What supports will the NDIS pay for?
The NDIS will typically fund a requested support if it meets ALL of the following criteria:
- it is for your impairments that meet the disability or early intervention requirements, or both
- it will help with your individual goals and aspirations
- it will help your social and/or economic participation
- it is value for money, which means that:
- the cost of the support is similar to or cheaper than alternative options that can provide you with the same outcome (NDIS Supports for Participants Rule 3.1(a)); and/or
- purchasing the support is likely to reduce the costs of funding for other supports in the long term (NDIS Supports for Participants Rule 3.1(c)).
- it is effective and beneficial for you
- it helps to maintain your informal supports
- it is an *NDIS support (see below)
For more information see What is Reasonable and Necessary ?
What's on the NDIS Supports IN and OUT list?
*What is an NDIS Support?
The NDIS Supports 'IN and OUT list' has finally been confirmed. The rules are transitional and apply from 3 October 2024, until the states and territories develop and agree on finalised Rules
This is part of the amendments introduced under the Getting the NDIS Back on Track Bill No. 1 which passed Parliament in August 2024.
What's changing?
Definition of "*NDIS support"
This explains what can and cannot be funded by the scheme.
The list of approved supports is extremely detailed and largely includes items or services directly linked to managing a disability.
The NDIS has created an 'IN' and an 'Out' List. You can access them here:
The NDIS IN List - Supports that will be funded
The NDIS OUT List - Supports that won't be funded
What happens if an NDIS participant needs something that is not on the list?
If a participant needs something to manage their disability that isn't on the list, they can make a request to the NDIA in writing.
In some specific circumstances, the NDIS can fund supports that are not NDIS supports. The NDIA calls these Replacement Supports.
What are Replacement Supports?
A Replacement Support:
- Is a service, item or equipment you would like to use instead of the NDIS support or supports in your plan.
- Is a support that the NDIS has agreed to fund (in writing).
- Replaces an existing NDIS support or supports in your plan - it is not an extra support
- Represents value for money and there is good evidence to support it.
This example was provided by the NDIS Minister The Hon.Bill Shorten:
"You might need a pair of specially designed shoes because of your disability. That could cost literally hundreds and hundreds of dollars," he told reporters on Tuesday.
"If you can prove that getting [that] particular shoe off the shelf actually is better than the specially designed one, even though that shoe is not on the list, the agency will take that into account."
See this comprehensive resource on what is on the Replacement List and how to apply.
Are there any exceptions?
There is a transitional rule allowing participants to continue to access supports that are not NDIS supports for the duration of their existing plan IF
- They were specifically identified as reasonable and necessary before 3 October 202
- The Administrative Appeals Tribunal has decided that the support should be funded as a reasonable and necessary support.
This rule does not apply to sexual services, alcohol or drugs. These supports are specified in the primary Act as non-NDIS supports.
When does the list come into effect?
The list comes with a 12-month "transition period", during which participants won't be automatically punished for accidentally buying something that isn't approved.
"If you make a mistake … we'll be in touch to let you know and help you understand what you can do," the NDIA says.
The agency says it may pursue action if the incorrectly claimed support is more than $1,500 or if someone continues to incorrectly claim items "despite us providing them with information and advice".
Changes to funding amounts and periods from 3 October
Currently, your NDIS plan shows line-by-line support items – but from 3 October, new plans will:
- show as a total budget figure and
- indicate how long that funding needs to last.
Will the change be applied to existing plans?
No, the changes will apply to new plans and each new plan will initially last for 12 months.
The NDIA says participants retain the right to appeal plan decisions.
Why are things changing?
A review of the NDIS last year called for changes to how disability support is structured and delivered.
The government has also been under pressure to ensure the now-$42-billion scheme's financial sustainability, which has been growing faster than expected.
It has said it expects these changes to reduce the projected growth of the NDIS by $14 billion over four years.
Community Feedback
Sam Paior of The Growing Space provided her initial thoughts here:
- Plan managers and all registered providers have 30 days after October 3rd to be compliant. Participants have 12 months.
- Debts will not be raised on participants who have spent less than $1500 on something that is not listed as an NDIS support.
- Support coordination only able to be spent if it stated in the plan. So participants will no longer be able to use support coordination from their core unless it’s stated in their plan.
- What we knew as the substitution rule is now replacement support determinations. This is where something is on the out list, but you would like to request that you get an exception.
It can be requested for standard commercially available household items. And for smartwatches, tablets, smartphones or apps used for accessibility or communication purposes.
- Specialised driver training appears to now be available to people with a range of disabilities, but it must be stated in their Plan and it must be delivered by a specialized driving instructor.
- Assistance animals and innovative community participation will also only be allowed to be paid for with NDIS funds by participants who have it stated in their plan.
- One notable item not on the out list is that hairdressing for hair washing is no longer on the OUT list. However, you’re still not allowed to claim a pedicure or manicure or fake nails, etc.
- Electricity generators remain on the out list.
- There appears to be a capacity for NDIS to fund repairs for disability-related damage to property.
- Legal costs are now on the out list, which will be a big blow to self managers who may need a lawyer to check employment contracts, etc.
- ILO arrangements appear to be untenable with rent on the out list. This will create significant extra expenses as Housemates will need to be paid for providing supports in home, and will need to be paid for appropriate overnight shifts. This will also likely shift the power dynamic and balance in housemate-shared homes and is especially disappointing.
It’s unknown what happens to all the existing agreements where rent for non-disabled supportive housemates covering "free" overnight passive supports is part of signed contracts.
- Meal delivery platforms are out except where the Food and ingredient components can be separately identified from the meal preparation and delivery costs.
- Gym membership seems to be a little softened with the changing of the wording to saying that you can’t have costs associated with recreational sports and activities, including membership costs, so that might potentially allow for some leeway where a gym membership is not for recreational purposes.
- Dating and relationship services remain on the out list. There is no definition of what a relationship service is.
This could be a big problem for people with intellectual or other cognitive disabilities who do need extra supports around safety and relationships, for example.
- Conference fees are now on the out list so I guess all of the disability specific conferences that are educational may need to change their names to training events or some such.
- Life coaches and career coaches and gaming therapists and cultural coaches are all on the out list still. So I suspect, if those services are to be claimable, they will need to be listed as community access/support work and charged accordingly.
- After school care, au pairs, vacation care school holiday programmes, etc. are all on the out list.
- Postal services are on the out list, so I don’t know how people are supposed to be able to claim for delivery of their assistive technologies.
Things that won't be covered are services which are:
- "not evidence-based" like 'cuddle therapy'
- not directly linked to someone's disability, such as childcare fees, crystal and wilderness therapy
- day-to-day living costs such as rent, groceries and bills.
What happens next?
The NDIA says most participants will start to see changes when the scheme transitions to the new planning framework later next year.
Other changes recommended by the NDIS review are still in the pipeline, including "foundational supports" — services for those outside the scheme, delivered through the likes of schools and health services.
Consultation on foundational supports began last month.
The government is also still looking at the Taskforce report on the issue of Provider Registration.
Sources:
- NDIS Guidelines - Will we fund it
- NDIS media release - 1 October 2024
- Section 10 - new legislation changes
- NDIS List (formal)
- NDIS FAQ on recent legislation
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