NDIS: Ultimate Guide to National Disability Insurance Scheme

ndis guidelines for providers

Several NDIS trial sites were established throughout Australia from 2013 to 2016. It occurred in Victoria’s Barwon Region, including Geelong and its surroundings.  There are no changes to existing services or disability support for people outside the Victorian region until the NDIS is introduced. The rollout of the NDIS in Victoria concluded in 2019.

Today, Australia has 4.3 million people (about twice the population of New Mexico) with disabilities. It is estimated that 500,000 Australians will receive $22 billion (about $68 per person in the US) in funding from NDIS over the next five years. The support they need will be the first time many people have ever received it.

In addition to providing information and links to local support groups, library services, and schools, the NDIS includes information about what support is provided in each state and territory.

Table of Contents

A Quick Overview of the National Disability Insurance Scheme


What is the NDIS, and what access can the NDIS cover?

Those with a permanent and significant disability who find it challenging to engage in daily activities may qualify for benefits under the National Disability Insurance Scheme (NDIS).

This disability support package is tailored to the individual needs of people with disabilities and is provided by the NDIS.

Implementation of the NDIS is the responsibility of the NDIA. A significant overhaul of disability services in Australia was long overdue, and the NDIA was created in July 2013 following years of discussion.


The key aim of the NDIS scheme in Australia

People with disabilities will benefit from the introduction of the NDIS since it will bring them closer to support; they need to achieve their goals and participate fully in community life.

Under the NDIS, the primary objective is to support people living with disabilities who have difficulty performing daily activities due to their disability.


What is the purpose of the NDIS scheme?

Among other things, the NDIS supports you in achieving your goals. You may consider establishing independence, participating in your community, pursuing education, finding employment, and maintaining good health.

You have the choice and control over how and when your support is delivered and the assurance that you will receive the help you need.

As well as early intervention, which can help reduce the impact of disability for you or your child, the book focuses on early support.


Eligibility of the NDIS scheme: Who can avail of the scheme in Australia?

Australia’s National Disability Insurance Scheme (NDIS) provides disability insurance coverage. Participants are given the support and guidance they need over time to improve their skills and independence.

 The requirements for NDIS eligibility must get met to avail yourself of the fund.

  • If you are an Australian citizen or hold a permanent or special category visa, you are eligible to apply for the program,
  •  If you are 7 to 65 years old and unable to work due to a permanent and significant disability.

Everyone receives funding directly from the NDIS.

Visit the NDIS website to learn more about how it works, who your local coordinator is, and how you can apply.


What individualized support is available for the NDIS service in Australia?

A person may receive financial assistance for education, employment, participation in society, independence, housing, and health and well-being. Among the services available are:

  • A daily schedule of activities
  • Transportation for social, economic, and everyday activities
  • Providing workplace assistance so that participants can gain or keep employment in the open or supported labour market by providing support for their behaviour (therapy approach)
  • Assisting the participant with household chores to keep their home in good condition
  • Assessment, setup, and training of aids and equipment provided by skilled personnel specializing in home modifications, including mobility equipment & vehicle equipment.


What kinds of support will not be funded or provided by NDIS Australia?

According to the NDIS Act 2013 and its regulations, specific support will not be funded by the NDIS.

The support must meet the following requirements to qualify for NDIS funding:

  • Governed by another system or community service
  • Other than one relating to disability
  • The cost that a participant regularly incurs, regardless of their support needs
  • Participants are at risk of harm, or others are at risk of injury.


Code of Conduct for the NDIS (providers)

In the NDIS Code of Conduct, providers and workers are expected to conduct themselves safely and ethically to promote safe and ethical service delivery.


Applicability of NDIS Code of Conduct

The Code of Conduct for the NDIS requires that:

  • Providers and employees registered with the NDIS
  • Employees and providers who are not registered with the NDIS
  • Providers of information, linkages, and capacity building (ILC)
  • Services are provided to senior citizens (65 years) through the Commonwealth Continuity of Support Program.

