DOCUMENT 1

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Including Specific Types of Supports in Plans Operational Guideline

1. What is the purpose of this operational guideline?

This Operational Guideline is intended to be used in conjunction with the Operational Guideline on Planning and provides additional guidance in relation to the preparation and review of a participant’s plan when specific types of supports are under consideration.

In particular, this Operational Guideline provides additional guidance in relation to making a decision to approve a statement of participant supports which includes one or more of these specific types of supports.

2. What is the relevant legislation?

Sections 3, 4, 5, 6, 9, 17A, 31 – 50, 51, 74, 99, 100 and 209(2A) of the National Disability Insurance Scheme Act 2013 (NDIS Act);
National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Supports for Participants Rules).

3. Overview

Once a person becomes a participant in the National Disability Insurance Scheme (NDIS), they develop a personal goal-based plan with the National Disability Insurance Agency (NDIA).

A participant’s plan must include the participant’s statement of goals and aspirations and a statement of participant supports (see what must be included in a participant’s plan?)

The statement of participant supports specifies, amongst other matters, the general supports (if any) that will be provided, and the reasonable and necessary supports (if any) that will be funded under the NDIS (section 33(2)).

When deciding to include any support in a participant’s plan, the NDIA must have regard to a range of matters set out in the NDIS Act, including the participant’s statement of goals and aspirations.

Specifically, before including any support in a participant’s plan, the NDIA must:

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 be satisfied that each support meets each of the criteria outlined in section 34(1)(a)-(f) of the NDIS Act and the Supports for Participants Rules (see deciding to include supports in a participant’s plan);

 have regard to the specific principles relating to plans;

 have regard to the other considerations which may apply when including supports in a participant’s plan; and

 depending on the specific type of support being considered, refer to the additional guidance available for specific support types outlined in this operational guideline which relate to:

o Assistive technology;

o Home modifications;

o Employment, higher education and vocational education training;

o Vehicle modifications;

o Prosthetic limbs;

o Personal care supports;

o Recreation supports;

o Sustaining informal supports;

o Transport;

o Specialist Disability Accommodation (SDA);

See also what must the NDIA consider when approving the statement of participant supports?

4. Assistive Technology

[Note: the Assistive Technology section was retired on 2 December 2020, and replaced by the new Assistive Technology Operational Guideline]

5. Home modifications

Home Modifications

Home modifications are changes to the structure, layout or fittings of the participant’s home that are required to enable the participant to safely access and move around frequently used areas in their home as a result of their disability.

It is expected that a home modification would only be considered where the home to be modified is the participant’s primary residence and the participant intends to remain living at the residence. If the property is a rental property, then the written agreement of the owner of the property will be required before any modifications take place.

There are a number of laws and regulatory frameworks, for example Building Codes and Australian Standards which regulate home modifications. The NDIA is unable to fund home modifications which, if provided, would be contrary to a law of the Commonwealth, state or territory (see which supports will not be funded or provided under the NDIS).

Therefore, the NDIA must be satisfied that there are no laws, regulations or other planning restrictions which would prevent the home modifications being undertaken.

In addition, the NDIA must also be satisfied, amongst other matters, that the home modification being considered represents value for money in that the costs of the support are reasonable relative to both the benefits achieved and the cost of alternative support (section 34(1)(c)).

When determining whether home modifications represent value for money, the NDIA will specifically consider:

whether the proposed home modification represents value for money when compared to the cost of other lower cost alternatives, for example less costly home modifications which reasonably achieve the same intended benefits or outcomes, or assistive technology;
whether the proposed home modification is cost effective when compared to the cost of other supports such as assistance with the cost of moving to accessible premises; and
the expected length of tenure for participants and whether this is commensurate to the cost of the home modifications.

The NDIA must also be satisfied that the provision of the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice (section 34(1)(d)).

Therefore, before including home modifications in a participant’s plan, the NDIA will also consider whether the home is suitable to be modified, including having consideration to:

any structural constraints such as size, surrounding terrain, or the condition of the building;

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 whether the home owner, and where applicable, any body-corporate, agrees and gives their permission for modifications to be made.

When complex and extensive home modifications are being considered, the NDIA may also fund oversight by a project manager or independent building certifier to ensure compliance of the modification and a qualified and experienced Occupational Therapist to certify the effectiveness of the modification to meet the participant’s goals and likely future needs.

Generally, the NDIA will fund reasonable and necessary home modifications:

 to the participant’s primary residence where, due to the impact of the participant’s disability, the participant or their carers are unable to reasonably access and use frequently used rooms and spaces using standard fixtures and fittings;

 when the participant’s primary residence, in its current condition, has a significant and adverse impact on the sustainability of current living and care arrangements; and

 where a suitably qualified Occupational Therapist has performed an assessment and recommended home modifications considering all possible alternatives, including the use of equipment.

Generally, the NDIA will also fund reasonable and necessary supports that are related or incidental to home modifications which may include:

 assistance with the cost of moving to accessible premises as an alternative to home modifications where this is cost effective to provide access. Generally, it would be expected that any new premises selected provide appropriate access and that any further modifications would be very basic and low cost. Potential costs that may be covered include:

1. costs associated with selling the participant’s current property, for
   example advertising, agents fees and legal costs;

2. costs associated with the purchase of the alternate property, for
   example stamp duty and legal costs;

3. removalist costs; and

4. minor modifications to install special equipment if necessary.

 additional costs incurred if the NDIA recommends or requires the use of qualified builders, trades people, project managers, building certifiers, building assessors or occupational therapists;

 the costs of normal repairs and maintenance to specialised fittings and assistive technology that have been installed as part of a home modification; and

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 costs related to council or other building approvals which are payable as a result of the required home modifications.

