For many people, the National Disability Insurance Scheme (NDIS) provides vital access to funding and support. However, the process can feel a bit overwhelming at first. Here we cover some of the key steps in the NDIS pathway to help you navigate your way through the system.
What is the NDIS?
The NDIS is a government scheme that provides funds for people aged 0-65 years with a ‘permanent and significant disability’. These funds allow them to access the services and supports they need. The NDIS is available all over Australia.
NDIS participants are able to access health services (such as Speech Pathology, Psychology, Physiotherapy and Occupational Therapy) with no out-of-pocket expenses. Some NDIS participants can also receive funding for other things, such as support workers to help them participate in the community, and assistive equipment to help them with mobility and communication.
The NDIS is broken up into two categories:
- NDIS Early Childhood Approach – this category is for children under 7. If this category applies to you or your child, your NDIS point of contact will be an Early Childhood Coordinator at a local Partner in The Community (PiTC).
- NDIS – this is the general category for people aged 7 to 65. If this category applies to you or a loved one, your NDIS point of contact will be a Local Area Coordinator (LAC) at a local Partner in The Community (PiTC).
How do I access the NDIS?
Before thinking about accessing the NDIS, you need to answer a few questions to see if you may be eligible to apply. You can find the checklist by clicking here. It is important to note that these questions will guide you as to whether you may be eligible or not. Final eligibility decisions are made by the National Disability Insurance Agency (NDIA).
Once you have determined that you may be eligible to access the NDIS, you can request to become a participant by filling out the Access Request Form here.
Is my young child eligible for NDIS funding for Speech Pathology?
If your child is younger than 7, their NDIS pathway will look different. Please refer to our specific Early Childhood Approach handout for more information.
Am I eligible for NDIS funding for Speech Pathology?
When you become a participant of the NDIS, you will write a plan with your LAC. This plan will specify the supports that will best assist you in working towards your NDIS goals. Your goals will determine the types of supports you are eligible for. Speech Pathology services come out of what is called a ‘Capacity Building’ budget. This is the budget that pays for Allied Health Services such as Speech Pathology, Occupational Therapy, Psychology and Physiotherapy. The amount of funding you receive in this budget will determine how frequently you can access Allied Health Supports.
Let’s look at an example:
- If a participant receives a Capacity Building budget of $7759.60 in a 12-month plan, they will need to think about how they would like to spend this in order to best support them.
- They will first need to work out how many hours of supports they have available to them, by dividing the total budget by the NDIS hourly rate for Allied Health, which is $193.99. We can now see that the participant has 40 hours available.
- This participant would like to see a Speech Pathologist to support their communication. This means they could see a Speech Pathologist once a fortnight for the whole year (26 hours), while still allowing a few hours for the Speech Pathologist to write the necessary reports. This will still leave 10 – 12 hours for them to see other Allied Health Professionals too, such as a Psychologist or Occupational Therapist.
I’ve got my NDIS plan. Now what?
Once you have received your plan, you have the choice and control to use the funds however it will benefit you the most. The way your funds are managed (Self-Managed, Plan Managed or Agency Managed) will determine the way you can access the services and supports you need
If you are Self-Managed or Plan Managed, you are able to access registered and non-registered NDIS providers. This gives you greater choice about which qualified clinicians you would like to see. You may also have other supports in your plan such as Support Coordination, in-home support, assistive technology and equipment, and consumables to purchase low-cost items to help with your goals. If you have any questions about this, it is best to ask your assigned or LAC.
What do I have to do for my plan review?
- Prepare your reports – A few months before your plan is going to expire, you are required to ask for progress reports from the services and supports you have been accessing with NDIS funds. Allied Health clinicians will be aware of the format and what needs to be included in the report.The report will outline the progress you have made, how you have worked towards your NDIS goals and recommendations for the next plan. It is important that you askfor these reports prior to your plan review appointment, as it can take clinicians a few weeks to prepare the report.
- Attend your plan review meeting – When your plan is due to expire, you will be contacted by your LAC to book in a ‘Plan Review Meeting’. In this plan review meeting, the LAC will discuss with you: your current functional capabilities, how you have been working towards your goals and if there are any goals you would like to change, remove or add. The LAC will ask you to send your progress reports through to them prior to the meeting to ensure they have an understanding of your capacity and what may need to be included in your next plan.
- Start your new plan – Once the meeting is completed, the LAC will build your new NDIS plan and it will be submitted to the NDIA. The NDIA will review your plan and either approve the supports that have been requested by the LAC or modify the plan to fit within the criteria. The criteria is that the requested supports must be deemed ‘reasonable and necessary’ for that particular person. You will then receive your new plan and it is ready to be utilised.
What happens if I do not receive the funding or supports I need to achieve my goals?
When you receive your next NDIS plan, it sometimes won’t include all the supports you were expecting or feel you need to have in order to reach your goals. The best way to understand why this is the case is to speak with your LAC. Your LAC can talk you through why you received reduced, different or no funding for certain supports in that area of your plan. If you are still not happy with your plan, you can request a plan review. This is facilitated by your LAC.
What happens if my plan expires prior to receiving my new plan?
Sometimes the NDIA is backlogged with approving plans. If your plan expires prior to your new plan being approved, your current plan will go into ‘auto-extension’. Auto-extension means that your plan will be duplicated and rolled over until your new plan is approved. This means that, even if you had utilised all of your allocated funds on the current plan, you will be able to continue to access funds from the day after expiry with no interruption to your supports.
It is important to note that, once your new plan is approved, all unused auto-extension funds will be overwritten and your new plan will start fresh.
For more information about the NDIS for children under 7, please ask to see our handout on the Early Childhood Approach.