  Along with the Australian Public Service Code of Conduct, the Code also applies to NDIS Commission employees.


A Code of Conduct for NDIS participants

NDIS workers and providers are expected to comply with the Code of Conduct:

  • Applicable regulations and conventions respect individual freedoms of expression, self-determination, and decision-making.
  • While ensuring that services and support are delivered safely and competently with care
  • Demonstrate integrity, honesty, and openness
  • Be proactive in raising concerns and acting on matters that might affect the quality and safety of support services for people with disabilities.
  • Take all the possible steps to respond to the abuse and exploitation of people with disabilities, including all measures to prevent and respond to sexual misconduct.

Providers and workers can review the NDIS Code of Conduct guidelines here to understand their respective obligations better.


What does the NDIS service provider do for the participants?

Participants can pursue their goals with the help of providers who provide them with support and services.

It is possible to register or unregister with the NDIS Quality and Safeguards Commission (NDIS Commission).


Support coordinators and plan managers

 In the NDIS, plan managers and support coordinators connect participants to support, enabling them to make decisions, choose options and value their support.


Managing plans

Having a plan management provider manage funding and budgets for participants is an option.


Providing support to coordinators

Support coordinators assist participants with implementing their plan, including informal support, government services, community activities, and funded programs.


Partnering with the Community

NDIS Partners in the Community support local communities in implementing the NDIS.

To provide services to individuals with disabilities and developmental delays, the NDIA partners with qualified and experienced organizations in the community.

 The Local Area Coordination (LAC) providers serve as key NDIS contacts within the community for people over seven years old.

Children younger than 7 are served by early childhood partners.


 Local Area Coordinators (LACs)

 Partner organizations in the Local Area Coordination (LAC) network know their local disability services and communities well.

LACs assist participants in understanding and utilizing the NDIS, creating, implementing and reviewing their plans. Local partners also play a role in making the community more welcoming and inclusive.

People aged seven and older receive LAC services from this organization in conjunction with the NDIA. Participants get connected to the NDIS and mainstream and community support in their area.


Partnering from early childhood

Early childhood providers support children with disability or developmental delays through the early childhood approach.

Children and their families benefit from early childhood partners because they are matched with support and services suited to their needs. Also, they assist with links to local community services, such as playgroups and health care.

Partners from early childhood can provide informational resources by helping children get the support they need. One can offer short-term early childhood support and assist families in applying for NDIS-funded plans if their children require long-term early childhood assistance.


 Providing payment for the National Disability Insurance Scheme

Price controls for support and services in the NDIS are described in the NDIS Pricing Arrangements and Price Limits (previously the NDIS Price Guide). Support those participants receive is regulated on a price basis so that participants receive value for money.

Your providers must adhere to the NDIA’s price limits in many cases. Your NDIS funding can be spent on support and services when and how pricing arrangements apply.


Who determines the price that a provider may charge?

For some of the services you receive, the NDIA sets price limits. NDIS-funded disability supports and services are subject to price limits set by registered providers.

The price providers charge depends on how much support or service they are providing. The NDIA does not set the prices to assess the service prices. Depending on the price limit, your provider cannot charge you more than your limit.

You should not pay more for the same services as anyone else. We need to know what the differences are if they exist.

You must follow the NDIS pricing arrangements and price limits if your plan is NDIA-managed or plan-managed. They are not bound by pricing arrangements and can use registered or unregistered providers.


Cost Model for Support Workers with Disabilities

In this model, the cost is measured by estimating all costs associated with delivering a billable hour of support, including base pay, shift loadings, holiday pay, salary on costs, supervision costs, utilization (non-billable activities), employee allowances, and corporate overheads and margins.

As a result of these estimates, price limits are set by the National Disability Insurance Agency (NDIA).


Is there a price limit and pricing arrangement?

A copy of the NDIS Pricing Arrangements and Price Limits explains the pricing rules and how NDIS price controls work.

Price Limits and Arrangements for the NDIS:

  • claim rules in general
  • describing your support budget types
  • by supporting categories that align with your outcomes or goals.

