Creating Your Plan

Quick summary: Once you’re an NDIS participant, we will work with you to create your plan. We will first have a planning conversation with you. This helps us decide what supports to fund in your plan, who will manage your funding, and when we’ll review your plan.

What’s on this page?

This page covers:

What principles do we follow to create your plan?
What is an NDIS plan?
How do we create your plan?
How do we decide what supports to include in your plan?
How do we decide how funding is managed in your plan?
How long will your plan go for?
When will we approve your plan?
What happens once you have your plan?
Appendix A: Plan duration guidance

What principles do we follow to create your plan?

The NDIS was set up as a world first approach to disability support. It puts people with disability at the centre of decision-making, through the principles of reasonable and necessary supports and individual choice and control.

As an insurance-based scheme, we take a lifetime approach to a participant’s support needs. We provide assurance to people with permanent and significant disability or developmental delay, and to people who might acquire disability or developmental delay.

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NDIS – Creating Your Plan

that they will get the support they need. Individual funding means we help participants to purchase services and supports from a competitive and consumer-driven marketplace.

What supports can we fund?

NDIS supports should complement, not replace, other supports available to you. That’s why we consider:

the things you’re able to do for yourself
support you have from others in your network, including family members, relatives, friends, local community services and mainstream government services.

One of our aims is to help maximise your independence by working with the local mainstream government and community services that help you live an ordinary life. We all do best when we’re connected to our communities.

And as an active consumer, it’s important you are able to shop for and access providers who meet your needs. We can help you find providers who meet your needs.

Once we’ve considered your circumstances, we need to follow the rules determined under the law for the NDIS in our planning decisions.¹ We fund supports that are reasonable and necessary. This means we will only fund a support if it meets all of the following criteria:

the support is related to your disability²
the support will help you pursue your goals and aspirations³
the support will help you undertake activities that will increase your social and economic participation⁴
the support is value for money,⁵ which means that the costs are reasonable:
- when compared to the benefits to be achieved, for example, whether purchasing the support is likely to reduce the cost of funding other supports in the long term⁶
- when compared to alternative options that may provide you with the same outcome at a similar or cheaper cost⁷
the support is likely to be effective and beneficial for you, having regard to good practice and evidence⁸
the support is required to complement the informal supports you have available, by taking into account what is reasonable for families, carers, informal networks and the community to provide⁹
the support is most appropriately funded or provided by the NDIS¹⁰

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What supports don’t we fund?

We do not fund a support if:

the support is not more appropriately funded by another service system, agency, person or body, such as the education system or the health system.¹¹ We can’t fund a support if it’s the responsibility of another service system.
it is likely to cause harm to you or others.¹³
it is not related to your disability.¹⁴
it duplicates other supports delivered by the NDIS.¹⁵
it is considered a day-to-day living cost (for example, rent, groceries or utility costs like your water bill) that are not attributable or caused by your disability support needs.¹⁶
providing the support would be against the law.¹⁷
it consists of income replacement.¹⁸
it is the responsibility of other service systems to provide (for example, your state government, the education system, or the health system).¹⁹ These different systems have different responsibilities, and are designed to complement each other to form a government safety net. Like all Australians, NDIS participants continue to have access to these systems. We can’t fund a support if it’s the responsibility of another service.

How do we manage the financial sustainability of the NDIS?

The NDIS is an insurance scheme, and one of our core functions is to manage the financial sustainability of the Scheme.²⁰

When we make decisions about the supports we fund in your plan, we must also consider our need to ensure the financial sustainability of the NDIS.²¹ This means we must work within our funding budget, set through agreements between the Australian, and State and Territory governments.

It’s also important to know the NDIS is only one part of the broader National Disability Strategy that supports people living with disability. The overall success and sustainability of the National Disability Strategy relies on:

people accessing their informal support network to get the help they need from day to day

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What principles do we use to create your plan?

 people using their personal income to pay for their day to day living expenses, as is expected of all Australians

 mainstream and community services being available from state and territory governments, and other federal government programs such as Medicare

 a fair distribution of NDIS supports to those who need them, provided within our funding budget.

Staying within our budget ensures the NDIS will be here to support generations of Australians and their families.

We use the following 7 principles, to create plans that help you get the reasonable and necessary supports you need, and to make sure the Scheme is financially sustainable:

 Fair for everyone, both today and for future generations

 Fair funding to pursue your goals

 Evidence-based best practice

 Fair early investments

 Fair support across service systems

 Fair supports for your disability needs

 Fair assistance from multiple programs

Fair for everyone, both today and for future generations

While we need to consider your individual circumstances and disability needs, we also need to make consistent decisions and treat people fairly.

This means participants with similar circumstances and disability needs should receive similar amounts of supports in their plans. We also need to ensure the total cost of all participant plans are within the overall NDIS budget set by governments.

We use Typical Support Packages to help us do this. The Typical Support Package give us an indication of what supports we’d usually expect to include in your plan, based on your situation and disability support needs.

Each support in your plan must be reasonable and necessary, but they also need to be reasonable and necessary as a package of supports. We approve your whole plan, not the individual supports in your plan in isolation.²² The Typical Support Package helps guide this validation process.

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The Typical Support Package also helps to guide the consistency of our decision making process. We use these to check your overall plan to make sure that all your supports make sense together, and that your support types and amounts will complement each other to help you fulfil an ordinary life.

We may then increase or decrease the funding in your plan based on:

our discussion with you
any reports or other information we have
applying the NDIS funding criteria.

This helps keep the system fair for everyone, and ensure we remain financially sustainable.

Fair funding to pursue your goals

Goals are important.²³ The supports we fund need to help you increase your independence and pursue your goals.²⁴ This means your supports should help overcome any disability- specific barriers which may be stopping you pursuing your goals.

This doesn’t mean we fund all support costs associated with you pursuing your goals. Also, you may have goals and aspirations we can’t fund supports for. This is because helping you pursue your goals is only one of the NDIS funding criteria, so not all supports that help you to pursue your goals will be reasonable and necessary.

Other things to know about when setting your goals:

Setting more goals or bigger goals doesn’t mean we’ll provide more funding or fund more supports. For example, if your goal is to live independently in a house with a swimming pool, we may fund home modifications that address your disability related needs. This might be a home modification to make your bathroom accessible.

We won’t fund the swimming pool because this isn’t related to your disability support needs. The funding in your plan might be similar to someone else who has a goal of ‘to have a more accessible bathroom’.
Setting a goal doesn’t mean we have an obligation to fund supports that help you pursue that goal. For example, if your goal is to get a gym membership to get fit, we wouldn’t usually fund this. Gym memberships are things that all people, with or without disability, might want or need.
Setting a goal about an explicit type or amount of support you might want doesn’t mean we have an obligation to fund that support or provide that amount of funding. For example, you may tell us your goal is ‘to get a top model shower commode’ and you show us the one you want costs $4,000.

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If there is a shower commode that costs $3,000, and your occupational therapist confirms this one will meet your needs, we are more likely to fund this one instead because it is likely to deliver the same result at a lower cost. We may also look at alternatives.

Evidence-based best practice

We only fund supports that will be, or are likely to be, effective and beneficial for you, having regard to current good practice.²⁵ This means we consider if there is evidence that the support is effective and beneficial for someone with similar disability support needs.

We will consider different types of evidence when making decisions and we won’t need an expert report for every support, as we can often rely on other information or evidence.

For example, we may already have information about whether the support is widely accepted to suit someone with your disability support needs.²⁶ The primary source of evidence we rely on, and give the greatest weight to, is evidence from sources that are reliable and widely- recognised. This includes published and refereed literature, and any consensus of expert opinions. If there is no evidence to show a support is reasonable and necessary,²⁷ we won’t fund the support.

You can find the types of evidence we need on our website, and in Our Guidelines.

Fair early investments

Having access to capacity-building supports early in your NDIS journey is considered to be an early investment. This early investment is intended to help increase your independence, and reduce your reliance on NDIS funding over time.

This is an important concept that we consider when we create your plan, and again at future plan reviews. When we review your plan, we reassess all the supports you require to meet your disability support needs at that time.

Over time, your capacity building supports may no longer be reasonable and necessary, in regard to your current functional capacity, the effectiveness of the capacity building supports,²⁸ and value for money.²⁹

If your overall funding level goes down from one plan to the next, it may be because you no longer need the same type or amount of supports, such as capacity building supports. Also, if the capacity building investment has been successful at building your independence, then your need for other supports may also decrease, for example core supports.

So other things being equal, you should expect your overall plan value to reduce over time as the benefits of capacity building are realised.

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Fair support across service systems

The support you need may be the responsibility of another government service, such as education or health. We don’t fund these services, and need to consider the supports you should receive from these services when determining the supports in your plan.

Fair supports for your disability needs

When we make decisions about which supports we can fund, we consider whether a support is reasonable and necessary for you and apply the NDIS funding criteria. Sometimes, you might ask for supports to help with impairments that were not part of your Access eligibility assessment. When this happens, we need to make sure the support will help you address needs that arise from an impairment that meets the same eligibility criteria we consider at Access.

You don’t need to make a new Access request if you ask for supports to help with an impairment that was not part of your Access eligibility assessment. We will work out if you need the support you have asked for to address an impairment that would meet our Access criteria. We may ask you to provide evidence to help us work this out. We will decide if the requested support is reasonable and necessary. We will apply the NDIS funding criteria based on the impairments that would meet our Access criteria.

By funding the right disability supports for your permanent impairments that meet our Access criteria, we are ensuring the system is fair for everyone, and that the NDIS remains financially sustainable.

Fair assistance from multiple programs

NDIS funding can’t duplicate other funding or supports you may receive due to your disability.

For example, you may have received a lump-sum payment or receive regular payments as a form of compensation for an accident. Or, you may be receiving ongoing supports from another program or insurance scheme, for example, Worksafe or the Transport Accident Commission.

We don’t duplicate this funding or these supports. We may reduce the total value of your NDIS plan to account for compensation you receive, or we may not fund certain supports.

What is an NDIS plan?

Once you’re an NDIS participant, we will work with you to create your NDIS plan. You can find out more about how to become a participant in Applying to the NDIS.

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Your NDIS plan sets out your goals and the supports that will help you pursue those goals.

We create your plan based on your disability support needs. Your plan will be just for you. You can have as many goals as you want in your plan and they can be as long as you want.

Your plan will include information about:

you and your living situation
your goals, or things you want to work towards
who supports you, for example your family, friends, community and other government services
any NDIS supports we fund
how you can use your NDIS funding
who will manage your NDIS funding
when we’ll review your plan.

This page is about how we make decisions when we create your plan. If you’d like general information about how planning works, check out the Creating Your Plan page on our website.

How do we create your plan?

Once you become an NDIS participant, we go through the planning process together.

When we create your plan, we:

set up a planning conversation, so we can get to know you and discuss your situation
consider what supports community and other government services can provide to help you pursue your goals and live as independently as possible
consider if you need any NDIS funded supports, and if they meet the NDIS funding criteria
ask for further information about your support needs, if we need to
develop and approve your plan
send your plan to you.

You can ask other people to help you, if you want to. For example, you can have friends, family or an advocate join the planning conversation. They can also help you to make your own decisions about your plan.

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If you need someone else to make decisions for you about your NDIS plan, we can help you set this up. This may be:

a plan nominee if you’re an adult
a child representative if you’re under 18 years old.

We’ll start creating your plan within 21 days after you become an NDIS participant.

Learn more about our timeframes to create your plan in our Participant Service Guarantee.

What can you expect from us when we create your plan?

We’ll create a plan that will:

be personalised and directed by you
respect the role of family, carers and other people who are important to you
build the capacity of families, carers and your community to support you where appropriate
consider the support your friends and family provide, and the support services available to everyone in the community
respect your right to have control over your life and make your own choices
help you participate in the community, and help you study or find and keep a job, if you want to
focus on choice and flexibility when it comes to your goals, needs and your supports.

What happens in your planning conversation?

The planning conversation is an important part of the planning process. We’ll talk with you about your daily life, living situation, goals and supports. This helps us decide what NDIS funded supports to include in your plan.

We’ll ask how you want to have your planning conversation, for example where and when we meet with you, or if you would prefer to do it over the phone. You can bring anyone you choose, such as your family, friends or advocates, to the meeting.

What information do we look at before your planning conversation?

Before your planning conversation, we review:

the information in your NDIS Application Form
any reports from your doctors or allied health professionals

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Creating Your Plan

 other assessments you give us, for example from other government agencies or disability service providers

 other relevant information we have about your support needs

 any other information you give us.

This helps us get to know you better, and learn about your situation. It also helps us check where we might need more information about you to help us create your plan.

What will we talk about in your planning conversation?

We’ll talk to you about your daily life, and what you’d like to do in the future. We’ll also talk about how the NDIS can help you do what you want to do.

We’ll ask you about things such as:

 your goals

 where you live, and your living arrangements

 how you move around your home and your community

 who supports you now, such as your family, friends or service providers

 support available from community and other government services to help you learn new skills and become more independent

 what self-care support you need

 if you use or need equipment, technology or devices, also known as assistive technology

 what social and recreation activities you’d like to do now or in the future

 if you need help to build friendships or connect with your family

 if you’d like to work or study now or in the future

 what support you need to build your skills and do more things yourself.

Learn more about preparing for your planning conversation.

We’ll also ask you how you would like to manage your NDIS funding. Learn more about plan management.

All the information you give us helps us create your plan. We will keep your personal information safe and secure. Learn more about Your Privacy and Information.

For a plan review, we might not need to ask all these questions again. Or we might not need to have a planning conversation at all. Learn more about plan reviews.

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How do you set the goals in your NDIS plan?

We need to know your goals so we know how we can help you.

Your goals are your own personal desires about what you’d like to do. You can have as many or as few goals as you want.

Your goals can be big or small, short term or long term, simple or complex. They can be about anything you want to work towards.

You may express your goals broadly, or you may have specific goals. For example, you may express one of your goals as ‘living independently’. Or, you may express your goal as ‘to have an accessible bathroom’.

You can set any goals you like, even if they’re about things we won’t fund supports for.

How can you tell us your goals and the information about you?

The first part of your plan has information about:

your daily life and living situation
your social, work and study life
the people who support you
your goals.

You, or your plan nominee or child representative, set your goals and tell us what information you want to include about your life. This is sometimes called the ‘participant’s statement of goals and aspirations’.

If you want, your family and friends who support you can also give us information about their life.

You can tell us your goals at any time before we approve your plan. If you tell us your goals in person or over the phone, we’ll write them down for you.

They are your goals and we’ll write them down in your own words. We can’t change your goals or choose them for you. But we can help you choose what words to use if you want us to.

Learn more about setting your goals.

Will we always fund supports for your goals?

Your NDIS funding is aimed to provide you with the supports you need for your disability.

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These supports may help you increase your independence and pursue your goals.

You can also be supported through mainstream and community services, or informal supports you can get through family and friends.

The supports we fund should help you pursue your goals, but you don’t need a specific goal for every support in your plan. When we decide if a support will help you pursue your goals, we consider your whole situation.

We look at the disability specific barriers that prevent you from pursuing your goals, and how the support will address your disability support needs.

There are some things to remember when setting goals:

Setting more and bigger goals doesn’t mean we’ll fund more and bigger funded supports.
Setting a goal doesn’t mean we have an obligation to fund supports that help you pursue that goal.
Setting a goal about an explicit type or amount of support you might want doesn’t mean we have an obligation to fund that support or in that amount.

This is because helping you pursue your goals is only one of the NDIS funding criteria. A support must meet all of the NDIS funding criteria to be funded under the NDIS. So not all supports that help you pursue your goals will be reasonable and necessary supports we can fund in your plan.

For example, you might be ready to look for work and have a goal to find a job. Disability Employment Services help people with a disability look for jobs, so we usually won’t be able to fund this support.

But we can help you connect with a Disability Employment Service, and consider what supports we could fund to help build your job skills. Learn more about Work and Study Supports.

Learn more about how we consider your goals when we decide what supports to include in your plan.

Who can help you set your goals?

You can ask other people for help to set your goals if you want to. For example, your friends, family, Local Area Coordinator or Early Childhood Partner can help you.

You can also change your goals at any time, even after we approve your plan. Learn more about goal setting.

We’ll talk with you in your planning conversation about what your goals will mean for your NDIS plan. For example, we could talk about:

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Creating Your Plan

 what your goals will look like for you  how you can work towards your goals  when you’d like to work on your goals  what supports you need to work towards your goals, noting that just because you have a goal doesn’t mean we have to provide funded supports for it  where you might get supports to work towards your goals, for example community or mainstream services  if we’ll fund supports to help you work toward your goals  how you could develop skills and talents you haven’t focused on before  what supports you need to overcome any challenges in working towards your goals  if you’d like to include smaller goals as part of a big goal  if you’d like to add a few steps to work towards your goals.

For example, you might choose a goal, ‘I want to go on a holiday next year’. You might also choose to add steps, like saving up money for your travel and hotel, towards achieving your goal.

Learn more about preparing your goals.

You can also check out the planning booklet (Booklet 2) to help prepare this information.

How do we think about risks when we create your plan?

You have the right to decide what you do each day and to make your own life choices. For all of us, our choices come with some risks. We all make our own choices about how much risk we want to take in our lives. You should also be able to choose how much risk you want to take in your life.

We can’t fund supports that risk harming you or someone else³⁷. But we will try and balance this with enabling you to make your own choices wherever possible.

Some of these risks might affect what we can fund in your plan, or who manages your NDIS funding. For example, there might be risks to your personal safety, your personal money, or your NDIS funding.

We think about if there are any risks with your current support arrangements. For example, there might be risks to your family or friends health if they keep supporting you when they get older. If so, we could look at including NDIS funded supports to reduce these risks.

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We also consider any risks around your safety and wellbeing. For example, there could be isks if you’re socially isolated, or rely only on providers for support. Or, there could be risks of physical injury to you or the people who support you.

When we create your plan, we’ll help you think about supports that help you live your life the way you want to.³⁸ We balance your right to take reasonable risks in pursuing your goals, with your safety and the safety of other people.³⁹

We’ll talk with you about how we can help you reduce risks where we can. There are a few things we could do to reduce risk, and make sure your plan meets your needs. For example, we could:

review your plan sooner
fund supports to help you build your support network, for example helping you make friends or build relationships in your community
set up regular chats with your planner, Local Area Coordinator or Early Childhood Partner
make sure any providers using restrictive practices are NDIS registered and follow the NDIS Quality and Safeguards Commission requirements
let you know about how you can complain about your service providers or complain about our service if there are any issues
include funded supports, such as budget training, to help you manage the funding in your plan.

How do we decide what supports to include in your plan?

NDIS supports are the services, items and equipment we fund or provide under the NDIS. An NDIS support is the practical description of how we help you under the NDIS.⁴⁰

There are two types of NDIS supports:

the general supports we provide to you
the reasonable and necessary supports we fund in your plan.

General supports

General supports are those we provide to you, such as a Local Area Coordinator or Early Childhood Partner.

We help you develop your plan and connect with supports and activities in your area. For example, we can help you connect with:

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 informal supports, such as your friends, family or other people you know in your community

 community supports that are open to everyone in the community, such as sporting clubs, activity groups or libraries

 mainstream supports – other government services such as the health and education systems.

General supports are not funded through your NDIS plan.

General supports can be provided by:

 an Early Childhood Partner for children under 7 years old

 a Local Area Coordinator for people aged 7 or older

 National Community Connectors

 community organisations through the Department of Social Services Information, Linkages and Capacity Building program.

We can provide these general supports to everyone with a disability, including people who are not NDIS participants.⁴¹

Reasonable and necessary supports

Reasonable and necessary supports are the disability supports we fund in your plan. You can use this funding to buy supports from service providers.

All NDIS supports need to meet the NDIS funding criteria. For example, they need to be related to your disability, value for money, and effective and beneficial.

Each support we fund in your plan must be a reasonable and necessary support, however we also consider how your supports will work together as a package to address your disability support needs, or to achieve an outcome. The supports we fund must be reasonable and necessary individually, but they must also be reasonable and necessary as a package of supports.⁴²

If you need a new support, which now means your overall package of supports doesn’t meet the NDIS funding criteria anymore, we may either:

 not include the new support in your plan

 include the new support in your plan, but also reduce the other supports in your plan.

For example, a home modification may reduce your need for other supports. If we plan to fund a home modification, we will need to take that home modification into account when

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considering what other supports are reasonable and necessary, such as the amount of care

you need at home.

We also decide how we describe the supports in your plan. We can describe your supports as:

Flexible – you have greater flexibility on what you buy within the description of the supports. This is sometimes called supports ‘described generally’.
Fixed – you must buy the support as we describe it in your plan. This is sometimes called a ‘stated support’ or supports ‘described specifically’.

We describe most supports as flexible when we can. When supports are described as fleasible, you will have greater flexibility over the support you can buy that falls within the description of the support in the plan. When supports are described as fixed, you will have less flexibility.

We divide your supports into 3 different budgets:

Core Supports – supports for everyday activities
Capacity Building Supports – supports to help you build your skills and increase your independence
Capital Supports – supports such as assistive technology, vehicle modifications, home modifications and Specialist Disability Accommodation.

Each budget is divided into a number of support categories. Support categories have more detail about what supports you can buy with your funding. When we describe your supports as flexible, you can usually choose what supports you buy within the descriptions for each s \support category.

Your Core Supports budget is the most flexible. You can usually use your funding across all the support categories except transport in the Core Supports budget if:

we described the supports as flexible
you have the same plan management options for your Core Supports.

Learn more about the support budgets and support categories in your plan.

We also consider our Participant Service Charter and what you can expect from us when we create your plan.

We look at all the information we have when we decide what supports to include in your plan.

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Check out our Reasonable and Necessary Supports Guideline

Check out our Reasonable and Necessary Supports Guideline for how we decide what supports to include in your plan, and how we describe them.

We also have detailed information on how we make decisions about different types of supports. Learn more on our Supports We Fund page.

What if we need more information?

Sometimes we might ask for more information to create and approve your plan. We’ll do this if we don’t have enough information to decide what supports to include in your plan.

We can ask you to:

give us more information that is reasonably necessary to create or approve your plan⁴³
get an assessment, usually from an allied health professional, of your support needs and send us the report⁴⁴
get a medical, psychiatric, or psychological examination and send us the report.⁴⁵

For example, we might need more information if you have complex care needs. We could ask you to get an assessment from an occupational therapist. This will help us understand your support needs at home and in the community. It also helps us work out what supports to fund in your plan.

With your consent, we can also ask someone else to give us information we need to create and approve your plan.⁴⁶ For example, we can ask your doctor, or the people who support you, to give us information.

When we ask for more information or to get an assessment, we’ll tell you:

what you need to do
what information we need
how you can send us the information
when you need to give us the information.

We must give you a reasonable opportunity, and a reasonable amount of time, to give us this information.⁴⁷ The sooner you can give us the information, the sooner we can create and approve your plan.

Your plan will include funding for any assessments or examinations we ask for. If we need independent information about you, we avoid any conflicts of interest as much as possible. This means we usually won’t choose an assessor you know.

We only ask for an assessment or examination if:

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Creating Your Plan

 it will help us create your plan  we don’t already have the information  the benefits outweigh the time and cost.

You don’t have to give us this information or get these assessments. But without them, we might not have enough information to understand and approve the supports you need.

Sometimes, we might need to approve your plan before you give us this information.⁴⁸ For example, we might approve your plan so you have funding for urgent self-care supports you need. We could then review your plan once you have the assessments and reports for other supports, such as assistive technology.

How do we decide how funding is managed in your plan?

What do we mean by managing your funding?

Managing your NDIS funding means:⁴⁹

 buying the supports in your plan, including paying taxes  claiming and managing your NDIS funding, such as paying for supports on time  keeping track of what you buy with your funding, including keeping receipts and invoices  spending your funding according to your plan.⁵⁰

Your plan will say who manages your NDIS funding.⁵¹

What are your plan management options?

You have three options for who manages the funding in your plan.⁵²

 Self-managed: you, or your plan nominee or child representative, manage the funding and pay your providers.  Agency-managed: we manage the funding and pay your providers.  Plan-managed: a registered plan management provider manages the funding and pays your providers.

You can also choose a mix of these types of plan management. For example, you might like to manage some of the funding yourself, and we’ll manage the rest.

There are a few other things to remember when you choose your plan management options. If your funding is:

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Agency-managed or Plan-Managed

Agency-managed, you must use NDIS-registered providers⁵³
Agency-managed or plan-managed, your providers or your plan manager can only claim up to the NDIS Price Guide rates.
plan-managed, we’ll always include plan-management fees in your plan.

Learn more about ways to manage the funding in your plan.

You can also check out our booklets for information about plan management.

You can ask us to change how you manage your plan at any time. There are no restrictions on how often you can ask to change your plan management.

If you want to change your plan management, you’ll need a plan review.⁵⁴ If this is the only change you want, we can often do this without the full plan review process. Learn more about reviewing your plan.

How do we decide who manages your funding?

We’ll ask you at your planning conversation who you want to manage your funding.

We must agree to your request, unless:⁵⁵

you already have a plan nominee, who can choose who manages your funding.
you want to self-manage the funding but you, or your plan nominee or child representative, are redacted.
you want to self-manage the funding but that would be an unreasonable risk to you.
it’s for in-kind supports, or cross-billing payments for younger people in residential aged care.

There are a few other things to remember.

We’ll let you know what your plan management options will mean for you.
You can also ask your friends, family or service providers for advice.
We need to consider any legal orders about your finances, such as court or tribunal orders.
If you’re under 18, your child representative can choose how to manage your plan funding.⁵⁶

If you’re not happy with the plan management decision we make, you can ask for a review of our decision.

Learn more about requesting a review of decisions we make.

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What if you have a plan nominee?

If you have a plan nominee, they will choose how to manage your plan funding if it’s part of their nominee arrangement.⁵⁷ This means we decide your nominee is responsible for managing your funding, and they agree to it.

Your nominee has a duty to work out what you want. They need to make decisions that help your personal and social wellbeing.⁵⁸

Learn more about nominees.

Can you manage your own funding?

We’re committed to helping you manage your own funding if that’s what you want to do. There are risks for us all in managing our money. Where possible, we’ll help you make decisions about money, just as all Australians do.

If you want to manage your own funding, there’s a few things to keep in mind. You’ll have more choice and control over your plan. You’ll also have extra responsibilities, like keeping receipts for what you buy with your funding.

Learn more about self-managing.

You, or your plan nominee or child representative, can self-manage your funding unless:⁵⁹

you, or your plan nominee or child representative, are currently bankrupt or insolvent under administration
there’s an unreasonable risk if you self-manage your funding.

Are you bankrupt or insolvent?

You can’t manage your NDIS funding if you’re currently an insolvent under administration.⁶⁰ Your plan nominee or child representative also can’t manage your funding if they’re an insolvent under administration.⁶¹

Insolvent generally means you can’t pay your debts when they are due.

Your NDIS funding can’t be self-managed if you, or your plan nominee or child representative:

are currently bankrupt – contact the Australian Financial Security Authority if you’re not sure
have your property under the control of people you owe money to.⁶² for example, your bank or the Australian Financial Security Authority
have a personal insolvency agreement to repay money you owe, and you haven’t followed the agreement.⁶³

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 have a debt agreement to repay money you owe.

This also applies if you, or your plan nominee or child representative, are an insolvent under administration in another country.

You might be able to self-manage your funding after you stop being an insolvent under administration. But we’ll consider if there might be an unreasonable risk in you managing your own funding.

Your plan nominee might be a company or body corporate, like a service provider or advocacy organisation. If so, they can’t be insolvent either.

A company or organisation can’t manage your funding if they are under voluntary administration, liquidation or receivership.

Is there an unreasonable risk if you self-manage your funding?

You have the same right as all Australians to take reasonable risks in managing your money. We respect your right to take reasonable risks in self-managing your NDIS funding.

But you can’t self-manage your funding if this would create an ‘unreasonable risk to you’. Your plan nominee or child representative also can’t manage your funding if that would be an unreasonable risk to you.

If you’re older than 18 and want to self-manage your funding, we’ll consider if this could put you at risk. This could be if you’re vulnerable to physical, mental or financial harm. Or, if someone might pressure you to do something.

We’ll also think about:

 how well you make decisions and manage your money

 how well you managed your funding in the past, for example if you managed disability funding before the NDIS

 if you were previously bankrupt or insolvent under administration, how well you manage your money now

 if you have a court or tribunal order that someone else, such as a financial trustee or guardian, manages your money

 if your informal supports could help you reduce any risks, for example if they help you manage your money.

We consider what strategies we could use to reduce risks, including:

 giving you a shorter plan

 having regular check-ins

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 including supports in your plan to help you manage your funding.

When we think about risks, we think about the types of supports you want to manage. There might be unreasonable risks for you to self-manage some supports, but you might be able to manage others.

For example, it might be risky for you to manage the funding for a $30,000 home modification. But you might be able to manage a $500 home modification like a grab rail.

If your plan nominee or child representative wants to manage your funding, we’ll think about:

how well they manage their money
if any business or other interests might affect how they manage your money
whether we believe they will use your NDIS funding according to your plan
if any safeguards or strategies in your plan could help reduce any risks to you.

What if you want to learn to manage your funding in the future?

We might be able to fund supports to help build your skills to manage your NDIS funding.

For example, we might be able to fund a support called ‘Training in plan and financial management’. This can help you learn to:

budget and keep records of your purchases
choose your supports and get the most out of your plan
claim your NDIS funding, pay providers and make service agreements.

This support will need to meet the NDIS funding criteria for us to fund it in your plan. Either a plan manager or a Support Coordinator can provide this support.

For more information about this support, talk to your planner, Local Area Coordinator or Early Childhood Partner.

When do we make your funding Agency-managed or plan-managed?

If you don’t choose who will manage your funding, or if you can’t self-manage any parts of your funding, we have to decide for you. We’ll choose to make those parts of your funding Agency-managed or plan-managed when we approve your plan.

When we decide if it’s Agency-managed or plan-managed, we think about your goals, supports and the providers you want to use. For example, we consider if you want to use providers that are not NDIS registered.

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What if the supports have already been paid?

In some rare cases, other government agencies have already paid for supports through funding outside your plan. These supports have already been paid for, so you won’t be able to manage the funding for these supports.

These include:

in-kind supports
cross-billing payments to the Department of Health if you’re a younger person in residential aged care.

How long will your plan go for?

Everyone has different goals, living situations, and circumstances. So we’ll work with you to decide how long it’ll be before we must create your next plan. This will be based on your individual situation.

We think about how long you want your plan to go for. We’ll try to make the plan length what you want, where we can.

If you’re not happy with how long your plan goes for, you can ask for a review. Learn more about reviewing decisions we make.

Your plan will say when we must do a plan review, if we haven’t reviewed your plan before a certain date or circumstance.⁷⁷ This is called the ‘plan review due date’. We could write this as:

a date, for example ‘1 January 2021’
a circumstance or milestone, ‘when Constantine starts school’
both a date and a milestone, ‘when Macey starts her new job, or 1 July 2021: whichever happens first’.

We have more information in Appendix A on how long we usually make your plan.

When will we give you a longer plan?

If your support needs and circumstances will likely stay the same, we usually give you a 24-36 month plan. We can give you a 24-36 month plan if:

you know how to use your NDIS plan
your disability support needs are stable
you have strong informal supports and living arrangements

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Example

Sarah is 35 years old and has her second planning conversation. Her previous plan worked well, and her support needs likely won’t change soon.

She asks for a longer plan as she knows what supports she needs. Her planner decides to approve a 36-month plan.

When will we give you a shorter plan?

We usually give you a shorter plan if your needs might change over the next year or two. This includes if you:

are younger than 8
have changing support needs, such as if your disability gets worse over time
might leave the NDIS in the next year or two, including if you were eligible for the NDIS under the early intervention requirements
might change your work or study in the next year or two
don’t have a strong support network, or there’s risks to your safety or your personal money
have very high support needs, or need behaviour supports
need assessments to determine your disability support needs
need high cost assistive technology or home modifications
need disability-related health supports.

We might also give you a shorter plan if you need extra help to link in with supports. Or, you might need extra help to use your funding according to your plan.

For example, we could give you a shorter plan and include funding for Support Coordination. A Support Coordinator could help you use the right amount of funding each month. When we next review your plan, we can check if you’re linked in to the supports you need. And, we’ll check if you’re using the right amount of funding.

If you’re a younger person in residential aged care, we usually give you a 12-month plan and we’ll check-in with you regularly. We’ll discuss how we can help you move out of aged care if you want to, or whether your supports work for you if you want to stay. We may be able to give you a longer plan if you want one.

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Remember, you can always talk to your Support Coordinator or planner if you want to move out of residential aged care.

Example

Joe is 16 and will finish school in 18 months. We give Joe a 17-month plan. He’ll have the chance to set new goals before he gets his next plan.

When it’s time to create his next plan, we can have another look at his supports. His next plan will assess his goals and support needs after he leaves school.

When will we approve your plan?

We’ll approve your plan as soon as we reasonably can based on your situation.⁷⁸ We may take longer to approve your plan if we need you to give us more information or get an assessment.

For children younger than 7, we aim to approve your plan within 90 days after you become a participant.

If you’re 7 or older, we aim to approve your first plan within 70 days after you become a participant.

Learn more about our timeframes to create your plan in our Participant Service Guarantee.

What do we think about when we approve your plan?

When we approve your plan we must:

think about your goals⁷⁹
consider any assessments about your support needs⁸⁰
decide that each support meets the NDIS funding criteria, and as a package of supports⁸¹
decide if we need to reduce the amount of funding in your plan because you can get compensation outside the NDIS⁸²
consider the principle that you should manage your plan as much as you want to⁸³
think about how your previous plans have worked for you, including how well they met your disability support needs.⁸⁴

We also consider the principles about plans.⁸⁵ These principles include things like:

Your plan is just for you.

