What is the National Disability Insurance Scheme?

The National Disability Insurance Scheme (the NDIS) is a radical new way of funding disability services and supports in Australia.

The NDIS reforms will see the disability sector:

  • Move away from eight separate State/Territory funding schemes to one uniform Insurance Scheme.
  • Change from block funding of disability service provider organisations by governments, to individualised funding for people with disabilities based on individual needs assessments
  • Ditching Australia’s old welfare and charity model of disability funding, replacing it with a legislatively guaranteed “insurance” model whereby all Australians who meet the eligibility criteria are  legally entitled to NDIS funding for all ‘necessary and reasonable’ supports.

By allocating funding for disability services and supports to people with disabilities themselves rather than to service provider organisations, and by introducing individualised funding packages, the NDIS aims to ensure that Australians with disability – and their families, where relevant – enjoy far greater choice and control over all necessary services and supports.

 

How will the NDIS work?

The NDIS will also provide ongoing financial support for the estimated 460,000 Australians with significant and permanent disability

The NDIS offers a comprehensive information and referral service to help all Australians with any level or type of disability to access mainstream, community and – where necessary – specialist disability support services.

In addition, the NDIS will also provide ongoing financial support for the estimated 460,000 Australians with significant and permanent disability. This support includes, for example, funding for intensive early intervention therapy services and/or equipment, where there is good evidence such therapy and/or equipment will substantially improve or arrest a decline in functioning.

If eligible for the NDIS, you will receive funding on an annual basis to purchase the services, aids and equipment that you have been assessed as needing from the service provider/providers of your choice. In addition, you can choose either to self-manage your own funds, in which case they will be paid into a nominated bank account, or else ask the NDIA – the agency established to administer the NDIS – to manage your funding for you.

As individual circumstances, condition or needs change, NDIS participants will be able to apply to have their funding plan adjusted accordingly.

 

What services and equipment will the NDIS provide?

The NDIS provides ongoing funding for all ‘reasonable and necessary’ disability equipment, care and support services.

The National Disability Insurance Act, passed by the Commonwealth Parliament in 2012, sets out guidelines to help decide what can be funded, but generally the supports and services provided to you, if eligible, need to assist you to:

  • achieve your goals
  • become as independent as possible
  • develop skills for day-to-day living
  • participate in the community
  • work and earn money

In practice this means providing support, as and if required, in areas including:

  • mobility
  • communication
  • self-care and self-management
  • social interactions
  • learning
  • capacity for social and economic participation.

In thinking about and developing your own individualised NDIS plan, you therefore need to consider all your daily activities and the aids, equipment, training and/or support that would make your life easier, whether currently provided or not.

 

When and where does the NDIS start?

The NDIS is being progressively rolled out across a number of trial sites.

The NDIS launched in July 2013 in four ‘trial site’ locations: the Hunter region of NSW and the Barwon region of Victoria, across SA for children with disabilities aged 0-5 and in Tasmania for people aged 15-24.

In July 2014, the scheme launched in the ACT, NT and parts of WA.

On 16 September 2015 the government announced that full roll out for NSW and Victoria will occur between 1 July 2016 and 30 June 2018. More information about the announcement can be found on the NDIS website. If you are in NSW or Victoria and are unsure about what you should be doing to get ready for the transition, read Fighting Chance’s hints and tips here.

Currently, full national roll out of the scheme is due to be completed by 2018-19.

More information:  National Disability Insurance Scheme page

 

Why is the NDIS initially available in only a few locations?  

The NDIS represents an exciting but huge change to the disability sector and trial sites should ensure a smooth transition.

Because the government accepted the Productivity Commission’s expert advice that building the NDIS in selected trial site locations to begin with was the best way to help ensure that implementation of such a radically new approach to disability support funding was fully informed by feedback from people with disability, their families and carers, service providers and community organisations. With the NDIS involving such major changes in the way Australia’s disability care and support system works, governments want to make sure they get this reform right so it is sustainable over the long term for people with disability, their families and carers.

 

Who will be eligible?

The NDIS will operate within a range of eligibility criteria.

Eligibility for individual support packages depends on:

Age: you have to be aged between 0-65 years old (although already enrolled participants, once they turn 65, can choose either to continue with the NDIS or transfer to the aged care support system available to all Australians over that age).

Disability requirement: you will be assessed based on the impact of your disability on functional capacity to communicate, interact socially, learn, move safely around your home and the built environment and manage your personal care and affairs (banking, bill paying etc).

Early intervention requirement: early intervention supports will be available to achieve a benefit that would help mitigate the effects of an impairment, to alleviate or prevent the deterioration of functional capacity, or strengthen informal supports.

More information:

My Access Checker – National Disability Insurance Scheme.

 

How does the NDIS assessment process work?

A series of eligibility and planning assessments will be used to determine allocated funding.

There are two assessment processes: first, an eligibility assessment to determine whether a person is eligible for funding, and if so, a planning assessment to determine a person’s goals and aspirations and then design an individualised funding package to help achieve those goals.

NDIA staff – called Planners – carry out these assessments using formal systems and tools designed to ensure consistency, fairness and objectivity. If necessary, there is also scope for NDIA staff to also call on specialist advice.

One of the central precepts of the NDIS is that agency planners and participants work together to identify what current and future supports will be required to make progress on the participant’s goals, resulting in a ‘Statement of Participant Supports’ that sets out the supports to be provided or funded by the NDIS, based on what is considered ‘reasonable and necessary’ to enable a good life. This could involve one-off and/or ongoing funding.

