NDIS Participants Guide To Your Planning Meeting

Your planning meeting is where you discuss your functional goals and any funding requirements you require for the life of your next NDIS Plan.

Prior to meeting with your NDIS Local Area Co-ordinator (LAC), we recommend our participants contact our NDIS Administration Staff at APC Prosthetics to discuss your requirements, so they can assist in formulating the finer details for discussion with your Local Area Co-ordinator at your meeting.

 

Key points to discuss during your initial planning meeting

  1. Provision for Maintenance: this includes the cost of maintenance to your current limb. Please note an assessment, quotation and Assistive Technology Request is required by NDIS. This cost should be included under Capacity Building (CB) Daily Activity, please account 4-6 hours for the report and 8 hours for maintenance.
  2. Provision for Capital Supports/Assistive Technology: this will include the funding for your prostheses. Please note these items need to be quoted and approved through the Assistive Technology approval process.
  3. Provision for Core Supports: this includes ongoing low-cost consumables related to your prostheses, such as socks and sprays. Please note higher cost consumables need to be quoted and approved.

 

We recommend requesting for your NDIS Local Area Co-ordinator’s phone number and email address, so we can communicate with them directly if you require us to do so.

If you would like to have a chat about the NDIS and how we can help you prepare for your planning meeting, please contact your local APC NDIS Coordinator.

 

Funding for your Prosthesis

Depending on your individual circumstance, your prosthetic care will be funded by one of the following funding bodies:

EnableNSW

EnableNSW – Prosthetic Limb Service provides funding for a basic prosthetic limb to all eligible amputees. Residents of NSW are eligible for admission to the PLS, provided they hold a valid Medicare Card. If you would like to find out more about the PLS please click on the following link:

http://www.enable.health.nsw.gov.au/services/pls

NDIS

The National Disability Insurance Scheme provides funding for eligible amputees under the age of 65. The team at APC Prosthetics have vast experience in navigating this scheme to ensure our client’s prosthetic care is optimised. See our guide here.

If you would like to find out more about the NDIS please click on the following link:

https://www.ndis.gov.au/

Insurance Clients

Patients with an insurance claim will be assessed comprehensively by a multidisciplinary team to determine the prosthetic management plan.

Once approval has been granted by your case manager, we will commence the prosthetics treatment immediately.

If you would like to find out more about this, please contact your case manager or alternatively, contact APC.

Private Clients                                                      

APC Prosthetics is Australia’s leading private prosthetic clinic and provides comprehensive services to private clients.

Private clients are free to determine what prosthetic technologies they wish to incorporate in their prostheses without restrictions. The specialists at APC are happy to provide consultations and advice without any demands or commitments to our clients.

Please feel free to contact APC if you wish to review your current and future treatment options.

Tips for navigating the NDIS

APC Prosthetics was at the forefront of the NDIS service provision, being involved in the start-up trials in Newcastle on the 1st July 2013. As a result, we have learnt much over the years, and have had a great many successful interactions with the NDIS in that time.

We have found that the main issue experienced by the NDIS participant, is the length of time for the limb approval process. To assist with the flow and expedite the approval process we have put together a checklist that should assist with your NDIS interactions and approval time. The listed items should assist both the new and experienced amputee.

5 Steps to getting NDIS approved

  1. Register with the NDIS
  2. NDIS will contact you and arrange a meeting with your NDIS representative. Be prepared to tell them what tasks you are having difficulty with. Make sure there are funds in your NDIS plan for your prosthetist to do a full assessment and report including outcome measures. You also need funding for adjustments and consumables built into your plan allowing for the upkeep of your current limb until approval comes through for your new limbs which may take some time. Ensure your listed goals are relevant to your prosthetic needs, they may focus on mobility, independence, return to sports etc. and will assist your NDIS representative and prosthetist in identifying the suitability of your prosthetic prescription.
  3. Make an appointment with your prosthetist for at least one hour and be prepared for a number of assessments to determine what type of limb is best suited to you and will assist in achieving the goals listed in your plan. Please bring your NDIS plan to this appointment, so your prosthetist can review and find solutions to the tasks you are having difficulty with. Communicate and work with your prosthetist, as this appointment determines your future limb provision.
  4. Be patient. There are many hours of research and report writing needed by your prosthetist to determine what type of limb is suited for your lifestyle. The quotation for your limb/limbs will accompany the report that is submitted to the NDIS by your service provider. This can take time depending on the complexity of the report.
  5. Once approval is provided by the NDIS you will be contacted by your service provider, an appointment will be made for the cast and measurements for your new limb.