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 Your plan will work alongside other supports you can get outside the NDIS, such as informal, community and mainstream supports.

 Your plan should give you as much choice and independence about your life.

You can read the full list of principles about plans in the NDIS Act.

What happens once you have your plan?

Once we approve your plan, you’ll get a copy within 7 days.⁸⁶ We’ll ask in your planning conversation about how you’d like to receive your plan.

We usually send it out by mail. You can also find it on the myplace participant portal as soon as we approve it.

If you have a nominee or child representative, they’ll get a copy too. You can also ask us to share it with other people. We can only share your plan where you ask us to. Learn more about Your Privacy and Information.

Once you have a plan, you can start using it to buy your supports. Your plan officially ‘starts’ on the day we approve it.⁸⁷ Your Local Area Coordinator, Early Childhood Partner or Support Coordinator can help you start using your plan.

We can only pay for supports you buy after your plan starts.

Your plan ends when we create a new one, or you leave the NDIS.⁸⁸ Your plan doesn’t expire or stop, even if we haven’t created a new plan by the plan review due date. You are never left without funding or supports.

Sometimes we’ll need to suspend your plan. This usually happens when:

 you’re overseas for more than 6 weeks – there are some situations we can extend the 6 week period

 you don’t claim compensation you’re entitled to after we ask you to, for example after you’ve sustained an injury.

Learn more about plan suspensions.

What happens during a check-in?

During your plan, we’ll check-in with you to see how you’re going, and how your plan is working for you. We may check-in with you:

 at regular intervals, such as each year

 if we think your plan might not be working for you, for example if you’re using too much or too little of your supports.

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Creating Your Plan

We usually discuss:

how you’re going with your goals
if your plan and funding works well for you
if your situation has changed.

After our check in, we may need to create and approve a new plan for you. This might be because your plan is due for review or because your plan doesn’t meet your needs. Learn more about plan reviews.

If your plan is working well for you and your supports still meet the NDIS funding criteria, we could give you a new plan with the same supports. Your new plan might also have less supports if there are some you no longer need. Or you might need a plan with more support.

We’ll make this decision based on your support needs, the principles we follow to create your plan and the NDIS funding criteria.

We’ll check each support is reasonable and necessary individually, as well as when considered as a package.

Learn more about check-ins in our Your Plan Guideline.

Can you change your plan?

Once it’s approved, your plan can’t be changed, but we can create a new plan if you need one.⁸⁹

If you want to change the information about you and your goals, we can create a new plan at any time.⁹⁰ This new plan will have the new statement about you and your goals. It’ll have the same supports as your existing plan.⁹¹

You can also request a plan review if your situation or support needs change. Please get in contact with your Local Area Coordinator, Early Childhood Partner, Support Coordinator, or planner if you’d like to request one. We also have a form you can complete.

Learn more about plan reviews.

What if you don’t agree with your plan?

If you’re not happy with your plan, you should talk to your Local Area Coordinator, Early Childhood Partner, Support Coordinator, or planner.

They may be able to explain the decision, clarify how you can use the funding, or help you fix any problems. It’s a good idea to do this soon after you get your plan.

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We can also give you written reasons on why we made the decision. [Contact us](if you’d like reasons for our decision).

If you don’t agree with our decision to approve your plan, you can ask for an internal review. Your Local Area Coordinator, Early Childhood Partner, Support Coordinator or planner can help you ask for an internal review. We also have a [form](you can complete).

Having an internal review means someone who wasn’t involved in creating your plan will review our decision to approve your plan. They’ll consider if we made the right decision under the laws for the NDIS. An internal review is different to a [plan review after a check-in](or when your situation changes).

Once you get your plan, you have 3 months to ask for an internal review.

You can learn more about reviewing our decisions.

Appendix A: Plan duration guidance

Below is a guide on how long we usually make your plan before we must do a plan review. When we decide the plan review due date, we always consider:

how long you want your plan to go for before we do a plan review
your current situation.

For children younger than 7, we recommend a plan length of 12 months. This is due to the major changes in early childhood. Sometimes, we can do a plan for up to 24 months for young children, if it is better aligned with important transition points and milestones. For more information, check out Early Childhood Early Intervention.

Plan Duration Criteria	Recommended plan duration (Aged 7 years and older)	Recommended plan duration (Younger than 7 years of age)
Your living situation and support needs are stable.	Up to 36 months	12-24 months
You are in an unstable living situation, for example if you are homeless or in temporary accommodation.	6 -12 months	6 -12 months

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Plan Duration Criteria

Recommended plan duration (Aged 7 years and older)	Recommended plan duration (Younger than 7 years of age)
You are likely to leave the NDIS in the next 12 months. For example, if you were eligible for the NDIS through the early intervention criteria, and you have built your skills.	6-12 months
You might need a 12-month plan if you still need to finish your skill development. Or, you might need a 6-month plan if you’re ready to leave.	6-12 months
You need more than $15,000 per year in Capacity Building supports.	12 months
You have used less than 20% of your NDIS funding in your current plan.	12 months
You are currently receiving compensation or may be eligible for compensation.	12 months
You live in Specialist Disability Accommodation (SDA).	12 months
You are a younger person in residential aged care aged under 65, or Indigenous and under 50, and you:

have a goal to change your living situation or move home
only have ‘cross-billing’ fees, or have additional aged care related fees that are likely to change
are living in, at risk of entering, or transitioning out of an aged care facility. | 12 months | | | Not applicable |

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Plan Duration Criteria

Recommended plan duration (Aged 7 years and older)	Recommended plan duration (Younger than 7 years of age)
You live in residential aged care and are 65 years or older, or you are Indigenous and aged 50 years or older, and you:

want a 24-month plan
only have cross-billing fees in your plan
have stable support needs and circumstances
are using the right amount of funding in your plan
don’t have a goal to explore alternate housing goals. | | 24 months | Not applicable |

You need disability-related health supports and:

your health support needs are unstable
your function is expected to change in the next 12 months
we ask you to get an assessment so we can understand your support needs. | 12 months | 12 months | You need behavioural support. | 12 months | Your plan will include in-kind supports. | 12 months |

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Reference list

NDIS Act and delegated legislation made under the NDIS Act, especially NDIS (Supports for Participants) Rules and NDIS (Plan Management) Rules.
NDIS (Supports for Participants) Rules r 5.1(b).
NDIS Act s 34(1)(a).
NDIS Act s 34(1)(b).
NDIS Act s 34(1)(c).
NDIS (Supports for Participants) Rules r 3.1(c).
NDIS Act s 34(1)(c); NDIS (Supports for Participants) Rules r 3.1(a).
NDIS Act s 34(1)(d).
NDIS Act s 34(1)(e).
NDIS Act s 34(1)(f).
NDIS Act s 34(1)(f).
NDIS (Supports for Participants) Rules part 5.
NDIS (Supports for Participants) Rules r 5.1(a).
NDIS (Supports for Participants) Rules r 5.1(b).
NDIS (Supports for Participants) Rules r 5.1(c).
NDIS (Supports for Participants) Rules r 5.1(d).
NDIS (Supports for Participants) Rules r 5.3(a).
NDIS (Supports for Participants) Rules r 5.3(b).
NDIS Act s 34(1)(f).
NDIS Act s 118(1)(b).
NDIS Act s 4(17)(b).
NDIS Act s 33(2).
NDIS Act s 33(5)(a).
NDIS Act s 34(1)(a).
NDIS Act s 34(1)(d).
NDIS (Supports for Participants) Rules r 4.1(d).
NDIS Act s 34(1).
NDIS Act s 34(1)(d); NDIS (Supports for Participants) Rules, rr 3.2-3.3.
NDIS Act s 34(1)(c); NDIS (Supports for Participants) Rules r 3.1.
NDIS Act s 33.
NDIS Act s 31.
NDIS Act s 33(1).
NDIS Act s 33(1).
NDIS Act s 33(8).
NDIS Act s 34(1)(a).
NDIS Act s 34(1)(a).
NDIS (Supports for Participants) Rules r 5.1(a).
NDIS Act s 4(4).
NDIS Act s 118(1)(a)(v).
McGarrigle v National Disability Insurance Agency (2017) 157 ALD 520 at [88].
NDIS Act s 13.
NDIS (Supports for Participants) Rules r 2.4; NDIS Act s 33(5)(c)
NDIS Act s 36(2)(a).
NDIS Act s 36(2)(b)(i).
NDIS Act s 36(2)(b)(ii).
NDIS Act s 36(2)(a).
NDIS Act s 36(3).
NDIS Act s 36(3).
NDIS Act s 42(1).
NDIS Act s 46(1).
NDIS Act ss 33(2)(d); 42(2).

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NDIS Act References

52 NDIS Act s 42(2). 53 NDIS Act s 33(6). 54 NDIS Act s 37(2). 55 NDIS Act ss 43(2), 44. 56 NDIS Act s 74(2). 57 NDIS Act s 43(2)(b). 58 NDIS Act s 80(1); NDIS (Nominees) Rules rr 5.3-5.6. 59 NDIS Act 43(2). 60 NDIS Act s 44(1). 61 NDIS Act ss 44(1A), 74(4)(a). 62 Bankruptcy Act 1966 (Cth) s 50, pt X div 2. 63 Bankruptcy Act 1966 (Cth) pt X. 64 Bankruptcy Act 1966 (Cth) pt IX. 65 NDIS Act s 44(2)(a). 66 NDIS Act ss 44(2A), 74(4)(b)(i). 67 NDIS (Plan Management) Rules rr 3.8(a)-(b). 68 NDIS (Plan Management) Rules rr 3.8(c)-(d). 69 NDIS (Plan Management) Rules r 3.8(d). 70 NDIS (Plan Management) Rules r 3.8(d). 71 NDIS (Plan Management) Rules r 3.8(e). 72 NDIS (Plan Management) Rules r 3.8(f). 73 NDIS (Plan Management) Rules rr 3.8(f)(ii), 3.9. 74 NDIS (Plan Management) Rules r 3.7. 75 NDIS Act ss 43(3)-(4). 76 NDIS Act s 43(5). 77 NDIS Act s 33(2)(c). 78 NDIS Act s 33(4). 79 NDIS Act s 33(5)(a). 80 NDIS Act s 33(5)(b). 81 NDIS Act, ss 33(5)(c), 34, NDIS (Supports for Participants) Rules. 82 NDIS Act, s 33(5(d, NDIS (Supports for Participants – Accounting for Compensation) Rules. 83 NDIS Act, s 33(5)(e). 84 NDIS Act, s 33(5)(f), 85 NDIS Act s 31. 86 NDIS Act s 38. 87 NDIS Act s 37(1). 88 NDIS Act s 37(3). 89 NDIS Act s 37(2). 90 NDIS Act s 47(1). 91 NDIS Act s 47(2). 92 NDIS Act s 100(2).

Document Information

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DOCUMENT 2

Creating Your Plan

Quick summary: Once you’re an NDIS participant, we will work with you to create your plan. We will first have a planning conversation with you. This helps us decide what supports to fund in your plan, who will manage your funding, and when we’ll change your plan.

What’s on this page?

This page covers:

What principles do we follow to create your plan?
What is an NDIS plan?
How do we create your plan?
How do we decide what supports to include in your plan?
How do we decide how funding is managed in your plan?
How long will your plan go for?
When will we approve your plan?
What happens once you have your plan?
Appendix A: Plan duration guidance

What principles do we follow to create your plan?

The NDIS was set up as a world first approach to disability support. It puts people with disability at the centre of decision-making, through the principles of reasonable and necessary supports and individual choice and control.

As an insurance-based scheme, we take a lifetime approach to a participant’s support needs. We provide assurance to people with permanent and significant disability or developmental delay, and to people who might acquire disability or developmental delay.

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that they will get the support they need. Individual funding means we help participants to purchase services and supports from a competitive and consumer-driven marketplace.

What supports can we fund?

NDIS supports should complement, not replace, other supports available to you. That’s why we consider:

the things you’re able to do for yourself
support you have from others in your network, including family members, relatives, friends, local community services and mainstream government services.

One of our aims is to help maximise your independence by working with the local mainstream government and community services that help you live an ordinary life. We all do best when we’re connected to our communities.

And as an active consumer, it’s important you are able to shop for and access providers who meet your needs. We can help you find providers who meet your needs.

Once we’ve considered your circumstances, we need to follow the rules determined under the law for the NDIS in our planning decisions.¹ We fund supports that are reasonable and necessary. This means we will only fund a support if it meets all of the following criteria:

the support is related to your disability²
the support will help you pursue your goals and aspirations³
the support will help you undertake activities that will increase your social and economic participation⁴
the support is value for money,⁵ which means that the costs are reasonable:
- when compared to the benefits to be achieved, for example, whether purchasing the support is likely to reduce the cost of funding other supports in the long term⁶
- when compared to alternative options that may provide you with the same outcome at a similar or cheaper cost⁷
the support is likely to be effective and beneficial for you, having regard to good practice and evidence⁸
the support is required to complement the informal supports you have available, by taking into account what is reasonable for families, carers, informal networks and the community⁹
the support is most appropriately funded or provided by the NDIS¹⁰

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 the support is not more appropriately funded by another service system, agency, person or body, such as the education system or the health system.¹¹ We can’t fund a support if it’s the responsibility of another service system.

What supports don’t we fund?

We do not fund a support if:¹²

 it is likely to cause harm to you or others¹³

 it is not related to your disability¹⁴

 it duplicates other supports delivered by the NDIS¹⁵

 it is considered a day-to-day living cost (for example, rent, groceries or utility costs like your water bill) that are not attributable or caused by your disability support needs¹⁶

 providing the support would be against the law¹⁷

 it consists of income replacement¹⁸

 it is the responsibility of other service systems to provide (for example, your state government, the education system, or the health system).¹⁹ These different systems have different responsibilities, and are designed to complement each other to form a government safety net. Like all Australians, NDIS participants continue to have access to these systems. We can’t fund a support if it’s the responsibility of another service.

How do we manage the financial sustainability of the NDIS?

The NDIS is an insurance scheme, and one of our core functions is to manage the financial sustainability of the Scheme.²⁰

When we make decisions about the supports we fund in your plan, we must also consider our need to ensure the financial sustainability of the NDIS.²¹ This means we must work within our funding budget, set through agreements between the Australian, and State and Territory governments.

It’s also important to know the NDIS is only one part of the broader National Disability Strategy that supports people living with disability. The overall success and sustainability of the National Disability Strategy relies on:

 people accessing their informal support network to get the help they need from day to day

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What principles do we use to create your plan?

 people using their personal income to pay for their day to day living expenses, as is expected of all Australians

 mainstream and community services being available from state and territory governments, and other federal government programs such as Medicare

 a fair distribution of NDIS supports to those who need them, provided within our funding budget.

Staying within our budget ensures the NDIS will be here to support generations of Australians and their families.

We use the following 7 principles, to create plans that help you get the reasonable and necessary supports you need, and to make sure the Scheme is financially sustainable:

 Fair for everyone, both today and for future generations

 Fair funding to pursue your goals

 Evidence-based best practice

 Fair early investments

 Fair support across service systems

 Fair supports for your disability needs

 Fair assistance from multiple programs

Fair for everyone, both today and for future generations

While we need to consider your individual circumstances and disability needs, we also need to make consistent decisions and treat people fairly.

This means participants with similar circumstances and disability needs should receive similar amounts of supports in their plans. We also need to ensure the total cost of all participant plans are within the overall NDIS budget set by governments.

We use Typical Support Packages to help us do this. The Typical Support Package give us an indication of what supports we’d usually expect to include in your plan, based on your situation and disability support needs.

Each support in your plan must be reasonable and necessary, but they also need to be reasonable and necessary as a package of supports. We approve your whole plan, not the individual supports in your plan in isolation.²² The Typical Support Package helps guide this validation process.

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The Typical Support Package also helps to guide the consistency of our decision making process. We use these to check your overall plan to make sure that all your supports make sense together, and that your support types and amounts will complement each other to help you fulfil an ordinary life.

We may then increase or decrease the funding in your plan based on:

our discussion with you
any reports or other information we have
applying the NDIS funding criteria.

This helps keep the system fair for everyone, and ensure we remain financially sustainable.

Fair funding to pursue your goals

Goals are important.²³ The supports we fund need to help you increase your independence and pursue your goals.²⁴ This means your supports should help overcome any disability- specific barriers which may be stopping you pursuing your goals.

This doesn’t mean we fund all support costs associated with you pursuing your goals. Also, you may have goals and aspirations we can’t fund supports for. This is because helping you pursue your goals is only one of the NDIS funding criteria, so not all supports that help you to pursue your goals will be reasonable and necessary.

Other things to know about when setting your goals:

Setting more goals or bigger goals doesn’t mean we’ll provide more funding or fund more supports. For example, if your goal is to live independently in a house with a swimming pool, we may fund home modifications that address your disability related needs. This might be a home modification to make your bathroom accessible.

We won’t fund the swimming pool because this isn’t related to your disability support needs. The funding in your plan might be similar to someone else who has a goal of ‘to have a more accessible bathroom’.
Setting a goal doesn’t mean we have an obligation to fund supports that help you pursue that goal. For example, if your goal is to get a gym membership to get fit, we wouldn’t usually fund this. Gym memberships are things that all people, with or without disability, might want or need.
Setting a goal about an explicit type or amount of support you might want doesn’t mean we have an obligation to fund that support or provide that amount of funding. For example, you may tell us your goal is ‘to get a top model shower commode’ and you show us the one you want costs $4,000.

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If there is a shower commode that costs $3,000, and your occupational therapist confirms this one will meet your needs, we are more likely to fund this one instead because it is likely to deliver the same result at a lower cost. We may also look at alternatives.

Evidence-based best practice

We only fund supports that will be, or are likely to be, effective and beneficial for you, having regard to current good practice.²⁵ This means we consider if there is evidence that the support is effective and beneficial for someone with similar disability support needs.

We will consider different types of evidence when making decisions and we won’t need an expert report for every support, as we can often rely on other information or evidence.

For example, we may already have information about whether the support is widely accepted to suit someone with your disability support needs.²⁶ The primary source of evidence we rely on, and give the greatest weight to, is evidence from sources that are reliable and widely- recognised. This includes published and refereed literature, and any consensus of expert opinions. If there is no evidence to show a support is reasonable and necessary,²⁷ we won’t fund the support.

You can find the types of evidence we need on our website, and in Our Guidelines.

Fair early investments

Having access to capacity-building supports early in your NDIS journey is considered to be an early investment. This early investment is intended to help increase your independence, and reduce your reliance on NDIS funding over time.

This is an important concept that we consider when we create your plan, and again for future changes to your plan. When we review your plan, we reassess all the supports you require to meet your disability support needs at that time.

Over time, your capacity building supports may no longer be reasonable and necessary, in regard to your current functional capacity, the effectiveness of the capacity building supports,²⁸ and value for money.²⁹

If your overall funding level goes down from one plan to the next, it may be because you no longer need the same type or amount of supports, such as capacity building supports. Also, if the capacity building investment has been successful at building your independence, then your need for other supports may also decrease, for example core supports.

So other things being equal, you should expect your overall plan value to reduce over time as the benefits of capacity building are realised.

Fair support across service systems

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Fair supports for your disability needs

The support you need may be the responsibility of another government service, such as education or health. We don’t fund these services, and need to consider the supports you should receive from these services when determining the supports in your plan.

When we make decisions about which supports we can fund, we consider whether a support is reasonable and necessary for you and apply the NDIS funding criteria. Sometimes, you might ask for supports to help with impairments that were not part of your Access eligibility assessment. When this happens, we need to make sure the support will help you address needs that arise from an impairment that meets the same eligibility criteria we consider at Access.

You don’t need to make a new Access request if you ask for supports to help with an impairment that was not part of your Access eligibility assessment. We will work out if you need the support you have asked for to address an impairment that would meet our Access criteria. We may ask you to provide evidence to help us work this out. We will decide if the requested support is reasonable and necessary. We will apply the NDIS funding criteria based on the impairments that would meet our Access criteria.

By funding the right disability supports for your permanent impairments that meet our Access criteria, we are ensuring the system is fair for everyone, and that the NDIS remains financially sustainable.

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Fair assistance from multiple programs

NDIS funding can’t duplicate other funding or supports you may receive due to your disability.

For example, you may have received a lump-sum payment or receive regular payments as a form of compensation for an accident. Or, you may be receiving ongoing supports from another program or insurance scheme, for example, Worksafe or the Transport Accident Commission.

We don’t duplicate this funding or these supports. We may reduce the total value of your NDIS plan to account for compensation you receive, or we may not fund certain supports.

What is an NDIS plan?

Once you’re an NDIS participant, we will work with you to create your NDIS plan. You can find out more about how to become a participant in Applying to the NDIS.

Your NDIS plan sets out your goals and the supports that will help you pursue those goals. We create your plan based on your disability support needs. Your plan will be just for you. You can have as many goals as you want in your plan and they can be as long as you want.

Your plan will include information about:

you and your living situation
your goals, or things you want to work towards
who supports you, for example your family, friends, community and other government services
any NDIS supports we fund
how you can use your NDIS funding
who will manage your NDIS funding
when we’ll change your plan.

This page is about how we make decisions when we create your plan. If you’d like general information about how planning works, check out the Creating Your Plan page on our website.

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How do we create your plan?

Once you become an NDIS participant, we go through the planning process together.

When we create your plan, we:

set up a planning conversation, so we can get to know you and discuss your situation
consider what supports community and other government services can provide to help you pursue your goals and live as independently as possible
consider if you need any NDIS funded supports, and if they meet the NDIS funding criteria
ask for further information about your support needs, if we need to
develop and approve your plan
send your plan to you.

You can ask other people to help you, if you want to. For example, you can have friends, family or an advocate join the planning conversation. They can also help you to make your own decisions about your plan.

If you need someone else to make decisions for you about your NDIS plan, we can help you set this up. This may be:

a plan nominee if you’re an adult
a child representative if you’re under 18 years old.

We’ll start creating your plan within 21 days after you become an NDIS participant.

Learn more about our timeframes to create your plan in our Participant Service Guarantee.

What can you expect from us when we create your plan?

We’ll create a plan that will:

be personalised and directed by you
respect the role of family, carers and other people who are important to you
build the capacity of families, carers and your community to support you where appropriate
consider the support your friends and family provide, and the support services available to everyone in the community
respect your right to have control over your life and make your own choices.

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 help you participate in the community, and help you study or find and keep a job, if you want to

 focus on choice and flexibility when it comes to your goals, needs and your supports.

What happens in your planning conversation?

The planning conversation is an important part of the planning process. We’ll talk with you about your daily life, living situation, goals and supports. This helps us decide what NDIS funded supports to include in your plan.

We’ll ask how you want to have your planning conversation, for example where and when we meet with you, or if you would prefer to do it over the phone. You can bring anyone you choose, such as your family, friends or advocates, to the meeting.

What information do we look at before your planning conversation?

Before your planning conversation, we look at:

 the information in your NDIS Application Form

 any reports from your doctors or allied health professionals

 other assessments you give us, for example from other government agencies or disability service providers

 other relevant information we have about your support needs

 any other information you give us.

This helps us get to know you better, and learn about your situation. It also helps us check where we might need more information about you to help us create your plan.

What will we talk about in your planning conversation?

We’ll talk to you about your daily life, and what you’d like to do in the future. We’ll also talk about how the NDIS can help you do what you want to do.

We’ll ask you about things such as:

 your goals

 where you live, and your living arrangements

 how you move around your home and your community

 who supports you now, such as your family, friends or service providers

 support available from community and other government services to help you learn new skills and become more independent

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 what self-care support you need

 if you use or need equipment, technology or devices, also known as assistive technology

 what social and recreation activities you’d like to do now or in the future

 if you need help to build friendships or connect with your family

 if you’d like to work or study now or in the future

 what support you need to build your skills and do more things yourself.

Learn more about preparing for your planning conversation.

We’ll also ask you how you would like to manage your NDIS funding. Learn more about plan management.

All the information you give us helps us create your plan. We will keep your personal information safe and secure. Learn more about Your Privacy and Information.

For a change to your plan, we might not need to ask all these questions again. Or we might not need to have a planning conversation at all. Learn more about Changing Your Plan.

How do you set the goals in your NDIS plan?

We need to know your goals so we know how we can help you.

Your goals are your own personal desires about what you’d like to do. You can have as many or as few goals as you want.

Your goals can be big or small, short term or long term, simple or complex. They can be about anything you want to work towards.

You may express your goals broadly, or you may have specific goals. For example, you may express one of your goals as ‘living independently’. Or, you may express your goal as ‘to have an accessible bathroom’.

You can set any goals you like, even if they’re about things we won’t fund supports for.

How can you tell us your goals and the information about you?

The first part of your plan has information about:

 your daily life and living situation

 your social, work and study life

 the people who support you

 your goals.

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You, or your plan nominee or child representative, set your goals and tell us what information you want to include about your life. This is sometimes called the ‘participant’s statement of goals and aspirations’.³³

If you want, your family and friends who support you can also give us information about their life.

You can tell us your goals at any time before we approve your plan. If you tell us your goals in person or over the phone, we’ll write them down for you.³⁴

They are your goals and we’ll write them down in your own words. We can’t change your goals or choose them for you. But we can help you choose what words to use if you want us to.

Learn more about setting your goals.

Will we always fund supports for your goals?

Your NDIS funding is aimed to provide you with the supports you need for your disability.

These supports may help you increase your independence and pursue your goals. You can also be supported through mainstream and community services, or informal supports you can get through family and friends.

The supports we fund should help you pursue your goals,³⁵ but you don’t need a specific goal for every support in your plan. When we decide if a support will help you pursue your goals, we consider your whole situation.

We look at the disability specific barriers that prevent you from pursuing your goals, and how the support will address your disability support needs.

There are some things to remember when setting goals:

Setting more and bigger goals doesn’t mean we’ll fund more and bigger funded supports.
Setting a goal doesn’t mean we have an obligation to fund supports that help you pursue that goal.
Setting a goal about an explicit type or amount of support you might want doesn’t mean we have an obligation to fund that support or in that amount.

This is because helping you pursue your goals is only one of the NDIS funding criteria.³⁶ A support must meet all of the NDIS funding criteria to be funded under the NDIS. So not all supports that help you pursue your goals will be reasonable and necessary supports we can fund in your plan.

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For example, you might be ready to look for work and have a goal to find a job.

Disability Employment Services help people with disability look for jobs, so we usually won’t be able to fund this support.

But we can help you connect with a Disability Employment Service, and consider what supports we could fund to help build your job skills. Learn more about Work and Study Supports.

Learn more about how we consider your goals when we decide what supports to include in your plan.

Who can help you set your goals?

You can ask other people for help to set your goals if you want to. For example, your friends, family, Local Area Coordinator or Early Childhood Partner can help you.

You can also change your goals at any time, even after we approve your plan. Learn more about goal setting.

We’ll talk with you in your planning conversation about what your goals will mean for your NDIS plan. For example, we could talk about:

what your goals will look like for you
how you can work towards your goals
when you’d like to work on your goals
what supports you need to work towards your goals, noting that just because you have a goal doesn’t mean we have to provide funded supports for it
where you might get supports to work towards your goals, for example community or mainstream services
if we’ll fund supports to help you work toward your goals
how you could develop skills and talents you haven’t focused on before
what supports you need to overcome any challenges in working towards your goals
if you’d like to include smaller goals as part of a big goal
if you’d like to add a few steps to work towards your goals.

For example, you might choose a goal, ‘I want to go on a holiday next year’. You might also choose to add steps, like saving up money for your travel and hotel, towards achieving your goal.

Learn more about preparing your goals.

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You can also check out the planning booklet (Booklet 2) to help prepare this information.

How do we think about risks when we create your plan?

You have the right to decide what you do each day and to make your own life choices. For all of us, our choices come with some risks. We all make our own choices about how much risk we want to take in our lives. You should also be able to choose how much risk you want to take in your life.

We can’t fund supports that are likely to risk harming you or someone else³⁷. But we will try and balance this with enabling you to make your own choices wherever possible.

Some of these risks might affect what we can fund in your plan, or who manages your NDIS funding. For example, there might be risks to your personal safety, your personal money, or your NDIS funding.

We think about if there are any risks with your current support arrangements. For example, there might be risks to your family or friends health if they keep supporting you when they get older. If so, we could look at including NDIS funded supports to reduce these risks.

We also consider any risks around your safety and wellbeing. For example, there could be isks if you’re socially isolated, or rely only on providers for support. Or, there could be risks of physical injury to you or the people who support you.

When we create your plan, we’ll help you think about supports that help you live your life the way you want to³⁸. We balance your right to take reasonable risks in pursuing your goals, with your safety and the safety of other people³⁹.

We’ll talk with you about how we can help you reduce risks where we can. There are a few things we could do to reduce risk, and make sure your plan meets your needs. For example, we could:

change your plan sooner
fund supports to help you build your support network, for example helping you make friends or build relationships in your community
set up regular chats with your planner, Local Area Coordinator or Early Childhood Partner
make sure any providers using restrictive practices are NDIS registered and follow the NDIS Quality and Safeguards Commission requirements
let you know about how you can complain about your service providers or complain about our service if there are any issues

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How do we decide what supports to include in your plan?

NDIS supports are the services, items and equipment we fund or provide under the NDIS. An NDIS support is the practical description of how we help you under the NDIS.⁴⁰

There are two types of NDIS supports:

the general supports we provide to you
the reasonable and necessary supports we fund in your plan.

General supports

General supports are those we provide to you, such as a Local Area Coordinator or Early Childhood Partner.

We help you develop your plan and connect with supports and activities in your area. For example, we can help you connect with:

informal supports, such as your friends, family or other people you know in your community
community supports that are open to everyone in the community, such as sporting clubs, activity groups or libraries
mainstream supports – other government services such as the health and education systems.

General supports are not funded through your NDIS plan.

General supports can be provided by:

an Early Childhood Partner for children under 7 years old
a Local Area Coordinator for people aged 7 or older
Remote Community Connectors
Aboriginal Disability Liaison Officers
community organisations through the Department of Social Services Information, Linkages and Capacity Building program.

We can provide these general supports to everyone with a disability, including people who are not NDIS participants.⁴¹

Reasonable and necessary supports

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Reasonable and Necessary Supports

Reasonable and necessary supports are the disability supports we fund in your plan. You can use this funding to buy supports from service providers.

All NDIS supports need to meet the NDIS funding criteria. For example, they need to be related to your disability, value for money, and effective and beneficial.

Each support we fund in your plan must be a reasonable and necessary support; however, we also consider how your supports will work together as a package to address your disability support needs, or to achieve an outcome. The supports we fund must be reasonable and necessary individually, but they must also be reasonable and necessary as a package of supports.

If you need a new support, which now means your overall package of supports doesn’t meet the NDIS funding criteria anymore, we may either:

not include the new support in your plan
include the new support in your plan, but also reduce the other supports in your plan.

For example, a home modification may reduce your need for other supports. If we plan to fund a home modification, we will need to take that home modification into account when considering what other supports are reasonable and necessary, such as the amount of care you need at home.

We also decide how we describe the supports in your plan. We can describe your supports as:

Flexible – you have greater flexibility on what you buy within the description of the supports. This is sometimes called supports ‘described generally’.
Fixed – you must buy the support as we describe it in your plan. This is sometimes called a ‘stated support’ or supports ‘described specifically’.

We describe most supports as flexible when we can. When supports are described as flexible, you will have greater flexibility over the support you can buy that falls within the description of the support in the plan. When supports are described as fixed, you will have less flexibility.

We divide your supports into 3 different budgets:

Core Supports – supports for everyday activities
Capacity Building Supports – supports to help you build your skills and increase your independence
Capital Supports – supports such as assistive technology, vehicle modifications, home modifications and Specialist Disability Accommodation.

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Each budget is divided into a number of support categories. Support categories have more detail about what supports you can buy with your funding. When we describe your supports as flexible, you can usually choose what supports you buy within the descriptions for each support category.

Your Core Supports budget is the most flexible. You can usually use your funding across all the support categories except transport in the Core Supports budget if:

we described the supports as flexible
you have the same plan management options for your Core Supports.

Learn more about the support budgets and support categories in your plan.

We also consider our Participant Service Charter and what you can expect from us when we create your plan.

We look at all the information we have when we decide what supports to include in your plan.

Check out our Reasonable and Necessary Supports Guideline for how we decide what supports to include in your plan, and how we describe them.

We also have detailed information on how we make decisions about different types of supports. Learn more on our Supports We Fund page.

What if we need more information?

Sometimes we might ask for more information to create and approve your plan. We’ll do this if we don’t have enough information to decide what supports to include in your plan.

We can ask you to:

give us more information that is reasonably necessary to create or approve your plan⁴³
get an assessment, usually from an allied health professional, of your support needs and send us the report⁴⁴
get a medical, psychiatric, or psychological examination and send us the report.⁴⁵

For example, we might need more information if you have complex care needs. We could ask you to get an assessment from an occupational therapist. This will help us understand your support needs at home and in the community. It also helps us work out what supports to fund in your plan.

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We can also ask someone else to give us information we need to create and approve your plan.¶ For example, we can ask your doctor, or the people who support you, to give us information.

When we ask for more information or to get an assessment, we’ll tell you:

what you need to do
what information we need
how you can send us the information
when you need to give us the information.

We must give you a reasonable opportunity, and a reasonable amount of time, to give us this information.· The sooner you can give us the information, the sooner we can create and approve your plan.

Your plan will include funding for any assessments or examinations we ask for. If we need independent information about you, we avoid any conflicts of interest as much as possible. This means we usually won’t choose an assessor you know.

We only ask for an assessment or examination if:

it will help us create your plan
we don’t already have the information
the benefits outweigh the time and cost.

You don’t have to give us this information or get these assessments. But without them, we might not have enough information to understand and approve the supports you need.

