MR25/00038 | FOI 24/25-0317 DOCUMENT 18

The Advice Support Tool

Theme: Other Sub-Theme(s): Family members as paid supports

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 - Sustaining informal supports | NDIS s47E(d) - certain operations of agencies e High Intensity Support Skills Descriptors - December 2022 (ndiscommission.gov.au) e Homepage | NDIS Quality and Safeguards Commission (ndiscommission.gov.au) e NDIS Code of Conduct | NDIS Quality and Safeguards Commission (ndiscommission.gov.au) e The Applied Principles and Tables of Support to Determine Responsibilities NDIS and other service | Department of Social Services, Australian Government dss.gov.au

note All criteria need to be met for the supports to be funded through the NDIS. The participant’s reasonable and necessary funding for support is considered a separate decision to the question of whether paid informal care can be utilised.

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	* Who is making the request? Is this the participant or their representative?

• What is the participant’s capacity to self-advocate?
• How is the participant communicating their request for paid informal supports/family members?
• What is the participant’s capacity to change providers or cease payments to informal supports?
• Is the participant a minor?
• Whatis the relationship between the Participant and informal support/s? How many informal supports would be included in this arrangement?
• What are the participant’s reasons for requesting paid informal supports? Is this related to risk of

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| Criteria for reasonable and necessary | Is criteria met? | Considerations (including evidence used) | :————————————— | a harm, religious/cultural reasons, or strong personal views? e What supports are being requested for the family member/informal support to provide? (e.g., community participation, personal care etc.) cme| e Is the request in-line or in conflict with current information regarding the participant’s engagement with support workers?

Suggested Evidence: e Allied health reports (i.e., Occupational Therapy, Speech Therapy, Psychology) e Reports from external support work providers.

34.1(b) Assist the participant’s social and economic participation

The supports will assist the participant to undertake activities to facilitate their social and economic participation).

O Yes O No e What activities in the community is the participant reported to be completing? e What are the barriers to the participant receiving supports from an external provider to complete activities in the community?

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Criteria for reasonable and necessary supports	Is criteria met?	Considerations (including evidence used)

suggested evidence: e Australian Bureau of Statistics e Allied health reports (i.e., Occupational Therapy, Speech Therapy, Psychology) e Reports from external support work providers

34.1(c) Value for money

(Supports represents value for money, i.e., the costs of support are reasonable, both in terms of the benefits achieved and the cost of alternative support).

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 participants’s independence and reduce the participant’s need for other kinds of supports? is there evidence the quoted support cost is comparable to expected cost of same kind of supports? s47E(@}:certain/operationsjor agency

o Yes → e what funded supports are the family/informal supports currently providing? e Is the participant receiving any NDIS funded supports by non-family members currently? (i.e., they may be attending a day program or have a support worker engaged for personal care supports).

o No → e If the participant has accessed paid external supports previously, what were the outcomes of this? s47E(d) - certain operations of agencies

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Supports

The table below outlines considerations for determining if criteria related to providing necessary supports have been met.

Criteria for Reasonable and Necessary Supports

Criteria
Is criteria met?
Considerations (including evidence used)

s47E(d) - certain operations of agencies

• How is the NDIS plan currently managed?
• How are the funds currently being implemented? redacted

e Industrial employment conditions needs to be considered. If the participant is receiving high levels of funded supports/hours in their NDIS plan, and this is being provided solely by one person, it is likely that they are exceeding reasonable work hours.

Suggested Evidence:

• Provider finder
• Support Coordination report
• Allied health reports redacted: s47A
• Reports from external support work providers
• Plan utilization on participant file
• Fair Work Ombudsman website

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Criteria for reasonable and necessary Is criteria Considerations (including evidence is supports met? used)

34.1(d) Support is effective or beneficial O Yes ? How many hours is the paid

informal support proposing to for the participant ?(supports will be, or are likely to be, effective D No 隶 seal

—~ > In regards for the informal support to be paid as a document. support worker, are they appropriately trained to meet the participant’s support eeds?

Have the required assessments occurred to inform how to support the participant? edacted: s47E - certain operations of agencies

has it been reported how the supports will be implemented throughout the proposed time frame the participant will require the care model of support? document. Is the proposal paid informal support care model of support age appropriate? redacted What is the timeframe that the participant or their representative requesting access paid informal supports has transition plan considered? does the informal support have other employment impact maximum recommended hours can

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Criteria for Reasonable and Necessary Supports

The table below outlines criteria related to providing necessary supports.

| Criteria | Is criteria met? | Considerations (including evidence used) | | :–––––––––––––––––––––– | :–––––––––– | :———————————————————————— | | work as per the National Employment Standards? | |

suggested evidence:

• Fair Work Ombudsman website
• High Intensity Support Skills Descriptors - December 2022 (ndiscommission.gov.au)
• Allied health reports redacted e Positive behaviour support plan

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

A participant’s needs are considered when determining if this criterion is met, along with whether funding or provision of supports takes account of what it’s reasonable to expect families, carers, informal networks and community provide.

