FOI 24/25-0753 DOCUMENT 6
AAT Case Management Guide
Disability Related Health Supports OFFICIAL For Internal Use Only
| Field | Content | Reference Documents |
|---|---|---|
| Title | Disability Related Health Supports | |
| Purpose | This document is part of a suite of guidance documents for case managers to use in formulating their approach to managing individual cases before the Administrative Appeals Tribunal (AAT). | |
| Scope | Disability-related health supports are health supports which directly relate to the functional impact of a participant’s disability on their functional capacity to partake in their day-to-day life, become independent, and pursue their goals. | Disability-related health supports [How do we decide what disability-related health supports we fund? |
| Escalation to Hearing Oversight Committee (HOC) | If a matter is within the parameters of this document, the AAT Case Management Branch Manager may approve proceeding to hearing. Where there is substantial risk or the matter is outside the parameters of this document, the matter should be referred to HOC. | |
| Current National Disability Insurance Agency (NDIA) policy on the subject | The AAT process is often seen as stressful and adversarial by the participants and our focus should be on resolving issues as practicably and quickly as possible. The role of the NDIA is to assist the AAT and the participant in reaching the best possible resolution for the participant by agreement. The NDIA will fund all reasonable and necessary supports which meet the NDIS funding criteria. This means that the NDIA will fund all disability related health supports which: • directly relate to a participant’s disability; • help increase a participant’s social and economic participation; • are effective and beneficial; • represent good value for money, in comparison to other supports which the NDIA may fund; and • would not be more appropriately funded by another mainstream service delivery system Particularly in the context of disability-related health supports, the NDIA is unable to fund supports which |
NDIA Dispute Resolution Policy Appendix B to the Legal Services Directions 2017 Sections 34(1) National Disability Insurance Scheme Act 2013 Dysphagia supports |
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AAT Case Management Guide
Disability Related Health Supports OFFICIAL For Internal Use Only
| Field | Content | Reference Documents |
|---|---|---|
| would more appropriately be funded by another mainstream service delivery system. Common examples of what this means the NDIA is able to fund include: Dysphagia supports • low-cost assistive technology (equipment or devices to help a participant eat and drink) • thickener products • help to prepare specific foods • a support worker • a speech pathologist, to make and implement a mealtime management plan and train support workers, family and/or carers Nutrition supports • a dietician, to create a disability-related meal plan for a participant • support to help follow that meal plan • Home Enteral Nutrition (HEN) and Percutaneous Endoscopic Gastrostomy (PEG) equipment • other products which may help a participant eat safely, and acquire the nutrition they need (such as good thickeners) • support to manage HEN and PEG strategies Diabetes management supports • a nurse or otherwise qualified person to create a disability-related diabetes management plan • support to follow that management plan • a support worker, to monitor glucose levels and administer insulin or other medication • training for support workers • a nurse or otherwise qualified person to monitor glucose levels and administer insulin or other medication (for participants with unstable diabetes, and/or complex disability support needs) • assistive technology to help manage diabetes, which a participant is otherwise unable to acquire through the healthcare system Continence supports |
Podiatry and foot care supports |
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AAT Case Management Guide
Disability Related Health Supports OFFICIAL For Internal Use Only
| Field | Content | Reference Documents |
|---|---|---|
| • pads and/or nappies • bedding and/or chair protection • liners or shields • anal plugs • collection bags • bottles • strapsor tape • professional training for someone to assist a participant with bodily functions and hygiene • continence assessment(s) • a bed wetting alarm Wound and pressure care supports • an enrolled/registered/clinical nurse consultant to develop a wound management plan or pressure care plan • a support worker, enrolled/registered/clinical nurse to help implement that management plan or care plan • training for a support worker to help implement that pressure care plan • wound care items (gauze, bandages, dressing and tape) • items to prevent wounds (including pressure relief cushions, moisturiser, barrier creams and non-PH washes) • review and planning of pressure care positioning • support to manage lymphoedema Podiatry supports • an initial consultation and assessment by a podiatrist, including the development of a podiatry care plan • regular re-assessment(s) during a care plan • appointments with a podiatrist to assist with overall foot care and foot health • a support worker • assistive technology (orthoses, custom made orthoses, medical grade/custom footwear, as well as maintenance and repair) Epilepsy supports • funding and training for a support worker to follow an epilepsy management plan |
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AAT Case Management Guide
Disability Related Health Supports OFFICIAL For Internal Use Only
| Field | Content | Reference Documents |
|---|---|---|
| • a nurse or support worker to monitor seizures • assistive technology (such as alarms or seizure monitors) • support coordination |
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| NDIA Posture in relation to this subject | The NDIA will fund all reasonable and necessary disability-related health supports which would not more appropriately be funded by any other mainstream service delivery system. | [How do we work out who should fund or provide your supports? |
| Evidence recommended to inform NDIA position in a specific matter before the Administrative Appeals Tribunal (AAT) | The NDIA must first consider whether a particular support would be more appropriately funded by any other mainstream service system. The nature and level of evidence then required to inform the NDIA position will depend on the particular disability and support in question. For example, funding for: • dysphagia supports — will be informed by evidence provided by a speech pathologist • nutrition supports — will be informed by evidence provided by a dietician, or other suitably qualified health professional • continence supports — will be informed by evidence provided by a continence nurse, or other suitably qualified health professional • diabetes management supports, wound and pressure care supports, podiatry supports, and epilepsy supports — will be informed by evidence provided by a suitably qualified health professional Matters concerning the provision of disability-related health supports will turn on the facts of each particular case, and the evidence available. The NDIA will seek to ensure the best possible evidence is made available to help guide the AAT towards the best possible outcome for the participant. |
Persons Giving Expert and Opinion Evidence Guideline |
| Other considerations | Where a participant also receives support from any other mainstream service delivery system, the NDIA expects that the participant ensures NDIS funding is not used to fund support(s) of the kind funded by that other mainstream service delivery system. |
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AAT Case Management Guide
Disability Related Health Supports OFFICIAL For Internal Use Only
| Field | Content | Reference Documents |
|---|---|---|
| Previous matters that may advise the NDIA position | Funding for general support to maintain an eating plan, as well as thickened fluids and nutritional supplements constitutes a reasonable and necessary support. The AAT set aside the decision under review. Additional funding for continence products was not a reasonable and necessary support, as existing plan funding for continence products remained unused. In the absence of any evidence supporting the participant’s request for specialised shoes, the AAT could not be satisfied that it would be reasonable or necessary for the NDIA to fund that support. The AAT Affirmed the decision under review. |
Burchell and National Disability Insurance Agency [2019] AATA 1256 Hoolachan and National Disability Insurance Agency [2019] AATA 4798 |
| Document admin | Assistant Director, Policy, Continuous Improvement | 10 September 2024 |
| Approved | Director, Continuous Improvement | 10 September 2024 |
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