A participant embarking on the process of making a plan may wish to clearly identify his or her goals and aspirations and how involved he or she wishes to be in plan development and management. This could clarify goals and assist with targeting advocacy where it is needed to achieve the best outcome for a participant. Tips
A participant’s plan consists of two statements:
- A statement of goals and aspirations, which outlines the individual’s life and what they want; and
- A statement of participant supports, which specifies what supports will be provided
Both are significant to the overall plan.
In expressing goals and aspirations, the participant has the opportunity to clarify and define what he or she wants to achieve. This statement is also relevant to the Agency’s decision of whether to approve proposed supports and therefore influences and informs other parts of the plan.
A statement of participant supports specifies what supports the NDIS will provide, so its development is crucial to a participant receiving necessary support and care.
The plan may also include additional matters, for instance, the contact arrangements between the Agency and the person, and other matter prescribed by the Rules. [s33(7)]
Overview of Plan Process
If a person becomes a participant, the Agency must facilitate the preparation of the participant’s plan in accordance with the relevant Rules. [s32] The Agency may exercise discretion to commence facilitating the preparation of a plan where satisfied that the circumstances are urgent. [s32a]
The statement of goals and aspirations does not need Agency approval and can be replaced at the will of the participant by providing a changed version to the Agency, whereas the statement of participant supports is prepared with Agency involvement and needs the approval of the Agency to take effect. The legislation allows for varying levels of input from a participant in the development of a statement of supports that meets the approval criteria.
The participant must also consider how involved he or she wishes to be in managing the funding for supports. The participant is able to make a plan management request that specifies who the participant wishes to manage the funding and to what extent.
The plan can specify that the funding is to be managed wholly, or to a specified extent, by:
Once approved by the Agency, the plan comes into effect and supports will be provided accordingly.
Statement of goals and aspirations
The statement of goals and aspirations is a statement prepared by the participant that specifies:
- the goals, objectives and aspirations of participant; and
- the environmental and personal context, including:
- living arrangements;
- informal community supports and other community supports; and
- social and economic participation [s33].
If prepared other than in writing, the Agency must record a copy in writing, and provide it to the participant. [s33(8)]
The participant’s statement of goals and aspirations can be changed at any time. If the environmental or personal context, or the goals, objectives or aspirations of the participant change, or the participant wishes to change the content of this statement, the participant can provide a changed version to the Agency to replace the previous statement of goals and aspirations. [s47]
Plan Management Requests
Managing the funding for supports is a significant responsibility under a participant’s plan and the plan can provide for the management of funding to be assigned wholly to one party or shared to a specified extent between:
A participant may make a plan management request:
- that he or she manage the funding for supports wholly or to the extent specified;
- that the funding for supports be managed wholly or the extent specified, by a registered plan management provider he or she nominates; or
- that the funding for supports be managed wholly or to the extent specified, by a person specified by the Agency [s43(1)].
If a participant does not make a plan management request, the statement of participant supports must provide that funding be managed by:
A statement of participant supports must not provide for the participant to manage the funding:
- to any extent, if the participant is an insolvent under administration; or
- to a particular extent, if the Agency is satisfied that self-management to that extent would present an unreasonable risk to the participant [s44].
If, however, the participant is prevented [s44] from managing funding, the statement of participant supports must provide that funding for supports under the plan be managed in accordance with the plan management request, to the extent that he or she is not prevented from managing it. The remainder of funding is to be managed by the Agency or a registered management provider specified by the Agency.
If funding for supports is to be managed to any extent by the Agency, or by a registered plan management provider specified by the Agency, the Agency must so far as reasonably practicable, have regard to the wishes of the participant in specifying who is to manage the funding for supports under the plan to that extent. [s43(5)]
In deciding whether there would be an unreasonable risk to the participant, if the participant were to manage the funding for supports to the extent proposed, the Agency must have regard to the criteria set out in [Part 3.8 Rules – Plan Management] and below, unless the participant is a child or is represented by a nominee. Different criteria contained in [Part 3.7 Rules-Plan Management] apply when assessing unreasonable risk for a plan nominee or child’s representative managing funding for supports.
