The NDS Helpdesk team have chosen the top five questions and responses from the past month. These questions cover NDIS Practice Standards and the NDIS price guide. Got a question on your mind? NDS members can ask the Helpdesk

Question 1

If a participant attends a group activity accompanied by their support worker can the provider providing the activity and the support worker (same organisation) bill for both 1:1 support work time and also 1:4 group activity attendance?

Answer

This will depend on the nature of the activity and the support that is being provided to the participant. There may be times when it is appropriate to claim for both the 1:1 supports required by the participant and for the group rate. Common examples include an art activity being conducted by an art teacher/facilitator and the participant requires 1:1 support to participate in the activity.

For any activity, it is important to assess the level of support that the participant receiving the 1:1 support would receive from the 'other support' worker. Using bowling as an example, it may be useful to identify what support the participant receives whilst bowling from their 1:1 support worker and what, if any, additional support they are sharing with the other participants in the group.

Any arrangements to claim against the participant's plan need to be discussed with and agreed to by the participant and documented. It may also be useful to discuss these arrangements with the LAC or support coordinator.

Question 2

Will the NDIS fund a participant’s continence material and care, and medication?

Answer

The Price Guide lays out which disability-related health supports may be funded under the NDIS - see page 33. This includes supports to assist with continence. More information is available on the NDIS website, and examples provided include catheter maintenance and care, and 'all continence consumables'. It would definitely be worth trying to obtain funding in the participant's plan for continence management.

The Price Guide also states: 'if a participant’s support needs become acute, that support should be provided in a hospital or another health setting by the relevant state/territory health care system or private health system and not be claimed from the participant’s plan' (p. 33).

The NDIS website is clear in the expectation that Health systems should fund medication.

Question 3

We are looking at providing supports for School Leaver Employment Supports (SLES). We would like information on how the provider bills the participant - how much and when? Do you need to be NDIS registered to provide SLES supports?

Answer

You do not have to be a registered NDIS provider to offer SLES. However, registered providers wanting to deliver SLES should be registered to deliver ‘Assistance to Access and Maintain Employment or Higher Education’.

SLES is claimed on a weekly basis for 48 weeks a year. The weekly rate is currently $474.78.

Question 4

For providers eligible to claim the Temporary Transformation Payment (TTP), do they need to charge it for all services they provide?

Answer

There is nothing in the Price Guide to suggest a provider eligible for TTP must claim TTP loading on all support items they are able to. Many providers charge TTP-inclusive prices for only some participants (as some have not agreed to pay the higher prices).

The Price Guide notes that providers not eligible for TTP should not claim the TTP price limit (p. 32). However, being eligible for TTP essentially raises the limit that providers can charge for certain eligible support items. If the provider would like to charge underneath this new higher limit (for example, to charge the non-TTP rate) that is their choice.

Question 5

Have other members had difficulty claiming SIL payments since recent price changes? We have been underpaid for a number of participants' weekly SIL claims - but the price somehow reverting in the claim to a lesser price meant this didn't show as a part-funded claim. Are providers claiming for each rostered service or continuing weekly claims?

Answer

Claims for SIL must now be made against ratios of support at the relevant time of day or day of the week. Most providers agree on a Program of Support with the participant which details how much support will be 1:1, 1:2, 1:3, and so on.

They then put in a claim, usually weekly, against the number of hours the participant received support at each of these ratios at the appropriate time of day or week. All up, they would make possibly 5-10 claims against different line items for each participant. With an agreed Program of Support, you can run these same claims each week for 12 weeks, before agreeing on another Program of Support.