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When the NDIS released their new Pricing Arrangements and Price Limits, there were a few notable changes including the release of new support item codes for therapeutic supports. The OG codes were categorised into three types: psychology, physiotherapy, and “other professional” but now there’s a whole lot more! Get to know the new therapy supports listed and the qualifications required by the NDIA. Expansion of therapeutic supports While the support list for those under the age of seven receiving Early Childhood Early Intervention (ECEI) have remained the same, the list of therapeutic supports for NDIS participants over the age of seven has expanded from three types to sixteen. Therapy supports can be incredibly important for participants with disability to help build their capacity and independence in their day-to-day life. This includes areas such as language and communication, mobility and movement, personal care, interpersonal interactions, and community living. Although the list expansion may have been unexpected from the NDIA, it has the potential to provide better clarification of supports for participants. New Therapy Qualifications & Definitions Listed in the latest Pricing Arrangements and Price Limits, there are several new therapeutic supports and support items listed, with the inclusion of qualifications that are necessary to be considered a provider in that field. Art Therapist – A person who is a Professional Member with the Australian, New Zealand and Asian Creative Arts Therapy Association (ANZACATA). Audiologist – A person who is either currently certified as an Audiology Australia Accredited Audiologist by Audiology Australia or as a Full Member as an audiologist with the Australian College of Audiology. Counsellor – A person who is either a member of the Australian Counselling Association or an accredited Registrant with the Psychotherapy and Counselling Federation of Australia. Developmental Educator – A person who is a Full Member of Developmental Educators Australia Inc. Dietitian – A person who is an Accredited Practising Dietitian with the Dietitians Australia. Exercise Physiologist – A person who is an Accredited exercise physiologist with Exercise and Sports Science Australia. Music Therapist – A person who is an Active “Registered Music Therapist” with the Australian Music Therapy Association. Occupational Therapist – A person who has a current Australian Health Practitioner Regulation Agency (AHPRA) Registration as an Occupational Therapist. Orthoptist – A person who has current registration with the Australian Orthoptic Board. Physiotherapist – A person who has a current AHPRA Registration as a Physiotherapist. Podiatrist – A person who has a current AHPRA Registration as a Podiatrist. Psychologist – A person who has a current AHPRA Registration as a Psychologist. Rehabilitation Counsellor – A person who is member of the Australian Society of Rehabilitation Counsellors Inc. or equivalent. Social Worker – A person who is a member of the Australian Association of Social Workers. Speech Pathologist – A person who is a Certified Practising Speech Pathologist (CPSP) as approved by Speech Pathology Australia. Other Professional – A person who is not one of the types of professionals listed above but who the provider considers to be an appropriate professional to deliver therapeutic supports in line with the NDIS Quality and Safeguarding Commission’s requirements for the Therapeutic Supports Registration Group. Originally when the NDIA released this Pricing Arrangements and Price Limits update, “other professional” was no longer included. This was later amended to include “other professional” with the above definition. If your invoice is unclear about the type of therapy provided, or there is reason to believe that a provider is invoicing incorrectly regarding their qualifications, plan managers can request evidence that the practitioner holds qualifications in line with the above list. To avoid confusion, structure your invoice to clearly show the type of service delivered. Whether you are registered or unregistered with the NDIS, it is important to consider you qualifications and ensure they are in line with and would meet the requirements of the NDIS Commission with regard to the Therapeutic Supports Registration Group. If a support is delivered by a therapy assistant, the NDIA have also outlined that the therapy assistant must be covered by the professional indemnity insurance of the supervising therapist (or the therapist's or therapy assistant's employing provider). Price Limits under the new Support Codes Just like with the original support items, these new items are subject to the price limits set out in the table in the Pricing Arrangements and Price Limits (page 93 and 94). Different price limits will apply depending on the Type of Therapist delivering the support. For therapists providing support to a group of participants, the price limit found in the table outlined in the Pricing Arrangements and Price Limits should be divided by the number of participants in the group. Providers should make a claim for each participant using the relevant support item. Each claim should be for the total time of the support but is subject to the lower price limit. If you have any questions, you can contact our friendly team on 1300 322 273 or support@first2care.com.au.

