Select
Next.
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o
No, select
Next.
To learn more about support coordination, go to Support coordinators (external). To learn more
about psychosocial recovery coaches (recovery coach), go to Psychosocial disability supports
(external).
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4 Explain plan changes and review of the decision
Talk about the date when their plan will be reassessed and where they can find their plan
reassessment date in their plan. To learn more, go to Our Guidelines – Changing your plan
(external). Explain what they need to do if they want to make a change to their plan. We call this
a plan reassessment or plan variation.
Explain to the participant their review rights. Explain what to do if they don't agree with our
decision. To learn more, go to Our Guidelines – Reviewing our decisions (external).
Note: If the participant or authorised representative requests a replacement support, go to
article Create and action a request for a replacement support.
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5 Next steps
Talk about how the participant's funding will be managed. To do this, go to article Discuss fund
management.
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Support Categories
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SGP KP Publishing – Support Categories
Table of Contents
1
Recent updates .................................................................................................................... 4
2
Our Guidelines ..................................................................................................................... 5
3
Published Guides ................................................................................................................. 6
4
How support categories have changed from SAP CRM to PACE ................................... 7
4.1
Understand frequency type in continued plans .................................................................. 7
5
Core support categories ...................................................................................................... 8
5.1
Assistance with daily life ..................................................................................................... 8
5.2
Assistance with social, economic and community participation ......................................... 8
5.3
Consumables ...................................................................................................................... 9
5.4
Transport (not recurring) ..................................................................................................... 9
6
Home and living ................................................................................................................. 10
6.1
Individualised Living Options (ILO) ................................................................................... 10
6.2
Medium Term Accommodation (MTA) ............................................................................. 10
6.3
Supported Independent Living (SIL) ................................................................................. 11
6.4
YPIRAC – Cross billing ..................................................................................................... 11
7
Capital support categories ................................................................................................ 13
7.1
Assistive Technology (not maintenance, repair and rental) ............................................. 13
7.2
Assistive Technology – maintenance, repair and rental ................................................... 13
7.3
Home modifications .......................................................................................................... 14
7.4
Specialist Disability Accommodation (SDA) ..................................................................... 14
8
Capacity building support categories .............................................................................. 15
8.1
Behaviour support ............................................................................................................ 15
8.2
Choice and control ............................................................................................................ 15
8.3
Finding and keeping a job ................................................................................................ 16
8.4
Health and wellbeing ........................................................................................................ 16
8.5
Improved daily living skills ................................................................................................ 16
8.6
Improved living arrangements .......................................................................................... 17
8.7
Increased Social and Community participation ................................................................ 17
8.8
Lifelong learning ............................................................................................................... 18
8.9
Relationships .................................................................................................................... 18
8.10
Support coordination and psychosocial recovery coaches ........................................... 18
9
Recurring support categories ........................................................................................... 20
9.1
Recurring transport ........................................................................................................... 20
Table of Contents – 2
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SGP KP Publishing – Support Categories
This article provides guidance for all NDIA staff and partners to understand NDIS support
categories.
Recent updates – 3
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1 Recent updates
10 February 2025 Information on funding therapy supports added for clarification purposes under section
'Improved daily living skills'.
16 December 2024 Guidance updated to:
• add section Understand frequency type in continued plans
• add link to new article Understand and talk about when a plan is automatically
continued (plan auto-extensions)
• update outdated article names.
Recent updates – 4
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SGP KP Publishing – Support Categories
2 Our Guidelines
Our Guidelines (external) are based on the NDIS Legislation and Rules. They explain what you
need to consider and how we make decisions based on the legislation. You should use Our
Guidelines to inform your reasonable and necessary decision making.
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3 Published Guides
• Guide – Aboriginal and Torres Strait Islander supports
• Guide – Assisting communication
• Guide – Assisting communication – Accessible formats
• Guide – Assisting communication – Considerations when arranging interpreting
services
• Guide – Assisting communication – Disability-related interpreting and translation
supports
• Guide – Assisting communication – Non-disability related interpreting and translation
supports
• Guide – Behaviour support
• Guide – How to support children and young people to remain in their family home
• Guide – Children living in statutory out-of-home care
• Guide – Complex support needs (CSN) pathway
• Guide – Conversation style guide
• Guide – Conversation style guide appendix A – During the conversation
• Guide – Conversation style guide appendix B – Navigate different types of conversation
• Guide – Hearing supports
• Guide – Hearing supports appendix A – Funding responsibilities
• Guide – Hearing supports appendix B – Capacity building supports
• Guide – Hearing supports appendix C – Capital supports
• Guide – Hearing supports appendix D – Core supports
• Guide – In-kind
• Guide – Motor Neurone Disease (MND)
• Guide – Psychosocial disability
• Guide – Psychosocial disability Case examples
• Guide – Psychosocial disability Appendix A – Discharge planning
• Guide – Psychosocial disability Appendix B – Definitions
• Guide – Psychosocial disability Appendix C – Supports – Guide for decision makers
• Guide – Respiratory supports
• Guide – Safeguarding the participant's interests
• Guide – Safeguarding the participant's interests – Context and background
• Guide – Therapy supports
• Guide – Therapy supports appendix A
• Guide – Therapy supports appendix B
• Guide – Transition to adulthood checklist for participants living outside the family home.
Published Guides – 6
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SGP KP Publishing – Support Categories
4 How support categories have changed from SAP
CRM to PACE
In PACE, we add funds at the support category level. The reason for this change is to allow the
participant more choice and control to buy the supports that they need.
This means when the participant's plan is approved in PACE, the funding will be set out
differently.
Some of the participant's funding may be included in new support categories. For example,
home and living and recurring transport supports have their own support category.
We're not changing the supports we'll fund, the names of support items or the way participants
claim from these support categories.
4.1 Understand frequency type in continued plans
It's important to understand what happens to NDIS supports when a plan is continued. A plan
continuation is where a participant's plan is continued for up to 12 months. This can happen if
the participant has stable support needs and a plan that is working for them, or if we haven't
created a new plan by their reassessment date. To learn more, go to articles Understand and
talk about a plan continuation and Understand and talk about when a plan is automatically
continued (plan auto-extensions).
An NDIS support funded with
Once-off as the
Frequency type is intended to be purchased
once, for example Assistive Technology. Once-off NDIS supports will not be provided again if a
plan is continued unless they've not been spent yet. When they've not been spent, the date the
participant can claim the funds will extend with the continued plan.
