Navigating the NDIS - For Participants and Healthcare Professionals

This article is intended to help healthcare professionals and people living with a disability to understand, access and navigate The National Disability Insurance Scheme.

The following topics will be covered:

What is the NDIS?

The National Disability Insurance Scheme (NDIS) is a government-led initiative, intended to support Australians who are living with an intellectual, physical, sensory, cognitive and/or psychosocial disability (Australian Department of Human Services 2019).

Support offered by the NDIS can be in the form of anything from services information, to financial and aide assistance, to linking individuals to support groups.

The NDIS is designed to help eliminate barriers to living a fulfilling and productive life for around 460,000 Australians (under the age of 65) who are living with a permanent and significant disability and to provide them with the necessary supports required (Australian Department of Human Services 2019).

This is achieved by providing information and connecting people to services in their communities such as doctors, sporting clubs, libraries and schools, as well as information about what support is provided by each State and Territory government (Australian Department of Human Services 2019).

The NDIS is not to be confused as a replacement of the Disability Support Pension – this pension still provides income support through Centrelink to people aged 16 to 65 who are unable to work as a result of their disability (Australian Department of Human Services 2019).

The NDIS does, however, offer additional funding to meet the particular special needs of a person with a disability, such as to buy a wheelchair or have assistance at home (The Conversation 2016).

Why is the NDIS Essential?

The NDIS was created in response to a 2011 Productivity Commission report in Disability and Care that found disability services, as they were in 2011, were:

• Underfunded;
• Unfair;
• Fragmented; and
• Inefficient.

(The Conversation 2016; Australian Government Productivity Commission 2011).

The commission suggested a system of flexible individual funding packages that could be accessed to purchase disability supports (The Conversation 2016) hence the implementation of the nation-wide service.

What is the NDIA?

The National Disability Insurance Agency (NDIA) is the independent government organisation that administers the NDIS.

The NDIA makes decisions regarding whether someone is eligible to become an NDIS participant and, if so, how much funding they are entitled to. This is based on legislation called the NDIS Act 2013 that details which supports and services the NDIS will fund (Australian Department of Human Services 2019).

What is Meant by ‘Insurance Scheme’?

The term ‘insurance scheme’, is intended to reflect the intention of the NDIS, which is to take ‘a lifetime approach’, providing support where needed and investing in people with disability early on to improve their outcomes later in life (Australian Department of Human Services 2019).

Where is the NDIS Available?

The NDIS has rolled out in all States and Territories except Western Australia, which is scheduled to be in operation by July 2020 (Australian Department of Human Services 2019).

What is Funded by the NDIS?

The NDIS funds a range of supports and services, including areas such as:

• Education;
• Employment;
• Social participation;
• Independence;
• Living arrangements; and
• Health and wellbeing.

(Australian Department of Human Services 2019)

In order to be considered reasonable and necessary, a support or service must:

• Be related to a participant’s disability;
• Not include day-to-day living costs unrelated to their disability support needs;
• Represent value for money;
• Be likely to be effective and work for the participant; and
• Take into account support given by other government services, their family, carers, networks and the community.

(Australian Department of Human Services 2019)

Applying for the NDIS

For healthcare professionals: although GPs and healthcare professionals are not required to make referrals, at times they may need to provide some direction and guidance regarding the steps required to access the NDIS.

For participants: do not hesitate to ask a trusted healthcare professional for assistance in applying, make sure your intentions and goals are clear and understood.

Lodging an Access Request Form

For healthcare professionals: you may be needed to support a patient in submitting an NDIS Access Request form. It is important to note that you must have the person with a disability with you while you complete the form (Summer Foundation 2018).

For participants: ensure that you are overseeing this process or are with a trusted person who can oversee it with you.