Claiming smart devices using you NDIS funding can be TOUGH! There are very specific eligibility requirements and processes that need to be adhered to because the NDIS consider smart devices to be an everyday item. That being said, it is still possible to claim under the NDIS. Find out if you meet the eligibility requirements and our top tips on claiming smart devices. How does NDIS funding work for smart devices NDIS funding for smart devices, such as tablets or iPads, works in the same way as most other NDIS supports and services – you need to show that you need the smart device because of your disability and that it ticks the NDIS boxes when it comes to reasonable and necessary. Top Tip #1: Determine if it’s necessary When you’re trying to figure out if something is reasonable and necessary, you should consider: Do you need the smart device to access support services (i.e., online sessions)? Has your provider recommended getting a smart device? Do you need the device specifically because of your disability? Do you already own or have access to a smart device that could be used for the intended purpose? Is it value for money? The last question is an important one, as the NDIS typically won’t fund the most expensive or fancy smart device, but instead they may fund a device that allows you to access the supports you need. If the smart device costs less than $600 it may be considered reasonable. If it costs more than $600, you will need to provide further evidence including specifying what feature the higher cost device has that is necessary due to your disability. Where does the funding come from? If it has been determined that a smart device is reasonable and necessary, the next step is to determine if you have funding available. Top Tip #2: Talk with your Plan Manager To claim a smart device, you will need to use funding from your core budget, your consumables budget, or your capacity building budget underline item 15_222400911_0124_1_3 Low-Cost AT. However, it is important that you use funding that is available and not needed for other supports. This is where your plan manager can help. They can work with you to determine what your current support costs are in your core budget, consumables budget and capacity building budget, and where there is funding available to make your claim. By doing this, you can ensure that you reduce the risk of impacting other necessary supports with your purchase. Claiming process To claim a smart device using your NDIS funding, you will need a letter from an assistive technology advisor such as a therapist confirming the support is necessary and to send this letter to the NDIA, then you will need to purchase the item. Keep in mind that having a letter of recommendation does not necessarily mean that the NDIS will determine that a smart device is reasonable and necessary Top Tip #3: How your plan is managed can make a difference If you are plan managed or self-managed, providers don’t need to be registered with the NDIA for you to access their supports or services. Which means, it is easier to purchase smart devices through “big box” electronic stores. If you are agency managed, you only have access to NDIA registered providers, which pretty much excludes “big box” stores. However, you may be able to find a store registered with the NDIA or purchase through your support coordinator if you have one. Case Study #1: Unsuccessful Claim Tamsin’s therapist has recommended several apps to help her manage her disability, and her therapist has provided a letter of recommendation to share with the NDIA. Will the NDIA approve her claim for a tablet? No. The reason the NDIA wouldn’t approve this claim is because most smart devices and computers are considered an everyday item for all Australians. Essentially this is considered a day-to-day living cost which typically isn’t funded under the NDIS. However, if the apps that the therapist has recommended are necessary in helping Tamsin manage her disability and there are costs involved with the apps, the NDIS may fund the purchase of the apps. Case Study #2: Successful Claim Lexie’s speech pathologist has recommended she use a tablet as her main form of communication. Her speech pathologist provides written evidence indicating that this is the most appropriate solution for her communication needs. Will the NDIA approve Lexie's claim for a tablet? Although a tablet is considered an everyday device, in Lexie’s case, this would be her main form of communication and would be considered reasonable and necessary. This NDIS are likely to approve this claim. For more details on claiming smart devices under the NDIS, click here. Read more about the benefits of working with an independent, professional Plan Manager. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.

Goodbye plan reviews and hello plan reassessments! The NDIS recently updated their terminology to replace the term ‘plan review’ with ‘plan reassessment’. The plan reassessment process, especially when participant initiated, is reportedly much smoother and simpler. However, like with any change made by the NDIS, knowledge is key – get to know the steps for NDIS initiated and participant-initiated plan reassessments. Understanding Plan Reassessments Every participant has their NDIS plan reevaluated by the NDIA after a period (typically ranging from 12 months to three years) to ensure the NDIS funding they receive is providing the necessary support. This process, which was formerly known as a plan review, is now called a plan reassessment. A NDIS initiated reassessment happens towards the end of a plan period. However, a participant can also request a plan reassessment at any time during their plan period. Although the change from plan review to plan reassessment is mostly just a name change for better clarification around the process, there is one minor difference – the default plan period duration has changed from 12 months to 24 months. Which means participants can expect fewer NDIS initiated plan reassessments as a result. If a plan reassessment has not been completed or the new plan is not finalised in the allotted 21-day response period, your plan will be automatically varied to extend the current plan for another 12 months. This ensures there is no gap in your funding and support services, while allowing time to complete the reassessment (if necessary) or finalise your new plan. There are two way a plan reassessment can occur – NDIA initiated, or participant initiated. Steps for a NDIA initiated plan reassessment Step 1: Participant check-in A plan reassessment initiated by the NDIA typically follows a participant check-in. Participant check-ins normally occur approximately three months before the end of current your plan period. However, it’s important to be aware that they can occur at any time, not just near the end of the plan period. If you’re uncertain when a participant check-in may occur, you can contact the NDIA to confirm a date. This will allow you to be better prepared for the check-in. During your scheduled participant check-in, your Local Area Coordinator (LAC) or NDIA planner will discuss your situation to determine whether your current plan can continue, if variations need to be made or if you need a reassessment. If you need a reassessment, this must be scheduled for a later date. A reassessment should not occur during a participant check in. You need time to collect evidence, supporting letters, and reports to ensure your reassessment and new NDIS plan accurately reflect your needs. During the check-in, the LAC or NDIA planner should also advise you on what information you need to bring to the reassessment. Step 2: Reassessment date On the plan reassessment date, you can discuss your current plan, supports, goals, and any changes in circumstances that are relevant for creating a new plan. This is your opportunity to provide evidence that supports and reflects your needs. This reassessment can take place in person, over the phone or via video call, and you can have a support person present with you. Step 3: Outcome Following your reassessment, the NDIA have 21 days to respond with their decision. If you’re unhappy with