When we say disability support needs, we mean supports you need for the impairments that meet the disability or early intervention requirements, or both.
Case
Danielle can’t eat, swallow and tolerate normal food because of her disability. This means she needs an alternative food such as enteral feeding to make sure she gets the nutrition she needs.
Would we fund this?
Yes, we would fund enteral feeding products to support Danielle’s disability support needs. Funding for the enteral feeding products she’s been prescribed would be provided if Daniella can’t get what she needs through the Pharmaceutical Benefits Scheme (PBS), which is part of the Australian health system.
Why would we fund this?
NDIS laws determine what we can and can’t fund. Things we can fund are called NDIS supports. You can use the funding in your plan to buy NDIS supports if they are related to your disability and are in-line with your plan.
We generally fund enteral feeding products and formula if you need them because of your disability support needs. For example, we will usually fund enteral feeding products or formula if your disability means you can’t eat or swallow everyday food.
To work out whether the enteral feeding product or formula is an NDIS support for you, we’ll look at the information you give us against the NDIS funding criteria.
We’ll also look at whether the PBS funds the enteral feeding product or formula prescribed for you. If it does, then it is not an NDIS support for you.
If you have either full or partial enteral feeding needs, and the PBS does not subsidise your prescribed formula, enteral feeding products may meet the NDIS funding criteria.
If your prescribed formula is not covered by the PBS, your planner will review your request individually.
What related supports might we fund?
We may also include NDIS supports in your plan that are additional to your enteral feeding formula and nutritional supplement needs.
These NDIS supports may include:
- enteral feeding and Percutaneous Endoscopic Gastrostomy (PEG) equipment and maintenance
- enteral feeding and PEG consumables such as feeding tubes and feed bags or bottles
- a support worker if you can’t independently manage your enteral feeding requirements, or to help with PEG maintenance and care
- a registered nurse to train your family member or support worker in PEG maintenance and care.
We won’t fund nutrition supports that aren’t related to your disability. For example, where you’d like to make healthier food choices for reasons that aren’t related to your disability support needs.
We generally won’t fund nutrition supports for health issues such as:
- a weight related health condition or obesity
- eating disorders
- food allergies
- diabetes
- cardiovascular (heart) disease
- kidney disease
- polycystic ovary syndrome
- irritable bowel syndrome.
These aren’t NDIS supports because they aren’t directly related to your disability support needs.
Case example
Ella is 4 years old and has Muscular Dystrophy, which means she can’t eat enough to make sure she stays in good health. Ella’s mother trialled making suitable food using a blender. However, she found homemade food doesn’t meet Ella’s nutritional needs and gives her stomach pains. Ella’s doctors suggest that she needs an enteral feeding formula to supplement her meals and give her enough nutrition. Her paediatrician recommends a specialised enteral feeding tube formula to improve her tolerance, growth and energy levels.
To support her funding request, Ella’s mother gives us a report from her paediatrician. The report shows that capacity building measures to increase Ella’s food intake by mouth have been put into place. But because she can’t tolerate blended food, she needs to use an enteral feeding tube formula. The report also includes the quoted cost of the formula and PEG equipment that’s needed for Ella’s support.
To work out whether the enteral feeding formula and PEG equipment are an NDIS support for Ella, the planner looks at the information provided against the NDIS funding criteria.
The planner thinks about whether:
- the need for the formula is because of Ella’s disability support needs.
- there are other more suitable options to give Ella the necessary nutrition for a child her age. These options should be better value for money relative to the benefits achieved.
In Ella’s case, the planner decides to include funding for the enteral feeding formula and PEG equipment in her plan, because:
- the formula and PEG equipment are directly related to Ella’s disability support needs
- other nutritional options have been trialled by Ella’s mother and have been found to be clinically unsuitable
- the cost of the prescribed formula and the PEG equipment is value for money, relative to the benefits achieved and the cost of other enteral feeding formulas available on the market
- the enteral feeding formula Ella needs is not funded or partially funded by the PBS.
For more information, refer to;
Our Guideline - Reasonable and necessary supports
Our Guideline – Disability Related Health supports