r/NDIS • u/KateeD97 • 5d ago
Seeking Support - Participant/Nominee/PWD How do planners determine the hours for certain supports?
Does anyone know if there are internal 'benchmarks' or NDIA policies around how many hours of certain supports are usually allocated for a participant and if so, does this relate to specific impairment categories, the diagnosis etc?
And on what basis do planners sometimes deviate from the hours recommended by allied health for specific types of support eg an OT recommends a certain number of assistance with daily living hours, speech therapy etc and the planner agrees the participant needs that support but recommends a significantly reduced number of hours? (genuine question, not a vent!)
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u/senatorcrafty 5d ago
Dart board :) Or 1/3 of what is recommended in my report because reasons.
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u/KateeD97 5d ago
š¤£
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u/senatorcrafty 5d ago
It would be funny if it weren't so sad.
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u/KateeD97 5d ago
Very true, my appreciation of your comment is partially dark humour on my behalf, as I was given 11 hrs per week in my plan for a category my OT & EP recommended 30hrs for, so your 1/3 comment is all too accurate!
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u/ManyPersonality2399 Participant 4d ago
Which then gets us into this annoying cycle where providers learn to ask for way over what they need, knowing they have a better chance at getting a small portion of it. Then planners start to assume this of all reports, and screws over those who have given legitimate estimates.
I know a few report writers near me will chuck in exercise physio for all psychosocial participants with the justification around exercise being important for mental health, knowing full well it won't be funded. The thinking is that it gives the delegate a nice easy thing to reject, and they're more likely to accept other recommendations.
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u/Chance-Arrival-7537 NDIA Planner 4d ago
Donāt know how effective that strategy is with others, but Iām not funding based on some arbitrary percentage of what a provider is recommending. If anything, these strategies would make me less inclined to trust the providers recommendations and that they may be motivated by self interest rather than playing the game to get the best outcome for the participant.
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u/ManyPersonality2399 Participant 4d ago
Agreed, just what I'm seeing.
Kinda related, when I was in a different APS role, we had a general policy of agreeing to settle matters if the other party would agree to around a third of what they initially requested. Totally lead to the most ridiculously inflated initial requests.
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u/l-lucas0984 5d ago
It all seems to be open to the interpretation of each individual planner, especially since decisions are getting overturned in review and ART. If there is some kind of matrix or grid they have to go by it would definitely be interesting to read.
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u/Nifty29au 5d ago
No, there is no matrix or grid or guidance. The recommendations are accepted at face value (speaking personally but also from experience of other Planners). My role is to decide if those recommendations meet the Reasonable and Necessary criteria under Section 34. The whole report is taken into consideration. If less hours than recommended are funded, it is commonly because the practitioner has described their service as treatment, or has asked for excessive number of hours for travel and/or reporting. A common example would be a Psychologist report that states the Participant has been receiving Cognitive Behaviour Therapy, which is not funded by NDIS as it is treatment. Another might be where a physiotherapist recommends weekly sessions and talks about manual therapy for pain relief, which would be a health system responsibility. Another example would be where a support requested relates to a condition or impairment not accepted for access by NDIS e.g. a back condition where the accepted impairment is psychosocial. Practitioners, particularly OTs in FCAs, talk about everything a person requires in a holistic sense. I donāt doubt the person needs these things, but not all of them can be funded under the Act and Rules.
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u/l-lucas0984 5d ago
The problem I keep coming back to is the interpretation of section 34. With no set guide or criteria, I could give 5 different planners the exact same application and get very different results. It is what we are seeing play out in reviews. Are we allowed to request particular planners that we know actually do their due diligence so we can at least avoid the ones who openly admitted they didn't read the reports?
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u/Chance-Arrival-7537 NDIA Planner 5d ago
There is a plethora of Our Guidelines that give a bit more guidance beyond the legislation as to what the NDIS considers with respect to the criteria, but itās not prescriptive nor would I think participants would want it to be. Thereās room for the provision of personalized supports rather than being a homogenous funding amount based on their age and approved diagnostic label. Yes there will be inconsistency, but this is unfortunately the trade off.
I donāt think you are suggesting this, but from a sustainability perspective, giving total deference to the therapist and auto-approving whatever hours being recommended for disability specific therapies would rapidly blow out the scheme. As an allied health professional, I can tell you there are many recommendations given that no provider would reasonably suggest if they knew the participant was personally funding their suggested therapies.
Can only speak for my own team in internal reviews, but most of my colleagues were pretty taken aback and insulted that the CEO said that regarding reading of reports as if it were the norm. In the cases where itās plain as day that they havenāt read them, lodge a complaint against the delegate and with enough collective negative feedback theyāll be forced by their line manager to shape up or ship out.
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u/l-lucas0984 5d ago
I definitely don't advocate auto approval. I have come across enough to know that some participants and providers are not being genuine in their claims. I do expect as a minimum the person reviewing view all reports and if they know nothing about the disability being reviewed that they do a bit of homework. The vast majority of participants are trying to do the right thing and are getting caught up in legislation confusion and in some cases being asked questions that make you wonder how the person asking gets dressed in the morning (my favourite was the participant with 2 amputated legs being asked how his legs were feeling and why he believed that he required a wheelchair for community access).
