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Agency Add or update self-care and community access supports in a plan approval case Insurance

Guidance in this document is not approved for use unless you view it in PACE.

This article provides guidance for a planner delegate to:

add assistance with self-care or community access funding
update assistance with self-care or community access funding
consider when to include high intensity supports.

Recent updates by

22 July 2024 Minor update to the definition of High Intensity supports based on updates in the NDIS Pricing Act Arrangements and Price Limits 2024-25.

Before you start You have:

read and understood Our Guideline - Reasonable and Necessary Supports (external)
read and understood Our Guideline – Social and Recreation Support (external) • referred to the NDIS Pricing Arrangements and Price Limits (external)
read and understood article Understand the product catalogue
read and understood article Support Categories.

Add assistance with self-care or community access funding If you have received evidence the participant may need high intensity supports, go to the section in this article Consider when to include high intensity supports.

To add assistance with self-care or community access funding to a draft budget:

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Steps for Plan Approval Case:

In a Plan Approval case, select the Draft Budget tab.
Select New Support Category.
Enter ‘assistance’ or ‘community’ into the Support Category field.
Select Assistance with Daily Life or Assistance with Social, Economic and Community Participation from the drop-down list.

Note: The Support Budget will be locked to Core.

Select the Budget Type from the drop-down list.
Select Regular in Instalment Type.
Plan Duration field will be locked. 36 months (3 years) is the default plan duration.
To change the plan duration, go to article Change plan duration.
Enter the Amount for this support.

Note: This is the monthly amount. PACE will calculate the frequency amount based on this figure. Use the Plan Conversation Support Tool to guide your decision making. Go to article Understand and update the plan conversation support tool.

Record the TSP Variance Reason from the drop-down box.
Record Additional Description about why this support is needed.

Note: This comment will not display on a participant’s plan. This description can be used as part of a discussion about funded supports in the plan approval meeting.

If the support meets all of the NDIS funding criteria under the Justifications heading, select the checkbox.
Record Justification in the free text field. For some supports, this might automatically populate. For more information about recording justifications, go to article Add budget justifications.

Note: This field has a character limit of 3000. Certain special characters in this field may cause an error; this is generally caused when copying justifications from SAP CRM into PACE. If you see the characters |% you will need to change these before you can select save.

If you’re using evidence to support your justification, select the Evidence Used checkbox. Otherwise, continue from step 19.
Select the Evidence Type from the drop-down list:

If you select Document, go to step 14.

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If you select Other, go to step 15.

Agency 16. Enter the Evidence Link name. You can view linked evidence on the Evidence tab of the Plan Approval case. To learn more about linking evidence, go to article Add and link evidence to a case. 17. Enter the Evidence Explanation into the free text field.

Insurance

If you need to add more evidence to support your justification, select the checkbox Add further evidence links and repeat from step 13.

Disability 19. Select Save.

Update assistance with self-care or community access

National gunding

the If you have received evidence the participant may need high intensity supports, go to the by section in this article Consider when to include high intensity supports.

1982To update self-care and community access supports in a draft budget:

Act 1. Select the Assistance with Daily Life or Assistance with Social, Economic and Community Participation support category under the Flexible Budget heading.

Enter the adjusted Amount for the support.

Note: The system will show the change from the original amount to the new amount. It will also show the change in the total amount over the duration of the plan. Use the Plan of Conversation Support Tool to guide your decision making. Go to article Understand and update the plan conversation support tool. 3. If the change to the amount is outside the threshold for the support category, PACE will Freedom display the TSP Variance Reason. Select the relevant TSP Variance Reason from the drop-down list.

Record Additional Description about why this support is needed.

Information under Note: These comments will not display on a participant’s plan. Use these comments to discuss funded supports as part of a plan approval meeting.

released 5. If the support meets all of the NDIS funding criteria under the Justifications heading, select the checkbox.

was

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6.

Record Justification in the free text field. For some supports, this might automatically populate. For more information about recording justifications, go to article Add budget Agency justifications.

Note: This field has a character limit of 3000. Certain special characters in this field may cause an error, this is generally caused when copying justifications from SAP CRM into PACE. If you see the characters |% you will need to change these before you can select save.

7.

If you’re using evidence to support your justification, select the Evidence Used checkbox.

8.

Select the Evidence Type from the drop-down list:

If you select Document, go to step 9.
If you select Other, go to step 10. The by

9.

Enter the Evidence Link name. You can view linked evidence on the Evidence tab of the Plan Approval case. To learn more about linking evidence, go to article Add and link evidence to a case 1982 Act

10.

Enter the Evidence Explanation into the free text field.

11.

If you need to add more evidence to support your justification, select the checkbox Add further evidence links and repeat from step 8.

12.

Select Save.