the decision they’ve made, you can request an internal review (more on this in the ‘steps for a participant-initiated plan reassessment’ below). Steps for a participant-initiated plan reassessment A plan reassessment can also be initiated by a participant at any time during your plan period. Step 1: Gather evidence The funding you receive in your NDIS plan is influenced by the evidence you provide. Which means if you want a reassessment - evidence is key. Before making your plan change request to the NDIA, you should start the process in collecting evidence including assessments, reports, or other supporting documentation. If you need assistance collecting evidence for your request, you can speak with your support coordinator, LAC, or a disability advocate. Step 2: Request a change There actually isn’t a specific option to request a reassessment on the NDIS website. If you would like a reassessment, then you need to request a change to your plan. There are three ways you can request a change: 1. Complete a form* 2. Call the NDIA 3. Visit your local NDIA office * To fill out the form go to Part C on page 3, select the 5th checkbox to identify that your situation has changed, then proceed to page 5 and complete Part H During your request to change your plan, you will need to provide information to help the NDIA understand the reasons for the change request Which will inform their decision on whether they do a plan variation or reassessment. For this reason, if you would like the NDIA to consider a reassessment over a variation, it is important to have evidence to back up your request. This information helps the NDIA better understand your situation and reasons for a reassessment. Please note, for participants just seeking a plan variation, for example if they want to change from agency management to plan management, providing evidence like this may not be necessary. The NDIA have 21 days to respond to your plan change request. If you have been approved for a reassessment, they will discuss a suitable date with you as well as your preference for either an in-person, over the phone or video call reassessment. Remember, you can have a support person with you during your reassessment. Step 3: Reassessment date During your reassessment, you can present all the evidence you have collected in support of a new plan. It is also a good opportunity to discuss in more detail: · What is working well & what isn’t working well in your current plan Any achieved goals New goals or changes to previous goals How you would like your plan to be managed (agency, self, or plan management) Changes to your situation or needs Length of your next plan (if you aren’t expecting any changes to your situation, you may be able to extend your plan period) Step 4: Receive the outcome Following the reassessment, the NDIA is required to respond within 21 days. As mentioned above in the ‘steps for a NDIA initiated reassessment’, if you are unhappy with the outcome, you can request an internal review. The internal review process is completed by someone within the NDIA who was not linked to the original outcome. It is up to them to determine whether the NDIA supports the original outcome or if changes need to be made. If they support the original outcome but you are still unhappy with this decision, then you can request an external review by the Administrative Appeals Tribunal (AAT), who are a separate entity to the NDIS. An internal review must be completed before you can request an external review. Read more about the benefits of working with an independent, professional Plan Manager. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.

Get Going Support are a NDIS provider that always puts the participant, their needs, and goals first. They focus on supporting NDIS participants in their journey through supported Independent Living, Independent Living Options, Community Access, and daily living. First2Care recommends Get Going Support as an organisation you should consider having on your support team. What are you waiting for? It’s time to get going and enjoy life with Get Going Support! Who are Get Going Support? Get Going Support are a boutique NDIS provider who offer a personalised experience for people with disability. Their aim is to help participants live the life they want through authentic connections, personal and relationship growth, and adventure. At Get Going Support, NDIS participants are put first. “We like to set up our participant and team members differently – we build teams around the participant.” To do this, they get to know each participant, their personalities, hobbies, and common interests and ensure that the teams supporting them are aligned with the participant and their goals. “To have a family member ring me in tears of joy because their loved one is growing, is happier, is healthier and safer. That is what it is all about.” Nikole Horan, Get Going Support Managing Director What services do they provide? Get Going Support focus on Supported Independent Living, Independent Living Options, Community Access, and daily living. They value the strong relationships they’ve built with ethical SDA providers and NFP property management specialists to help provide all participants with the support they need to find suitable housing. Supported Independent Living They pride themselves on being experts when it comes to Supported Independent Living (SIL). Through their long-standing relationships with real-estate agencies, SDA developers, and providers, Get Going Support assist in ensuring a positive outcome in the search and securement of your future home and supports. For participants already residing in a home but needing new supports to assist in daily living within a SIL context, Get Going Support can assist in finding the right support match for you and your needs. The relationship between you and your support team is important, which is why they will never send a support person to you that you don’t know. A safe, positive, and comfortable environment is key. Daily Living If you live independently but need a support worker to assist with some tasks either daily or weekly, they can help you to develop a plan, so you have the support you need when you need it. Their support workers are experienced in personal care, medication and meal preparation, and can provide a way of companionship and community access. Community Access “We will go above and beyond to move mountains for you. All the dreams of any person are possible if the right people believe in them. Get Going Support is only made up of these people.” Community is so important. However, sometimes accessing your community and building meaningful connections can be challenging. They can help to facilitate community access, develop and grow relationships, and ensure you have the opportunity to live your life the way you want. Whether that’s assisting you to watch your favourite sports team, do your shopping, get involved in local events or community groups and so much more. How does NDIS funding work with GGS? Get Going Support are a fully registered NDIS provider. Their primary services are in SIL, community participation and daily living, which means participants who have been funding in these categories can access Get Going Support’s services. Get Going Support & Queensland Powerchair Football Association (QPFA) “It is important to us to work together with our fellow industry providers to extend opportunities for our participants so being able to support organisations such as QPFA is a win-win for both. Ultimately the client is the primary focus.” Earlier this year First2Care approached Get Going Support and 4 other providers within the disability community to sponsor two Queensland Powerchair Football Club teams to travel to Sydney to represent Queensland at the Powerchair Football Australian Club Championships. Overcoming logistic and financial hurdles in the disability space is often expensive but the return on the investment is priceless. For more information about QPFA, click here. Read more about the benefits of working with an independent, professional Plan Manager. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.

