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As a plan manager, one of the most important aspects of our role is guiding Participants and the Nominees through the complexities of their funding. The NDIS is a powerful tool designed to empower participants by providing them with the resources they need to live more independently and achieve their goals. However, managing these funds effectively can be challenging, and may result in a Participants struggle with either overspending or underspending. Striking the right balance is crucial, and it’s our job to help Participants navigate this terrain so they can make the most of their NDIS plan. Understanding the NDIS Budget Every NDIS plan is uniquely tailored to the participant’s specific needs, providing financial support across categories like core supports, capacity building, and capital supports. As a plan manager, we work closely with Participants to ensure they understand these categories and how their funds can be best utilised. However, even with a clear plan, participants can fall into the traps of overspending or underspending, each of which can create significant challenges. The Consequences of Overspending Overspending occurs when Participants exhaust their allocated funds before the end of their plan period. There are several reasons this might happen: Underestimating Costs: Participants may not fully grasp the cost of the services they need or might overestimate the amount of support required. Lack of Financial Planning: Without planning ahead, it’s easy for funds to be spent too quickly, or on non-essential services and products. Unforeseen Expenses: Sometimes, unexpected needs arise, leading to unplanned spending that wasn’t accounted for in the budget. When overspending occurs, Participants may find themselves at risk of being without essential services toward the end of their plan period. This can lead to stress and the need for a plan reassessment, or variation, which is an additional process that could have been avoided with better financial planning. Risk of Underspending Conversely, underspending is when Participants do not fully utilise their NDIS funds. While it might seem prudent to save, underspending can also have negative repercussions: Missed Opportunities for Support: Participants might forgo services that could significantly improve their quality of life because they’re hesitant to spend. Potential Future Funding Reductions: Consistent underspending might signal to the NDIS that the Participant doesn’t need as much funding, which could result in a reduced budget in future plans. Stalled Progress: Funds intended for skill development or capacity building may go unused, leading to slower progress toward the Participants' goals. How We Help Participants Achieve Balance Our goal as a plan manager is to help Participants avoid both overspending and underspending, ensuring they make the most of their NDIS funding. Here’s how we approach this: Educating Participants About Their Plan: We ensure that our Participants thoroughly understand their NDIS plan, including what each funding category covers and how they can be used effectively. Regular Budget Reviews: We work with Participants to regularly review their spending. By comparing their expenditure against their plan, we can identify areas where they might need to adjust their spending habits. Planning for Contingencies: We advise Participants to allocate a portion of their budget for unexpected expenses. This helps prevent overspending due to unforeseen needs. Providing Expert Advice: We offer professional guidance to help Participants navigate their budget. Whether it’s deciding on the right services or reallocating funds, our role is to ensure they’re making informed decisions. Aligning Spending with Goals: We encourage Participants to set clear, achievable goals. By aligning their spending with these goals, we can prioritise funds in a way that supports their long-term aspirations. Final Thoughts Managing NDIS funds effectively is a delicate balance that requires careful planning and ongoing support. As a plan manager, we’re committed to helping Participants avoid the pitfalls of overspending and underspending, ensuring they get the most out of their NDIS plan. By educating Participants, regularly reviewing their budget, and providing tailored advice, we help them navigate their financial journey with confidence, enabling them to achieve their goals, with better outcomes and improved quality of life.