The NDIS will generally not fund:

 fixtures, fittings or materials which are above standard grade;

 modifications for a property purchased after a participant was granted access to the NDIS, unless the NDIA was involved in the decision to purchase the property, or the purchase of a more accessible property was not possible;

 the installation of swimming pools (including hydrotherapy) and spas;

 repairs or remediation of damage to the home that is pre-existing or discovered during the modification process;

 any additional insurance premiums which may be payable to insure the property once the required home modifications are completed;

 ongoing repairs and maintenance to non-specialised structures, fixtures or fittings of the home even when these form part of the modification work. For example, repainting a modified bathroom and maintaining plumbing;

 remediation of work that does not comply with the specifications of work or did not comply with the Building Code or relevant Australian Standards (this is the responsibility of the builder);

 for modifications to be removed when a person no longer requires them, except when there has been prior agreement in the case of a rental property;

 home modifications to group homes, residential facilities and other specialist accommodation, or other public buildings, including boarding schools; and

 capital building additions such as additions of rooms, stories or lifts or inclinators to allow access to multiple levels of a home or steep blocks of land. However, when considering whether the funding of items of this kind is reasonable and necessary the NDIA will also consider:

whether other parts of the house can be reasonably organised as an alternative;
whether alternate accommodation which is more accessible or more easily modified is available and the cost;
whether there are compelling factors related to the participant, their family, community or employment which makes moving premises unrealistic; and
the long term costs and benefits of alternative funded supports against the costs and benefits of the modifications to the home.

5. See also is the support most appropriately funded or provided through the NDIS? In particular, housing and community infrastructure.

It is generally expected that home modifications will be suitable for the participant’s anticipated long term needs. Therefore, it is unlikely that further modifications will be funded for the same premises except where there are unforeseen and significant changes to the participant’s needs.

Where the NDIA has funded complex or extensive modifications and the participant or their family subsequently sells the property the NDIA expects:

future premises selected will be as accessible as possible;
money from the sale of the first property, commensurate with the value of the modifications funded by the NDIA will be directed towards modifying the participant’s new premises; and
if there is more than one residence that a participant needs to access, for example, because of shared parenting arrangements or holiday homes, modifications to the second property will be restricted to access and basic hygiene requirements.

6. Employment, higher education and vocational education and training

[Note: the Employment, higher education and vocational education and training section was retired on 15 December 2020, and replaced by the new Work and Study Supports guideline]

7. Vehicle modifications

Vehicle modifications include changes to a vehicle, or the installation of equipment in a vehicle that enable a participant to gain access to a vehicle and in some cases operate the vehicle. This can include enabling the participant to:

get in and out of the vehicle with or without a wheelchair;
carry their wheelchair in or on the vehicle without lifting;
be transported safely whilst seated in their wheelchair; or
drive the vehicle with specialised controls or other adaptions.

For the NDIA to consider funding vehicle modifications to enable a participant to drive, the participant must have an endorsed license for that vehicle at the time of request, or be assessed as having the capacity to obtain an endorsed license by:

an evaluation by a medical practitioner using the national ‘Assessing Fitness to Drive’ medical standards;

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 a driving assessment by a driver trained Occupational Therapist; or

 a driving assessment by the state licensing authority.

The NDIA must be satisfied, amongst other matters, that the vehicle modification being considered represents value for money in that the costs of the support are reasonable relative to both the benefits achieved and costs of alternative support (section 34(1)(c)).

When determining whether vehicle modifications represent value for money, the NDIA will specifically consider:

 whether the proposed vehicle modifications are the best alternative for effectively achieving the participant’s driving or transport needs;

 whether the participant’s specific needs can be achieved using a less costly alternative;

 the cost of vehicle modifications compared to the cost of other funded transport supports over the life of the vehicle. For example, modified taxi fares, modified vehicle hire or personal assistance; and

 the suitability of the type of vehicle proposed to be modified in terms of:

1. whether the vehicle is of an age, type and mileage that is cost effective to modify relative to the cost of the modifications, anticipated use and expected longevity of the modified vehicle; and

2. whether the vehicle is of a type that will require the development of a unique engineering solution.

Note, vehicles less than five years old and under 80,000kms are generally considered suitable to modify. However, older vehicles and those with higher mileage may still be considered. In these cases, evidence of road worthiness and the expected lifespan of the vehicle will need to be provided.

Also, the NDIA may fund modifications that exist on a second hand vehicle at a rate commensurate with the depreciated value of the modifications.

The NDIA must also be satisfied that the provision of the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice (section 34(1)(d)).

Therefore, before funding vehicle modifications the NDIA will also consider the effectiveness of vehicle modifications having consideration to:

 whether the modifications have been prescribed by a suitably qualified occupational therapist and installed by a supplier in line with the relevant standards and state or territory regulations;

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 whether the participant owns the vehicle, or in the case of a vehicle owned by a family member, whether the participant has use of the vehicle for their transport needs; and

 whether the participant is able to fund ongoing vehicle running costs including registration, regular insurance, fuel, repairs and maintenance.

The NDIA may also fund supports that are related or incidental to vehicle modifications, for example:

 driver assessments for the purpose of obtaining an endorsed license;

 driving lessons where a participant requires lessons to establish skills to use the modified vehicle, or additional lessons where a participant’s disability results in them taking longer to learn to drive;

 additional insurance costs, where an additional insurance premium is payable as a result of the modifications. Note, the NDIA will only fund the increased amount of the premium, not the total cost of the policy;

 the cost of engineering certification and other checks required for initial registration; and

 the cost of removal of modifications and reinstallation on a new vehicle when doing so is practicable and represents value for money.

