Advice Support Tool
Theme: Disability Related Health Support
Sub-Theme(s): Epilepsy
References:
- NDIS Act 2013 Section 34 1. (a) - (f) and 2.
- NDIS Support for Participant Rules 2013
- Applied Principles and Tables of Support to Determine Responsibilities
- Disability Related Health Supports Operational Guideline
- Our Guidelines — Epilepsy Support
- SOP — Disability Related Health Supports
Note: All criteria need to be met for the supports to be funded through the NDIS.
| Criteria for reasonable and necessary | Is criteria | Considerations (including evidence used) |
|---|---|---|
| 34.1(a) Enabling the participant’s goals (support will assist the participant to pursue the goals and objectives in their plan) |
Does the participant require support to manage their epilepsy due to the functional impact of their disability? The participant may not have a specific goal outlining epilepsy support is required, however, consider how epilepsy support may underpin and assist the participant to pursue stated plan goals. s47E(d) - certain operations of agencies |
|
| 34.1(b) Assist the participant’s social and economic participation: (support will assist the participant to undertake activities to facilitate their social and economic participation) |
The support itself may not specifically be utilised to assist economic and social participation, however; consider the integral impact of having epilepsy support upon the participant’s social and economic participation. | |
| 34.1(c) Value for money: (support represent value for money, i.e. the costs of support are reasonable, both in terms of the benefits achieved and the cost of alternative support) |
Consideration: AT versus line of sight support Consider whether there has been exploration/trial of AT, redacted |
Criteria for reasonable and necessary supports
Consider NDIS Support for Participant Rules 2013 Part 3.1 (a) – (f); 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?
34.1(d) Support is effective and beneficial for the participant:
(support 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 supports | Is criteria met? | Considerations (including evidence used) |
|---|---|---|
| Consider NDIS Support for Participant Rules 2013 Part 3.1 (a) – (f); | ||
| 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 agencies | |
| If AT has been considered but not recommended, have reasons been outlined why they are not recommended? | ||
| If AT has been recommended, is there evidence it has it been successfully trialled? | ||
| If registered or enrolled nurse support is requested for seizure monitoring and/or management (rather than a disability support worker), has evidence been provided that the support cannot be delegated to an appropriately trained disability support worker? | ||
| 34.1(d) Support is effective and beneficial for the participant: | ||
| (support 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? | Yes > | Has a current s47E(d) - certain operations of agencies |
| epilepsy management plan (EMP) been provided to the NDIS? If yes, has the epilepsy management plan been authorised by the participant’s relevant medical practitioner e.g., GP, neurologist, paediatrician? | ||
| If the epilepsy management plan indicates the participant has an emergency medication management plan (EMMP), has a copy of this been provided to the NDIS? | ||
| Has a seizure log or other record of the participant’s seizure activity been submitted to the NDIS? | ||
| 34.1(d) Support is effective and beneficial for the participant: | ||
| (support 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? | No —> |
| Criteria for reasonable and necessary supports | Is criteria met? | Considerations (including evidence used) |
|---|---|---|
| s47E(d) - certain operations of agencies | ||
| 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 → | |
| 34.1(f) Support is most appropriately funded by the NDIS: (support is 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 → | NDIS funded supports should not used to avoid hospital admissions. |
| redacted: s47E(d) - certain operations of agencies | ||
| Refer to the Applied Principles and Tables of Support to Determine Responsibilities |
| Criteria for reasonable and necessary Is criteria Considerations (including evidence | supports met? used) | Support will not cause harm: | Yes > | Is the support requested a restrictive | (support will not be funded if it is likely to pescitey Nye | cause harm to the participant or pose arisk | NO -——~>!¢ Does the participant have | to others, or the support would be contrary to funding in the CB- | a law of a jurisdiction) . * Relationships budget? | Consider NDIS Support for Participant Rules | 2013 Part 5.1 and 5.3 | e If CB Relationships funding is | required, refer to the relevant | advice support tool template | for specific wording. | Support is directly related to the O Yes >| Is the support associated with an | participant’s disability: impairment that would meet NDIS | (support will not be funded under the NDIS if | CINo >| SUaPhllly stteria ittested against | they do not relate to the participant’s y | disability, are day-to-day expenses or The participant may have entered the | income replacement) NDIS with an assessed impairment | Consider NDIS Support for Participant Rules 5.4 that was not epilepsy. Supports for | 2013 Part 5.1 and 5.2 impairments not considered at the | access decision must be assessed | against section 34. | Support does not duplicate other 0 Yes ? supports: (supports do not duplicate other supports ne. > delivered under alternative funding through the NDIS such as Information, Linkages and Capacity Building (ILC) funding.)
Criteria for reasonable and necessary supports
Consider NDIS Support for Participant Rules 2013 Part 5.1 Are all the above criteria met for all supports?
Version Control
| Version # | Status | Date | Modified by | Brief Description of Modification |
|---|---|---|---|---|
| V1.0 | Cleared | 01/09/2023 | LFH743 | 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 Version 1.0 Page 5 of 5 Page 114 of 442