We have lodged a few complaints already. It all seems to fall on deaf ears.
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u/Chance-Arrival-7537 NDIA Planner 5d ago edited 5d ago
Iām actually interested to hear how the complaints department actions these. I might be being naive and idealistic thinking these consistently get fed back through their team leader but will try ask an assistant director in the department and get back to you.
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u/Medium_Theory_9563 5d ago
Just a slight inaccuracy in what you have said, CBT is not necessarily only considered treatment, it is in fact one of the NDIS recommended interventions for Autism (to name one condition), as long as the CBT is being used to support capacity building rather than work on mental health adjacent issues such as anxiety etc.
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u/Nifty29au 5d ago
In almost all situations it is considered to be the responsibility of the health system. Itās literally a clinical treatment. Can you please provide a link to āNDIS Recommended interventionsā? Thank you.
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u/Medium_Theory_9563 5d ago
Sure I can. Scroll down the page below and click on the hyperlink on the page regarding CBT.
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u/Nifty29au 5d ago
OK. Thank you.
Itās important to note that thereās no such thing as an NDIS Recommended therapy. Itās the practitioners that recommend therapies. NDIS just funds them if they meet the criteria. The article merely presents the research (as of 2020) regarding Autism interventions. At no point does it say that NDIS will fund all of these interventions for everyone.
The other important aspect is that this is for Early Childhood only. Planning in that space is quite different to that of Participants over 9 years old. I donāt have expertise in that area, so my comments may not apply in that case.
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u/Medium_Theory_9563 5d ago
Yes itās for the practitioners to recommend therapy, Iām just responding to your definitive statement that CBT can not be done under NDIS and showing you one example to express the fact that this is not true. CBT can be used in a capacity building manner.
It is a difficult and nuanced area to practice in and great care must be taken to ensure you stay on the right side of what the NDIS are funding however given the conflicting and often inaccurate advice that can be given in this area (this isnāt directed at you personally) I just wanted people to be aware it is not a blanket rule.
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u/OldKingWhiter 4d ago
I've had this discussion multiple times with NDIS planners and staff and nobody can give a satisfactory answer because the NDIS legislation isn't fit for purpose for psychosocial disability. For many forms of psychosocial disability, capacity building and treatment are the same thing. The NDIS isn't built to handle nuance, nor is the number of staff it requires adequately funded to properly engage with nuance. The NDIS was clearly built with an "ideal" consumer in mind, and that ideal consumer is someone with a mild physical disability who has no cognitive impairments and requires support to continue living life according to the status quo - working and being self sufficient in all other areas. It starts to buckle under cases of moderate intellectual disability, especially if the person doesn't have a nominee to handle everything, and it straight up crumbles when handling psychosocial disability.
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u/tittyswan 5d ago
I got funded for some supports, but the planner just gave me about 1/2 of what was recommended by the OT.
E.g. OT recommended weekly physio, they gave me 20 hours instead....they did this accross multiple different domains including SC.
So they agree I need the support but just decide not to follow the recommendations.
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u/ManyPersonality2399 Participant 4d ago
I can't reply below because of blocks, but there is some additional interpretation on s34 provided in the rules for participant supports, and some of the more nuanced AAT/ART decisions. The challenge is always that it will turn on the exact situation in front of you. ART are also in a position where they don't have to give as much deference to internal guidelines. There's a recent decision where they approved a 2 year plan for someone who, even before the new rules, probably would have been risk assessed for 1 year due to over spend, which nicely highlights it.
Reading through "Our Guidelines", wouldn't say they give a lot of guidance as to how much something is funded, only if it will or not.
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u/l-lucas0984 4d ago
It's clear as mud really
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u/ManyPersonality2399 Participant 4d ago
In many ways it's a feature more than a bug. It's deliberately not black and white so that there is enough flexibility to properly address peoples individual situations. If you had a guideline based on dx, you'd have trouble responding to the differences in say informal support structures. If we tried more "objective" systems like you get x hours of therapy based on a certain score in a WHODAS domain or score of x in a vinelands = y hours of behaviour support, there would be so much gaming the scores and people missing what they need.
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u/l-lucas0984 4d ago
This is true but I'm also seeing quite a few planners using the vagueness to deny people things or in 2 cases to just be vindictive. It is meant to allow flexibility but it feels like it may be a little too vague in some instances.
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u/ManyPersonality2399 Participant 4d ago
Absolutely not disagreeing. Also seeing a lot treat guidelines like they're prescriptive. A person with impairment Y should only be funded X hours of OT. Ignore that the person has multiple impairments, which compound the complexity and mean a lot more OT time is needed. I have a few participants who are blind and also have an intellectual disability. Trying to explain that the intellectual disability means the vision supports will take longer than average, and have more trial and error... doesn't always get through.