The NDIA will generally not fund:

 the purchase of a motor vehicle;

 regular insurance, registration or running costs;

 non-standard items, for example auto docking where the person or their attendant is able to manually dock;

 driving supervision in order for a participant to accrue hours to pass a driving test; or

 major modifications (over $10,000) to a vehicle where less than 8 years has lapsed since the most recent funding of vehicle modifications, unless the participant’s circumstances and needs have significantly changed.

See also is the support most appropriately funded or provided through the NDIStransport.

It is generally expected that vehicle modifications will be suitable for the participant’s anticipated long term needs. Therefore, it is unlikely that further modifications will be funded for the same vehicle except where there are unforeseen and significant changes to the participant’s needs.

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Where a participant purchases a new vehicle

Where a participant purchases a new vehicle, where practicable, minor modifications (less than $10,000) should be removed from the old vehicle and re-installed in the new vehicle.

8. Prosthetic limbs

Prosthetic (artificial) limbs are devices that provide a portion of functions normally provided by natural arms and legs. They are often used when there is absence of part or all of a limb , for example due to an accident or birth defect, and help to improve function and quality of life.

Prosthetic limbs consist of a custom made socket which fits the residual limb and a terminal device made up of different components that assist in performing functional tasks and providing compatible cosmesis.

Prosthetic limbs vary considerably in their sophistication by virtue of their complexity, cost, and specialisation and due to the varying levels of function they provide. For example, a prosthetic limb may be a simple device that is functionally efficient, or an enhanced limb that is configured to have an appearance and functional performance that is similar to that of a natural limb.

The NDIA must be satisfied, amongst other matters, that the funding of a prosthetic limb represents value for money in that the costs of the support are reasonable relative to both the benefits achieved and costs of alternative support (section 34(1)(c)).

In considering whether a proposed prosthetic limb represents value for money, the NDIA will consider whether:

the total labour and associated costs, including the number of hours and hourly rate of the prosthetist, represents value for money in the participant’s local market; and
the cost of componentry proposed represents value for money when compared to the cost of similar prosthetic components that would meet the participant’s functional needs and goals.

The NDIA will generally fund definitive limbs only where they are specified (prescribed) by health professionals who are designated and accredited (where applicable) by the artificial limb service in the state or territory where the participant resides.

For upper and lower limbs, the specifications should propose the minimum level or grade of socket materials, componentry and coverings required that relate to:

the participant’s weight;
the participant’s goals and aspirations;

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 The ability to use, put on and remove the limb;

 The ability to care for the limb; and

 The medical needs, that is, residual limb shape, fixed deformity to be accommodated, skin integrity and alignment-relevant co-morbidities.

In addition the necessity for a particular level of componentry should relate to factors that include:

 The participant’s expected or known functional level (based on standard measures such as the K classification);

 Functional needs related to the environment of use, for example typical floor surfaces and gradients, the use of stairs, the amount of time walking, typical terrain if used outside, expected impacts; and

 The impact of actual or expected vocational demands on limb type.

Generally, the NDIA will fund:

 Entry level or standard grade prostheses for participants up to K2 classification and will consider higher prosthesis for people up to K3 and K4 classification;

 Repairs, maintenance, minor and major adjustments to prosthetic limbs (or prosthetic limbs funded by other systems prior to the participant joining the NDIS);

 Ancillary costs related to prosthetic limbs such as residual limb socks and sheaths (typically 6 per year);

 Limbs external to Osseo integrated implants; and

 Upper limb myoelectric prostheses where the participant is either a bi-lateral amputee or has contralateral overuse syndrome which prevents the use of body powered prosthetics and where there is demonstrated commitment and success using a training device.

Generally, the NDIA will not fund:

 Repairs due to damage resulting from use of a limb outside of recommended use and care guidelines;

 More than one prosthetic limb (i.e. a spare prosthetic limb), unless reasonable and necessary to do so having regard to any vocational demands or other relevant considerations (for a second limb for recreational use, recreational supports; and

 For K4 level, C-legs and computerised components unless reasonable and necessary to do so having regard to the functional benefits expected to be achieved and whether such benefits can be achieved in other ways.

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Limbs will be replaced at typical replacement intervals unless more frequent replacement is warranted. Typical replacement periods are 3 years for most adults and, as needed, due to growth for children under 18 years of age (typically no more than bi-annually).

The NDIA may consider whether more frequent replacement is warranted on the basis of the participant’s needs.

9. Personal care supports

Personal care supports relate to assistance with daily personal activities including assistance with, or supervision of, personal tasks of daily life. For example:

personal hygiene, including showering, bathing, oral hygiene, dressing and grooming;
toileting, bladder and bowel management and menstrual care;
eating and drinking;
attending appointments;
use of aids and appliances, hearing and communication devices;
mobility and transferring, for example moving in and out of bed and on or off the toilet; or
application of splints, basic first aid due to injuries sustained as a result of a participant’s disability.

Personal care supports may be required across a variety of settings. For example, a participant living alone in their own home, living with family or other people, when undertaking social, recreational, education or employment activities or during holidays away from home.

When personal care supports are being considered, the NDIA will have regard to the degree to which these supports:

maximise the independence and functional skills of the participant;
are appropriate to the participant’s age and circumstances; and
whether alternative arrangements or supports could meet a participant’s needs in a less intrusive manner. For example, aids and equipment may enable a participant to complete tasks for themselves or the provision of training may increase the participant’s independence in the tasks.