An NDIS support funded with
Regular as the
Frequency type is intended to continue for the
duration of the participant's plan, for example Assistance with Daily Living. Regular NDIS
supports will be repeated if a plan is continued, adjusted in line with annual indexation. This is to
make sure the participant can continue to access funds for their usual NDIS supports.
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Understand and check plan
comments
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SGP KP Publishing – Understand and check plan comments
Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Understand plan comments ................................................................................................ 6
4
Check plan comments ......................................................................................................... 7
5
Action plan comments ......................................................................................................... 8
5.1
Assistance with daily life plan comments ........................................................................... 8
5.2
Assistive Technology plan comments .............................................................................. 10
5.3
Assistive Technology Maintenance, Repair, Rental and Trial plan comments ................ 10
5.4
Behaviour support plan comments ................................................................................... 11
5.5
Consumables plan comments .......................................................................................... 11
5.6
Health and wellbeing plan comments ............................................................................... 12
5.7
Home and Living plan comments ..................................................................................... 12
5.8
Home modifications plan comments ................................................................................ 12
5.9
Improved daily living skills plan comments ....................................................................... 13
5.10
Recurring transport plan comments .............................................................................. 14
5.11
Specialist Disability Accommodation (SDA) plan comments ........................................ 14
5.12
Support Coordination and Psychosocial Recovery Coaches ....................................... 15
5.13
Transport plan comments ............................................................................................. 15
Table of Contents – 2
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SGP KP Publishing – Understand and check plan comments
This article provides guidance for a planner delegate, planner (non-partnered area) or review
officer to:
• understand plan comments
• check plan comments
• action plan comments.
Recent updates – 3
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1 Recent updates
9 December 2024Linked article name change from Add onsite shared supports in Specialist
Disability Accommodation (SDA) funding to Understand and add onsite shared support in
specialist disability accommodation (SDA).
4 November 2024 New plan comments added to reflect legislation changes from 3 October 2024.
New comments have been added to:
• Assistance with Daily Life
• Consumables
• Assistance with social, economic and community participation
• Improved daily living skills
• Specialist disability accommodation (SDA).
Recent updates – 4
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2 Before you start
You have added or updated a support in a plan approval, plan change or participant budget
update case.
To add or update a support category for a:
•
Plan Approval case, go to article Change the draft budget
•
Participant Budget Update or
Plan Change case, go to article Action a budget
update.
Note: only plan comments you need to edit are included in this article.
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3 Understand plan comments
Each support item will have a pre-populated comment. The comment will populate when you
select support items which meet the NDIS funding criteria (external).
Make sure you use the pre-populated comment for each of the support items you include in the
participant's plan. Only edit the comment if you need to include extra information about the
participant's NDIS funded supports.
These comments will print in the participant's plan. They'll also appear on the participant's portal
and where consent has been provided, the provider portal.
Comments need to clearly explain the support item and what has been funded. This will help
the participant to have a better understanding of what supports they can buy with their plan.
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4 Check plan comments
If you've added funding to a support category, select at least one support item to include in the
participant's plan. If you don't select at least one support item for a support category, you'll get
an error message.
Note: the only time you shouldn't include a support item is when there's a $0 support category
in the budget. For example, a $0 support category to allow core budget flexibility. If you include
a support item for a $0 support category, you'll get an error message.
Use the pre-populated comment for each of the support items you include. Only edit the
comment if extra information is needed or you need to show which support you're funding. For
example, to describe the specific support item, funded amount or ratio of support.
In a
Plan Approval,
Plan Change or
Participant Budget Update:
1. From
Plan Comments, select
Yes for each support item you're funding in the
participant's plan.
2. Make sure you edit any comments which include text in square brackets or a dollar
amount. For example, any text in [ ] or $XX.XX to include extra information or to remove
support items you aren’t funding. This may include the type of support, funded amount,
hours included or the ratio of support. If the plan comments has these fields, go to
section
Action plan comments in this article.
3. Once all comments are recorded, select
Next. Go to section
Review and Submit in the
below articles:
o For
Plan Approval case, go to article Change the draft budget.
o For
Plan Change or
Participant Budget Update case, go to article Action a
budget update.
Check plan comments – 7
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Reasonable and Necessary Supports
Quick summary: There are new laws about what we can and can’t fund under the NDIS. All
supports need to meet each of the reasonable and necessary criteria before we can fund
them in your plan. For example, your supports need to relate to the impairments you meet
the disability or early intervention requirements for, be value for money, and effective and
beneficial. We also need to make sure each support is an NDIS support. This means it is a
service, item, or equipment that can be funded by the NDIS. Examples of NDIS supports
include support with personal daily living tasks and accessing the community, therapeutic
supports, and personal mobility equipment.
Note:
• When we say 'your plan' we mean your NDIS plan.
• When we say ‘disability support needs’, we mean supports you need for the
impairments that meet the disability or early intervention requirements, or both.
• If you’re aged between 9 and 65 years and are looking for information about
community connections, go to Our Guideline – Community Connections.
• If your child is younger than 9 and you’re looking for information about early
connections, go to Our Guideline – Early Connections.
• As part of the recent changes to the NDIS laws we are moving towards a new
framework for planning. Rules need to be developed for this new framework. We’re
working on how and when we’ll introduce these changes.
Until then, the information in this Our Guideline is about our ‘old framework’ for
planning, which include the legislative changes that become operational when the law
commences. All current plans will be known as 'old framework' plans, and we will
continue to develop these until all participants have transitioned to the new
framework.
What’s on this page?
This page covers:
•
What are reasonable and necessary supports?
•
How do we make decisions about what is reasonable and necessary?
•
How do we include the reasonable and necessary supports in your plan?
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•
What if you don’t agree with our decision?
You may also be interested in:
• Mainstream supports
• Creating your plan
• Changing your plan
• Reviewing our decisions
• Would we fund it?
What are reasonable and necessary supports?
The National Disability Insurance Scheme (NDIS) was set up as a world first approach to
disability support. It puts people with disability at the centre of decision-making, through the
principles of reasonable and necessary supports and individual choice and control.
We provide funding for reasonable and necessary supports to people with a permanent and
significant disability or developmental delay.
Reasonable and necessary supports are the supports we fund in your plan to meet your
disability needs. All supports we fund in your plan need to meet the criteria set out in law for
the NDIS of what we can and can’t fund
.1 For information on what is an NDIS support and
what is not, go to NDIS support.
NDIS supports should complement, not replace, other supports available to you. That’s why
we consider:
• the things you’re able to do for yourself
• support you have from others in your network, including family members, relatives,
friends, local community services and mainstream government services.