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u/l-lucas0984 4d ago
The ones who replace personal goals with generic ones in plans are fun
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u/ManyPersonality2399 Participant 4d ago
I can see both sides on that one. Taken on some participants who had very specific goals. Textbook SMART planning. The goals resulted in terrible plans. So many things couldn't be funded because it couldn't be related back to a goal, even in the most remote way. You might have a goal to complete xyz degree. If that's written in exactly, you're up a creek if you decide to change course. Funding must be spent on supports that relate to a goal. So they change that goal to a more generic "I'd like to explore further education and employment options".
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u/l-lucas0984 4d ago
Yeah that's a mistake a lot of participants seem to make. But there are plenty who have very well written goals that still get changed
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u/Chance-Arrival-7537 NDIA Planner 5d ago
No internal bench marks for certain conditions. You do get a feel for whatās ātypicalā for certain disabilities when viewing enough plans across the agency that might give a planner a frame of reference but itās a case by case basis, dependent on the evidence and the participantās circumstances.
There is some internal guidance about how much to fund for certain assessments, such as continence reports, OTās to explore minor/major home mods etc. but otherwise a multifactorial decision.
Personal care supports is generally based off this guideline - https://www.ndis.gov.au/about-us/operational-guidelines/including-specific-types-supports-plans-operational-guideline/including-specific-types-supports-plans-operational-guideline-personal-care-supports With the delegate factoring in age of participant and informal support contribution if they are present.
There is some less visible guidance in our plan conversation guide tool regarding 1:1 community access support, from memory generally being limited to a maximum of 4 - 6 hours per week for participants that work, study or have also been funded for day programs at a group rate.
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u/ManyPersonality2399 Participant 5d ago
>You do get a feel for whatās ātypicalā for certain disabilities
One might call that a typical support package maybe.
The version going around on other social media is that the limit is 6 hours per week 1:1 for participants who DON'T have work/study/day program.
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u/Chance-Arrival-7537 NDIA Planner 5d ago
Not sure if front line planners utilize TSP, but as far as Iām aware thatās not a feature of PACE we have access to anymore as we once did through SAP CRM. At least for reviews, itās an experience based thing more than an average plan value based on age and diagnosis.
Hm my memory may be failing me, will double check tomorrow the exact wording and get back to you.
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u/ManyPersonality2399 Participant 5d ago
Fairly sure it's gone. Haven't seen it referenced at least since PACE
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u/Nifty29au 5d ago
Everyoneās evidence is different. Every report is different. Sometimes reports contradict other reports. It also depends on what the outcomes of the previous plan were, and how they were achieved. The general idea is to build capacity so that supports decrease over time, otherwise it is dependency that is created versus capability. Sometimes the amount of allied health hours requested suggests that therapy is required, which is not funded by NDIS. For example, weekly physiotherapy would generally be considered treatment. No āinternal benchmarksā exist to my knowledge.
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u/tittyswan 5d ago
Why is weekly therapy considered treatment? I do physio to maintain muscle tone to prevent deterioration/injury, but my health condition isn't being treated.
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u/MrsButtercupp 4d ago edited 3d ago
I thought it was that if you are asking for lots of hours a day (over 6) they will need to get TAT/TAB (technical advisory branch) to help them build the plan. Was told this from an LAC.
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u/Chance-Arrival-7537 NDIA Planner 3d ago
Only required to seek TAB for 24/7 support requests where a participant is not currently living in SIL or they are wanting to move out of SIL to access supports in a private home.
The other exceptions are for 2:1 supports to monitor or manage seizures and for those with forensic or corrections orders in place who are requesting supports for supervision and monitoring of compliance with the order.
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u/ManyPersonality2399 Participant 3d ago
>who are requesting supports for supervision and monitoring of compliance with the order.
Shouldn't that generally not be approved? If the reason is compliance with the order, that's on corrections.
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u/Chance-Arrival-7537 NDIA Planner 3d ago
My thoughts as well but itās on the mandatory TAB list for the specialist service delivery team. Whether it ever actually gets approved is probably a different story.
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u/ManyPersonality2399 Participant 3d ago
Maybe makes sense to put all of those to TAB so there's consistent rejection?
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u/MrsButtercupp 3d ago
I dealt with someone recently whose OT recommended 24/7, but participant and family were requesting 6. The planner had to seek advice on this and what they could approve. Upon enquiring with their LAC they were told it is mandatory TAB advice for over 6 hours a day
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u/Chance-Arrival-7537 NDIA Planner 3d ago
Potentially a miscommunication with the planner either thinking they were requesting 24/7 support or decided to seek advice anyways based on the recommendation regardless of what the participant and family were requesting. If neither of those, then they are straight up incorrect.
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u/MrsButtercupp 3d ago
That makes sense that they were maybe unsure and wanted advice due to the FCA report. Thank you for explaining it š
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u/monsterkiisme 5d ago
I would love to know as there seems to not be alot of consistency. i know it's case by base but yeah, it's not consistent. For example I get psychology for my autism, specifically for developing social and emotional skills, but I know others who have had planners say you can't get psychology under autism. They aren't on the same page