What Are NDIS Gap Fees? NDIS gap fees refer to the difference between the cost of a service or support and the amount covered by the NDIS funding. In other words, it's the out-of-pocket expense that participants may need to pay to access certain services. While the NDIS covers a wide range of supports, it may not always cover the full cost, leading to a gap that needs to be filled by the participant. Why Do Gap Fees Exist? There are several reasons why gap fees might arise, here are a couple of them: Service Pricing Above NDIS Rates: The NDIS sets pricing limits (this is a maximum price for the listed service) for various services, but some providers may charge more than these limits. In such cases, participants are responsible for covering the difference. Limited NDIS Funding: Participants receive a set amount of funding based on their NDIS plan, which is intended to cover their support needs. However, if the cost of services exceeds this funding, a gap fee may be incurred. How to Manage NDIS Gap Fees Managing gap fees effectively requires careful planning and budgeting. Here are some strategies to consider: Negotiate with Providers: Don’t be afraid to discuss pricing with your service providers. They should be willing to tailor their rates to better fit within the NDIS pricing limits, reducing or eliminating the gap fee. Review Your NDIS Plan Regularly: Make sure that your plan accurately reflects your current needs. If your circumstances change, or if you find that the allocated funding is insufficient, you may need to request a plan reassessment or adjustment to assess your budget needs. Choose Providers Carefully: While it’s essential to receive quality services, it’s also important to be aware of the costs. Compare different providers and their pricing structures to find ones that align with your budget and NDIS funding. Use Your Funding Wisely: Prioritise your spending on essential supports and services. Avoid using your NDIS funds on services that may not be critical to your needs, thereby minimising the risk of running out of funding and facing gap fees. Seek Further Advice: If you’re struggling to manage your NDIS budget, consider seeking further support from your Plan Manager. They can help you create a sustainable plan to manage your funds effectively. Understanding Your Rights It’s also important to know your rights as an NDIS participant. The NDIS Quality and Safeguards Commission oversees the rights of participants and ensures that providers are charging fair and reasonable prices. If you believe that a provider is charging unfair gap fees, you can file a complaint with the commission. The price a Provider sets, must be agreed by the Participant or their nominated representative. It is always advisable to refer to the Pricing Arrangement and Price Limits. NDIS gap fees can be a source of stress for participants, but with the right knowledge and planning, they can be managed effectively. By understanding why gap fees exist and taking proactive steps to manage them, you can make the most of your NDIS funding and access the services you need without undue financial burden. Remember, the key is to stay informed, plan ahead, and seek help when needed.

One of the more contentious recommendations from the NDIS Review is the proposal that all services providers should be registered in some way with the NDIS Quality and Safeguards Commission. This was outlined as a risk-proportionate model, where providers delivering higher risk supports would be subject to more obligations than those delivering lower risk services. The NDIA have established a taskforce, chaired by lawyer and disability advocate Natalie Wade, to provide advice on the design and implementation of Review recommendation 17. The taskforce is conducting feedback and consultation sessions to hear the voices of people with disability as they compile their report. Why does the Review recommend compulsory registration? The short answer to this is that there are over 150,000 unregistered providers in the NDIS market, a number that has grown well beyond what was anticipated, and the fact that the existing quality and safeguard framework has not kept pace with the rapid growth and changes within the Scheme. The NDIS Review is concerned that there is not sufficient oversight of providers to ensure the quality of supports delivered and the safety of participants. Essentially, managing quality and safety is almost entirely in the hands of participants and their families. Many participants will no doubt have plenty of stories about poor providers and a lack of regulatory support to protect the market, and while it is true that registration does not always mean safer outcomes, it brings greater visibility to how service providers operate. On the other hand, provider registration in its current form is a one-size-fits-all approach, where every provider is audited against the same number of practice standards. This can be an administrative burden for smaller providers, especially those delivering low-risk supports. A granulated model would relieve this burden. What are the concerns? At the heart of participant alarm is the uncertainty about what changes may occur to impact existing, trusted relationships with long-standing unregistered providers with a particular focus on those providers that are not disability-specific in their business, such as cleaning and gardening companies, local pharmacies for consumable products, and online stores for low-cost assistive technology. Similarly, the erosion of choice and control and dignity of risk are key points that echo the importance of one of the fundamental principles of the Scheme: that participants have the right to be in control of who provides support. Co-design and the embedding of lived experience into policy decisions has been a central point of reference in the current government’s rhetoric. While the NDIS Review has pointed to many quality and safety shortcomings that mean change is required, many participants remain uncertain as to how a new registration model will impact their choice and control over supports. This is why the taskforce encouraged submissions and feedback from participants and their families, as well as from providers of disability supports. The taskforce closed for submissions in May 2024 and has published a series of online webinars on the DSS website: NDIS Provider and Worker Registration Taskforce | Department of Social Services, Australian Government (dss.gov.au) The latest webinar from May 2024 includes a summary of the feedback received from the consultation period. There are currently no estimated timeframes for the results of these discussions from the feedback provided. These results have the potential to shake up the NDIS for providers and participants alike. We will be keeping our ear to the ground to ensure that we are able to provide the latest and most recent information on this topic.