Once we’ve considered your situation, we need to follow the rules determined under the law
for the NDIS in our planning decisions
.2
This guideline explains how we decide what reasonable and necessary supports must
consider, which we’ll explain in detail.
When creating your plan, we also follow these principles.
We also have Would we fund it guides. They have examples of how we decide if we fund
different types of supports.
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How do we make decisions about what is reasonable and
necessary?
When we create your plan with you, we’ll discuss what supports you need for the
impairments that meet the disability or early intervention requ
irements.3 We want to help you
pursue your goals, increase your independence, and help you work, study and join social
activities.
The NDIS will only fund a support if it meets
all the reasonable and necessary criteria. We
also won’t fund a support if the law says we can’t fund it. We explain t
he reasonable and
necessary criteria in more detail further down.
What supports can you get outside the NDIS?
Before we decide what reasonable and necessary supports to fund in your plan, we’ll first
discuss what other supports may be available outside the NDIS. This is an important
information-gathering step. For example, there may be mainstream, community and informal
supports that suit you.
There are many supports you can get outside the NDIS. Other government and community
services provide supports to all Australians, including people with disability. And your friends,
family, and other people you know can often be your best supports.
To find out more about supports you can get outside the NDIS, go to Creating your plan.
It’s important we gather this information and help you access these services before we
consider what reasonable and necessary supports we can fund. That way, we can help
make sure you’re able to access mainstream, community, and informal supports wherever
possible.
For more information, go to Mainstream and community supports.
What types of supports may be included in your plan?
Your plan may include ‘general supports’ and ‘reasonable and necessary supports’
.4
General supports
General supports are the coordination, strategic or referral services and activities we provide
or arrange to be provided, for yo
u.5 They’re how we help you develop your plan and connect
with support and activities in your community. This includes the support you get from your
early childhood coordinator or local area coordinator to connect to mainstream, community,
and informal supports. You don’t need to pay for your general supports from your plan as the
NDIS pays for them directly.
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Reasonable and necessary supports
Reasonable and necessary supports are the NDIS supports we fund or provide in your plan
to meet your disability support nee
ds.6 NDIS supports need to be for your impairments that
meet the disability or early intervention requirements, or both
.7 NDIS supports are the
services, items, and equipment we can fund or provide under the ND
IS.8 For information on
what supports are considered NDIS supports, go to NDIS supports.
The laws for the NDIS tell us what we can fund in your plan
.9 All supports we fund in a plan
need to meet all the criteria set out in these laws. We call these t
he NDIS funding criteria.
• We’ll check your support types and amounts of support will complement each other to
help you fulfil
an ordinary life.10 Any funded supports must be an ND
IS support11 that
is right for you.
• It must not
be a type of support the law says we can’t fund or provide.12
Each support must be reasonable and necessary individually, but the supports must also be
reasonable and necessary when considered as a package of supports.
Does the support meet the reasonable and necessary criteria?
We can only include supports in your plan if they meet
all the reasonable and necessary
criteria
.13
This means that before we can include a funded support in your plan, we need to be
satisfied it meets all the following criteria:
• The support
is for the impairments you meet the disability or early intervention
requirements for, or both.14
• The support will help
you to pursue your goals in your plan.15
• The support will help you to
undertake activities, to facilitate your social and economic
participation.16 This means the support will help you join in social outings, recreation,
work and study by reducing the disability-related barriers that prevent you from
participating.
• The support represent
s value for money. This means we need to consider the costs
and benefits of the support, as well as the costs and benefits of
alternative supports.17
• The support will be, or is likely to
be, effective and beneficial for you, having regard to
curr
ent good practice.18 This means we consider if there is evidence the support
works for someone with similar disability support needs. We won’t need an expert
report for every support, as we can often rely on other information or evidence. For
example, we may have information already about whether the support is widely
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accepted to suit someone with your disability support nee
ds.19 We also consider your
lived experience.
• The funding of the support
takes account of what it is reasonable to expect families,
carers, informal networks and the community to provide.20 This means we need to
consider what support is reasonable for your family, friends and community to
provide.
• The support is
an NDIS support for you.21
The law for the NDIS sets out things that we need to consider when we apply the reasonable
and necessary criteria
.22
For example, funding a vehicle modification may reduce your need for other supports. By
funding a vehicle modification in your plan, we’ll look at whether you need less support to
access the community.
If the vehicle modification will reduce your support needs, we might reduce the amount of
support we fund for you to access the community. This is because the same amount of
support might not be reasonable and necessary when the whole package of supports is
considered.
Is the support related to the impairments you meet disability or early intervention
requirements for, or both?
We’ll only fund a support if it relates to the impairments you meet the disability or early
intervention requirements for, or both
.23 This means there must be a direct link between your
disability support needs and the NDIS supports we fund.
We consider if the support addresses your disability support needs. Your disability support
needs are those that come from, or are caused by, your disability.
For example, we don’t fund things like flights to go on a holiday or a gym membership to get
fit.
This is because you’re unlikely to need these supports because of your disability support
needs. They are things that all people, with or without disability, might want or need.
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Example
Alan uses a wheelchair and needs some changes to their house. They need to be able to
independently use their bathroom and kitchen. They also want to set up an outdoor
entertainment area for when their friends visit.
We may be able to fund home modifications so Alan can access areas of their home,
including their bathroom and kitchen. They need the home modification because they can’t
access those areas due to their disability.
Alan will need to pay for the outdoor entertainment area, as it’s not related to their disability.
Does the support help you pursue your goals?
We need to be satisfied that the support will help you pursue the goals, objectives and
aspirations in your pla
n.24 This helps us determine if the support is necess
ary.25
While we only fund supports that help you pursue your goals, objectives and aspirations, we
understand that different people express themselves in different ways.
Reasonable and necessary supports should help you pursue your goa
ls,26 but you don’t
need a specific goal for every support in your plan. When we decide if a support will help you
pursue your goals, we consider your whole situation.
We look at how a support will address your disability support needs, and the disability
specific barriers that prevent you from pursuing your goals.
A support that addresses your disability related support needs is most likely to help you
pursue your goals, objectives and aspirations in your plan.
This means that if your goal is to ‘live independently’, we
may fund home modifications that
address your disability related needs. However, we won’t fund supports that aren’t NDIS
supports, including day-to day-living costs like rent or utilities. These costs aren’t incurred
solely and directly because of your disability support needs, so they don’t meet other funding
criteria
.27
Also, choosing a different goal ‘to have a more accessible home’ won’t change the supports
we could fund in your plan.