The current Access Request form requires the participant (with a healthcare professional’s assistance) to address the following points:

• Proof of identity;
• Contact information;
• Information regarding carers and family;
• Their disability and need for support (list all disabilities here);
• Whether they have partaken in specified assessments;
• Copies of reports, letters and assessments regarding their disability;
• The specific needs of the patient (consider this in terms of what they would need on their worst day);
• Mobility assistance that they may need (in terms of what they would need on their worst day);
• Communication assistance that they may need (in terms of what they would need on their worst day);
• Social interaction assistance that they may need (in terms of what they would need on their worst day);
• Learning assistance that they may need (in terms of what they would need on their worst day); and
• Remember to photocopy the form; keep it safe and on record (with permission).

(Summer Foundation 2018)

The Summer Foundation has provided a resource to help clarify the Access Request Form process for both participants and healthcare professionals (see Additional Resources).

Contacting the NDIS for a Form

An individual can lodge an access request over the phone by calling the NDIA on 1800 800 110 between 8 a.m. and 8 p.m.

• They will need to provide information about themselves to assist the NDIA in determining their eligibility for the NDIS.
• They can also give permission for someone they trust to provide information on their behalf.
• As stated in the previous section, they will be asked to provide the following information:
  • Their name, age, where they live and whether they have permission to live in Australia permanently.
  • Evidence of their age and residence.
  • Details and information about their disability and how it impacts them each day.
  • Current and/or relevant reports they already have from medical specialists or allied health professionals.
  • Whether they give permission for the NDIA to talk to other people about their disability, including Centrelink, their GP or a person providing support to them.
• Once their access request is made, the NDIA will send them a letter requesting any evidence they need to provide.
• Patients, their family or advocate, can alternatively use the NDIS eligibility check-list to see if they are eligible at www.ndis.gov.au/applying-access-ndis/am-i-eligible.

(Australian Department of Human Services 2019)

If the individual’s application is accepted, a planning conversation will then be held with an NDIS representative about the person’s life situation, current supports and hopes for the future (Australian Department of Human Services 2019).

Where to Go for Further Help Applying

If aged 7 and above, one of the NDIS’ partners may deliver local area coordinator (LAC) services, which involves linking a potential participant to the NDIS and to supports in their area (Australian Department of Human Services 2019).

If the individual is eligible for an NDIS plan, a LAC will talk to them to learn about their current situation, supports, and goals to help develop their plan. Note that LACs cannot approve an NDIS plan (Australian Department of Human Services 2019).

Access those links here: https://www.ndis.gov.au/applying-access-ndis/how-apply/get-help-applying

Creating a Plan

For healthcare professionals: you may need to assist a patient with creating an NDIS plan. A plan is intended to aid the NDIA in gaining an understanding of a participant’s support needs. The planning process can also involve family, carers and significant others (Australian Department of Human Services 2019).

For participants: your plan should outline your short-term and long-term goals – made as specific as possible. Goals are milestones you want to achieve with support from the NDIS as well as other supports and services. (Australian Department of Human Services 2019).

Goals might include becoming more independent, getting a job, learning new skills, enrolling in an educational course, engaging with their community, or improving their relationships and making friends (Australian Department of Human Services 2019).

It is ideal that the planning process is led by the participant (to the extent they want to) and from there, an individualised plan is devised (Australian Department of Human Services 2019).

Considerations for the Plan

Potential participants must make considerations such as:

• Their aspirations;
• Their goals; and
• Their strengths and abilities.

(Continence Foundation of Australia 2019)

They also need to consider:

• The type of supports they may need;
• How much funding they receive now;
• Steps that will help them to achieve their goals; and
• Current providers they can speak to about their current services.

(Continence Foundation of Australia 2019).

The Summer Foundation has provided a resource to help clarify the Planning process for both participants and healthcare professionals (see Additional Resources).

Further NDIS Responsibilities for the Healthcare Professional

Healthcare professionals are able to carry out the following tasks:

• Refer patients to information about who can access the NDIS;
• Provide supporting evidence as part of an Access Request form;
• Document that the patient has or is likely to have a permanent disability; and
• Provide copies of reports or assessments relevant to the diagnosis/condition to describe the extent of the functional impact of the disability.

(Australian Department of Human Services 2019)

For more information, please see the NDIS’ Information for GPs and health professionals, available at: https://www.ndis.gov.au/...information-gps-and-health-professionals.