Information you need to know

  • The funding for a limb is broken into two categories, one for limb componentry and the other for the clinical time (face to face) with your prosthetist, including the ongoing maintenance of your limb.
  • It is imperative that the participant is aware of how their plan and associated funding is managed. Confusion with this will significantly delay limb provision and cause frustration for all parties.
  • We have found from our experience, that the best and fastest way for limb approval, is for the participant to be NDIA Managed. Your provider will claim directly through the NDIS portal which generally results in faster provision of services and approval for limb fabrication.
  • If the participant is Self-Managed, all interactions with the NDIS are done by the participant. The participant is responsible for funding the approved limb and making payment directly to the service provider. They must navigate the online NDIS portal, uploading bills for payment and billing from the correct categories, so be prepared for this if you select this option (computer knowledge is recommended).  All records of transaction should be kept on hand for audit purposes.  Self-Managed participants should be familiar with the full process and can successfully navigate the NDIS system. Any problems experienced throughout the process will need to be solved by the participant and NDIS, with limited or no input from the service provider.
  • Plan Managed means a third party will be processing your invoices. Your prosthetist will need the details of the Plan Manager to communicate and sort out funding so they can provide your prosthetic services. Be prepared for some delays due to the interaction required between the provider and Plan Manager. Participants may have a delay of up to two weeks due to Plan Management processing of payments.

If these points are used as a guide the system should flow smoothly. In general, the approval process has improved over the last year, with the complete process taking months or at times weeks from start to finish.

If in doubt or you have any questions, please contact your service provider as they have experience in successfully navigating the NDIS system.

Changing Landscape of NDIS

Much has changed since the NDIS commenced their 3-year pilot program on 1st July 2013 in five areas across Australia. APC was fortunate to be have been involved in the Hunter region NDIS pilot program, managing approximately half of the NDIS amputee clients who went through the trial program in the 3-year period.

Throughout the trial, and following the 1st July 2016 roll-out, we have seen significant change and have been active in working with our NDIS partners to shape the processes for amputees. The NDIS systems are strengthening and becoming more consistent as time moves on.

The NDIS is a CLIENT FOCUSED and CLIENT DRIVEN program. The NDIS is insisting on clients advocating for themselves, and not relying upon service providers to do this for them as they have in the past. The NDIS is empowering amputees to take care of themselves and take control of their prosthetic care. One constant with the NDIS system is the input needed by the participant to create their plan. Participants have the power to expedite their plan approvals and outcomes. The participant driving their own care is the backbone of the NDIS, and as participants, the importance of follow up calls and emails to your planner and local area coordinators cannot be underestimated.

The focus in the planning meeting should be on the inability to perform tasks and other hurdles experienced on a day to day basis by the amputee. The solutions to the listed limitations can then be addressed by your prosthetist and as achievable goals with the provision of the correct Assistive Technology (AT). This is a total change of thinking needed from the amputee population, as historically the mindset has always been on what the amputee can do, not what they cannot do. The key point to be made here is that your prosthetist will find a solution to those listed difficulties through the provision of the appropriate technology.

As a prosthetic service provider, one of our constant hurdles is the approval of the treatment plan, and the subsequent allocation of funding for the treatment. If the correct NDIS procedures are followed by your planner, things simply work. The importance of working with your prosthetist is paramount to achieve a timely and positive outcome. Our client/NDIS interactions now run into the many hundreds and our knowledge and experience in the NDIS system has enabled us to guide our clients through the system in an efficient way. We have found that when things deviate from the normal NDIS process, long delays and client frustrations are the result. I strongly suggest you have discussions with your prosthetist prior to attending your planning meeting.

Some points to remember

  • Talk to your prosthetist prior to your planning meeting
  • Attend your planning meeting with a specific list of achievable goals.
  • A goal of “want to get on with life” is not helping your prosthetist find a solution to your limitation
  • Remember that ongoing maintenance of a prosthesis is just as important as the prosthesis provision itself
  • Funding must be allocated in the correct category for the system to work
  • If your planner is unsure of anything, ask them to contact your prosthetist
  • The participant is the driver so be proactive
  • Your prosthetist will know the NDIS system involving prosthetics better than your planner so ask them for advice

The NDIS are asking all registered service providers to have a quality system in place, and the NDIS will audit all service providers in 2019 to ensure they comply with NDIS standard and requirements.  APC have recently completed this NDIS/Quality and Safeguards audit and have successfully demonstrated that our quality systems meet the high standards the NDIS require from their service providers. APC is one of, if not the first prosthetic service provider to be NDIS accredited through this system in Australia. APC are currently engaged in this audit process, which will demonstrate APC has the systems and processes in place to meet the needs of NDIS participants.  These audits will continue to take place on an annual basis, and successfully completing the audit is a pre-requisite in continuing to be able to provide services to our NDIS amputee clients.

This industry wide audit process will involve all NDIS service providers involved in prosthetics and orthotics and raise the professionalism of our industry. Our professional association AOPA is also heavily involved in assuring the service provision for the amputee participants is at the forefront of care. This governance and guidance based around the NDIS system will set the stage for the continued successful service provision for our clients.

As the landscape changes and we adapt and grow in our knowledge of the system, our clients can be assured that amputee care is in a far better place than it was prior to the start of the NDIS in 2013.  We continue to make ourselves available to support our clients as they work their way through the new system.

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