With a Crisis brings Flexibility to the NDIS – but for how long?

As much as this pandemic has been difficult and trying across the healthcare industry, there have been some changes made to the NDIS in response to COVID-19 that have been long awaited.

With these positive steps, going forward for both participants and service providers in the Australian disability sector things will get better. However, some of these changes will be for the short term only. These almost forced changes bring about what has been necessary to ensure the continuity of exceptional care and the financial sustainability of organisations during this unprecedented time.

Welcomed by so many working in the industry and overwhelming appreciated by those living with disability, let’s watch and see which updates to the NDIS will stand the test of times. It’s our hope that the new flexibility will remain in place even after this pandemic is under control.

So let’s take a closer look at these fast moving updates. With a little more insight into how you can best support yourself with servicing and claiming, you too will be able to continue moving forward through this crisis and into the future.

10% Loading on Pricing:

You may be aware that as part of a financial assistance package, the 10 per cent COVID-19 loading has been added to price limits for certain supports. But this has a time limit. For up to six months. It’s a positive response, in the fact that registered service providers will be financially assisted to continue to deliver supports during this period.

The increase is for price controlled supports only for specific Support Categories. These include:

• assistance with Daily Life (but not including Supported Independent Living)
• assistance with Social and Community Participation
• improved Health and Wellbeing (but not including personal training)
• improved Daily Living Skills.

As always, NDIS participants continue to have choice and control over how they use the funded supports. Importantly, service providers need to discuss and agree on these new pricing arrangements with participants. Using collaborative technology to support an engaged approach will ultimately improve the ability to claim funding compliantly and efficiently, and support providers financially. Which in turn means better quality care for the community.

• Service bookings created at the category level will not need to be updated.
• Service bookings created at the line item level will need to be updated.
• The NDIA removed service booking restrictions to allow editing by both the provider and the participant.
• The 10% loading does not apply for quotable items.

Participants Plans:

All plans will be automatically extended for a 12 month period this will ensure that there are no plan gaps which can make things difficult for providers especially relating to claiming.

Extended plans will have the same core and capacity building budget funding as the current plan.

For new plans that were updated before auto extension came into play, service providers are able to claim against expired plans for up to 12 months.

• Capital funding will need to be reviewed before being added to an extended plan.
• Plans are not being provided by post. The NDIS portal is the only way to see new plan dates and budgets.
• The NDIS will still be conducting Plan Reviews. In most cases, these will be conducted by phone with participants having options to have plans in place for 24 months.

Now that the NDIA has released APIs for better integration with the NDIS portals, its even more important that service providers choose a technology partner who supports the Australian disability industry. Improve transparency in one place and on one platform.

Funding Flexibility:

Participants are now able to use their Core Support funding flexibly to meet their support needs. This includes Transport funding. But who is this available for?

If a participant’s NDIS Plan is Plan or Agency-Managed only, and if their transport funding is not being received as a periodic payment.

This is what has been offered at this stage, but it’s best to keep an eye on it as we progress through the aftermath of the pandemic. This type of flexibility will be a positive support change that should remain as a more permanent feature of the NDIS.

• Plan flexibility for Self Managed Participants is expected to roll out in June 2020.
• If a participants Core Support funding is low, the NDIS will move some of their capacity building funding over to the Core Support funding. But there’s a condition. The NDIS must be contacted to make this change.

Support Coordination:

Good news if you are providing support coordination to a participant and they require additional hours above what is funded in their Capacity Building funds. Core Support funding is able to be used flexibly to ensure participants are getting the additional support they need, including increased support coordination.

Additional line items have been added to the Price Catalogue for Support Coordinators to claim from the Core Support budget.

• COVID specific support items were duplicated under the Assistance with Daily Life Support Category.
• In consultation with the participant, any agreed increase in support coordination must have a service agreement and new service booking in place.

Supported Independent Living:

As outlined on the NDIS website, a participant’s Supported Independent Living (SIL) plan will not expire. It will automatically be extended by 12 months to make sure participants have the funding they need. This is great news! Moreover, service bookings for SIL and Specialist Disability Accommodation (SDA) will be extended as well.

As a result of the pandemic, a key change that has been made to the rules for claiming services relates to a provider giving further support because a participant has chosen either not to or is unable to attend an activity. Examples of these could be Therapy or Group services.

Service providers can “step in” (in accordance with the NDIS’s naming) and claim for additional services:

• Intermittent occurrences: one to three days. These will be covered in the current SIL quote (under intermittent events), provided up to the total in the quote.
• All intermittent days used as per the estimated SIL quote. A SIL provider should create a service booking for Community Participation from the participant’s Core Support funding.
• Longer occurrences: more than three days. The SIL provider should create a service booking for the time their services have been provided to the participant.

• The SIL provider may be required to be registered for Community Participation.
• A service booking will be required to be created against the participant’s Core Budget.
• SIL quotes will still need to be submitted when the participant’s plan comes into review.

