Levels of Support

The Scheme does not provide income replacement benefits, such as a disability pension or weekly compensation entitlement, but may fund supports, such as:

• Permanent prosthetics, othoses, specialist hearing and vision supports;
• Occupational therapy, speech therapy, physiotherapy and specialist behavior interventions;
• Care by clinically trained staff and routine non clinical care to enable activities of daily living (eg. PEC feeding, catheter changes, skin integrity checks or trachea tube changes);
• For those suffering from a mental health condition, assistance with planning, decision making, personal hygiene, household chores, financial management, tenancy support, transport and non-clinical residential accommodation; as well as allied and other therapy, education and training.
• In relation to early childhood development, examples include post diagnosis information, early childhood mainstream and specialist services; therapies, and behavior management supports.
• Portable aids and equipment at schools; transport to and from schools, training for school staff.
• Personal attendant care in the workplace, aids or equipment (that aren’t funded by other legislation), transport to and from work.
• Home modifications, assistance to obtain and maintain accommodation or tenancies and training to assist a person to live independently.
• Training and support to use public transport, modifications to private vehicles, costs associated with use of transport.

Participant Requirements

To become a ‘Participant’ in the Scheme (requirements for entry are only in draft at this stage) a person must meet age requirements (in NSW if they were aged from birth to 65 when they accessed the Scheme), reside in Australia and meet the disability or early intervention requirements. The Scheme is applicable to persons who:

• Have a disability (intellectual, cognitive, neurological, sensory, physical or psychiatric);
• Impairment resulting from the disability is permanent (irreversible or likely to be);
• The impairments results in a substantially reduced capacity to undertake communication, social interaction, learning, mobility, self-care, self-management;
• The impairment affects the person’s capacity for social and economic participation;
• Support needs in relation to a person’s impairment are likely to continue for a person’s lifetime.
• Has a disability or is a child with developmental delay that would benefit from early intervention supports that would reduce future needs.

A person ceases to be a ‘Participant’ in the Scheme when they either choose to exit the Scheme, enter a residential care service on a permanent basis, or start being provided with community care on a permanent basis, after the person turns 65 years of age (Section 29). ‘Participant’ status can also be revoked in some circumstances.

Once a person becomes a ‘Participant’, they develop a Plan with DisabilityCare Australia comprising:

(a) the Participant’s statement of goals and aspirations, which is prepared by the participant and specifies their goals, objectives, aspirations and circumstances; and

(b) the Statement of Participant supports, which is prepared with the participant and approved by the CEO, and sets out, among other matters, the supports that will be provided or funded by the Scheme.

The ‘Participant’ can request a review of the Plan at any time, and if the ‘Participant’ is absent from Australia for more than 6 weeks, the Plan may be suspended.

Decisions made under the Scheme are subject to second review by DisabilityCare Australia and are then subject to review by the Administrative Appeals Tribunal.

If a person is entitled to compensation for ‘personal injury’ (other than through the Scheme), for example through a worker’s compensation scheme or at common law, a person can be reasonably required to seek and obtain that compensation and a participant’s ‘Plan’ can be suspended until that action is taken.

DisabilityCare Australia can also seek indemnification or recovery of payments from insurers or other persons who may be potential compensation payers to the ‘Participant’, and in some circumstances can take action on behalf of the person to recover compensation.