Sometimes, we might need to approve your plan before you give us this information.¸ For example, we might approve your plan so you have funding for urgent self-care supports you need. We could then change your plan once you have the assessments and reports for other supports, such as assistive technology.

How do we decide how funding is managed in your plan?

What do we mean by managing your funding?

Managing your NDIS funding means doing one or more of these things:¹

buying the supports in your plan, including paying taxes
receiving and managing your NDIS funding, such as paying for supports on time

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 keeping track of what you buy with your funding, including keeping receipts and invoices

 spending your funding according to your plan.

Your plan will say who manages your NDIS funding.

What are your plan management options?

You have three options for who manages the funding in your plan.

 Self-managed: you, or your plan nominee or child representative, manage the funding and pay your providers.

 Agency-managed: we manage the funding and pay your providers.

 Plan-managed: a registered plan management provider manages the funding and pays your providers.

You can also choose a mix of these types of plan management. For example, you might like to manage some of the funding yourself, and we’ll manage the rest.

There are a few other things to remember when you choose your plan management options. If your funding is:

 Agency-managed, you must only use NDIS-registered providers

 Agency-managed or plan-managed, your providers or your plan manager can only claim up to the NDIS Pricing Arrangements and Price Limits rates

 plan-managed, we’ll always include plan-management fees in your plan.

Learn more about ways to manage the funding in your plan.

You can also check out our booklets for information about plan management.

You can ask us to change how you manage your plan at any time. There are no restrictions on how often you can ask to change your plan management.

If you want to change your plan management, you’ll need a plan variation. If this is the only change you want, we can often do this without the full plan reassessment process. Learn more about Changing your plan.

How do we decide who manages your funding?

We’ll ask you at your planning conversation who you want to manage your funding.

We must agree to your request, unless:

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 you already have a plan nominee, who may need to manage your funding or can choose who manages your funding

 your plan nominee wants to self-manage your funding but that would be an unreasonable risk to you⁵⁶

 you want to self-manage the funding but you, or your plan nominee or child representative, are bankrupt or insolvent under administration

 you want to self-manage the funding but that would be an unreasonable risk to you

 you want a registered plan management provider to manage your funding but that would be an unreasonable risk to you

 it’s for in-kind supports, or cross-billing payments for younger people in residential aged care.

There are a few other things to remember.

 We’ll let you know what your plan management options will mean for you.

 You can also ask your friends, family or service providers for advice.

 We need to consider any legal orders about your finances, such as court or tribunal orders.

 If you’re under 18, your child representative can choose how to manage your plan funding.⁵⁷

If you’re not happy with the plan management decision we make, you can ask for a review of our decision.

Learn more about requesting a review of decisions we make.

What if you have a plan nominee?

If you have a plan nominee, they’ll manage your plan funding if it’s part of their nominee arrangement. But, if they’re insolvent under administration or present an unreasonable risk, we won’t allow them to manage your plan funding.

When we think about unreasonable risk and your plan nominee, we look at:

 if they have any business or other interests which might affect how they manage your money

 whether we believe they will use your NDIS funding according to your plan

 if any safeguards or strategies in your plan could help reduce any risks to you.

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Your plan nominee may also be able to request who manages your plan funding. They can do this if their nominee arrangement allows them to do things on your behalf related to the preparation, review, variation and replacement of your plan.

Your nominee has a duty to work out what you want. They need to make decisions that help your personal and social wellbeing.⁵⁸

Learn more about nominees.

Can you manage your own funding?

We’re committed to helping you manage your own funding if that’s what you want to do. There are risks for us all in managing our money. Where possible, we’ll help you make decisions about money, just as all Australians do.

If you want to manage your own funding, there’s a few things to keep in mind. You’ll have more choice and control over your plan. You’ll also have extra responsibilities, like keeping receipts for what you buy with your funding.

Learn more about self-managing.

You, or your plan nominee or child representative, can self-manage your funding unless:⁵⁹

you, or your plan nominee or child representative, are currently bankrupt or insolvent under administration
there’s an unreasonable risk if you self-manage your funding.

Are you bankrupt or insolvent?

You can’t manage your NDIS funding if you’re currently an insolvent under administration.⁶⁰ Your plan nominee or child representative also can’t manage your funding if they’re an insolvent under administration.⁶¹

Insolvent generally means you can’t pay your debts when they are due.

Your NDIS funding can’t be self-managed if you, or your plan nominee or child representative:

are currently bankrupt – contact the Australian Financial Security Authority if you’re not sure
have your property under the control of people you owe money to.⁶² for example, your bank or the Australian Financial Security Authority
have a personal insolvency agreement to repay money you owe, and you haven’t followed the agreement⁶³
have a debt agreement to repay money you owe.⁶⁴

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This also applies if you, or your plan nominee or child representative, are an insolvent under administration in another country.

You might be able to self-manage your funding after you stop being an insolvent under administration. But we’ll consider if there might be an unreasonable risk in you managing your own funding.

Your plan nominee might be a company or body corporate, like a service provider or advocacy organisation. If so, they can’t be insolvent either.

A company or organisation can’t manage your funding if they are under voluntary administration, liquidation or receivership.

Is there an unreasonable risk if you self-manage your funding?

You have the same right as all Australians to take reasonable risks in managing your money. We respect your right to take reasonable risks in self-managing your NDIS funding.

But you can’t self-manage your funding if this would create an ‘unreasonable risk to you’.⁶⁵ Your plan nominee or child representative also can’t manage your funding if that would be an unreasonable risk to you.⁶⁶

If you’re older than 18 and want to self-manage your funding, we’ll consider if this could put you at risk. This could be if you’re vulnerable to physical, mental or financial harm. Or, if someone might pressure you to do something.⁶⁷

We’ll also think about:

how well you make decisions and manage your money⁶⁸
how well you managed your funding in the past,⁶⁹ for example if you managed disability funding before the NDIS
if you were previously bankrupt or insolvent under administration, how well you manage your money now⁷⁰
if you have a court or tribunal order that someone else, such as a financial trustee or guardian, manages your money⁷¹
if your informal supports could help you reduce any risks, for example if they help you manage your money.⁷²

We consider what strategies we could use to reduce risks, including:⁷³

giving you a shorter plan
having regular check-ins
including supports in your plan to help you manage your funding.

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When we think about risks, we think about the types of supports you want to manage. There might be unreasonable risks for you to self-manage some supports, but you might be able to manage others.

For example, it might be risky for you to manage the funding for a $30,000 home modification. But you might be able to manage a $500 home modification like a grab rail.

If your plan nominee or child representative wants to manage your funding, we’ll think about:

how well they manage their money
if any business or other interests might affect how they manage your money
whether we believe they will use your NDIS funding according to your plan
if any safeguards or strategies in your plan could help reduce any risks to you.

What if you want to learn to manage your funding in the future?

We might be able to fund supports to help build your skills to manage your NDIS funding.

For example, we might be able to fund a support called ‘Training in plan and financial management’. This can help you learn to:

budget and keep records of your purchases
choose your supports and get the most out of your plan
claim your NDIS funding, pay providers and make service agreements.

This support will need to meet the NDIS funding criteria for us to fund it in your plan. Either a plan manager or a Support Coordinator can provide this support.

For more information about this support, talk to your planner, Local Area Coordinator or Early Childhood Partner.

Can a registered plan management provider manage your funding?

You may want a plan management provider who is registered to manage your funding. We’ll agree to this unless it would be an unreasonable risk for you to use a registered plan management provider.

Is there an unreasonable risk if a registered plan management provider manages your funding?

You have the same right as all Australians to take reasonable risks. We respect your right to take reasonable risks in having a registered plan management provider manage your NDIS funding.

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But, if this creates an unreasonable risk to you, we’ll talk to you about what things might reduce these risks.

When we think about whether there is an unreasonable risk to you, we will consider if you’re vulnerable to physical, mental, or financial harm. We also consider whether a provider has delivered supports to you in a way that has caused you physical, mental or financial harm. Or, if someone might pressure you to do something.

We’ll think about:

how well you make decisions about money
if your informal supports could help you reduce any risks.

We consider what strategies we could use to reduce risks, including:

giving you a shorter plan
having regular check-ins
including supports in your plan to help you manage your funding
having a combination of plan management types for different parts of your plan
supporting you to change plan management providers if necessary
stating that some supports are spent or delivered in a certain way. This means we state it in your plan so the funds allocated are spent on this particular support instead of alternative supports

If there are no strategies we can introduce to reduce the risks we’ve talked about, we may consider it an unreasonable risk for you to have these supports managed by a registered plan management provider. These supports would need to be Agency-managed and delivered by a NDIS-registered provider.

When do we make your funding Agency-managed?

If you don’t choose who will manage your funding, or if you can’t self-manage any parts of your funding, we have to decide for you. We’ll choose to make those parts of your funding Agency-managed when we approve your plan.

When we decide if it’s Agency-managed, we think about your goals, supports and the providers you want to use. For example, we consider if you want to use providers that are not NDIS registered.

What if the supports have already been paid?

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In some rare cases, other government agencies have already paid for supports through funding outside your plan. These supports have already been paid for, so you won’t be able to manage the funding for these supports.

These include:

in-kind supports
cross-billing payments to the Department of Health if you’re a younger person in residential aged care.

How long will your plan go for?

Everyone has different goals, living situations, and circumstances. So we’ll work with you to decide how long it’ll be before we must create your next plan. This will be based on your individual situation.

We think about how long you want your plan to go for. We’ll try to make the plan length what you want, where we can.

If you’re not happy with how long your plan goes for, you can ask for a variation to your plan. Learn more about Changing your plan.

Your plan will say when we must do a plan reassessment, if we haven’t reassessed your plan before this.⁶ This is called the ‘plan reassessment due date’. We could write this as:

a date, for example ‘1 January 2024’
a circumstance or milestone, ‘when Constantine starts school’
both a date and a milestone, ‘when Macey starts her new job, or 1 July 2023: whichever happens first’.

We have more information in Appendix A on how long we usually make your plan.

When will we give you a longer plan?

If your support needs and circumstances will likely stay the same, we generally give you a 36 month plan. We can give you a 36 month plan if:

you know how to use your NDIS plan
your disability support needs are stable
you have strong informal supports and living arrangements
any work or study situation is stable.

Example

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Sarah is 35 years old and has her second planning conversation

Sarah is 35 years old and has her second planning conversation. Her previous plan worked well, and her support needs likely won’t change soon.

She asks for a longer plan as she knows what supports she needs. Her planner decides to approve a 36-month plan.

When will we give you a shorter plan?

We usually give you a shorter plan if your needs might change over the next year or two. This includes if you:

are younger than 7
have changing support needs, such as if your disability gets worse over time
might leave the NDIS in the next year or two, including if you were eligible for the NDIS under the early intervention requirements
might change your work or study in the next year or two
don’t have a strong support network, or there’s risks to your safety or your personal money
have very high support needs, or need behaviour supports
need assessments to determine your disability support needs
need high cost assistive technology or home modifications
need disability-related health supports.

We might also give you a shorter plan if you need extra help to link in with supports. Or, you might need extra help to use your funding according to your plan.

For example, we could give you a shorter plan and include funding for Support Coordination. A Support Coordinator could help you use the right amount of funding each month. When we next change your plan, we can check if you’re linked in to the supports you need. And, we’ll check if you’re using the right amount of funding.

If you’re a younger person in residential aged care, we usually give you a 12-month plan and we’ll check-in with you regularly. We’ll discuss how we can help you move out of aged care if you want to, or whether your supports work for you if you want to stay. We may be able to give you a longer plan if you want one.

Remember, you can always talk to your Support Coordinator or planner if you want to move out of residential aged care.

Example

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Joe is 16 and will finish school in 18 months. We give Joe a 17-month plan. He’ll have the chance to set new goals before he gets his next plan.

When it’s time to create his next plan, we can have another look at his supports. His next plan will include his goals and support needs after he leaves school.

When will we approve your plan?

We’ll approve your plan as soon as we reasonably can based on your situation.⁷⁷ We may take longer to approve your plan if we need you to give us more information or get an assessment.

For children younger than 7, we aim to approve your plan within 90 days after you become a participant.

If you’re 7 or older, we aim to approve your first plan within 56 days after you become a participant.

Learn more about our timeframes to create your plan in our Participant Service Guarantee.

What do we think about when we approve your plan?

When we approve your plan we must:

think about your goals⁷⁸
consider any assessments about your support needs⁷⁹
decide that each support meets the NDIS funding criteria, and as a package of supports⁸⁰
decide if we need to reduce the amount of funding in your plan because you can get compensation outside the NDIS⁸¹
consider the principle that you should manage your plan as much as you want to⁸²
think about how your previous plans have worked for you, including how well they met your disability support needs.⁸³

We also consider the principles about plans.⁸⁴ These principles include things like:

Your plan is just for you.
Your plan will work alongside other supports you can get outside the NDIS, such as informal, community and mainstream supports.
Your plan should give you as much choice and independence about your life.

You can read the full list of principles about plans in the NDIS Act.

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What happens once you have your plan?

Once we approve your plan, you’ll get a copy within 7 days.⁸⁵ We’ll ask in your planning conversation about how you’d like to receive your plan.

We usually send it out by mail. You can also find it on the myplace participant portal as soon as we approve it.

If you have a nominee or child representative, they’ll get a copy too. You can also ask us to share it with other people. We can only share your plan where you ask us to. Learn more about Your Privacy and Information.

Once you have a plan, you can start using it to buy your supports. Your plan officially ‘starts’ on the day we approve it.⁸⁶ Your Local Area Coordinator, Early Childhood Partner or Support Coordinator can help you start using your plan.

We can only pay for supports you buy after your plan starts.

Your plan ends when we create a new one, or you leave the NDIS.⁸⁷ Your plan doesn’t expire or stop, even if we haven’t created a new plan by the plan reassessment date. You are never left without funding or supports.

Sometimes we’ll need to suspend your plan. This usually happens when:

you’re overseas for more than 6 weeks – there are some situations we can extend the 6 week period
you don’t claim compensation you’re entitled to after we ask you to, for example after you’ve sustained an injury.

Learn more about plan suspensions.

What happens during a check-in?

During your plan, we’ll check-in with you to see how you’re going, and how your plan is working for you. We may check-in with you:

at regular intervals, such as each year
if we think your plan might not be working for you, for example if you’re using too much or too little of your supports.

We usually discuss:

how you’re going with your goals
if your plan and funding works well for you
if your situation has changed.

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After our check in, we may need to vary or create and approve a new plan for you.

This might be because your plan is due for reassessment or because your plan doesn’t meet your needs. Learn more about Changing your plan.

If your plan is working well for you and your supports still meet the NDIS funding criteria, we could give you a new plan with the same supports. Your new plan might also have less supports if there are some you no longer need. Or you might need a plan with more support.

We’ll make this decision based on your support needs, the principles we follow to create your plan and the NDIS funding criteria.

We’ll check each support is reasonable and necessary individually, as well as when considered as a package.

Learn more about check-ins in our Your Plan Guideline.

Can you change your plan?

Once it’s approved, your plan can be changed, and we can also create a new plan if you need one.⁸⁸

If you want to change the information about you and your goals, we can change your plan to include this .⁸⁹ This new plan will have the new statement about you and your goals. It’ll have the same supports as your existing plan.⁹⁰

You can also request a change to your plan at any time. Please get in contact with your Local Area Coordinator, Early Childhood Partner, Support Coordinator, or planner if you’d like to request one. We also have a form you can complete.

Learn more about Changing your plan.

What if you don’t agree with your plan?

If you’re not happy with your plan, you should talk to your Local Area Coordinator, Early Childhood Partner, Support Coordinator, or planner.

They may be able to explain the decision, clarify how you can use the funding, or help you fix any problems. It’s a good idea to do this soon after you get your plan.

We can also give you written reasons on why we made the decision. Contact us if you’d like to discuss the reasons for our decision.

If you don’t agree with our decision to approve your plan, you can ask for an internal review. Your Local Area Coordinator, Early Childhood Partner, Support Coordinator or planner can help you ask for an internal review. We also have a form you can complete.

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Having an internal review means someone who wasn’t involved in creating your plan will review our decision to approve your plan. They’ll consider if we made the right decision under the laws for the NDIS. An internal review is different to a change or plan reassessment after a check-in or when your situation changes.

Once you get your plan, you have 3 months to ask for an internal review.°’

Learn more about reviewing our decisions.

Appendix A: Plan duration guidance

Below is a guide on how long we usually make your plan before we must do a plan check-in. When we decide the plan reassessment date, we always consider:

how long you want your plan to go for before we change your plan
your current situation.

For children younger than 7, we recommend a plan length of 12 months. This is due to the major changes in early childhood. Sometimes, we can do a plan for up to 24 months for young children, if it is better aligned with important transition points and milestones. For more information, check out Early Childhood Early Intervention.

Plan Duration Criteria	Recommended plan duration (Aged 7 years and older)	Recommended plan duration (Younger than 7 years of age)
Your living situation and support needs are stable.	Up to 36 months	12-24 months
You are in an unstable living situation, for example if you are homeless or in temporary accommodation.	6 -12 months	6 -12 months
You are likely to leave the NDIS in the next 12 months. For example, if you were eligible for the NDIS through the early intervention criteria, and you have built your skills.	6 -12 months	6-12 months
You might need a 12-month plan if you still need to finish your skill development. Or, you might need a 6-month plan if you’re ready to leave.

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Plan Duration Criteria

Recommended plan duration (Aged 7 years and older)	Recommended plan duration (Younger than 7 years of age)
You need more than $15,000 per year in Capacity Building supports.	12 months
You have used less than 20% of your NDIS funding in your current plan.	12 months
You are currently receiving compensation or may be eligible for compensation.	12 months
You are a younger person in residential aged care aged under 65, or Indigenous and under 50, and you:

* have a goal to change your living situation or move home
* only have ‘cross-billing’ fees, or have additional aged care related fees that are likely to change
* are living in, at risk of entering, or transitioning out of an aged care facility. | Not applicable

| You live in residential aged care and are 65 years or older, or you are Indigenous and aged 50 years or older, and you: * want a 24-month plan * only have cross-billing fees in your plan * have stable support needs and circumstances * are using the right amount of funding in your plan * don’t have a goal to explore alternate housing goals. | Not applicable

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Plan Duration Criteria

Recommended plan duration (Aged 7 years and older)	Recommended plan duration (Younger than 7 years of age)
12 months	12 months

You need disability-related health supports and:

your health support needs are unstable
your function is expected to change in the next 12 months
we ask you to get an assessment so we can understand your support needs.

You need behavioural support. 12 months

Your plan will include in-kind supports. 12 months

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Reference list

NDIS Act and delegated legislation made under the NDIS Act, especially NDIS (Supports for Participants) Rules and NDIS (Plan Management) Rules.
NDIS (Supports for Participants) Rules r 5.1(b).
NDIS Act s 34(1)(a).
NDIS Act s 34(1)(b).
NDIS Act s 34(1)(c).
NDIS (Supports for Participants) Rules r 3.1(c).
NDIS Act s 34(1)(c); NDIS (Supports for Participants) Rules r 3.1(a).
NDIS Act s 34(1)(d).
NDIS Act s 34(1)(e).
NDIS Act s 34(1)(f).
NDIS Act s 34(1)(f).
NDIS (Supports for Participants) Rules part 5.
NDIS (Supports for Participants) Rules r 5.1(a).
NDIS (Supports for Participants) Rules r 5.1(b).
NDIS (Supports for Participants) Rules r 5.1(c).
NDIS (Supports for Participants) Rules r 5.1(d).
NDIS (Supports for Participants) Rules r 5.3(a).
NDIS (Supports for Participants) Rules r 5.3(b).
NDIS Act s 34(1)(f).
NDIS Act s 118(1)(b).
NDIS Act s 4(17)(b).
NDIS Act s 33(2).
NDIS Act s 33(5)(a).
NDIS Act s 34(1)(a).
NDIS Act s 34(1)(d).
NDIS (Supports for Participants) Rules r 4.1(d).
NDIS Act s 34(1).
NDIS Act s 34(1)(d); NDIS (Supports for Participants) Rules, rr 3.2-3.3.
NDIS Act s 34(1)(c); NDIS (Supports for Participants) Rules r 3.1.
NDIS Act s 33.
NDIS Act s 31.
NDIS Act s 33(1).
NDIS Act s 33(1).
NDIS Act s 33(8).
NDIS Act s 34(1)(a).
NDIS Act s 34(1)(a).
NDIS (Supports for Participants) Rules r 5.1(a).
NDIS Act s 4(4).
NDIS Act s 118(1)(a)(v).
McGarrigle v National Disability Insurance Agency (2017) 157 ALD 520 at [88].
NDIS Act s 13.
NDIS (Supports for Participants) Rules r 2.4; NDIS Act s 33(5)(c)
NDIS Act s 36(2)(a).
NDIS Act s 36(2)(b)(i).
NDIS Act s 36(2)(b)(ii).
NDIS Act s 36(2)(a).
NDIS Act s 36(3).
NDIS Act s 36(3).
NDIS Act s 42(1).
NDIS Act s 46(1).

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51 NDIS Act ss 33(2)(d); 42(2). 52 NDIS Act s 42(2). 53 NDIS Act s 33(6). 54 NDIS Act s 47A 55 NDIS Act ss 43(2), 44. 56 NDIS Act s 43(6)(e). 57 NDIS Act s 74(2). 58 NDIS Act s 80(1); NDIS (Nominees) Rules rr 5.3-5.6. 59 NDIS Act 43(2). 60 NDIS Act s 43(3)(c). 61 NDIS Act ss 43(6)(d), 74(4)(a). 62 Bankruptcy Act 1966 (Cth) s 50, pt X div 2. 63 Bankruptcy Act 1966 (Cth) pt X. 64 Bankruptcy Act 1966 (Cth) pt IX. 65 NDIS Act s 43(3)(d). 66 NDIS Act ss 43(6)(e), 74(4)(b)(i) 67 NDIS (Plan Management) Rules rr 3.8(a)-(b). 68 NDIS (Plan Management) Rules rr 3.8(c)-(d). 69 NDIS (Plan Management) Rules r 3.8(d). 70 NDIS (Plan Management) Rules r 3.8(d). 71 NDIS (Plan Management) Rules r 3.8(e). 72 NDIS (Plan Management) Rules r 3.8(f). 73 NDIS (Plan Management) Rules rr 3.8(f)(ii), 3.9. 74 NDIS (Plan Management) Rules r 3.7. 75 NDIS Act s 43(8). 76 NDIS Act s 33(2)(c). 77 NDIS Act s 33(4). 78 NDIS Act s 33(5)(a). 79 NDIS Act s 33(5)(b). 80 NDIS Act, ss 33(5)(c), 34, NDIS (Supports for Participants) Rules. 81 NDIS Act, s 33(5(d), NDIS (Supports for Participants – Accounting for Compensation) Rules. 82 NDIS Act, s 33(5)(e). 83 NDIS Act, s 33(5)(f), 84 NDIS Act s 31. 85 NDIS Act s 38. 86 NDIS Act s 37(1). 87 NDIS Act s 37(3). 88 NDIS Act s 37(2). 89 NDIS Act s 47(1). 90 NDIS Act s 47(2). 91 NDIS Act s 100(2).

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Practice Guide — Determine Reasonable and Necessary Supports

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DOCUMENT 3

Purpose ………………………………………………………………………………………………………. 4
To be used by ………………………………………………………………………………………………. 4
Scope ………………………………………………………………………………………………………….. 4
Prerequisites ………………………………………………………………………………………………… 4
Planning ………………………………………………………………………………………………………. 5

5.1 No reasonable and necessary supports identified …………………………………………… 5

The Typical Support Package (TSP) ………………………………………………………………… 6
Reasonable and Necessary ……………………………………………………………………………. 6
Core supports ………………………………………………………………………………………………. 7

8.1 Core budget flexibility …………………………………………………………………………………. 8

8.2 Meal preparation and delivery ……………………………………………………………………… 9

8.3 Transport ………………………………………………………………………………………………… 12

Capacity Building supports …………………………………………………………………………… 14

9.1 Capacity building for self-managing support funding ……………………………………… 15

9.2 Funding for Plan Management …………………………………………………………………… 16

9.3 CB Daily Activity ………………………………………………………………………………………. 17

9.4 CB Employment ……………………………………………………………………………………….. 17

9.5 Provider Travel ………………………………………………………………………………………… 18

9.6 Medicare …………………………………………………………………………………………………. 19

Capital supports ………………………………………………………………………………………….. 19

10.1 Assistive Technology ……………………………………………………………………………… 20

10.2 Home Modifications ……………………………………………………………………………….. 20

Quote required support items ……………………………………………………………………….. 21
Plan Duration ……………………………………………………………………………………………… 21
Stated supports …………………………………………………………………………………………… 22
In-kind ……………………………………………………………………………………………………….. 22
Compensation …………………………………………………………………………………………….. 22
Changes to the TSP …………………………………………………………………………………….. 23

16.1 Parental responsibility ……………………………………………………………………………. 23

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NDIS

16.2 Disability-Related Health Supports…………………………………………………………… 24 16.3 Other considerations ……………………………………………………………………………… 25 17. Justification for reasonable and necessary supports ………………………………………… 25 17.1 Justifications for plan management ………………………………………………………….. 26 17.2 Best practice justification examples ………………………………………………………….. 26 18. Ghosting ……………………………………………………………………………………………………. 28 19. Plan Reviews ……………………………………………………………………………………………… 28 20. The next steps ……………………………………………………………………………………………. 28 20.1 High Decision Delegate approval …………………………………………………………….. 28 21. Appendices ………………………………………………………………………………………………… 29 21.1 Appendix 1 - Standard TSP Changes Summary ………………………………………… 29 22. Supporting material ……………………………………………………………………………………… 33 23. Process Owner and approver ……………………………………………………………………….. 33 24. Feedback …………………………………………………………………………………………………… 33 25. Version change control ………………………………………………………………………………… 33

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1. Purpose

This Practice Guide will support you to consider the reasonable and necessary funded supports (if any) to be included in the participant’s National Disability Insurance Scheme (NDIS) plan.

2. To be used by

Plan Developers – Planners and NDIS Partners in the Community (Local Area Coordinators [LACs]).
NDIA Plan Delegates.

3. Scope

The National Disability Insurance Agency (NDIA) must be satisfied the funded supports in the participant’s NDIS plan meet each of the reasonable and necessary criteria outlined in:

section 34(1) of the National Disability Insurance Scheme Act 2013
the NDIS (Supports for Participants) Rules
Operational Guideline - Including Specific Types of Supports in Plans.

Important: Do not use this Practice Guide if you are planning for an ECEI participant. Refer to the Standard Operating Procedure - Determine the Funded Supports for Early Childhood Early Intervention (ECEI).

4. Prerequisites

Before you consider any reasonable and necessary funded supports, you must:

complete and submit all relevant and mandatory pre-planning tasks
complete the Review and Submit for Funded Supports acknowledgement. When this step is not completed, you may not be able to access the Determine the Funded Supports task.
make sure the primary disability recorded on the participant’s record is correct
check the appropriate severity indicator tool has been completed. You can find further information in Standard Operating Procedure – Update Severity Tools
check the plan duration recorded within the Risk Assessment task reflects the participant’s circumstances. You can find further information in Standard Operating Procedure – Complete the Risk Assessment
discuss with the participant, their plan nominee or child representative(s) who they want to manage the support funding in their plan. You can find further information in Standard Operating Procedure – Determine Plan Management

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Planning

 check the Practice Guidance page of the intranet and use other practice guidance relevant to the participant’s circumstances together with this Practice Guide. For example Practice Guide – Motor Neurone Disease (MND), Practice Guide – Younger People in Residential Aged Care or Practice Guide – Assistance Animals.

Planning

During the planning conversation with the participant, their child representative and/or nominee you will develop an understanding of the participant’s individual circumstances. You will also gather information to complete the pre-planning tasks and create a personalised plan.

When completing the pre-planning tasks you record the mainstream, informal and community supports the participant currently uses, and their goals. You now need to determine which reasonable and necessary funded supports (if any) will be included in the participant’s plan to support them to achieve their goals.

Planning tasks may be completed by NDIA staff or Partners in the Community and include:

 understanding the participant, their individual circumstances and their support needs  providing information about the principles of the NDIS  assisting the participant to identify their goals  identifying any supports the participant currently receives through mainstream, informal and/or community channels including any funded supports in place  identifying any risks  identifying the appropriate reasonable and necessary funded supports  identify how the participant would like the funding in their plan managed, including any request to self-manage, and make a plan management recommendation.

5.1 No reasonable and necessary supports identified

In some cases, the participant may meet the NDIS access requirements however there are no reasonable and necessary supports identified for the current plan. You may determine mainstream, community and/or informal supports currently meet the participant’s support needs, but in the future the participant is likely to require funded supports. For example, for a participant living with a slow degenerative condition, you may determine that for the current plan period the participant only needs support to better understand the condition and improve their health and well-being.

If no reasonable and necessary funded supports are identified:

 complete the participant statement  complete the pre-planning tasks

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 develop the participant’s plan - in the Determine the Funded Supports task do not generate the support plan. Instead, submit the task with $0.00 funding

 complete an interaction which includes details of:

your discussions with the participant,
justification for your decision that no funded supports are required in the participant’s current plan.

The participant’s plan will outline the informal, community and/or mainstream supports that will meet the participant’s goals and support needs.

6. The Typical Support Package (TSP)

The TSP is an amount of funding based on the participant’s disability, individual support needs and characteristics. TSPs provide an efficient, evidence-based and nationally consistent approach to planning.

During the planning conversation you will gather and record information in the NDIS Business System (System) including the participant’s age, primary disability, other disabilities, level of functional impairment, current and potential mainstream, informal and community supports.

The primary disability recorded in the System is one of the factors which influence the TSP. If the participant has more than one impairment, you need to record the primary disability as the impairment which has the greatest functional impact on the participant.

The NDIS actuarial team developed TSPs in collaboration with disability experts. These include people with a disability, professionals and subject matter experts. They take into consideration real life participant experiences and experiences gained through trial. Refer to Appendix 1 - Standard TSP Changes Summary.

Important: TSP is an internal term used by the Agency and should not be discussed with the participant.

7. Reasonable and Necessary

With the exception of Section 43 (Plan Management) of the NDIS Act, you must apply reasonable and necessary decision making to NDIS funded supports in the participant’s plan to ensure the supports are effective and beneficial to the participant.

NDIS funded supports should:

 assist the participant to pursue their goals

 facilitate the participant’s social and/or economic participation

 represent value for money

 be likely to be effective and beneficial for the participant (having regard to current good practice)

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take into account what support is reasonable to expect families, carers, informal networks and the community to provide
complement (not replace) other government services. You must also consider whether any funded supports should not be provided or funded under the NDIS. A support will not be funded under the NDIS if it:
- is more appropriately funded by another government service
- is likely to cause harm to the participant or pose a risk to others
- is not related to the participant’s disability
- duplicates other supports delivered under alternative funding through the NDIS
- relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to a participant’s disability support needs
- is contradictory to a law of the Commonwealth or the State or Territory in which the support would be provided
- consists of income replacement. You should take a whole of person approach when considering which supports are reasonable and necessary in the participant’s plan. If the participant acquires an impairment after they have met access to the NDIS, you should consider how each impairment affects the participant’s life, and the support they need to achieve their goals. Your decision to include reasonable and necessary supports in the participant’s plan is based on whether the support meets all sections of the reasonable and necessary criteria. In exceptional circumstances some day-to-day living costs may be funded by the NDIS, if they are:
- additional living costs which are a direct result of the person’s disability support needs
- ancillary costs associated with a funded support, which the participant would not otherwise incur.

Core supports

Core supports assist the participant to manage aspects of their daily living such as self-care and accessing the community. There are four Core support categories:

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 Daily Activities: includes assistance with self-care, including additional care for short periods used for carers respite, shared living arrangements, household cleaning and/or yard maintenance

 Social, Community and Civic Participation: includes individual and group based community, social and recreational activity participation. These supports may be used for carers respite

 Transport: includes general and specialised transport for attending school, employment or going out in the community.

You need to ensure the participant has the Core support funding they need to meet their plan goals. Review the funding generated by the TSP and either increase or decrease the level of support funding in line with the reasonable and necessary criteria.

You will record justifications for your decisions in the Review and Submit Plan for Approval and/or Finalised Plan and Approve tasks.

8.1 Core budget flexibility

The four Core support categories Consumables, Daily Activities, Social, Community and Civic Participation and Transport are flexible. This means funding from one Core category (such as Daily Activities) can be used to purchase supports from another Core category (for example, Consumables). For funds to be used flexibly, the categories must have the same fund management type (such as Agency Managed).

It is important to look at the total value of the Core supports (for instance total combined value of Consumables, Daily Activities and Social, Community and Civic Participation and Transport) when determining the reasonable and necessary Core support funding amount.

Often the TSP will only generate funding in one or two of the Core support categories. If this occurs, you will need to check how the funding is allocated. You may need to adjust how the funding is distributed based on the participant’s individual Core support needs, plan goals and circumstances. However, participants are able to use their funding flexibly across the Core categories, even if $0 are allocated to the support category.

If the participant receives periodic transport funding, the Transport category is not flexible. Periodic transport is not included in Core flexibility as it is paid directly to the participant. Activity based transport can be claimed from the participant’s Core funding by providers with the participants agreement. Refer to section 8.3 Transport for more information.

Although Core funds can be used flexibly, it is important to ensure the participant understands the Core funding can only be used to purchase reasonable and necessary supports in line with the plan’s objectives regardless of whether the funding is Agency, self or plan managed.

Example of Core flexibility: Juan requires support to access his community activities and everyday use continence items. Funding of $21,606 is included in Juan’s plan for his Core s \support needs, as follows.