Before including any personal care support in a participant’s plan, the NDIA must, amongst other matters, be satisfied that the support will assist the participant to pursue their goals. objectives and aspirations (section 34(1)(a)).

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Personal Care Supports

Personal care supports are likely to be supports which assist a participant to pursue a number of different goals, rather than being related to a specific goal.

Personal care supports for children are not intended to replace the usual care and supervision provided, or paid for, by a parent (see does the funding of the support take into account what is reasonable to expect others to provide?). However, the NDIA may fund personal care supports for children with complex needs where the level of support needed is beyond the level usually required for children of the same age.

A participant’s request that intimate personal care not be provided by family members or friends should always be respected and taken into account when determining the level of assistance that should be funded.

Supports to provide assistance with daily personal activities should generally be limited to a maximum of 6 hours per day. This level of support is based on:

bathing, dressing, toileting and grooming up to 2 hours per day – including bowel management, skin care, bladder management, menstrual care;
assistance with eating up to 2 hours per day which may include assistance with medication;
mobility including exercise, positioning, moving up to 1 hour per day; and
where toileting assistance alone is required, up to 1 hour a day.

In some circumstances, the NDIA may decide to fund higher levels of personal care support. In considering whether a higher level of support is needed, the NDIA will give consideration to:

whether the participant has high care needs, for example unstable seizure activity or respiratory support;
the weight (and other physical aspects) of the participant;
the medical condition of the participant, including any medication required;
whether the need for a higher level of support is of a temporary nature. For example, due to waiting for a suitable home modification (for example, a bathroom modification) to be completed;
whether two people are required for transfers;
whether there are behavioural concerns which require more intensive assistance with personal care activities and there are no other options, for example behavioural support intervention; and
whether additional time limited funding is likely to reduce a participant’s longer term support costs by building their capacity to independently perform personal care activities.

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The NDIA will also consider whether assistive technology, home modifications or other supports can be used to reduce the level of assistance with daily personal activities.

10. Recreation supports

[Note: the Recreation Supports section was retired on 2 December 2020, and replaced by the new Social and Recreation Supports Operational Guideline]

11. Sustaining informal supports

The informal support provided by parents, siblings and other family members is vitally important to people with disabilities. In addition to the support provided, the close relationships that participants have with the people who provide this informal support can also be highly important.

Therefore, the ongoing capacity of family members and carers to provide these informal supports can often be critical to the wellbeing of participants.

Support loads and other factors such as illness or ageing can place a carer’s wellbeing at risk and compromise their capacity to continue in their caring role. Accordingly, the NDIA recognises that sustaining these informal supports can often be an integral component of meeting a participant’s needs.

The NDIA aims to increase the social and economic participation of people with disabilities within the context of their families and existing support networks. The NDIA will use the planning process to build an understanding of a participant’s overall support needs, including identifying the range of informal supports which are available and how they can be sustained.

11.1 Does the NDIA fund family members to provide supports?

Funding a family member to provide supports to a participant can be detrimental to family relationships.

For example, the consequences of funding a family member to provide supports may include unintentionally creating an environment where a participant’s wishes in relation to their care arrangements or the delivery of their supports is diminished, or there is no or limited respite for the family worker taking on the role of support worker.

Generally, the NDIA will only fund family members to provide supports in exceptional circumstances. For example, when:

there is a risk of harm or neglect to the participant;
there are religious or cultural reasons for funding a family member to provide supports; or

Transport

 the participant has strong personal views, for example in relation to their privacy or dignity.

The NDIA will consider the circumstances of each case, any wishes expressed by the participant and also take into account what is reasonable to expect others to provide.

The NDIA will not fund a family member to provide personal care or community access supports unless all other options to identify a suitable provider of supports have been exhausted.

Note, if the funding for supports under a participant’s plan is managed by the NDIA, family members will only be able to be funded to provide supports if they are a registered provider of supports (see Registered Providers).

Transport supports include supports that enable participants to build capacity to independently travel, including through personal transport-related aids and equipment, or training to use public transport.

A participant’s transport supports may also include the reasonable and necessary costs of taxis or other private transport options for participants who are not able to travel independently, as well as transport to and from school for students.

Transport supports only relate to participants and do not relate to travel for families, carers or providers of supports. However, providers of supports may claim reasonable travel time when delivering reasonable and necessary supports in the home, or when accompanying participants to access the community.

When considering whether transport is a reasonable and necessary support, the NDIA must consider, amongst other matters, whether the support is related to the participant’s disability (see what are the general criteria for supports).

A support will not be provided or funded under the NDIS if it relates to day-to-day living costs (rule 5.1(d) of the Supports for Participants Rules).

Day-to-day living costs may include rent, groceries or utility fees, however, this is not an exhaustive list. Transport is an incidental cost of everyday life for most people and, therefore, can also be considered to be a day to day-to-day living cost.

However, the NDIS may fund day-to-day living costs that are incurred by a participant solely and directly as a result of their disability support needs (rule 5.2(a) of the Supports for Participants Rules).

These additional living costs (i.e. those incurred by a participant solely and directly as a result of their disability support needs) may be funded under the NDIS if they relate to reasonable and necessary supports.

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Before including any transport support in a participant’s plan, the NDIA must also be satisfied that the support will assist the participant to pursue their goals, objectives and aspirations.

In addition, the NDIA must take into account what is reasonable for families, carers, informal networks and the community to provide. In relation to transport, this consideration may be different for participants who are children as compared to participants who are adults.

When considering whether a proposed transport support represents value for money, the NDIA will compare the costs of transport to the overall costs of alternative supports which may provide a similar level of independence or reduce a participant’s future needs for supports. For example, vehicle modifications.

