What are the rules for billing additional public holiday supports for SIL?

For example, Customer A wants to go to an event on a public holiday by himself. His usual supports are shared at a 1:3 ratio, so in his Roster of Care (ROC), the regular SIL value for public holiday supports is not enough to cover 1:1 on a public holiday.

What are our options here?

Should this be:

• non billable as covered under regular SIL
• billable as irregular
• billable as CP
• something else?

Thank you for your enquiry. Your options are:

1. Claim it as 1:1 Community Participation (if he has the funds and you have a service agreement for these services), because this is a support provided outside of the SIL environment.
2. Claim it as irregular SIL (if he has the funds).
3. Not claim it and absorb the difference in costs.

To claim for Irregular SIL Supports, you need to make sure all conditions that are outlined in the Pricing Arrangement and Price Limits document are met.

Irregular SIL Supports are intermittent or unplanned events that disrupt supports planned for in the SIL plan budget. For example, Irregular SIL Supports would be required when participants are at home and require SIL supports for a period that was not initially planned and rostered for, such as when they fall ill or their day program is cancelled.

Claims for Irregular SIL supports are made using the “Irregular SIL Support” option in the myplace portal.

SIL Providers are only permitted to claim from a participant’s plan for Irregular SIL Supports if all the following conditions are met:

• The NDIS Pricing Arrangements and Price Limits indicates that providers can claim for Irregular SIL Supports in respect of that support item.
• The proposed charges for the activities comply with the NDIS Pricing Arrangements and Price Limits.
• Where the SIL activity does not sit within the definition of a Regular SIL Supports.
• The provider works with the participant or their nominee to explain why Irregular SIL Supports are required, and the other options available.
• The provider has agreement from the participant or their nominee to claim for the support before a payment request is made — that is, the service agreement between the participant and the provider should specify that Irregular SIL Supports can be claimed when required.

In contrast, Regular SIL supports (claimed as Direct Services) are those planned for as part of a usual week in the SIL plan budget. It requires an agreement between participant and provider, based on the levels of care that can be provided within the approved SIL budget.

The SIL Operational Guideline provides more detail about the types of services that are included and excluded from the provision of SIL supports. Please also read the latest guidance on SIL Claiming and Pricing Arrangements and Price Limits.

When does the tender start for the new DES contract?

When does the new Disability Employment Services (DES) contract start? We are hoping to apply for Employment Service Area’s (ESA) in the tender process.

The new Disability Employment Services (DES) tender will be released in 2024. The opening date for the tender has not been announced, but the new DES program starts on 1 July 2025.

There are likely to be changes to the structure and boundaries of ESAs to better align with participant needs and the labour market. There will be an emphasis on flexibility in service provision and more tailored support for participants.

Keep an eye on the Department of Social Services Engage webpage, which will have all the information when it is announced. The department’s consultation on the new specialist disability program is open and you can have your say until 30 August.

Is there a 28-day cap on STA services?

I am writing to enquire into the 28-day STA (Short Term Accommodation) cap on services.

Our organisation currently provides STA services to a number of participants. Some Plan Management (PM) services are enforcing a strict cap of 28 days of STA and refusing to pay services exceeding this number. Whereas other PM services are quite flexible and allow more than this cap to be provided and paid with no questions asked.

Could you please advise where this 28-day limit is stated, as I am unable to find it in the current PAPL (Pricing Arrangements and Pricing Limits) document.

While not stated directly in the Pricing Arrangements and Price Limits (PAPL) document, the STA operational guideline states that the Agency typically funds 28 days per year.

However, STA funding is in the core funding group. Participants have flexibility in how they choose to use these funds, unless the NDIA planner has indicated in the plan that it is a stated support. If it is not a stated support, the participant should be able to choose to use more of their core funds on STA. It should, however, be noted that the use of funds will be scrutinised in future planning processes. The participant will need to demonstrate how the use of STA aligns with their goals and meet the reasonable and necessary funding criteria.

Are board members workers under the NDIS Act?

The NDIS Practice Standards and Quality Indicators v.4 11/21, in Core, Governance, HR makes completion of the mandatory NDIS worker orientation module a requirement for workers.

1. Can you please tell me if and where it is written by NDIS that this is mandatory for workers other than in the standards?
2. Are board members included as workers in this context? Unfortunately, workers are not defined in the standards.

“Worker” is defined in National Disability Insurance Scheme (Provider Registration and Practice Standards) Rules 2018 as:

(a) a person employed or otherwise engaged by a registered NDIS provider;

(b) a partner (of a partnership that is a registered NDIS provider) whose role is of the kind mentioned in paragraph (b) or (c) of the definition of risk assessed role in the National Disability Insurance Scheme (Practice Standards—Worker Screening) Rules 2018;

(c) an individual (who is a registered NDIS provider) whose role is of the kind mentioned in paragraph (b) or (c) of the definition of risk assessed role in the National Disability Insurance Scheme (Practice Standards—Worker Screening) Rules 2018.

In the National Disability Insurance Scheme (Practice Standards—Worker Screening) Rules 2018, “risk assessed role” means:

(a) a key personnel role of a person or an entity;

(b) a role for which the normal duties include the direct delivery of specified supports or specified services to a person with disability; or

(c) a role for which the normal duties are likely to require more than incidental contact with a person with disability.

Therefore, it would seem that if, according to the NDIS Standards Rules, a board member is considered under (a) to be included as “otherwise engaged by a registered provider”, they are considered workers.

If they are not considered workers “as otherwise engaged”, then under (c) in the NDIS Worker Screening Rules those board members who have more than incidental contact with a person with disability would be included.

The NDIS Quality and Safeguards Commission define key personnel as:

• a member of the group of persons responsible for the executive decisions of the person or entity
• any other person having authority or responsibility for (or significant influence over) planning, directing or controlling the activities of the person or entity.

Key personnel include CEOs, executive staff members, managers and all members of the board of directors. It is an expectation of registration that key personnel have a current worker screening and have completed the worker orientation module.

Does the latest price review take in costs for support coordination?

The NDIS provider newsletter states:

“The pricing changes to become effective on 1 July 2024 include: Fully implementing the Fair Work Commission's decision to increase minimum wages in awards and superannuation, ensuring providers can fairly compensate their workers.”

Is this correct, given, for example, a price freeze in support coordination and the SCHADS award is increased for SCs, as well as 0.5 per cent increase in super without any increase in the price guide?

NDS is concerned that the NDIA has not adequately increased prices to reflect increased costs in providing quality services to NDIS participants. NDS is continuing to advocate for fair pricing.

The pricing decision and the statement you reference relates to disability support workers and the elements in the NDIA disability support worker cost model that uses the SCHADS award as a reference point. Services such as Support Coordination are not linked to a specific award classification and the NDIA do not consider this in their modelling.

NDS along with several other organisations has called for immediate steps to address the crisis in the disability service sector:

• Increase prices for support coordination (level 2 and 3) and therapy at least in line with wage increases in the Disability Support Worker Cost Model.
• Reinstate high intensity payments for behaviour support.
• Implement a loading for all registered providers of at least one per cent.