In this post, you’ll find detailed answers to all the questions asked during the webinar. Our goal is to ensure you have the clarity and insights you need to navigate the evolving NDIS landscape with confidence.
So, let’s dive into your questions and provide the information you’ve been waiting for!
Do we know yet if the 3-month pools of funding under PACE will limit just core funding, or capacity building too? That will impact the ability to access OT reporting.
The NDIS has not stated this specifically but have published a summary of this change here: https://www.ndis.gov.au/changes-ndis-legislation/summary-legislation-changes For me it indicates that all categories will be subject to funding periods, including the CB budget.
Is there data available of people overspending their funding?
The NDIS states that the ADA did a “bottom-up analysis” of participants, showing that there is large scale over utilisation of participants’ plan. These sources of information can be found here. Senator Jordan Steele has questioned the veracity of the reports. Protecting the NDIS and here: Plan Inflation Slides and report
I heard that any reports are to be done through the therapy sessions, not separately at the end, to stop the amount of funding being used?
There are no published directives from the NDIS that this is a requirement. We see that therapists will either provide 45-minute sessions and then take 15 minutes at the end to do notes, or they may do a full 1-hour session, then charge 15 minutes non face to face time for notes. At this stage, CB providers can charge non fact to face time and there is nothing that explicitly says they can’t charge either way. All providers that can charge non face to face supports must discuss this with the participant and have it agreed too before charging.
Can I ask - what’s becoming of the activity code 04_210 in the future?
For our readers, this code covers the cost of activities for participants to help them engage in social and recreational activities where costs may be a prohibitive factor, or they are at risk of social isolation or because of the cost. This also covers camps, vacation care, courses and membership fees.
I can only hazard a guess at this point and say that potentially we will see its removal from future price guides if the NDIS continues as it has been. The NDIS has been clear since October 3rd that activities are not funded unless they fall within the hourly rate charged by a provider.
Does NDIS have a clear group pricing rate?
Yes, they do. You can find the Group pricing rates and information here: Group Pricing Transition Document
A general rule of thumb is that any group support (2 people or more is considered a group support) must be charged by dividing the hourly rate by the number of participants in the group. There are some provisions to charge a small amount of centre costs and non face-to-face support, if the conditions are met for those.
What do you mean by Agency managed?
Agency managed refers to how a participant's funding is managed. A participant can be self, plan, or agency managed.
Can a Support Worker charge for giving a participant a haircut if they are skilled at it?
Like all things NDIS, Support Coordinators need to understand that often there are multiple different guidelines that you need to look at to determine if a support is an NDIS support or not.
How to determine that?
Supports must meet all the following requirements:
The NDIS supports list states that hair washing IS an NDIS support if it fits all the above criteria; however it states that hair cutting is NOT an NDIS support, so the answer here would be that a Support Worker could not be funded to provide a haircut to a participant, as this is on the NOT an NDIS support list.
The usual response to this information is “How would the NDIS know?” Well, they probably won’t! However, participants and providers have a legal responsibility not to use NDIS funds for supports that are not NDIS supports. Support Coordinators need to support participants to understand this.
Is there now a specific fraud team we register the complaint with, rather than the commission in general? - FRAUD TEAM INFORMATION
Short Term Accommodation Questions
What does it mean when the NDIS says a participant in STA is in "individual settings"?
An individual setting would be a 1:1 STA that is provided in general accommodation, not in a respite centre.
Are NDIS retreats considered above board?
No, for several reasons.
The transitional rules state that health retreats are not an NDIS support. A “health” retreat can still encompass general disability and any other STA that is advertised as a retreat will likely be scrutinised. This is because the NDIS is starting to enforce that STA should not resemble a holiday; it is an opportunity for both carer and participant to have a break from each other.
NDIS does not endorse any kind of “retreat” so anybody calling themselves and “NDIS Retreat” would be instantly scrutinised and also potentially have a complaint lodged against them under the recently released ACCC guidelines regarding NDIS supports: ACCC Advertising Guidelines.
How do we know what STA providers are legit and approved by the NDIA?
It is important to be aware that there are no categories of goods or services which are automatically NDIS approved or funded for all NDIS participants. Whether goods and services will be approved or funded under an individual NDIS participant’s plan will depend on the needs and goals identified in their plan. The NDIS also does not provide specific approval or accreditation for any goods or services in general.
People often feel that NDIS registration also makes people “Approved” by the NDIS. It does not. It simply states that they have met the practice standards that the Quality and Safeguards Commission sets out for registered providers.
A good way to know if a provider has good standards and that they are a legitimate provider is to support participants to check the following:
What do we do if a Plan Manager is still willing to pay invoices when the support being funded is on the “Not and NDIS support” list?
NIB Thrive are currently taking over many existing plan managers, wouldn’t this be seen as a serious conflict of interest for them to also be providing support coordination services?
Well, the simple answer is “yes, it is” According to the NDIS recently released COI guidelines, I would very much say that it is a HUGE conflict of interest!