The NDIA may also consider what options may be available for the participant in their local community, or whether funding other supports has the potential to build a participant’s capacity to engage in local community activities.

Transport should only be funded where it has been determined to be reasonable and necessary, where it is an additional cost incurred solely and directly as a result of a participant’s disability support needs and, where ancillary to another funded support, it is a cost which the participant would not otherwise incur.

It does not follow, merely because transport is ancillary to a funded support, that it should be funded. The circumstances in which transport may be funded are strictly limited. Transport must:

relate to a support that has been determined to be reasonable and necessary; and
be an additional cost and incurred solely and directly as a result of disability support needs; and
where transport is ancillary to another funded support, it must be a cost which the participant would not otherwise incur (see JQJT and NDIA [2016] AATA 478 at [35]).

The NDIS will not be responsible for:

ensuring that public transport options are accessible to a person with disability, including through the funding of concessions to people with disability to use public transport;
compliance of transport providers and operators with laws dealing with discrimination on the basis of disability, including the Disability Standards for Accessible Public Transport 2002;

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 transport infrastructure, including road and footpath infrastructure, where this is a part of a universal service obligation or reasonable adjustment (including managing disability parking and related initiatives); or

 support to compensate for the lack of a public transport system.

See also is the support most appropriately funded or provided through the NDIS? In particular, transport.

12.1 Transport and considerations relating to children

Parents of NDIS participants aged under 18 years have a responsibility to meet their child’s daily transportation requirements. However, some children may require additional assistance, for example children who cannot use public transport or their parent’s vehicle, even if modified, due to their disability.

The NDIS will generally not fund day to day living costs associated with caring for children, including transport costs, as parents are expected to meet a child’s everyday transport requirements (see JQJT and NDIA [2016] AATA 478 at [35]).

When considering whether transport is a reasonable and necessary support for a child, the NDIA must take into account what is reasonable for families, carers, informal networks and the community to provide (section 34(1)(e)).

What is reasonable for a family to provide in respect of a particular support should be considered in light of the support they have to provide the child generally because of his or her disability (see JQJT and NDIA [2016] AATA 478 [39]).

When considering whether funding for transport for a participant who is a child takes account of what it is reasonable to expect families, carers, informal networks and the community to provide, the NDIA will consider:

 that it is normal for parents to provide substantial care and support for children;

 whether, because of the child’s disability, the child’s care needs are substantially greater than those of other children of a similar age;

 the extent of any risks to the wellbeing of the participant’s family members or carer or carers; and

 whether the funding or provision of the support would improve the child’s capacity or future capacity, or would reduce any risk to the child’s wellbeing. (rule 3.4(a) of the Supports for Participants Rules).

The NDIS will be responsible for supports that a student requires that are associated with the functional impact of the student’s disability on their daily living activities, such as transport to and from school (rule 7.13 of the Supports for Participants Rules).

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When considering if specialist transport to and from school for a participant who is a child is a reasonable and necessary support the NDIA will consider:

if any other transport option is available and appropriate; and
whether providing the supports would substitute for parental responsibility.

12.2 Transport and considerations relating to adults

A participant will generally be able to access funding through the NDIS for transport assistance if the participant cannot use public transport without substantial difficulty due to their disability.

The funding the NDIS provides will take into account any relevant taxi subsidy schemes available to the participant and does not cover transport assistance for carers or family members to transport the participant for everyday commitments.

There are generally three levels of funding support for transport. The levels are used to provide a transport budget for participants. In exceptional circumstances, participants may receive higher funding if the participant has either general or funded supports in their plan that enable their participation in employment.

Level 1

The NDIS will provide up to $1,606 per year for participants who are not working, studying or attending day programs but are seeking to enhance their community access.

Level 2

The NDIS will provide up to $2,472 per year for participants who are currently working or studying part-time (up to 15 hours per week), participating in day programs and for other social, recreational, or leisure activities.

Level 3

The NDIS will provide up to $3,456 per year for participants who are currently working, looking for work, or studying, at least 15 hours per week, and are unable to use public transport because of their disability.

When considering whether funding for transport for a participant who is an adult takes account of what it is reasonable to expect families, carers, informal networks and the community to provide, the NDIA will consider:

the extent of any risks to the wellbeing of the participant arising from the participant’s reliance on the support of family members, carers, informal networks and the community; and
the suitability of family members, carers, informal networks and the community to provide the supports that the participant requires, include such factors as:

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the age and capacity of the participant’s family members and carers, including the extent to which family and community supports are available to sustain them in their caring role;
the intensity and type of support that is required and whether it is age and gender appropriate for a particular family member or carer to be providing that care; and
the extent of any risks to the long term wellbeing of any of the family members or carers (for example, a child should not be expected to provide care for their parents, siblings or other relatives or be required to limit their educational opportunities); and

the extent to which informal supports contribute to or reduce a participant’s level of independence and other outcomes;
for all participants – the desirability of supporting and developing the potential contributions of informal supports and networks within their communities.

13. Medium Term Accommodation

[Note: the Medium Term Accommodation section was retired on 26 October 2020, and replaced by the new Medium Term Accommodation Operational Guideline]

14. Assistance Animals

The NDIA has used many reports to inform its definitions, including the La Trobe University report ‘Key terms for animals in disability assistance roles (DOCX)’.

14.1 Definitions of terms

Assistance Animal is an animal that is trained to perform at least three tasks or behaviours that reduce the functional impacts of a person’s impairment and is assessed by an authorised body for public access.