Achieving goals usually takes many different kinds of supports. NDIS supports will most
likely be just one kind of support that helps you work toward your goals.
Learn more about setting your goals in Creating Your Plan and the Setting Goals fact sheet.
Example
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Morgan is ready to look for work and they have a goal in their plan to get a job. They have
built up their skills and know the type of work they want to do. Disability Employment
Services are helping Morgan find work, so we can’t fund this support for Morgan.
However, because of their disability, Morgan will need personal care supports to help them
get ready for work in the morning. We will consider:
• how Morgan’s disability support needs relate to their goals
• if funding NDIS supports that address these disability support needs will help Morgan
pursue their goals.
Morgan’s planner determines the personal care supports meet this criteria. The supports that
address their personal care needs will help Morgan to pursue their employment goals.
Morgan’s planner then needs to look at if the support meets the other NDIS funding criteria.
In this case Morgan does get personal care in their plan. Morgan doesn’t have a job yet but
will need personal care support to help them get ready to look for work. Morgan will also be
able to use these supports when they get a job.
We don’t fund all the supports that relate to Morgan’s employment goals. We only fund the
supports we consider are reasonable and necessary – that is, when they meet all the NDIS
funding criteria.
Does the support help you do activities that will help your social and economic
participation?
We need to be satisfied that the support will help you to do activities, which make it easier for
you to participate socially and econo
mically.28
Social participation means doing things you enjoy, like going out with friends, playing sport or
going out into the community. It also means doing the things you need to do, like going to
school or medical appointments.
Economic participation usually means being involved in things that help you work towards
getting and keeping a job. This might be things like volunteering, study, learning new skills or
trying work experience. Research tells us that work can lead to health benefits and improve
our quality of life. Learn more about the Health Benefits of Good Work.
Social and economic participation are important to most people. They are critical to living an
ordinary life.
To work out if a support meets this criteria, we look at the purpose of the support and how it
will help you.
We fund reasonable and necessary supports that reduce the barriers that prevent you from
doing activities. This will help you increase your social and economic participation.
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Some supports help economic and social participation directly. There are lots of supports we
can fund to directly help with social and economic participation. Learn more about Social and
recreation supports and Work and study supports.
Other supports help you do activities like self-care, which indirectly help your economic and
social participation.
Example
Sue is going to university next year. She has a vision impairment and has been working with
her Guide Dog Mobility Instructor to decide if a Dog Guide is right for her. A Dog Guide can
help her leave her home safely and independently, and travel to and from university.
A Dog Guide could also help her go out with friends and join in other community activities.
As long as it meets the other funding criteria, we could fund a Dog Guide for Sue. It will help
her with activities of daily living.
In Sue’s case, a Dog Guide will also increase her social and economic participation. Having
a Dog Guide will help her get to her university independently where she studies and also has
lots of friends.
Is the support value for money?
All supports we fund under the NDIS need to be value for money. This means the cost of the
support is reasonable when we consider the benefits of the support and the cost of other
supports.
Making sure your supports are value for money is one of the ways we keep the NDIS
financially sustainable. This means we make careful decisions about funding so that we
make sure the NDIS exists for future generations. It’s also one of our principles
.29
When we decide if the support is value for money, we consider:
• if other supports would achieve the same result at a substantially lower cost
.30 This
means there should be a real or material difference in cost
• if there’s evidence that the support will substantially improve your life stage outcomes
and benefit you in the long ter
m31
• if the support will likely reduce the cost of other supports over
time32
• how the cost compares to other supports of the same kind in your ar
ea33
• if the support will make you more independent and mean you won’t need as many
supports in the future. For example, in some situations home modifications may
reduce the need for support in your home.
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When we consider the likely cost of supports, we consider the cost over the long term. We
consider if the support will help you achieve milestones at different ages or stages of your life
and have long term benefits.
For example, some supports like home modifications may be expensive now, compared to
other supports. But getting these supports now may mean you need much less support in a
few years, or later in life. Or it may delay the need for other more costly suppor
ts.34
When determining if the cost of the support is value for money, we consider:
• the prices for NDIS supports in the NDIS Pricing Arrangements and Price Limits
• quotes for specific or high risk supports.
It’s important we consider the cost of the support. This will be the level of funding we include
in your plan, if we decide the support is reasonable and necessary.
When we fund equipment or modifications, we also need to consi
der:35
• how the cost of buying the equipment or modifications compares to the cost of renting
them
• if it’s appropriate to fund the equipment or modifications you want, based on your
situation and any expected changes in technology.
Learn more about how we consider value for money when we fund assistive technology,
home modifications and vehicle modifications.
Example
Elias needs a shower commode.
He got an assessment and sent us a quote for one that will suit his needs. As part of the
process to work out if this meets the reasonable and necessary criteria, his planner
considers other similar shower commodes.
There’s another commode that’s $5,000 cheaper than the one Elias has asked for. It won’t
meet Elias’ needs, as it doesn’t provide enough support for his back. That means, it won’t
achieve the same result as the one Elias has asked for.
Elias’s planner finds a commode that’s $1,000 cheaper. The planner contacts Elias’s
occupational therapist who confirms this commode will meet Elias’ needs.
Elias’ planner decides to fund the commode that’s $1,000 cheaper. This has the same
features and will have the same benefits for Elias at a substantially lower cost.
Is the support effective and beneficial?
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We need to be satisfied that the support will be, or is likely to be, effective and beneficial,
when we consider current good practice.
We need to work out if the support is likely to be both:
•
effective – it will do what you need it t
o do36
•
beneficial – the support will help you do things you can’t otherwise do and meets
your support
needs.37
It can also be effective and beneficial if it will help you maintain your current level of
functioning. That is, it will help you keep doing the things you can currently do. And it’ll help
you maintain your work, study and social life as much a
s you can.38
When we decide if a support is effective and beneficial, we look at what is current good
practice. This means we look at if there is evidence that the support works for someone with
similar disability support needs to you. We won’t need an expert opinion or report for every
support, because we can often rely on other evidence.
For example:
• We may have information already about whether the support is widely accepted to
suit someone with your disability support nee
ds.39 For example, we could rely on
academic research and other literature. This could include university studies on
therapies that have been published and referred in academic journals, evidence
based practice resources, or clinical practice guidelines.