More information:

My Access Checker – National Disability Insurance Scheme.

 

Who decides what is ‘reasonable and necessary’?

The NDIS will provide individual participants with whatever is necessary to achieve their life goals and aspirations and participate in the community to the fullest extent possible.

As might be imagined, the NDIA has put a great deal of effort and thought into defining as precisely as possible what is meant by  ‘reasonable and necessary’, since this definition fundamentally determines the entire scope of what the NDIS provides – not to mention its future costs and, potentially, the scheme’s very financial and economic viability.

According to the agency, ‘reasonable and necessary’ means the NDIS will provide individual participants with whatever is necessary to achieve their life goals and aspirations and participate in the community to the fullest extent possible, whilst at the same time ensuring the support provided “represents value for money, in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support”.  So for example, the NDIS will fund a wheelchair if that is what you need for mobility, but would refuse to pay for any “frills” such as decorations or special colours.

Commonly available disability supports and services the NDIS covers include aids and equipment, home and community care, personal care, domestic assistance, respite, home and vehicle modifications and community access. However, supports which are already available from other mainstream services, including from health, housing, education and aged care sectors, are most unlikely to be covered by the NDIS.

 

Will there be choice and flexibility in what I  can purchase with NDIS funds?

A participant’s funding will be divided into two parts – fixed supports and flexible supports.

The fixed supports will need to be spent on specified supports such as equipment, home modifications and certain types of early intervention therapy services. Generally speaking, ‘fixed supports’ are those services deemed necessary to ensure participants’ goals or desired outcomes can be met, or those which require certain skills or qualifications from the provider involved. If a certain amount is allocated for a new power wheelchair, it will need to be spent on a new power wheelchair.

‘Flexible supports’ – such as funding for recreational, community access and home-based support activities – will however be funded in more general terms, enabling participants to switch funding from one item to another, depending on their personal needs from week to week.

More information:

Planning and assessment – National Disability Insurance Scheme.

 

How will I be able to choose the things I want?

A key principle underpinning the design of the NDIS is to give Australians with disability far greater choice and control over the supports and services they receive.

Each individualised funding package allows participants the right to choose the service agency or agencies they wish to provide the supports identified in their package, and participants are entirely free to change service providers who do not adequately and satisfactorily meet their needs.

Participants can choose either to directly employ their own support workers, or else purchase supports from mainstream and/or specialist providers of support workers. .

If people wish or need to, they can also get support from intermediaries in making their choices and handling administrative tasks. Or, they can choose to manage their own package and purchase their own supports.

 

What happens if I’m deemed to be ineligible for NDIS funding?

People ineligible for an individualised funding package can still get general advice and information from the NDIA.

For people whose application is unsuccessful, there is also a formal review and appeals process, with an internal review process as a first step followed, if unsatisfactory, with full rights of appeal to the Commonwealth government’s Administrative Appeals Tribunal.

More information:

Review of Decisions – National Disability Insurance Scheme

 

Will I have to travel far for my assessment?

There will be NDIA offices in every city and large town, as well as a range of other ways to access the NDIS, including online, face-to-face and over the telephone.

More information:

Visit us – National Disability Insurance Scheme

 

 

 

When will I be contacted by the NDIA?

Some eligible clients may be contacted by the NDIA as the scheme roll out continues, but people can also be proactive if they wish and contact the agency in advance to log their interest.

The NDIS website also has an eligibility checker, called My Access Checker, if you’d like to get some initial idea of your own (or, if a parent, your child’s) eligibility.

This checker involves a series of questions that help a person with a permanent and significant disability (or their representative) understand whether they may be able to access the NDIS. The process is anonymous, meaning you will only be asked for your first name, and takes between 10 and 20 minutes to complete.

More information:

My Access Checker – National Disability Insurance Scheme.

Visit us – National Disability Insurance Scheme

Contact Us – National Disability Insurance Scheme

 

I have a permanent disability – do I really have to go through yet another “assessment”?

An initial assessment by NDIA staff is however necessary to help determine your eligibility for the NDIS.

Unfortunately yes, but once enrolled in the NDIS you will not need to constantly re-prove your eligibility. An initial assessment by NDIA staff is however necessary to help determine your eligibility for the NDIS, and then to draw up your individualised support plan, including funding. Each plan will also include a monitoring and review timetable to accommodate future changes in an individual’s needs or circumstances.

 

Am I responsible for managing my own plan? Is there support available?

Once your individualised plan has been drawn up and formally agreed to, you have three choices as to how your plan gets managed from then on: self-management, using a plan management service, or nominating the NDIA to carry out this role.  

If you choose to self-manage your own plan’s financial and administrative processes, you are also entitled to request a “plan nominee” to support you with these processes. (The NDIA estimates that up to 20% of participants may select this self-management option.)

A participant may request to use a Plan Management Provider, meaning you engage a business/ organisation to undertake all financial and administrative processes involved on your behalf. This includes such tasks as paying supplier invoices, developing service agreements with providers, assisting you with the hiring and paying of staff and preparing reports and reconciliations on how NDIS funds are being used.

If you choose to nominate the NDIA for this role, the agency will make all the payments necessary to any registered care and/or support providers chosen by the participant.

More information:

People with disability – National Disability Insurance Scheme.

 

Will I need to change anything?

If you currently receive any form of federal or state government disability care and/or support funding, you are basically 100% guaranteed to be eligible for NDIS funding. 

However, if you have any concerns or questions, please do not hesitate to discuss your own particular circumstances and needs with anybody at Fighting Chance and we help you to find an answer to your questions.