Wow! On the back of a bunch of changes with a new pricing list on 1 July we got another one at the beginning of October.
The new list includes a bunch of changes for participation transport that a real gotcha and could leave people in serious debt or with limited options to access community activities. Please talk to your support coordinator and/or plan manager if you have one - they can assist to work through the best options for you. A lot of community and daily activity providers are struggling with these changes too. Its a weird way of doing things. SchemeWise thinks the way transport was charged was OK... but we were really very unhappy with some provider's price gouging. Our view is that the NDIA would have better serviced participants by recognising that community transport is actually 'essential' in most cases and not simply a nice to have. For example, there are VERY FEW accessible transport options readily available... like almost everywhere! This makes provider transport for community access quite a pressing need actually.
With the above in mind, rather than what has been implemented, it would have been better in our view to have price-controlled the transport cost at 78 cents per kilometre (the rate under relevant disability worker awards) just as per most other disability services, therapy travel, etc. All that would have taken is one extra new NDIS item code in the support catalogue. The existing practice of adding daily kilometres within service agreements could have then been used. We know some providers were charging as high as $1.30/km and then only reimbursing their staff at the 78 cent rate - this is a predatory practice toward their workers and participants we are glad to see ended regardless of that ending being harsh toward very vulnerable people. Overall, this seems a little gift horse someone might want to raise it to the Disability Royal Commission in terms of the NDIA probably not getting this issue right... yet?!
As a further alternative, we are seeing almost no providers opting to have their staff move to logbook-based travel reimbursement (keep a log book for a period of three months then claiming 12 months of travel) an option which would allow workers to directly claim 68 cents per kilometre back through the taxation system. Given the capacity to have further considered these options the confused approach of the NDIA... well... makes no real sense for people who often do not have the capacity to understand the more complicated arrangement which has arrived with barely a moments notice. It places the onus on vulnerable end users rather than leveraging market arrangements already available and easily implementable.
Onto other matters...
HEALTH supports are now more broadly available under the NDIS. There has been a pressing need for some of these services and the new role of the NDIA in provision of these supports is welcome news. Specifically its great to see a recognition around diabetes management which can add additional complications across the board especially where diabetes itself is a complication of medications use - like in epilepsy or high level psychosocial disability. Feeding support is a further welcomed option as is dietitian support which has been somewhat contentious for a while now.
Wound care is also clarified and now formally recognised which is another real issue that is helpful to say the least.
Below is a full list of options.... happy reading! SchemeWise nurses can help with a range of these options too. Just reach out for a chat... obligation free of course!
Continence supports
- An NDIS-funded suitably qualified and competent worker to undertake insertion, removal or change of indwelling urethral catheter, suprapubic catheter and/or clean intermittent catheter.
- Training of an NDIS-funded suitably qualified and competent worker to provide catheter maintenance and care.
- Provision of daily catheter maintenance and care by an NDIS-funded suitably qualified and competent worker.
- All continence consumables (for example catheter, bags, pads, bottles, straps).
Diabetic management supports
- Development and periodic review of a diabetic management plan by an NDIS-funded suitably qualified and competent clinician.
- Implementation of a diabetic management plan and daily maintenance and care by an NDIS-funded suitably qualified and competent worker.
- Training of an NDIS-funded suitably qualified and competent worker to implement a diabetic management plan.
Dysphagia supports
- Development and periodic review of a meal time management plan by an NDIS-funded suitably qualified and competent clinician.
- Implementation of a meal time management plan by an NDIS-funded suitably qualified and competent worker.
- Development and periodic review of an oral eating and drinking care plan (OEDCP) by an NDIS-funded suitably qualified and competent clinician.
- Implementation of an oral eating and drinking care plan (OEDCP) by an NDIS-funded suitably qualified and competent worker.
- Training of an NDIS-funded suitably qualified and competent worker to implement the meal time management plan and OEDCP.
- Swallowing therapy associated with dysphagia provided by an NDIS-funded suitably qualified and competent worker.
- Consumables such as thickeners to enable a participant to swallow more easily and reduce their risk of aspiration/choking.
Epilepsy supports
- Training of an NDIS-funded suitably qualified and competent worker to implement the participant’s Epilepsy Management Plan (EMP) and/or Emergency Medication Management Plan (EMMP).
- Epilepsy seizure monitoring by an NDIS-funded suitably qualified and competent worker including the application of assistive technology.
Nutrition supports
- Dietitian consultations and the development and periodic review of a nutritional meal plan by an NDIS-funded suitably qualified and competent clinician.
- Implementation of a nutritional meal plan by an NDIS-funded suitably qualified and competent worker.
- Training of an NDIS-funded suitably qualified and competent worker to implement the nutritional meal plan.
- Percutaneous Endoscopic Gastrostomy (PEG) Stoma Changes (to assist feeding).
- Provision of PEG maintenance and care by a suitably qualified and competent worker.
- Training of an NDIS-funded suitably qualified and competent worker to provide PEG maintenance and care.
- Home Enteral Nutrition (HEN) and (PEG) and equipment and consumables excluding food.
- HEN formula/nutritional supplements (to meet participant’s nutritional needs).
Podiatry supports
- Assessment, development and periodic review of a podiatry care plan by an NDIS-funded suitably qualified and competent clinician.
- Implementation of a podiatry care plan by an NDIS-funded suitably qualified and competent worker.
- Training of an NDIS-funded suitably qualified and competent worker to implement the podiatry care plan and perform any required daily maintenance and care related to the plan.
Respiratory supports
- Development and periodic review of clinical care and daily maintenance of tracheostomy (insertion, removal and change) by an NDIS-funded suitably qualified and competent clinician
- Implementation of daily maintenance of tracheostomy (insertion, removal and change) by an NDIS-funded suitably qualified and competent worker
- Training of an NDIS-funded suitably qualified and competent worker to provide tracheostomy maintenance and care.
- Provision of tracheostomy equipment and consumables.
- Provision of a Constant Positive Airway Pressure machine (CPAP) machine and consumables.
- Provision of a Bilevel Positive Airway Pressure (BIPAP) machine and consumables.
- Provision of a ventilator, air humidifier, portable suction machine and/or cough assist machine and consumables.
- Assistance with the use of all respiratory medical equipment as well as the training of a suitably qualified and competent worker to use the equipment.
Wound and pressure care supports
- Wound care and pressure care (including pressure injury management) by an NDIS-funded suitably qualified and competent worker.
- Wound care and pressure care consumables (e.g. dressings, gauze, bandages, tape, lymphedema garments and pressure wraps).
- Lymphoedema machines as well as assistance with the use of the equipment and the training of an NDIS-funded suitably qualified and competent worker to use the machine.
How can you access these options?
Supporting these services the NDIA has introduced a range of new nursing line items which cover enrolled nurses, registered nurses, more senior registered nurses (known as clinical nurses) nurse consultants and nurse practitioners. SchemeWise can provide registered and clinical nurses for assessment and support activities.
The last 2 nursing options above are somewhat interesting because they essentially only exist as roles within the health system. What this really means is that health services may seek cost recovery from people living with disability whom require high level nursing supports despite the health system usually providing public medicare-based services free of charge. Watch out for such practices and push back people - its your right as an Australian citizen!
