What does a participant’s planning process involve?

What is the role of a NDIA Planner? 

After a person has been deemed eligible for the scheme by the NDIA they become a “participant” of the NDIS. The participant will then be linked with a NDIA Planner or Local Area Coordinator to develop a plan in relation to the person’s goals[1]. The participant’s first plan is considered to be the beginning of a person’s lifelong relationship with the NDIA. The NDIA will continue to work with the participant to review and update their plan as the person’s needs change over their lifetime.

The NDIA Planner will work with the participant (and where relevant their family and other informal supports) to determine what supports and services will assist the participant to achieve their goals. The NDIA Planner will consider the role that informal supports, including family and friends can adopt, and explore how mainstream services and wider community options can assist the participant to achieve their goals.

Given that people have different goals and have different informal, mainstream and community supports available to them, this means that the supports the NDIS will fund in participants’ plans will be different from one participant to the next. The NDIS will only fund “reasonable and necessary”[2] supports for participants to achieve their goals. Once a participant’s reasonable and necessary supports have been identified they will be built into the participant’s plan.


[1] The definitions of these roles are currently fluid and different models are being trialled. In addition, where the roles are located (i.e. government employees or contracted non-government providers that specialise in planning and support co-ordination, as distinct from provision of specialist disability services) will evolve over time.

What does a person’s first NDIS Plan involve?  

My NDIS Pathway focusses on the development of a participant’s “first plan”. The planning process is based on developing an understanding of the person’s goals and what supports are needed to help the person achieve their goals. Planning meetings are currently being conducted by telephone or in face-to-face meetings.

The NDIS Planner will discuss with the participant how they achieve everyday activities such as getting to work, personal hygiene, shopping, cooking, linking to community activities, etc. This conversation forms the basis of understanding what supports a person needs in relation to their disability to achieve the goals of an ordinary life.

An NDIS plan may also document other supports including informal supports, health services, education, social housing and community activities. For participants who are already receiving supports their first plan is likely to contain the same or similar supports they are currently receiving under state disability programs.

The NDIA will document all supports in a participant’s first plan including the reasonable and necessary supports funded by the NDIS. There will be an individualised budget included in the plan that is directly associated with the NDIS funded supports.  

As a general rule the participant’s first plan will remain in place for 12 months. However it is possible for a review of a plan to be requested at any time if the participant’s circumstances change. Leading up to a plan review it is important that the participant think about what supports and services have worked and not worked in relation to assisting them to achieve their goals. The review is an opportunity to reconsider what would be most helpful in achieving goals or indeed establish new or different goals.

Who can be involved in an NDIA Planning Meeting? 

A participant can choose to include anyone they would like in their planning conversation. It is important to understand that it is a participant’s choice (or guardian/nominee where relevant) who they invite into their planning conversations. The participant has the primary relationship with the NDIA and is in control of their own planning and who they choose to include in this process.

Typical stakeholders might include family members, advocate, a statutory decision-maker, a service provider. A participant can invite their healthcare practitioner (e.g. physician) into a planning meeting if they choose too. While it is considered to be a participant’s choice about who they involve in a planning meeting, there are pragmatic issues that may limit the involvement of some stakeholders. The NDIA provide short notice for planning meetings and many meetings also take place by phone. A physician or other specialist may not be available at short notice to attend a meeting. 

How can a physician or paediatrician contribute to a planning meeting?

There are other ways that physicians and paediatricians can support their patients outside of the planning meeting. A physician can provide information in writing to their patients for the NDIA to consider for eligibility and planning purposes. The medical information the NDIA will be seeking from participants will include information that provides evidence of the person’s disability, functional impairment and the impact on the participant’s day to day life. A physician or paediatrician can provide information about the nature of functional impairment as it relates to their patient’s disability, the type of assistance (e.g. a person, assistive technology, special equipment) and a description of the assistance that the participant will require to support them in this area.

