News & Updates

How to Avoid Delays to Short Term Accommodation Payments

If you have recently submitted a Short Term Accommodation (STA) claim, you may have noticed that some claims or reimbursements are being rejected by the NDIA. This increased scrutiny is due to the NDIA’s heightened focus on what participants are claiming as Short Term Accommodation and Respite, as well as the documentation required for approval.

Changes to Your Eligibility and Access to Short Term Accommodation, Music, and Art Therapy

We have some short but very important updates to share with you today. If you are accessing Short Term Accommodation (STA), Music Therapy, or Art Therapy, please review the details outlined below carefully.

NDIS-Funded Music and Art Therapy

The advice regarding art and music therapy has now changed. For the most up-to-date information, refer to the latest guidance. The NDIS exists to ensure participants have access to evidence-based, disability-related supports they require. Recent changes to legislation have introduced updated definitions of NDIS supports, clarifying what participants can and cannot use their funding for.

Updates to NDIS Access and Eligibility

On 3 October 2024, important changes to the National Disability Insurance Scheme (NDIS) took effect, aimed at enhancing clarity, fairness, and consistency for participants. These adjustments stemmed from extensive discussions with the disability community and marked a significant advancement toward a more sustainable and participant-centered NDIS.

Changes to the NDIS legislation and policies

Starting 3 October 2024, NDIS funding can only be utilised for designated NDIS supports, per the new regulations. This transitional rule outlines both eligible expenses and those that are prohibited. However, there may be specific situations where you can request approval to use your funding for a support that doesn’t fall under NDIS, but these instances are limited and subject to review.

What does the NDIS fund, and what does it not cover?

The National Disability Insurance Scheme (NDIS) provides a variety of supports and services tailored for eligible participants with disabilities, aiming to enhance their quality of life and independence. However, it’s important to note that certain items and services are explicitly not covered by the NDIS, which can include basic living expenses and mainstream healthcare costs.

Pricing updates - announced 1 October 2024

Starting 1 October 2024, providers can claim Intensive and Complex Behaviour Supports at the same price limit as High Intensity Supports under certain conditions, addressing concerns after “challenging behaviours” was removed from the definition. Providers must ensure supports align with participant plans and be registered for Module 2A by 30 June 2025.

FAQs

What types of support does NDIS funding cover?

Not all types of support required by a person living with a disability fall under the responsibility of the NDIS .

Some supports are funded by other areas of government (e.g. state health systems) or existing public/community services.

In general, the NDIS will fund reasonable and necessary supports that help a person living with a disability enjoy an ordinary life.

These supports and services fall into three categories.

Core

A support that assists with activities of daily living.

Capital

A support for an investment, such as assistive technologies; equipment and home or vehicle modifications; or funding for capital costs (e.g. to pay for Specialist Disability Accommodation).

Capacity building

A support that helps build independence and skills.

Common examples of supports provided or funded by the NDIS include:

Help with personal care activities and/or household tasks
Home and vehicle modifications
Assistive technology, aids and mobility equipment, including set up and training by skilled personnel
Transport to enable participation in community, social, economic and daily life activities, e.g. workplace, gym or places of learning
Support to find and keep a job
Therapeutic supports like occupational therapy, speech therapy and behaviour support
Health-related supports (as long as they are a regular part of your patient’s life and the need for them arises from a disability), e.g. continence, diabetic management, dysphagia, epilepsy, nutrition, podiatry, respiratory and wound and pressure care supports (see the Disability-related health supports page for full details).

If you are uncertain if the supports your patient requires are funded by the NDIS, refer the patient to a Local Area Coordinator for further advice before proceeding with an Access Request, as other public or community services may be more appropriate.

Does the NDIS cover costs for medical care like assessments, treatment, medication, hospital visits, or Medicare gap fees?

The NDIS is not designed to fund supports more appropriately funded or provided by the health system.

Assessment, diagnosis and treatment of health conditions, along with medications and hospital care, remain the responsibility of the health system.

As a general guide, the following health-related services and supports are not provided or funded through the NDIS:

Items and services covered by the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), nor Medicare gap fees.
Treatment, services or supports delivered by a doctor or medical specialist, including diagnosis and assessment of a health condition.
Items and services provided as part of diagnosis, early intervention and treatment of health conditions, including ongoing care of chronic health conditions.
Medically prescribed care, treatment or surgery for an acute illness or injury including post-acute care, convalescent care and rehabilitation.
Sub-acute care including palliative care, end of life care and geriatric care.