Yes > e If the participant is minor, what is a reasonable level of support that any primary informal support would need to provide?

Consider NDIS Support for Participant Rules 2013 Part 3.4

Criteria for reasonable and necessary _| Is criteria Considerations (including evidence supports. met? used)

e Has the risk of carer burnout been considered? The paid informal support may not have sufficient respite due to providing both paid and unpaid care.

Suggested evidence:

e Allied health reports (i-e., Occupational Therapy, Speech Therapy, Psychology)

e Carer impact statement

34.1(f) Support is most appropriately O Yes > e Is the provision of income funded by the NDIS support more appropriately (supports are not more appropriately funded | No ——> funced oF provided rouge ided th Naphae al ; other support services offered oF ee rou ; dcxere er as part of a universal services systems or universal service obligations obligation? (e.g., Carer’s Version 1.0 Page 7 of 11

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| Criteria for reasonable and necessary supports | | Is criteria met? | Considerations (including evidence used)

:
Consider NDIS Support for Participant Rules 2013 Schedule 1.
Payment and Carer’s Allowance via Centrelink).

Consider the Applied Principles and Tables of Support (APTOS) which states that NDIS funded supports must not replace, duplicate, nor fill in gaps to services required that are provided by and remain the responsibility of another services system.

Suggested Evidence:

Carer statement regarding any carer allowances they receive.

• Carer Allowance - Services Australia
• The lied Principles and Tables of Support to Determine Responsibilities NDIS and other service Department of Social Services, Australian Government (dss.gov.au) |- |Support will not cause harm redacted (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 → s47E(d)- certain operations of agencies No → |- Could paid informal support care be detrimental to the relationship between the car erand participant? The consequences of funding a family member to provide supports may include unintentionally creating an environment where the participant’s wishes in relation to their care arrangements or the delivery of their supportsare diminished.

Consider potential of multiple roles and any real/perceived Conflict of interest: i.e., a paid informal support could holdroles such as: sibling, NDIA|

Criteria for Reasonable and Necessary Supports

The following table outlines criteria considered when assessing whether supports are reasonable and necessary.

Criteria	Is criteria met?	Considerations (Including Evidence Used)
Plan Nominee,
Personal/professional advocate, informal support,
Paid carer, and potentially a legal representative. Where one person/provider hold so many roles, the potential for a conflict of interest may arise.		Does the participant have the capacity to understand any real/perceived conflict of interest regarding paid informal support care?

Should the request for paid informal care be raised due to previous experiences with formal care, the role of the NDIS National Quality and Safeguarding Commission should be explained. Information can be provided regarding how the commission will regulate and monitor service provision to eliminate risks.

The NDIS National Quality and Safeguard Commission (NQSC), sets out reportable incidents that must be reported by registered Service Providers to the Quality and Safeguards Commissioner. Registered providers must report to the NDIS Commission serious incidents (including allegations) arising in the context of NDIS supports or services, including abuse or neglect of an NDIS participant. Reportable incidents can be captured by NDIA staff if they are advised of this by a participant, their carer, nominee, or other relevant party.

is the proposed model of Supports focused on functional Capacity building and maximising quality of life through promoting independence and community

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Criteria for reasonable and necessary supports	Is criteria met?	Considerations (including evidence used)
participation via an active support model?		e If the paid informal support will be delivering both paid care and unpaid care to the participant

Suggested Evidence: e Allied health reports (i.e., Occupational Therapy, Speech Therapy, Psychology) e Support Coordinator report e Carer impact statement e NDIS Code of Conduct | NDIS Quality and Safequards Commission (ndiscommission.gov.au) e Homepage | NDIS Quality and Safeguards Commission (ndiscommission.gov.au)

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 ☐ No

e Note that the participant’s disability-related support needs are a separate consideration to who provides the support. cATE(d) - cae arf Ee ’) Vet

Suggested evidence: e Allied health reports

e Positive behaviour support plan

Support does not duplicate other supports

(supports do not duplicate other supports delivered under alternative funding through )

☐ Yes ☐ No

e Is the provision of income support more appropriately funded or provided through other support services offered as part of a universal service?

Criteria for Reasonable and Necessary Supports

The NDIS such as Information, Linkages and Capacity Building (ILC) funding. Consider NDIS Support for Participant Rules 2013 Part 5.1

Suggested Evidence:

• Carer statement regarding any carer allowances they receive.
• Carer Allowance – Services Australia

are All of the Above Criteria Met For All? ☐Yes ☐No—

Version Control

Version #	Status	Date	Modified By	Brief Description of Modification
V1.0	Cleared	30/08/2023	AAN591	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 134 of 442 Page 11 of 11