• If you or other participants have used the support before, we can consider your
experience and the experience of your family members and carer
s.40
We may consider things we have learnt from other participants in the NDIS with similar
support needs to
you.41 We know you’re the expert in your own life, and we use your own
experience as much as we can.
For example, we will talk to you about any supports that have helped you do things you can’t
otherwise do. Or some supports may have helped maintain your ability to be as independent
as possible.
If it’s a new support such as new assistive technology, we might fund a trial. This is so we
can learn from your experience of using the support to check if it’s likely to do what you need
it to.
Your evidence can be particularly useful when it’s consistent with other evidence, or if we
don’t have expert evidence.
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We’ll look at the opinions held by the majority of experts and what they generally agree o
n.42
Sometimes we will have to seek expert opinion or report to make a decisi
on.43
Example
Vivek is 12 and has a goal to improve his communication skills. He and his family want him
to improve his social skills with the kids in his class.
When he was younger, Vivek’s family tried speech therapy, and believe it really helped him
improve his communication. His family told his planner about how it helped Vivek learn how
to respond to different social settings.
Vivek’s speech therapist also believes it could work well for him now and help him interact
with his classmates.
When deciding if the therapy is effective and beneficial, Vivek’s planner will consider:
• how speech therapy has helped Vivek in the past, including first-hand information
from Vivek, his family members, and carers
• the reports or assessments from his speech therapist on the effectiveness and
benefits of speech therapy for Vivek
• other information or expert evidence about the effectiveness and benefits of speech
therapy, including for children of the same age, with the same impairments and
functional capacity.
Based on this information and evidence, Vivek’s planner decides the speech therapy is
effective and beneficial. If it meets the other funding criteria, we will be able to fund speech
therapy in Vivek’s plan.
Is the support something we would reasonably expect your informal supports, like
family or friends, to provide?
We need to be satisfied that funding the support takes into account what is reasonable to
expect families, carers, informal networks and the community to p
rovide.44
To make sure we understand how disability supports might work for you, we consider:
• the things you’re able to do for yourself
• any support you have from others in your network – including family members,
relatives, friends and local community services.
When we fund supports under the NDIS, we need to consider if it’s reasonable to expect
your informal supports to provide that support. We can’t fund supports that an ordinary
person would think is reasonable to expect friends, family or the community to provide for
you.45
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Informal supports are the help and support you get from friends, family and the community.
They are called ‘informal’ because you don’t pay for them, and they’re not part of a formal
agreement. They are the usual things friends and family do for us, and with us.
Most of us get some kind of help and support from friends and family. In our society, we
expect that friends, family and our community will support each other and help each other
out when they need it.
A good example is families who have young children. In our community, we expect families
will provide most of the support a young chil
d needs.46 They will care for the child, make sure
they are safe and drive them around places.
Grandparents, uncles and aunties often have a role to play in supporting young children as
well. Neighbours and friends might also help care for the child.
As a child gets older, our society’s expectations of the role of the family and community in
caring for the child changes. For example, we expect schools to provide a child’s learning
needs.
We also usually expect the role of family in providing personal care for a child would reduce
as they get older and develop new skills and independence. But families are usually still
responsible for things like food, emotional support, decision-making and providing a safe
home.
It’s a similar idea for adults. Our society expects that adults – like family, friends and
neighbours – will provide some support to each other. This might be things like taking a
friend with you to the football game, or providing emotional support if someone is upset.
NDIS supports won’t ever replace the support people like your friends and family provide to
you. This support is given freely because people care and is often quite different to supports
bought with NDIS funding.
You have a special bond with your friends and family that’s different from your relationship
with paid carers. And there are potential risks and problems for you if your friends and
families become your paid carers.
We also must consider the benefits you may get from your informal supports. For example,
your family and friends may be better at helping you meet other people, or helping to build
your social skills, than paid supports.
We consider if we can help these relationships so that you get the support
you need.47 For
example, we may be able to fund training for your informal supports, so they can help you
build your skills.
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We also think about the capacity of your informal supports to continue caring for you, for
example if they’re ageing or sick.
There are different things the law for the NDIS says we need to consider for adults and
children.
If you’re under 18, we consider what support is reasonable to expect parents to provide at
your age. It’s normal for parents to provide substantial care and support for child
ren.48 We
consider that it’s usual for parents to provide almost all the care and support that young
children need.
For example, it’s reasonable to expect parents or other family members to provide transport
to and from their child’s after-school activities. Of course, the amount of care and support for
a child without a disability would typically reduce as they get older.
For children under 18, we consider:
• if your needs are substantially greater because of your disability, compared to other
children the same age
.49 This means you need much more disability support
• any risks to the wellbeing of people providing informal support to y
ou50
• if including funding for the support will help build your skills and capacity in the future
or reduce any risks to yo
u.51
For example, we consider any health, safety or other impacts resulting from what’s involved
in meeting your disability support needs.
If you’re over 18, we consider:
• if there are any risks to you or your informal supports if you rely on them to provide
the support
you need52
• how much your informal supports would help improve or reduce your independence
and other outcom
es.53
We also consider the suitability of informal supports to provide the supports you need
,54
including:
• how old your carers are and their capacity to provide the
support55
• if other family members and the community can help your informal supports in their
caring role56
• the intensity and type of support you need, and if it’s appropriate for your informal
supports to provide this, based on their age and gende
r57
• any long-term risks to the wellbeing of your informal
supports.58
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When we consider the risks for people over 18, we consider if the supports are sustainable
for your informal supports. We consider the health, safety and other impacts on family and
carers in the long term.
For example, we wouldn’t expect a child to have their schooling affected because they need
to provide care. We also wouldn’t expect an elderly parent to be responsible for physical
activities, if it may result in inju
ry.59
We generally don’t fund family members to provide supports funded under the NDIS. There
are very limited situations where we can consider this.
Learn more about Sustaining Informal Supports.
Example 1
Simon is getting his first plan. For the last 15 years, Simon and his wife Jan’s preference was
that Jan provide all the physical support he needs at home, such as toileting, showering and
dressing.
But as Jan is getting older, it’s not safe for her to do this. It’s becoming risky for both Jan and
Simon to keep providing this support informally.
Jan and Simon think it might be best for someone else to provide the personal care support
that Simon needs. Their children have moved out of home, and it’s not reasonable to expect
them to help Simon with personal care.
Based on this information and other evidence, Simon’s planner decides that the personal
care support meets this criteria. It takes into account what is reasonable for his family and
others to provide. If the personal care support meets the other funding criteria, we may fund
the personal care support for Simon.
