Price Guide Update: New NDIS Funded Health Supports

The NDIA have just released the hotly anticipated Price Guide update that follows on from COAG’s June decision that the NDIS should fund disability-related health supports. It’s a big update with a fair bit of important detail behind it. Here’s what you need to know.

Which health supports will the NDIS now fund?

The disability-related health supports that the NDIS will fund include, but are not limited to, the following:

1.   Continence supports including:

o  An NDIS-funded suitably qualified and competent worker to undertake insertion, removal or change of indwelling urethral catheter, suprapubic catheter and/or clean intermittent catheter.

o  Training of an NDIS-funded suitably qualified and competent worker to provide catheter maintenance and care.

o  Provision of daily catheter maintenance and care by an NDIS-funded suitably qualified and competent worker.

o  All continence consumables (for example catheter, bags, pads, bottles, straps.)

2.   Respiratory supports including:

o  Development and periodic review of clinical care and daily maintenance of tracheostomy (insertion, removal and change) by an NDIS-funded suitably qualified and competent clinician

o  Implementation of daily maintenance of tracheostomy (insertion, removal and change) by an NDIS-funded suitably qualified and competent worker

o  Training of an NDIS-funded suitably qualified and competent worker to provide tracheostomy maintenance and care.

o  Provision of tracheostomy equipment and consumables.

o  Provision of a Constant Positive Airway Pressure machine (CPAP) machine and consumables.

o  Provision of a Bilevel Positive Airway Pressure (BIPAP) machine and consumables.

o  Provision of a ventilator, air humidifier, portable suction machine and/or cough assist machine and consumables.

o  Assistance with the use of all respiratory medical equipment as well as the training of a suitably qualified and competent worker to use the equipment.

3.   Nutrition supports including:

o  Dietetic consultations and the development and periodic review of a nutritional meal plan by an NDIS-funded suitably qualified and competent clinician.

o  Implementation of a nutritional meal plan by an NDIS-funded suitably qualified and competent worker.

o  Training of an NDIS-funded suitably qualified and competent worker to implement the nutritional meal plan.

o  Percutaneous Endoscopic Gastrostomy (PEG) Stoma Changes (to assist feeding.)

o  Provision of PEG maintenance and care by a suitably qualified and competent worker.

o  Training of an NDIS-funded suitably qualified and competent worker to provide PEG maintenance and care.

o  Home Enteral Nutrition (HEN) and (PEG) and equipment and consumables excluding food. 

o  HEN formula/nutritional supplements (to meet participant’s nutritional needs).

4.   Dysphagia supports including:

o  Development, implementation and periodic review of a meal time management plan by an NDIS-funded suitably qualified and competent clinician.

o  Implementation of a meal time management plan by an NDIS-funded suitably qualified and competent worker.

o  Development, implementation and periodic review of an oral eating and drinking care plan (OEDCP) by an NDIS-funded suitably qualified and competent clinician.

o  Implementation of an oral eating and drinking care plan (OEDCP) by an NDIS-funded suitably qualified and competent worker.

o  Training of an NDIS-funded suitably qualified and competent worker to implement the meal time management plan and OEDCP.

o  Swallowing therapy associated with dysphagia provided by an NDIS-funded suitably qualified and competent worker.

o  Consumables such as thickeners to enable a participant to swallow more easily and reduce their risk of aspiration/choking.

5.   Wound and pressure care supports including:

o  Wound care and pressure care (including pressure injury management) by an NDIS-funded suitably qualified and competent worker.

o  Wound care and pressure care consumables (e.g. dressings, gauze, bandages, tape, lymphedema garments and pressure wraps).

o  Lymphoedema machines as well as assistance with the use of the equipment and the training of an NDIS-funded suitably qualified and competent worker to use the machine.

6.   Diabetic management supports including:

o  Development and periodic review of a diabetic management plan by an NDIS-funded suitably qualified and competent clinician.

o  Implementation of a diabetic management plan and daily maintenance and care by an NDIS-funded suitably qualified and competent worker.

o  Training of an NDIS-funded suitably qualified and competent worker to implement a diabetic management plan.

7.   Podiatry supports including:

o  Assessment, development, implementation and periodic review of a podiatry care plan by an NDIS-funded suitably qualified and competent clinician.

o  Training of an NDIS-funded suitably qualified and competent worker to implement the podiatry care plan and perform any required daily maintenance and care related to the plan.

8.   Epilepsy supports including:

o  Training of an NDIS-funded suitably qualified and competent worker to implement the participant’s Epilepsy Management Plan (EMP) and/or Emergency Medication Management Plan (EMMP). 

o  Epilepsy seizure monitoring by an NDIS-funded suitably qualified and competent worker including the application of assistive technology.

How has this been translated into the Support Catalogue?

It’s expected that many health-related disability supports will be claimed using existing line items for disability support workers and therapists (including OTs, physiotherapists, psychologists, ECEI specialists, dieticians and exercise physiologists). But there are also 94 new line items in the Support Catalogue, including:

  • Health related supports line items (including allied health) under both Core and Capacity Building to allow Participants to pay from either budget (more on that in a minute)

  • New support items covering 5 levels of nurses: Enrolled Nurse, Registered Nurse, Clinical Nurse, Clinical Nurse Consultant, Nurse Practitioner

  • New health-related assistive technology line items including Respirators, Ventilators, Aspirators as well as generic lines for their repairs, maintenance, setup, training and delivery

  • Line items for high cost and low cost disability-related health consumables (quotes required for high cost items)

How can participants claim these items? Are plan reviews needed?

To allow people to start accessing these supports right away, the NDIA have made a transitional arrangement that allows Participants to use their core budgets to purchase these items. The ability to pay for disability-related therapy and nursing health supports from the core support budget will cease when participant plan reviews are completed. The NDIA will communicate more on this as it happens.

To be able to purchase low cost AT or consumable items, people must have at least $1 in their consumables budget.

People whose core budgets are insufficient to cover these items should request a plan review. There will be no automatic plan adjustments for existing plans.

When can these new items be claimed?

People can start purchasing these items from 1 October.

Who can deliver these supports?

People with agency managed funds will need to purchase these supports from a provider registered for the relevant registration group:

  • 0114 – Nursing

  • 0118 – Early Intervention Supports for Early Childhood

  • 0128 – Therapeutic Services

  • 0103 – Assistive products for personal care

What else has changed?

There have been a number of other tweaks to the Support Catalogue with this update, including (but not limited to):

  • The price of the existing community nursing care line item has been increased in line with the new supports. Providers now wanting to charge this higher price will need the Participant’s consent to do so.

  • The price of Capacity Building and Training in Plan and Financial Management has increased from $58.52 to $60.16

  • The price limit for Establishment Fee For Personal Care/Community Access has been removed (though the rules in the Price Guide about how much can be charged remain unchanged)

  • Quotable items and Non-Price Controlled items no longer have crosses or ticks about whether they can charge for travel, non face to face time or cancellations as the NDIA expect these to be included in quotes where relevant.

Where can I see the changes for myself?

The new Support Catalogue is available now on the NDIS website.