Providing Evidence of Disability to Support a Patient

The evidence you supply to support an NDIS Access Request must relate to the patient’s primary disability, which has the greatest impact on the life of your patient. Any additional evidence relating to other disabilities that may affect your patient and the impact they have on their functional capacity will also be accepted (Australian Department of Human Services 2019).

A patient may need you to provide evidence that:

• They have, or are likely to have, a permanent disability, including information about:
  • The type of disability;
  • The date their disability was diagnosed (if available);
  • How long the disability will last; and
  • Available treatments (i.e. medications, therapies or surgeries).

(Australian Department of Human Services 2019)

It’s important to link the impact of the disability on the patient’s day-to-day function in areas such as:

• Mobility;
• Communication;
• Social interaction;
• Learning;
• Self-care; and
• Their ability to self-manage.

(Australian Department of Human Services 2019)

How to Manage Funding

Individuals who receive allocated funding can select a registered service provider to manage and provide support. Alternatively, they can self-manage and negotiate the supports specified in their confirmed plan, including employing support workers (The Conversation 2016).

In many cases, family members can assist heavily on the participant’s behalf. Numbers indicate that only 7% of participants choose to self-manage their funds, while 35% combine self-management and agency management and 58% are fully agency-managed (The Conversation 2016).

Interested in Becoming a Provider either as an Individual or Organisation?

Visit: https://providertoolkit.ndis.gov.au/

Conclusion

As a healthcare professional, your compassion, professionalism and guidance can greatly help to facilitate a patient’s NDIS journey.

As a prospective participant of the scheme, remember that you do not need to navigate the NDIS on your own; there are individuals, communities, agencies and resources readily available to you.

It does not need to be thought of as a daunting process.

Additional Resources

• Australian Department of Human Services NDIS General Information: https://www.ndis.gov.au/
• Australian Department of Social Services Health Related Supports: https://www.dss.gov.au/sites/default/files/documents/06_2019/attachment-drc-communique-fact-sheet-health-related-supports.pdf
• Creating an NDIS Plan with The Continence Foundation: https://www.continence.org.au/pages/ndis-participant-.html
• The Conversation ‘Understanding the NDIS’ series: https://theconversation.com/au/topics/understanding-the-ndis-28996
• Summer Foundation ‘How To Fill Out the NDIS Access Request Form’: https://www.summerfoundation.org.au/wp-content/uploads/2018/04/How-to-fill-out-the-NDIS-Access-Request-Form.pdf
• Summer Foundation ‘Sample Plan’:https://www.summerfoundation.org.au/ndis/developing-an-ndis-plan/

References

• Australian Department of Human Services 2019 ‘NDIS Information for GPs and Health professionals’, ADHS, viewed 1 July 2019, https://www.ndis.gov.au/applying-access-ndis/how-apply/information-gps-and-health-professionals
• Australian Government Productivity Commission 2011, Australian Government, viewed 2 July, https://www.pc.gov.au/inquiries/completed/disability-support/report
• Continence Foundation of Australia 2019, ‘Planning for the NDIS’, Continence Foundation of Australia, viewed 1 July 2019,https://www.continence.org.au/pages/ndis-participant-.html?gclid=EAIaIQobChMI0-zH1eqU4wIVxAorCh29Bg6rEAAYAyAAEgJRZfD_BwE
• The Conversation 2016, Understanding the NDIS, The Conversation, viewed 1 July 2019, https://theconversation.com/understanding-the-ndis-how-does-the-scheme-work-and-am-i-eligible-for-funding-58726
• Summer Foundation 2018, ‘Step By Step: How To Fill Out The NDIS Access Request Form’, viewed 4 July 2019, https://www.summerfoundation.org.au/wp-content/uploads/2018/04/How-to-fill-out-the-NDIS-Access-Request-Form.pdf
• Summer Foundation 2018, ‘Developing an NDIS Plan’, Summer Foundation, viewed 4 July, https://www.summerfoundation.org.au/ndis/developing-an-ndis-plan/