Dog Guide - is a type of assistance animal that is specifically trained to support people with vision impairment or blindness. The terms Guide Dog and Seeing Eye Dog are brands of dog guides.
Companion animal - is generally an animal kept for companionship or pleasure and otherwise known as a pet.
Emotional support animal - is an animal that provides informal support for a person with a diagnosed mental illness or condition.
Facility animal - is an animal that is trained to work in a specific facility or type of facility, like a residential aged care home. The animal may or may not live on-site.

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Medical Alert Animals

 Medical alert animal - an example of a medical alert animal is an epilepsy seizure dog. Epilepsy seizure dogs are intended to assist a person having a seizure by alerting the caregiver to the seizure, by moving in a way to protect the person having a seizure, or by activating an alarm.

 Therapy animal - is an animal that takes part in therapy interventions that are led by a qualified allied health professional.

 Visitation animal - is an animal belonging to a volunteer, who trains the animal to visit residential, health, or educational facilities, to bring enjoyment to the clients or students.

Animals that don’t fit the definition of ‘assistance animal’ or ‘dog guide’ are unlikely to meet NDIS funding criteria. This is explained in more detail later in this operational guideline.

Other key definitions for this operational guideline are:

 Functional outcomes - are measurable results linked with how well a person is able to perform specific tasks.

 Mechanical restraint - is the use of a device to prevent or limit a person’s movement for the main purpose of controlling their behaviour. Mechanical restraint is a type of restrictive practice.

 Primary handler - is the person responsible for the control, care and wellbeing of the animal.

 Public Access Test - is a test which an animal must pass to be considered safe and effective in accessing public places and public transport. This test varies across states and territories. Generally, this test should be conducted by an unbiased, independent assessor.

 NDIS Participant assistance animal provider - is a provider demonstrating all the requirements to be registered with the NDIS Quality and Safeguards Commission (the ‘Commission’). Generally, if a provider is not registered with the Commission they will be registered with the relevant state or territory body.

 Restrictive practice - refers to any practice or intervention that restricts or limits the rights or freedom of movement of a person with disability. Any proposed restrictive practice requires a behaviour support plan with a clear plan to reduce and eliminate the practice, and appropriate authorisation and consent as required by the state or territory in which the person resides.

 Suitability assessment - is an independent assessment of a participant’s suitability to receive and use an assistance animal from a NDIS Participant assistance animal provider. This includes an assessment of the person

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responsible for the animal (i.e. the primary handler), should this not be the participant (e.g. in the case of a child).

14.2 What does the NDIS need to consider when funding Assistance Animal supports?

When funding supports in a participant’s plan, such as assistance animals, the NDIA has to consider whether the support meets all of the general criteria for supports and reasonable and necessary criteria (see Section 34 of the NDIS Act and Section 10 of the Planning Operational Guideline).

What supports will the NDIS fund?

When funding an assistance animal, funded supports include the following:

a suitable and qualified animal, inclusive of associated participant assessment and provider incurred animal training costs; and
costs associated with maintenance of the animal for the working life of the animal.

What evidence do I need to provide?

The NDIA needs evidence in writing with input from all of the following:

an NDIS Participant assistance animal provider;
allied health professionals; and
the participant.

Information from other professionals, such as a doctor, may also be provided where relevant to the assistance animal request.

What format do I use to provide the evidence?

The NDIA needs the information outlined in the next sections (14.3 and 14.4) to be provided in a report. The ‘NDIS Assistance Animal Assessment Template (DOCX)’ is available as the NDIA’s preferred format to help assessors and participants to provide the required information.

14.3 How to meet Part 5 of the Supports for Participants Rules?

Before funding a support, the NDIA must make sure all the criteria in Part 5 of the ‘Supports for Participants’ Rules are met. Specific considerations for Rule 5.1(a) and 5.3(a) are set out below.

A support will not be provided or funded under the NDIS if it is likely to cause harm to the participant or pose a risk to others (Rule 5.1(a))

To meet this criterion, the NDIA needs information and evidence confirming the following:

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 ability of the primary handler to control, care for and maintain the wellbeing of an assistance animal. This includes the evidence that the property where the assistance animal will live is suitable;

 the assistance animal will not cause health risks to the participant and others living in the property (e.g. allergies);

 where the assistance animal will support the participant at school, the NDIA needs:

o evidence the school will allow the animal;

o information on who the primary handler in the school will be and the training they will receive;

o information on how student interaction with the animal will be managed, so as to ensure the safety of both students and the animal; and

o the assistance animal will not cause health risks to others in the school.

Generally, the NDIA will not fund assistance animals where:

 there is risk to the wellbeing and safety of the assistance animal;

o in performing its tasks. This may include lifting or pulling items that are too heavy, or unrealistic expectations (e.g. guiding an electric wheelchair);

o where a participant has behaviours of concern, such as aggressive or violent behaviour;

o where a participant has hospital admission(s) for suicide attempt(s) or self-harm behaviours in the previous 12 months;

o where a participant has had drug or alcohol misuse that has not stabilised in the previous 12 months; or

o due to any other identified risk factors.

 there is an intention to use the assistance animal as a mechanical restraint (unless there is a behaviour support plan in place);

o Mechanical restraint includes using the assistance animal to physically stop the participant from moving, or having an animal lie on the participant to prevent behaviours escalating.

Supports which are identified as restrictive practices cannot be funded without a supporting behaviour support plan which has been agreed and approved by the state or territory authority where the participant lives.

Cruelty to animals is against the law in every state and territory.

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A support will not be provided or funded under the NDIS where it would be contrary to a law of the Commonwealth or the State or Territory in which the support would be provided (Rule 5.3(a)).

