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Agency Understand self-care and community access supports 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:

understand self-care and community access supports
consider when to include high intensity supports.

National Recent updates the by 12 August 2024 Guidance updated to:

advise the Plan Conversation Support Tool (PCST) must be used for all new plans and plan reassessment
change article Calculate disability-related health supports and meal preparation supports to Determine disability-related health supports and meal preparation supports.

Information of Freedom the to releasedBefore you start You have:

read and understood Our Guideline – Reasonable and Necessary Supports (external)

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read and understood Our Guideline – Social and Recreation Support (external)
referred to the NDIS Pricing Arrangements and Price Limits Agency
read and understood article Support Categories. Understand self-care and community access supports Insurance

When you include self-care or community access supports in a participant’s plan, you’ll need to make sure you include the appropriate support category.

Disability Self-care

Self-care supports provide assistance with daily personal activities. This could include:

personal care such as, bathing, dressing, toileting and grooming
assistance with eating
mobility including exercise, positioning and moving.

To include supports for self-care, you’ll need to use the support category Assistance with Daily Life.

Community access

Community access supports provide assistance with participation in community, social and civic activities.

Information of To include supports for community access, you’ll need to use the support category Assistance with Social, Economic and Community Participation.

To learn more, go to article Support Categories.

Freedom the Consider when to include high intensity support

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.

Developing a plan with high intensity supports was A participant’s plan doesn’t change by including high intensity support. This means you’ll 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.

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For Internal Use Only You’ll need to make a decision based on the NDS funding criteria to determine if the participant’s support needs are standard or high intensity. Support items are explained in the Agency NDIS pricing arrangements and price limits (external). Use the Plan Conversation Support Tool to guide your decision making. You must use the PCST for all new plans and plan reassessments and attach to the participant record. Go to article Understand and update theplan conversation support tool.

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

Standard support Participants without high intensity support needs would generally require a support worker with standard skills.

High intensity support 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. 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

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functional assessments
therapy reports
behaviour reports
medical information.

Go to Our Guideline – Disability-related health supports (external) and article Determine 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:

determine if there’s enough funding in the plan to cover any increased costs
re-arrange their supports to better meet their needs. You should support the participant to seek a plan change if they’re 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

The price controls are the maximum prices that can be charged for each support. Go to NDIS Pricing Arrangements and Price Limits (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.

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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 Agency 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

For a:

Plan Approval case, you’ll need to use the plan conversation support tool to calculate the funded supports. To add or update this support in a draft budget go to article Change the draft budget
Plan Change or Participant Budget Update case, go to article Action a budget update.

Insurance

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Guidance updated to advise PCST SGH107 must be used for all new plans and plan reassessment.

UFEX8 Peer review

SGH107 Action peer review

JS0082 Class 1 Approval

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