Advice Support Tool
Theme: Orthotics
Sub-Theme(s): Knee ankle foot orthoses (KAFOs)
References: [include any relevant referenced documents]
NDIS Act 2013 Section 34.1. (a) - (f) and 2. NDIS Support for Participant Rules 2013 Including Specific Types of Supports in Plans Operational Guideline - Prosthetic limbs | NDIS
Note: All criteria need to be met for the supports to be funded through the NDIS.
| Criteria for reasonable and necessary supports | Is criteria met? | Considerations (including evidence used) |
|---|---|---|
| 34.1(a) Enabling the participant’s goals and objectives (supports will assist the participant to pursue the goals and objectives in their plan) | ☐ Yes → | - Goals around functional mobility/support and increased independence |
- What activities is the participant involved/planning to do? | | 34.1(b) Assist the participant’s social and economic participation (supports will assist the participant to undertake activities to facilitate their social and economic participation) | ☐ Yes → | - Has the provider considered any likely changes such as the impact of growth or a degenerative condition?
- Has there been previously funded orthoses
- What other AT (e.g. MWC, PWC, Scooter) does the participant have?
- Is there a functional capacity assessment (FCA) or physiotherapy report outlining participants current function? | | 34.1(c) Value for money (supports represents value for money, ie the costs of support are reasonable, both in terms of the benefits achieved and the cost of alternative support) | ☐ Yes → | - Stance-controlled KAFO:
- Is the request for a trial, if so has there been clear
- Are there comparable support options which would achieve the same outcome at |
Criteria for reasonable and necessary supports
- a substantially lower cost? What alternative supports were considered?
- Is there evidence that the support will substantially improve the life stage outcomes and be of long-term benefit to the participant?
- Is there evidence that funding support is likely to increase independence and reduce funded support costs in the long-term?
- Is there evidence the support will increase the participant’s independence and reduce the participant’s need for other kinds of supports?
34.1(d) Support is effective or beneficial for the participant (supports will be, or are likely to be, effective for desired effect and beneficial for the participant, having regard to current good practice)
Consider NDIS Support for Participant Rules 2013 Part 3.2 and 3.3
- What are the expected benefits of the support provision?
- How will effectiveness of achieved outcome be measured?
- When will effectiveness of achieved outcome be achieved?
- Are there other supports required to achieve or maximise the reported support outcomes for participant?
| Criteria for reasonable and necessary | Is criteria met? | Considerations (including evidence used) |
|---|---|---|
| a substantially lower cost? What alternative supports were considered? | functional activities identified for a trial? If a trial has occurred, redacted What functional activities is the participant able to do with the requested support? s47E(d) - certain operations of agencies |
|
| Is there evidence that the support will substantially improve the life stage outcomes and be of long-term benefit to the participant? | ||
| Is there evidence that funding support is likely to increase independence and reduce funded support costs in the long-term? | ||
| Is there evidence the support will increase the participant’s independence and reduce the participant’s need for other kinds of supports? |
Clinical presentation
If a trial has been undertaken is their subjective and objective outcome measures which relate back to functional capacity
Trial evidence
If a trial has been undertaken is their subjective and objective outcome measures which relate back to functional capacity
Lived experience
If the participant has lived experience, how long for and is the support still meeting their needs for safe and functional mobility but also goal pursuit.
Broken componentry
When did it break? How did it break? Is the componentry within warranty period and was it being used appropriately. s47E(d) - certain operations of agencies
| Criteria for reasonable and necessary supports | Is criteria met? | Considerations (including evidence used) |
|---|---|---|
| 34.1(e) Support coordinates with but does not replace informal support (funding or provision of supports takes account of what it is reasonable to expect families, carers, informal networks and the community to provide) | ☐ Yes → | N/A |
| 34.1(f) Support is most appropriately funded by the NDIS (supports are not more appropriately funded or provided through other general service systems or universal service obligations) | ☐ No → | s47E(d) - certain operations of agencies redacted: s47E(d) - certain operations of agencies |
| Support will not cause harm (Supports will not be funded if it is likely to cause harm to the participant or pose a risk to others, or the support would be contrary to a law of a jurisdiction) | ☐ Yes → | Is there evidence that the recommended orthosis is in line with the participant’s individual needs? |
| Support is directly related to the participant’s disability (supports will not be funded under the NDIS if they do not relate to the participant’s disability or are day-to-day expenses or income replacement) | ☐ No → | N/A |
| Support does not duplicate other supports (supports do not duplicate other supports delivered under alternative funding through the NDIS such as Information, Linkages and Capacity Building (ILC) funding.) | ☐ Yes → | N/A |
Version Control
| Version # | Status | Date | Modified by | Brief Description of Modification |
|---|---|---|---|---|
| V1.0 | Cleared | 01/09/2023 | SGO256 | Production of initial V1.0 |
| V1.0 | Cleared | 05/09/2023 | JIF775 | Transferred to Key Advisor Advice Resources repository |
Note: Document uncontrolled in hard copy