NDIS hot topic… participant check-ins. Although participant check-ins are not exactly a new NDIS process, they have been brought up in several disability forums, community pages, websites, blogs, and other platforms recently. Why? Like so many NDIS changes, there is a bit grey area of what to expect. Get to know the ins and outs of participant check-ins, how to prepare, and what the pros and cons are. What is a participant check-in? Participant check-ins, which is a process that started during the COVID-19 pandemic, are a way for your Local Area Coordinator (LAC) or NDIA planner to touch base with you regarding your NDIS plan, your current supports, goals, and wellbeing. With participants now opting for longer plans (typically two years) over the original planning period duration of approximately 12 months, a participant check-in can determine whether you may need a plan variation or a plan reassessment. Plan variation (formerly known as ‘light touch review’) is the same plan with a minor change Plan reassessment (formerly known as ‘full plan review’) is a new NDIS plan where all supports are reconsidered Typically, a participant check-in will happen towards the end of your planning period in preparation for a new NDIS plan. However, they can happen at any time throughout your planning period. How to prepare for a participant check-in As with all things NDIS – preparation is key – and participant check-ins are no different. Considering that a participant check-in could occur at any time, it’s important to be prepared. You can prepare for a participant check-in by: Assessing current funding and any gaps in that funding Gathering any new evidence that you may wish to discuss with the NDIS Considering about your current and new goals for the next plan and if your funding supports them Thinking about whether your support needs and/or circumstances have changed or are about to change Deciding if you want to change your plan management option If you need assistance in preparing for a participant check-in, you can contact your support coordinator, LAC, ECEI coordinator or plan manager. What to expect during a participant check-in When an LAC or NDIA planner contacts you for a participant check-in to discuss your current situation, you can expect one of three outcomes: No changes made for your next plan Plan variation Plan reassessment If the outcome is that you need a plan reassessment, this should be scheduled for a later date. If the LAC or NDIA planner tries to push for a plan reassessment during a participant check-in, you can refuse and take time to collect all the evidence, supporting letters, and reports you may need to ensure your plan reassessment accurately represents your current needs. If you need a plan variation or a plan reassessment, the NDIA will respond within 21 days. If you would like changes to be made to your NDIS plan, you don’t need to wait for a participant check-in, you can request a variation or reassessment at any time. Pros & Cons Participant check-in pros: Benefit participants with stable supports Reduce the need to update plans regularly The check-in has the potential to change your plan and/or supports so you receive the supports you need Avoids the potential costly, stressful, and time-consuming process of obtaining a new plan If the check-in is scheduled and you are notified for the upcoming check-in, it can allow for preparation time Participant check-in cons: If you’re not aware of or prepared for the check-in, this could be daunting and not provide adequate time to prepare and/or organise a support person to be present for the call The current format and schedule are not clearly defined and seems to be different for each person The check-in has the potential to change your plan and or supports in a way you may not want them to change Lack of clarity around participant check-ins (i.e., will they happen three months before the end of a plan or at another time?) If you have any questions about participant check-ins, you can contact our support team on 1300 322 273 or via email at support@first2care.com.au. Alternatively, you can contact your support coordinator, LAC, NDIA planner or ECEI coordinator. Read more about the benefits of working with an independent, professional Plan Manager. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.

When it comes to the invoicing and payments process under the NDIS, we know two things to be true… providers want seamless invoice payments and the NDIS is a big fan of rules and regulations. To help ensure that the rules laid out by the NDIS are being followed and that payments are swift, we wanted to share some key information that should be included in every invoice for a smooth payment process. What to include There are three main sections – Provider, Participant and Invoice Details – that need to be included in an invoice that adheres to the NDIS invoicing process. Provider details to include are: Provider name Provider ABN Unique Invoice number Provider invoice date – dd/mm/yyyy format only Provider bank details Participant details to include, if available, are: Participant name Participant NDIS number Participant residential address Invoice details to include are: Support item number – you can use the NDIS Support Catalogue to find the correct number Support date/s – dd/mm/yyyy format only Description of the support Quantity – in decimal format e.g., use 1.5 to represent one hour and thirty minutes Unit price – your unit or hourly rate GST – if applicable Individual line subtotal and invoice total When we process invoices On average, our First2Care Accounts Team processes and pays invoices received Monday through Thursday within the same week. If an invoice is received on Friday then payments will likely be made on the following Monday. You should also consider sending invoices on a weekly basis as monthly invoices could be impacted by Pricing Arrangements and Price Limits updates or different plan periods. This can cause delays in invoice processing times. Ideally your invoice should have a daily breakdown of your services. Having a correct invoice helps to ensure that there are no delays in processing your invoice. What format and how to send them Invoices should be attached as a PDF when being sent to our Accounts Team. A PDF format is preferred but other accepted formats are JPG or PNG. Invoices sent as Word or Excel documents, or as an embedded link in an email, will be slightly delayed in processing. If you have an invoice that needs processing, you can send it to our Accounts Team by emailing accounts@first2care.com.au. Make sure to include the invoice number and the participant’s name or NDIS Number in the email subject. Seven Easy Invoicing Tips to Know Ensure that the amount you are charging for the support or service you have provided accurately reflects the hourly rates within the current NDIS Pricing Arrangements and Price Limits. If the price you are charging exceeds the NDIS’ rates, it will only be partially funded. Keep in mind that the Pricing Arrangements are set by the NDIS, not by First2Care, and the maximum rates should only be charged if agreed with the Participant. Always ensure that the quantity is included on each line item and that it is correct. Quite often we see a quantity defaulted to “1” which can cause the invoice to be short-funded. Make sure each line item on your invoice has a service date, even if it only has one line item. This way, there is never any confusion over which rate to use and you are less likely to be short-funded. Ensure days falling on a weekend or public holiday where a different rate applies are entered as separate line items. If you do not include an NDIS code, make your description of the service as accurate as possible. Check that the weekday, weekend, and evening rates are clearly outlined to prevent any payment processing delays. If you know which NDIS code your service aligns with, include this in your invoice. If you are unsure of which code to choose, you can contact our Support Team on 1300 322 273 or email support@first2care.com.au. Alternatively, you can see a full list of codes and descriptions of these line items in the NDIS Pricing Arrangements and Price Limits on the NDIS website. If you have a participant who is plan managed with First2Care, you can register your details with our First2Care team for quick and easy payment processing. Read more about First2Care Plan Management here.