Simon and Jan still prefer Jan to do the other support Simon needs though, such as helping
Simon eat his meals. At this time, we wouldn’t fund a support worker in Simon’s plan to help
him eat his meals. It’s reasonable to expect Jan to help Simon with this, because it’s what
they want to do and it’s not a safety risk for Jan or Simon.
Example 2
Qing is 14 and wants to join a local chess club. Like most 14-year-olds in this situation, she
needs someone to drop her off and pick her up from the mid-week and weekend gatherings.
But unlike most 14-year-olds, she needs someone to help her get dressed before she can go
to the chess club. Her parents have been doing this, but as Qing is getting older, she no
longer wants her family to help her get dressed.
It’s reasonable to expect her family or other informal supports to drop Qing to and from the
match and training sessions. So, we wouldn’t fund transport in Qing’s plan.
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But at age 14, it’s not reasonable to expect her family to help her get dressed.
Based on this information and other evidence, Qing’s planner finds that the personal care
support considers what is reasonable for family and others to provide. If it meets the other
funding criteria, we may fund personal care support in her plan.
Is the support an NDIS support for you?
A support will only be an NDIS support for you if either:
• the Rules say that the support is a NDIS support for everyone, or
• the Rules say that the support is only for a specific group of people, and you are part
of
that group.60
NDIS supports are the services, items, and equipment that can be funded under the NDIS.
Remember, we can only fund a support if it is:
• an NDIS support for you
• necessary for your impairments that meet the disability or early intervention
requirements, or
both.61
Go to NDIS supports to find more information on what is and isn’t an NDIS support.
Example
Max has a spinal cord injury and uses a manual wheelchair to move around. His home has a
carport at the front. The path from the carport to the front door is too narrow for his
wheelchair and the uneven ground makes it unsafe for him to use his wheelchair on his own.
In Max’s planning meeting, he requests the installation of a pathway from the carport to the
front door to enable safe access to his home.
Max’s planner checks that the home modifications are an NDIS support.
Because Max needs a pathway to access his house safely, the planner decides that the
home modifications are an NDIS support.
What types of supports can’t be funded or provided under the NDIS?
Under the law for the NDIS, there are things we can’t fund or provid
e.62 We can’t fund goods
and services that are not ND
IS supports.63 For example, we can’t fund or provide supports
that:
• consist of sexual services and sex work, alcohol, or dr
ugs64
• are not le
gal65
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• are income repl
acement66
• are likely to cause harm to you, or pose a risk to other peopl
e67
• relate to a ‘day-to-day living cost’, like groceries, rent or utilitie
s68
• duplicate other supports provided by the NDIS under alternative fundin
g69
• include tickets to events or the cost of going on a holiday
.70
For more information on what we can’t fund, go to NDIS supports.
What else do you need to know about deciding if supports meet the NDIS
funding criteria?
From our experience, we learned there are some common misunderstandings about how we
work out what supports meet the NDIS funding criteria.
Why don’t we always fund what your health professionals recommend?
Although we take expert opinions into account, we can’t and don’t always fund everything
your health professional might recommend. This is because every support we fund needs to
meet all the NDIS funding criteria.
For example, your therapist might recommend a piece of equipment on the basis that it will
be ‘effective and beneficial’ for you. But if there is something cheaper that will achieve the
same outcome, we won’t be able to fund what the therapist recommended.
This is because it may not
be value for money. We may be able to fund the cheaper option
instead if it meets all t
he NDIS funding criteria.
Why don’t we fund the same supports as your last plan?
We might fund different supports in your next plan. This is because we will fund supports in
your plan based on how we use the NDIS funding criteria at that point in time.
Your needs and situation will most likely change over time. This means it’s likely your NDIS
supports and needs for those supports will change over time.
For example, we may have funded supports to help you build your skills in a particular area.
Once you have built those skills, you won’t need funding for that anymore. So, we probably
won’t include that funding for those supports in your next plan.
Supports to build your skills may have met the NDIS funding criteria before, but the same
supports might not meet the criteria in the future.
Or, your disability support needs might increase or decrease over time. This may mean we
consider funding more or less supports as a result.
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What else do we consider when deciding what to include in your plan?
As far as possible, we have to act according to principles set out in the law for the NDIS
.71
These principles guide us when we make decisions about what we can fund.
These principles don’t override or replace t
he NDIS funding criteria under the law for the
NDIS. They can help us apply the funding criteria, by giving us more guidance when we
decide what supports to approve in your plan.
The principles include the following:
• You have the same right as other Australians to realise your potential for physical,
social, emotional, and intellectual develo
pment.72
• You should be supported to take part in and contribute to social and economic
life.73
• You should be supported to make choices about planning and how your supports will
be delivered. This includes taking reasonable risks, so you can pursue your goal
s.74
• You have the same right as other Australians to decide your own best interests. You
have the right to be an equal partner in decisions that af
fect your life.75
• Your privacy and dignity should be r
espected.76
• We must make sure the NDIS is financially sustainable
.77
The principles also tell us that the reasonable and necessary supports we fund shoul
d:78
• support you to pursue your goals and maximise your independence
• support you to live independently and to be included in the community as a fully
participating citizen
• develop and support your capacity to do things that help you participate in the
community and employment.
Just because a support helps you do these things doesn’t mean we’ll fund it in your plan. All
supports we fund need to meet all the NDIS funding criteria.
We consider these principles set out in the law for the NDIS, along with the principles we
follow to create your plan.
How do we think about an ordinary life when deciding what supports to include in
your plan?
To help guide us in our decision-making about reasonable and necessary supports, we took
advice from the NDIS Independent Advisory Council (The Council).
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The Council represents people with disability and carers, bringing their own lived experience
and expertise of disability. They give us advice on how the NDIS should work.
The Council advised us that all Australians, including people with disability, should have an
‘ordinary life’. They also told us we should think about the idea of an ordinary life when we
apply our principles and use the NDIS funding criteria.
An ordinary life is a life where you have the same opportunities as people without a disability.
An ordinary life is one that is typical or usual for everyone in modern day Australia. It’s a life
where you can pursue your potential and participate in society on an equal basis with others.
An ordinary life will be different for different people. We are all different and come from
different cultures and backgrounds. We each have our own values, experiences, beliefs, and
goals.
But there are some common things that can improve the quality of our lives and help us
participate equally. These are the things, such as the following, that make up an ordinary life:
• Positive relationships with families and informal support networks.
• Individual autonomy. This means being free and independent, and having the same
opportunities as people without disability.