Specific supports, sometimes called ‘support items,’ come with maximum price tags in the NDIS Support Catalogue.

There are also useful items in the Support Catalogue, such as:

  • Codes, sometimes known as support item numbers
  • Identify the starting and ending dates of support under which your provider is allowed to claim travel costs
  • In what circumstances can a provider claim non-face-to-face support costs
  • A support provider may be entitled to charge more for services in remote or very remote areas.


NDIS pricing updates

The NDIA regularly reviews the pricing arrangements and makes changes as necessary to ensure:

  • Participant, participant’s family, caregiver, and provider needs should be better met to ensure that health coverage remains affordable and available in the future.

Specialist Disability Accommodations Pricing Arrangements

 Prices for Specialist Disability Accommodation under the NDIS are outlined in the Pricing Arrangements for Specialist Disability Accommodation (previously the Price Guide for Specialist Disability Accommodation).


Technology, home modifications, and consumables related to assistive technology cost

 The document lists the most used supports in the Assistive Technology, Home Modifications and Consumables Code Guide. The list may not contain all proper and necessary support under the NDIS.


 Specialist Disability

The Special Disability Accommodation (SDA) definition applies to buildings listed with the National Disability Insurance Administration (NDIA) as eligible for SDA payments. This kind of assistance is needed every day by people who require a prominent level of physical support or safety.


SDAs are like houses in that they have all the same amenities.

An apartment building, a house, or any other structure can be regarded as a building. Support, such as personal care, is excluded from this measure. Personal care is not included. The NDIS offers these types of housing to participants, who will have to pay rent to their property owner as they would to any other proprietor.

Typically, people share SDAs with other participants, but the NDIS permits individuals to live in SDAs alone or with individuals who do not have disabilities. A single SDA dwelling unit may not accommodate more than five people.


SDA (Supported Disability Accommodation): what is it?

Specifically designed accommodation for people with exceedingly high support needs is known as Specialized Disability Accommodation. It is built with the intent of being accessible and livable.

Housing for people with developmental disabilities aims to minimize the support people might need in their home from others, such as support workers or informal caregivers. A space designed to be functional for you is a space designed with SDAs.


How do Specialist Disability Accommodations differ from others?

As part of the NDIS, standard criteria must be met by SDA to provide you with an apartment that gives you the best chance to live as independently as possible.

An SDA home can have the following features:

  • Cooking benches that are easily accessible
  • ADA-compliant bathrooms and amenities
  • Access to hoists and other assistive devices
  • Provide technology, like wheelchair lifts.
  • Lighting and window coverings that can be operated by voice or touch.

SDA funding will be available to only 6% of those on the NDIS because of the nature of the service.

You can use your NDIS funds to live the way and where you want, just as you would with other funding under the NDIS. Typically, we provide accessible single-family apartments and villas with kitchen, bathroom, and laundry facilities that meet the highest standards of accessibility.


 How does Supported Independent Living (SIL) work?

It is a term that describes the help with or supervision of daily tasks that aims to improve a person’s skills and enable them to live independently as much as possible.

As a SIL resident, you are provided with daily support for cleaning, cooking, counselling, grocery shopping, attending appointments, and personal care (like showering and dressing).

The SIL program provides support in a shared home for individuals with disabilities who cannot live independently or with their families.

As part of Challenge Community Services’ SIL programs, clients have access to shared homes ranging from three to five bedrooms and will be matched with others who are their age and share the same interests. Access to support, independence, and the opportunity to make new friends are all on the table.


Why is SIL different from SDA?

Meanwhile, SIL refers to onsite programs and daily living services that help housemates become more independent. If you also require daily living assistance as well as specially designed or modified housing, you will be funded separately in your plan.

Specifically designed apartments for people with high needs, or existing apartments modified to meet these needs, may be found in areas that allow easy access to complex or costly supports that enable residents to live independently.

The funding is segregated, so you can change support services without moving out of your SDA-funded accommodations. Your SDA funding will have to be reapplied if you decide to move.

