The NDIS (Federal) have recently updated their explanation on what can and cannot be claimed through a Participant’s self-managed therapy budget.

The NDIS will NOT cover the gap amount created when a person claims for services under Medicare and/or through their private health fund.

According to the NDIS website, the health system has responsibility for assisting participants with clinical and medical treatment including:

  • the diagnosis and assessment of health conditions
  • clinical services and treatment of health conditions – including all medical services such as general practitioners, care while admitted in hospital, surgery, the cost of medical specialists
  • medications and pharmaceuticals
  • sub-acute care, such as palliative care, geriatric and psychogeriatric care
  • post-acute care, including nursing care for treating health conditions and wound management
  • dental care and all dental treatments

Individuals and families sometimes also have a role in funding the medical and clinical services, such as out of pocket expenses, gap payments and private health insurance fees. The NDIS will not cover those costs.

Further information can be found at https://www.ndis.gov.au/news/qanda-15sep.html

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