Recently, the NDIS has been under increasing pressure to reduce inflation and increasing costs. In interviews throughout May, NDIS Minister Bill Shorten identified several ways in which the NDIS will be addressing some of these concerns. At the top of the list was reducing Intra-Plan Inflation. What is Intra-Plan Inflation? Intra-Plan inflation is when a participant on the NDIS is encouraged to use up their funding early, with additional funding then being made available through early plan reviews and/or payment enquiries. While Bill Shorten and the NDIS do acknowledge that not all plans are built perfectly for a participant’s needs, and that early plan reviews are still needed, they will be looking further into those participants who are encouraged to exhaust funding early with the expectation of a “top up” that is necessarily needed. Early exhaustion of funding is simply happening too frequently for the NDIS’s liking, and they will be reviewing why this is happening and cracking down on reoccurring issues. What Causes Intra-Plan Inflation? Several key areas have been identified by the NDIS as driving factors behind early exhaustion of plan funding. These are: Hours and rates of supports being used exceeding what the participant is funded for. Overspending core budgets outside of intended purpose. Claiming supports incorrectly. The NDIS will be looking at providers, including plan managers and support coordinators, who encourage participants to spend above their means with the promise of additional funding being made available at the end of the plan. How Might This Affect Plans with Exhausted Funding? Since this focus on reducing Intra-Plan Inflation was announced, there have been some changes to how the NDIS addresses plans with exhausted funding. They have recently clarified that “Spending a budget before the end of a set plan timeframe is not a reason to request a plan review.” This may result in fewer plans being renewed early. As a plan manager, we have also noticed that a higher percentage of payment enquiries are now being rejected. The payment enquiry process has never been a guarantee for additional funding at the conclusion of an exhausted plan, but now providers can rely less on unpaid invoices being approved by the NDIA. What Can Be Done to Avoid Intra-Plan Inflation? The best way providers can ensure that participants aren’t exhausting funding early is to ensure that service agreements and/or schedules of support are written up before services commence. These documents should outline the agreed rates and delivery frequencies of any supports. This should also be arranged in discussion with the participant to ensure that it is within their allocated budgets. Any variations or expected overspending from these agreed documents should be discussed directly with the participant or their representatives. Plan managers and support coordinators can assist with ensuring that all proposed supports fit into a participant’s budget.

Some therapy support item codes have been present within Assistance with Daily Life in the flexible Core budget for several years. These are classed as Disability-Related Health Supports and exist to respond to the disability-related health needs of participants where that care is not the usual responsibility of the health system. The NDIA have recently clarified and updated their list of Disability-Related Health Supports that these support items may be used in relation to: Dysphagia Respiratory Nutrition Diabetes Continence Wound & Pressure Care Podiatry Epilepsy In addition, the list of qualified professionals who may deliver these supports is limited compared to the standard therapies supports in the Improved Daily Living Budget. Only the following types of therapists and therapy assistants can claim from the core support items: Dietitian Occupational Therapist Physiotherapist Podiatrist Psychologist Speech Pathologist Other Professional (must be delivering Disability-Related Health Supports in line with the NDIS Quality and Safeguarding Commission’s requirements for the Therapeutic Supports Registration Group) In short, service providers should only use these support items if you are delivering one of the listed Disability-Related Health Supports AND are one of the listed qualified practitioners. This means that not all therapy supports can appropriately be funded through the Core Budget should Improved Daily Living Skills exhaust. For fast, compliant NDIS claiming it is important to ensure that the item code being billed matches the service provided. Using a core line item for therapy, whether on an invoice or in a service agreement is something that should only be done if the provider is delivering the qualified supports. Full details can be found in the NDIA’s Operational Guideline on Disability-Related Health Supports: Disability-related health supports | NDIS

Many providers will be aware that some therapy support item codes have been present within Assistance with Daily Life in the flexible Core budget for several years. These are classed as Disability-Related Health Supports and exist to respond to the disability-related health needs of a participant where that care is not the usual responsibility of the health system. These items are: 01_760_0128_3_3 - Assessment Recommendation Therapy or Training Supports – Dietitian 01_661_0128_1_3 - Assessment Recommendation Therapy or Training Supports - Occupational Therapist 01_721_0128_1_3 - Assessment Recommendation Therapy or Training Supports – Physiotherapist 01_663_0128_1_3 - Assessment Recommendation Therapy or Training Supports – Podiatrist 01_701_0128_1_3 - Assessment Recommendation Therapy or Training Supports – Psychologist 01_665_0128_1_3 - Assessment Recommendation Therapy or Training Supports - Speech Pathologist 01_741_0128_1_3 - Assessment Recommendation Therapy or Training Supports - Other Professional The NDIA have published a list of Disability-Related Health Supports that these support items may be used in relation to: Dysphagia Respiratory Nutrition Diabetes Continence Wound & Pressure Care Podiatry Epilepsy In addition, the list of qualified professionals who may