Scope

Please provide data of the increase of average plan value since Sept 2019, due to the addition of health related supports that were previously covered by Health, as per below operational guidelines.

Please provide the numbers of plans that have items from the below Operational Guidelines in their plan.

[https://www.ndis.gov.au/about-us/operational-guidelines/disability-related-health-supports-operational-guideline/disability-related-health-supports-operational-guideline-breakdown-disability-related-health-supports]

Response

Additional DRHS items added to NDIS support catalogue at 1 October 2019

In October 2019 the NDIS increased the number of support items available for DRHS items.

[https://www.ndis.gov.au/understanding/supports-funded-ndis/disability-related-health-supports]

Clarification of responsibilities for some health supports

Some DRHS items were already available to participants prior to October 2019, but the DRC decision clarified some responsibilities. Examples of items that were already included in support catalogues prior to 1 October 2019 included continence and feeding (HEN) consumables, nurse for continence, orthotics for foot care, pressure care assistive technology, dietician and exercise.

Training of disability support workers and carers

Some of the supports listed in all DRHS category groupings relate to the time/cost of training disability support workers and other carers in relation to medical/health needs. The DRC decision confirmed that the NDIS was responsible for the time taken to train support workers and other carers in relation to various ‘medical care plans’ prepared by the participant’s medical professionals. In most cases, this such training was already being performed and included in the tasks and services that disability support workers provided to participants.

The new support item codes available from 1 October 2019 do not have a specific code for each of the specific eight categories. For example where the Operational Guidance notes funding for: “Training of an NDIS-funded suitably qualified and competent worker to provide assistance to manage their …..[medical condition] … where needed.” There was already a Core support item code for [Training for Carers/Parents] and this can continue to be utilised for such training.

There are also two other support items in Core and Capacity Building where it is possible that participants claim against (i.e. if it is itemised separately in invoicing from the participants’ care providers): The code is: [Assessment, Recommendation, Therapy and/or Training (including AT) – Other Therapy]. However, these two support codes (one under Core and one under Capacity Building) may also be used by participants for non-DRHS services, and therefore the activity under these support item codes is not solely in respect of

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DHRS Items Included in This Reporting

A summary list of the support items that relate to the DRHS categories is given in Attachment A. Some supports appear to be duplicates but they are separate codes under Core and Capacity Building to allow participants flexibility in terms of the use of their budgets.

Stated Items

Not all plans include specific Stated Items even if the planning process considered specific items during the planning process and finalisation of plans. Whether to include the DRHS item as a Stated Item is part of the discussion between each participant and their planner. Having the items as a Stated Item restricts the use of funding in that support category. For example, eligible participants will have a Core Consumable budget and this budget is not restricted in its use across the DRHS consumable supports and non-DRHS consumables, as noted in Attachment A.

Changes to Plan Budgets

Changes and increases to total and category budgets from plan to plan is dependent on many factors, not only in respect of changes to DRHS needs. Therefore, it is not appropriate to compare the increase in budgets from plan to plan as solely being related to DRHS, even if DRHS items formed part of the planning discussions and plans includes some DHRS as Stated Items. This is particularly the case for Assistive Technology where items are one-off and would not appear in subsequent budgets once purchased.

Number of Participants with a DRHS as a Stated Item at 30 June 2021

The number of participants who had at least one DRHS item as a stated item in their active plan:

Number of Participants with a DRHS Stated Item at 30 June 2021

DRHS Category	Number of Participants with at least one (1) Stated Item in their Active Plan at 30 June 2021	Number of Participants who have a Consumable Budget ^ at 30 June 2021
DRHS - Nurse	869
DRHS - Consumables (Continence)	199	345,170
DRHS - Consumables (Health)	15
DRHS - Consumables (Feeding)	657
DRHS - AT - Epilepsy	23
DRHS - AT - Foot care	5,157
DRHS - AT - Pressure care	6,281
DRHS - AT - Respiratory	444
DRHS - AT - Thermoregulation	0
DRHS - Dietician	143
DRHS - Exercise	103
DRHS - Training Carers/Parents	186

Numbers are not cumulative as participants can have stated items in more than DRHS category. ^ Consumable Budget can be used for non-DRHS items such as hearing aid batteries, spokes for wheelchairs, etc

Participants can purchase DRHS supports with their Core and Capacity Building budgets without requiring it to be a Stated Item (except for some Assistive Technology items).

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Number of Participants who utilised funds for DRHS items between 1 October 2019 and 30 June 2021

345,170 out of 466,619 (almost 75%) active participants at 30 June 2021 have a Consumable Budget.

As can be seen from the following table, the number of participants who choose to spend on DRHS items is materially greater than the number of participants with a specific Stated Item in their Plan.