A physician or paediatrician can offer advice to their patients on optimal disability supports to improve and maintain their function, which may include services or products directly related to maintaining their health. Rehabilitation physicians can provide advice to their patients leaving hospital on allied health supports or programs that may help improve or manage their functional disability. Occupational physicians can provide advice to the patient on employment opportunities and modifications that can assist them in an employment setting. A physician can also provide specific advice to their patients around their likely requirements for disability supports that allow for their functional impairments when accessing healthcare (for example, when visiting specialists as an outpatient, attending hospital as an inpatient, general healthy living practices, and education for carers around use of specific health prostheses (eg. percutaneous gastrostomy tubes)). 

What happens once a participant’s plan is approved?

An approved plan triggers the option for support from a Local Area Coordinator or funded Support Coordinator to work with participants to identify the best options for implementing their plan. This might involve identifying suitable specialist disability service providers to deliver the funded supports and mainstream services in the wider community to support the person to achieve the goals in their plan. There are various pathways for implementing a participant’s plan which are in part dependent on what plan management option a participant chooses. 

What are the options for managing NDIS participant plans?

NDIS individualised plans contain a number of elements that need to be managed by someone. There are multiple options available to NDIS participants regarding how they would like to have their NDIS individual plan managed. The following diagram illustrates the four options for plan management[1].

NDIS Plan Management Options

NDIS plan management options

Key responsibilities of self managing NDIS plans include:

  • Choosing preferred service providers
  • Seek an invoice for the service you have purchased
  • Make a claim for the expense to the NDIA
  • Keep appropriate records
  • Pay the service provider
[1] Source – graphic created by National Disability Services based on information from the NDIA Participant Self-Managing Budgets guide

What does self-managing a plan involve?

All participants are encouraged and assisted to direct their own plan but there are several options available for management of the funds allocated to the participant’s plan. If a participant chooses to self-manage any part of their NDIS budget, their key responsibilities include[1]:

  • Selecting and arranging their own preferred services
  • Ensuring they obtain invoices for their services
  • Paying their suppliers of services on time
  • Maintaining appropriate records and receipts for services provided; claims made to the NDIA; and payments to suppliers
  • Reporting to the NDIA on the budget allocation spent on the self-managed items of their NDIS plan.

[1] Source - NDIA Participant Self-Managing Budgets

Can a person access assistance to self-manage their plan?

The NDIA recognise that participants or their nominees may want to consider self-management of the funds but may not have the necessary knowledge and skills to undertake the responsibilities associated with self-management. The NDIA provides opportunity for participants to choose to transition to self-management through funding the support item, self-management capacity building, available under Core Supports. Information on this option is available in the Learning the Skills to self-manage, Your guide to selecting self-management capacity building supports

Under self-management participants can opt to employ their own staff or pay another party to do this on their behalf. A participant can select a combination of approaches and hiring self-employed contractors for some services and a service provider who is registered with the NDIA to deliver other supports or services. When a participant is self-managing they are able to purchase services and supports from suppliers who are not NDIA registered providers. There are a range of employment responsibilities participants need to undertake if they are engaging staff directly. Participants can access information about their responsibilities in the NDIA’s Directing engaging my own staff booklet. 

What if a participant chooses the NDIA to manage their plan?

A participant can choose the NDIA to manage the funding of supports in their plan. If the NDIA manage a participant’s plan, the NDIA will be responsible to pay the suppliers of services on behalf of the participant. The participant or their nominee will still choose their preferred suppliers of services and establish a service agreement with the service providers detailing how and when supports are to be delivered. The participant will need to certify that the services have been delivered in accordance with the service agreement for NDIA to pay the service provider. 

The NDIA will provide the participant with a monthly statement detailing the supports paid by the NDIA on behalf of them. Where the NDIA are undertaking plan management for a participant, the NDIA require that participants choose NDIS registered providers for the supply of supports and services.   

