The new guide for self-managers

As a Support Coordinator, I have found that self-managing participants rely on me to supply accurate answers to eternal questions such as: ‘Can I use my self-managed funding to purchase X support?’ and ‘Will I get in trouble if I do Y?’. Of course, answers depend on individual participant circumstances, however, the newly updated NDIS Your Guide to: Self-management provides straightforward directions and guidelines for self-managers to follow.

Let’s recap the benefits of self-management and unpack what has changed in the new guide.

Self-management increases choice and control for participants

Participants can choose how they want to manage their NDIS funding and each option offers a different level of flexibility:

NDIA managed: is the least flexible option as funds must be spent with NDIS registered providers and participants cannot pay more than the NDIS Pricing Arrangements and Price Limits (PAPL).
Plan Managed: funds can be spent with either registered or non-registered providers. However, Plan Managers cannot claim more than the PAPL.
Self-managed: offers the most flexibility because participants can engage either registered or non-registered providers. They can negotiate with providers to pay less than the PAPL or choose to pay more.
Combination: a participant can also choose some combination of the above.

Note that some support types can only be engaged through an NDIS registered provider, such as Specialist Disability Accommodation, behaviour support and any support involving a restrictive practice. These supports will be NDIA managed in a participant plan and may also be a ‘stated support’ signalling the funds have been allocated for that specific purpose and can’t be used flexibly.

What’s new in the new self-management guide?

Here are the helpful points and clarifications in the new guide:

‘Plan Managers cannot claim more than the NDIS Pricing Arrangements and Price Limits. Providers delivering support can charge more, however they would only be able to claim up to the price limit via the plan manager. The participant would have to pay the gap’ (Page 3). This was news to me, and I haven’t worked out how a split payment would be handled by the participant, plan manager and provider, so I will watch this with interest.
Explanation of the responsibilities of self-managers including staying within the plan budget, maintaining records for 5 years and cooperating with a payment review when asked (Page 5).
Encouragement for participants to try self-managing, the request to self-manage can be made at any time, and there is no limit to how often a request to change is made (Page 9).
Suggestion to either use informal supports such as friends, family and online networks or funded supports including Support Coordinators, Plan Managers, bookkeepers, and online training to learn how to self-manage and maintain records (Page 9).
Details of the specific instances when the NDIA will not allow self-management - which includes when someone is bankrupt, insolvent under administration of where self-managing would pose and unreasonable risk to the participant (Page 10).
A list of what the NDIA consider an ‘unreasonable risk’ to self-management that would rule out the option to self-manage for a participant, plan nominee or child representative (Page 11).
A list of what flexible core funding can and can’t be used for on Page 14. For example, self-managers can purchase support coordination, plan management assistance, legal advice, bookkeeping and accounting, employment services to recruit and manage staff, peer support organisation events or memberships using flexible core supports. They can’t use NDIS funding to pay school fees, Medicare gaps, dental costs, groceries, rent, utilities, and expenses not related to disability.
Firm words about paying for supports: ‘As a self-manager, you’re responsible for paying your providers, contractors and staff. The NDIA cannot pay your providers for you. If you don’t pay your providers, they may stop delivering services to you, pursue debt recovery, or report your non-payment to the NDIS. ‘If you can’t keep on top of payments to providers, we may reconsider if self-management is right for you’. I have written previously about what to do when a participant doesn’t pay the invoice, so my updated advice is to ‘refer to Page 22’.

What’s different in the new Your Guide to: Self-management.

An updated version of one of my favourite tools, the ‘Can you buy it with your NDIS funding’ is on Page 15. Here are the seven questions self-managers should ask themselves to determine that they are using their funding in line with their plan:

Do you need the support because of your disability?
Is the support likely to meet your needs?
Is the cost of the support reasonable?
Can you afford the support within your support budget?
Is the support something that should be funded by the NDIS and not another government service?
Is the support safe?
Is the support legal?

If the answer is ‘yes’ to these questions, the support is likely to be in line with the supports included in the plan.

‘In line with supports in the plan’ is rivalling ‘reasonable and necessary’ and the multiple uses of the word ‘review’ for top spot on the list of NDIS phrases keeping me awake at night. Pages 14 & 15 of the new guide provide some clarity on how to avoid falling ‘out of line’ and into the NDIA’s bad books.

Mistakes

The guide states ‘We know self-managers try to do the right thing but sometimes we make mistakes. We want to help participants, nominees and child representatives learn how to do the right thing before it becomes an issue. If you make a mistake, we’ll work with you to fix it’.

Step by step instructions are provided for claims via the myplace portal and the NDIS mobile app as well as a reminder that a mistake in a claim can be cancelled using the portal, app or by calling the National Call Centre for help.

Payment reviews

Most self-managing participants report some fear of a ‘payment review’. The NDIA compliance team may conduct a payment review if they think a mistake has been made, if they think there is something wrong with a payment from the plan, or as part of a random review.

The guide states that NDIA may request receipts, invoices, bank statements or payroll records. Participants may also provide evidence ‘how the supports purchased fit with your plan – this might be by providing evidence you have or through conversations about how you use the supports you have purchased’. So, if in doubt, I suggest self-managers keep a record of their answers to the questions on Page 15 of the guide, together with organised files of submitted claims in the event of a dreaded payment review down the track.

This is going straight to the toolkit

My Support Coordinator Toolkit is a collection of documents and links that I refer to most frequently in my role. The new NDIS Your Guide to: Self-management is available in PDF, doc and Easy English. Add it to your toolkit, and you will be able to provide straight answers to the commonly asked questions of self-managing participants, plan nominees, child representatives and the providers who support them.

Artwork by Annika Strand.