Advice Support Tool

Theme: Prosthetics

Sub-Theme(s): Transfemoral (above knee) & Hip Disarticulation (HD)

References:

• 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
• OG - Social and Recreation Support v3.0 APPROVED - EXTERNAL 2022-06-28 (2).pdf
• OG Assistive technology 20230216 PDF 298KB (3).pdf
• How do we fund assistive technology? | 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 and activities around functional mobility support

• s47E(d) - certain operations of agencies
• 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? | | 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 → | - Has the provider considered any likely changes such as the impact of growth or a degenerative condition? |

Criteria for reasonable and necessary supports

Criteria for reasonable and necessary supports	Is criteria met?	Considerations (including evidence used)
Consider NDIS Support for Participant Rules 2013 Part 3.1 (a) – (f); S47E(d)-certain operations of agency	- Does the participant have multiple limbs? s47E(d) - certain operations of agencies What other AT does the participant have? or is required for mobility 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 the support will increase the participant’s independence and reduce the participant’s need for other kinds of supports?

S47E(d)-certain operations of agency Is there evidence the quoted support cost is comparable to expected cost of same kind of supports? S47 |

Criteria for reasonable and necessary supports	Is criteria met?	Considerations (including evidence used)
s47E(d) - certain operations of agencies	Has the provider considered the lowest cost option that may meet all the PCT needs?	Potential alternative lower cost options prior to going to high-cost range. Trials

• Has the PCT trialled the requested knee and or hip unit device. s47E(d) - certain operations of agencies |

Criteria for reasonable and necessary supports

Is criteria met?

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?

Is criteria met?

• Yes
• No

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

Is criteria met?

• Yes
• No

Criteria for reasonable and necessary supports

Criteria for reasonable and necessary supports	Is criteria met?	Considerations (including evidence used)
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 | 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) Consider NDIS Support for Participant Rules 2013 Part 5.1 and 5.3.

| Yes | - Is there evidence that the recommended prosthesis 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) Consider NDIS Support for Participant Rules 2013 Part 5.1 and 5.2.

| Yes | 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.) Consider NDIS Support for Participant Rules 2013 Part 5.1.

| Yes | N/A | | Are all of the above criteria met for all supports?

| Yes |

s47E(d) - certain operations of agencies

Criteria for reasonable and necessary supports	Is criteria met?	Considerations (including evidence used)
PP	No →

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s47E(d) - certain operations of agencies

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

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