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Consumables: $4,000 (Agency managed $3,000, plan managed $1,000)
Daily Activities: $0
Social, Community and Civic Participation: $16,000 (Agency managed $9,000, plan managed $7,000)
Transport – $1,606 (periodic payment)

During his plan Juan has short term need for self-care support. Depending on the funding remaining available, Juan could chose to use the flexibility of his Core budget for Daily Activities (up to $12,000 Agency managed and/or up to $8,000 plan managed). Juan’s periodic transport budget of $1,606 is not flexible with his other Core funding.

8.1.1 Limitations to flexibility with stated supports When considering making a Core support item Stated, carefully consider:

the impact on flexibility for the participant and their providers
whether the support is a composite item. Providers are unable to claim for a specific time of day, day of week etc. if the composite item is stated.

8.1.2 Limitations to flexibility for transport in the Core budget In exceptional circumstances, transport can be used flexibly however, only if;

the transport funding is not set up as an automated periodic payment, and
the transport funding is not included as a stated support, and
there are remaining funds in the Core budget to be utilised, and
the transport funding plan management type is the same as other Core Supports, and
the transport Service Booking is amended to a higher amount than what is provided in the transport category in the Core budget.

8.2 Meal preparation and delivery The participant may request meal preparation and delivery to be included in their NDIS plan when they are unable to prepare meals due to their disability. Some examples include when the participant is experiencing:

difficulties with organisation
difficulties completing multi-step instructions
a physical disability that impacts their ability to prepare meals. For some participants the inclusion of meal preparation and delivery can support them to safely maintain independent living and reduce their reliance on other supports.

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When making a reasonable and necessary decision on including meal preparation and delivery in the participants plan you should consider:

goal attainment and building independence
the functional impact of the participant’s disability for the preparation of meals
assessments
duplication of funding
reviewing the quote
considerations when including funding in the participants plan.

8.2.1 Goal attainment and building independence

You need to consider how including funding for meal preparation and delivery will assist the participant to achieve their goals and build their independence.

Talk to the participant to understand how meal preparation and delivery will support them. Discuss:

How they currently prepare meals?
How meal preparation and delivery will support them to achieve their goals?
Have they considered other supports that would develop their ability to prepare meals more independently such as an individualised program and support to participate in preparation of meals? Is this something they would like to do? Have they tried this previously? If yes, what were the outcomes?
Have they explored the use of Assistive Technology (AT) to assist with meal preparation tasks? Is this something they would be interested in exploring?
Are there risks for the participant preparing their own meals?

For participants with the potential to develop independence in meal preparation you should consider funding for meal preparation and delivery while they explore AT and capacity building supports. At the next scheduled plan review the plan developer and participant can discuss the outcomes of these supports to determine whether meal preparation and delivery continues to be required.

8.2.2 Meal preparation for children

When the participant is a child and they require mealtime preparation that is above what would be considered reasonable to expect families and carers to provide you should consider the inclusion of funding for meal preparation and delivery.

For example, the family or caregiver for a child who is on a ketogenic diet due to their disability needs may need significantly more time for meal preparation than a child not on a specialist diet due to their disability needs.

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Discuss requests for meal preparation and delivery for the child participant with your line manager.

Seek further advice from the Technical Advisory Branch if you are still uncertain that the request meets the reasonable and necessary criteria.

8.2.3 Assessments

Assessments may be useful in helping you make a decision on whether to include meal preparation and delivery in the participants plan. However, they are not always necessary when there is a clear link between the functional impact of the participant’s disability and preparation of meals.

For example, you may find that you have enough information to make a reasonable and necessary decision using information from the planning conversation, previous reports, previous NDIS plans and other supporting evidence.

If the participant gives you a copy of an assessment from a suitably qualified allied health professional supporting their request for meal preparation and delivery you need to consider this when making your decision.

You may be able to use information from a previous assessment to better understand the participants support needs where there has been no change to the participant’s functional capacity.

You should only ask the participant for an assessment from a suitably qualified allied health professional if you have reviewed all current information and still need additional information to make your decision. When you request an assessment, make sure you include funding in the Capacity Building budget for this to be completed.

8.2.4 Duplication of funding

If you are including support for meal preparation and delivery in the participants plan you need to review other supports to make sure you are not duplicating funding.

Examples of other areas where support may be duplicated are:

funding for a support worker to assist the participant to prepare the meals
funding for a support worker to assist the participant with their mealtime management routine
when the participant is receiving support for 24 hours each day (for example, SIL)
funding for capacity building supports to build independence in meal preparation.

Note: There may be times where these supports are not duplications. If you are unsure, please discuss with your line manager.

8.2.5 Reviewing the quote

Meal preparation and delivery is a quote-required support. This means that the participant needs to submit a quote for you to consider as part of the reasonable and necessary decision making process.

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When you are reviewing the quote check:

The amount is for the preparation and delivery of meals only. NDIS does not cover the cost of food as this is considered a day-to-day living cost.
The quote is value for money.
You can check if a quote is value for money by comparing the quoted amount to the Product Catalogue (benchmark price) in the System. If it is 10% over the catalogue price, seek decision-making advice from your line manager.

8.2.6 Considerations when including funding in the participants plan

If the request meets the reasonable and necessary criteria you need to:

Include funding for the support using the participants plan management preference.
Include a comment in the plan so that the participant knows that funding has been included.
For example “$xx.xx per week of funding for meal preparation and delivery.”

8.3 Transport

Transport funding should be considered when the participant is unable to use public transport without substantial difficulty due to the impact of their disability.

Transport funding does not cover transport assistance which is considered a day to day living cost. For example, transport to appointments, shopping or recreational activities.

This support needs to be directly linked to plan goals and include a skill development focus.

You should use the three levels of supports for transport assistance as a guide only:

Level 1 $1606-$1,784: For participants who are not working, studying or attending day programs but want to enhance their community access
Level 2 $2472-$2,676: For participants who are currently working or studying part-time (up to 15 hours a week), participating in day programs and for other goal based social, recreational or leisure activities
Level 3 $3456-$3,567: For participants who are currently working, looking for work, or studying (15 hours or more a week), and are unable to use public transport because of their disability.

To ensure the participant has transport funding to meet their transport support needs, you will need to review the TSP generated amount. Also consider the levels of support for transport assistance and include an amount based on your reasonable and necessary decision making.

Record justifications for your decision in the Review and Submit Plan for Approval and/or Finalise Plan and Approve Task.

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Important: If a participant is currently receiving mobility allowance from Centrelink, this allowance will stop upon approval of their first NDIS plan.

8.3.1 Transport periodic payments

Unlike other support categories, transport can be paid to participants as an automated periodic payment (fortnightly payment).

The System will automatically tick the Periodic Payment check box next to the Transport support category in the Determine Funded Supports Task. This means the funding is paid periodically to the participant.

It is important to review this and update the check box to reflect the participant’s circumstances. For example, if transport funding is in-kind you need to untick the Periodic Payment check box.

Periodic payments are self-managed payments. You must discuss this with the participant, their child representative and/or plan nominee.

You should not approve self-managed periodic payment:

when current bankruptcy is declared in the risk assessment,
if self-managing transport funding is likely to present an unreasonable risk to the participant.

So that periodic payments can be made, you need to check bank account details of the participant, their child representative and/or plan nominee are collected and recorded in the System before the plan is approved. Refer to Standard Operating Procedures – Record Bank Details.

8.3.2 Participant transport as part of community participation

The participant can use funding from their Core budget for a support worker to help them participate in community outings and/or transport from their home to the community. Providers claim these costs at the relevant community participation hourly rate. When the provider is supporting more than one participant to access the community at the same time, they need to claim the group rate.

Funding from the participant’s Core budget can also be used for the provider’s non-labour costs associated with providing transport to participants:

accessing community participation supports
accessing or maintaining employment
accessing or maintaining or higher education.

Non-labour costs associated with participant transport can include:

public transport fares
road tolls

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 parking fees

 reasonable vehicle running costs

- up to $0.85 a kilometre for a standard vehicle not modified for accessibility

- up to $2.40 a kilometre for a vehicle that is modified for accessibility or a bus

 taxi or ride-share fares.

You need to consider the non-labour costs associated with providing this transport when determining the reasonable and necessary Core funding in the participant’s plan.

8.3.3 Provider travel

Provider travel is different to participant transport. There are two types of provider travel:

Travel to provide daily activities and community access (Core) supports
Travel to and from Capacity Building supports – Refer to section 9.5 Provider Travel for further information.

When the participant agrees, providers can claim the time spent travelling to the participant. Only the actual travel time can be claimed.

For Core support, this refers to the time spent by the provider travelling to deliver a service to the participant (participant is not in the car). Where a support worker provides services to more than one participant the travel time can be shared between the participants, if each participant agrees in advance.

You may need to consider provider travel for delivering Core supports when developing Core funding in the participant’s plan. Maximum limits apply to the amount of travel time providers can claim. Refer to NDIS Price Guide for further information on provider travel.

When implementing the plan, participants should be encouraged to negotiate their supports with providers, particularly around the cost of provider travel.

9. Capacity Building supports

Capacity Building (CB) supports assist participants to increase their ability to live their life independently.

These supports are designed to deliver improved outcomes for the participant and reduce the need for funded supports in the future. CB supports focus on outcomes and are always linked to one of the participant’s goals.

Unlike the Core support budget, CB supports are only flexible in the same CB support category. For example, funding from CB Daily Activity can be used flexibly across all non- stated support items in the CB Daily Activity budget, but cannot be used to purchase supports from any other CB budget.

In the System, the TSP will generate CB support funding based on the response to the guided planning question ‘What level of Capacity Building is required?’ You need to apply

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reasonable and necessary decision-making regardless of whether CB support budget funding has or has not been generated by the TSP.

The exception is Plan Management (Financial Administration) supports. When the participant requires Plan Management, you must include funding in the CB Choice and Control budget. For further information refer to Standard Operating Procedure - Plan Management and Financial Administration Support Items.

All funding generated for Capacity Building will default to the CB Choice and Control budget. You will need to allocate the funding across the relevant CB budgets as you determine the reasonable and necessary supports in line with the participant’s goals and expected plan outcomes.

The nine Capacity Building (CB) support categories are:

CB Choice and Control: Includes support items relating to plan management and financial administration. Refer to section 9.2 Funding for Plan Management below
CB Daily Activity: Individual assessment/therapy/training, group therapy, carer/parent training and individual skills development. Refer to section 9.3 CB Daily Activity below
CB Employment: Includes individual employment support, assistance in specialised supported employment (such as Australian Disability Enterprises), School Leaver Employment Support (SLES), employment-related assessments and counselling. Refer to section 9.4 CB Employment below
CB Health & Wellbeing: Includes dietary and exercise physiology supports
CB Home Living: Includes assistance with accommodation and tenancy obligations
CB Lifelong Learning: Includes transition through school and to further education
CB Relationships: Includes behaviour support, as well as social skills development and capacity building. Refer to Practice Guide – Positive Behaviour Support and Behaviours of Concern for information on including supports to address Behaviours of Concern (BoC)
CB Social, Community and Civic participation: Includes community participation activities, skills development and training as well as life transition planning such as mentoring and peer support. These supports may sometimes be used for carers respite
Support Coordination: Refer to section 9.4.3 Support Coordination below.

9.1 Capacity building for self-managing support funding

The participant should be presumed to have the capacity to self-manage unless there is unreasonable risk. This is supported by the NDIS legislation and principles of the NDIS.

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Funding may be included in the participant’s plan to build capacity and support their goal to self-manage supports in their plan now, or in the future. This is a reasonable and necessary decision under section 34 of the NDIS Act.

When considering supports to build, or continue to build the participant’s capacity to manage their support funding, consider:

strategies to safeguard the participant’s interests, including informal supports
supports which could build the participant’s independence and capacity to self-manage
whether including additional supports in the plan could mitigate risks to the participant
whether support with budgeting, book keeping and financial record keeping will support the participant’s goal to manage their supports in the future
any supports to assist the participant to negotiate services and utilise the supports in their plan.

For further information about the different types of plan management, who can manage NDIS f funds and capacity building supports for self-management, refer to Practice Guide – Determine Plan Management.

9.2 Funding for Plan Management

Plan management and financial administration funding is a stated support that allows the participant to engage an NDIS Registered Plan Management Provider to manage the financial functions of their plan.

Funding for plan management and financial administration support is not included in the TSP. If the participant, their nominee or child representative requests to have a plan manager for one or more of their supports, you are required to add funding for the plan management activities in the participant’s plan.

The participant’s choice to have a plan manager manage the funded supports in their plan is a legislative entitlement under section 43(2) of the NDIS Act 2013. Where the participant requests their funding to be managed by a plan manager, this is not subject to reasonable and necessary criteria.

Refer to Standard Operating Procedure - Plan Management and Financial Administration Support Items to include financial administration supports in a participant’s plan.

Where it is a goal of the participant to learn how to manage their own funds and/or build capacity to self-manage their plan, if reasonable and necessary, this support funding is included in one of the following CB budgets:

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 CB – Choice and Control (Plan and Financial capacity building): Generally used when a participant is plan managed and has goals around financial independence and/or to build capacity to move to self-managing in the future

 CB – Support Coordination (Training in Planning and Plan Management):- Generally used for participants who are self-managed and require some assistance to get started with this process, or where a participant has support coordination included in their plan and the plan is not plan managed.

When including funding to build capacity to self-manage, ensure you discuss whether the participant will be able to locate and access appropriate service providers to assist them.

9.3 CB Daily Activity

9.3.1 Allied Health Practitioners

Allied health practitioners (AHP) hold a university qualification, specialise in different areas and work directly with the person requiring support. AHPs are not part of the medical, dental or nursing professions. AHPs include, but are not limited to: occupational therapists, physiotherapists, speech therapists, exercise physiologists, psychologists, prosthetists or orthotists, podiatrists, dieticians or respiratory therapists.

Refer to Practice Guide – Understanding Therapy Supports for a full description of each of the allied health practitioners.

Reasonable and necessary funding can be included in a participant’s plan to meet their disability-related health support needs. For example continence supports, diabetic supports, dysphagia supports, epilepsy supports, podiatry supports, nutrition supports, podiatry and foot care supports, respiratory supports or wound and pressure care supports. Refer to section 16.2 Disability-Related Health Supports and Practice Guide – Disability-Related Health Supports for further information.

9.3.2 Nursing

Reasonable and necessary nursing supports can be included in a participants plan to meet their disability-related health support needs as per section 6.8 of Practice Guide – Disability- Related Health Supports.

9.4 CB Employment

The CB Employment category includes individual employment support, assistance in specialised supported employment (Australian Disability Enterprises - ADE), School Leaver Employment Support (SLES), employment-related assessments and counselling.

9.4.1 School Leaver Employment Support (SLES)

SLES funding will be auto-generated as part of the TSP to the CB Employment budget based on the response to the guided planning question, ‘Is the participant eligible for School Leaver

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Employment Support (SLES)?

For the current guidance on SLES, please refer to the Employment intranet page.

9.4.2 Assistance in specialised supported employment (ADE)

To include funding for employment in an Australian Disability Enterprise (ADE) refer to:

Appendix 1 – Standard TSP Changes Summary
Standard Operating Procedure – Supports in Employment.

9.4.3 Support Coordination

The Support Coordination category is part of the Capacity Building budget but is separate from the eight Capacity Building (CB) sub-categories. This category includes the support items for support connection, support coordination and specialised support coordination, as well as support for building a participant’s capacity to learn to self-manage their own plan (training in planning and plan management).

Refer to:

Appendix 1 – Standard TSP Changes Summary
Standard Operating Procedure – Update Participant Streaming
Standard Operating Procedure – Include Support Coordination in a Plan.

9.5 Provider Travel

Providers of some supports are able to claim non-direct services, including provider travel, short notice cancellations and where an NDIA report is required.

Provider travel for capacity building supports can be claimed for travel to each participant, and return travel from the last appointment of the day. The participant must agree to the travel costs to be claimed in advance.

Where a worker travels to an area and provides services to more than one participant, if agreed to in advance by each participant, the cost of time and travel could be split between the participants.

CB support categories where providers may be able to claim provider travel include:

CB Daily Activity
CB Social Community and Civic Participation
CB Employment
CB Relationships
CB Health and Wellbeing
Support Coordination.

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When considering the level of reasonable and necessary CB supports, consider how the services will be delivered. Also consider any other circumstances that may affect how the participant utilises their plan funding, such as provider travel, and how this may impact the level of supports available, particularly for participants living in regional and remote areas.

Maximum limits apply to the amount of travel time providers are permitted to claim. Refer to the NDIS Price Guide for further information.

9.6 Medicare

The participant may access Medicare funded allied health services with a referral from their GP alongside allied health supports funded in their NDIS plan. There is no requirement for the participant to use or exhaust these Medicare funded services before receiving allied health supports funded in their NDIS plan if the supports required relate to the participant’s functional impairment and are considered reasonable and necessary.

Where considered reasonable and necessary, the funded supports should be included to cover the full cost of the supports. Where Medicare funded allied health supports are not considered reasonable and necessary, the supports funded through Medicare can work side by side with other funded supports to enable the participant to achieve their goals.

For example:

NDIS funded psychology supports to address disability related barriers and build capacity to engage in social situations and participate in employment.
The participant also accessed Medicare funded psychology supports for clinical treatment such as ongoing counselling and medication management (not funded by the NDIS).

10. Capital supports

Capital supports assist a participant to increase independence and participation in a range of different environments, such as their home, community and the workplace.

The two support categories within Capital are Assistive Technology and Home Modifications.

When responses to the guided planning questions generate assistive technology or home modifications support funding, the intended purpose is to fund equipment or an assessment appropriate to meet the participant’s needs.

Unlike the Core support budget, Capital support categories are not flexible between Assistive Technology and Home Modifications.

It is the responsibility of the plan developer to review the TSP generated Capital supports and adjust the budget amounts for the participant’s reasonable and necessary support needs.

Note: Capital items including AT and Home modifications must not be added to a plan (even if they are quote required) unless evidence and reports are attached in the System to justify that the equipment is reasonable and necessary.

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10.1 Assistive Technology

Includes equipment for mobility, personal care, communication and recreational inclusion such as wheelchairs, pressure mattresses, standing frames, bathing and toileting equipment, personal readers and vision equipment, and vehicle modifications.

For further information on including Assistive Technology within a plan refer to:

Practice Guide – Assistive Technology
Standard Operating Procedure – Include Assistive Technology (AT) in Plans
Standard Operating Procedure – Assistive Technology or Home Modification Supports between $1,500 and $5,000
Assistive Technology (AT) Complexity Level Classification.

10.2 Home Modifications

Home modifications includes interior and exterior home modifications, consultation and project management. For further information on including funding for Home Modifications in the participant’s, refer to the Standard Operating Procedure – Include Home Modification Supports in Plans.

10.2.1 Specialist Disability Accommodation (SDA)

The support item for Specialist Disability Accommodation (SDA) sits in the Home Modifications budget of a plan.

The three different types of SDA are:

new
in-kind
existing.

The two occasions when SDA may be included in a plan are:

when there is a new SDA decision
when the participant was already residing in disability related supported accommodation at the time of transition to the NDIS.

10.2.1.1 Existing or In-Kind SDA

When a participant is already residing in an SDA dwelling when they transition to the NDIS they are considered to be in existing or in-kind SDA. SDA funding needs to be included in the participant’s NDIS Plan. Refer to:

Standard Operating Procedure – Include Existing (non in-kind) SDA in a Plan: Participants Residing in SDA Prior to Transition
Standard Operating Procedure – Adding In-Kind Supports in a Plan.

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10.2.1.2 A new SDA decision

When a participant wishes to move in to SDA for the first time or wishes to move to a different SDA dwelling, from an existing or in-kind SDA dwelling, this is considered to be new. SDA.

For new SDA, the SDA support funding must not be included in the participant’s plan without referral to the SDA panel for advice.

The SDA panel will review the SDA eligibility and provide a recommendation for the participant’s SDA request. The SDA panel will also provide information on the eligible SDA type and level for the participant. This information is recorded in the Housing and Accommodation section of the participant’s record.

Refer to Standard Operating Procedure – Determine Specialist Disability Accommodation - Change of Address or a New Decision.

Note: For more information regarding transitional accommodation, while the participant is waiting for Assistive Technology or Home Modifications, refer to the Practice Guide - Medium Term Accommodation.

11. Quote required support items

A quote is required for some supports such as high cost assistive technology, complex home modifications and vehicle modifications.

Where a quote required support is included in the participant’s plan the quote process must be followed. For further information refer to Standard Operating Procedure – Manage Quotations.

12. Plan Duration

The duration of a participant’s plan may vary depending on the participant’s disability, streaming decision and individual circumstances. You can find guidance for determining plan duration in Standard Operating Procedure – Complete the Risk Assessment.

The TSP generates Core supports based on the chosen plan duration. For example, a 36- month plan will generate 36 months of Core supports, a 24-month plan will include 24 months of core supports and a 6-month plan will generate 6 months of Core supports.

Manual adjustment may be required for Capacity Building and Capital supports for plans other than 12 months duration. You will need to use reasonable and necessary decision making to adjust funding in these budgets to reflect the participant’s needs for the duration of the plan.

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13. Stated supports

A stated support is a support recorded in the plan at the support item level, and selected as stated in the support calculator.

When a support is stated the funding for that item can only be used for that particular support. As defined in Part 6 of the NDIS (Plan Management) Rules, stated supports must be purchased by the participant as they are described in the plan.

Carefully consider if a support you are including needs to be stated, as stated items reduce flexibility for the participant and the provider.

When including stated support item(s), make sure the comments in the related support category clearly outline the intent of the stated support.

For example: In CB Relationships, you may include a stated support item for the development of a Behaviour Support Plan by a registered provider. Marking the support item as stated quarantines this funding from the rest of the support category budget, and ensures it can only be used by the participant as intended.

14. In-kind

Before the NDIS was established, States and Territories paid service providers directly to deliver services to people with disabilities. In some situations, States and Territories continue to pay for these services directly and NDIS participants continue using these services.

When these pre-paid supports are provided as reasonable and necessary supports in a participant’s plan they are called in-kind and must be recorded as in-kind specifically within the participant plan. Refer to Practice Guide – In-Kind.

15. Compensation

If the participant responds ‘yes’ to the risk assessment question ‘Is your disability the result of an accident or event?’ this indicates the participant has received, or is entitled to receive compensation. Additional questions will be generated in the System for you to complete in relation to compensation.

Compensation, for NDIS purposes, is either a lump sum or periodic payment.

If you identify the participant is, or has been entitled to compensation, follow the steps below:

Give the participant or their nominee the Compensation and the NDIS Fact Sheet.
Advise the participant or nominee they can get additional information on the Compensation and your plan page of the NDIS website.
Email the Compensation Recoveries Team (CRT) as soon as you become aware of the potential for compensation. In the subject line of your email include the participant’s NDIS number and last name.

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Changes to the TSP

Add an alert to the participant record in the System.
Create an interaction that compensation has been identified.
Proceed with developing and approving the participant’s plan.

For further information refer to the Compensation intranet page.

Sometimes, the generated TSP has not enough or more than enough funding to meet a participant’s needs or enable them to achieve their goals. Funding generated in each individual support category is informed by the participant’s support needs identified in response to the details recorded in the System. Use reasonable and necessary decision making to adjust the TSP up or down in response to information available to you regarding the participant and their individual circumstances.

Sometimes, evidence of support needs may indicate that the funding generated in the TSP is above the reasonable and necessary support requirements. For example, a participant may be very engaged in the community for recreational and social activities or be working, and have strong, sustainable informal care networks. This information must be taken into account when determining the funded supports to prevent supports being funded in the plan that are in addition to what is reasonable and necessary.

The standard TSP changes include varying the TSP for specific supports. These supports include:

Defined Programs
Plan Management costs
Behaviours of Concern
Supported Independent Living (SIL) (group)
Specialist Disability Accommodation (SDA)
Assistive Technology (including composite items)
Home Modifications
Coordination of Support
School Leaver Employment Services (SLES)
Australian Disability Enterprises (ADE).

16.1 Parental responsibility

You must also recognise parental responsibility when considering funded supports for children under 18 years. All parents are responsible for providing substantial care and support for their children whether they experience a disability or not, for example, transporting them to activities and meeting the cost of after school activities.

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Reasonable and necessary disability-related health supports can be included in a participant’s NDIS plan if they:

directly relate to a person’s ongoing functional impairment, and
are a regular part of daily life, and
are most appropriately funded or provided by the NDIS, and
are evidenced meaning supporting information can generally be obtained.

Refer to the Practice Guide – Disability-Related Health Supports for full guidance. For further information about specific disability-related health supports refer to the relevant practice guidance:

Practice Guide – Continence Supports
Practice Guide – Diabetic Management Supports
Practice Guide – Dysphagia Supports
Practice Guide – Epilepsy Supports
Practice Guide – Nutrition Supports
Practice Guide – Podiatry and Foot Care Supports
Practice Guide – Respiratory Supports
Practice Guide – Wound and Pressure Care Supports

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It is unlikely that funding for most disability-related health supports will be generated in the TSP. This means you will need to include them as a reasonable and necessary adjustment to the TSP. Make sure you include the participant’s need for disability-related health supports in your justifications for increasing the TSP and include a comment in the NDIS plan to describe these supports.

16.3 Other considerations

16.3.1 Duplication of supports

Consider duplication of supports when developing the plan. For example, if it has been deemed reasonable and necessary to include SLES or ADE supports in a participant’s plan to achieve their goal of economic and social participation, then funding generated by the TSP in other support categories (such as social, community participation) which achieve the same goal should be reduced or removed where appropriate.

16.3.2 Evidence

Any decision to vary the funding generated by the TSP must be informed by validated supporting evidence and have a justification recorded in the System to allow the delegate to make the funding decision. If the TSP is exceeded as a result of a reasonable and necessary decision, clear evidence from a relevant professional or written information supporting your recommendation must be attached to the participant record and referenced in the plan justification.

16.3.3 Increases over 10%

Any increase to the TSP above 10% must be reviewed by an executive level delegate prior to plan approval. Record details of this review, including the name of the reviewing delegate, in an interaction. If you are the plan developer, details can be recorded when completing the Plan Approval Considerations – Plan Submitted for Approval interaction template. If you are the plan delegate, details can be recorded when completing the Plan Approved and Ready for Implementation interaction template.

16.3.4 Technical Advisory Branch (TAB) referrals

Ensure you submit TAB mandatory referrals. Where you are unable to make a decision on what is reasonable and necessary (for instance high cost or high complexity requests), liaise with your manager/s and your TAB Regional Advisor as a first step. If you are still unable to make a reasonable and necessary decision make a request for TAB advice.

17. Justification for reasonable and necessary supports

Plan developers and delegates must record a justification for each support category in the participant’s plan. Justifications should be clear and concise, and only include information relevant to your decision.

You must include the following information in each justification:

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 description of the support and how it relates to the participant’s disability support needs

 how the support will help the participant achieve their goals

 how the support meets reasonable and necessary criteria

 refer to any supporting evidence to support the inclusion of proposed supports.

17.1 Justifications for plan management

Plan management funding (plan management set up and administration fees) is not a reasonable and necessary decision.

You do not need to provide detailed justification for this support. Refer to section 9.2 Funding for Plan Management for more information on these supports.

You can record the following standard justification for this support:

 Plan management fees – Funding for the plan to be plan managed as requested.

Note: Funding to support the participant to learn to self-manage their funding is a reasonable and necessary decision, and you will need justify including this support. Refer to Practice Guide – Determine Plan Management.

17.2 Best practice justification examples

Note: Names used in the examples are fictitious.

Helen has a moderate intellectual disability and requires support to access her community and to participate in individual and group activities in order to achieve her goal of continuing to spend time with her friends.

Core funding is included for Helen to attend her current group day program three days (18 hours) per week. Funding is also included for 1:1 support three hours per week to attend her community choir group. These supports will help her maintain her friendships and social activities, as she is unable to participate without support. Helen’s parents will continue to support her at home, including overnight and on weekends.

17.2.2 Example 2 – Capacity Building Supports: CB Relationships

Michael has complex behaviours of concern and has a current behaviour support plan (refer to “Behaviour Support Plan 2020” uploaded to inbound documents). Funding for ongoing monitoring and review of the behaviour support plan will support Michael to:

 build capacity in managing his emotions

 develop relationships with others

 enhance his communication skills

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 develop, implement and review strategies to engage appropriately with others at home and when out in the community.

These strategies will support Michael’s goal of accessing the community, and help him build stable relationships with his support network. It is anticipated this support will reduce his need for intensive 1:1 funded supports over the next 12 months, therefore representing value for money in the long term.

17.2.3 Example 3 – Capacity Building Supports: CB Daily Activity

Lucy has a primary disability of bi-polar disorder and a secondary disability of vision impairment. Lucy has a goal of being able to do more things for herself at home. Specifically, she would like to be able to prepare a basic meal for her family.

Lucy has difficulty reading a recipe, following the instructions and operating kitchen appliances. She currently relies on her parents to complete all meal preparation tasks. This funding allows an occupational therapist to assess her capacity to complete household tasks independently. The therapist can recommend capacity building strategies in a skill development plan, and recommend assistive technology to help her achieve this goal.

17.2.4 Example 4 – Capital Supports: Assistive Technology replacement

Salim has cerebral palsy and currently uses a manual wheelchair that is seven years old. Salim said at the planning meeting that the wheelchair cannot be repaired, and he will need a ew wheelchair in the next two months so that he can continue going out independently. Salim submitted a quote for a new, similar wheelchair for $9,684.00.

Salim’s occupational therapist has stated the new wheelchair does not pose significant risks. The replacement wheelchair meets the three criteria for replacement AT in the Practice Guide – Assistive Technology:

Evidence of existing use – Salim has submitted the original purchase receipt, and a report from his repairer that his current wheelchair cannot be repaired.
No change to functional capacity – the Occupational Therapist letter uploaded to inbound documents states that his support needs are stable.
Cost – the new wheelchair is less than $15,000.

17.2.5 Example 5 – Core Supports: Transport

Sally has autism, and cannot use public transport independently. Currently, she does not know how to hail a bus or which stop to get off. She also experiences anxiety in crowds and public places. One of her goals is to join a sports class approximately 20 minutes away from home. She will not require support when she is at the class.

Funding is included for Level 1 transport to allow her to use taxis to attend the class and other social activities. Sally is not currently working or studying, but she is looking to increase her community access. The funding in the Capacity Building Daily Activity support category will support her to build her skills in using public transport independently. She may not require transport support in future plans.

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18. Ghosting

There are issues with ghosting in the Determine the Funded Supports task in the System. Ghosting means that supports that have been added using the support calculator and later removed may still show up in the Finalise Plan and Approve task. For more information, refer to the Standard Operating Procedure – Determine Reasonable and Necessary Supports.

19. Plan Reviews

When determining the funded supports at plan review, you must consider the previous plans value and the utilisation of any funded supports in comparison with the new plan’s total budget, including the generated TSP. The duration of a plan will affect the supports generated in the TSP.

For guidance on determining the plan duration refer to Standard Operating Procedure – Complete the Risk Assessment.

For information on completing a plan review, refer to:

Standard Operating Procedure – Complete a Plan Review (full), or
Standard Operating Procedure – Complete a Plan Review (light touch).

20. The next steps

Once you have completed and submitted the Determine Funded Supports and Determine Plan Management tasks, submit the draft plan for approval via the Review and Submit Plan for Approval task, refer to Standard Operating Procedure – Review and Submit a Plan for Approval.

The plan approval decision will involve the plan delegate reviewing all available information and evidence on the record relating to the participant’s circumstances, their capacity and any risks and safeguards. Evidence and justification to support the inclusion of funded supports in the plan (as recommended by the plan developer) to meet reasonable and necessary will also be reviewed and considered as part of the plan approval decision.

Prior to submitting a plan for approval it is important you are satisfied you have provided enough evidence to justify and support the proposed reasonable and necessary funding including any adjustments to the TSP with the justification recorded in the Review and Submit Plan for Approval task.

20.1 High Decision Delegate approval

Depending on the overall plan value and/or other risk factors, the plan may need to be assigned to the High Decision Delegate (HDD) team for review and approval. The System will not allow a delegate with insufficient delegation to approve the plan. If delegation level 4 approval is required, follow the steps as outlined in the Standard Operating Procedure – Finalise and Approve a Plan.

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21. Appendices

21.1 Appendix 1 - Standard TSP Changes Summary

The TSP is the first step in determining the reasonable and necessary funded supports and you may need to adjust the funding generated using reasonable and necessary decision-making principles to reflect participant’s individual circumstances.

This document is a guideline for determining reasonable and necessary supports for specific items. Items or supports listed as TAB mandatory referrals must be submitted to TAB for advice.

Any variation to the TSP must meet the reasonable and necessary criteria and be informed by validated evidence which is recorded in the System in the Review and Submit Plan for Approval and/or Finalise Plan and Approve tasks. Increases to the TSP above 10% must be approved by an executive level delegate and this approval recorded in an interaction before the plan is approved. Assessment reports and other supporting evidence must be attached as an inbound document.

Topic	Considerations for Change	Guidance
Defined Programs	Some participants are transitioning to the NDIS from Defined Programs. These participants must not be disadvantaged by their move to the NDIS; however, funded supports can only be included in a plan if they meet the reasonable and necessary criteria. There should be appropriate reasonable and necessary supports in the plan to enable the participant to achieve at least the same outcomes as they were receiving prior to transition. This is not necessarily the same level of funding — rather it is their ability to achieve the same level of outcomes.	Standard Operating Procedure – Determine Reasonable and Necessary Supports Planning Operational Guideline – 10.9.1 The Principle of “no disadvantage”
	Note: In some cases, the participant may have been receiving supports prior to entering the NDIS that do not meet the reasonable and necessary criteria and these cannot be funded in their NDIS plan.

