NDIA Accountability Project

This project is in DRAFT

Advice Support Tool Theme: Respiratory supports Sub-Theme(s): Respiratory AT/CB/Core support considerations

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Advice Support Tool

Theme: Respiratory supports

Sub-Theme(s): Respiratory AT/CB/Core support considerations

References: [include any relevant referenced documents]

NDIS Act 2013 Section 34.1 (a) - (f) and 2.

NDIS Support for Participant Rules 2013

PG_RespiratorySupports.docx

Note: All criteria need to be met for the support to be funded through the NDIS.

CRITERIA FOR REASONABLE AND NECESSARY SUPPORTS Are 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 Consider how the provision of funding of the requested support will assist the participant in meeting their goals and objectives. This is individual to each participant and reflective of their individualized goals and objectives.

s47E(d) - certain operations of agencies | | 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 | Consider how the provision of funding the requested support will assist the participant with social/economic participation.

s47E(d) - certain operations of agencies | | 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 | If the participant has requested assistive technology- when assessing the request ensure that the requested device and consumables/accessories are reflective of market pricing,

s47E(d) - certain operations of agencies | | Are there comparable support options which would achieve the same outcome at 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 that the support will increase the participant’s independence and | | Consider if the requested support can be delegated to a high intensity support worker under the RN Delegation of care model of support? Our Guideline - Disability-related health supports. |

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reduce the participant’s need for other kinds s47E(d) - certain operations of agencies of support? S47E(d)-certain operations of agency

                           support

cost is comparable to the expected cost of the same kind of support? S47E(d)-certain operations of agency

                                                    The following document
                                                       contains an outline of the skills that can
                                             be delegated to high intensity support
                                                   workers under the RN delegation and
                                                        supervision of care model of support.
                                                  High Intensity Support Skills
                                                        Descriptors - December 2022

                                                   Consider potential changes to the
                                                             participants respiratory function which
                                        may result in the participant no longer
                                                            requiring the requested support long
                                                  term?
                                                    s47E(d) - certain operations of agencies

34.1(d) Support is effective or beneficial for ☒ Yes The requested support must be the participant. ☐ No reflective of current evidence-based (supports will be, or are likely to be, effective practice and in the example of assistive for desired effect and beneficial for the technology and consumables participant, having regard to current good prescribed by an appropriate clinician practice) post a comprehensive review Consider NDIS Support for Participant Rules 2013 Part 3.2 and 3.3 For assistive technology specifically, What are the expected benefits of the evidence that the participant is support provision? engaged with a respiratory physician How will effectiveness of achieved outcome (for ventilation including bi-pap/cpap) or be measured? a respiratory physiotherapist (cough When will the effectiveness of the achieved assist devices), the requested device is outcome be achieved? related to their assessed impairment Are there other supports required to achieve and any trail information available or maximise the reported support outcomes should be presented, in line with the for participant? mid cost AT approach.

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MR25/00038 | FOI 24/25-0317

| 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) Consider NDIS Support for Participant Rules 2013 Part 3.4 | ☒ Yes | ☐ No

| 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) Consider NDIS Support for Participant Rules 2013 Schedule 1. | ☒ Yes | ☐ No

The NDIS typically funds disability-related respiratory support where they are required as a direct result of the participant’s impairment, are an ongoing support need and are provided in the community. Evidence from a medical practitioner, Respiratory Specialist (physician or physiotherapist) should outline the ongoing respiratory supports required and how these supports directly relate to the participant’s assessed impairment as discussed above.

| 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) Consider NDIS Support for Participant Rules 2013 Part 5.1 and 5.3 | ☒ Yes | ☐ No

For Capacity building supports it is essential that the support provided to the participant is in the support provider’s scope of practice. It is essential that the provider/supplier of this respiratory equipment provides the participant, informal and/or formal supports training to ensure its safe use. This includes setup, use, management, maintenance and care of this equipment. In the event the supplier does not provide these services, these MUST be sourced from a provider who does BEFORE the equipment is issued to the participant. The equipment provider/supplier is to be notified of this expectation in writing either by the participant, LAC or Support Coordinator (where consent has been provided) when support is included in a plan for this purpose.

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MR25/00038 | FOI 24/25-0317

s47E(d) - certain operations of agencies

If the participant is unable to independently manage the use of this equipment, reasonable and necessary support should be provided to assist them as required.

The participant or their representative is to be made aware they must engage a suitably skilled and competent provider (with applicable experience in respiratory device use) to implement the care prescribed by their treating Practitioner. Providers need to ensure direct delivery and clinical oversight of respiratory supports will be met when they are providing these services.

The participant must remain engaged with their Respiratory Physician to regularly review their respiratory needs to ensure the equipment and prescribed settings continue to meet their needs. Any change to participant respiratory status must be documented by a treating Practitioner and communicated to the provider of services, including any change required to equipment, settings or support needs. A copy of this information should be provided to NDIA for the Participant’s record.

Support is directly related to the participant’s assessed impairments (supports will not be funded under the NDIS if they do not relate to the participant’s assessed impairments or are day-to-day expenses or income replacement) Consider NDIS Support for Participant Rules 2013 Part 5.1 and 5.2

Is the request for respiratory support directly related to the participants’ assessed impairments in which they made access to the scheme?

The NDIS will not fund respiratory support if they are not a regular part of a participant’s daily life and the requirement for the support does not result from their functional impairment.

s47E(d) - certain operations of agencies

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Version Control

Version # Status Date Modified by Brief Description of Modification
v1.0 Cleared 31/08/2023 CFD218 Production of initial V1.0
v1.0 Cleared 05/09/2023 JIF775 Transferred to Key Advisor Advice Resources repository
v1.1 Drafted 19/11/24 CDF218 Minor update regarding evidence required
v1.1 Endorsed KIM222 Endorsed with [describe final changes]
v1.1 Cleared KM0032 Cleared with no further changes.

Note: Document uncontrolled in hard copy