NDIS Support List Changes

Effective from October 3rd, 2024, the National Disability Insurance Scheme (NDIS) introduced new rules that clarify what supports can and cannot be claimed from NDIS Participant plans. These changes aim to enhance consistency and transparency across the scheme, ensuring that funds are used appropriately to meet participants’ needs.

The Role of Plan Managers

Plan Managers play a key role in ensuring these rules are followed and that all claims are compliant with NDIS guidelines. Processing claims that do not meet the new standards could lead to a debt being pursued against the NDIS participant. If the NDIS declines to fund a support that has already been provided, the cost will not be covered, and the provider will need to seek payment directly from the participant’s personal funds.

You can view the list of supports here and read a Q&A about the new rules here.

Key Changes to Understand

One of the significant updates is that items that were previously purchased using a decision tool or letter of support will now be declined. If specific supports are not clearly outlined in an NDIS participant’s plan, they will not be approved for payment. Therefore, it is crucial to ensure that we have a full copy of your plan on file if it includes any particular items. Before making any non-standard purchases, consult with your Local Area Coordinator (LAC), Support Coordinator (SC), or the NDIS for further guidance on 1800 800 110.

What’s Not Allowed Under the New Rules

The following items are now on the “not allowed” list:

• Everyday and Household Items: Clothing, grooming products, kitchen equipment, tools, headphones, laptops, iPads, etc. Limited exceptions apply for replacement supports.
• Pool Maintenance: Including water filtering.
• Toys, Games, and Sensory Items: Generally no longer allowed.
• Massages: Only permitted if provided by a remedial massage therapist and explicitly related to a disability (must be stated in the plan).
• Meals: Unless clearly outlined in the plan, and the preparation and delivery are separated from ingredients.
• Lessons, Memberships, and Activities: Including gym memberships, camps, team sports, etc.
• Educational Camps, Classes, and Tutorials
• Pharmacy Items and Medical Supplies: Unless directly related to the participant’s primary disability.
• Alternative Therapies: Such as equine/animal therapy, yoga, or any other therapies not delivered by a professional from an approved category.
• Subscriptions: Only allowed if directly related to a disability, like a falls monitor stated in the plan.

Therapy Claims

To claim therapy, all therapists must be members of a professional organisation and fit within the suitable registration groups. This ensures that professional accreditation is maintained, and regular audits are conducted to verify compliance. Read more about the therapist guide to suitability here.

If you enable a non-suitable or non-accredited provider to submit invoices, you may be responsible for paying those funds back. We understand that these changes may affect some of the supports you previously enjoyed under your plan, but it is essential to adhere to these guidelines. Please reach out to your LAC, Support Coordinator, or the NDIS for support in finding compliant alternatives.

Steps to Take if You Have a Specific Support Stated in Your Plan

If a support is specifically noted in your plan and we do not have a copy, you will need to provide it for verification before we can process any payments. We cannot advise on how to get specific items approved in your plan. Any invoices submitted after October 3rd, 2024, that are not compliant will be returned to the provider, and a notification will be sent to you, your nominee, or your support coordinator. The invoice will be archived and will not be paid, including those submitted before October 3rd but not yet processed.

Next Steps to Ensure Compliance

1. Cease Non-Compliant Supports: Immediately cease purchasing items that are now on the “not an NDIS support” list.
2. Set Up Invoice Approvals: Ensure you have a process to approve all invoices or designate a trusted person to do this for you.
3. Reach Out for More Information: Contact your LAC, Support Coordinator, or the NDIS for further details on how to navigate these changes.

Moving Forward

We understand that these updates may require adjustments, and we are committed to supporting you throughout this transition. Please ensure that your claims align with the new NDIS rules to avoid any disruptions. If you have questions or need assistance, our team is always here to help guide you.