The NDIS is notorious for its many changes. Recently following the government change over, more changes have been made. This time to the terminology used. The intention for this terminology change is to provide better clarity for NDIS participants to ask for what they want or need. Get to know the new lingo below! Why the change? Feedback from participants, disability advocates and others within the disability community, indicated that the way plan reviews were discussed and defined was confusing. To remedy this, the NDIA made changes to the terminology in the NDIS Act which came into effect on 1st July 2022. Terminology Changes to Know Review date > Reassessment date Every NDIS participant will have a reassessment date (formerly known as a ‘review date’ or ‘end of participants plan date’). This date signifies the end of your current plan and the beginning of a new plan. The NDIA will assess your plan by this date and decide if any changes are needed. If your plan reaches the reassessment date, and your reassessment is yet to be completed, your current plan will be varied* to extend it by 12 months to ensure you maintain access to the supports you need. Full Plan Review > Plan Reassessment When it comes to terminology changes, this one has been long awaited. Formerly known as a plan review, full plan review, scheduled or unscheduled review, change of circumstances review (CoC), or S48 review (let’s be honest that is way too many names for one thing!), now this process will simply be known as a plan reassessment. A plan reassessment is typically conducted by the NDIA prior to your reassessment date. However, you can request a plan reassessment at any time. When the NDIA conduct a reassessment, they will determine if a new plan needs to be created or if the current plan can be varied. This will depend on your situation. ‘Light Touch’ Plan Review > Plan Variation This is another one that originally had more names than necessary - ‘light touch’ plan review, plan extension, rollover or continuation, new plan with similar supports, or new plan with minor changes. Now known as a plan variation, this process is used for situations where a plan needs to be varied without needing a full reassessment. A plan variation can be requested by you at any time and will be completed by the NDIA within seven days. S100 Review > Internal Review of a Decision The S100 review, also known as ‘review of reviewable decision’ (RORD) will now be known as internal review of a decision. Participants can ask for a review of NDIA decision making at any time. If you are unhappy with the outcome of an internal review, you can escalate the review from an internal review to an external review with the Administrative Appeals Tribunal (AAT). Although these terminology changes are positive, if you are not sure which of them apply to you and your situation you can reach out to our First2Care support team on 1300 322 273 or via email at support@first2care.com.au. Alternatively you can contact your support coordinator, local area coordinator (LAC) or the NDIA. For more information on these changes, click here. Read more about the benefits of working with an independent, professional Plan Manager. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.

Gap fees (or out-of-pocket expenses) can sometimes sneak up on you, often at the worst possible time. It's important to have a clear understanding of gap fees, how they work, and how to minimise them. Find out everything you need to know about gap fees below. What are gap fees? Gap fees are the left-over amount, or gap amount, remaining after Medicare or your private health cover a portion of the cost for a support or service. Essentially, it’s an out-of-pocket expense that you need to pay for a support or service. Medicare, Private Health Insurance & Gap Fees If you have Medicare, there will typically be a gap fee that will need to be paid by you. However, if you also have private health insurance, depending on your cover, most or all the cost may be covered. For example: The image below, there are three bar lines showing the total medical cost, potential combined Medicare and private health insurance cover, and the covered medical fee and potential gap fee. Here is an example using the image above as reference, for further clarification. If you need surgery and you have both Medicare and private health insurance, Medicare will cover part of your fee as will your private health insurance policy. If you have no excess attached to your private health insurance and your doctor only charges the scheduled fee for your treatment, then your Medicare and private health insurance may cover the total cost, meaning you won’t have a gap fee to cover. If you only have Medicare, or if you have Medicare and private health insurance but your doctor charges above the scheduled fee for your treatment, then there may be a gap fee that needs to be paid by you. NDIS & Gap Fees Gap fees are typically associated with medical costs, which means the NDIS will not cover the gap fees that may be associated with those costs. One of the main reasons behind this is that a support paid for by the NDIS is not claimable against any other Commonwealth Program (such as Medicare). The NDIS is not designed to fund supports more appropriately funded or provided by the health system. Things like assessment, diagnosis, and treatment of health conditions, along with medications and hospital care are the responsibility of the healthcare system. The NDIS won’t typically fund the following health-related services and supports: Items and services covered by the Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS), 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 Your NDIS Plan should cover the full costs of any ‘reasonable and necessary’ supports, so there should be no additional costs or gaps. If you are unsure about what you can buy with your NDIS funding, you can check with our First2Care support team, your Local Area Coordinator (LAC) or NDIA planner. How can you reduce or avoid gap fees? Although the NDIS won’t cover gap fees, there are ways that you may be able to reduce the out-of-pocket expense. If you have private health insurance: Some private health funds have an agreement with specific hospitals or medical professionals to help reduce out-of-pocket expenses. These are known as gap cover schemes and there are two types: No-gap is when your health fund has a no-gap agreement, and your health fund will cover costs not covered by Medicare. Known gap is when your health fund has a known gap agreement and will cover the gap cost at a capped amount. If you’re privately insured, get in touch with your health fund and ask for a list of healthcare professionals with gap cover arrangements. That way, you can choose a provider that won’t leave you with high out-of-pocket expenses. If you only have Medicare: Private health insurance can offer more flexibility when it comes to receiving treatment. If you need a surgery or specific type of treatment, and you can use the public health system, your Medicare cover may be able to cover some or most of the associated costs. Whether you are only covered by Medicare or you have Medicare and private health insurance, it is vital that you discuss any decisions based around your health and wellbeing with a professional. Read more about the benefits of working with an independent, professional Plan Manager. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.

