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Agency Add self-care and community access supports Insurance This article provides guidance for a delegate to:

• determine if you need to include high intensity supports

• include assistance for self-care funding

• include community access funding.

National the Before you start by You have:

1982 Act • made a decision that self-care and community access supports meet the NDIS funding criteria using Our Guideline – Social and Recreation Support

• read the guidance in appendix - High Intensity Support and determined if you need to include funding for standard or high intensity supports

• determined the funding amount for assistance with selfcare or community access supports using the guidance above, evidence from the participant and referring to the NDIS price guides and information (external)checked and confirmed all relevant documents have been uploaded to the participants record.

Information of Freedom the Determine if you need to include high intensity support Decide if you will include standard or high intensity supports. Refer to appendix - High Intensity under Support in this article for information on when to consider. Include assistance with self-care funding was 1. Add funding in the Assistance with daily life support category with an Additional Description so the participant knows what the funding is for.

 To add the funding and the Additional Description, go to article 'Change the budget'.

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Agency Include community access funding

1. Add funding in the Assistance with Social, Economic and Community Participation support category with an Additional Description so the participant knows what the funding is for.

To add the funding and the Additional Description, go to article ‘Change the budget’.

DisabilityAppendix – High Intensity Support

You will need to make a decision on including standard or high intensity support for theparticipant.

High intensity support includes three levels, and these three levels include price controls. The price controls include:

• Standard support
• High intensity support for participants with complex needs who require assistance from a support worker with additional qualifications and experience. High intensity support includes three levels.

When to consider high intensity support

You will consider high intensity supports when the participant needs: of

• frequent (at least one time per shift) assistance to manage challenging behaviours that require intensive positive behaviour support; and/or Freedom - continuous active support because of high medical support needs (such as unstable seizure activity or respiratory support). the

The three levels of high intensity support price controls allow for the provider to match the skill underlevel of support workers to the participant. The participant and the provider need to work together to find the right level of support. This will help the participant:

• best use the funding in their plan released
• to be provided with an appropriate mix of support was
• engage with higher skilled workers where required and get value for money supports.

The price limits for levels 1, 2 and 3 line up with the skill level of the worker who delivers the support. The support worker will deliver support in line with the Social, Community, Home Care documentand Disability Industry Award 2010 (SCHADS Award). Page 2 of 6 This This document is uncontrolled when printed OFFICIAL

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Definition of each level of high support

AgencyLevel 1

You will use Level 1 worker support items to calculate funding when the worker is classified as a Social and Community Services Employee level 2 (below the maximum pay point), if theyare employed under the SCHADS Award 2010. This is SCHADS pay points 2.1 to 2.3. Insurance

Level 2

You will use Level 2 worker support items to calculate funding when the worker is classified as Disabilitya:

• Social and Community Services Employee level 2 (at the maximum pay point); or • Social and Community Services Employee level 3 (at the minimum pay point) if they are National employed under the SCHADS Award. the This is level 2.4 or level 3.1 by

In general, the Level 2 price limit applies to most high intensity supports with the following 1982exceptions: Act • If the worker providing the support does not have the skills and experience to deliver high intensity support. The provider should use the Level 1 price limit.

• If a more highly skilled or experienced worker will provide the support. The provider can consider charging the Level 3 price limit. The provider will need to discuss this with the Information participant. The participant should agree to the price before the provider charges this of price.

Level 3 You will use Level 3 worker support items to calculate funding when the worker is classified as Freedom a Social and Community Services Employee level 3 (at the minimum pay point), if they were the employed under the SCHADS Award. This is between level 3.2 and level 3.4. underDeveloping a plan with high intensity supports

The plan does not change by the three levels of price controls for high intensity support. This means you will continue to develop the plan as normal. Participants with complex needs may released need some of their supports provided by higher skilled workers. wasYou will need to make a reasonable and necessary decision to determine if the participant’s support needs are standard or high intensity. Support items are explained in the NDIS price guides and information (external). document

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Information from the participant, their providers, functional assessments, therapy reports, behaviour reports and medical information may assist in determining if the participant has higher intensity support needs.

Standard Support:

• The participant without high intensity support needs would generally receive a standard level support worker, which is Level 1.

High Intensity Support:

• The participant with high intensity support needs would generally receive a mix of support workers from Level 1, Level 2 and Level 3. It is important to note that Level 1 is the equivalent of the standard rate. An appropriate balance would generally be to include Level 2 support in the plan.

• In exceptional circumstances. If the participant will always need a level 3 worker to provide all of their supports, you will:

  o make a reasonable and necessary decision about whether additional funding should be included in the plan

  o talk to your team leader and/or the Technical Advisory Branch for very high intensity supports.

Registered nurse (RN) delegation of careAnother factor for determining support levels is to consider whether the participant meets the criteria for disability-related health supports. The use of registered nurse (RN) delegation of care may be used. This allows a RN to delegate high level care to another suitably trained person based on the level of support required. These are called tier levels:

• Tier 1 where participants will require a very high level of support or have a very complex health support need will likely require Level 3 support.

• Tier 2 where participants with a disability who require an intermediate level of support will likely require Level 2 supports.

• Tier 3 where participants with a disability who have low level support needs will likely require Level 1 supports.

Refer to Our Guideline - Disability-related health supports and article ‘Add disability-related health supports’ for further information.

Plan Changes

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The total cost of an appropriate mix of supports for the participant is not likely to increase as a result of the three levels of price controls. Plan changes should only be considered where necessary. The participant should talk to their provider first to understand their supports and the price control being claimed. The early childhood partner, local area coordinator and/or support coordinator who implemented the plan may assist to:

• Determine if there is enough funding in the plan to cover any increased costs
• Re-arrange their supports in order to better meet their needs. You should support the participant to request a plan change if they are considerably disadvantaged and unable to purchase their supports because of the change in price controls. The prioritisation of the plan changes will be considered in line with the current prioritisation process.

Encourage the participant to discuss with their providers how the delivery of their supports can be improved to create the most efficient use of their plan. Providers are encouraged to assist the participant to configure their supports within the available plan budget to deliver efficient service and value. This includes where higher skilled workers may be appropriate for some supports.

The early childhood partner, local area coordinator or support coordinator assists the participant to implement the plan and develop their service agreements.

The price controls are the maximum price that can be charged for each level of support. Refer to NDIS price guides and information (external) for more information on price controls. This enables the participant to utilise their plan budget to purchase an appropriate mix of supports, including higher skilled workers if necessary.

Claims will be subject to audit. Providers may be required to provide proof that the staff member who delivered a support was subject to the level 2 or level 3 price control, and had the relevant skills or experience.

If the participant has concerns about their provider and the use of the three levels of price controls, they should escalate these to the local provider engagement team.

Version control

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Version | Approved | Brief Description of Change | Status | Date | by | —|—|—|—|—| 0.1 | JJP788 | Draft | redacted | 2022-11-09 | 0.2 | NAN927 | EL1 review | redacted | 2022-11-17 | 1.0 | CS0074 | Class 1 approval | APPROVED | 2022-11-18 |

Insurance Disability National the by 1982 Act document Information of Freedom under released was document

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