By choosing SIL housing suited to your needs, you will have more choices over the SIL supports.

SIL funding is available at three levels:

  • The ‘Lower Needs’ program provides regular supervision of living arrangements. ‘
  • Most daily tasks are actively assisted by the ‘Standard Needs’ 24/7.
  • A ‘higher need’ individual receives ongoing assistance that is more complex.


NDIS participants have the right to choose and control what they receive; what are they?

Supports and services are chosen and controlled by NDIS participants

  • Participants in the NDIS may select the SIL providers they wish to work with
  • More than one provider may provide SIL services to the participant

Choosing to self-manage or plan-manage an NDIS program provides participants with the freedom to choose either registered or unregistered providers to provide the support and services

  • an unregistered provider can provide SIL depending on the support provided
  • Participants have the right to choose and control other NDIS support services not dependent on their choice of disability accommodation dwelling.”


How does the NDIS support independent living (SIL) for the NDIS?

 SIL (Supported Independent Living) helps an individual stay as independent as possible by assisting with daily tasks by a paid support worker. Individuals or groups of people can receive this support in their own homes or the home of a group of people living together.

As part of Supported Independent Living (SIL), the following support might be provided:

  • Aid with dressing, taking a shower, and using the toilet
  • Assist with chores around the house, including shopping, cooking, washing clothes, and cleaning
  • Assist with sleepovers, active overnight care, and complex medical needs.
  • Support for positive behaviour.
  • Assistance with medication administration, as well as managing issues related to bowel care, catheters, epilepsy, asthma, and tube feeding


How can NDIS participants apply for Supported Independent Living (SIL)?

It does not matter where you live if you want to participate in SIL. It is possible for anyone experiencing the NDIS to receive SIL funding, regardless of whether they rent, own, live with others, or reside in Specialized Disability Accommodation.  SIL is used by NDIS participants who need assistance with and/ or guidance to enable them to perform tasks of daily living.

Participants receive funding from SIL for a variety of purposes, including assisting NDIS people in developing their independence skills through regular support that includes full-time or frequent behavioural management.


SIL funding: how does it work?

 Under the category Assistance in Daily Life, you will receive special funding for SIL if it is included in your NDIS plan. Although it is technically a Core Service, you cannot access Core Support using your flexible Core budget.

SIL funding is determined by how much support is required and how much money is available. NDIS will calculate the amount based on SIL quotes from providers and documents such as occupational therapy reports (OTs).

Your Support Coordinator will assist you in exploring your housing goals, finding and connecting with the best SIL provider and coordinating all your supporting documentation to receive SIL funding.


 In what ways can SIL be included in your plan?

 The steps you need to take if SIL sounds like it would help you live the life you want are:

  1. Have an occupational therapist assess your needs to determine whether you might qualify for SIL funding.
  2. Choosing the right housing option and SIL provider will be a team effort between your support coordinator and you.
  3. SIL providers prepare quotes based on your support needs.
  4. SIL accommodation can get obtained by submitting a change in circumstances form to your support coordinator.
  5. The NDIS will review all supporting evidence and the quote from the SIL providers to determine its reasonableness and necessity. The NDIS will work closely with the provider in this step.
  6. SIL accommodation can get accessed as soon as you are approved.


Cost for SIL and SDA for the NDIS

Mid-cost assistive technology: The support catalogue has been updated to include a wide range of support items for AT so that AT valued between $1,500 and $15,000 can be included as part of mid-cost AT.

Meal preparation cost: The NDIS lets participants use these funds to pay for ready-to-eat meals or grocery shopping support in certain circumstances, such as when they have a support worker prepare meals at home. The NDIS service providers must no longer submit quotes to claim for meal preparation, and delivery supports included in new plans.

However, a participant must have this service included in their program. Existing plans are unaffected by the revised plan published on March 1, 2022.


Price Limits and NDIS Pricing Arrangements for the participants

 When providers lodge a payment request, they can use the Support Catalogue to find all available tools. Furthermore, it indicates what claim types (travel, non-face-to-face, etc.) apply to each price-limited item and the current price limits (and previous price limits).