The criteria to otherwise be applied is;
- whether material harm to the participant could result if the participant were to manage the funding for supports to the extent proposed, taking into account the nature of supports identified in the plan;
- the vulnerability of the participant to severe physical, mental or financial harm, exploitation or undue influence;
- the ability of the participant to make decisions;
- the capacity of the participant to manage finances; and
- whether, and the extent to which, any risks could be mitigated by, the participants informal support network or any appropriate safeguards or strategies the Agency could build into the participant’s plan.
- whether a court or a tribunal has made an order under Commonwealth, State or Territory law under which the participant’s property or affairs are to be managed by another person.
The rules include examples of safeguards including:
- shorter periods before review of the participant’s plan;
- regular contact between the Agency and the participant; and
- funding for supports, such as budgeting training to assist the participant to manage their own plan.
Plan Nominee or Child’s Representative
If the participant is represented by a plan nominee or is a child and therefore represented by a child’s representative, the Agency must have regard to the criteria in [Part 3.7 Rules – Plan Management] including:
- the capacity of the child’s representative or the plan nominee for financial management;
- whether the child’s representative or the plan nominee has an interest that could lead a reasonable person to consider that NDIS amounts within their control might be spent other than in accordance with the participant’s plan (for instance a conflict of interest that may prevent the best outcome from being achieved for the participant); and
- whether, and the extent to which, any risks could be mitigated by any appropriate safeguards or strategies the Agency could put in place through the participant’s plan.
Statement of participant supports
The statement of participant supports is a statement prepared with the participant and approved by the Agency, that specifies;
- the general supports (if any) that will be provided to or in relation to, the participant;
- the reasonable and necessary supports (if any) that will be funded under the NDIS;
- the date by which, or the circumstances in which the Agency must review the plan; and
- the management of the funding for supports under the plan and of other aspects of the plan.
For the development of the statement of participant supports, the participant must decide how involved he or she would like to be. The Participant can choose to:
- develop a statement and submit it to the Agency for approval against the relevant criteria;
- cooperate with the Agency to develop a statement consistent with the relevant criteria; or
- let the Agency develop a statement for the participant, in accordance with the relevant criteria and influenced by the participant’s statement of goals and aspirations.
When developing a statement of participant supports, the various aspects of the approval criteria must be kept in mind.
In outlining the supports that will be funded or provided under the NDIS, the supports may be specifically identified or described generally in the plan, possibly with reference to a specified purpose. [s33(3)]
A statement of participant supports will specify:
- the general supports provided to or in relation to the participant; and
- the reasonable and necessary supports that will be funded under the NDIS.
Some supports in a participant’s plan may be described generally, whether by reference to a specified purpose or otherwise. [s33] For such supports, the participant will have a high degree of flexibility over the implementation of the supports, which may be advantageous.
Some supports may be specifically identified in the plan. In the case of reasonable and necessary supports, the plan could specify the type of supports that are to be funded and the way in which they are to be provided, where to do so would help ensure that the expected outcomes from the supports are attained by the participant. Such supports will have to be purchased in the way described in the plan. This will create more certainty but will reduce flexibility.
The Agency will decide whether the support in a participant’s plan should be described generally or more specifically, having regard to the criteria expressed in [Part 6 Rules – Plan Management]. Relevant factors include:
- the cost of the support;
- any expected return or saving in costs from providing the support;
- whether a particular support is vital to the achievements of goals or the effectiveness of other supports;
- supports previously provided by the Commonwealth, a State or a Territory.
The Agency is to specify that the support is to be provided by the Agency if:
- it is more cost-effective for the support to be provided by the Agency; or
- the support was being provided by a State or Territory government prior to the commencement of the NDIS and there is a funding agreement that relates to the support that remains in force after commencement of the NDIS.
The Agency may specify that the support is to be provided by the Agency. The participant may wish to challenge such specification where it limits his or her exercise of choice and control over supports without adequate justification or benefit.