What are the responsibilities for a Plan Management Provider?

A registered plan management provider is an individual or organisation that undertakes the management of the funding of the supports in a participant’s plan. It can be all or some of the supports. This can include some or all of the supports in a plan. Similar to the other forms of plan management, the primary responsibilities for plan management providers involve the financial management of the plan including payments to providers, expense claims processing, monthly statements for participants and making claims from the NDIA. In addition to these standard management practices, a plan management provider is also required to:

  • Build the financial and organisational skills of the participant; and
  • Enhance the participant’s ability to direct their supports and/or develop self-management capabilities.

What options are there for people who require support with decision-making?

A key pillar of the NDIS is to enable people with disability to exercise their agency about matters that affect them. As a general premise the NDIA acknowledge that people with disability have capacity to make decisions that affect their own lives. There is however recognition that there are participants who want support to make decisions. The NDIA Operational Guideline, General Conduct, Supporting Participants’ Decision Making outlines the NDIA’s approach to supporting participants to make their own decisions. Supported decision-making is a person-centred approach and refers to making decisions with the person, not for (or on behalf of) the person.

The intent of supported decision-making is to ensure that a person’s preferences and wishes are being taken into account in the decision-making process.  Supported decision-making is typically relevant for people with cognitive or intellectual disability where it has been determined that the person does not have capacity to make decisions regarding certain areas of their life. The NDIA can provide support for decision-making in a number of ways:

  1. Acknowledging and facilitating the role of families and/or carers in supporting participants to make decisions
  2. Acknowledging and respecting the role of advocates in supporting participants to make decisions 
  3. Supporting the participant to develop the capacity to make their own decisions through the provision of information and resources 

What are the responsibilities of nominees in the NDIS?

The United Nations Convention on the Rights of P​ersons with Disabilities (UNCRPD) promotes the rights of people with disability to make their own decisions wherever possible and to access support to make decisions where necessary. The NDIA are able to appoint nominees under section 86 or 87 of the NDIS Act 2013 to support people to make their own decisions. Where such arrangements are implemented nominees must support the participant wherever possible to make their own decision and to develop the capacity of the participant to make their own decisions. Where a person has a formal guardian appointed the guardian will act as the person’s nominee.

The NDIA advises guardians and nominees that the NDIA planners will support participants to make their own decisions in relation to their supports and choice of service providers.

There are two types of nominees including correspondence and plan nominees. A plan nominee can undertake all activities that a participant would ordinarily undertake including informing the preparation and review of the participant’s plan and/or management of the funding for supports in the participant's plan. A correspondence nominee can undertake all activities that a participant would ordinarily undertake, with the exception of the preparation and review of the participant's plan and the management of the funding for supports in the participant's plan. It is possible for the same person to undertake the different nominee roles. 

What rules apply to nominees to safeguard people with disability?

The National Disability Insurance Scheme (Nominees) Rules 2013 provide detailed information on the responsibilities of plan nominees and information to the NDIA on the considerations and rules of appointing nominees.[1]

The object and principles particularly relevant to the nominee rules include:

Objects

(a)    to enable people with disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports;

Principles

(b)    people with disability should be supported to exercise choice, including in relation to taking reasonable risks, in the pursuit of their goals and the planning and delivery of their supports;

(c)    people with disability have the same right as other members of Australian society to be able to determine their own best interests, including the right to exercise choice and control, and to engage as equal partners in decisions that will affect their lives, to the full extent of their capacity;

(d)    people with disability should be supported in all their dealings and communications with the Agency so that their capacity to exercise choice and control is maximised in a way that is appropriate to their circumstances and cultural needs;

(e)    the role of families, carers and other significant persons in the lives of people with disability is to be acknowledged and respected;

(f)     where acts or things are done on behalf of persons with disability:

(i)      they should be involved in decision-making that affects them, including making decisions for themselves, to the extent possible;

(ii)     they should be encouraged to engage in the life of the community;

(iii)     the judgements and decisions they would have made for themselves should be taken into account;

(iv)    their cultural and linguistic circumstances, and gender, should be taken into account; and

(v)     their supportive relationships, friendships and connections with others should be recognised.[2]

A plan nominee is able to act on behalf of a participant where the participant is not capable of undertaking the action or being supported to undertake the action. The nominee can also undertake the action where the participant does not want to undertake the action themselves.