To meet this criterion, the NDIA needs information and evidence confirming the following:

the assistance animal can legally access public spaces and venues required by the participant (i.e. the assistance animal has passed a Public Access Test); and
the identity of the person who will be legally responsible for the wellbeing and safety of the assistance animal.

14.4 How to meet section 34 of the NDIS Act?

Before funding a support, the NDIA must make sure all the criteria in section 34 of the NDIS Act 2013 are met. These are known as the reasonable and necessary criteria.

Will the support assist the participant to pursue their goals, objectives and aspirations included in the participant’s statement of goals and aspirations? (Section 34(1)(a))

To meet this criterion, the NDIA needs information and evidence confirm how the assistance animal will assist the participant to work towards and/or achieve their functional goals, objectives and aspirations identified in their plan.

Example 1. Joe is a 30 year old participant with low vision

Joe has a goal to travel by himself on the train to his new workplace. This goal is identified in his plan. To achieve this goal, he requires support with mobility.

The report to NDIA must outline the above, confirming that Joe possesses the required independent mobility skills to successfully navigate the environment and that the dog guide can provide support with mobility.

Example 2. Mandy is a 45 year old participant with post-traumatic stress disorder (PTSD)

Mandy has a goal to independently complete her grocery shopping. This goal is identified in her NDIS plan. To do so, she requires a support that enables her to manage her anxiety to a level that enables her to successfully complete her shopping.

The report to NDIA must outline the above and confirm that an assistance animal can provide support with anxiety management.

Example 3. Connor is a 15 year old participant with autism spectrum disorder

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Connor and his parents identify the goal of increased engagement at school. This goal is identified in his NDIS plan. To achieve this, he requires support with regulating his emotions when he becomes overwhelmed.

The report to NDIA must outline the above and confirm that an assistance animal can provide support with emotional regulation.

Will the support assist the participant to undertake activities, so as to facilitate the participant’s social and economic participation? (Section 34(1)(b))

To meet this criterion, the NDIA needs information and evidence confirming the following:

the participant’s current level of function and any barriers to social and economic participation; and
how the assistance animal will assist in overcoming these barriers.

Example 1. Joe

Joe identifies that he will often need to travel via the train station at peak times, to get to and from work. He needs a support that helps him to overcome the current barrier of negotiating complex environments, with open spaces and large crowds. In open spaces, particularly where there are crowds, Joe reports reduced confidence, unreasonably slow pace, and that he easily becomes disorientated.

Joe has a reasonable level of independent mobility using a long cane. He has had an trial walk with a dog guide, including during peak time at the train station.

The report to NDIA must outline the functional outcomes of this trial walk and demonstrate how a dog guide will facilitate his economic or social participation, in comparison to not having this support.

Example 2. Mandy

Mandy gets increased anxiety when in busy and crowded places, to a level where she will avoid leaving her house without the support of another person. Mandy has previously owned an assistance animal, during which time she says she accessed the community more than she has over the past two years, since being without this support.

The report to NDIA must provide an outline from Mandy’s treating therapists of their assessment of her, both with and without the support of an assistance animal, in relation to her access to the community for social and economic participation.

Example 3. Connor

Connor and his parents identify the opportunities school provides him in making friends and developing his social interaction skills. He requires a support that enables him to display socially appropriate behaviours and engage in social interaction with his peers.

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The report to NDIA must outline how an assistance animal can support Connor to manage his emotions to a level that supports his social interactions.

Does the support represent value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternate support? (Section 34(1)(c))

To meet this criterion, the NDIA needs information and evidence confirming the following:

the functional outcomes to be achieved through the use of the assistance animal;
the long term benefit of the assistance animal (for example a dog guide is expected to have a working life of approximately 8 years);
other supports which may achieve the same outcome, such as assistive technology, therapy supports, a behaviour support plan and/or a self-funded companion animal; and
how the assistance animal will reduce the need for other supports and over what time period (e.g. a few months, several years etc.).

An animal can have significant therapeutic benefits for people, including participants. However, the report must explain how the assistance animal will benefit the participant over and above that of a companion animal.

Example 1. Joe

In relation to Joe’s mobility support needs, he and his assessor should first explore the use and effectiveness of a long cane and other orientation and mobility techniques. Upon trial, there should be assessment of whether these alternatives assist him to navigate the train station at a reasonable pace and remain orientated.

The report to NDIA must outline the outcomes of the trial with these lower cost alternatives.

Example 2. Mandy

In relation to Mandy’s anxiety management support needs, she and her assessor should first explore the outcomes of alternative supports, including best-practice, evidence-based interventions, such as clinical mental health supports.

The report to NDIA must outline the best-practice evidence-based interventions Mandy has accessed and the associated outcomes of these supports, including Mandy’s ability to complete her grocery shopping independently.

Example 3. Connor

In relation to Connor’s emotional regulation support needs, his parents and assessor should first explore the outcomes of best-practice, evidence-based interventions, including a multidisciplinary therapy program and a behaviour support plan.

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The report to NDIA must outline the best-practice evidence-based interventions Connor has accessed and associated outcomes of these supports. The report should clearly identify what progress he has made thus far and the expected outcomes of future sessions where applicable.

Will the support be, or likely to be, effective and beneficial for the participant, having regard to current good practice? (Section 34(1)(d))

To meet this criterion, the NDIA needs information and evidence confirming the following:

best-practice interventions that have been used or trialled and how effective they are;
how the assistance animal will perform at least three tasks that the participant is unable to do;
pre- and post-trial outcome measures and/or lived experience;
how the outcomes are a direct result of the assistance animal;
the assistance animal has completed relevant training, and been assessed as suitably qualified as an assistance animal, and
how the assistance animal has been assessed as suitable for the participant.