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Considerations for Change

Topic	Considerations for Change	Guidance
Behaviours of Concern	Some participants require supports to address behaviours of concern. There may not be enough funding in the generated TSP to allow for the required behavioural supports. Use reasonable and necessary decision making to increase the CB Relationships budget as required.	Standard Operating Procedure — Behaviour Intervention Supports
Supported Independent Living (Group) and Specialist Disability Accommodation (SDA)	For Supported Independent Living (SIL) — add supports in accordance with the relevant resource.
Note: To avoid duplication of supports, it is important that the relevant SIL guidance is followed and adjustments made to the Core budget as required.
For existing and in-kind SDA — add supports in accordance with Standard Operating Procedure — Include Existing (non In-Kind) SDA in a Plan or Standard Operating Procedure — Adding in-kind Support to a Plan. For new SDA refer to SDA Panel.	Practice Guidance — Identifying Housing Solutions
Standard Operating Procedure — Include Existing (non in-kind) SDA in a Plan: Participants Residing in SDA Prior to Transition
Standard Operating Procedure — Adding in-kind Support to a Plan
Standard Operating Procedure — Include Supported Independent Living (SIL) in Plans
Standard Operating Procedure - Determine Specialist Disability Accommodation - Change of Address or a New Decision
Assistive Technology	Funds to be allocated according to the Standard Operating Procedure - Assistive Technology and Practice Guide — Assistive Technology.	Standard Operating Procedure - Include Assistive Technology (AT) in Plans
TAB
Practice Guide — Assistive Technology

Considerations for Change

Topic	Considerations for Change	Guidance
Home Modifications	Funds to be allocated according to the Standard Operating Procedure — Include Home Modifications Supports in Plans.	Standard Operating Procedure — Include Home Modification Supports in Plans
Coordination of Supports	Where indicated as being required in the Guided Planning Questionnaire, the TSP generates funding for Coordination of Supports equivalent to 21.7 hours per year for participants aged 16 years and over. Participants who are supported by an LAC will not require this funding. Some participants will require an adjustment to the Coordination of Supports funding to implement their plan and address any current complexities in their life. The Standard Operating Procedure — Include Support Coordination in a Plan provides information and guidance around levels of Coordination of Support (low to very high).	Standard Operating Procedure — Include Support Coordination in a Plan Standard Operating Procedure — Review and Submit Plan for Approval Practice Guide — Motor Neurone Disease (may also be used for participants with other rapidly degenerating neurological conditions) Standard Operating Procedure — Adding In-kind Supports to a Plan

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Considerations for Change

Guidance

School Leaver Employment Services (SLES)

and Australian Disability Enterprises (ADE)

If a participant has been assessed and identified as suitable for SLES funding — add supports in accordance with the SLES Standard Operating Procedure.

If a participant is attending an ADE, include ADE funding as per the relevant ADE resource.

Note: Where SLES or ADE is funded in a plan, generated supports relating to community participation and CB must be considered and reduced as required to avoid duplication of supports. For example, most SLES participants will have SLES activities for a minimum of 3 days per week. ADE participation may vary from 1 day to full time employment. Please refer to the relevant resource for further information.

Standard Operating Procedure - Add School Leaver Employment Support to the Participant’s Plan

Standard Operating Procedure — Supports in Employment

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22. Supporting material

National Disability Insurance Scheme Act 2013
National Disability Insurance Scheme (Supports for Participants) Rules 2013
Planning Operational Guideline

23. Process Owner and approver

General Manager Participant Experience and Design.

24. Feedback

If you have any feedback about this Practice Guide please email Service Guidance and Practice. In your email, remember to include the title of the resource you are referring to and to describe your suggestion or issue concisely.

25. Version change control

Version No	Amended by	Brief Description of Change	Status	Date
19.0	CS0074 JS0082	Agency and Plan Managed participants are able to use their Core funding flexibly even where $0 are allocated to the support category. For participants receiving periodic transport support, the Transport category is not flexible Class 1 and 2 approval.	APPROVED	2020-05-08
20.0	JS0082/ CW0032	From 16 June self-managed participants can use their Core funding flexibly across all four categories. Periodic transport is not included in Core flexibility. New guidance on making a reasonable and necessary decision for the inclusion of meal preparation and delivery in the participants plan. Class 2 Approval	APPROVED	2020-06-11

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Version Control

Version No	Amended by	Brief Description of Change	Status	Date
21.0	CS0074	Meal preparation and delivery content endorsed by Technical Advisory Branch (KM0032). Content approved (CW0032) Class 1 approval Additional task included in Prerequisites - Review and Submit for Funded Supports	APPROVED	2020-07-01

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Practice Guide — Determine Reasonable and Necessary Supports

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DOCUMENT 4

Purpose ………………………………………………………………………………………………………. 4
To be used by ………………………………………………………………………………………………. 4
Scope ………………………………………………………………………………………………………….. 4
Prerequisites ………………………………………………………………………………………………… 4
Planning ………………………………………………………………………………………………………. 5

5.1  No reasonable and necessary supports identified ................................................... 5

The Typical Support Package (TSP) ………………………………………………………………… 6
Reasonable and Necessary ……………………………………………………………………………. 6
Core supports ………………………………………………………………………………………………. 7

8.1  Core budget flexibility .............................................................................................. 8

8.2  Meal preparation and delivery ................................................................................. 9

8.3   Transport ............................................................................................................... 12

9. Capacity Building supports …………………………………………………………………………… 14

9.1  Capacity building for self-managing support funding ............................................. 16

9.2  Funding for Plan Management .............................................................................. 16

9.3  CB Daily Activity .................................................................................................... 17

9.4  CB Employment ..................................................................................................... 17

9.5  Support Coordination ............................................................................................. 18

9.6   Provider Travel ...................................................................................................... 18

9.7  Medicare ................................................................................................................ 19

10. Capital supports ………………………………………………………………………………………….. 19

10.1    Assistive Technology .......................................................................................... 19

10.2  Home Modifications ............................................................................................ 20

11. Quote required support items ……………………………………………………………………….. 21

Plan Duration ……………………………………………………………………………………………… 21
Stated supports …………………………………………………………………………………………… 22
In-kind ……………………………………………………………………………………………………….. 22
Compensation …………………………………………………………………………………………….. 22
Changes to the TSP …………………………………………………………………………………….. 23

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Determine Reasonable and Necessary Supports

Parental responsibility … 23
Disability-Related Health Supports … 24
Other considerations … 25
Justification for reasonable and necessary supports … 25
- Justifications for plan management … 26
- Best practice justification examples … 26
Ghosting … 28
Plan Reviews … 28
The next steps … 28
- High Decision Delegate approval … 29
Appendices … 30
- Appendix 1 - Standard TSP Changes Summary … 30
Supporting material … 34
Process Owner and approver … 34
Feedback … 34
Version change control … 34

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1. Purpose

This Practice Guide will support you to consider the reasonable and necessary funded supports (if any) to be included in the participant’s National Disability Insurance Scheme (NDIS) plan.

2. To be used by

Plan Developers – Planners and Partners in the Community (Local Area Coordinators [LACs]).
NDIA Plan Delegates.

3. Scope

The National Disability Insurance Agency (NDIA) must be satisfied the funded supports in the participant’s NDIS plan meet each of the reasonable and necessary criteria outlined in:

section 34(1) of the National Disability Insurance Scheme Act 2013
the National Disability Insurance Scheme (Supports for Participants) Rules 2013
Operational Guideline - Including Specific Types of Supports in Plans.

Important: Do not use this Practice Guide if you are planning for participants less than seven years of age. Refer to the Standard Operating Procedure - Determine the Funded Supports for Early Childhood Early Intervention (ECEI).

4. Prerequisites

Before you consider any reasonable and necessary funded supports, you must:

Complete and submit all relevant and mandatory pre-planning tasks.
Complete the Review and Submit for Funded Supports acknowledgement. When this step is not completed, you may not be able to access the Determine the Funded Supports task.
Make sure the primary disability recorded on the participant’s record is correct.
Check the appropriate severity indicator tool has been completed. You can find further information in Standard Operating Procedure – Update Severity Tools.
Check the plan duration recorded within the Risk Assessment task reflects the participant’s circumstances. You can find further information in Standard Operating Procedure – Complete the Risk Assessment
Discuss with the participant, their plan nominee or child representative(s) who they want to manage the support funding in their plan. You can find further information in Standard Operating Procedure – Determine Plan Management.

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Planning

 Check the Practice Guidance page of the intranet and use other practice guidance relevant to the participant’s circumstances together with this Practice Guide. For example Practice Guide – Motor Neurone Disease (MND), Practice Guide – Younger People in Residential Aged Care or Practice Guide – Assistance Animals.

Planning

During the planning conversation with the participant, their child representative and/or nominee you will develop an understanding of the participant’s individual circumstances. You will also gather information to complete the pre-planning tasks and create a personalised plan.

When completing the pre-planning tasks you recorded the mainstream, informal and community supports the participant currently uses, and their goals. You now need to determine which reasonable and necessary funded supports (if any) will be included in the participant’s plan to support them to achieve their goals.

Planning tasks may be completed by NDIA staff or Partners in the Community and include:

 understanding the participant, their individual circumstances and their support needs  providing information about the principles of the NDIS  assisting the participant to identify their goals  identifying any supports the participant currently receives through mainstream, informal and/or community channels including any funded supports in place  identifying any risks  identifying the appropriate reasonable and necessary funded supports  identify how the participant would like the funding in their plan managed, including any request to self-manage, and make a plan management recommendation.

5.1 No reasonable and necessary supports identified

In some cases, the participant may meet the NDIS access requirements however there are no reasonable and necessary supports identified for the current plan. You may determine mainstream, community and/or informal supports currently meet the participant’s support needs, but in the future the participant is likely to require funded supports. For example, for a participant living with a slow degenerative condition, you may determine for the current plan period the participant only needs support to better understand the condition and improve their health and well-being.

If no reasonable and necessary funded supports are identified:

 Complete the participant statement.  Complete the pre-planning tasks.

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 Develop the participant’s plan - in the Determine the Funded Supports task do not generate the support plan. Instead, submit the task with $0.00 funding.

 Complete an interaction which includes details of:

- your discussions with the participant,

- justification for your decision that no funded supports are required in the
  participant’s current plan.

The participant’s plan will outline the informal, community and/or mainstream supports that will meet the participant’s goals and support needs.

6. The Typical Support Package (TSP)

The TSP is an amount of funding based on the participant’s disability, individual support eeds and characteristics. TSPs provide an efficient, evidence-based and nationally consistent approach to planning.

During the planning conversation you will gather and record information in the NDIS Business System (System) including the participant’s age, primary disability, other disabilities, level of functional impairment, current and potential mainstream, informal and community supports.

The primary disability recorded in the System is one of the factors which influence the TSP. If the participant has more than one impairment, you need to record the primary disability as the impairment which has the greatest functional impact on the participant.

The NDIS actuarial team developed TSPs in collaboration with disability experts. These include people with a disability, professionals and subject matter experts. They take into consideration real life participant experiences and experiences gained through trial. Refer to Appendix 1 - Standard TSP Changes Summary.

Important: TSP is an internal term used by the Agency and should not be discussed with the participant.

7. Reasonable and Necessary

With the exception of Section 43 (Plan Management) of the NDIS Act, you must apply easonable and necessary decision making to NDIS funded supports in the participant’s plan to ensure the supports are effective and beneficial to the participant.

NDIS funded supports should:

 assist the participant to pursue their goals

 facilitate the participant’s social and/or economic participation

 represent value for money

 be likely to be effective and beneficial for the participant (having regard to current good practice)

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take into account what support is reasonable to expect families, carers, informal networks and the community to provide
complement (not replace) other government services. You must also consider whether any funded supports should not be provided or funded under the NDIS. A support will not be funded under the NDIS if it:
- is more appropriately funded by another government service
- is likely to cause harm to the participant or pose a risk to others
- is not related to the participant’s disability
- duplicates other supports delivered under alternative funding through the NDIS
- relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to the participant’s disability support needs
- is contradictory to a law of the Commonwealth or the State or Territory in which the support would be provided
- consists of income replacement. You should take a whole of person approach when considering which supports are reasonable and necessary in the participant’s plan. If the participant acquires an impairment after they have met access to the NDIS, you should consider how each impairment affects the participant’s life, and the support they need to achieve their goals. Your decision to include reasonable and necessary supports in the participant’s plan is based on whether the support meets all sections of the reasonable and necessary criteria. In exceptional circumstances some day-to-day living costs may be funded by the NDIS, if they are:
- additional living costs which are a direct result of the person’s disability support needs
- ancillary costs associated with a funded support, which the participant would not otherwise incur.

Core supports

Core supports assist the participant to manage aspects of their daily living such as self-care and accessing the community. There are four Core support categories:

Consumables: includes disability-related health consumables products, dog guide consumables, Low Cost assistive technology and interpreting services.

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 Daily Activities: includes assistance with self-care, including additional care for short periods used for carers respite, shared living arrangements, household cleaning and/or yard maintenance.

 Social, Community and Civic Participation: includes individual and group based community, social, recreational activity and economic participation. These supports may be used for day-to-day on the job assistance to assist participants to meaningfully participate at work. These supports may also be used for carers’ respite.

 Transport: includes general and specialised transport for attending school, employment or going out in the community.

You need to ensure the participant has the Core support funding they need to meet their plan goals. Review the funding generated by the TSP and either increase or decrease the level of support funding in line with the reasonable and necessary criteria.

You will record justifications for your decisions in the Review and Submit Plan for Approval and/or Finalised Plan and Approve tasks.

8.1 Core budget flexibility

The four Core support categories Consumables, Daily Activities, Social, Community and Civic Participation and Transport are flexible. This means funding from one Core category (such as Daily Activities) can be used to purchase supports from another Core category (for example, Consumables). For funds to be used flexibly, the categories must have the same fund management type (such as Agency Managed).

It is important to look at the total value of the Core supports (for instance total combined value of Consumables, Daily Activities and Social, Community and Civic Participation and Transport) when determining the reasonable and necessary Core support funding amount.

Often the TSP will only generate funding in one or two of the Core support categories. If this occurs, you will need to check how the funding is allocated. You may need to adjust how the funding is distributed based on the participant’s individual Core support needs, plan goals and circumstances. However, participants are able to use their funding flexibly across the Core categories, even if $0 are allocated to the support category.

If the participant receives periodic transport funding, the Transport category is not flexible. Periodic transport is not included in Core flexibility as it is paid directly to the participant. Activity based transport can be claimed from the participant’s Core funding by providers with the participants agreement. Refer to section 8.3 Transport for more information.

Although Core funds can be used flexibly, it is important to ensure the participant understands the Core funding can only be used to purchase reasonable and necessary supports in line with the plan’s objectives regardless of whether the funding is Agency, self or plan managed.

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Example of Core flexibility: Juan requires support to access his community activities and everyday use continence items.

Funding of $21,606 is included in Juan’s plan for his Core support needs, as follows:

Consumables: $4,000 (Agency managed $3,000, plan managed $1,000)
Daily Activities: $0
Social, Community and Civic Participation: $16,000 (Agency managed $9,000, plan managed $7,000)
Transport – $1,606 (periodic payment)

During his plan Juan has short term need for self-care support. Depending on the funding remaining available, Juan could chose to use the flexibility of his Core budget for Daily Activities (up to $12,000 Agency managed and/or up to $8,000 plan managed). Juan’s periodic transport budget of $1,606 is not flexible with his other Core funding.

Limitations to flexibility with stated supports

When considering making a Core support item Stated, carefully consider:

The impact on flexibility for the participant and their providers
Whether the support is a composite item. Providers are unable to claim for a specific time of day, day of week etc. if the composite item is stated.

Limitations to flexibility for transport in the Core budget

In exceptional circumstances, transport can be used flexibly however, only if;

the transport funding is not set up as an automated periodic payment, and
the transport funding is not included as a stated support, and
there are remaining funds in the Core budget to be utilised, and
the transport funding plan management type is the same as other Core Supports, and
the transport Service Booking is amended to a higher amount than what is provided in the transport category in the Core budget.

Meal preparation and delivery

The participant may request meal preparation and delivery to be included in their NDIS plan when they are unable to prepare meals due to their disability. Some examples include when the participant is experiencing:

difficulties with organisation
difficulties completing multi-step instructions
a physical disability that impacts their ability to prepare meals.

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For some participants the inclusion of meal preparation and delivery can support them to safely maintain independent living and reduce their reliance on other supports.

When making a reasonable and necessary decision on including meal preparation and delivery in the participant’s plan you should consider:

goal attainment and building independence
the functional impact of the participant’s disability for the preparation of meals
assessments
duplication of funding
reviewing the quote
considerations when including funding in the participant’s plan.

8.2.1 Goal attainment and building independence

You need to consider how including funding for meal preparation and delivery will assist the participant to achieve their goals and build their independence.

Talk to the participant to understand how meal preparation and delivery will support them. Discuss:

How they currently prepare meals?
How meal preparation and delivery will support them to achieve their goals?
Have they considered other supports that would develop their ability to prepare meals more independently such as an individualised program and support to participate in preparation of meals? Is this something they would like to do? Have they tried this previously? If yes, what were the outcomes?
Have they explored the use of Assistive Technology (AT) to assist with meal preparation tasks? Is this something they would be interested in exploring?
Are there risks for the participant preparing their own meals?

For participants with the potential to develop independence in meal preparation you should consider funding for meal preparation and delivery while they explore AT and capacity building supports. At the next scheduled plan review the plan developer and participant can discuss the outcomes of these supports to determine whether meal preparation and delivery continues to be required.

8.2.2 Meal preparation for children

When the participant is a child and they require mealtime preparation that is above what would be considered reasonable to expect families and carers to provide you should consider the inclusion of funding for meal preparation and delivery.

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For example, the family or caregiver for a child who is on a ketogenic diet due to their disability needs may need significantly more time for meal preparation than a child not on a specialist diet due to their disability needs.

Discuss requests for meal preparation and delivery for the child participant with your line manager. Seek further advice from the Technical Advisory Branch if you are still uncertain that the request meets the reasonable and necessary criteria.

8.2.3 Assessments

Assessments may be useful in helping you make a decision on whether to include meal preparation and delivery in the participants plan. However, they are not always necessary when there is a clear link between the functional impact of the participant’s disability and preparation of meals.

For example, you may find that you have enough information to make a reasonable and necessary decision using information from the planning conversation, previous reports, previous NDIS plans and other supporting evidence.

If the participant gives you a copy of an assessment from a suitably qualified allied health professional supporting their request for meal preparation and delivery you need to consider this when making your decision.

You may be able to use information from a previous assessment to better understand the participants support needs where there has been no change to the participant’s functional capacity.

You should only ask the participant for an assessment from a suitably qualified allied health professional if you have reviewed all current information and still need additional information to make your decision. When you request an assessment, make sure you include funding in the Capacity Building budget for this to be completed.

8.2.4 Duplication of funding

If you are including support for meal preparation and delivery in the participants plan you need to review other supports to make sure you are not duplicating funding.

Examples of other areas where support may be duplicated are:

funding for a support worker to assist the participant to prepare the meals
funding for a support worker to assist the participant with their mealtime management routine
when the participant is receiving support for 24 hours each day (for example, SIL)
funding for capacity building supports to build independence in meal preparation.

Note: There may be times where these supports are not duplications. If you are unsure, please discuss with your line manager.

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8.2.5 Reviewing the quote

Meal preparation and delivery is a quote-required support. This means that the participant needs to submit a quote for you to consider as part of the reasonable and necessary decision making process.

When you are reviewing the quote, check:

The amount is for the preparation and delivery of meals only. NDIS does not cover the cost of food as this is considered a day-to-day living cost.
The quote is value for money.
You can check if a quote is value for money by comparing the quoted amount to the Product Catalogue (benchmark price) in the System. If it is 10% over the catalogue price, seek decision-making advice from your line manager.

8.2.6 Considerations when including funding in the participants plan

If the request meets the reasonable and necessary criteria you need to:

Include funding for the support using the participants plan management preference.
Include a comment in the plan so that the participant knows that funding has been included.
For example, “$xx.xx per week of funding for meal preparation and delivery.”

8.3 Transport

Transport funding should be considered when the participant is unable to use public transport without substantial difficulty due to the impact of their disability.

Transport funding does not cover transport assistance which is considered a day-to-day living cost. For example, transport to appointments, shopping or recreational activities.

This support needs to be directly linked to plan goals and include a skill development focus.

You should use the three levels of supports for transport assistance as a guide only:

Level 1 $1606-$1,784: For participants who are not working, studying or attending day programs but want to enhance their community access.
Level 2 $2472-$2,676: For participants who are currently working or studying part-time (up to 15 hours a week), participating in day programs and for other goal based social, recreational or leisure activities.
Level 3 $3456-$3,567: For participants who are currently working, looking for work, or studying (15 hours or more a week), and are unable to use public transport because of their disability.

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To ensure the participant has transport funding to meet their transport support needs, you will need to review the TSP generated amount. Also consider the levels of support for transport assistance and include an amount based on your reasonable and necessary decision making.

Record justifications for your decision in the Review and Submit Plan for Approval and/or Finalise Plan and Approve Task.

Important: If a participant is currently receiving mobility allowance from Centrelink, this allowance will stop upon approval of their first NDIS plan.

8.3.1 Transport periodic payments

Unlike other support categories, transport can be paid to participants as an automated periodic payment (fortnightly payment).

The System will automatically tick the Periodic Payment check box next to the Transport support category in the Determine Funded Supports Task. This means the funding is paid periodically to the participant.

It is important to review this and update the check box to reflect the participant’s circumstances. For example, if transport funding is in-kind you need to untick the Periodic Payment check box.

Periodic payments are self-managed payments. You must discuss this with the participant, their child representative and/or plan nominee.

You should not approve self-managed periodic payment:

when current bankruptcy is declared in the risk assessment,
if self-managing transport funding is likely to present an unreasonable risk to the participant.

So that periodic payments can be made, you need to check bank account details of the participant, their child representative and/or plan nominee are collected and recorded in the System before the plan is approved. Refer to Standard Operating Procedures – Record Bank Details.

8.3.2 Participant transport as part of community participation

The participant can use funding from their Core budget for a support worker to help them participate in community outings and/or transport from their home to the community. Providers claim these costs at the relevant community participation hourly rate. When the provider is supporting more than one participant to access the community at the same time, they need to claim the group rate.

Funding from the participant’s Core budget can also be used for the provider’s non-labour costs associated with providing transport to participants:

accessing community participation supports

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 accessing or maintaining employment

 accessing or maintaining or higher education.

Non-labour costs associated with participant transport can include:

public transport fares
road tolls
parking fees
reasonable vehicle running costs
- up to $0.85 a kilometre for a standard vehicle not modified for accessibility
- up to $2.40 a kilometre for a vehicle that is modified for accessibility or a bus
taxi or ride-share fares.

You need to consider the non-labour costs associated with providing this transport when determining the reasonable and necessary Core funding in the participant’s plan.

8.3.3 Provider travel

Provider travel is different to participant transport. There are two types of provider travel:

travel to provide daily activities and community access (Core) supports
travel to and from Capacity Building supports – refer to section 9.5 Provider Travel for further information.

When the participant agrees, providers can claim the time spent travelling to the participant. Only the actual travel time can be claimed.

For Core support, this refers to the time spent by the provider travelling to deliver a service to the participant (participant is not in the car). Where a support worker provides services to more than one participant the travel time can be shared between the participants, if each participant agrees in advance.

You may need to consider provider travel for delivering Core supports when developing Core funding in the participant’s plan. Maximum limits apply to the amount of travel time providers can claim. Refer to NDIS Price Guide for further information on provider travel.

When implementing the plan, participants should be encouraged to negotiate their supports with providers, particularly around the cost of provider travel.

9. Capacity Building supports

Capacity Building (CB) supports assist participants to increase their ability to live their life independently.

These supports are designed to deliver improved outcomes for the participant and reduce the need for funded supports in the future. CB supports focus on outcomes and are always linked to one of the participant’s goals.

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Unlike the Core support budget, CB supports are only flexible in the same CB support category. For example, funding from CB Daily Activity can be used flexibly across all non- stated support items in the CB Daily Activity budget, and cannot be used to purchase supports from any other CB budget.

In the System, the TSP will generate CB support funding based on the response to the guided planning question ‘What level of Capacity Building is required?’ You need to apply easonable and necessary decision-making regardless of whether CB support budget funding has or has not been generated by the TSP.

The exception is Plan Management (Financial Administration) supports. When the participant requires Plan Management, you must include funding in the CB Choice and Control budget. For further information refer to Standard Operating Procedure - Plan Management and Financial Administration Support Items.

All funding generated for Capacity Building will default to the CB Choice and Control budget. You will need to allocate the funding across the relevant CB budgets as you determine the easonable and necessary supports in line with the participant’s goals and expected plan outcomes.

The nine Capacity Building (CB) support categories are:

CB Choice and Control: Includes support items relating to plan management and financial administration. Refer to section 9.2 Funding for Plan Management below.
CB Daily Activity: Individual assessment/therapy/training, group therapy, carer/parent training and individual skills development. Refer to section 9.3 CB Daily Activity below.
CB Employment: Includes School Leaver Employment Support (SLES) and employment-related assessments and counselling. Refer to section 9.4 CB Employment below.
CB Health & Wellbeing: Includes dietary and exercise physiology supports.
CB Home Living: Includes assistance with accommodation and tenancy obligations.
CB Lifelong Learning: Includes transition through school and to further education.
CB Relationships: Includes behaviour support, as well as social skills development and capacity building. Refer to Practice Guide – Positive Behaviour Support and Behaviours of Concern for information on including supports to address Behaviours of Concern (BoC).
CB Social, Community and Civic participation: Includes community participation activities, skills development and training as well as life transition planning such as mentoring and peer support. These supports may sometimes be used for carers respite.

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9.1 Capacity building for self-managing support funding

The participant should be presumed to have the capacity to self-manage unless there is unreasonable risk. This is supported by the NDIS legislation and principles of the NDIS. Funding may be included in the participant’s plan to build capacity and support their goal to self-manage supports in their plan now, or in the future. This is a reasonable and necessary decision under section 34 of the NDIS Act.

When considering supports to build, or continue to build the participant’s capacity to manage their support funding, consider:

strategies to safeguard the participant’s interests, including informal supports
supports which could build the participant’s independence and capacity to self-manage
whether including additional supports in the plan could mitigate risks to the participant
whether support with budgeting, bookkeeping and financial record keeping will support the participant’s goal to manage their supports in the future
any supports to assist the participant to negotiate services and utilise the supports in their plan.

For further information about the different types of plan management, who can manage NDIS funds and capacity building supports for self-management, refer to Practice Guide – Determine Plan Management.

9.2 Funding for Plan Management

Plan management and financial administration funding is a stated support that allows the participant to engage an NDIS Registered Plan Manager to manage the financial functions of their plan.

Funding for plan management and financial administration support is not included in the TSP. If the participant, their nominee or child representative requests to have a plan manager for one or more of their supports, you are required to add funding for the plan management activities in the participant’s plan.

The participant’s choice to have a plan manager manage the funded supports in their plan is a legislative entitlement under section 43(2) of the NDIS Act 2013. Where the participant requests their funding to be managed by a plan manager, this is not subject to reasonable and necessary criteria.

Refer to Standard Operating Procedure - Plan Management and Financial Administration Support Items to include financial administration supports in a participant’s plan.

Where it is a goal of the participant to learn how to manage their own funds and/or build capacity to self-manage their plan, if reasonable and necessary, this support funding is included in one of the following CB budgets:

CB – Choice and Control (Plan and Financial capacity building): Generally used when a participant is plan managed and has goals around financial independence and/or to build capacity to move to self-managing in the future.
CB – Support Coordination (Training in Planning and Plan Management): Generally used for participants who are self-managed and require some assistance to get started with this process, or where a participant has support coordination included in their plan and the plan is not plan managed.

When including funding to build capacity to self-manage, ensure you discuss whether the participant will be able to locate and access appropriate service providers to assist them.

9.3 CB Daily Activity

9.3.1 Allied Health Practitioners

Allied health practitioners (AHP) hold a university qualification, specialise in different areas and work directly with the person requiring support. AHPs are not part of the medical, dental or nursing professions. AHPs include, but are not limited to: occupational therapists, physiotherapists, speech therapists, exercise physiologists, psychologists, prosthetists or orthotists, podiatrists, dieticians or respiratory therapists.

Refer to Practice Guide – Understanding Therapy Supports for a full description of each of the allied health practitioners.

Reasonable and necessary funding can be included in the participant’s plan to meet their disability-related health support needs. For example continence supports, diabetic supports, dysphagia supports, epilepsy supports, podiatry supports, nutrition supports, podiatry and foot care supports, respiratory supports or wound and pressure care supports. Refer to section 16.2 Disability-Related Health Supports and Practice Guide – Disability-Related Health Supports for further information.

9.3.2 Nursing

Reasonable and necessary nursing supports can be included in the participants plan to meet their disability-related health support needs as per section 6.8 of Practice Guide – Disability- Related Health Supports.

9.4 CB Employment

The CB Employment category includes School Leaver Employment Support (SLES), and employment-related assessments and counselling.

9.4.1 School Leaver Employment Support (SLES)

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SLES funding will be auto-generated as part of the TSP to the CB Employment budget based on the response to the guided planning question, ‘Is the participant eligible for School Leaver Employment Support (SLES)?’ For the current guidance on SLES, please refer to the Employment intranet page.

9.5 Support Coordination

The Support Coordination category is part of the Capacity Building budget but is separate from the eight Capacity Building (CB) sub-categories. This category includes the support items for support connection, support coordination and specialised support coordination, as well as support for building a participant’s capacity to learn to self-manage their own plan (training in planning and plan management).

Refer to:

Appendix 1 – Standard TSP Changes Summary
Standard Operating Procedure – Update Participant Streaming
Standard Operating Procedure – Include Support Coordination in a Plan.

9.6 Provider Travel

Providers of some supports are able to claim non-direct services, including provider travel, short notice cancellations and where an NDIA report is required.

Provider travel for capacity building supports can be claimed for travel to each participant, and return travel from the last appointment of the day. The participant must agree to the travel costs to be claimed in advance.

Where a worker travels to an area and provides services to more than one participant, if agreed to in advance by each participant, the cost of time and travel could be split between the participants.

CB support categories where providers may be able to claim provider travel include:

CB Daily Activity
CB Social Community and Civic Participation
CB Employment
CB Relationships
CB Health and Wellbeing
Support Coordination.

When considering the level of reasonable and necessary CB supports, consider how the services will be delivered. Also consider any other circumstances that may affect how the participant utilises their plan funding, such as provider travel, and how this may impact the level of supports available, particularly for participants living in regional and remote areas.

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Medicare

The participant may access Medicare funded allied health services with a referral from their GP alongside allied health supports funded in their NDIS plan. There is no requirement for the participant to use or exhaust these Medicare funded services before receiving allied health supports funded in their NDIS plan if the supports required relate to the participant’s functional impairment and are considered reasonable and necessary.

Where considered reasonable and necessary, the funded supports should be included to cover the full cost of the supports. Where Medicare funded allied health supports are not considered reasonable and necessary, the supports funded through Medicare can work side by side with other funded supports to enable the participant to achieve their goals.

For example:

NDIS funded psychology supports to address disability related barriers and build capacity to engage in social situations and participate in employment.
The participant also accessed Medicare funded psychology supports for clinical treatment such as ongoing counselling and medication management (not funded by the NDIS).

Capital supports

Capital supports assist a participant to increase independence and participation in a range of different environments, such as their home, community and the workplace.

The two support categories within Capital are Assistive Technology and Home Modifications.

When responses to the guided planning questions generate assistive technology or home modifications support funding, the intended purpose is to fund equipment or an assessment appropriate to meet the participant’s needs.

Unlike the Core support budget, Capital support categories are not flexible between Assistive Technology and Home Modifications.

It is the responsibility of the plan developer to review the TSP generated Capital supports and adjust the budget amounts for the participant’s reasonable and necessary support needs.

Note: Capital items including AT and Home modifications must not be added to a plan (even if they are quote required) unless evidence and reports are attached in the System to justify that the equipment is reasonable and necessary.

10.1 Assistive Technology

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Includes equipment for mobility, personal care, communication and recreational inclusion such as wheelchairs, pressure mattresses, standing frames, bathing and toileting equipment, personal readers and vision equipment, and vehicle modifications.

For further information on including Assistive Technology within a plan refer to:

Practice Guide – Assistive Technology
Standard Operating Procedure – Include Assistive Technology (AT) in Plans
Standard Operating Procedure – Assistive Technology or Home Modification Supports between $1,500 and $5,000
Assistive Technology (AT) Complexity Level Classification.

10.2 Home Modifications

Home modifications includes interior and exterior home modifications, consultation and project management. For further information on including funding for Home Modifications in the participant’s, refer to the Standard Operating Procedure – Include Home Modification Supports in Plans.

10.2.1 Specialist Disability Accommodation (SDA)

The support item for Specialist Disability Accommodation (SDA) sits in the Home Modifications budget of a plan.

The three different types of SDA are:

new
in-kind
existing.

The two occasions when SDA may be included in a plan are:

when there is a new SDA decision
when the participant was already residing in disability related supported accommodation at the time of transition to the NDIS.

10.2.1.1 Existing or In-Kind SDA

When the participant is already residing in an SDA dwelling when they transition to the NDIS they are considered to be in existing or in-kind SDA. SDA funding needs to be included in the participant’s NDIS Plan. Refer to:

Standard Operating Procedure – Include Existing (non in-kind) SDA in a Plan: Participants Residing in SDA Prior to Transition
Standard Operating Procedure – Adding In-Kind Supports in a Plan.

10.2.1.2 A new SDA decision

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When the participant wishes to move in to SDA for the first time or wishes to move to a different SDA dwelling, from an existing or in-kind SDA dwelling, this is considered to be new. SDA.

For new SDA, the SDA support funding must not be included in the participant’s plan without referral to the SDA panel for advice.

