NDIS bows to pressure, funds health services

Since before the National Disability Insurance Scheme had even come into existence, Australia’s State and Federal governments have been locked in an uneasy game of Chicken. That game may now becoming to an end.


Pineapples wearing party hats celebrating the political break through!

In a communique posted on the Federal government’s Department of Social Services website it was announced the National Disability Insurance Agency (the organisation responsible for administering the NDIS) would now fund some of what it had previously deemed ‘health-related’ services.



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People with Disability on the Brink

The fight between State and Federal government’s over what the NDIS would and would not fund has been a battle of brinksmanship that has left People with Disability on the brink.

Transition to the NDIS has required a shift of both funding and responsibilities between State and Federal governments. With billions of dollars on the line, all sides have been working to maximise their revenues and minimise their costs.

One major battle ground for the State and Federal governments has been the murky line between ‘health-related’ services and ‘disability-related’ supports. In Australia’s system of three tiered system of government, Health services are largely the domain of the States.

As such, the States would ideally like to see the NDIS be generous in its definition of supports it funds. This would include supports they may be considered overlapping with the domain of health.

Diagram demonstrating the link between health and disability related supports.

By contrast, the Federal Government and by extension the NDIA would prefer to seek a conservative interpretation of what services and products are considered disability-related. This would then see NDIS participants still reliant on the States funded health services (or private services paid for by the participant or their private insurer) for any supports considered ‘health-related’.


A big step forward

With this announcement, the NDIA has made a big step towards a more generous interpretation of disability-related supports or as the agency calls them ‘disability-related health supports’. The agency notes in its statement:

NDIS participants may need regular and ongoing disability-related health supports as a regular part of their life to support them to undertake activities of daily living.


What’s covered?

Under the new rules, the statement provides that the NDIA will now cover the following ‘disability-related health supports’:

SupportCovered
Dysphagia Supports• Development of oral eating and drinking care plans (OEDCP)
• Swallowing therapy associated with dysphagia provided by an allied health professional
Diabetic Management Supports• Development of diabetic management plan
• Daily maintenance and care associated with
diabetic management plan (where participant is unable to self-manage due to their disability)
Continence Supports• Catheter changes
• Cleaning of catheters 
• Consumables
• Assessments, plans and reviews
Wound and Pressure Care Supports•  Wound care consumables (e.g. dressings)
•  Lymphoedema machines
•  Lymphoedema garments
Respiratory Supports•  Tracheostomy changes
•  Tracheostomy clinical management
•  Tracheostomy equipment and consumables
•  Constant Positive Airway Pressure (CPAP)
machine and consumables
•  Bi-level Positive Airway Pressure (BiPAP)
machine and consumables
•  Air humidifier
•  Portable suction machine
•  Cough assist machine
•  Ventilator
Nutrition Supports•  Percutaneous Endoscopic Gastrostomy (PEG) and HEN equipment (or similar) and consumables, excluding Food Formula
•  Thickeners and nutritional supplements
•  PEG stoma changes
•  Dietetic consultations
•  Development of nutritional meal plans
•  Development of meal time management plans
Podiatry and Foot Care Supports• Podiatry diagnosis and assessment and development of podiatry care plan
Epilepsy Supports•  Epilepsy seizure monitoring
•  Epilepsy monitoring through assistive
technology

War is over?

While this is a huge step forward in putting people before politics, the somewhat awkward language of the communique demonstrates that this is not the end of the debate. While the above ‘disability-related health supports’ will be covered by the NDIS under this new interpretation, the NDIA is also explicit that it will not cover health-related supports.

Amongst the Agency’s list of things it won’t cover are things that are covered by the Pharmaceutical Benefits Scheme (PBS), acute illness or injury and services from doctors or medical specialists.


When does it start?

The new rules inclusive of ‘disability-related health supports’ are currently scheduled to come into effect from October 1st, 2019. The communique implies that these ‘disability-related health services’ will be available to all NDIS participants, however it might be wise to expect the NDIA to roll this back to new plans and/or renewals when the Agency gets nervous about the cost as we get closer to that date.


Insiders can read the communique in full here

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