The NDIA recognises that timely access to best practice early childhood intervention is vital for children to ensure that they achieve the best possible outcomes throughout their life. Using the NDIS Early Childhood Early Intervention approach it would be expected that a multidisciplinary team would have worked with each individual child and family prior to requesting funding for an assistance animal.

There is insufficient published and refereed evidence at this time to support the use of epilepsy seizure dogs as an effective and reliable disability support.

Example 1. Joe

Through trial walks with a dog guide, Joe and his assessor note the outcomes the dog guide enables Joe to achieve. Outcomes include better mobility to and from work, including negotiating the train station; increased confidence and capability in negotiating crowded areas; better ability to negotiate open areas without becoming disorientated; and the ability to move at a more comfortable and acceptable pace.

The report to NDIA must outline these outcomes and how they relate to the achievement of Joe’s goal. The report must identify how these outcomes compare to those that can be achieved by the lower cost alternatives also trialled

Example 2. Mandy

To confirm that an assistance animal will still help Mandy, a two week trial is conducted. The purpose of the trial is to work out if Mandy is able to better manage

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her anxiety in public places that are familiar to her and complete her grocery shopping without the support of another person.

Throughout the trial, Mandy and her assessor note the outcomes the assistance animal helps Mandy to achieve. Outcomes include independently getting to and from the supermarket in a taxi, independence in finding the items from her shopping list in a logical order, ability to stay on task when there are distractions such as loud noises and ability to interact with other customers and staff while shopping.

The report to NDIA must outline these outcomes and how they relate to the achievement of Mandy’s goal. The report must identify how these outcomes compare to those that can be achieved by alternate support options.

Example 3. Connor

To explore whether an assistance animal will help Connor with emotional regulation, engagement at school and interactions with his peers, a trial should be conducted in the school setting. This trial should only proceed dependent on the status and outcomes of best-practice evidence-based interventions previously referred to.

The report to NDIA must outline the outcomes of this trial, where this has been considered appropriate to proceed. The report must identify how these outcomes compare to those that can be achieved by alternate support options.

Does the funding or provision of the support take into account what is reasonable to expect families, carers, informal networks and the community to provide? (Section 34(1)(e))

To meet this criterion, the NDIA needs information and evidence confirming the following:

the tasks and supports expected of the assistance animal would not generally be considered parental responsibility;
the tasks and supports that would reasonably be provided by family and other household members; and
how the assistance animal will provide benefits above that of a companion animal (e.g. pet) that would generally be provided by an individual or their family.

Example 1. Joe

Prior to consideration of a dog guide, Joe and his assessor must consider whether it would generally be considered a reasonable expectation of others, including family, to regularly support another adult to get to and from work.

The report to NDIA must outline the tasks and supports that would reasonably be provided by family and other household members and evidence that the assistance animal will provide benefits above that of a companion animal.

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Example 2. Mandy

Prior to consideration of an assistance animal, Mandy and her assessor must consider whether it would generally be considered a reasonable expectation of others, including family, to regularly support another adult to complete their grocery shopping.

Example 3. Connor

Prior to consideration of an assistance animal, Connor’s parents and his assessor must consider the level and frequency of support that a child of Connor’s age would typically require to manage their emotions in the school setting.

The report to NDIA must outline:

tasks which would generally be considered parental responsibility;
tasks and supports that would reasonably be provided by family and the school; and
evidence that the assistance animal will provide benefits above that of a companion animal.

Is the support most appropriately funded by the National Disability Insurance Scheme? (Section 34(1)(f))

Generally, assistance animal supports are most appropriately funded under the NDIS for a participant where all the above criteria have been met.

14.5 Will the NDIS fund maintenance costs?

Where an assistance animal meets all of the reasonable and necessary criteria, the NDIA will generally fund supports related to the ongoing maintenance of the assistance animal.

This may include costs related to:

food
grooming
flea and worm treatments
medication
vaccinations
veterinary services.

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14.6 Will the NDIA provide funding to train a dog before it has become a qualified assistance animal?

La Trobe University completed a study ‘NDIS participant-trained assistance dogs (DOCX)’ in relation to the training of assistance dogs. Based on these findings the NDIA will generally not provide funding for a dog before it has become a qualified assistance animal.

The study found:

not all dogs who undertake training go on to successfully qualify as an assistance animal; and
there is no reliable way to predict if a particular dog will successfully qualify as an assistance animal before it has completed its training.

Therefore, it is unlikely the dog will meet the following reasonable and necessary criteria:

the support represents value for money, in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternate support (34(1)(c)); As it is not possible to guarantee the dog will successfully complete the training, the value for money criteria will not be met.
the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice (34 (1) (d)); or As the dog may not complete training the NDIA is unable to state the animal will be beneficial or effective as the dog may not address the participant’s functional impairments.
the funding or provision of the support takes into account of what is reasonable to expect families, carers, informal networks and community to provide (34 (1) (e)). Funding a dog that has not successfully completed assistance animal training is no different to providing a companion animal (e.g. pet). It is reasonable to expect that individuals/families would self-fund a companion animal.

Based on this evidence, the NDIS does not provide funding for a participant to train their own dog to be an assistance animal. This also applies if a registered assistance animal provider is engaged to train the dog, as not all dogs go on to successfully qualify as an assistance animal.

For the same reasons, the NDIS does not fund a provider to supply a dog as an NDIS support until they are fully trained and qualified assistance animals.

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