The SDA panel will review the SDA eligibility and provide a recommendation for the participant’s SDA request. The SDA panel will also provide information on the eligible SDA type and level for the participant. This information is recorded in the Housing and Accommodation section of the participant’s record.

Refer to Standard Operating Procedure – Determine Specialist Disability Accommodation - Change of Address or a New Decision.

Note: For more information regarding transitional accommodation, while the participant is waiting for Assistive Technology or Home Modifications, refer to the Practice Guide - Medium Term Accommodation.

11. Quote required support items

A quote is required for some supports such as high cost assistive technology, complex home modifications and vehicle modifications.

Where a quote required support is included in the participant’s plan the quote process must be followed. For further information refer to Standard Operating Procedure – Manage Quotations.

12. Plan Duration

The duration of the participant’s plan may vary depending on the participant’s disability, streaming decision and individual circumstances. You can find guidance for determining plan duration in Standard Operating Procedure – Complete the Risk Assessment.

The TSP generates Core supports based on the chosen plan duration. For example, a 36- month plan will generate 36 months of Core supports, a 24-month plan will include 24 months of core supports and a 6-month plan will generate 6 months of Core supports.

Manual adjustment may be required for Capacity Building and Capital supports for plans other than 12 months duration. You will need to use reasonable and necessary decision making to adjust funding in these budgets to reflect the participant’s needs for the duration of the plan.

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13. Stated supports

A stated support is a support recorded in the plan at the support item level, and selected as stated in the support calculator.

When a support is stated the funding for that item can only be used for that particular support. As defined in Part 6 of the NDIS (Plan Management) Rules, stated supports must be purchased by the participant as they are described in the plan.

Carefully consider if a support you are including needs to be stated, as stated items reduce flexibility for the participant and the provider.

When including stated support item(s), make sure the comments in the related support category clearly outline the intent of the stated support.

For example: In CB Relationships, you may include a stated support item for the development of a Behaviour Support Plan by a registered provider. Marking the support item as stated quarantines this funding from the rest of the support category budget, and ensures it can only be used by the participant as intended.

14. In-kind

Before the NDIS was established, states and territories paid service providers directly to deliver services to people with disabilities. In some situations, states and territories continue to pay for these services directly and NDIS participants continue using these services.

When these pre-paid supports are provided as reasonable and necessary supports in the participant’s plan they are called in-kind and must be recorded as in-kind specifically within the participant plan. Refer to Practice Guide – In-Kind.

15. Compensation

If the participant responds ‘yes’ to the risk assessment question ‘Is your disability the result of an accident or event?’ this indicates the participant has received, or is entitled to receive compensation. Additional questions will be generated in the System for you to complete in relation to compensation.

Compensation, for NDIS purposes, is either a lump sum or periodic payment.

If you identify the participant is, or has been entitled to compensation, follow the steps below:

Give the participant or their nominee the Compensation and the NDIS Fact Sheet.
Advise the participant or nominee they can get additional information on the Compensation and your plan page of the NDIS website.
Email the Compensation Recoveries Team (CRT) as soon as you become aware of the potential for compensation. In the subject line of your email include the participant’s NDIS number and last name.

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Changes to the TSP

Add an alert to the participant record in the System.
Create an interaction that compensation has been identified.
Proceed with developing and approving the participant’s plan.

For further information refer to the Compensation intranet page.

Sometimes, the generated TSP has not enough or more than enough funding to meet a participant’s needs or enable them to achieve their goals. Funding generated in each individual support category is informed by the participant’s support needs identified in response to the details recorded in the System. Use reasonable and necessary decision making to adjust the TSP up or down in response to information available to you regarding the participant and their individual circumstances.

Sometimes, evidence of support needs may indicate that the funding generated in the TSP is above the reasonable and necessary support requirements. For example, a participant may be very engaged in the community for recreational and social activities or be working, and have strong, sustainable informal care networks. This information must be taken into account when determining the funded supports to prevent supports being funded in the plan that are in addition to what is reasonable and necessary.

The standard TSP changes include varying the TSP for specific supports. These supports include:

Defined Programs
Plan Management costs
Behaviours of Concern
Supported Independent Living (SIL) (group)
Specialist Disability Accommodation (SDA)
Assistive Technology (including composite items)
Home Modifications
Coordination of Support
School Leaver Employment Services (SLES)
Australian Disability Enterprises (ADE).

16.1 Parental responsibility

You must also recognise parental responsibility when considering funded supports for children under 18 years. All parents are responsible for providing substantial care and s \support for their children whether they experience a disability or not, for example, transporting them to activities and meeting the cost of after school activities.

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Reasonable and necessary disability-related health supports can be included in a participant’s NDIS plan if they:

directly relate to a person’s ongoing functional impairment, and
are a regular part of daily life, and
are most appropriately funded or provided by the NDIS, and
are evidenced meaning supporting information can generally be obtained.

Refer to the Practice Guide – Disability-Related Health Supports for full guidance. For further information about specific disability-related health supports refer to the relevant practice guidance:

Practice Guide – Continence Supports
Practice Guide – Diabetic Management Supports
Practice Guide – Dysphagia Supports
Practice Guide – Epilepsy Supports
Practice Guide – Nutrition Supports
Practice Guide – Podiatry and Foot Care Supports
Practice Guide – Respiratory Supports
Practice Guide – Wound and Pressure Care Supports

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It is unlikely that funding for most disability-related health supports will be generated in the TSP. This means you will need to include them as a reasonable and necessary adjustment to the TSP. Make sure you include the participant’s need for disability-related health supports in your justifications for increasing the TSP and include a comment in the NDIS plan to describe these supports.

16.3 Other considerations

16.3.1 Duplication of supports

Consider duplication of supports when developing the plan. For example, if it has been deemed reasonable and necessary to include SLES or ADE supports in a participant’s plan to achieve their goal of economic and social participation, then funding generated by the TSP in other support categories (such as social, community participation) which achieve the same goal should be reduced or removed where appropriate.

16.3.2 Evidence

Any decision to vary the funding generated by the TSP must be informed by validated supporting evidence and have a justification recorded in the System to allow the delegate to make the funding decision. Supporting evidence includes the lived experience of the participant and published peer-reviewed literature. If the TSP is exceeded as a result of a easonable and necessary decision, clear evidence from a relevant professional or written information supporting your recommendation must be attached to the participant record and referenced in the plan justification.

16.3.3 Increases over 10%

Any increase to the TSP above 10% must be reviewed by an executive level delegate prior to plan approval. Record details of this review, including the name of the reviewing delegate, in an interaction. If you are the plan developer, details can be recorded when completing the Plan Approval Considerations – Plan Submitted for Approval interaction template. If you are the plan delegate, details can be recorded when completing the Plan Approved and Ready for Implementation interaction template.

16.3.4 Technical Advisory Branch (TAB) referrals

Ensure you submit TAB mandatory referrals. Where you are unable to make a decision on what is reasonable and necessary (for instance high cost or high complexity requests), liaise with your manager/s and your TAB Regional Advisor as a first step. If you are still unable to make a reasonable and necessary decision make a request for TAB advice.

17. Justification for reasonable and necessary supports

Plan developers and delegates must record a justification for each support category in the participant’s plan. Justifications should be clear and concise, and only include information relevant to your decision.

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You must include the following information in each justification:

description of the support and how it relates to the participant’s disability support needs
how the support will help the participant achieve their goals
how the support meets reasonable and necessary criteria
refer to any supporting evidence to support the inclusion of proposed supports.

17.1 Justifications for plan management

Plan management funding (plan management set up and administration fees) is not a reasonable and necessary decision.

You do not need to provide detailed justification for this support. Refer to section 9.2 Funding for Plan Management for more information on these supports.

You can record the following standard justification for this support:

Plan management fees – Funding for the plan to be plan managed as requested.

Note: Funding to support the participant to learn to self-manage their funding is a reasonable and necessary decision, and you will need justify including this support. Refer to Practice Guide – Determine Plan Management.

17.2 Best practice justification examples

Note: Names used in the examples are fictitious.

Helen has a moderate intellectual disability and requires support to access her community and to participate in individual and group activities in order to achieve her goal of continuing to spend time with her friends.

Core funding is included for Helen to attend her current group day program three days (18 hours) per week. Funding is also included for 1:1 support three hours per week to attend her community choir group. These supports will help her maintain her friendships and social activities, as she is unable to participate without support. Helen’s parents will continue to support her at home, including overnight and on weekends.

17.2.2 Example 2 – Capacity Building Supports: CB Relationships

Michael has complex behaviours of concern and has a current behaviour support plan (refer to “Behaviour Support Plan 2020” uploaded to inbound documents). Funding for ongoing monitoring and review of the behaviour support plan will support Michael to:

build capacity in managing his emotions
develop relationships with others

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enhance his communication skills
develop, implement and review strategies to engage appropriately with others at home and when out in the community.

These strategies will support Michael’s goal of accessing the community, and help him build stable relationships with his support network. It is anticipated this support will reduce his need for intensive 1:1 funded supports over the next 12 months, therefore representing value for money in the long term.

17.2.3 Example 3 – Capacity Building Supports: CB Daily Activity

Lucy has a primary disability of bi-polar disorder and a secondary disability of vision impairment. Lucy has a goal of being able to do more things for herself at home. Specifically, she would like to be able to prepare a basic meal for her family.

Lucy has difficulty reading a recipe, following the instructions and operating kitchen appliances. She currently relies on her parents to complete all meal preparation tasks. This funding allows an occupational therapist to assess her capacity to complete household tasks independently. The therapist can recommend capacity building strategies in a skill development plan, and recommend assistive technology to help her achieve this goal.

17.2.4 Example 4 – Capital Supports: Assistive Technology replacement

Salim has cerebral palsy and currently uses a manual wheelchair that is seven years old. Salim said at the planning meeting that the wheelchair cannot be repaired, and he will need a new wheelchair in the next two months so that he can continue going out independently.

Salim submitted a quote for a new, similar wheelchair for $9,684.00.

Salim’s occupational therapist has stated the new wheelchair does not pose significant risks. The replacement wheelchair meets the three criteria for replacement AT in the Practice Guide – Assistive Technology:

Evidence of existing use – Salim has submitted the original purchase receipt, and a report from his repairer that his current wheelchair cannot be repaired.
No change to functional capacity – the Occupational Therapist letter uploaded to inbound documents states that his support needs are stable.
Cost – the new wheelchair is less than $15,000.

17.2.5 Example 5 – Core Supports: Transport

Sally has autism, and cannot use public transport independently. Currently, she does not know how to hail a bus or which stop to get off. She also experiences anxiety in crowds and public places. One of her goals is to join a sports class approximately 20 minutes away from home. She will not require support when she is at the class.

Funding is included for Level 1 transport to allow her to use taxis to attend the class and other social activities. Sally is not currently working or studying, but she is looking to increase her community access. The funding in the Capacity Building Daily Activity support category

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will support her to build her skills in using public transport independently. She may not require transport support in future plans.

18. Ghosting

There are issues with ghosting in the Determine the Funded Supports task in the System. Ghosting means that supports that have been added using the support calculator and later removed may still show up in the Finalise Plan and Approve task. For more information, refer to the Standard Operating Procedure – Determine Reasonable and Necessary Supports.

19. Plan Reviews

When determining the funded supports at plan review, you must consider the previous plans value and the utilisation of any funded supports in comparison with the new plan’s total budget, including the generated TSP. The duration of a plan will affect the supports generated in the TSP. Changes to the plan duration or funded supports will impact on the type of plan review you should conduct.

For guidance on determining the plan duration refer to Standard Operating Procedure – Complete the Risk Assessment.

For information on completing a plan review, refer to:

Scheduled Plan Review Approach – Support Tool
Standard Operating Procedure – Complete a Plan Review (full)
Standard Operating Procedure – Complete a Plan Review (light touch)
Standard Operating Procedure – Complete a Scheduled Plan Review (Renewal).

20. The next steps

Once you have completed and submitted the Determine Funded Supports and Determine Plan Management tasks, submit the draft plan for approval via the Review and Submit Plan for Approval task, refer to Standard Operating Procedure – Review and Submit a Plan for Approval.

The plan approval decision will involve the plan delegate reviewing all available information and evidence on the record relating to the participant’s circumstances, their capacity and any r risks and safeguards. Evidence and justification to support the inclusion of funded supports in the plan (as recommended by the plan developer) to meet reasonable and necessary will also be reviewed and considered as part of the plan approval decision.

Prior to submitting a plan for approval it is important you are satisfied you have provided enough evidence to justify and support the proposed reasonable and necessary funding incluing any adjustments to the TSP with the justification recorded in the Review and Submit Plan for Approval task.

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20.1 High Decision Delegate approval

Depending on the overall plan value and/or other risk factors, the plan may need to be assigned to the High Decision Delegate (HDD) team for review and approval. The System will not allow a delegate with insufficient delegation to approve the plan. If delegation level 4 approval is required, follow the steps as outlined in the Standard Operating Procedure – Finalise and Approve a Plan.

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21. Appendices

21.1 Appendix 1 - Standard TSP Changes Summary

The TSP is the first step in determining the reasonable and necessary funded supports and you may need to adjust the funding generated using reasonable and necessary decision-making principles to reflect participant’s individual circumstances.

This document is a guideline for determining reasonable and necessary supports for specific items. Items or supports listed as TAB mandatory referrals must be submitted to TAB for advice.

Any variation to the TSP must meet the reasonable and necessary criteria and be informed by validated evidence which is recorded in the System in the Review and Submit Plan for Approval and/or Finalise Plan and Approve tasks. Increases to the TSP above 10% must be approved by an executive level delegate and this approval recorded in an interaction before the plan is approved. Assessment reports and other supporting evidence must be attached as an inbound document.

Topic	Considerations for Change	Guidance
Defined Programs	Some participants are transitioning to the NDIS from Defined Programs. These participants must not be disadvantaged by their move to the NDIS; however, funded supports can only be included in a plan if they meet the reasonable and necessary criteria. There should be appropriate reasonable and necessary supports in the plan to enable the participant to achieve at least the same outcomes as they were receiving prior to transition. This is not necessarily the same level of funding — rather it is their ability to achieve the same level of outcomes.	Standard Operating Procedure – Determine Reasonable and Necessary Supports Planning Operational Guideline – 10.9.1 The Principle of “no disadvantage”
	Note: In some cases, the participant may have been receiving supports prior to entering the NDIS that do not meet the reasonable and necessary criteria and these cannot be funded in their NDIS plan.

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Considerations for Change

Topic	Considerations for Change	Guidance
Behaviours of Concern	Some participants require supports to address behaviours of concern. There may not be enough funding in the generated TSP to allow for the required behavioural supports. Use reasonable and necessary decision making to increase the CB Relationships budget as required.	Standard Operating Procedure — Behaviour Intervention Supports
Supported Independent Living (Group) and Specialist Disability Accommodation (SDA)	For Supported Independent Living (SIL) — add supports in accordance with the relevant resource.
Note: To avoid duplication of supports, it is important that the relevant SIL guidance is followed and adjustments made to the Core budget as required.
For existing and in-kind SDA — add supports in accordance with Standard Operating Procedure — Include Existing (non In-Kind) SDA in a Plan or Standard Operating Procedure — Adding in-kind Support to a Plan. For new SDA refer to SDA Panel.	Practice Guidance — Identifying Housing Solutions
Standard Operating Procedure — Include Existing (non in-kind) SDA in a Plan: Participants Residing in SDA Prior to Transition
Standard Operating Procedure — Adding in-kind Support to a Plan
Standard Operating Procedure — Include Supported Independent Living (SIL) in Plans
Standard Operating Procedure - Determine Specialist Disability Accommodation - Change of Address or a New Decision
Assistive Technology	Funds to be allocated according to the Standard Operating Procedure - Assistive Technology and Practice Guide — Assistive Technology.	Standard Operating Procedure - Include Assistive Technology (AT) in Plans
TAB
Practice Guide — Assistive Technology

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Considerations for Change

Topic	Considerations for Change	Guidance
Home Modifications	Funds to be allocated according to the Standard Operating Procedure — Include Home Modifications Supports in Plans.	Standard Operating Procedure — Include Home Modification Supports in Plans
Coordination of Supports	Where indicated as being required in the Guided Planning Questionnaire, the TSP generates funding for Coordination of Supports equivalent to 21.7 hours per year for participants aged 16 years and over. Participants who are supported by an LAC will not require this funding. Some participants will require an adjustment to the Coordination of Supports funding to implement their plan and address any current complexities in their life. The Standard Operating Procedure — Include Support Coordination in a Plan provides information and guidance around levels of Coordination of Support (low to very high).	Standard Operating Procedure — Include Support Coordination in a Plan Standard Operating Procedure — Review and Submit Plan for Approval Practice Guide — Motor Neurone Disease (may also be used for participants with other rapidly degenerating neurological conditions) Standard Operating Procedure — Adding In-kind Supports to a Plan

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School Leaver Employment Supports (SLES) and Supports in Employment

If a participant has been assessed and identified as suitable for SLES funding — add supports in accordance with the SLES Standard Operating Procedure.

Note: If SLES is included in a plan, generated supports relating to community participation and CB must be considered and reduced as required to avoid duplication of supports. For example, most SLES participants will have SLES activities for a minimum of 3 days per week.

Some participants will require frequent and ongoing supports to assist them to take part in work. These supports are called Supports in Employment. Because the TSP does not automatically generate funding for Supports in Employment, you will need to use reasonable and necessary decision making and if needed adjust the TSP. For further guidance, refer to Standard Operating Procedure - Supports in Employment.

Standard Operating Procedure - Add School Leaver Employment Supports to the Participant’s Plan Standard Operating Procedure — Supports in Employment

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Supporting material

e NDIS Act 2013 e National Disability Insurance Scheme (Supports for Participants) Rules 2013

e Planning Operational Guideline

Process Owner and approver

General Manager Participant Experience and Design.

Feedback

If you have any feedback about this Practice Guide please email Service Guidance and Practice. In your email, remember to include the title of the resource you are referring to and to describe your suggestion or issue concisely.

Version change control

Version No	Amended by	Brief Description of Change	Status
21.0	CS0074	Class 1 approval APPROVED	2020-07-01
		Additional task included in Prerequisites - Review and Submit for Funded Supports
22	CW0032	Class 2 Approved DRAFT	2020-07-29
		From 1 July 2020, supports in employment will be included under the Core budget. Assistance in Specialised Supported Employment support items, used by Australian Disability Enterprises will no longer be used in plans developed from 1 July.
		Links to participant check in resources added.

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Practice Guide — Determine Reasonable and Necessary Supports

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DOCUMENT 5

Purpose ………………………………………………………………………………………………………. 4
To be used by ………………………………………………………………………………………………. 4
Scope ………………………………………………………………………………………………………….. 4
Prerequisites ………………………………………………………………………………………………… 4
Planning ………………………………………………………………………………………………………. 5

5.1 No reasonable and necessary supports identified …………………………………………… 5
The Typical Support Package (TSP) ………………………………………………………………… 6
Reasonable and Necessary ……………………………………………………………………………. 6
Core supports ………………………………………………………………………………………………. 8

8.1 Core budget flexibility …………………………………………………………………………………. 8

8.2 Meal preparation and delivery ……………………………………………………………………. 10

8.3 Transport ………………………………………………………………………………………………… 12
Capacity Building supports …………………………………………………………………………… 15

9.1 Capacity building for self-managing support funding ……………………………………… 16

9.2 Funding for Plan Management …………………………………………………………………… 17

9.3 CB Daily Activity ………………………………………………………………………………………. 17

9.4 CB Employment ……………………………………………………………………………………….. 18

9.5 Support Coordination ………………………………………………………………………………… 18

9.6 Provider Travel ………………………………………………………………………………………… 18

9.7 Medicare …………………………………………………………………………………………………. 19
Capital supports ………………………………………………………………………………………….. 20

10.1 Assistive Technology ……………………………………………………………………………… 20

10.2 Home Modifications ……………………………………………………………………………….. 20
Quote required support items ……………………………………………………………………….. 21
Plan Duration ……………………………………………………………………………………………… 21
Stated supports …………………………………………………………………………………………… 22
In-kind ……………………………………………………………………………………………………….. 22
Compensation …………………………………………………………………………………………….. 22
Changes to the TSP …………………………………………………………………………………….. 23

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Determine Reasonable and Necessary Supports

Parental responsibility … 24
Disability-Related Health Supports … 24
Other considerations … 25
Justification for reasonable and necessary supports … 26
- Justifications for plan management … 26
- Best practice justification examples … 26
Ghosting … 28
Plan Reviews … 28
The next steps … 28
- High Decision Delegate approval … 29
Appendices … 30
- Appendix 1 - Standard TSP Changes Summary … 30
Supporting material … 35
Process Owner and approver … 35
Feedback … 35
Version change control … 35

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1. Purpose

This Practice Guide will support you to consider the reasonable and necessary funded supports (if any) to be included in the participant’s National Disability Insurance Scheme (NDIS) plan.

2. To be used by

Plan Developers – Planners and Partners in the Community (Local Area Coordinators [LACs]).
NDIA Plan Delegates.

3. Scope

The National Disability Insurance Agency (NDIA) must be satisfied the funded supports in the participant’s NDIS plan meet each of the reasonable and necessary criteria outlined in:

section 34(1) of the National Disability Insurance Scheme Act 2013
the National Disability Insurance Scheme (Supports for Participants) Rules 2013
Operational Guideline - Including Specific Types of Supports in Plans.

Note: Do not use this Practice Guide if you are planning for participants less than seven years of age. Refer to the Standard Operating Procedure - Determine the Funded Supports in Early Childhood Early Intervention (ECEI).

4. Prerequisites

Before you consider any reasonable and necessary funded supports, you must:

Have read and understood the Participant Experience Delivery (PED) Key Performance Indicators (KPIs) and comply with the PED KPI and target relevant to reasonable and necessary supports.
Complete and submit all relevant and mandatory pre-planning tasks.
Complete the Review and Submit for Funded Supports acknowledgement. When this step is not completed, you may not be able to access the Determine the Funded Supports task.
Make sure the primary disability recorded on the participant’s record is correct.
Check the appropriate severity indicator tool has been completed. You can find further information in Standard Operating Procedure – Update Severity Tools.
Check the plan duration recorded within the Risk Assessment task reflects the participant’s circumstances. You can find further information in Standard Operating Procedure – Complete the Risk Assessment

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 Discuss with the participant, their plan nominee or child representative(s) who they want to manage the support funding in their plan. You can find further information in Standard Operating Procedure – Determine Plan Management.

 Check the Practice Guidance page of the intranet and use other practice guidance relevant to the participant’s circumstances together with this Practice Guide. For example Practice Guide – Motor Neurone Disease (MND), Our Guideline - Younger People in Residential Aged Care or Practice Guide – Assistance Animals.

 Check if a mandatory referral to Technical Advisory Branch (TAB) is required by referring to the TAB Requesting Advice intranet page.

5. Planning

During the planning conversation with the participant, their child representative and/or ominee you will develop an understanding of the participant’s individual circumstances. You will also gather information to complete the pre-planning tasks and create a personalised plan.

When completing the pre-planning tasks you recorded the mainstream, informal and community supports the participant currently uses, and their goals. You now need to determine which reasonable and necessary funded supports (if any) will be included in the participant’s plan to support them to achieve their goals.

Planning tasks may be completed by NDIA staff or Partners in the Community and include:

 understanding the participant, their individual circumstances and their support needs

 providing information about the principles of the NDIS

 assisting the participant to identify their goals

 identifying any supports the participant currently receives through mainstream, informal and/or community channels including any funded supports in place

 identifying any risks

 identifying the appropriate reasonable and necessary funded supports

 identify how the participant would like the funding in their plan managed, including any request to self-manage, and make a plan management recommendation.

5.1 No reasonable and necessary supports identified

In some cases, the participant may meet the NDIS access requirements however there are no reasonable and necessary supports identified for the current plan. You may determine mainstream, community and/or informal supports currently meet the participant’s support needs, but in the future the participant is likely to require funded supports. For example, for a participant living with a slow degenerative condition, you may determine for the current plan

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period the participant only needs support to better understand the condition and improve their health and well-being.

If no reasonable and necessary funded supports are identified:

complete the participant statement
complete the pre-planning tasks
develop the participant’s plan - in the Determine the Funded Supports task do not generate the support plan. Instead, submit the task with $0.00 funding.
complete an interaction which includes details of:
- your discussions with the participant,
- justification for your decision that no funded supports are required in the participant’s current plan.

The participant’s plan will outline the informal, community and/or mainstream supports that will meet the participant’s goals and support needs.

6. The Typical Support Package (TSP)

The TSP is an amount of funding based on the participant’s disability, individual support eeds and characteristics. TSPs provide an efficient, evidence based and nationally consistent approach to planning.

During the planning conversation you will gather and record information in the NDIS Business System (System) including the participant’s age, primary disability, other disabilities, level ofunctional impairment, current and potential mainstream, informal and community supports.

The primary disability recorded in the System is one of the factors which influence the TSP. If the participant has more than one impairment, you need to record the primary disability as the impairment which has the greatest functional impact on the participant.

The NDIS actuarial team developed TSPs in collaboration with disability experts. These include people with a disability, professionals and subject matter experts. They take into consideration real life participant experiences and experiences gained through trial. Refer to Appendix 1 - Standard TSP Changes Summary.

Note: TSP is an internal term used by the Agency and should not be discussed with the participant.

7. Reasonable and Necessary

With the exception of Section 43 (Plan Management) of the NDIS Act, you must apply easonable and necessary decision making to NDIS funded supports in the participant’s plan to ensure the supports are effective and beneficial to the participant.

NDIS funded supports should:

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assist the participant to pursue their goals
facilitate the participant’s social and/or economic participation
represent value for money
be likely to be effective and beneficial for the participant (having regard to current good practice)
take into account what support is reasonable to expect families, carers, informal networks and the community to provide
complement (not replace) other government services. You must also consider whether any funded supports should not be provided or funded under the NDIS. A support will not be funded under the NDIS if it:
is more appropriately funded by another government service
is likely to cause harm to the participant or pose a risk to others
is not related to the participant’s disability
duplicates other supports delivered under alternative funding through the NDIS
relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to the participant’s disability support needs
is contradictory to a law of the Commonwealth or the State or Territory in which the support would be provided
consists of income replacement. You should take a whole of person approach when considering which supports are reasonable and necessary in the participant’s plan. If the participant acquires an impairment after they have met access to the NDIS, you should consider how each impairment affects the participant’s life, and the support they need to achieve their goals. Your decision to include reasonable and necessary supports in the participant’s plan is based on whether the support meets all sections of the reasonable and necessary criteria. In exceptional circumstances some day-to-day living costs may be funded by the NDIS, if they are:
additional living costs which are a direct result of the person’s disability support needs
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8. Core supports

Core supports assist the participant to manage aspects of their daily living such as self-care and accessing the community. There are four Core support categories:

Consumables: includes disability-related health consumables products, dog guide consumables, Low Cost assistive technology and interpreting services.
Daily Activities: includes assistance with self-care, including additional care for short periods used for carers respite, shared living arrangements, household cleaning and/or yard maintenance.
Social, Community and Civic Participation: includes individual and group based community, social, recreational activity and economic participation. These supports may be used for day-to-day on the job assistance to assist participants to meaningfully participate at work. These supports may also be used for carers respite.
Transport: includes general and specialised transport for attending school, employment or going out in the community.

You need to ensure the participant has the Core support funding they need to meet their plan goals. Review the funding generated by the TSP and either increase or decrease the level of support funding in line with the reasonable and necessary criteria.

You will record justifications for your decisions in the Review and Submit Plan for Approval and/or Finalised Plan and Approve tasks.

8.1 Core budget flexibility

The four Core support categories Consumables, Daily Activities, Social, Community and Civic Participation and Transport are flexible. This means funding from one Core category (such as Daily Activities) can be used to purchase supports from another Core category (for example, Consumables). For funds to be used flexibly, the categories must have the same fund management type (such as Agency Managed).

It is important to look at the total value of the Core supports (for instance total combined value of Consumables, Daily Activities and Social, Community and Civic Participation and Transport) when determining the reasonable and necessary Core support funding amount.

Often the TSP will only generate funding in one or two of the Core support categories. If this occurs, you will need to check how the funding is allocated. You may need to adjust how the funding is distributed based on the participant’s individual Core support needs, plan goals and circumstances. However, participants are able to use their funding flexibly across the Core categories, even if $0 are allocated to the support category.

If the participant receives periodic transport funding, the Transport category is not flexible. Periodic transport is not included in Core flexibility as it is paid directly to the participant.

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Activity based transport can be claimed from the participant’s Core funding by providers with the participants agreement. Refer to section 8.3 Transport for more information.

Although Core funds can be used flexibly, it is important to ensure the participant understands the Core funding can only be used to purchase reasonable and necessary supports in line with the plan’s objectives regardless of whether the funding is Agency, self or plan managed.

Example of Core flexibility: Juan requires support to access his community activities and everyday use continence items. Funding of $21,606 is included in Juan’s plan for his Core support needs, as follows:

Consumables: $4,000 (Agency managed $3,000, plan managed $1,000)
Daily Activities: $0
Social, Community and Civic Participation: $16,000 (Agency managed $9,000, plan managed $7,000)
Transport – $1,606 (periodic payment)

During his plan Juan has short term need for self-care support. Depending on the funding emaining available, Juan could chose to use the flexibility of his Core budget for Daily Activities (up to $12,000 Agency managed and/or up to $8,000 plan managed). Juan’s periodic transport budget of $1,606 is not flexible with his other Core funding.

8.1.1 Limitations to flexibility with stated supports

When considering making a Core support item Stated, carefully consider:

The impact on flexibility for the participant and their providers
Whether the support is a composite item. Providers are unable to claim for a specific time of day or day of week if the composite item is stated.

8.1.2 Limitations to flexibility for transport in the Core budget

In exceptional circumstances, transport can be used flexibly however, only if;

the transport funding is not set up as an automated periodic payment, and
the transport funding is not included as a stated support, and
there are remaining funds in the Core budget to be utilised, and
the transport funding plan management type is the same as other Core Supports, and
the transport Service Booking is amended to a higher amount than what is provided in the transport category in the Core budget.

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8.2 Meal preparation and delivery

The participant may request meal preparation and delivery to be included in their NDIS plan when they are unable to prepare meals due to their disability. Some examples include when the participant is experiencing:

difficulties with organisation
difficulties completing multi-step instructions
a physical disability that impacts their ability to prepare meals.

For some participants, the inclusion of meal preparation and delivery can support them to safely maintain independent living and reduce their reliance on other supports.

When making a reasonable and necessary decision on including meal preparation and delivery in the participant’s plan, you should consider:

goal attainment and building independence
the functional impact of the participant’s disability for the preparation of meals
assessments
duplication of funding
reviewing the quote
considerations when including funding in the participant’s plan.

8.2.1 Goal attainment and building independence

You need to consider how including funding for meal preparation and delivery will assist the participant to achieve their goals and build their independence.

Talk to the participant to understand how meal preparation and delivery will support them. Discuss:

How they currently prepare meals?
How meal preparation and delivery will support them to achieve their goals?
Have they considered other supports that would develop their ability to prepare meals more independently such as an individualised program and support to participate in preparation of meals? Is this something they would like to do? Have they tried this previously? If yes, what were the outcomes?
Have they explored the use of Assistive Technology (AT) to assist with meal preparation tasks? Is this something they would be interested in exploring?
Are there risks for the participant preparing their own meals?

For participants with the potential to develop independence in meal preparation, you should consider funding for meal preparation and delivery while they explore AT and capacity building supports. At the next scheduled plan review, the plan developer and participant can

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Discussing Meal Preparation and Delivery

discuss the outcomes of these supports to determine whether meal preparation and delivery continues to be required.

8.2.2 Meal preparation for children

When the participant is a child and they require mealtime preparation that is above what would be considered reasonable to expect families and carers to provide you should consider the inclusion of funding for meal preparation and delivery.

For example, the family or caregiver for a child who is on a ketogenic diet due to their disability needs may need significantly more time for meal preparation than a child not on a specialist diet due to their disability needs.

Discuss requests for meal preparation and delivery for the child participant with your line manager.

8.2.3 Assessments

Assessments may be useful in helping you make a decision on whether to include meal preparation and delivery in the participants plan. However, they are not always necessary when there is a clear link between the functional impact of the participant’s disability and preparation of meals.

For example, you may find that you have enough information to make a reasonable and necessary decision using:

information from the planning conversation
previous reports
previous NDIS plans
other supporting evidence.

If the participant gives you a copy of an assessment from a suitably qualified allied health professional supporting their request for meal preparation and delivery you need to consider this when making your decision.

You may be able to use information from a previous assessment to better understand the participants support needs where there has been no change to the participant’s functional capacity.

You should only ask the participant for an assessment from a suitably qualified allied health professional if you have reviewed all current information and still need additional information to make your decision. When you request an assessment, make sure you include funding in the Capacity Building budget for this to be completed.

8.2.4 Duplication of funding

If you are including support for meal preparation and delivery in the participants plan you need to review other supports to make sure you are not duplicating funding.

Examples of other areas where support may be duplicated are:

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funding for a support worker to assist the participant to prepare the meals
funding for a support worker to assist the participant with their mealtime management routine
when the participant is receiving support for 24 hours each day (for example, SIL)
funding for capacity building supports to build independence in meal preparation.

Note: There may be times where these supports are not duplications. If you are unsure, please discuss with your line manager.

8.2.5 Reviewing the quote

Meal preparation and delivery is a quote-required support. This means that the participant needs to submit a quote for you to consider as part of the reasonable and necessary decision making process.

When you are reviewing the quote check:

The amount is for the preparation and delivery of meals only. NDIS does not cover the cost of food as this is considered a day-to-day living cost.
The quote is value for money.
You can check if a quote is value for money by comparing the quoted amount to the Product Catalogue (benchmark price) in the System. If it is 10% over the catalogue price, seek decision-making advice from your line manager.