• Active involvement in decision-making including the ability to make meaningful
decisions, and exercise choice and control.
• Using your strengths in ways that provide a challenge and enjoyment.
• A sense of belonging to our families, friendship networks, communities, workplaces
and society.
• Active involvement and contribution to society and your community.
An ‘ordinary life’ in the context of the NDIS involves supporting you to:
• have and maintain good relationships
• belong and participate in your community
• be involved in making choices about your own life.
One way we can help you have an ordinary life is to support you to access mainstream,
community, or informal supports wherever possible. These are the usual supports that
everyone in the community uses.
When we fund reasonable and necessary supports under the NDIS, we need to make sure
they meet th
e NDIS funding criteria.
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When we apply the NDIS funding criteria and make decisions about reasonable and
necessary supports, we’re guided by the principles in the law for the NDIS. We also consider
how the supports will best help you to live an ordinary life.
What other services or systems are responsible for providing supports?
We have to be satisfied that the support is considered an NDIS support which means the
support is something that can be funded or provided through the NDIS. Some supports are
not considered an NDIS support because they’re more appropriately funded or provided
through:
• other service systems or supports offered by a person, agency or body (like a State or
Territory Statutory Scheme)
• services or supports offered as part of a universal service obligation (like the health or
education system)
• services or supports offered in line with reasonable adjustments required under
discrimination laws (like your employer, or the health or education system
).79
We won’t fund the support if the support should be provided by someone else, even if the
other service system doesn’t actually provide it. We don’t make up for other organisations
and systems that don’t provide the supports they should.
The list of goods and services that are not NDIS supports includes supports that are
considered the responsibility of service systems such as:
• Health
• Mental health
• Child protection and family support
• Early childhood development
• School education
• Higher education and vocational education and training
• Employment
• Housing and community infrastructure
• Transport
• Justice.
For more information, go to Mainstream and community supports.
How does the NDIS work with other government services?
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We call supports provided by other government services, including those provided as part of
a universal service obligation, ‘mainstream supports’. When we talk about mainstream
supports, we mean supports available to everyone in your state or territory, or across
Australia, regardless of if you have a disability.
This includes services provided by state and federal governments, related to health care,
education and mental health services.
You have the same right as all Australians to access these services. There are certain things
that mainstream services have to do to make their services accessible for people with
disability. Using mainstream supports can also help you be part of your community, or to
work or study.
When we fund NDIS supports, we won’t fund supports that are not considered NDIS
supports because the support is more appropriately funded or provided by a mainstream
service or system, such as the education system or
health system.80 Under the law for the
NDIS, we can’t fund supports that should be provided by a mainstream service.
The Australian federal, state and territory governments agreed on responsibilities for funding
different types of supports. The law for the NDIS has an outline of funding responsibilities
and were developed with the agreement of each State and Territory
.81
Learn more about who is responsible for the supports you need.
What is reasonable adjustment and why is it important?
People with a disability can sometimes face barriers that make it harder to do the same
things as people who don’t have a disability. For example, it might be harder to find and keep
a job. Or it might be harder to get in and around places, or to get the same services as other
people.
It’s against the law to discriminate against people with a disability in many area
s.82 This
includes in employment, when providing goods and services, and when accessing public
places.
This means organisations or people who are responsible for providing these services have to
make what are called ‘reasonable adjustments’. They have to make sure people with a
disability have equal access to the services they provide, as far as is reasonable.
They have to do reasonable things that will make their services equally available to
everyone, whether or not you have a disability.
Reasonable adjustments do not mean they have to provide everything you need because of
your disability. It means they have to do what’s reasonable to make sure you have equal
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access to employment, public spaces or services. This takes into account what they can
afford to do and what is reasonable to expect them to provide in the circumstances.
When we decide what supports to include in your plan, we need to consider what should be
provided through reasonable adjustments. Under the law for the NDIS, we can’t fund a
support if it should be provided by someone else through reasonable adjustments.
What about in-kind supports?
We agreed that state and territory governments will keep providing some supports for a
period of time. We call these ‘in-kind supports’.
If we fund in-kind supports like specialist school transport or personal care in schools, you
will need to use state or territory government providers for these supports. These supports
are most efficiently and effectively provided by state and territory government provi
ders.83
Learn more about Work and study supports.
For most other in-kind supports, you can choose your provider if you don’t want to use your
in-kind provider anymore. We can let you choose another provider if we consider that the
support isn’t most effectively and efficiently provided by the in-kind provider.
We usually let you choose another provider if:
• another provider can give you the same support or level of support as the in-kind
provider
• the supports with the new provider still meet t
he NDIS funding criteria, including that
they’re value for money compared to the in-kind support
• there are no serious risks with changing providers.
Learn more about in-kind supports.
How do we include the reasonable and necessary
supports in your plan?
Once we’ve identified the supports, and decided they meet the NDIS funding criteria, we can
include the description and funding for the NDIS support in your plan.
If the support doesn’t meet the NDIS funding criteria, we can’t include the support in your
plan. We may consider if a differently described support meets the NDIS funding criteria
instead.
When we approve your plan, we’ll also make sure all your supports are reasonable and
necessary when consi
dered as a package of supports.84
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Sometimes you might not need any supports under the NDIS. For example, your informal
supports may meet all your disability support needs. If so, we’ll approve a plan with no
funded supports.
Learn more about how we create and approve your plan.
Learn more about using the funding in your plan.
Learn more about changing your plan.
What happens if we don’t include the supports you want?
If we decide a support doesn’t meet t
he NDIS funding criteria, we can’t include the support in
your plan. Also, if the amount of support you want doesn’t meet the criteria, we can’t include
that amount in your plan.
But, we’re committed to our principles and helpi
ng you live an ordinary life. Even if we can’t
fund a particular support, we may still be able to help.
If the support doesn’t meet the NDIS funding criteria, we can consider if a different support
meets the NDIS funding criteria. We might be able to consider describing the support
differently or funding a different type of support.
Or we may be able to connect you to mainstream or community supports that can help.
Mainstream and community supports are available to everyone. They can be a good way to
connect with your local community, learn new skills and gain independence.
There are lots of ways we might be able to help, so talk to us if you’re in this situation. We
can do this at any time. We may be able to help before we approve your plan.
We’ll give you the reasons for our decision to approve your plan in writin
g.85 You can contact
us if you’d like more detail about the reasons for our decision.
What happens if I want to replace a support for something else?