 Price controls used in the NDIS are explained in the NDIS Pricing Arrangements and Price Limits document (formerly the NDIS Price Guide). Thanks to the price regulation, participants receive quality support at an affordable price. Providers who register with NDIS can charge maximum prices for specific supports.

However, participants and providers can discuss lowering prices. Participants enrolled in NDIS-managed or plan-managed programs must adhere to NDIS pricing arrangements and price limits.


Assistance with daily living (ADL) for the NDIS

Assistance with Daily Living (ADL) refers to the support that pertains to assisting with and/or supervising participants’ activities of daily living so that they can live independently. As part of the program, participants receive individual support in a range of environments, including the comfort of their own homes. These supports are billed by the hour.

Personal attendant care is funded by both SIL and ADL, with SIL intended for participants requiring 24-hour care in shared housing arrangements. ADL often supports activities of daily living.

ADL or SIL does not cover daily living expenses such as groceries and rent. Funding for Specialized Disability Accommodation (SDA) is available for participants who need more support daily and require specialized housing.


How can you include SIL, SDA, or ADL in your NDIS plan?

If your SIL supports are reasonable and essential to your individual needs, the NDIS will approve the funding package for you. Eligibility is restricted to adults over the age of 18. To determine if you are eligible for SIL, SDA or ADL, the NDIS considers factors such as:

  • What is important to you and your circumstances
  • Your age (you must be over 18 to receive SIL support)
  • Preferences and goals
  • Ability to live independently and build your capacity
  • If you can increase your independence and safety by modifying your home or obtaining assistive technology
  • Medical professionals and your other health care providers relevant information, reports, and assessments
  • If you require significant one-on-one support because of your disability
  • Alternatives to your current living arrangement


Frequently Asked Questions (FAQ)


1. National Disability Insurance Scheme – what is it?

 Australians with disabilities now have access to funds and support through the National Disability Insurance Scheme (NDIS). The company provides NDIS services throughout Victoria and is a registered provider. Individuals who meet the eligibility criteria are provided with lifetime support through the NDIS.

As part of the support, a support plan is created that includes your support needs, goals, and aspirations. Personalized plans are devised in consultation based on your goals and expectations.


2. How does the National Disability Insurance Agency work?

A company called the National Disability Insurance Agency (NDIA) administrates the NDIS. Some of their funds come from the Department of Social Services (DSS), for which the federal government appoints them.

Besides administering NDIS funding, the NDIA can provide you with information about the NDIS, including how it will work, if you or your loved one qualify, and how to participate.


3. NDIS vs. NDIA: What is the difference?

 Disability and Individuals with Disabilities Act (NDIS) is the umbrella name given to the system. The new program provides support and resources to people with disabilities and families. Personalized funding assures people with disabilities have a choice and flexibility.  Participants in the scheme are people with disabilities who meet eligibility criteria.

Disability insurance is provided by the National Disability Insurance Agency, or NDIA. Its objective is to ensure people with disabilities receive the support they need through the implementation and administration of the NDIS.


4. What are the steps involved in the NDIS?

NDIS beneficiaries receive funding through the service provider/providers of their choice – for example, Scope – to purchase the services, aids, and equipment they have been assessed as needing.

 Aside from self-management, you may also request the NDIA – the government agency established to administer the NDIS – to manage your funding on your behalf. The NDIS will allow NDIS participants to request adjustments to their funding plans as their circumstances, conditions, or needs change.


5. Under the NDIS, what services are available through Scope?

Through its services, Scope supports individuals with disabilities and their families through every stage of life. Some of the services we provide include:

  • Gaining more independence
  • Through living on your own or moving out of the house
  • Gaining access to therapy
  • Developing new skills
  • Enhancing relationships with loved ones, friends, and coworkers
  • Become an active member of your community
  • Find employment and work experience


6. How does the NDIS determine eligibility?

Four factors determine whether you qualify for NDIS funding:

Early Intervention & Disability – you must:

Is your disability such that you have difficulty participating in your community, obtaining employment, and performing basic daily tasks independently without assistance?