Through supportive work that always puts the participant first, Inclusive Support Service strive to be more than just an ordinary provider. They are part of the disability community, supporting, working with and advocating for participants. Get to know more about Inclusive Support Service and how they can help you live your best life. Who is Inclusive Support Service? “Inclusive provides me the supports to live the life I want to live, helping me work, play sport, and all the other things that matter to me.” Testimonial provided by NDIS participant. Inclusive Support Service has been providing support care services to NDIS participants in the Brisbane, Sunshine Coast, and the Gold Coast region since 2012. Throughout their many years of experienced and dedicated support, Inclusive Support Service have helped (and continue to help) NDIS participants to live the life of their choice. Inclusive Support Service help you build your independence by: Ensuring the care that you receive is consistent across all your supports Meeting with you and your support network to identify and understand your needs, wishes and goals Designing a care plan Ensuring you maintain choice and control, and understands your rights Focusing on wellbeing, preventions, promoting independence and connection to communities For Inclusive Support Service, the participant is what matters. They focus on being inclusive of people of all ages and abilities including Aboriginal and Torres Strait Islander peoples, Australian South Sea Islanders, and people from culturally and linguistically diverse backgrounds, with the support they provide. What services do they offer? Inclusive Support Service offers in-home, community access, Specialist Disability Accommodation (SDA), Supported Independent Living (SIL), and concierge supports. In-Home Support Having a trained support worker on your team that you can trust is important in ensuring that you are receiving the support you deserve. This is why Inclusive Support Service place a huge emphasis on the quality of training for support workers. They can assist with daily activities like personal care, eating and drinking, using aids and appliances, planning and preparing meals, getting in and out of bed, and moving around the house. Community Access Support Community Access Support is all about facilitating community access, engagement in activities, sports and even travel for participants. Inclusive Support Service currently have a three-week international trip organised with one of their participants. Specialist Disability Accommodation (SDA) Support Inclusive Support Service currently provide Concierge Supports at three locations, where there are ten individual apartments with an on-call service that provides support to participants when they have no core supports or when they require 2:1 support. When there are vacancies, they are the Specialist Disability Accommodation (SDA) and Supported Independent Living (SIL) provider for independent and multiple living SDA properties. Supported Independent Living (SIL) Support Supported Independent Living (SIL) is for people with complex disabilities who are seeking a home that suits their needs. Inclusive Support Service offers a range of assisted living options that can help people live the life of their choice. Through understanding your wants and needs, Inclusive Support Service can help ensure you have choice and control over the services you receive, as well as provide a tailored disability service plan based on your goals, hopes and dreams. Concierge Support Inclusive Support Service’s Concierge Service is a complimentary service that runs separately to your individual support needs. This service offers: Access 24/7 on call service for unplanned support Transition assistance for participants moving into a new home On-site team assistance ensuring consistency of support If you connect well with the on-site team, it may be possible to engage them as the core support in an ongoing capacity as part of your support team. Advocacy Inclusive Support Service work closely with their participants to ensure that they, and their families are heard. If you need advocacy support from Inclusive Support Service, they can liaise with you to assist in breaking down barriers that may be challenging to overcome or that you need additional support for. They can also assist to compile relevant information and collate reports to submit to the NDIS advocating for supports that may be required. Inclusive Support Service in the Community Inclusive Support Service recently joined First2Care and other providers in sponsoring the Queensland Powerchair Football Association (QPFA) to send two teams to the club championship games in Sydney. Although this was the first year Inclusive Support Service sponsored the competition, they have provided support to participants attending local and interstate competitions for many years. “It was amazing being able to support the teams to attend the competition in Sydney and for our team to be able to support some of the athletes during this trip. “We are looking forward to seeking new players try the sport and would love to see many more teams and competitions develop over the next few years but at this point the most exciting one is the upcoming world cup. This is a competition very close to our hearts and it is one that we would love to continue to sponsor in the future.” Stef Wilson, Inclusive Support Regional Manager Read more about the benefits of working with an independent, professional Plan Manager. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.