Just to note: If a participant chooses not to, or is unable to attend their usual therapy or group events, they should not be charged for these supports. The participant or their support coordinator will likely need to amend the existing service booking to reflect this.

New Line Items Specific to COVID-19 Response:

There are two new line items for cleaning and additional supports that ensure SIL providers can continue to deliver services with support and ensure participants receive the care they need.

These line items can be used if a participant in a SIL arrangement is diagnosed with COVID-19. When a participant is diagnosed with Coronavirus, there are three situations that trigger the two new line items support claims. These include:

• the participant continues to reside in the normal SIL accommodation
• the participant is admitted to hospital
• the participant is relocated to alternative housing for isolation purposes or while transitioning into or out of hospital.

A participant could move through all of these situations, and funding will follow to the provider in all of these circumstances.

The two new support items are:

• Cleaning Services: $300 to cover the cost of a one-off professional deep cleaning of a residence per participant newly diagnosed with coronavirus (COVID-19), with one claim allowable per participant diagnosed with Coronavirus (COVID-19).
• Additional Supports: $1,200 maximum daily rate to cover the cost of higher intensity support including staffing increase, Personal Protective Equipment (PPE), professional laundering, and any ancillary costs directly related to the participant’s diagnosis. This item may be claimed throughout a participant’s period of infection (based on number of days from diagnosis to negative test result), whether they are located in their normal accommodation, in hospital, or isolated in alternative accommodation.

• A service provider with a participant residing in SIL who is diagnosed with COVID-19 you must immediately notify the NDIS Quality and Safeguards Commission.
• A service provider can continue to claim usual SIL costs while a participant diagnosed with Coronavirus (COVID-19) is in hospital or isolated in alternative accommodation.
• Alternative accommodation will also be claimable through the short term accommodation support item.
• A service provider cannot use the two new line items until they have made contact with the NDIS Quality and Safeguard Commission, and a participant’s plan has been renewed/updated with these as stated line items.
• The NDIS will not cover additional administrative costs, staff sick leave, medical costs associated with a hospital stay or everyday expenses.
• $300 is the maximum that can be claimed against each participant diagnosed with Coronavirus (COVID-19) for the cleaning services line item.

Low Cost Assistive Technology:

Where appropriate and with the agreement from the participant to reduce risk of exposure to COVID-19. Participants can now use their existing Core Support funding to purchase an Assistive Technology (AT) item to support them with changes to existing supports such as telehealth/video conferencing or exercise equipment.

Low cost AT can only be purchased to meet both conditions:

• to maintain funded NDIS supports like a program, therapy or requirement (for example physiotherapy or Auslan interpreting provided via video conferencing), and
• the service provider has confirmed in writing the device is necessary to continue support while maintaining physical distancing requirements.

Further to this, providers and participants must ensure:

• the item is the lowest specification that will maintain funded supports
• participants do not already have the item, another suitable or access to the item
• the item has not been funded by another service system (such as education)
• the item or circumstances are not specifically excluded.

It’s important to note that participants are able to spend up to $1500 on low cost AT items from their existing budgets. However, participants should not spend more than $750 on electronic devices that are needed to maintain existing services.

• Plan managed or self-managed participants can purchase low cost AT items from any provider.
• Agency managed participants can purchase low cost AT items from any registered NDIS provider, such as a therapy or support coordination provider.
• For those participants with funding in their capacity building budget only, they can use the new special line item (COVID-19 Low Cost AT to support Capacity Building support delivery). Thus, being supported by the new flexibility of the NDIS.
• An appropriate record as evidence of why the participant needs to purchase the AT is to be documented and retained.
• For self-managing participants that don’t have enough money under the consumables support category, they will be able to access funding allocated to other support categories in June.
• This is a time limited policy which will be in place until September 2020 and will be reviewed at the end of June 2020.

The best way to manage all these changes and still deliver quality care to participants is to use a healthcare platform. With real-time technology you can securely store records, files and case notes. Be supported to transparently deliver services and compliantly claim funding from the NDIS.

With the NDIA doing its best to support participants and providers during this time, it’s can be appreciated that there will be a lot of change, and some unknowns as to what the future looks like for ongoing flexibility in the system. But for now, the NDIA has pulled together a dedicated team to manage Coronavirus (COVID-19) related participant issues. So if you’re ever in doubt, make sure to reach out to the resources that are available on the NDIS website. And remember you can always contact the NDIS Quality and Safeguards Commission directly.

For all you digital business needs, be sure to reach out to the Lumary team. We are here to support you with the right software solution that will give you better insight into your care management and delivery, increase collaboration within your team, and streamline claiming to improve your overall business efficiency. Make the worry of the unknown a thing of the past. We’ll continue to support you as we work through the remains of these troubled times and into the future as the NDIS continues to evolve.