The case of children under six years old have a permanent disability (or developmental delay) and require immediate support to reduce the additional stress.

Your residency status must be as follows:

You must be a citizen of Australia


Possess a valid permanent visa


Persons with Protected Special Category Visas who are New Zealand citizens.


7. What are the eligibility requirements? Am I eligible for the NDIS?

 Get help from the NDIS by using My Access Checker, which lets you know if you qualify and what the next steps are. Existing funding and support will continue for people living outside an NDIS trial site. These will remain in place until your area or age group becomes eligible for the NDIS.


 8. Can people over the age of 65 years apply for NDIS?

The NDIS does not assist people over age 65. The NDIS will continue to provide the same support and funding to people aged 65 and older who currently receive disability support.


 9. Can the NDIS provide any support?

Disability support, disability services, and disability equipment are covered by the NDIS, where they are deemed reasonable and necessary.

Therapy, education, living arrangements, home modifications, communication assistive technology, mobility equipment, community participation activities, and employment support.

 The term ‘reasonable and necessary can be used to refer to supports that help in one or more of the following ways:

  • Setting and achieving goals.
  • Maintaining and gaining independence.
  • Learning skills for daily living, for example.
  • Engaging in community activities.
  • Securing employment.

Your plan must also include the following supports:

  • Effortlessly funded.
  • Consider what can be expected of families, caregivers, and the community.
  • Providing support through another system may be a better option.
  • Consent does not replace income.


 10. Can I get funding for my plan up to a certain amount?

There is no defined funding limit for each participant of the NDIS. Amounts of funding will vary with your circumstances. You may be eligible for funding when support is deemed reasonable and necessary. Instead of focusing on the cost of funding, we seek to support you in reaching your goals.


11. What happens when a person with SIL funding moves out of a shared home?

In a change of circumstances, the NDIA will review the SIL arrangement and decide on any changes. Another roommate may be required.


12. Can NDIS also recommend my best SIL provider?

 You may choose the SIL provider if their roster of services falls within the approved funding limits.

 The guides of NDIS participants must perform essential research before choosing a SIL provider. Make sure the provider you choose has a record of accomplishment of delivering the services they promise.


13. What is the difference between SIL (Specialized Disability Accommodation) and SDA (Specialized Disability Assistance)?

Specialized Disability Accommodations (SDA) are designed for people with severe disabilities or highly high care needs. Participants in NDIS that receive SDA are a tiny minority.

Participants in NDIS that receive SDA are an exceedingly small minority. SDA recipients in NDIS are a small minority; SIL does not provide or fund housing.  A person with a disability resides in shared arrangements with support that enables them to live more independently. NDIS participants living in different homes can use SIL because it is more widely available. SIL and SDA benefits can both be received.


14. What is the SDA funding model for the NDIS participants?

Participants in the NDIS can choose and enter into agreements with registered providers of the services they need according to their own decisions. NDIS emphasizes a wide range of participant control and choice. A funding model based on individuals would provide several benefits:

  • Housing subsidies are awarded based on where participants choose to live, not on the decisions of government agencies about the merit of provider grant applications.

 Rather than being restricted to incumbent players familiar with grant processes or established models of accommodation and support, funding can flow to a wide range of providers offering innovative solutions at different scales.

  • Funding levels are predictable and stable, as they are linked to participants’ needs rather than lumped together due to lumpy and random grant cycles.


15. Which criteria are used to determine eligibility for SDA funding?

NDIS participants are intended to participate in SDA only in a limited number. To qualify, participants must require continuous or immediate assistance or suffer from extreme functional impairments in a core area (self-care, mobility, or management).

Although other assistive technology, home modifications, and capacity-building support may be employed, this statistic will remain unchanged.

SDA funding will be allocated according to individual participants’ needs based on assessing their level of support. The NDIA uses SDA price limits to determine what amount to include in participants’ plans.