8.2.6 Considerations when including funding in the participants plan

If the request meets the reasonable and necessary criteria you need to:

include funding for the support using the participants plan management preference
include a comment in the plan so that the participant knows that funding has been included. For example “$xx.xx per week of funding for meal preparation and delivery.”

8.3 Transport

Transport funding should be considered when the participant is unable to use public transport without substantial difficulty due to the impact of their disability.

Transport funding does not cover transport assistance which is considered a day-to-day living cost. For example, transport to appointments, shopping or recreational activities.

This support needs to be directly linked to plan goals and include a skill development focus.

You should use the three levels of supports for transport assistance as a guide only:

Level 1 $1606-$1,784: For participants who are not working, studying or attending day programs but want to enhance their community access.

Level 2 $2472-$2,676

For participants who are currently working or studying part-time (up to 15 hours a week), participating in day programs and for other goal based social, recreational or leisure activities.

Level 3 $3456-$3,567

For participants who are currently working, looking for work, or studying (15 hours or more a week), and are unable to use public transport because of their disability.

To ensure the participant has transport funding to meet their transport support needs, you will need to review the TSP generated amount. Also consider the levels of support for transport assistance and include an amount based on your reasonable and necessary decision making.

You will need to seek advice from the Technical Advisory Branch (TAB) for transport costs significantly above Transport level 3 or not related to activity-based transport.

Record justifications for your decision in the Review and Submit Plan for Approval and/or Finalise Plan and Approve Task.

Note: If a participant is currently receiving mobility allowance from Centrelink, this allowance will stop upon approval of their first NDIS plan.

8.3.1 Transport periodic payments

Unlike other support categories, transport can be paid to participants as an automated periodic payment (fortnightly payment).

The System will automatically tick the Periodic Payment check box next to the Transport support category in the Determine Funded Supports Task. This means the funding is paid periodically to the participant.

It is important to review this and update the check box to reflect the participant’s circumstances. For example, if transport funding is in-kind you need to untick the Periodic Payment check box.

Periodic payments are self-managed payments. You must discuss this with the participant, their child representative and/or plan nominee.

You should not approve self-managed periodic payment:

when current bankruptcy is declared in the risk assessment,

if self-managing transport funding is likely to present an unreasonable risk to the participant.

So that periodic payments can be made, you need to check bank account details of the participant, their child representative and/or plan nominee are collected and recorded in the System before the plan is approved. Refer to the Standard Operating Procedures – Record Bank Details.

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8.3.2 Participant transport as part of community participation

The participant can use funding from their Core budget for a support worker to help them participate in community outings and/or transport from their home to the community. Providers claim these costs at the relevant community participation hourly rate. When the provider is supporting more than one participant to access the community at the same time, they need to claim the group rate.

Funding from the participant’s Core budget can also be used for the provider’s non-labour costs associated with providing transport to participants:

accessing community participation supports
accessing or maintaining employment
accessing or maintaining or higher education.

Non-labour costs associated with participant transport can include:

public transport fares
road tolls
parking fees
reasonable vehicle running costs
- up to $0.85 a kilometre for a standard vehicle not modified for accessibility
- up to $2.40 a kilometre for a vehicle that is modified for accessibility or a bus
taxi or ride-share fares.

You need to consider the non-labour costs associated with providing this transport when determining the reasonable and necessary Core funding in the participant’s plan.

8.3.3 Provider travel

Provider travel is different to participant transport. There are two types of provider travel:

travel to provide daily activities and community access (Core) supports
travel to and from Capacity Building supports – refer to section 9.5 Provider Travel for further information.

When the participant agrees, providers can claim the time spent travelling to the participant. Only the actual travel time can be claimed.

For Core support, this refers to the time spent by the provider travelling to deliver a service to the participant (participant is not in the car). Where a support worker provides services to more than one participant the travel time can be shared between the participants, if each participant agrees in advance.

You may need to consider provider travel for delivering Core supports when developing Core funding in the participant’s plan. Maximum limits apply to the amount of travel time providers

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can claim. Refer to the NDIS Price Guides and Pricing for further information on provider travel.

When implementing the plan, participants should be encouraged to negotiate their supports with providers, particularly around the cost of provider travel.

9. Capacity Building supports

Capacity Building (CB) supports assist participants to increase their ability to live their life independently.

These supports are designed to deliver improved outcomes for the participant and reduce the need for funded supports in the future. CB supports focus on outcomes and are always linked to one of the participant’s goals.

Unlike the Core support budget, CB supports are only flexible in the same CB support category. For example, funding from CB Daily Activity can be used flexibly across all non-stated support items in the CB Daily Activity budget, and cannot be used to purchase supports from any other CB budget.

In the System, the TSP will generate CB support funding based on the response to the guided planning question ‘What level of Capacity Building is required?’ You need to apply reasonable and necessary decision-making regardless of whether CB support budget funding has or has not been generated by the TSP.

The exception is Plan Management (Financial Administration) supports. When the participant requires Plan Management, you must include funding in the CB Choice and Control budget. For further information refer to Standard Operating Procedure - Plan Management and Financial Administration Support Items.

All funding generated for Capacity Building will default to the CB Choice and Control budget. You will need to allocate the funding across the relevant CB budgets as you determine the reasonable and necessary supports in line with the participant’s goals and expected plan outcomes.

The nine Capacity Building (CB) support categories are:

CB Choice and Control: Includes support items relating to plan management and financial administration. Refer to section 9.2 Funding for Plan Management below.
CB Daily Activity: Individual assessment/therapy/training, group therapy, carer/parent training and individual skills development. Refer to section 9.3 CB Daily Activity below.
CB Employment: Includes School Leaver Employment Support (SLES) and employment-related assessments and counselling. Refer to section 9.4 CB Employment below.
CB Health & Wellbeing: Includes dietary and exercise physiology supports.

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CB Home Living

Includes assistance with accommodation and tenancy obligations.

CB Lifelong Learning

Includes transition through school and to further education.

CB Relationships

Includes behaviour support, as well as social skills development and capacity building. Refer to the Practice Guide – Positive Behaviour Support and Behaviours of Concern for information on including supports to address Behaviours of Concern (BoC).

Includes community participation activities, skills development and training as well as life transition planning such as mentoring and peer support. These supports may sometimes be used for carers’ respite.

Support Coordination

Refer to section 9.5 Support Coordination below.

9.1 Capacity building for self-managing support funding

The participant should be presumed to have the capacity to self-manage unless there is unreasonable risk. This is supported by the NDIS legislation and principles of the NDIS. Funding may be included in the participant’s plan to build capacity and support their goal to self-manage supports in their plan now, or in the future. This is a reasonable and necessary decision under section 34 of the NDIS Act.

For supports to build, or continue to build the participant’s capacity to manage their support funding, you should consider:

strategies to safeguard the participant’s interests, including informal supports
supports which could build the participant’s independence and capacity to self-manage
whether including additional supports in the plan could mitigate risks to the participant
whether support with budgeting, book keeping and financial record keeping will support the participant’s goal to manage their supports in the future
any supports to assist the participant to negotiate services and utilise the supports in their plan.

For further information about the different types of plan management, who can manage NDIS funds and capacity building supports for self-management, refer to the Practice Guide – Determine Plan Management.

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9.2 Funding for Plan Management

Plan management and financial administration funding is a stated support that allows the participant to engage an NDIS Registered Plan Manager to manage the financial functions of their plan.

Funding for plan management and financial administration support is not included in the TSP. If the participant, their nominee or child representative requests to have a plan manager for one or more of their supports, you are required to add funding for the plan management activities in the participant’s plan.

The participant’s choice to have a plan manager manage the funded supports in their plan is a legislative entitlement under section 43(2) of the NDIS Act 2013. Where the participant requests their funding to be managed by a plan manager, this is not subject to reasonable and necessary criteria.

Refer to the Standard Operating Procedure - Plan Management and Financial Administration Support Items to include financial administration supports in a participant’s plan.

Where it is a goal of the participant to learn how to manage their own funds and/or build capacity to self-manage their plan, if reasonable and necessary, this support funding is included in one of the following CB budgets:

CB – Choice and Control (Plan and Financial capacity building): Generally used when a participant is plan managed and has goals around financial independence and/or to build capacity to move to self-managing in the future.
CB – Support Coordination (Training in Planning and Plan Management):- Generally used for participants who are self-managed and require some assistance to get started with this process, or where a participant has support coordination included in their plan and the plan is not plan managed.

When including funding to build capacity to self-manage, ensure you discuss whether the participant will be able to locate and access appropriate service providers to assist them.

9.3 CB Daily Activity

9.3.1 Allied Health Practitioners

Allied health practitioners (AHP) hold a university qualification, specialise in different areas and work directly with the person requiring support. AHPs are not part of the medical, dental or nursing professions. AHPs include, but are not limited to: occupational therapists, physiotherapists, speech therapists, exercise physiologists, psychologists, prosthetists or orthotists, podiatrists, dieticians or respiratory therapists.

Refer to Practice Guide – Understanding Therapy Supports for a full description of each of the allied health practitioners.

Reasonable and necessary funding can be included in the participant’s plan to meet their disability-related health support needs. For example continence supports, diabetic supports,

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dysphagia supports, epilepsy supports, podiatry supports, nutrition supports, podiatry and foot care supports, respiratory supports or wound and pressure care supports. Refer to section 16.2 Disability-Related Health Supports and Practice Guide – Disability-Related Health Supports for further information.

9.3.2 Nursing

Reasonable and necessary nursing supports can be included in the participants plan to meet their disability-related health support needs as per section 6.8 of Practice Guide – Disability- Related Health Supports.

9.4 CB Employment

The CB Employment category includes School Leaver Employment Support (SLES), and employment-related assessments and counselling.

9.4.1 School Leaver Employment Support (SLES)

SLES funding will be auto-generated as part of the TSP to the CB Employment budget based on the response to the guided planning question, ‘Is the participant eligible for School Leaver Employment Support (SLES)?’ For the current guidance on SLES, please refer to the Employment intranet page.

9.5 Support Coordination

The Support Coordination category is part of the Capacity Building budget but is separate from the eight Capacity Building (CB) sub-categories. This category includes the support items for support connection, support coordination and specialised support coordination, as well as support for building a participant’s capacity to learn to self-manage their own plan (training in planning and plan management).

Refer to:

Appendix 1 – Standard TSP Changes Summary
Standard Operating Procedure – Update Participant Streaming
Standard Operating Procedure – Include Support Coordination in a Plan.

9.6 Provider Travel

Providers of some supports are able to claim non-direct services, including provider travel, short notice cancellations and where an NDIA report is required.

Provider travel for capacity building supports can be claimed for travel to each participant, and return travel from the last appointment of the day. The participant must agree to the travel costs to be claimed in advance.

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Where a worker travels to an area and provides services to more than one participant, if agreed to in advance by each participant, the cost of time and travel could be split between the participants.

CB support categories where providers may be able to claim provider travel include:

CB Daily Activity
CB Social Community and Civic Participation
CB Employment
CB Relationships
CB Health and Wellbeing
Support Coordination.

When considering the level of reasonable and necessary CB supports, consider how the services will be delivered. Also consider any other circumstances that may affect how the participant utilises their plan funding, such as provider travel, and how this may impact the level of supports available, particularly for participants living in regional and remote areas.

Maximum limits apply to the amount of travel time providers are permitted to claim. Refer to the NDIS Price Guides and Pricing for further information.

9.7 Medicare

The participant may access Medicare funded allied health services with a referral from their GP alongside allied health supports funded in their NDIS plan. There is no requirement for the participant to use or exhaust these Medicare funded services before receiving allied health supports funded in their NDIS plan if the supports required relate to the participant’s functional impairment and are considered reasonable and necessary.

Where considered reasonable and necessary, the funded supports should be included to cover the full cost of the supports. Where Medicare funded allied health supports are not considered reasonable and necessary, the supports funded through Medicare can work side by side with other funded supports to enable the participant to achieve their goals.

For example:

NDIS funded psychology supports to address disability related barriers and build capacity to engage in social situations and participate in employment.
The participant also accessed Medicare funded psychology supports for clinical treatment such as ongoing counselling and medication management (not funded by the NDIS).

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10. Capital supports

Capital supports assist a participant to increase independence and participation in a range of different environments, such as their home, community and the workplace.

The two support categories within Capital are Assistive Technology and Home Modifications.

When responses to the guided planning questions generate assistive technology or home modifications support funding, the intended purpose is to fund equipment or an assessment appropriate to meet the participant’s needs.

Unlike the Core support budget, Capital support categories are not flexible between Assistive Technology and Home Modifications.

It is the responsibility of the plan developer to review the TSP generated Capital supports and adjust the budget amounts for the participant’s reasonable and necessary support needs.

Note: Capital items including AT and Home modifications must not be added to a plan (even if they are quote required) unless evidence and reports are attached in the System to justify that the equipment is reasonable and necessary.

10.1 Assistive Technology

For further information on including assistive technology in the participant’s plan refer to the Assistive Technology Standard Operating Procedures and Fact sheets on the Planning resources Intranet page.

10.2 Home Modifications

Home modifications includes interior and exterior home modifications, consultation and project management. For further information on including funding for Home Modifications in the participant’s, refer to the Standard Operating Procedure – Include Home Modification Supports in Plans.

10.2.1 Specialist Disability Accommodation (SDA)

The support item for Specialist Disability Accommodation (SDA) sits in the Home Modifications budget of a plan.

The three different types of SDA are:

new
in-kind
existing.

The two occasions when SDA may be included in a plan are:

when there is a new SDA decision

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 when the participant was already residing in disability related supported accommodation at the time of transition to the NDIS.

10.2.1.1 Existing or In-Kind SDA

When the participant is already residing in an SDA dwelling when they transition to the NDIS they are considered to be in existing or in-kind SDA. SDA funding needs to be included in the participant’s NDIS Plan. Refer to:

 Standard Operating Procedure – Include Existing (non in-kind) SDA in a Plan: Participants Residing in SDA Prior to Transition

 Standard Operating Procedure – Adding In-Kind Supports in a Plan.

10.2.1.2 A new SDA decision

When the participant wishes to move in to SDA for the first time or wishes to move to a different SDA dwelling, from an existing or in-kind SDA dwelling, this is considered to be new SDA.

For new SDA, the SDA support funding must not be included in the participant’s plan without referral to the SDA panel for advice.

The SDA panel will review the SDA eligibility and provide a recommendation for the participant’s SDA request. The SDA panel will also provide information on the eligible SDA type and level for the participant. This information is recorded in the Housing and Accommodation section of the participant’s record.

Refer to the Standard Operating Procedure – Determine Specialist Disability Accommodation

Change of Address or a New Decision.

Note: For more information regarding transitional accommodation, while the participant is waiting for Assistive Technology or Home Modifications, refer to the Practice Guide - Medium Term Accommodation.

11. Quote required support items

A quote is required for some supports such as high cost assistive technology, complex home modifications and vehicle modifications.

Where a quote required support is included in the participant’s plan the quote process must be followed. For further information refer to the Standard Operating Procedure - Initiate and Record Quotes and Standard Operating Procedure - Consider and Action Quotes.

12. Plan Duration

The duration of the participant’s plan may vary depending on the participant’s disability, streaming decision and individual circumstances. You can find guidance for determining plan duration in Standard Operating Procedure – Complete the Risk Assessment.

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The TSP generates Core supports based on the chosen plan duration. For example, a 36- month plan will generate 36 months of Core supports, a 24-month plan will include 24 months of core supports and a 6-month plan will generate 6 months of Core supports.

Manual adjustment may be required for Capacity Building and Capital supports for plans other than 12 months duration. You will need to use reasonable and necessary decision making to adjust funding in these budgets to reflect the participant’s needs for the duration of the plan.

13. Stated supports

A stated support is a support recorded in the plan at the support item level, and selected as stated in the support calculator.

When a support is stated the funding for that item can only be used for that particular support. As defined in Part 6 of the NDIS (Plan Management) Rules 2013, stated supports must be purchased by the participant as they are described in the plan.

Carefully consider if a support you are including needs to be stated, as stated items reduce flexibility for the participant and the provider.

When including stated support item(s), make sure the comments in the related support category clearly outline the intent of the stated support.

For example: In CB Relationships, you may include a stated support item for the development of a Behaviour Support Plan by a registered provider. Marking the support item as stated quarantines this funding from the rest of the support category budget, and ensures it can only be used by the participant as intended.

14. In-kind

Before the NDIS was established, states and territories paid service providers directly to deliver services to people with disabilities. In some situations, states and territories continue to pay for these services directly and NDIS participants continue using these services.

When these pre-paid supports are provided as reasonable and necessary supports in the participant’s plan they are called in-kind and must be recorded as in-kind specifically within the participant plan. Refer to the Practice Guide – In-Kind.

15. Compensation

If the participant responds ‘yes’ to the risk assessment question ‘Is your disability the result of an accident or event?’ this indicates the participant has received, or is entitled to receive compensation. Additional questions will be generated in the System for you to complete in elation to compensation.

Compensation, for NDIS purposes, is either a lump sum or periodic payment.

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If you identify the participant is, or has been entitled to compensation, follow the steps below:

Give the participant or their nominee the Compensation and the NDIS Fact Sheet.
Advise the participant or nominee they can get additional information on the Compensation and your plan page of the NDIS website.
Email the Compensation Recoveries Team (CRT) as soon as you become aware of the potential for compensation. In the subject line of your email include the participant’s NDIS number and last name.
Add an alert to the participant record in the System.
Create an interaction that compensation has been identified.
Proceed with developing and approving the participant’s plan.

For further information refer to the Compensation Recoveries intranet page.

16. Changes to the TSP

Sometimes, the generated TSP has not enough or more than enough funding to meet a participant’s needs or enable them to achieve their goals. Funding generated in each individual support category is informed by the participant’s support needs identified in response to the details recorded in the System. Use reasonable and necessary decision making to adjust the TSP up or down in response to information available to you regarding the participant and their individual circumstances.

Sometimes, evidence of support needs may indicate that the funding generated in the TSP is above the reasonable and necessary support requirements. For example, a participant may be very engaged in the community for recreational and social activities or be working, and have strong, sustainable informal care networks. This information must be taken into account when determining the funded supports to prevent supports being funded in the plan that are in addition to what is reasonable and necessary.

The standard TSP changes include varying the TSP for specific supports. These supports include:

Defined Programs
Plan Management costs
Behaviours of Concern
Supported Independent Living (SIL) (group)
Specialist Disability Accommodation (SDA)
Assistive Technology (including composite items)
Home Modifications
Coordination of Support

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 School Leaver Employment Services (SLES)

 Australian Disability Enterprises (ADE).

16.1 Parental responsibility

You must also recognise parental responsibility when considering funded supports for children under 18 years. All parents are responsible for providing substantial care and support for their children whether they experience a disability or not, for example, transporting them to activities and meeting the cost of after school activities.

When considering if support is reasonable and necessary you should consider:

 the goals for the child and the support needs of their disability

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

 whether the support will improve the child’s capacity, future capacity or reduce risks to wellbeing.

For example, it is likely reasonable and necessary to include support for a teenager who does not have the capacity to complete self-care routines independently due to their disability. This is because a teenage child would be reasonably expected to undertake all self-care activities independently and the funded supports may address the functional needs and or support the participant to build their capacity to increase independence.

If the example was for a young child where generally children of that age are assisted by a parent or carer, it may be a reasonable expectation for a parent to provide all self-care supports, as this would be a parental expectation for any child of a young age regardless of disability.

Reasonable and necessary disability-related health supports can be included in a participant’s NDIS plan if they:

 directly relate to a person’s ongoing functional impairment, and

 are a regular part of daily life, and

 are most appropriately funded or provided by the NDIS, and

 are evidenced meaning supporting information can generally be obtained.

Refer to the Practice Guide – Disability-Related Health Supports for full guidance. For further information about specific disability related health supports refer to the relevant practice guidance:

 Practice Guide – Continence Supports

 Practice Guide – Diabetic Management Supports

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Practice Guide – Dysphagia Supports
Practice Guide – Epilepsy Supports
Practice Guide – Nutrition Supports
Practice Guide – Podiatry and Foot Care Supports
Practice Guide – Respiratory Supports
Practice Guide – Wound and Pressure Care Supports

It is unlikely that funding for most disability-related health supports will be generated in the TSP. This means you will need to include them as a reasonable and necessary adjustment to the TSP. Make sure you include the participant’s need for disability-related health supports in your justifications for increasing the TSP and include a comment in the NDIS plan to describe these supports.

16.3 Other considerations

16.3.1 Duplication of supports

Consider duplication of supports when developing the plan. For example, if it has been deemed reasonable and necessary to include SLES or ADE supports in a participant’s plan to achieve their goal of economic and social participation, then funding generated by the TSP in other support categories (such as social, community participation) which achieve the same goal should be reduced or removed where appropriate.

16.3.2 Evidence

Any decision to vary the funding generated by the TSP must be informed by validated supporting evidence and have a justification recorded in the System to allow the delegate to make the funding decision. Supporting evidence includes the lived experience of the participant and published peer-reviewed literature. If the TSP is exceeded as a result of a reasonable and necessary decision, clear evidence from a relevant professional or written information supporting your recommendation must be attached to the participant record and referenced in the plan justification.

16.3.3 Increases in plan value

A senior delegate must check and endorse any increase above 108 per cent:

TSP for first plans
super imposed inflation for review plans.

Record details of this review, including the name of the reviewing delegate, in an interaction. If you are the plan developer, details can be recorded when completing the Plan Approval Considerations – Plan Submitted for Approval interaction template. If you are the plan delegate, details can be recorded when completing the Plan Approved and Ready for Implementation interaction template.

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16.3.4 Technical Advisory Branch (TAB) referrals

Ensure you submit any mandatory TAB referrals for advice. Check the TAB Requesting Advice intranet page for a list of supports that require referral to TAB and how to request advice.

17. Justification for reasonable and necessary supports

Plan developers and delegates must record a justification for each support category in the participant’s plan. Justifications should be clear and concise, and only include information relevant to your decision.

You must include the following information in each justification:

description of the support and how it relates to the participant’s disability support needs
how the support will help the participant achieve their goals
how the support meets reasonable and necessary criteria
refer to any supporting evidence to support the inclusion of proposed supports.

17.1 Justifications for plan management

Plan management funding (plan management set up and administration fees) is not a reasonable and necessary decision.

You do not need to provide detailed justification for this support. Refer to section 9.2 Funding for Plan Management for more information on these supports.

You can record the following standard justification for this support:

Plan management fees – Funding for the plan to be plan managed as requested.

Note: Funding to support the participant to learn to self-manage their funding is a reasonable and necessary decision, and you will need justify including this support. Refer to the Practice Guide – Determine Plan Management.

17.2 Best practice justification examples

Note: Names used in the examples are fictitious.

Helen has a moderate intellectual disability and requires support to access her community and to participate in individual and group activities in order to achieve her goal of continuing to spend time with her friends.

Core funding is included for Helen to attend her current group day program three days (18 hours) per week. Funding is also included for 1:1 support three hours per week to attend her community choir group. These supports will help her maintain her friendships and social

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activities, as she is unable to participate without support. Helen’s parents will continue to support her at home, including overnight and on weekends.

17.2.2 Example 2 – Capacity Building Supports: CB Relationships

Michael has complex behaviours of concern and has a current behaviour support. Funding for ongoing monitoring and review of the behaviour support plan will support Michael to:

build capacity in managing his emotions
develop relationships with others
enhance his communication skills
develop, implement and review strategies to engage appropriately with others at home and when out in the community.

These strategies will support Michael’s goal of accessing the community, and help him build stable relationships with his support network. It is anticipated this support will reduce his need for intensive 1:1 funded supports over the next 12 months, therefore representing value for money in the long term.

17.2.3 Example 3 – Capacity Building Supports: CB Daily Activity

Lucy has a primary disability of bi-polar disorder and a secondary disability of vision impairment. Lucy has a goal of being able to do more things for herself at home. Specifically, she would like to be able to prepare a basic meal for her family.

Lucy has difficulty reading a recipe, following the instructions and operating kitchen appliances. She currently relies on her parents to complete all meal preparation tasks. This funding allows an occupational therapist to assess her capacity to complete household tasks independently. The therapist can recommend capacity building strategies in a skill development plan, and recommend assistive technology to help her achieve this goal.

17.2.4 Example 4 – Capital Supports: Assistive Technology replacement

Salim has cerebral palsy and currently uses a manual wheelchair that is seven years old. Salim said at the planning meeting that the wheelchair cannot be repaired, and he will need a ew wheelchair in the next two months so that he can continue going out independently. Salim submitted a quote for a new, similar wheelchair for $9,684.00.

Salim’s occupational therapist has stated the new wheelchair does not pose significant risks. The replacement wheelchair meets the three criteria for replacement AT in the Our Guideline – Assistive Technology:

Evidence of existing use – Salim has submitted the original purchase receipt, and a report from his repairer that his current wheelchair cannot be repaired.
No change to functional capacity – the Occupational Therapist letter uploaded to inbound documents states that his support needs are stable.
Cost – the new wheelchair is less than $15,000.

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17.2.5 Example 5 – Core Supports: Transport

Sally has autism, and cannot use public transport independently. Currently, she does not know how to hail a bus or which stop to get off. She also experiences anxiety in crowds and public places. One of her goals is to join a sports class approximately 20 minutes away from home. She will not require support when she is at the class.

Funding is included for Level 1 transport to allow her to use taxis to attend the class and other social activities. Sally is not currently working or studying, but she is looking to increase her community access. The funding in the Capacity Building Daily Activity support category will support her to build her skills in using public transport independently. She may not require transport support in future plans.

18. Ghosting

There are issues with ghosting in the Determine the Funded Supports task in the System. Ghosting means that supports that have been added using the support calculator and later removed may still show up in the Finalise Plan and Approve task. For more information, refer to the Standard Operating Procedure – Determine Reasonable and Necessary Supports.

19. Plan Reviews

When determining the funded supports at plan review, you must consider the previous plans value and the utilisation of any funded supports in comparison with the new plan’s total budget, including the generated TSP. The duration of a plan will affect the supports generated in the TSP. Changes to the plan duration or funded supports will impact on the type of plan review you should conduct.

For guidance on determining the plan duration refer to the Standard Operating Procedure – Complete the Risk Assessment.

For information on completing a plan review, refer to:

Standard Operating Procedure – Support Tool to Determine the Scheduled Plan Review Approach
Standard Operating Procedure – Complete a Plan Review (Full)
Standard Operating Procedure – Complete a Plan Review (Light Touch)
Standard Operating Procedure – Complete a Scheduled Plan Review (Renewal).

20. The next steps

Once you have completed and submitted the Determine Funded Supports and Determine Plan Management tasks, submit the draft plan for approval via the Review and Submit Plan for Approval task, refer to Standard Operating Procedure – Review and Submit a Plan for Approval.

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The plan approval decision will involve the plan delegate reviewing all available information and evidence on the record relating to the participant’s circumstances, their capacity and any risks and safeguards. Evidence and justification to support the inclusion of funded supports in the plan (as recommended by the plan developer) to meet reasonable and necessary will also be reviewed and considered as part of the plan approval decision.

Prior to submitting a plan for approval it is important you are satisfied you have provided enough evidence to justify and support the proposed reasonable and necessary funding including any adjustments to the TSP with the justification recorded in the Review and Submit Plan for Approval task.

20.1 High Decision Delegate approval

Depending on the overall plan value and/or other risk factors, the plan may need to be assigned to the High Decision Delegate (HDD) team for review and approval. The System will not allow a delegate with insufficient delegation to approve the plan. If delegation level 4 approval is required, follow the steps as outlined in the Standard Operating Procedure – Finalise and Approve a Plan.

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Appendices

Appendix 1 - Standard TSP Changes Summary

The TSP is the first step in determining the reasonable and necessary funded supports and you may need to adjust the funding generated using reasonable and necessary decision-making principles to reflect participant’s individual circumstances. This document is a guideline for determining reasonable and necessary supports for specific items. Items or supports listed as TAB mandatory referrals must be submitted to TAB for advice. Any variation to the TSP must meet the reasonable and necessary criteria and be informed by validated evidence which is recorded in the System in the Review and Submit Plan for Approval and/or Finalise Plan and Approve tasks. A senior delegate must check and endorse any increase above 108 per cent:

TSP for first plans
super imposed inflation for review plans. Assessment reports and other supporting evidence must be attached as an inbound document.

Considerations for Change

Defined Programs

Some participants are transitioning to the NDIS from Defined Programs. These participants must not be disadvantaged by their move to the NDIS; however, funded supports can only be included in a plan if they meet the reasonable and necessary criteria. There should be appropriate reasonable and necessary supports in the plan to enable the participant to achieve at least the same outcomes as they were receiving prior to transition. This is not necessarily the same level of funding — rather it is their ability to achieve the same level of outcomes.

Note: In some cases, the participant may have been receiving supports prior to entering the NDIS that do not meet the reasonable and necessary criteria and these cannot be funded in their NDIS plan.

Behaviours of Concern

Some participants require supports to address behaviours of concern. There may not be enough funding in the generated TSP to allow for the required behavioural supports. Use reasonable and necessary decision making to increase the CB Relationships budget as required.

Guidance

Standard Operating Procedure — Determine Reasonable and Necessary Supports
Planning Operational Guideline — 10.9.1 The Principle of “no disadvantage”
Standard Operating Procedure — Behaviour Intervention Supports
TAB Requesting advice intranet page

Considerations for Change & Guidance

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Topic	Considerations for Change	Guidance
Supported Independent Living (Group) and Specialist Disability Accommodation (SDA)	For Supported Independent Living (SIL) — add supports in accordance with the relevant resource.
Note: To avoid duplication of supports, it is important that the relevant SIL guidance is followed and adjustments made to the budget as required. For existing and in-kind SDA — add supports in accordance with Standard Operating Procedure — Include Existing (non-In-Kind) SDA in a Plan or Standard Operating Procedure — Adding in-kind Support to a Plan. For new SDA refer to SDA Panel.	Practice Guidance – Identifying Housing Solutions
Standard Operating Procedure – Include Existing (non in-kind) SDA in a Plan: Participants Residing in SDA Prior to Transition
Standard Operating Procedure – Adding In-kind Supports to a Plan
Standard Operating Procedure – Include Supported Independent Living (SIL) in Plans
Standard Operating Procedure - Determine Specialist Disability Accommodation - Change of Address or a New Decision
Assistive Technology	For Assistive Technology allocate funding in accordance with the relevant resources.	Refer to the Assistive Technology Standard Operating Procedures and Fact sheets on the Planning resources Intranet page TAB
Our Guideline - Assistive Technology
Home Modifications	Funds to be allocated according to the Standard Operating Procedure — Include Home Modifications Supports in Plans.	Standard Operating Procedure – Include Home Modification Supports in Plans

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Coordination of Supports

Where indicated as being required in the Guided Planning Questionnaire, the TSP generates funding for Coordination of Supports equivalent to 21.7 hours per year for participants aged 16 years and over. Participants who are supported by an LAC will not require this funding.

Some participants will require an adjustment to the Coordination of Supports funding to implement their plan and address any current complexities in their life.

The Standard Operating Procedure — Include Support Coordination in a Plan provides information and guidance around levels of Coordination of Support (low to very high).

Considerations for Change	Guidance
Where indicated as being required in the Guided Planning Questionnaire, the TSP generates funding for Coordination of Supports equivalent to 21.7 hours per year for participants aged 16 years and over. Participants who are supported by an LAC will not require this funding.	Standard Operating Procedure — Include Support Coordination in a Plan
Some participants will require an adjustment to the Coordination of Supports funding to implement their plan and address any current complexities in their life.	Standard Operating Procedure — Review and Submit Plan for Approval
The Standard Operating Procedure — Include Support Coordination in a Plan provides information and guidance around levels of Coordination of Support (low to very high).	Practice Guide — Motor Neurone Disease (may also be used for participants with other rapidly degenerating neurological conditions)
	Standard Operating Procedure — Adding In-kind Supports to a Plan

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School Leaver Employment Supports (SLES) And Supports in Employment

If a participant has been assessed and identified as suitable for SLES funding — add supports in accordance with the SLES Standard Operating Procedure.

Note: If SLES is included in a plan, generated supports relating to community participation and CB must be considered and reduced as required to avoid duplication of supports. For example, most SLES participants will have SLES activities for a minimum of 3 days per week.

Some participants will require frequent and ongoing supports to assist them to take part in work. These supports are called Supports in Employment. Because the TSP does not automatically generate funding for Supports in Employment, you will need to use reasonable and necessary decision making and if needed adjust the TSP. For further guidance, refer to Standard Operating Procedure - Supports in Employment.

Standard Operating Procedure - Add School Leaver Employment Supports to the participant’s plan

Standard Operating Procedure — Calculate Supports in Employment Funding

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22. Supporting material

NDIS Act 2013
National Disability Insurance Scheme (Supports for Participants) Rules 2013
Planning Operational Guideline

23. Process Owner and approver

General Manager Participant Experience and Design.

24. Feedback

If you have any feedback about this Practice Guide, please complete our Feedback form.