deliver these supports is limited compared to the standard therapies supports in the Improved Daily Living Budget. Only the following types of therapists and therapy assistants can claim from the core support items: Dietitian Occupational Therapist Physiotherapist Podiatrist Psychologist Speech Pathologist Other Professional (must be delivering Disability-Related Health Supports in line with the NDIS Quality and Safeguarding Commission’s requirements for the Therapeutic Supports Registration Group) In short, service providers should only use these support items if you are delivering one of the listed Disability-Related Health Supports AND you are one of the listed qualified practitioners. For fast, compliant NDIS claiming it is important to ensure that the item code being billed matches the service provided. Using a core line item for therapy, whether on an invoice or in a service agreement is something that should only be done after careful consideration of the qualifications of the therapist, the type of service being delivered, and the arrangements in place with the participant. Full details can be found in the NDIA’s Operational Guideline on Disability-Related Health Supports: Disability-related health supports | NDIS

Community Activities Alternative Funding Options With some recent pressure on the NDIS to reduce costs, we have decided to investigate how participants on the scheme can reduce costs by seeking out alternative ways for funding supports. There are several options in place for people with disabilities to reduce expenses beyond utilising NDIS funding. We have highlighted a few of the options that may be available to you. Companion Card Every state and territory in Australia have their own version of the Companion Card. There may be some differences in eligibility and use between the regions, but, generally speaking, a Companion Card allows for an attendant carer to participate at venues and activities without incurring the cost of a second ticket. Attendant care support is defined as needing significant assistance with mobility, communication, self-care or learning, where the use of aids, equipment or alternative strategies does not enable a person to carry out these tasks independently. Attendant care support does not include the companion providing only social company, reassurance, or encouragement. A companion is then defined as any person who accompanies a cardholder and provides attendant care support. The chosen companion may be a paid or unpaid carer, family member, friend, or partner. Eligibility for a Companion Card is dependent on several factors. You must: be a lawful Australian resident, living in the relevant State or Territory you are applying for have a disability because of the impact of the disability, be unable to participate at most community venues or activities without attendant care support need, or be likely to need, lifelong attendant care support. It should be noted that eligibility is always determined for the person with the disability, not with the carer or any other organisation. Eligibility requirements are different to that for the NDIS, so eligibility for one does not necessarily mean eligibility for the other. You can determine eligibility for a Companion Card with links to the States and Territories for application here: National Companion Card | Department of Social Services, Australian Government (dss.gov.au) Taxi Subsidy Scheme The Taxi Subsidy Scheme is available for Queensland residents with permanent and temporary disabilities to fund half of the total fare (up to a maximum far of $60) of a taxi journey. There is no limit to the number of taxi journeys an eligible member may make. Membership for this program typically lasts for five year periods, though those with temporary disabilities have available to them 6 and 12 month periods. This program is available to NDIS participants up until 31/10/2025, with alternative appropriate transport support arrangements intending to be in place by this time. To be eligible for this program, you must meet at least one of the following criteria: Physical disability requiring dependence on a wheelchair for all mobility outside the home. Severe ambulatory problem that cannot functionally be improved and restricts walking to an extremely limited distance. Total loss of vision or severe visual impairment (both eyes). Severe and uncontrollable epilepsy with seizures involving loss of consciousness. Intellectual impairment or dementia resulting in the need to be accompanied by another person at all times for travel on public transport. Severe emotional and/or behaviour disorders with a level of disorganisation resulting in the need to be accompanied by another person at all times for travel on public transport. If you wish to check eligibility criteria or apply for this scheme, you can find all the relevant information here: Taxi Subsidy Scheme and Lift Payment | People with disability | Queensland Government (www.qld.gov.au) Qantas Carer Card This card is an example of a service provider acting with initiative and offering specific supports to people with a disability. The Qantas Carer Card provides a discount on domestic flights for eligible people and their carers. As the NDIS does not cover flights, this provides a viable option when a flight is necessary. A person may be eligible if they need to have one-on-one support when seated on the aircraft for assistance with meals/drinks, toileting, administration of medication, orientation, communicating with the flight staff etc. A person is not eligible if they only need assistance boarding the aircraft, or when they arrive at their destination. This scheme allows eligible participants to get a discount on their flights and also that for any required carer. You may find out further information, including eligibility criteria, here: Qantas Carer Concession Card - People with Disability Australia (pwd.org.au)