Across many, if not all, cultural and social groups within Australia, there are LGBTQIA+ identifying people, including within the disability community. Get to know the NDIS LGBTQIA+ Strategy and how to access inclusive services. LGBTQIA+ people with disability LGBTQIA+ stands for lesbian, gay, bisexual, transgender, queer/questioning, intersex, and agender/asexual. This acronym, ever evolving, is used to inclusively describe the diverse group of sexual preferences and orientations of people who do not identify as heterosexual (a person attracted to the opposite sex) and/or Cisgender (identifying with the gender assigned at birth). Data provided by the latest census reveals that although roughly one in five Australians’ have a disability, LGBTQIA+ people are twice as likely to require support due to a disability. Research also shows that Queer people are more likely than to be a carer for a person with a disability than other Australians. Does the NDIS have a LGBTQIA+ strategy? In June 2020, the NDIS released their LGBTQIA+ Strategy in direct response to individuals and organisations asking for changes to be made regarding the treatment of LGBTQIA+ people with disability. The strategy was developed in consultation with people with disability who identify as LGBTQIA+ and peak organisations in the LGBTQIA+ community and disability sector. The NDIS recognise that LGBTQIA+ people with disability often encounter challenges and obstacles that prevent them from being fully supported. Challenges LGBTQIA+ people with disability may experience are: Limited access to LGBTQIA+ inclusive and fully accessible services Bullying and exclusion Employment barriers Denial of care Harassment Provider discrimination Since releasing the LGBTQIA+ Strategy, the NDIA has introduced: A Cultural Awareness Training module: Celebrating Diversity: LGBTQIA+ Inclusion Targeted NDIA community engagement initiative with community engagement teams focusing on ensuring that LGBTQIA+ communities are aware of and feel safe to access and use the NDIS Information Linkages and Capacity (ILC) grant options for initiatives specifically aimed at people with disability from LGBTQIA+ communities Promotion of LGBTQIA+ days of significance, taking opportunities to actively engage with important events in the LGBTQIA+ calendar to raise awareness and promote inclusion NDIA LGBTQIA+ Allies Network for employees to provide expert knowledge, shared experiences, and to further support people who identify with LGBTQIA+ communities For the full LGBTQIA+ Strategy, click here. Although LGBTQIA+ people with disability still encounter many challenges and barriers, NDIS cannot discriminate based on sexual orientation, gender identity, race, religion, and any other aspects of diversity. If you are applying to the NDIS, the only criteria to be considered is based around your disability (check out the NDIS website for more information on their criteria). How to access inclusive LGBTQIA+ services A key aim of the NDIS is to provide choice and control over the supports and services you want as part of your NDIS journey. Although, all these services should be inclusive, research shows that the LGBTQIA+ community under uses the supports and services available to them, often due to actual or anticipated cases of discrimination. For LGBTQIA+ people seeking inclusive services, there is an initiative called the Rainbow Tick. This is a “framework that helps health and human services organisations show that they are safe, inclusive, and affirming services and employers for the LGBTIQ community.” The accreditation process is provided by the Quality Innovation Performance and Australian Council on Healthcare Standards through independent assessment. The assessment provides national recognition for those that meet the Rainbow Tick Standards, which have been specifically designed to suit health and community organisations that are committed to safe, inclusive practice and service delivery for LGBTQIA+ people. The initiative is owned and developed by Rainbow Health Australia and is designed to build lasting LGBTQIA+ inclusion. For more information on Rainbow Health, click here. For more information on Rainbow Tick, click here. Read more about the benefits of working with an independent, professional Plan Manager. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.

