Are your services on the 'out' list?
Recent updates to the NDIS legislation have redefined which services are eligible for funding, leaving some supports on the 'EXCLUSION' list. These changes are aimed at tightening compliance and ensuring that funding is used appropriately.
Here’s what you need to know as a provider:
1. Clarified Funding Criteria
The recent NDIS changes have refined the criteria for what qualifies as an NDIS-funded support. Services must now clearly address participants' disability-related needs and contribute directly to their functional improvement or daily living. If a service is deemed to be outside the core purpose of disability support—such as general lifestyle or wellness activities not directly linked to a participant's disability—it may no longer qualify for funding.
To stay compliant, providers should:
- Review the Latest NDIS Guidelines: Regularly assess your service offerings to ensure they meet the updated eligibility criteria. This may involve discontinuing services that aren't primarily focused on addressing disability-related goals.
- Match Services with Participant Goals: Ensure each service aligns with the goals outlined in the participant’s NDIS plan. Funding is more likely to be approved for supports that directly contribute to achieving these specified outcomes.
- Be Cautious with Add-On Services: Add-on or supplementary services may no longer be eligible for NDIS funding if they do not clearly relate to a participant's disability. For instance, recreational or social activities that lack a therapeutic component might fall outside the funding scope.
Providers should double-check if their services meet the clarified criteria by consulting the latest NDIS Price Guide and supporting documents. Being proactive in understanding the new regulations will help avoid rejections, reduce compliance risks, and maintain a smooth claiming process.
For further details on the changes, visit the NDIS website.
2. Excluded Supports
The recent NDIS changes emphasize funding only for services that clearly support participants' disability-related needs. Services considered non-essential or lacking a direct therapeutic benefit may no longer be eligible. This includes:
- Non-Therapeutic Wellness Activities: Services like general fitness classes, meditation, or massage that don't address a specific disability need or therapeutic goal may not qualify for funding.
- Lifestyle or Recreational Activities: Social outings, hobby classes, or entertainment-focused activities that don't have a functional or developmental component related to the participant's disability are generally excluded.
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Animal therapy: Animal "therapy" rendered by someone who is not qualified or trained as an allied health professional.
P.s I never knew goat therapy existed! - Alternative Therapies Without Proven Disability Benefits: Certain alternative therapies (e.g., aromatherapy or unregulated health treatments) that aren't widely recognized as effective disability interventions may be ineligible for funding.
To ensure compliance, providers should verify that their services have a clear and documented disability-related purpose, contributing directly to a participant's goals and outcomes. Each service should be aligned with NDIS plan goals, with detailed documentation justifying its inclusion as a necessary support.
Staying up to date with the latest guidelines and consulting the NDIS Price Guide can help avoid providing services that fall outside funding eligibility.
3. Service Code Accuracy
Using the correct NDIS support codes is crucial when billing for approved services, as these codes classify the type of support provided and determine the eligibility for funding. Inaccurate or outdated codes can lead to claim rejections, payment delays, or audits. To avoid these issues:
- Regularly Update Your Knowledge of Codes: The NDIS updates support codes periodically. Stay informed about changes by frequently reviewing the NDIS Price Guide and Support Catalogue.
- Match Codes to Service Descriptions: Ensure that each code accurately reflects the service delivered. The description in your invoice should align with the NDIS support code used, specifying the type of service and its connection to the participant's plan goals.
- Avoid Generic or Inaccurate Coding: Using vague or catch-all codes can trigger claim rejections. Be specific with codes to demonstrate the service's relevance to disability-related support.
Accurate coding not only facilitates timely payment but also ensures compliance with NDIS requirements, reducing the risk of errors or disputes. Regular audits of your coding practices can help identify any discrepancies and maintain adherence to the latest guidelines.
4. Stay Informed on Updates
The NDIS is continually evolving. Regularly review any legislative changes and updates to the Price Guide to ensure compliance.
For a detailed list of excluded services, visit the NDIS website or consult the latest NDIS Price Guide.
Avoid 'Nonpayment' surprises by keeping your service offerings aligned with current NDIS requirements to ensure funding continuity.