We’ve all been there before. A Support Coordinator is working with a participant who has particularly complex disability support needs, who experiences a crisis that requires an urgent increase in their supports. You will need to coordinate the urgent intervention from their support provider and clinical team and before you know it, your carefully managed Support Coordination budget has been exhausted.
What are your options?
You effectively have two choices: you can either continue to provide your services and then submit a manual claim when the participant’s NDIS plan ends; or cease providing your services until a new plan is approved.
As a registered organisation, you should have a policy in place that outlines what steps are required before you can continue to provide your services. These steps are driven by compliance requirements that relate to your registration as well as your insurance and general business compliance.
You should commence these actions as soon as it is apparent that you are likely to require additional funds. Don’t wait until the Support Coordination funds are exhausted!
These are the actions a Support Coordinator needs to consider in this situation:
- At this point in time, you should have already conducted a risk assessment to justify the additional supports, therefore it is a simple extension of that exercise to consider the risks to the participant(s) if you were to stop your services when your support coordination budget is exhausted.
- You will also need to receive written approval from the NDIA to continue providing supports after the exhaustion of the Support Coordination budget. This request should be submitted at the same time you submit the Change of Situation or s100 forms (you will include the incident reports and risk assessments if they haven’t already been submitted).
- In this request you will need to outline what circumstances gave rise to the need to exceed the allocated budget, what steps you have taken to avoid exhausting your budget and what the risks are to the participant if you withdraw your supports.
- You need to give yourself as much time as possible to get these processes completed – just in case your request is denied, or if you receive a delayed response from the NDIA.
- A key point to note is that your standard service agreement will include the amount of support you agreed to provide at the beginning of the plan. By virtue of exceeding that agreed level of service, your service agreement is technically void as soon as the budget is exhausted.
- Therefore, you will require written consent from your participant to continue to provide your supports as an extension of all of the other terms within the existing service agreement. This agreement should outline how many hours, the type of work you will do and when you will review this new agreement.
The final piece to this jigsaw puzzle is when and how do you claim your funds?
The when is easy – you can’t make your claim until after the plan has ended.
When making your claim you will need to write a letter requesting payment of the funds for your billable hours that outlines:
- why the funds were exhausted in the first place
- what steps you undertook to avoid the funds being exhausted
- the NDIA delegate’s name, reference number and date you received approval to continue to provide your services
- why your supports were still required (this should refer to a risk assessment that has already been submitted at the time of the original incident/crisis)
- what activities you are seeking the funds for
- and a reference to any other supporting documents you are submitting with this claim.
The supporting documents you will need to submit in addition to this letter are:
- an invoice that specifies the individual service events described above
- the written approval from the NDIS representative to continue to provide services
- any incident reports or risk assessments that have not yet been submitted*
- any other evidence documents that will assist to substantiate your claim (e.g. police reports, hospital discharge reports etc.)
*it is expected that all incidents will be reported shortly after they happen, therefore it is expected that they would be summarised or catalogued in the letter of request.
Once you have prepared your submission you can lodge the claim within the “enquiries” tab in PACE.
To wrap up your manual claim process confidently and professionally, remember that clear documentation, proactive communication, and thorough risk assessment are your strongest tools.
While the process of submitting a manual claim can be time-consuming, following each step carefully ensures you meet compliance requirements and improves your chances of the claim being approved.
Keep detailed records throughout the participant’s plan period and maintain open lines of communication with both the NDIA and the participant. This approach not only strengthens your claim but reinforces your role as a responsible and accountable Support Coordinator acting in the best interest of the participant.
Want to find out more about how Support Coordination Software keeps you updated with your budget allocation in real time? Click here to book a demo or sign up for a no obligation 14-day free trial.