Advice Support Tool: Core supports, support under core daily activities/ social civic and community participation budgets | FOI document library

Advice Support Tool

Theme: Core supports Sub-Theme(s): S47E(d) certain operations of agencies

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References:

NDIS Act 2013 Section 34 1. (a) - (f) and 2.
NDIS Support for Participant Rules 2013
Functional Capacity Assessment report
Behaviour Support Plan

Other allied health reports

Our Guideline —

Including Specific Types of Supports in Plans Operational Guideline - Personal care supports | NDIS Social and recreation support | NDIS Work and study supports | NDIS Including Specific Types of Supports in Plans Operational Guidance – Sustaining informal supports | 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?
34.1(a) Enabling the participant’s goals
(supports will assist the participant to pursue the goals and objectives in their plan)	Yes
	No
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(supports will assist the participant to undertake activities to facilitate their social and economic participation )

Criteria for reasonable and necessary _| Is criteria Considerations (including evidence used) supports met? The participant’s goal may be to continue living in their own home or their current living arrangement. 34.1(b) Assist the participant’s social and | & Yes The participant requires person to person economic participation support to undertake activities, so as to ONo facilitate the participant’s social and economic

participation.

Is there a weekly schedule of social and community activities?

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The following table outlines considerations regarding reasonableness and necessity supports.

Criteria for Reasonable and Necessary Supports	Is criteria met?	Considerations (including Evidence Used)
34.1(c) Value For Money (Supports represents value for money, ie the costs of support are reasonable, both in terms of benefits achieved and the cost of alternative support) Consider NDIS Support for Participant Rules 2013 Part 3.1 (a)-(f); s47E(d) - certain operations of agencies	Yes / No	s47E(d) – Certain Operations Of Agencies

e Are there comparable support options which would achieve the same outcome at a substantially lower cost? What alternative supports were considered?

e Is there evidence that the support will substantially improve life stage outcomes and be long term benefit to participant?

Criteria for Reasonable and Necessary Supports

The following criteria are considered when assessing whether requested supports meet requirements.

e Is there evidence that funding support is likely to increase independence and reduce funded support costs in the long-term?

e Is there evidence the support will increase the participant’s independence and reduce the participant’s need for other kinds of supports?

e Is there evidence the quoted support cost is comparable to expected cost of same kind redacted: s47E - certain operations of agencies

Criteria for reasonable and necessary | Iscriteria._| Considerations (including evidence used)

The person to person support will be, or is

red ee ee aes ¥es likely to be, effective and beneficial for the pace participant, having regard to current good (supports will be, or are likely to be, effective | No = ——ppractice:

for desired effect and beneficial for the

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Criteria for Reasonable and Necessary Supports

The following table outlines considerations when determining reasonable and necessary supports:

| Is criteria | Considerations (including evidence used) | | Consider NDIS Support for Participant Rules 2013 Part 3.2 and 3.3; participant having regard to current good practice | | Part 3.2 of the NDIS Supports for Participants

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?

(a) Published and referred literature and any consensus of expert opinion.

(b) The lived experience of the participant or their carers e what supports are currently in place, how has the participant been using their plan?

Criteria for Reasonable and Necessary Supports

The following table outlines considerations regarding criteria for reasonable and necessary supports.

Criteria	Is criteria met?
Considerations (including evidence used)
(c ) Anything the Agency has learnt through the delivery of the NDIS
Part 3.3 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to take into account, and if necessary, seek expert opinion.	Independent assessment

34.1(e) Support coordinates with but does not replace informal support

__+\The funding or provision of person to person support takes account of what it is reasonable to expect families, carers, informal networks\ __-\pand the community to provide: Part 3.4 of the NDIS Supports for Participants Rules, 2013 Reasonable family, carer and other support, consider:

Criteria for reasonable and necessary supports

Is criteria

Considerations (including evidence used)

Consider NDIS Support for Participant Rules 2013 Part 3.4

(a) for a participant that is a child:

(I) It is normal for parents to provide substantial care for children

(ii) Whether because of disability the child’s care needs are substantially greater than those of other children a similar age;

e Consider the functional impairment, the caring arrangement, and the child’s age

| a | i 9, o i

(iii) Any risks to wellbeing of the participant’s family members/carers

e Consider family member’s wellbeing, =“

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Criteria for Reasonable and Necessary Supports

Criteria
Is criteria

|(iv) Whether the support for a family would improve the child’s capacity or reduce risks to their wellbeing

e Would the support improve the child’s capacity or reduce risk to family member? s47E(d) - certain operations of agencies

(b) For other participants:

(I) The extent of any risks to well being to the participant arising from reliance on informal supports.

e Is there a risk to the informal support breaking down? redacted: s47

e Risk to wellbeing of family members if paying informal supports due to reliance.

(ii) Suitability of family members, carers to provide supports, considering factors such as age and capacity of family members; intensity

Criteria for reasonable and necessary Is criteria Considerations (including evidence used) supports met? and type of support required and whether it is age/gender appropriate for a particular carer to provide that care; and risk to long term wellbeing of family member. 34.1(f) Support is most appropriately % Yes | Schedule 1 Part 7 Considerations relating to funded by the NDIS whether supports are most appropriately ; ___| funded through the NDIS: note the Rules (supports are not more appropriately funded | [No P provide broad detail on what NDIS would oF provided through other general service typically be responsible for and what other systems or universal service obligations service systems would be responsible for. eee Res aaa for Participant Rules 4. ‘Part7.4 and75 Health 2. Part 7.6 and 7.7 Mental Health

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Criteria for Reasonable and Necessary Supports

| Criteria for reasonable and necessary supports | | Is criteria met? | | Considerations (including evidence used) | | | Part 7.8, 7.9, 7.10 Early Childhood Development | | | | Part 7.11 and 7.12 Child Protection & Family Support | | | | Part 7.13 and 7.14 School Education | | | | Part 7.17 and 7.18 Employment | | | | Part 7.19 and 7.20 Housing | | | | Part 7.21 and 7.22 Transport | | | | Part 7.23, 7.24 and 7.25 Justice | | | | Relevant Agency Guidance: Justice System; Psychosocial Disability; Mainstream and Community Interfaces redacted: s47E(d) - certain operations of agencies | |

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Criteria for reasonable and necessary supports

The following table outlines criteria used in determining whether proposed supports are considered ‘reasonable and necessary’.

Criteria
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 Part 5.1 and 5.3
Is criteria met?
Yes
Considerations (including evidence used)
Part 5 of the NDIS Supports for Participants Rules, 2019 – General criteria for supports
§5.1 A support will not be provided or funded under the NDIS if: (a) It is likely to cause harm to the participant or pose a risk to others; or
e Relevant Agency Guidance: Safeguarding the participant’s interests, SOP: Participant Critical Incident;
Support is directly related to the participant’s disability (supports will not be funded under the NDS if they do not relate to the participants disability or are day-to-day expenses or income replacement)
Is criteria met? Yes
No

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The following table outlines considerations regarding reasonable and necessary supports.

Criteria: Support Does Not Duplicate Other Supports

\Yes - Consider whether we are already funding support that will meet that need redacted: No - Supports do not duplicate other supports delivered under alternative funding through the NDIS such as Information, Linkages and Capacity Building (ILC) funding.

Criteria: Support Does Not Relate To Day-To-Day Living Costs

\ Yes No - Support does not relate to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to a participant’s disability support needs.

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A table showing Criteria, whether they are Met, and related considerations:

Criteria
Are all of the above criteria met for all supports?