General supports are those supports provided by the Agency to a person, and activities engaged in by the Agency in relation to a person that is in the nature of a coordination, strategic or referral service. The Agency may provide general supports to, or in relation to, people with a disability who are not participants. [s13]
Reasonable and Necessary Supports
Reasonable and necessary supports are those supports funded under a participant’s plan in accordance with the approval criteria for the statement of participant supports.
Reasonable and necessary supports for people with disability should:
- support people with disability to:
- pursue their goals and maximise their independence;
- live independently; and
- be included in the community as fully participating citizens; and
- develop and support the capacity of people with disability to undertake activities that enable them to participate in the mainstream community and in employment. [s4(11)]
In deciding whether or not to approve a statement of participant supports, the Agency must:
- have regard to the statement of goals and aspirations;
- have regard to relevant assessments conducted;
- be satisfied in relation to the reasonable and necessary supports that will be funded and general supports that will be provided; and
- have regard to the principle that participant should manage his or her plan to the extent they wish to do so. [s33(5)]
In relation to the funding or provision of each support, the Agency must be satisfied that:
- the support will assist the participant to pursue the goals, objectives and aspirations included in the participant’s statement of goals and aspirations;
- the support will assist the participant to undertake activities, so as to facilitate the participant’s social and economic participation;
- the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;
- the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;
- the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide;
- the support is most appropriately funded or provided through the NDIS, and is not more appropriately funded or provided through other service systems; and
- the funding of the support complies with the methods and assessment tools specified in the Rules for deciding the reasonable and necessary supports that will be funded under the NDIS. [s34]
Value for Money
[Part 3.1 Rules- Supports for Participants] provide criteria and some examples for determining whether the support represents ‘value for money’. To approve the plan, the Agency must be satisfied in relation to each support, that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support. The participant should develop the statement of supports keeping these considerations of cost-effectiveness in mind.
In deciding whether the support represents value for money, the Agency should consider:
- whether there are comparable supports which would achieve the same outcome at a substantially lower cost;
- whether there is evidence that the support will substantially improve the outcomes for, and be of long‑term benefit to, the participant;
- whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term;
- for supports that involve the provision of equipment or modifications:
- the comparative cost of purchasing or leasing the equipment or modifications; and
- whether there are any expected changes in technology or the participant’s circumstances in the short term that would make it inappropriate to fund the equipment or modifications;
- whether the cost of the support is comparable to the cost of supports of the same kind that are provided in the area in which the participant resides; and
- whether the support will reduce the participant’s need for other kinds of supports.
Effective and Beneficial Support
In deciding whether the support will be, or is likely to be, effective and beneficial for a participant having regard to current good practice, the CEO is to consider the available evidence of effectiveness of the support for others in like circumstances.
That evidence may include:
- published and refereed literature and any consensus of expert opinion; or
- the lived experience of the participant or their carers; or
- anything the Agency has learnt through delivery of the NDIS. [Part 3.2 Rules- Supports for Participants]
In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the Agency is to take into account, and if necessary seek, expert opinion. [Part 3.3 Rules- Supports for Participants]
If a difference of opinion exists between the Agency and the participant on what supports will be effective and beneficial, further evidence should be sought out, shared and evaluated with a view to resolving differences in perspectives. The participant should be considered as a unique individual and advocacy may be needed to ensure his or her specific needs are catered to in the design of supports. Best practice will not be the mere provision of supports the Agency has found to be good practice for most NDIS participants, but the application of that knowledge in a way that responds and adapts to the particular circumstances, needs and interests of the participant. Participants can provide a valuable perspective on what supports will be effective and beneficial for them.
In deciding whether funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide, the Agency should consider the desirability of supporting and developing the potential contributions of informal supports and networks within their communities.
[Part 3.4 Rules- Supports for Participants] provides criteria and some examples to assist this determination.
If the participant is an adult, the Agency should consider:
- the extent of any risks to the wellbeing of the participant arising from the participant’s reliance on the support of family, carers, informal networks and the community;
- the extent of any risks to the wellbeing of the participant’s family members or carer or carers;
- the suitability of family, carers, informal networks and the community to provide the supports that the participant requires;
- the extent of any difference between the age of the participant and the age of any family members caring for the participant, and the appropriateness of that difference; and
- the extent to which informal supports contribute to or detract from the outcomes to the participant.
