In October 2024, the National Disability Insurance Scheme (NDIS) introduced significant reforms to its funding policies. These changes include clear lists specifying which supports are eligible for funding and which are excluded. The Government have brought the reforms in aiming to enhance clarity for participants and providers while also ensuring the scheme’s longevity.
Transitional Rules:
For participants with plans approved before October 3, 2024, two key transitional rules apply:
- Existing Stated Supports: If a support is explicitly stated in the plan, it can continue to be funded—even if it now appears on the excluded list. However, there is some confusion regarding whether this applies to supports described in the plan but not explicitly labelled as stated. Some participants have reported that plan managers have been refusing invoices based on the new rules despite it being described in the plan.
- Tribunal-Approved Supports: If the Administrative Appeals Tribunal (AAT) has previously approved funding for a support, the NDIS will continue to recognize it, even if it has since been excluded.
Additionally, the National Disability Insurance Agency (NDIA) have assured participants that they will not enforce compliance actions for minor mistakes for 12 months. Specifically:
- The NDIS will not raise debts for prohibited supports costing less than $1,500.
- Participants will receive at least two warnings before compliance action is taken for supports under $1,500.
Plan Managers were also exempt from compliance actions for a period of 30 days, which has now elapsed.
Understanding the New NDIS Support Lists
The updated NDIS guidelines categorize supports into two primary lists:
- Approved Supports List
- This includes services, equipment, and items deemed reasonable and necessary by the government for a participant’s disability.
- There are 36 categories, covering items such as mobility aids, assistance animals, hearing aids, and SDA.
- Excluded Supports List
- This specifies supports that NDIS funds cannot be used for, divided into 15 categories.
- Exclusions include alternative therapies, personal mobility devices, sex work, and life coaching.
- Some exclusions may disproportionately affect participants, such as not allowing memberships to Gyms or clubs as part of a participant’s physiotherapy homework.
The exclusions also raise concerns about and dignity. For example, excluding wigs disregards the needs of participants who experience hair loss due to disability-related conditions. Crucially, even if a support appears on the Approved list, it cannot be funded if it is also on the Excluded list.
The NDIS have also outlined a replacement list that are not NDIS supports but may be considered a replacement of supports. Currently, there are only two categories of replacement supports, assistive technology and consumables. An example of a replacement support is a tablet that is used by the participant to communicate.
Impact on Participants
For NDIS participants, these changes mean they must carefully review the lists and ensure they are not sourcing supports on the exclusion list. While the NDIS has stated that participants can continue receiving funding for excluded supports until their current plan ends, some are already facing difficulties with reimbursement due to confusion among plan managers, support coordinators, and within the NDIS itself.
Public feedback of the draft NDIS lists was limited to a short 19 day consultation period, yet the NDIS received over 7,000 responses. This overwhelming response highlights the concern within the disability community about the impact of the reforms.
Under the new legislation, the definition of a NDIS support carries significant implications:
- People applying for the NDIS must demonstrate a clear need for a NDIS support.
- Non-NDIS supports will not be funded unless specifically approved through the replacement process.
- Flexible funding can no longer be used for non-NDIS supports without NDIA approval.
- Spending on non-NDIS supports without authorisation could lead to compliance action.
Participants who require excluded supports will need to apply for a replacement and prove eligibility based on strict criteria. You must already be on the NDIS scheme to apply for a replacement support.
Applying for a replacement support
When a participant applies for a replacement support, they need to tell the NDIS what it is, how much it costs, what’s being replaced and how it will work better or the same as the support it’s replacing. The replacement support needs to be on the approved supports list or replacement list.
There’s no need for reports or additional assessments to back up the claim, however the NDIA does not allow participants to appeal the decision if it is not approved. When looking at a replacement support, the NDIS considers whether it is safe, whether it costs less or the same as current supports, whether it will help you more effectively or the same as your current supports and whether it’s replacing an existing support in your plan.
The two categories for replacement support are:
- Standard Commercially Available Household Items/Consumables
- Must be necessary due to the participant’s impairment.
- Must increase independence in completing tasks.
- Must reduce or eliminate reliance on a support worker or assistive technology.
- Communication & Accessibility Devices (e.g., Smartwatches, Tablets, Smartphones, Apps)
- Must address communication or accessibility needs related to the participant’s impairment.
Participants need to explain how the support will keep them doing what they are already doing or participate in the community and social activities or help them stay or become more independent.
What the NDIS Funds
What the NDIS funds and doesn’t fund is based on criteria related to disability:
- Relevance: The support must be directly related to the participant’s disability.
- Value for Money: The cost must be reasonable relative to the benefits and alternatives.
- Effectiveness: The support must align with best practices and be beneficial.
- No Duplication: The support cannot be something already funded by other government services (e.g., healthcare, education).
- Not a Daily Living Expense: General living costs, such as rent and groceries, are not covered.
Next Steps for Participants
Participants are strongly encouraged to:
- Review Their Plans: Ensure that all supports align with the new rules.
- Seek Clarification: Consult their plan managers or NDIS representatives about specific concerns.
- Prepare for the Replacement Process: If an essential support is excluded, gather medical reports, allied health assessments, and personal statements to strengthen a future application.
- Explore Alternative Funding Sources: State-based disability services, community grants, and charities may offer financial assistance for excluded supports.
Here’s the list of supports that the NDIS does fund.
Here’s the list of supports that the NDIS doesn’t fund.