The not so simple answer – NIB Thrive not only have Plan Management and Support Coordination on their list of things they want to provide, they are also angling to use the “Digital marketplace” platform they also purchased (KYND) as the primary place where NDIS participants go to find their supports.
What that means is that if their plan for NDIS market domination works, they could potentially control how many participants look for support, who can help them do that and when and if they will pay for the support. Quite the level of control.
NIB Thrive handed a submission to the government earlier this year which outlined their belief that they are best placed to bring all these services in house and provide them all.
What kind of evidence do you require if 1:1 STA is provided? Would a psychologist's report or OT report be enough?
The NDIS has outlined a few new key areas that they are looking at when they decide if STA meets their guidelines or not. What they have said however is that participants must provide evidence to show that 1:1 support is required because of their disability. They have not provided further guidance around what exactly that means; however, I would hazard a guess that they would firstly need to meet the general disability-related requirements for any supports.
What needs to be addressed is:
They would then need to provide individual evidence to show that they require 1:1 support. A Psychologist could certainly provide evidence that may outline why a person with psychosocial disability may need 1:1 STA; however, that does not mean the NDIS will find it reasonable or necessary. I believe that if there are behavioural issues that mean a participant cannot stay with others, then that would be taken into account. I believe that people with significant symptoms of a complex mental health concern such as Schizophrenia or Bipolar will probably be able to demonstrate that they require 1:1 support. I think it is important to note that the NDIS wants to build capacity in people, so if there were no complex symptoms, they may still not be eligible for 1:1 support. I do not believe that not liking being around other people, or the condition causing a level of anxiety, would be enough to demonstrate eligibility.
Has there been any information further for the grace period time frame on registration for SC?
Nothing will happen before July 2025 and at that point, if consultations have been collated and the next steps are ready, the NDIS will announce the transition will begin. Providers of SC will have 3 months to BEGIN the registration process from the date they announce the transition. No word on specific details, but you can read more about this on my LinkedIn page here:
I am a participant who has completed a plan manager approved STA for 14 days in a camping site. No service agreement available. Would there be a possibility that the plan manager changes their mind later?
Hi there, there are a lot of variables here, but I will try my best! It is possible that the Plan Manager may submit the STA invoices, and the NDIS integrity team may decide not to pay them, in which case the Plan Manager cannot process the invoice. The NDIS integrity team may ask for an outline of what happened on the STA and if there are no records to support the STA, they may hold up or decline payment. I would advise that the provider who supports your STA’s always have a service agreement and ensure that the STA fits the guidelines very clearly. They should also keep very clear records of that too.
Are STA changes in place now or when the operational guidelines are available?
Officially, all plans that were in place before 3rd of October are old plans and sit under the old legislation and guidelines until they move over to PACE. The reality is that the NDIS is enforcing the new guidelines now, even if they are not available to be read online. Regarding the STA guidelines, there are actually little changes to these right now. However, for a long time people have been offering STA that was never intended to be funded. The current “guidelines” they have outlined in the “FAQs - Legislation” on the NDIS website around things like participants not being able to go on STA if they live alone etc, seem to be what is coming in the new guidelines.
Can NDIS just put a payment block on providers without asking for any evidence?
The NDIS should be supporting all providers and participants to address payment issues as soon as possible, and it would be odd if they did not tell a provider why they have had a payment block put on an invoice.
Their website outlines the following.If the information is not satisfactory or if we receive no response, the claim will stay on hold until we receive the information necessary to validate the claim.
If a claim is not compliant, it will be rejected and not be paid. We will email the provider advising that the claim has been rejected and the reasons why.
Re-submitting a claim that has been held for review is non-compliant behaviour. Duplicate claiming it will not help you get paid faster, instead it will trigger a deeper review.
If a claim within a bulk upload is being reviewed, only the claim under review will be held. All other claims will be paid according to NDIA payment terms.
If a support worker also had a certification for personal training, could they support the participant with some personal training?
If a Support Worker is insured and qualified to provide Personal Training services to a participant, then they would need to deliver these services under the Personal Training line item. The NDIS wants to know that people are using their funding as outlined in their plans. It is important that all providers are clearly outlining what support they are delivering, and that it fits a person’s plan. If a participant is not funded for personal training supports, and has no fitness goals, then they could not use their funding to purchase that support.
The transitional rules state the following:
IS an NDIS support: Supports that maintain or increase physical mobility or well-being through personal training or exercise physiology to address the disability.
This includes the following:
(a) accessing services from an appropriately qualified professional.
(b) assessment and development of a personalised exercise program which aims to increase or
maintain a functional capacity.
(c) maintenance of muscle strength, range of motion, balance and mobility.
Is NOT an NDIS support: general health, fitness, social or recreational activity costs or services.
A Support Worker that is using, for example: the social and community line item to charge
for PT supports, because a participant is not funded for personal training, would be providing a general fitness activity which is not
funded.
A Support Worker could support a participant to access personal training resources such as YouTube Videos, help them download an app for PT exercises, or help to implement a Physiotherapists Exercise plan under the supervision of the Physio.
Thank you for asking your questions! We hope the above answers them for you.