25. Version change control

Version	Amended by	Brief Description of Change	Status	Date
21.0	CS0074	Class 1 approval Additional task included in Prerequisites - Review and Submit for Funded Supports.	APPROVED	2020-07-01
22.0	CW0032	Class 2 Approved From 1 July 2020, supports in employment will be included under the Core budget. Assistance in Specialised Supported Employment support items, used by Australian Disability Enterprises will no longer be used in plans developed from 1 July. Links to participant check in resources added.	APPROVED	2020-07-29
23.0	JC0075	Class 2 approval Update for plan developers to refer to the Technical Advisory Branch	APPROVED	2020-12-04

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Version Control

Version No	Amended by	Brief Description of Change	Status	Date
24.0	CS0074	intranet page for supports that require mandatory TAB advice. Class 1 approval KPI pre-requisite added. Changes to TSP updated to reflect PED KPI 10	APPROVED	2020-12-23

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Practice Guide — Determine Reasonable and Necessary Supports

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DOCUMENT 6

Purpose ………………………………………………………………………………………………………. 4
To be used by ………………………………………………………………………………………………. 4
Scope ………………………………………………………………………………………………………….. 4
Prerequisites ………………………………………………………………………………………………… 4
Planning ………………………………………………………………………………………………………. 5

5.1  No reasonable and necessary supports identified ................................................... 5

The Typical Support Package (TSP) ………………………………………………………………… 6
Reasonable and Necessary ……………………………………………………………………………. 6
Core supports ………………………………………………………………………………………………. 8

8.1  Core budget flexibility .............................................................................................. 8

8.2  Meal preparation and delivery ............................................................................... 10

8.3   Transport ............................................................................................................... 12

9. Capacity Building supports …………………………………………………………………………… 15

9.1  Capacity building for self-managing support funding ............................................. 16

9.2  Funding for Plan Management .............................................................................. 17

9.3  CB Daily Activity .................................................................................................... 17

9.4  CB Employment ..................................................................................................... 18

9.5  Support Coordination ............................................................................................. 18

9.6   Provider Travel ...................................................................................................... 18

9.7  Medicare ................................................................................................................ 19

10. Capital supports ………………………………………………………………………………………….. 20

10.1    Assistive Technology .......................................................................................... 20

10.2  Home Modifications ............................................................................................ 20

11. Quote required support items ……………………………………………………………………….. 21

Plan Duration ……………………………………………………………………………………………… 21
Stated supports …………………………………………………………………………………………… 22
In-kind ……………………………………………………………………………………………………….. 22
Compensation …………………………………………………………………………………………….. 22
Changes to the TSP …………………………………………………………………………………….. 23

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Determine Reasonable and Necessary Supports

Parental responsibility … 24
Disability-Related Health Supports … 24
Other considerations … 25
Justification for reasonable and necessary supports … 26
- Justifications for plan management … 26
- Best practice justification examples … 26
Ghosting … 28
Plan Reviews … 28
The next steps … 28
- High Decision Delegate approval … 29
Appendices … 30
- Appendix 1 - Standard TSP Changes Summary … 30
Supporting material … 35
Process Owner and approver … 35
Feedback … 35
Version change control … 35

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1. Purpose

This Practice Guide will support you to consider the reasonable and necessary funded supports (if any) to be included in the participant’s National Disability Insurance Scheme (NDIS) plan.

2. To be used by

Plan Developers – Planners and Partners in the Community (Local Area Coordinators [LACs]).
NDIA Plan Delegates.

3. Scope

The National Disability Insurance Agency (NDIA) must be satisfied the funded supports in the participant’s NDIS plan meet each of the reasonable and necessary criteria outlined in:

section 34(1) of the National Disability Insurance Scheme Act 2013
the National Disability Insurance Scheme (Supports for Participants) Rules 2013
Operational Guideline - Including Specific Types of Supports in Plans.

Note: Do not use this Practice Guide if you are planning for participants less than seven years of age. Refer to the Standard Operating Procedure - Determine the Funded Supports in Early Childhood Early Intervention (ECEI).

4. Prerequisites

Before you consider any reasonable and necessary funded supports, you must:

Have read and understood the Participant Experience Delivery (PED) Key Performance Indicators (KPIs) and comply with the PED KPI and target relevant to reasonable and necessary supports.
Complete and submit all relevant and mandatory pre-planning tasks.
Complete the Review and Submit for Funded Supports acknowledgement. When this step is not completed, you may not be able to access the Determine the Funded Supports task.
Make sure the primary disability recorded on the participant’s record is correct.
Check the appropriate severity indicator tool has been completed. You can find further information in Standard Operating Procedure – Update Severity Tools.
Check the plan duration recorded within the Risk Assessment task reflects the participant’s circumstances. You can find further information in Standard Operating Procedure – Complete the Risk Assessment

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 Discuss with the participant, their plan nominee or child representative(s) who they want to manage the support funding in their plan. You can find further information in Standard Operating Procedure – Determine Plan Management.

 Check the Practice Guidance page of the intranet and use other practice guidance relevant to the participant’s circumstances together with this Practice Guide. For example Practice Guide – Motor Neurone Disease (MND), Our Guideline - Younger People in Residential Aged Care or Practice Guide – Assistance Animals.

 Check if a mandatory referral to Technical Advisory Branch (TAB) is required by referring to the TAB Requesting Advice intranet page.

5. Planning

During the planning conversation with the participant, their child representative and/or ominee you will develop an understanding of the participant’s individual circumstances. You will also gather information to complete the pre-planning tasks and create a personalised plan.

When completing the pre-planning tasks you recorded the mainstream, informal and community supports the participant currently uses, and their goals. You now need to determine which reasonable and necessary funded supports (if any) will be included in the participant’s plan to support them to achieve their goals.

Planning tasks may be completed by NDIA staff or Partners in the Community and include:

 understanding the participant, their individual circumstances and their support needs

 providing information about the principles of the NDIS

 assisting the participant to identify their goals

 identifying any supports the participant currently receives through mainstream, informal and/or community channels including any funded supports in place

 identifying any risks

 identifying the appropriate reasonable and necessary funded supports

 identify how the participant would like the funding in their plan managed, including any request to self-manage, and make a plan management recommendation.

5.1 No reasonable and necessary supports identified

In some cases, the participant may meet the NDIS access requirements however there are no reasonable and necessary supports identified for the current plan. You may determine mainstream, community and/or informal supports currently meet the participant’s support needs, but in the future the participant is likely to require funded supports. For example, for a participant living with a slow degenerative condition, you may determine for the current plan

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period the participant only needs support to better understand the condition and improve their health and well-being.

If no reasonable and necessary funded supports are identified:

complete the participant statement
complete the pre-planning tasks
develop the participant’s plan - in the Determine the Funded Supports task do not generate the support plan. Instead, submit the task with $0.00 funding.
complete an interaction which includes details of:
- your discussions with the participant,
- justification for your decision that no funded supports are required in the participant’s current plan.

The participant’s plan will outline the informal, community and/or mainstream supports that will meet the participant’s goals and support needs.

6. The Typical Support Package (TSP)

The TSP is an amount of funding based on the participant’s disability, individual support eeds and characteristics. TSPs provide an efficient, evidence based and nationally consistent approach to planning.

During the planning conversation you will gather and record information in the NDIS Business System (System) including the participant’s age, primary disability, other disabilities, level ofunctional impairment, current and potential mainstream, informal and community supports.

The primary disability recorded in the System is one of the factors which influence the TSP. If the participant has more than one impairment, you need to record the primary disability as the impairment which has the greatest functional impact on the participant.

The NDIS actuarial team developed TSPs in collaboration with disability experts. These include people with a disability, professionals and subject matter experts. They take into consideration real life participant experiences and experiences gained through trial. Refer to Appendix 1 - Standard TSP Changes Summary.

Note: TSP is an internal term used by the Agency and should not be discussed with the participant.

7. Reasonable and Necessary

With the exception of Section 43 (Plan Management) of the NDIS Act, you must apply easonable and necessary decision making to NDIS funded supports in the participant’s plan to ensure the supports are effective and beneficial to the participant.

NDIS funded supports should:

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assist the participant to pursue their goals
facilitate the participant’s social and/or economic participation
represent value for money
be likely to be effective and beneficial for the participant (having regard to current good practice)
take into account what support is reasonable to expect families, carers, informal networks and the community to provide
complement (not replace) other government services. You must also consider whether any funded supports should not be provided or funded under the NDIS. A support will not be funded under the NDIS if it:
is more appropriately funded by another government service
is likely to cause harm to the participant or pose a risk to others
is not related to the participant’s disability
duplicates other supports delivered under alternative funding through the NDIS
relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to the participant’s disability support needs
is contradictory to a law of the Commonwealth or the State or Territory in which the support would be provided
consists of income replacement. You should take a whole of person approach when considering which supports are reasonable and necessary in the participant’s plan. If the participant acquires an impairment after they have met access to the NDIS, you should consider how each impairment affects the participant’s life, and the support they need to achieve their goals. Your decision to include reasonable and necessary supports in the participant’s plan is based on whether the support meets all sections of the reasonable and necessary criteria. In exceptional circumstances some day-to-day living costs may be funded by the NDIS, if they are:
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8. Core supports

Core supports assist the participant to manage aspects of their daily living such as self-care and accessing the community. There are four Core support categories:

Consumables: includes disability-related health consumables products, dog guide consumables, Low Cost assistive technology and interpreting services.
Daily Activities: includes assistance with self-care, including additional care for short periods used for carers respite, shared living arrangements, household cleaning and/or yard maintenance.
Social, Community and Civic Participation: includes individual and group based community, social, recreational activity and economic participation. These supports may be used for day-to-day on the job assistance to assist participants to meaningfully participate at work. These supports may also be used for carers respite.
Transport: includes general and specialised transport for attending school, employment or going out in the community.

You need to ensure the participant has the Core support funding they need to meet their plan goals. Review the funding generated by the TSP and either increase or decrease the level of support funding in line with the reasonable and necessary criteria.

You will record justifications for your decisions in the Review and Submit Plan for Approval and/or Finalised Plan and Approve tasks.

8.1 Core budget flexibility

The four Core support categories Consumables, Daily Activities, Social, Community and Civic Participation and Transport are flexible. This means funding from one Core category (such as Daily Activities) can be used to purchase supports from another Core category (for example, Consumables). For funds to be used flexibly, the categories must have the same fund management type (such as Agency Managed).

It is important to look at the total value of the Core supports (for instance total combined value of Consumables, Daily Activities and Social, Community and Civic Participation and Transport) when determining the reasonable and necessary Core support funding amount.

Often the TSP will only generate funding in one or two of the Core support categories. If this occurs, you will need to check how the funding is allocated. You may need to adjust how the funding is distributed based on the participant’s individual Core support needs, plan goals and circumstances. However, participants are able to use their funding flexibly across the Core categories, even if $0 are allocated to the support category.

If the participant receives periodic transport funding, the Transport category is not flexible. Periodic transport is not included in Core flexibility as it is paid directly to the participant.

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Activity based transport can be claimed from the participant’s Core funding by providers with the participants agreement. Refer to section 8.3 Transport for more information.

Although Core funds can be used flexibly, it is important to ensure the participant understands the Core funding can only be used to purchase reasonable and necessary supports in line with the plan’s objectives regardless of whether the funding is Agency, self or plan managed.

Example of Core flexibility: Juan requires support to access his community activities and everyday use continence items. Funding of $21,606 is included in Juan’s plan for his Core support needs, as follows:

Consumables: $4,000 (Agency managed $3,000, plan managed $1,000)
Daily Activities: $0
Social, Community and Civic Participation: $16,000 (Agency managed $9,000, plan managed $7,000)
Transport – $1,606 (periodic payment)

During his plan Juan has short term need for self-care support. Depending on the funding emaining available, Juan could chose to use the flexibility of his Core budget for Daily Activities (up to $12,000 Agency managed and/or up to $8,000 plan managed). Juan’s periodic transport budget of $1,606 is not flexible with his other Core funding.

8.1.1 Limitations to flexibility with stated supports

When considering making a Core support item Stated, carefully consider:

The impact on flexibility for the participant and their providers
Whether the support is a composite item. Providers are unable to claim for a specific time of day or day of week if the composite item is stated.

8.1.2 Limitations to flexibility for transport in the Core budget

In exceptional circumstances, transport can be used flexibly however, only if;

the transport funding is not set up as an automated periodic payment, and
the transport funding is not included as a stated support, and
there are remaining funds in the Core budget to be utilised, and
the transport funding plan management type is the same as other Core Supports, and
the transport Service Booking is amended to a higher amount than what is provided in the transport category in the Core budget.

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8.2 Meal preparation and delivery

The participant may request meal preparation and delivery to be included in their NDIS plan when they are unable to prepare meals due to their disability. Some examples include when the participant is experiencing:

difficulties with organisation
difficulties completing multi-step instructions
a physical disability that impacts their ability to prepare meals.

For some participants, the inclusion of meal preparation and delivery can support them to safely maintain independent living and reduce their reliance on other supports.

When making a reasonable and necessary decision on including meal preparation and delivery in the participant’s plan, you should consider:

goal attainment and building independence
the functional impact of the participant’s disability for the preparation of meals
assessments
duplication of funding
reviewing the quote
considerations when including funding in the participant’s plan.

8.2.1 Goal attainment and building independence

You need to consider how including funding for meal preparation and delivery will assist the participant to achieve their goals and build their independence.

Talk to the participant to understand how meal preparation and delivery will support them. Discuss:

How they currently prepare meals?
How meal preparation and delivery will support them to achieve their goals?
Have they considered other supports that would develop their ability to prepare meals more independently such as an individualised program and support to participate in preparation of meals? Is this something they would like to do? Have they tried this previously? If yes, what were the outcomes?
Have they explored the use of Assistive Technology (AT) to assist with meal preparation tasks? Is this something they would be interested in exploring?
Are there risks for the participant preparing their own meals?

For participants with the potential to develop independence in meal preparation, you should consider funding for meal preparation and delivery while they explore AT and capacity building supports. At the next scheduled plan review, the plan developer and participant can

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discuss the outcomes of these supports to determine whether meal preparation and delivery continues to be required.

8.2.2 Meal preparation for children

When the participant is a child and they require mealtime preparation that is above what would be considered reasonable to expect families and carers to provide, you should consider the inclusion of funding for meal preparation and delivery.

For example, the family or caregiver for a child who is on a ketogenic diet due to their disability needs may need significantly more time for meal preparation than a child not on a specialist diet due to their disability needs.

Discuss requests for meal preparation and delivery for the child participant with your line manager.

8.2.3 Assessments

Assessments may be useful in helping you make a decision on whether to include meal preparation and delivery in the participants plan. However, they are not always necessary when there is a clear link between the functional impact of the participant’s disability and preparation of meals.

For example, you may find that you have enough information to make a reasonable and necessary decision using:

information from the planning conversation
previous reports
previous NDIS plans
other supporting evidence.

If the participant gives you a copy of an assessment from a suitably qualified allied health professional supporting their request for meal preparation and delivery, you need to consider this when making your decision.

You may be able to use information from a previous assessment to better understand the participants support needs where there has been no change to the participant’s functional capacity.

You should only ask the participant for an assessment from a suitably qualified allied health professional if you have reviewed all current information and still need additional information to make your decision. When you request an assessment, make sure you include funding in the Capacity Building budget for this to be completed.

8.2.4 Duplication of funding

If you are including support for meal preparation and delivery in the participants plan, you need to review other supports to make sure you are not duplicating funding.

Examples of other areas where support may be duplicated are:

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 funding for a support worker to assist the participant to prepare the meals

 funding for a support worker to assist the participant with their mealtime management routine

 when the participant is receiving support for 24 hours each day (for example, SIL)

 funding for capacity building supports to build independence in meal preparation.

Note: There may be times where these supports are not duplications. If you are unsure, Please discuss with your line manager.

8.2.5 Reviewing the quote

Meal preparation and delivery is a quote-required support. This means that the participant needs to submit a quote for you to consider as part of the reasonable and necessary decision making process.

When you are reviewing the quote check:

 The amount is for the preparation and delivery of meals only. NDIS does not cover the cost of food as this is considered a day-to-day living cost.

 The quote is value for money.

 You can check if a quote is value for money by comparing the quoted amount to the Product Catalogue (benchmark price) in the System. If it is 10% over the catalogue price, seek decision-making advice from your line manager.

8.2.6 Considerations when including funding in the participants plan

If the request meets the reasonable and necessary criteria you need to:

 include funding for the support using the participants plan management preference

 include a comment in the plan so that the participant knows that funding has been included. For example “$xx.xx per week of funding for meal preparation and delivery.”

8.3 Transport

Transport funding should be considered when the participant is unable to use public transport without substantial difficulty due to the impact of their disability.

Transport funding does not cover transport assistance which is considered a day-to-day living cost. For example, transport to appointments, shopping or recreational activities.

This support needs to be directly linked to plan goals and include a skill development focus.

You should use the three levels of supports for transport assistance as a guide only:

 Level 1 $1606-$1,784: For participants who are not working, studying or attending day programs but want to enhance their community access.

Level 2 $2472-$2,676

For participants who are currently working or studying part-time (up to 15 hours a week), participating in day programs and for other goal based social, recreational or leisure activities.

Level 3 $3456-$3,567

For participants who are currently working, looking for work, or studying (15 hours or more a week), and are unable to use public transport because of their disability.

To ensure the participant has transport funding to meet their transport support needs, you will need to review the TSP generated amount. Also consider the levels of support for transport assistance and include an amount based on your reasonable and necessary decision making.

You will need to seek advice from the Technical Advisory Branch (TAB) for transport costs significantly above Transport level 3 or not related to activity-based transport.

Record justifications for your decision in the Review and Submit Plan for Approval and/or Finalise Plan and Approve Task.

Note: If a participant is currently receiving mobility allowance from Centrelink, this allowance will stop upon approval of their first NDIS plan.

8.3.1 Transport periodic payments

Unlike other support categories, transport can be paid to participants as an automated periodic payment (fortnightly payment).

The System will automatically tick the Periodic Payment check box next to the Transport support category in the Determine Funded Supports Task. This means the funding is paid periodically to the participant.

It is important to review this and update the check box to reflect the participant’s circumstances. For example, if transport funding is in-kind you need to untick the Periodic Payment check box.

Periodic payments are self-managed payments. You must discuss this with the participant, their child representative and/or plan nominee.

You should not approve self-managed periodic payment:

when current bankruptcy is declared in the risk assessment,

if self-managing transport funding is likely to present an unreasonable risk to the participant.

So that periodic payments can be made, you need to check bank account details of the participant, their child representative and/or plan nominee are collected and recorded in the System before the plan is approved. Refer to the Standard Operating Procedures – Record Bank Details.

8.3.2 Participant transport as part of community participation

The participant can use funding from their Core budget for a support worker to help them participate in community outings and/or transport from their home to the community. Providers claim these costs at the relevant community participation hourly rate. When the provider is supporting more than one participant to access the community at the same time, they need to claim the group rate.

Funding from the participant’s Core budget can also be used for the provider’s non-labour costs associated with providing transport to participants:

accessing community participation supports
accessing or maintaining employment
accessing or maintaining or higher education.

Non-labour costs associated with participant transport can include:

public transport fares
road tolls
parking fees
reasonable vehicle running costs
- up to $0.85 a kilometre for a standard vehicle not modified for accessibility
- up to $2.40 a kilometre for a vehicle that is modified for accessibility or a bus
taxi or ride-share fares.

You need to consider the non-labour costs associated with providing this transport when determining the reasonable and necessary Core funding in the participant’s plan.

8.3.3 Provider travel

Provider travel is different to participant transport. There are two types of provider travel:

travel to provide daily activities and community access (Core) supports
travel to and from Capacity Building supports – refer to section 9.5 Provider Travel for further information.

When the participant agrees, providers can claim the time spent travelling to the participant. Only the actual travel time can be claimed.

For Core support, this refers to the time spent by the provider travelling to deliver a service to the participant (participant is not in the car). Where a support worker provides services to more than one participant the travel time can be shared between the participants, if each participant agrees in advance.

You may need to consider provider travel for delivering Core supports when developing Core funding in the participant’s plan. Maximum limits apply to the amount of travel time providers

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can claim. Refer to the NDIS Price Guides and Pricing for further information on provider travel.

When implementing the plan, participants should be encouraged to negotiate their supports with providers, particularly around the cost of provider travel.

9. Capacity Building supports

Capacity Building (CB) supports assist participants to increase their ability to live their life independently.

These supports are designed to deliver improved outcomes for the participant and reduce the need for funded supports in the future. CB supports focus on outcomes and are always linked to one of the participant’s goals.

Unlike the Core support budget, CB supports are only flexible in the same CB support category. For example, funding from CB Daily Activity can be used flexibly across all non-stated support items in the CB Daily Activity budget, and cannot be used to purchase supports from any other CB budget.

In the System, the TSP will generate CB support funding based on the response to the guided planning question ‘What level of Capacity Building is required?’ You need to apply reasonable and necessary decision-making regardless of whether CB support budget funding has or has not been generated by the TSP.

The exception is Plan Management (Financial Administration) supports. When the participant requires Plan Management, you must include funding in the CB Choice and Control budget. For further information refer to Standard Operating Procedure - Plan Management and Financial Administration Support Items.

All funding generated for Capacity Building will default to the CB Choice and Control budget. You will need to allocate the funding across the relevant CB budgets as you determine the reasonable and necessary supports in line with the participant’s goals and expected plan outcomes.

The nine Capacity Building (CB) support categories are:

CB Choice and Control: Includes support items relating to plan management and financial administration. Refer to section 9.2 Funding for Plan Management below.
CB Daily Activity: Individual assessment/therapy/training, group therapy, carer/parent training and individual skills development. Refer to section 9.3 CB Daily Activity below.
CB Employment: Includes School Leaver Employment Support (SLES) and employment-related assessments and counselling. Refer to section 9.4 CB Employment below.
CB Health & Wellbeing: Includes dietary and exercise physiology supports.

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CB Home Living

Includes assistance with accommodation and tenancy obligations.

CB Lifelong Learning

Includes transition through school and to further education.

CB Relationships

Includes behaviour support, as well as social skills development and capacity building. Refer to the Practice Guide – Positive Behaviour Support and Behaviours of Concern for information on including supports to address Behaviours of Concern (BoC).

Includes community participation activities, skills development and training as well as life transition planning such as mentoring and peer support. These supports may sometimes be used for carers’ respite.

Support Coordination

Refer to section 9.5 Support Coordination below.

9.1 Capacity building for self-managing support funding

The participant should be presumed to have the capacity to self-manage unless there is unreasonable risk. This is supported by the NDIS legislation and principles of the NDIS. Funding may be included in the participant’s plan to build capacity and support their goal to self-manage supports in their plan now, or in the future. This is a reasonable and necessary decision under section 34 of the NDIS Act.

For supports to build, or continue to build the participant’s capacity to manage their support funding, you should consider:

strategies to safeguard the participant’s interests, including informal supports
supports which could build the participant’s independence and capacity to self-manage
whether including additional supports in the plan could mitigate risks to the participant
whether support with budgeting, book keeping and financial record keeping will support the participant’s goal to manage their supports in the future
any supports to assist the participant to negotiate services and utilise the supports in their plan.

For further information about the different types of plan management, who can manage NDIS funds and capacity building supports for self-management, refer to the Practice Guide – Determine Plan Management.

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9.2 Funding for Plan Management

Plan management and financial administration funding is a stated support that allows the participant to engage an NDIS Registered Plan Manager to manage the financial functions of their plan.

Funding for plan management and financial administration support is not included in the TSP. If the participant, their nominee or child representative requests to have a plan manager for one or more of their supports, you are required to add funding for the plan management activities in the participant’s plan.

The participant’s choice to have a plan manager manage the funded supports in their plan is a legislative entitlement under section 43(2) of the NDIS Act 2013. Where the participant requests their funding to be managed by a plan manager, this is not subject to reasonable and necessary criteria.

Refer to the Standard Operating Procedure - Plan Management and Financial Administration Support Items to include financial administration supports in a participant’s plan.

Where it is a goal of the participant to learn how to manage their own funds and/or build capacity to self-manage their plan, if reasonable and necessary, this support funding is included in one of the following CB budgets:

CB – Choice and Control (Plan and Financial capacity building): Generally used when a participant is plan managed and has goals around financial independence and/or to build capacity to move to self-managing in the future.
CB – Support Coordination (Training in Planning and Plan Management):- Generally used for participants who are self-managed and require some assistance to get started with this process, or where a participant has support coordination included in their plan and the plan is not plan managed.

When including funding to build capacity to self-manage, ensure you discuss whether the participant will be able to locate and access appropriate service providers to assist them.

9.3 CB Daily Activity

9.3.1 Allied Health Practitioners

Allied health practitioners (AHP) hold a university qualification, specialise in different areas and work directly with the person requiring support. AHPs are not part of the medical, dental or nursing professions. AHPs include, but are not limited to: occupational therapists, physiotherapists, speech therapists, exercise physiologists, psychologists, prosthetists or orthotists, podiatrists, dieticians or respiratory therapists.

Refer to Practice Guide – Understanding Therapy Supports for a full description of each of the allied health practitioners.

Reasonable and necessary funding can be included in the participant’s plan to meet their disability-related health support needs. For example continence supports, diabetic supports,

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dysphagia supports, epilepsy supports, podiatry supports, nutrition supports, podiatry and foot care supports, respiratory supports or wound and pressure care supports. Refer to section 16.2 Disability-Related Health Supports and Practice Guide – Disability-Related Health Supports for further information.

9.3.2 Nursing

Reasonable and necessary nursing supports can be included in the participants plan to meet their disability-related health support needs as per section 6.8 of Practice Guide – Disability- Related Health Supports.

9.4 CB Employment

The CB Employment category includes School Leaver Employment Support (SLES), and employment-related assessments and counselling.

9.4.1 School Leaver Employment Support (SLES)

SLES funding will be auto-generated as part of the TSP to the CB Employment budget based on the response to the guided planning question, ‘Is the participant eligible for School Leaver Employment Support (SLES)?’ For the current guidance on SLES, please refer to the Employment intranet page.

9.5 Support Coordination

The Support Coordination category is part of the Capacity Building budget but is separate from the eight Capacity Building (CB) sub-categories. This category includes the support items for support connection, support coordination and specialised support coordination, as well as support for building a participant’s capacity to learn to self-manage their own plan (training in planning and plan management).

Refer to:

Appendix 1 – Standard TSP Changes Summary
Standard Operating Procedure – Update Participant Streaming
Standard Operating Procedure – Include Support Coordination in a Plan.

9.6 Provider Travel

Providers of some supports are able to claim non-direct services, including provider travel, short notice cancellations and where an NDIA report is required.

Provider travel for capacity building supports can be claimed for travel to each participant, and return travel from the last appointment of the day. The participant must agree to the travel costs to be claimed in advance.

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Where a worker travels to an area and provides services to more than one participant, if agreed to in advance by each participant, the cost of time and travel could be split between the participants.

CB support categories where providers may be able to claim provider travel include:

CB Daily Activity
CB Social Community and Civic Participation
CB Employment
CB Relationships
CB Health and Wellbeing
Support Coordination.

When considering the level of reasonable and necessary CB supports, consider how the services will be delivered. Also consider any other circumstances that may affect how the participant utilises their plan funding, such as provider travel, and how this may impact the level of supports available, particularly for participants living in regional and remote areas.

Maximum limits apply to the amount of travel time providers are permitted to claim. Refer to the NDIS Price Guides and Pricing for further information.

9.7 Medicare

The participant may access Medicare funded allied health services with a referral from their GP alongside allied health supports funded in their NDIS plan. There is no requirement for the participant to use or exhaust these Medicare funded services before receiving allied health supports funded in their NDIS plan if the supports required relate to the participant’s functional impairment and are considered reasonable and necessary.

Where considered reasonable and necessary, the funded supports should be included to cover the full cost of the supports. Where Medicare funded allied health supports are not considered reasonable and necessary, the supports funded through Medicare can work side by side with other funded supports to enable the participant to achieve their goals.

For example:

NDIS funded psychology supports to address disability related barriers and build capacity to engage in social situations and participate in employment.
The participant also accessed Medicare funded psychology supports for clinical treatment such as ongoing counselling and medication management (not funded by the NDIS).

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10. Capital supports

Capital supports assist a participant to increase independence and participation in a range of different environments, such as their home, community and the workplace.

The two support categories within Capital are Assistive Technology and Home Modifications.

When responses to the guided planning questions generate assistive technology or home modifications support funding, the intended purpose is to fund equipment or an assessment appropriate to meet the participant’s needs.

Unlike the Core support budget, Capital support categories are not flexible between Assistive Technology and Home Modifications.

It is the responsibility of the plan developer to review the TSP generated Capital supports and adjust the budget amounts for the participant’s reasonable and necessary support needs.

Note: Capital items including AT and Home modifications must not be added to a plan (even if they are quote required) unless evidence and reports are attached in the System to justify that the equipment is reasonable and necessary.

10.1 Assistive Technology

For further information on including assistive technology in the participant’s plan refer to Our Guidelines - Assistive technology on the NDIS website and Assistive Technology guidance on the Planning resources Intranet page.

10.2 Home Modifications

Home modifications includes interior and exterior home modifications, consultation and project management. For further information on including funding for Home Modifications in the participant’s, refer to the Standard Operating Procedure – Include Home Modification Supports in Plans.

10.2.1 Specialist Disability Accommodation (SDA)

The support item for Specialist Disability Accommodation (SDA) sits in the Home Modifications budget of a plan.

The three different types of SDA are:

new
in-kind
existing.

The two occasions when SDA may be included in a plan are:

when there is a new SDA decision

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 when the participant was already residing in disability related supported accommodation at the time of transition to the NDIS.

10.2.1.1 Existing or In-Kind SDA

When the participant is already residing in an SDA dwelling when they transition to the NDIS they are considered to be in existing or in-kind SDA. SDA funding needs to be included in the participant’s NDIS Plan. Refer to:

 Standard Operating Procedure – Include Existing (non in-kind) SDA in a Plan: Participants Residing in SDA Prior to Transition

 Standard Operating Procedure – Adding In-Kind Supports in a Plan.

10.2.1.2 A new SDA decision

When the participant wishes to move in to SDA for the first time or wishes to move to a different SDA dwelling, from an existing or in-kind SDA dwelling, this is considered to be new SDA.

For new SDA, the SDA support funding must not be included in the participant’s plan without referral to the SDA panel for advice.

The SDA panel will review the SDA eligibility and provide a recommendation for the participant’s SDA request. The SDA panel will also provide information on the eligible SDA type and level for the participant. This information is recorded in the Housing and Accommodation section of the participant’s record.

Refer to the Standard Operating Procedure – Determine Specialist Disability Accommodation

Change of Address or a New Decision.

Note: For more information regarding transitional accommodation, while the participant is waiting for Assistive Technology or Home Modifications, refer to the Practice Guide - Medium Term Accommodation.

11. Quote required support items

A quote is required for some supports such as high cost assistive technology, complex home modifications and vehicle modifications.

Where a quote required support is included in the participant’s plan the quote process must be followed. For further information refer to the Standard Operating Procedure - Initiate and Record Quotes and Standard Operating Procedure - Consider and Action Quotes.

12. Plan Duration

The duration of the participant’s plan may vary depending on the participant’s disability, streaming decision and individual circumstances. You can find guidance for determining plan duration in Standard Operating Procedure – Complete the Risk Assessment.

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The TSP generates Core supports based on the chosen plan duration. For example, a 36- month plan will generate 36 months of Core supports, a 24-month plan will include 24 months of core supports and a 6-month plan will generate 6 months of Core supports.

Manual adjustment may be required for Capacity Building and Capital supports for plans other than 12 months duration. You will need to use reasonable and necessary decision making to adjust funding in these budgets to reflect the participant’s needs for the duration of the plan.

13. Stated supports

A stated support is a support recorded in the plan at the support item level, and selected as stated in the support calculator.

When a support is stated the funding for that item can only be used for that particular support. As defined in Part 6 of the NDIS (Plan Management) Rules 2013, stated supports must be purchased by the participant as they are described in the plan.

Carefully consider if a support you are including needs to be stated, as stated items reduce flexibility for the participant and the provider.

When including stated support item(s), make sure the comments in the related support category clearly outline the intent of the stated support.

For example: In CB Relationships, you may include a stated support item for the development of a Behaviour Support Plan by a registered provider. Marking the support item as stated quarantines this funding from the rest of the support category budget, and ensures it can only be used by the participant as intended.

14. In-kind

Before the NDIS was established, states and territories paid service providers directly to deliver services to people with disabilities. In some situations, states and territories continue to pay for these services directly and NDIS participants continue using these services.

When these pre-paid supports are provided as reasonable and necessary supports in the participant’s plan they are called in-kind and must be recorded as in-kind specifically within the participant plan. Refer to the Practice Guide – In-Kind.

15. Compensation

If the participant responds ‘yes’ to the risk assessment question ‘Is your disability the result of an accident or event?’ this indicates the participant has received, or is entitled to receive compensation. Additional questions will be generated in the System for you to complete in elation to compensation.

Compensation, for NDIS purposes, is either a lump sum or periodic payment.

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If you identify the participant is, or has been entitled to compensation, follow the steps below:

Give the participant or their nominee the Compensation and the NDIS Fact Sheet.
Advise the participant or nominee they can get additional information on the Compensation and your plan page of the NDIS website.
Email the Compensation Recoveries Team (CRT) as soon as you become aware of the potential for compensation. In the subject line of your email include the participant’s NDIS number and last name.
Add an alert to the participant record in the System.
Create an interaction that compensation has been identified.
Proceed with developing and approving the participant’s plan.

For further information refer to the Compensation Recoveries intranet page.

16. Changes to the TSP

Sometimes, the generated TSP has not enough or more than enough funding to meet a participant’s needs or enable them to achieve their goals. Funding generated in each individual support category is informed by the participant’s support needs identified in response to the details recorded in the System. Use reasonable and necessary decision making to adjust the TSP up or down in response to information available to you regarding the participant and their individual circumstances.

Sometimes, evidence of support needs may indicate that the funding generated in the TSP is above the reasonable and necessary support requirements. For example, a participant may be very engaged in the community for recreational and social activities or be working, and have strong, sustainable informal care networks. This information must be taken into account when determining the funded supports to prevent supports being funded in the plan that are in addition to what is reasonable and necessary.

The standard TSP changes include varying the TSP for specific supports. These supports include:

Defined Programs
Plan Management costs
Behaviours of Concern
Supported Independent Living (SIL) (group)
Specialist Disability Accommodation (SDA)
Assistive Technology (including composite items)
Home Modifications
Coordination of Support

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