Remove assistance with self-care or community access funding

To remove assistance with self-care or community access funding: Freedom 1. In the Plan Approval case, select the Draft Budget tab. the

Select the Assistance with Daily Life or Assistance with Social, Economic and Community Participation support category under the Flexible Budget heading. under
You will not have the option to remove budget item. In Amount, type $0.00.
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If the support meets all of the NDIS funding criteria under the Justifications heading,

select the checkbox.

Agency

Record Justification in the free text field. For some supports, this might automatically populate. For more information about recording justifications, go to article Add budget insurance justifications.

Note: This field has a character limit of 3000. Certain special characters in this field may cause an error, this is generally caused when copying justifications from SAP CRM into PACE. If you see the characters |% you will need to change these before you can select save.

Consider when to include high intensity support the A support is considered a High Intensity support if it’s a support provided to a participant who requires assistance from a disability support worker who has one or more high intensity support skills. These skills are specified in the NDIS Commission’s NDIS Practice Standards: skills descriptors (external).

Developing a plan with high intensity supports The plan does not change by including high intensity support. This means you will continue to develop the plan as normal. Participants with complex needs may need some or all of their supports provided by a support worker with high intensity skills. You will need to make a decision based on the NDIS funding criteria to determine if the participant’s support needs are standard or high intensity. Support items are explained in the NDIS pricing arrangements and price limits (external). Use the Plan Conversation Support Tool to guide your decision making. Go to article Understand and update the plan conversation support tool. The information from the participant, their providers, functional assessments, therapy reports, behaviour reports and medical information may help in determining if the participant has higher intensity support needs. Standard support Participants without high intensity support needs would generally require a support worker with standard skills. High intensity support Information released was document V3.0 2024-07-05 Add or update self-care and community access supports in a plan approval case 192248066 Page 5 of 8 This This document is uncontrolled when printed OFFICIAL Page 882 of 910

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Participants with high intensity support needs will generally require a mix of support workers with standard skills and high intensity skills to have their support needs met.

Agency

For example, a mixture of standard and high intensity support may be required when a participant:

only needs a support worker with high intensity skills for their disability related health supports (DRHS) that occur at a certain time of the day.

In some situations, the participant will always need a support worker with high intensity skills to provide all their supports. Talk to your team leader if you need help to decide what level of worker is needed.

Registered nurse (RN) delegation of care

Registered nurse (RN) delegation of care allows an RN to delegate high level care to another suitably trained person.

Participants who meet the criteria for DRHS may need a support worker who is skilled to meet this need. The provision of these supports could be delegated by the RN to a support worker who has the required high intensity support skills. The number of hours needed will depend on the tasks required. When determining the number of hours to fund for DRHS, information from the following sources will help you to make sure the support meets the NDIS funding criteria (external):

the participant
their providers
functional assessments
therapy reports
behaviour reports
medical information.

Go to Our Guideline - Disability-related health supports (external) and article Calculate disability-related health supports and meal preparation supports for further information.

Plan Changes

A plan change 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 my NDIS contact or support coordinator who implemented the plan may help to:

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determine if there is enough funding in the plan to cover any increased costs
re-arrange their supports to better meet their needs.

Agency

You should support the participant to seek 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 change will be considered in line with the current prioritisation process.

Implementation

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 help the participant to arrange their supports within the available plan budget to deliver efficient service and value. This includes where a support worker with high intensity skills may be appropriate for some supports.

The participant’s my NDIS contact, or support coordinator, supports the participant to implement the plan and develop their service agreements.

Providers

Price controls are the maximum prices that can be charged for each support. Go to NDIS Price Guides and Information (external) for more information on price controls. This enables the participant to use their plan budget to purchase an appropriate mix of supports, including support workers with high intensity skills if necessary.

Service bookings and 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 high intensity price control and had the relevant skills or experience.

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

Next steps

If you have added or updated assistance with self-care or community access supports, you will need to make a fund management decision. Go to article Make fund management decision.
If you need to add further support, go to article Change the draft budget.

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Article labels – internal use only

Agency PACE user role names

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InsuranceTopics

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DisabilityCase names

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National Ownership

the

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by Version control

1982 Act Amended

Version Brief Description of Change Status Date by

Minor update to the definition of High Intensity supports based on updates in the NDIS Pricing Arrangements and Price Limits 2.1 DCM308 DRAFT 2024-07-01 2024-25 (DOCX 358KB). Updated PCST content to direct users to the KA instead of the 3P hub. 2.2 SGH107 Peer review DRAFT 2024-07-03 under

Action peer review. 2.3 DCM308 DRAFT 2024-07-03 Sent for EL1 review and VT released 2.4 DD0014 EL1 review DRAFT 2024-07-04 was 3.0 JS0082 Class 1 Approval APPROVED 2024-07-05 document V3.0 2024-07-05 Add or update self-care and community access supports in a plan approval case 192248066 Page 8 of 8 This This document is uncontrolled when printed OFFICIAL

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