We fund NDIS supports in your plan. NDIS laws set out what we can and can’t
fund.86
Sometimes, we may agree that you can spend your funding on supports that are not NDIS
supports. We call this a ‘replacement support’. Go to Your plan for more information. For
more information about replacement supports, go to NDIS supports.
What if you don’t agree with our decision?
If we decide the supports you requested don’t meet ou
r NDIS funding criteria, we can’t
include them in your plan.
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If you’d like more details about the supports that make up your plan’s total funding amount,
we can send this to you. You can contact us and ask for a Budget Breakdown.
We’ll give you written reasons why we made the decision. You can contact us if you’d like
more detail about the reasons for our decision.
If you don't agree with a decision we make about what supports to include in your plan, you
can ask for an internal review of our decisi
on.87
You’ll need to ask for an internal review within 3 months of get
ting your plan.88
Learn more about reviewing our decisions.
Reference List
1 NDIS Act s 34(1)(aa).
2 NDIS Act and delegated legislation made under the NDIS Act, especially NDIS (Supports for Participants)
Rules and NDIS (Plan Management) Rules.
3 NDIS Act s 34 (1)(aa).
4 NDIS Act ss 33(2)(a), 33(2)(b), 33(5)(c), 34.
5 NDIS Act ss 13, 33(2)(a).
6 NDIS Act s 34 (1).
7 NDIS Act s 34 (1) (aa).
8 NDIS Act s 10.
9 NDIS Act and delegated legislation made under the NDIS Act, especially NDIS (Supports for Participants)
Rules and NDIS (Plan Management) Rules.
10 NDIS (Supports for Participants) Rules r 2.4; NDIS Act s 33(5)(c).
11 NDIS Act s 34(1)(f).
12 NDIS Act ss 33(5)(d), 35(1)(b); NDIS (Supports for Participants) Rules pt 5.
13 NDIS Act ss 33(5)(c), 34(1).
14 NDIS Act s 34(1)(aa).
15 NDIS Act s 34(1)(a).
16 NDIS Act s 34(1)(b).
17 NDIS Act s 34(1)(c).
18 NDIS Act s 34(1)(d).
19 NDIS (Supports for Participants) Rules r 3.2(a).
20 NDIS Act s 34(1)(e).
21 NDIS Act s 34(1)(f).
22 NDIS (Supports for Participants) Rules pts 3, 4.
23 NDIS (Supports for Participants) Rules r 5.1(b), NDIS Act s 34(1)(aa).
24 NDIS Act s 34(1)(a).
25
McGarrigle v National Disability Insurance Agency (2017) 252 FCR 121 at [91].
26 NDIS Act s 34(1)(a).
27 NDIS (Supports for Participants) Rules r 5.1(d).
28 NDIS Act s 34(1)(b).
29 NDIS Act ss 3(3)(b), 4(17).
30 NDIS (Supports for Participants) Rules r 3.1(a).
31 NDIS (Supports for Participants) Rules r 3.1(b).
32 NDIS (Supports for Participants) Rules r 3.1(c).
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33 NDIS (Supports for Participants) Rules r 3.1(e).
34 NDIS (Supports for Participants) Rules r 3.1(c).
35 NDIS (Supports for Participants) Rules r 3.1(d).
36 McCutcheon and NDIA [2015] AATA 624 at [34].
37 McCutcheon and NDIA [2015] AATA 624 at [34].
38 McCutcheon and NDIA [2015] AATA 624.
39 NDIS (Supports for Participants) Rules r 3.2(a).
40 NDIS (Supports for Participants) Rules r 3.2(b).
41 NDIS (Supports for Participants) Rules r 3.2(c).
42 NDIS (Supports for Participants) Rules r 3.3.
43 NDIS (Supports for Participants) Rules r 3.3.
44 NDIS Act s 34(1)(e).
45 NDIS Act s 34(1)(e).
46 NDIS (Supports for Participants) Rules r 3.4(a)(i).
47 NDIS (Supports for Participants) Rules r 3.4(c).
48 NDIS (Supports for Participants) Rules r 3.4(a)(i).
49 NDIS (Supports for Participants) Rules r 3.4(a)(ii); JQJT and National Disability Insurance Agency [2016]
AATA 478 at [39].
50 NDIS (Supports for Participants) Rules r 3.4(a)(iii).
51 NDIS (Supports for Participants) Rules r 3.4(a)(iv).
52 NDIS (Supports for Participants) Rules rr 3.4(b)(i), (ii).
53 NDIS (Supports for Participants) Rules r 3.4(b)(iii).
54 NDIS (Supports for Participants) Rules r 3.4(b)(ii).
55 NDIS (Supports for Participants) Rules r 3.4(b)(ii).
56 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(A).
57 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(B).
58 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(C).
59 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(C).
60 NDIS Act s 34(1)(f).
61 NDIS (Supports for Participants) Rules r 5.1(b), NDIS Act s 34(1)(aa).
62 NDIS (Supports for Participants) Rules r 5.
63 NDIS Act s 10.
64 NDIS Act s 10.
65 NDIS Act s 10.
66 NDIS Act s 10.
67 NDIS Act s 10.
68 NDIS Act s 10.
69 NDIS Act ss 33(5)(d), 35(1)(a); NDIS (Supports for Participants) Rules r 5.1(c).
70 NDIS Act s 10.
71 NDIS Act ss 4, 31.
72 NDIS Act s 4(1).
73 NDIS Act s 4(2).
74 NDIS Act s 4(4).
75 NDIS Act s 4(8).
76 NDIS Act s 4(10).
77 NDIS Act s 4(17).
78 NDIS Act s 4(11).
79 NDIS Act s 34(1)(f).
80 S10(b1) -(3).
81 NDIS (Supports for Participants) Rules rr 3.5-3.7, Schedule 1; NDIS Act ss 209(4), (8) item 1.
82 Disability Discrimination Act 1992 (Cth); Discrimination Act 1991 (ACT); Anti-Discrimination Act 1977 (NSW);
Anti-Discrimination Act 1996 (NT); Anti-Discrimination Act 1991 (Qld); Equal Opportunity Act 1984 (SA); Anti-
Discrimination Act 1998 (Tas); Equal Opportunity Act 2010 (Vic); Equal Opportunity Act 1984 (WA).
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83 NDIS (Plan Management) Rules r 6.6.
84 NDIS Act s 33(5)(c).
85 NDIS Act s100(1).
86 NDIS Act s 10.
87 NDIS Act s 100.
88 NDIS Act s 100(2).
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