There has recently been a lot of discussion in the media and within the NDIA about how to reduce expenses across the sector. One way that this can be done is looking at how competitive the prices and rates are that providers charge for their services. There has been some misconception amongst some providers that the prices listed in the NDIA’s Pricing Arrangements and Price Limits (Pricing arrangements | NDIS) document are set and fixed by the NDIA. This is not the case, these prices are maximum limits that cannot be exceeded. There is nothing that indicates a provider can’t charge beneath this rate. In fact, it is usually more appropriate to charge beneath this capped limit, as these maximums are set to be mindful of the more intensive needs and requirements of certain participants. What Can I Do About This? It is the expectation of the NDIA that all charges and costs are negotiated and arranged between the provider and participant (or their representative). This is typically represented in a service agreement signed by both parties. We recommend discussing with potential providers what the expected rates should be. If the provider proposes only the maximum limit, then it is reasonable for you to ask them why their rate is all that is suitable. What Benefit Does a Lower Rate Have for a Provider? A provider won’t want to intentionally lower their rates, will they? What benefit will it have to them to charge less per hour? By charging a lower rate than their competitors, they can actually attract more potential clients who see the opportunity to save money on their plan. So long as they can demonstrate the quality of their work is equal to or greater than their competitors, they can often see an upsurge in interested clients. Why Is This Important for Me? If you are able to negotiate fairer, more appropriate prices for your supports, then you will be spending less. This will result in being able to engage with more supports as required and reduce the risk of overspending and exhausting your funding early.

What is STA/Respite? Short Term Accommodation (STA), also known as Respite, can be one of the more complicated supports in the NDIS to determine eligibility for participants and how it can be covered in a plan. There can be additional complications relating to how STAs can be arranged and organised, which we hope to resolve in this blog. What STA is not. The NDIA is very clear when stating that STA is not a holiday. We have covered this topic in previous blogs: STA or Holiday? (first2care.com.au) and Will the NDIS Fund my Holiday? (first2care.com.au). Put simply, funding should not be used for anything that is deemed a holiday for the participant. Further details on how the NDIA differentiates between holiday and STA will be laid out below. What STA is. STA is support for when a participant needs to live out of home for a short period of time. This is generally available to participants at a maximum of 28 days per calendar year, with a recommended maximum of 14 days consecutively. This can also be limited by funding availability. STA can be used by a participant for a number of reasons: Providing respite to the participant and/or their primary caregivers, The usual support network is temporarily unavailable, The participant making new friends or developing new skills aligned with their plan goals, Maintaining the participant’s functional capacity. The reasons for engaging with STA must be directly related to the participant’s disability or plan goals. This is the primary rationale that the NDIS uses to differentiate between holiday and STA. If the activity is purely for recreation and does not link to the participant’s goals, then it is likely to be viewed as a holiday by the NDIA. This reasoning also provides the basis for the Reasonable & Necessary criteria that justifies all supports to the NDIA. How STA can be funded. Because of the intricacies of STA and the funding requirements, it is generally considered best practice to use a dedicated STA/Respite agency. These providers arrange, organise, and invoice for the STA in one neat package and are familiar with NDIS rules regarding prepayments and other such requirements. All activities, personal care, accommodation, and food are also covered by a single invoice. This allows us as the plan manager to know exactly what is being claimed and for how much. We can ensure that everything meets the NDIA’s funding criteria and does not exceed the maximum price limits. Sometimes, using a STA agency is not suitable or appropriate. In these circumstances, STAs can be constructed by the participant in conjunction with their support workers and support coordinator. To manage this, we recommend following the below steps: Combine the complete STA expenses into a single invoice or, at the very least, a single invoice per day. The support worker or support coordinator would pre-pay for all accommodation, supports, food, and activities and include receipts for these purchases with the invoice, ensuring that this fits within the maximum price for a 24-hour period for STA supports. Once the supports have been delivered, these invoices can then be submitted for the support worker or support coordinator to receive payment for these expenses. Effectively, this means that the support worker or support coordinator would be acting as an unofficial STA agency. STA does not need to be stated within a participant’s plan. As it is funded from the flexible Assistance with Daily Life budget within the Core category, there is simply the requirement for suitable funds and the Reasonable & Necessary criteria to be met. This last point is important to consider. Incorrect use of STA has been a focus of the NDIA to reduce the inappropriate use of NDIS funding. If there are not clear links to a participant’s disability, then this is likely to be seen as a holiday by the NDIA. Can STA be used in a crisis situation? The NDIA states that STA is not appropriate for housing crisis solutions. STA should only be funded when the needs relate directly to the participant’s disability. If a crisis occurs where a participant’s regular carers are unable to care for them, then STA may be deemed appropriate for a limited time. Long term solutions should always be discussed with the participant’s LAC or Planner as this would be more appropriately covered under Medium Term Accommodation (MTA).