A nominee has a duty to consult with other appointed nominees and decision-makers in a participant’s life including court-appointed decision-makers or participant-appointed decision-makers and carers who manage the day to day activities and make decisions. 

Part 6 of the NDIS Nominee Rules provides for the conditions under which the NDIA can suspend or cancel the appointment of a nominee.

Where the participant is a child the National Disability Insurance Scheme (Children) Rules 2013 provide the processes for decision-making. Typically decision-making for children will reside with those who hold parental responsibility.

[1] Source - NDIA What are nominees and guardians

[2] Source - National Disability Insurance Scheme (Nominees) Rules 2013

Can a physician be appointed as a participant’s nominee?

Section 88(4) of the NDIS Act, rs.4.4 and 4.8 of the Nominees Rules provides specific information about who can and cannot be appointed as a participant’s nominee. Generally speaking a person who has parental responsibility for a child is a preferred nominee. If a participant has a court-appointed decision-maker and the powers and responsibilities of this role are similar to those of a nominee, it is likely that this person would be appointed as the nominee. [1]

The NDIA cannot appoint the following persons as nominees:

  1. a person under 18 years of age
  2. the NDIA 
  3. any person formally associated with the NDIA.

Section 88(5) of the NDIS Act, rs. 5.12 and 5.13 of the Nominees Rules specifies that a nominee has a duty to avoid or manage conflicts of interest. Specifically, 5.12 of the Nominee Rules obliges a nominee to avoid or manage any conflict of interest in relation to the nominee and the participant and inform the NDIA CEO of any conflict of interest as it arises. Section 88(5) rs. 5.13 indicates that it would be a conflict of interest for a person’s treating physician to be appointed as their nominee, stating that [w]ithout limiting paragraph 5.12, a conflict arises if the nominee is, in a professional or administrative capacity, directly or indirectly responsible for, or involved in, the provision of any services for fee or reward to the participant.[2]

[​1] Source – Section 88(5), rs.4.4 and 4.8 National Disability Insurance Scheme (Nominees) Rules 2013
[​2] Source – Section 88(5), rs.5.12 and 5.13 of National Disability Insurance Scheme (Nominees) Rules 2013

What choice and control does a person have over their funded supports?

Participants have choice and the control over how funded supports are used in their plan. This includes choice of how the supports are given and which service providers are used to provide the supports.

In some cases the NDIA or others will manage the funding for these supports. For example, where there is an unreasonable risk to a participant.

What if a participant doesn’t agree with the decision about the supports in their plan?

Mechanisms for internal review of decisions made by the NDIA are available to participants. If participants remain unsatisfied following an internal review they are able to access an external review through the NDIS appeals process.  

What is the principle of 'no disadvantage'?

Governments made a commitment through the Intergovernmental Agreement for the NDIS Launch (IGA) that if a person was receiving supports before becoming a participant in the NDIS they should not be disadvantaged by their transition to the NDIS.

This commitment is in place to ensure that participants in the NDIS are able to achieve at least the same outcomes under the NDIS as they have been able to with their previous services. This commitment does not mean that a participant will always have the same amount of funding or supports provided in the same way. A participant will have access to reasonable and necessary supports consistent with the NDIS Act.

Where the NDIS does not fund a support a person had previously received under another program, the NDIA will seek to identify alternative supports or refer the person to other systems with a view to ensuring they are able to achieve substantially the same outcomes as a participant in the NDIS.

Close overlay