[Part 3.4 Rules- Supports for Participants] outlines different criteria for a participant who is a child.
The Agency must be satisfied that the support is most appropriately funded through the NDIS rather than through another service system. Many supports should be provided outside the NDIS, through systems of service delivery or support services offered by another agency, body or person, or offered as part of universal service obligation, or in accordance with reasonable adjustments required under anti-discrimination law.
In developing a statement of supports the participant should consider what supports may the responsibility of other service systems, including:
- Health (excluding mental health);
- Mental Health;
- Early Childhood Development;
- Child protection and family support;
- School Education;
- Housing and Community Infrastructure;
- Transport; and
[Part 7 Rules- Supports for Participants] offers guiding principles on what supports the NDIS will and will not be responsible for. These examples may help resolve a participant’s queries as to whether a particular support can be provided in a plan or must be sought by advocating to another area of government or to the private sector. As more exact boundaries are established through the ongoing implementation of the NDIS, further guidance will be available.
[Part 5 Rules- Supports for Participants] specifies that certain supports will not be funded under the NDIS. The support will not be funded or provided if:
- it is likely to cause harm to the participant or pose a risk to others;
- it is not related to the participant’s disability;
- it duplicates other supports delivered under alternative funding through the NDIS; or
- it relates to day-to-day living costs of a kind incurred by general members of the community (unless those costs are incurred solely and directly as a result of their disability support needs, or are ancillary to another support funded or provided under the plan, and would not otherwise be incurred).
Supports will not be provided or funded under the NDIS if it takes the form of income replacement or if its provision would be contrary to any law of the Commonwealth or the relevant state or territory.
[Part 4 Rules- Supports for Participants] provide a method for the Agency to follow when deciding whether to approve a statement of participant supports. This part of the rule also provides some explanation of the assessment tools that the Agency may use in the assessing the participant’s needs and situation.
This method provides some guidance for making a decision based on the approval criteria in [s33] and [s34]. When deciding whether or not to approve a statement of participant supports, the Agency is to:
- identify the participant’s goals, aspirations, strengths, capacity, circumstances and context;
- assess activity limitations, participation restrictions and support needs arising from a participant’s disability;
- assess risks and safeguards in relation to the participant; and
- relate support needs to the participant’s statement of goal’s and aspirations.
The NDIS operational guidelines will specify assessment tools for making assessments when following this method. The Agency is required to ensure the relevant assessment tools are applied appropriately to each participant. Different tools may be tailored to age and particular disabilities.
According to [Part 4.6 Rules- Supports for Participants], an assessment tool must:
- be designed to ensure the fair and transparent assessment of reasonable and necessary supports for participants (including early intervention supports); and
- be consistent with areas of activity and social and economic participation identified in the World Health Organisation International Classification of Functioning, Disability and Health as in force from time to time.
Requests from Agency
The Agency can make a variety of requests when making a decision about a statement of participant supports. The approval criteria and method may require the participant to provide a large amount of personal information and evidence to the Agency.
For the purposes of preparing a statement of participant supports or deciding whether to approve a statement of participant supports, the Agency may make requests that:
- the participant, or another person, provide information that is reasonably necessary for these purposes; and
- the participant undergo an assessment and/or examination and provide the report(s) in the approved form. Info
The Agency may prepare the statement or make a decision before all requested information or reports are provided but must give the participant a reasonable opportunity to provide them. If provided after approval, the plan may be reviewed and replaced to respond to the information or reports provided. [s36]
Once the Agency has received the statement of goals and aspirations, and has approved the statement of participant supports, the plan comes into effect. [s37] The participant should receive a copy of the plan within seven days. [s38] The Agency’s decision to approve a statement of participant supports is a reviewable decision.
The Agency must comply with the statement of participant supports once the plan is in effect. [s39] If the participant wishes to alter the supports provided under the plan prior to the specified occasion for plan review, he or she should make a request for review of the statement of participant supports. A plan cannot be varied but can be replaced with a new version. A plan will only cease if it is replaced by another plan or the person ceases to be a participant. Suspension can occur is some circumstances.