PACE and Behavioural Support Behavioural Support, while already being a highly intensive and regulated type of support, has seen further changes within PACE. While all the newly added categories are stated, behaviour support has the added requirement of being a “my provider” category, meaning that only registered providers under the registration group 110 can be paid to deliver this type of service, even if this aspect of the plan is self- or plan managed. This is to ensure that there is appropriate reporting and scrutiny for the potential use of restrictive practices. Summary of what has changed The original category 11 in the capacity building budget – Improved Relationships – has been split into two categories. New category 20 – Behaviour support includes the support items: 11_022_0110_7_3 - Specialist Behavioural Intervention Support; and 11_023_0110_7_3 - Behaviour Management Plan Including Training in Behaviour Management Strategies. Category 11 has been renamed to Relationships. This leaves a solitary support item, 11_024_0117_7_3 - Individual Social Skills Development in Relationships (along with supplemental Provider Travel – Non-Labour Costs and Activity Based Transport) within the original Relationships 11 category. It is therefore important to ensure that supports are correctly invoiced, and that the participant’s plan is correctly set up and understood prior to engaging with supports. It is possible that these two categories are not consistent with both being plan managed – one may be agency managed. In this case, invoices will need to be split between getting sent to the NDIA and the Plan Manager.

Fraud/Compliance At the end of March, the NDIA made changes to how it processes claims submitted for payment. This was part of a movement by the NDIA to reduce the risk of fraud and to better identify non-compliance in invoicing. While this has been well covered in previous blogs, the main takeaway from this is that invoice processing times have increased. For First2Care, this means that our average turnaround time on invoices has increased to payment within five business days of receiving invoices. We have also been working hard to implement procedures to reduce non-compliant invoices being submitted to the NDIA. What is fraud and non-compliance? Fraud is the willing and intentional act to submit invoices that do not accurately reflect services provided. This could be by invoicing for supports not delivered, or inflating the number of hours of work given. Non-compliance is the unintentional errors on an invoice that results in them being inaccurate. A significant majority of invoices with issues are due to non-compliance, often the result of typos or forgetting to fully update an invoice template with new information. How can I avoid non-compliance? The best way to ensure invoices are accurate and contain all the necessary information is to utilise an invoice template. First2Care have put together one such template for use: Invoice_Template.pdf (first2care.com.au) We have also put together a useful checklist to ensure that all relevant details are included: Provider_InvoicingChecklist_V1 copy (first2care.com.au) We recommend double checking every invoice before submitting them to First2Care to ensure that all details are accurate and correct. Errors often increase processing times while we chase up correct information, resulting in slower payments. Ensuring a service agreement is in place with a participant allows plan managers or the NDIA to determine how supports should be delivered. Any variations from this may identify any unintentional non-compliance with invoices. What are the consequences of fraud and non-compliance? The NDIA has zero tolerance for deliberate and wilful fraudulent activity. Suspicions of fraud are investigated with perpetrators prosecuted. More likely, the issue at hand will be an unintentional mistake causing non-compliance. First2Care as plan managers and the NDIA both recognise that mistakes can be made. Human error can result in invoices appearing inaccurate. There is no punishment or reprimand for non-compliant invoices beyond the slower processing times resulting in having to chase up for accurate information. Repeated errors may result in conversations to ensure that these mistakes are identified and eliminated going forward, as the same error appearing across multiple invoices may be seen as negligent behaviour by the NDIA. For providers who are concerned by the NDIA’s increased determination to remove fraudulent claims within the system, the old adage hold true: those with nothing to hide have nothing to fear. Fraud is a wilful and deliberate action. Mistakes can happen from time to time. First2Care and the NDIA are both aware of this and are happy to work with all providers who deliver quality and legitimate services to participants on the NDIA. We can also work with providers to ensure that non-compliance is reduced by providing all the necessary resources to ensuring invoices are correct and accurate. Our templates are a great place to start.

