Removal of Disability-Related Health Supports from Core

The 2024-25 Pricing Arrangements and Price Limits (PAPL) set a timeline for removing therapeutic Disability-Related Health Supports (DRHS) line items from Core. For several years, these line items have been in both Capacity Building and Core. But from 30 June 2025, they will only be available in Capacity Building. This change will have significant ramifications for providers and participants. It is important to note that this change impacts therapy supports, the line items for nursing and lost cost AT will remain available in Core. In this article will uncover what DRHSs are and what the change will mean.

What are Disability-Related Health Supports?

DRHSs are NDIS funded supports for people who need help to manage their health conditions due to their disability. The NDIA funds eight main DRHS areas:

• Continence
• Diabetes Management
• Dysphagia
• Epilepsy
• Nutrition
• Podiatry and Foot Care
• Wound and Pressure Care
• Respiratory Supports

The NDIA officially says they would consider funding supports to manage other health conditions on a case-by-case basis. But we haven’t seen many examples of support for other health conditions being covered by DRHS.

In addition, the new transitional Rules to define an NDIS support also include the following as DRHS:

• Support for people with complex communication access needs or behaviours when accessing health or mental health services, including hospital and in-patient facilities
• Specialist allied health services and supports that facilitate enhanced functioning and community re-integration of people with recently acquired severe conditions including newly acquired spinal cord and severe acquired brain injury;

But the DRHS operational guidelines have not yet been updated to include these yet.

DRHS funding can be used for: therapists developing plans, delivering DRHS services and training support workers and carers, support workers completing DRHS tasks, consumables, Assistive Technology, Support Coordination, and sometimes specific High Intensity tasks delegated by a Registered Nurse to a support worker.

What isn’t a Disability-Related Health Support?

The transitional Rules to define an NDIS support and the NDIA’s Operational Guidelines for DRHS make it very clear that other service systems are still responsible for:

• improving health outcomes for all Australians
• diagnosis of health conditions (including chronic health conditions)
• acute and emergency health services
• health services following an event (like an accident or injury)
• medication related to health needs (like antibiotics)
• general hearing and vision services unrelated to the person’s disability
• and more

These services might be provided by mainstream health systems or more specialised government-funded services like the National Diabetes Services Scheme.

So not all ‘health supports’ are automatically DRHS. The definition of a DRHS is very specific. It might be something that is covered by a mainstream health system’s Universal Principle commitment to support people with a disability.

So what’s changing?

Since 2019, DRHSs could be claimed from both Core and Capacity Building. This temporary duplication was designed to give participants access to potentially vital supports from Core, rather than wait for a plan review to get funds in Capacity Building.

It is fair to say that after five years, these line items did not feel very temporary. Many providers and participants have come to rely on them, particularly when a therapy budget was underfunded. However, the latest update of the PAPL announced that therapy DRHS line items Core will be removed after 30 June 2025.

This means that from 1 July 2025, all therapy supports, including DRHS, can only be billed from Improved Daily Living in Capacity Building.

What about nursing supports?

DRHS in Core has line items for therapy supports and nursing supports. It is important to note that the only line items being removed from Core are the ones related to Therapeutic Disability-Related Health Supports. This includes:

• Dietitian
• Occupational Therapist
• Physiotherapist
• Podiatrist
• Psychologist
• Speech Pathologist
• Other Professional

The codes related to the provision of nursing care for disability-related health needs are still in Core.

What does the end of the temporary duplication mean for participants and providers?

Mostly, it means a lot of work for everyone.

While the temporary duplication was mostly used for its intended purpose, it was also sometimes used to top up therapy services. An underfunded Capacity Building budget could be remedied by a provider using the DRHS line items from Core to fund general therapy, but this was never the intention of the temporary duplication (and masks genuine Capacity Building needs). The NDIA became more alert to this and announced the end of the temporary duplication. So from 30 June 2025 - every hour of therapy will have to come from Capacity Building, and none can be billed to Core.

So most providers will have to do some degree of analysis of current DRHS services offered, where they fit, and whether they will be funded in Capacity Building in the future.

So here are our hot tips for moving forward:

1. Assess which supports you provide are DRHS and which are general therapy supports
2. Explain to participants what the changes mean for them and their NDIS plan
3. Create a continuity of support plan for therapy supports
4. Complete the relevant DRHS assessments as soon as possible and provide these to the NDIA. Providers should check the Operational Guidelines to make sure the right professional is completing the right assessment
5. Come to our short, sharp 1hr workshop on this topic! We go into more detail on how to get DRHS funded in a Plan, how to assess current DRHS, and how to create a transition plan for the 30 June 2025 deadline.