NDIA Accountability Project

This project is in DRAFT

Advice Support Tool Theme: Capacity Building Sub-Theme(s): Exercise Physiology

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FOI 23/24-1328

Advice Support Tool Theme: Capacity Building Sub-Theme(s): Exercise Physiology

References: NDIS Act 2013 Section 34 1. (a) - (f) and 2. NDIS Support for Participant Rules 2013

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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 Yes With requests for Exercise Physiology, it is likely that this criterion will be met.
(supports will assist the participant to pursue the goals and objectives in their plan) No If a Participant’s goals are not related to any sort of physical function, then this criterion may not be met.
34.1(b) Assist the participant’s social and economic participation Yes The intention of Exercise Physiology is typically for the management of disability related deficits in functional capacity (i.e., strength, mobility, balance). Maintaining these aspects of function are important for a Participant’s ability to access the community for social and economic participation.
(supports will assist the participant to undertake activities to facilitate their social and economic participation) No This criterion is usually met.
34.1(c) Value for money Yes There are 2 scenarios where an increase can be considered (should 34.1(c) be the only R&N criteria not met):
(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) No
Consider NDIS Support for Participant Rules 2013 Part 3.1 (a) - (f)
Are there any expected changes to the participant’s circumstances in the next 1-2 years that may make it inappropriate to fund the requested equipment or modifications?
If yes, have comparative costs of purchasing or hiring the equipment or modifications been provided?
Are there comparable support options which would achieve the same outcome at a

In both instances, the exercises being completed within the therapist-led sessions should be required (i.e., are they doing things in therapy that are not addressing the Participants functional deficits?).

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

substantially lower cost? What alternative supports were considered?

If it is clear they are completing appropriate exercises to address the Participant’s needs AND lower cost options have been explored and are not suitable, then an increase can be considered.

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

If it is evident that the Participant is making progress/maintaining function with an amount of support that is LESS than what is being requested, then it is fair to say that the current level is sufficient.

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

Evidence to consider whether 34.1c is met/not met:

  • Is there a home program in place? If the Participant can exercise at home or in the community, this should be encouraged as much as possible. It is likely that better outcomes will be achieved from implementation of daily strategies to address strength, mobility, and balance compared to isolated therapy sessions.

  • Has the therapist and Participant trailed a home program? If yes, has the therapist provided reasons why it was inappropriate or insufficient to meet their needs. If no, why not?

  • Can support workers or informal supports be used to oversee a basic home program written by an EP?

  • Can the Participant access a community gym with a support worker using Core SCCP funding?

  • What else is the Participant funded for? Physio? OT? Are there overlaps in what the other therapists are doing? A lot of times Physiotherapists will be working towards more localized

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

Consider the primary purpose of support and if any additional or non-standard features have direct functional outcomes that will reduce funded support needs.

Is there evidence the quoted support cost is comparable to expected cost of same kind of supports? Consider NDIA benchmark pricing guide and PANDA tool.

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Criteria for reasonable and necessary supports | Is criteria met?

Considerations (including evidence used)

aspects of a disability (i.e., respiratory function, range of motion, transfers) and an exercise physiologist will be focusing on more global aspects (strength, mobility, and balance). It should be noted that Physiotherapists are qualified to and will prescribe generalized exercise programs to address strength, mobility and balance.

  • Is the amount being requested excessive? Especially considering CB supports are typically provided for maintenance of function (excluding early childhood). Anything more than 1 hour per week could be considered rehabilitative and not in-line with what is provided for maintenance of function or to improve the capacity of the Participant to independently manage their disability. Creating a reliance on therapists is not the aim of NDIS funded CB supports.

  • Is 1 hour per week likely to produce a different outcome to 1 hour per fortnight or 1 hour per month? Depending on the level of physical disability, the evidence provided by the therapist and whether the Participant’s disability is acquired or congenital should impact decision making. If a home program has been found to be unsafe or ineffective, then increased therapist contact can be considered.

  • Generally, for physical disabilities which are acquired later in life, a higher frequency of therapy can be considered. For congenital disabilities which are stable, it is likely the Participant’s function can be managed with a lesser level of

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Criteria for reasonable and necessary supports

Is criteria met? Considerations (including evidence used)
therapist support and a delegated model of care can be used to deliver the exercise program (Therapy Assistants, Support Workers, or Informal Supports)
Therapy Assistants - Therapy Assistants have a Cert IV in Allied Health Assistant and are qualified to assist with the delivery of EP prescribed exercise programs.
  • In most instances, these are a suitable lower cost option for Participants requesting EP supports.
  • EP’s will claim TA’s don’t have the knowledge, skills or qualifications to adjust prescription due to the Participants fluctuating presentation, which is true.
  • It is expected that the EP provide the TA with multiple programs that can be completed based on the Participants presentation (i.e., 3 programs - one for a “normal” day, “good” day and “bad “day)
  • TA’s can be difficult to find and sometimes the EP’s will use this as a justification for their increased involvement. Unfortunately, this is not something the NDIS considers when applying $34.1 criteria. |

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
Yes The EP must provide measurable outcomes to justify their recommendations to prove that the therapy is effective and beneficial for the Participant.
Reports that uses words like “increased”, “decreased” or “improved”.
No

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

What are the expected benefits of the support provision? is not measurable and should be flagged.

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?

Data such as strength assessments (measured in kg’s), range of motion (measured in degrees), balance (timed) and mobility (distance covered, gait description) should all be captured every 3-6 months. Laypersons descriptions for completions of ADL’s (i.e., couldn’t make a cup of tea and can now make a cup of tea) can be sufficient but it can be difficult to determine whether these outcomes can be directly attributed to EP therapy.

If the EP is unable to prove that the therapy, they are completing is effective in managing the Participants function, then 34.1d may not be met.

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)

Yes | As discussed above in 34.1c:

  • If the Participant can exercise at home with supervision from informal or formal supports, this should be encouraged.
  • If the Participant can access a community gym (alone or with a support worker) this should be encouraged. An EP may go to a gym or to the Participants home with the Participant and support worker present to determine which equipment and exercises are suitable for completion independently or with a support worker present.

Consider NDIS Support for Participant Rules 2013 Part 3.4.

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)

Yes -> Requesting EP for the following purposes USUALLY will not meet 34.1f:

  • Weight management
  • Cardiovascular health
  • Bone density (osteoporosis, osteopenia)
  • Mental health or mood management

Consider NDIS Support for Participant Rules 2013 Schedule 1.

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Criteria for reasonable and necessary supports

Criteria Is criteria met? Considerations (including evidence used)
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 Criteria usually met
No
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 Criteria usually met. Even in instances where a Participant has met access for a Psychosocial disability, EP support can be related to a Participant’s disability in most instances
No
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 As discussed, there can be some duplication risk with Physiotherapy in particular. It is important to understand what each therapist is completing with the Participant (the goals may be the same but the strategies should differ).
No
Are all of the above criteria met for all supports? ✅ Yes Criteria most often NOT met = 34.1c and 34.1e. Usually lower cost options are suitable and can produce comparable outcomes and usually some delegation of the exercise program is appropriate.
No

Version Control

Version# Status Date Modified by Brief Description of Modification
V1.0 Cleared 01/09/2023 JGM776 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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