What You Need to Know About Memberships! Participating in sporting activities can be a fantastic way to be fit, healthy, and socially active within your community. If you’re wanting to focus on being more active and social, it’s a good idea to include this in your NDIS goals to ensure that the correct budget categories can be added to your plan. The NDIS can provide funding towards supporting your goals if they meet the Reasonable & Necessary criteria. Let's get physical! The NDIS recognises that regular physical activity can be beneficial, especially when tailored towards the specific needs of a disability. These benefits can include: - Stronger bones and muscles - Lower blood pressure - Improved cholesterol - Reduced risk of heart problems - Reduced stress and anxiety - Improved mental health As a NDIS participant, it is possible to receive funding for sporting activities and sporting equipment. It is important that this must be related to the stated goals within your plan and meet the Reasonable & Necessary criteria. What do my funds cover? Sporting activities can potentially be funded from one of three support categories. Within Capacity Building is the option of the Increased Health and Wellbeing or Increased Social and Community Participation budget categories. Within the Core Budgets is the option for Assistance with Social and Community Participation. Increased Health and Wellbeing – this support category can help cover exercise physiology and personal training. Increased Social and Community Participation – this support category can help you to build your skills and independence through fitness classes, coaching, and other recreational activities in a one-on-one capacity and group classes. Gym memberships and other such membership costs are discussed later in this blog. Assistance with Social and Community Participation – this support category can help you to participate in sporting activities through supports, such as with a support worker. Can my funds cover equipment? The NDIS can potentially also fund specialised sporting equipment. There are two categories of funding that this can utilise. Within the Core Budgets is the option for Consumables. Alternatively, there is also the Assistive Technology budget category. Consumables – this support category covers the cost of adapting basic equipment to suit specialised needs. The NDIS won’t typically cover the cost of basic/off-the-shelf items, but they can cover the cost of any disability-required modifications needed on such equipment. Assistive Technology – this support category covers specialised equipment provided by a specialist disability supplier. For this type of equipment to be funded, you will either need a recommendation from your service provider or an OT assessment depending on the AT costing. Can I use my funds for a Gym Membership? Gym membership is frequently a common request to have funded through a NDIS plan. Whether this is suitable for accessing funding is sometimes tricky to determine. Typically speaking, the NDIS does not consider gym memberships to be suitable. The reasons they generally give for this are as follows: - Gym membership is an everyday expense everyone can be expected to pay, regardless of disability. - The membership costs are not related to the participants' disability. If you believe you can prove that gym membership expenses do meet the Reasonable & Necessary criteria, then there remains a possibility this can be funded. Alternatively, you can claim for the expense of a support worker assisting you in a gym environment, but not the gym fees directly. Other membership fees, for example pool, sports club, or social groups, would also fall under the same criteria and requirements. Some additional limits and restrictions are placed on what activities and equipment the NDIS will fund. These budget categories are intended for people participating at an entry level rather than at a professional level or for competitions. This means that the NDIS will not fund competitions with significant prize money or performance contracts, and they won’t fund competing at State or National Championships or higher. Do these meet my goals? To ensure that these activities or equipment can be funded from your plan, it is important to consider your goals and what is allocated within your plan. If the required budget categories are not included in your plan, then it can be difficult – or even impossible – to have certain supports or activities funded. It is important to have clear goals outlined prior to your NDIS planning meeting or plan review meeting with any supporting evidence you may have, so the NDIA can assess what funding you may need to put your goals into action.