DRHS Category	DRHS Support in Period (1 Oct 2019 to 30 Jun 2020)	DRHS Support in Period (1 Jul 2020 to 30 Jun 2021)
DRHS - Nurse	7,803	14,881
DRHS - Consumables (Continence)	54,760	64,686
DRHS - Consumables (Health)	13,375	41,024
DRHS - Consumables (Feeding)	2,787	4,710
DRHS - AT - Epilepsy	272	329
DRHS - AT - Foot care	3,889	5,532
DRHS - AT - Pressure care	4,331	4,802
DRHS - AT - Respiratory	849	2,386
DRHS - AT - Thermoregulation	29	50
DRHS - Dietician	5,502	16,018
DRHS - Exercise	17,426	30,904
DRHS - Training Carers/Parents	2,443	3,527

Numbers are not cumulative as participants can utilise funding from more than DRHS category.

In addition, during 2020/21, 3,919 participants were provided with supports specifically related to COVID19.

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ATTACHMENT A

The following is a brief summary of the support items available under the various Disability Related Health Support categories:

Nurses (at various level of nurse qualification)

Delivery Of Health Supports By A Nurse Daily Activities
Delivery Of Health Supports By A Nurse CB Daily Activity

Respiratory Supports

Ventilators – Invasive Ventilation For Continuous Use Assistive Technology
AT Rental – Assistive Products for Respiration Support Assistive Technology
Powered Ventilator Rental Assistive Technology
Cough Assist Machine Assistive Technology
Filters And/or Humidifiers For Ventilators Assistive Technology
Repairs and Maintenance – Disability-Related Heath Assistive Technology Machines
Ventilators – Supplemental Ventilation Support (Including Assistive Technology CPAP and BPAP machines and supplemental ventilation
Aspirators Assistive Technology

Nutrition (including Consumables)

Dietitian Consultation And Diet Plan Development CB Daily Activity
Dietitian Group Session - Group of 3 CB Daily Activity
Dietitian Consultation And Diet Plan Development Daily Activities
Dietitian Consultation And Diet Plan Development CB Health and Wellbeing
Dietitian Group Session - Group of 3 CB Health and Wellbeing
Dietician group session CB Health and Wellbeing
Home Enteral Nutrition equipment: assessment, Consumables recommendation and training
HEN - pumps, bolus, strying, gastrotomy devices Consumables
HEN - extension sets, given sets Consumables
Other HEN Equipment Including Additional Cost Of Food Consumables When Necessary
HEN - pump accessories Consumables
HEN - delivery and repairs Consumables
Assistance with HEN and other special diet costs exceeding Daily Activities normal food costs

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Continence Consumables

Continence Products - Consumables
All continence (for example catheter, bags, pads, bottles, straps). - Consumables
Incontinence pads, alarms, urine bags, urinals - Consumables
Single use and washable pads and pants, nappies - Consumables
Continence aids: assessment, recommendation, training - Consumables

Low Cost Disability-Related Health Consumables - Consumables
Delivery – Personal Care, Safety and Disability-Related Health Consumables - Consumables
High Cost Disability-Related Health Consumables - Consumables
Disability-Related Health Equipment and Consumables – Set Up/Training - Consumables
Disability-Related Health Equipment and Consumables Delivery - Consumables
Disability-Related Health Consumables – Funding Only - Consumables *includes consumables for wound care, feeding (thickeners)

Exercise (Health and Wellbeing)

Exercise Physiology - CB Health and Wellbeing
Exercise Physiology in A Group – Group of 3 - CB Daily Activity
Exercise Physiology - CB Daily Activity
Exercise Physiology in A Group – Group of 3 - CB Health and Wellbeing

Thermoregulation

Cooling Vest - All Sizes - Assistive Technology

Epilepsy

Monitored Phone Alert System - Assistive Technology
Seizure Mat Location Alert Type Alarm Systems - Assistive Technology
Seizure Mat And Alarm - Assistive Technology

Foot care (mobility)

Orthopaedic shoes, orthosis to assist with foot care - Assistive Technology

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Assessment and Training of Disability Support Workers/Carers

Training For Carers/Parents CB Daily Activity

Pressure Care

Air-Filled Garments And Compression Units for Managing Circulation Problems Assistive Technology
Replacement Garments And Compression Sleeves For Cyclic Pressure Units Assistive Technology
Pressure mattresses Assistive Technology
Pressure Cushions Assistive Technology
Seat cushions for pressure care Assistive Technology
Limb, foot, Seat, Back and Head supports for tissue integrity Assistive Technology management
AT for tissue integrity Assistive Technology
Postural chairs for pressure care Assistive Technology

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