Accessing the NDIS can take a lot of planning, paperwork, and time. So, when you finally receive your NDIS plan it can be easy to accept without reviewing it critically. However, to ensure that your NDIS plan contains the funding and information relevant to your needs and goals, reviewing your plan is a vital step that you need to invest time in. Tip #1: Read your plan Your NDIS plan is considered active from the approval date listed on the first page, so when you receive your NDIS plan, you should take time to read it thoroughly to better understand your plan and supports. NDIS plans do not always have the most comprehensive language, so if you need assistance understanding what is contained within your plan, you can discuss this with your Local Area Coordinator (LAC), Support Coordinator (if funded), a Disability Advocate or possibly a friend or family member. Tip #2: Understand your Funded Categories Your NDIS plan is made up of three funding support categories: Core, Capital, and Capacity Building Supports. Core supports is the main support category, and it seeks to assist with everyday activities. Core supports are flexible which means you can use your funding across any of the support items and services within your Core budget. Capital supports include Assistive Technology and Home Modification funding. Capacity Building supports are designed to help you build skills and independence in your daily life and to help you pursue your goals. You may receive funding for all three categories or just one or two. If you know where your funding is allocated, it can help you to maximise your NDIS plan ensuring that you receive the supports you need. If these allocations need tweaking to ensure you maximise the spending of your plan funds, this can be a good strategy. Tip #3: Break your supports down into hours When you receive your NDIS plan funding, the funding will be shown as the total funding for your plan period (typically 12 months). The issue with this is that it can be all too easy to think you have enough funding to cover your supports across that planning period but discover after a few months that your funding is running low. One of the best things to do when receiving your plan funding is to break it down into smaller portions i.e., break it down into week, fortnight, or monthly budgets. When you know how much funding you have available, it’s important to know what supports you plan to access, how much they cost, how often you need to access those supports and how much you need to also set aside for the cost of reports that are generated. For example: If your Core Supports funding is $16,000 for a 12-month (52 weeks) plan and you want to know how much you can spend each week then you need to divide the cost by the number of weeks. $16,000 ÷ 52 = $307.69 per week If your supports cost $50 per hour you can access approximately six hours of support each week. If you are unsure about how to breakdown your plan funding, you can always speak with your First2Care Client Liaison Officer, and they will be able to help you. Tip #4: Check if there is anything missing or needing adjustments When reviewing your NDIS plan, the funding categories and how much funding has been allocated, you should check that your plan meets your needs, goals and addresses what was discussed with your LAC or NDIA planner during your planning meeting or plan review meeting. If there is something missing, incorrect or that needs to be changed, you can contact the NDIA to request an internal review. It is not uncommon to find your plan writer due to a lack of time may have simply cut and pasted details from the previous plan without fully understanding your new stated situation. Check everything! It’s best to do this sooner rather than later, which is why critically reviewing your plan is so important. If you don’t receive the desired outcome following your internal review, you can request, which is your right, an external review to be carried out by the Administrative Appeals Tribunal (AAT). An internal review must be completed before you can request and external review. Tip #5: Activate your plan After reviewing your plan, if you are happy with it, you’ll need to visit ‘myplace’ your NDIS participant portal. To access the portal, you need to link 'myplace' to your myGov account. Once you’ve done that, you can login and submit your activation code (found in the letter you receive with your plan). The code expires within ten days. If you don’t use the code before the ten-day cut-off, you’ll need to contact your LAC or NDIA planner for a new code. Read more about the benefits of working with a mid-size independent, professional Plan Manager like First2Care. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.

Although the NDIS is in place to provide people with disability the funding they need to live their lives, work towards goals, and receive necessary support, sometimes the National Disability Insurance Agency (NDIA) doesn't get it right. If you believe the NDIA have made an error in their decision making process, there are options you can explore to help ensure your NDIS plan is tailored to your support needs. Internal vs External Reviews If the NDIA has made a decision that you’re unhappy with, the first step is to request an internal review of the decision. The internal review is completed by a person within the NDIA who was not linked to the original decision. They must review the decision to determine if the original outcome is supported under the NDIS. However, if you don’t agree with an internal review decision, then you can request that the Administrative Appeals Tribunal complete an external review. The Tribunal is a separate entity to the NDIS, which means the external reviews are carried out independently of the NDIA. An internal review must be completed before you can request and external review. What decisions can be reviewed? Essentially all NDIA related decisions can be reviewed. However, there are some more common decisions that are requested for review, including: Eligibility to be part of the NDIS (both if the NDIA determine that you are not eligible and if they determine you are no longer eligible) Plan approval and adequate support funding Early plan review Changes to your plan nominee or child representative What NDIS-funded supports are included in your plan How your supports are described How your funding is managed How long your plan goes for If the original decision made is reviewable, the NDIA will contact you and let you know in writing. How to request an internal review Whether this is your first NDIS plan or your seventh, be sure to check that your plan covers what you discussed with your Local Area Coordinator (LAC). If you have had a NDIS plan before you should also check that the plan matches your previous plan or better supports your needs. If the plan is not what was discussed and agreed to or it isn’t an improvement from your previous plan, you can request an immediate review. To do this you can either contact the NDIA at your local office or via phone on 1800 800 110 to make the request. Alternatively, you can fill in a review request form and submit it to the NDIS via post or you can email enquiries@ndis.gov.au. It’s important that you a clear about what you would like changed or what is missing from your plan before you request a review. If you need assistance with this process to advocate for your rights, a disability advocator can help. If you don’t currently have a disability advocator, you can use the disability advocacy finder here. How to apply for an external review If your NDIS plan still doesn’t meet your needs following the internal review, you can apply for the Administrative Appeals Tribunal (AAT) to complete the review. The AAT are separate to the NDIA. The AAT cannot review a decision until the NDIA has had the opportunity to review internally. To apply for an external review, you can apply online, fill out an application form or write a letter to be sent via post, email or fax. If you choose to write a letter or email, it’s important to include the following: Your name, postal address, telephone number and email address The date you reviewed the decision Brief description of the reasons why you think the internal review is wrong A copy of the internal review outcome For more information on how to apply for a review with the AAT, check out this video. For more information about applying for a review by the AAT, visit their website or call 1800 228 333. What if I have concerns about the decision-making process? If you are not happy with the way the NDIA managed the review process and decision making, you can make a complaint by filling in a NDIS Complaint form. Once the form has been completed, you can email it to the NDIS at feedback@ndis.gov.au, send it via mail or take it to your local NDIS office. Please note: the new Labor Government and the new Minister for the NDIS, Bill Shorten, have stated they are looking into the recent increase in cases submitted to the AAT with Shorten saying he wants to "find alternative, less costly ways to resolve disputes." Read more about the benefits of working with an independent, professional Plan Manager. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.