Participant Name:

NDIS No.:

Parent/Guardian Name/s:  

Provider: De Silva Kids Clinic  –

NDIS Plan Start Date:

NDIS Plan End Date:

Funds Management:

Responsibilities of the Provider:

The provider agrees to:

• Review the provision of supports at least 3 monthly with the participant
• Once agreed, provide supports that meet the participant’s needs
• Communicate openly and honestly in a timely manner
• Treat the participant with courtesy and respect
• Consult the participant on decisions about how supports are provided
• Give the participant information about managing any complaints or disagreements and details of the provider’s cancellation policy (if relevant)
• Listen to the participant’s feedback and resolve problems quickly
• Where possible, give the participant a minimum of 48 hours' notice if the provider must change a scheduled appointment to provide supports
• Give the participant the required notice if the provider needs to end the Service Agreement
• Protect the participant’s privacy and confidential information
• Provide supports in a manner consistent with all relevant laws, including the National Disability Insurance Scheme Act 2013 and rules, and the Australian Consumer Law; keep accurate records on the supports provided to the participant
• Issue regular invoices and statements of the supports delivered to the participant as per the Terms of Business for Registered Providers.

Responsibilities of the Participant:

The participant agrees to:

• Inform the provider about how they wish the supports to be delivered to meet the participant’s needs
• Treat the provider with courtesy and respect
• Talk to the provider if the participant has any concerns about the supports being provided
• Adhere to the provider’s cancellation policy
• Give the provider the required notice if the participant needs to end the Service Agreement
• Let the provider know immediately if the participant’s NDIS plan is suspended or replaced by a new NDIS plan or the participant stops being a participant in the NDIS

Pricing and Payments

Self-Managed: The Provider will seek payment for the provision of services at the time of receiving supports. The Provider will provide an invoice to the Participant/Representative for payment on the day the services are provided. Payment is required on the same day.

Our prices for Speech Pathology, Occupational Therapy and Psychology are based on pricing limits developed and published by the NDIA and do not exceed these limits. The NDIA review price limits on at least an annual basis, taking account of market trends, changes in costs and wage rates. Changes to price limits will be published on the NDIA website. Our fees are updated in line with pricing limits released on the NDIA website.

Plan-Managed: The Provider will seek payment for the provision of services after the delivery of those supports. The Provider will claim payment for those services from the Plan Management Agency (provided by the Participant/Representative). Our prices for Speech Pathology, Occupational Therapy and Psychology supports are based on pricing limits developed and published by the NDIA and do not exceed these limits. The NDIA review price limits on at least an annual basis, taking account of market trends, changes in costs and wage rates. Changes to price limits will be published on the NDIA website. Our fees are updated in line with pricing limits released on the NDIA website.

NDIS Funding Information: NDIS has moved to allocating NDIS funding in quarterly blocks. As a result, you will need to calculate the estimated costs associated with your service at De Silva Kids Clinic (this includes sessions, meetings, and report writing) and compare this to your allocated funding to ensure you don’t run out of funds during your blocks of therapy. Please note, each quarterly funding block needs to cover all services delivered during the given time frames on your NDIS plan, including external services from other providers. Please refer to the DSKC fee structure below as a guide to assist estimating your funding allocation per quarter. Your plan manager can assist with calculations if needed.

The Participant/Representative and the Provider agree that: The plan is expected to remain in effect during the period of the services are provided and

• The Participant/Representative will immediately notify the Provider if the plan is replaced by a new plan or if the Participant ceases to be a participant of the NDIS.

Consent

If Plan-managed: I understand that my plan manager will claim for services on my behalf.

If Self-managed: I understand that I will pay for services at the time of receiving the service and claim the amount directly from NDIA

You have selected:

Insufficient Funds

It is the responsibility of the Participant/Representative to be aware of the amount of funds used in the plan period to ensure that there are adequate funds available to last the duration of the plan period.

In the event that there are insufficient funds remaining in the Participant’s Plan to enable a claim to be completed, the Participant’s Representative will be responsible for settling a private invoice for the amount which was to be claimed via the Participant’s Plan.

Payment of this invoice is required within seven (7) days of receiving the invoice.

If the participant has any unpaid invoices, the provider will pause sessions until all invoices are paid.

If an invoice remains unpaid beyond the due date, the account may be referred to a debt collection agency, and all associated recovery costs will be the responsibility of the client, not the provider.

I agree to the above condition regarding insufficient funds.

Service Provision

A combination of direct and indirect services may be provided to the Participant through the period of this service agreement. Direct services include face to face interventions within either the clinic, home, school or community settings. Depending upon your child’s individual needs, direct intervention may include clinical observations, formal assessments, and/or the use of specialist equipment. Indirect service provision includes non-face-to-face services such as attending meetings with the Participant's educational staff, allied health team or others involved in their daily life; researching appropriate intervention options and providing written support for funding; and/or other such activities. Any indirect service provision will be agreed the participant/Representative in advance.

Management/Support Plans

As a requirement under the NDIS guidelines, all participants are required to have regular planning sessions with providers to discuss and update goals. At De Silva Kids Clinic, these appointments are scheduled 4 times per year, generally during school holiday periods. These appointments provide the opportunity for you to formally discuss your child’s progress and inform the therapy team of any changes that you would like to be reflected in the therapy plan for your child. Your therapist will provide their clinical knowledge to set goals in consultation with you, plan the most suitable treatment, and regularly review the intervention to ensure it continues to be the most suitable for you and your child. To ensure the most effective outcomes for your child, it is expected that you will actively collaborate with your therapist to review and set goals, participate in therapy activities to learn strategies during sessions, complete agreed upon home practice activities, and provide regular feedback to your therapist

If Plan-managed: I understand that my plan manager will claim for services on my behalf.

If Self-managed: I understand that I will pay for services at the time of receiving the service and claim the amount directly from NDIA.

Cancellation of Services

Cancellation Policy: When scheduling an appointment, time is specifically reserved for the therapist to dedicate to your child. If you advise our clinic that you are unable to attend an appointment with adequate notice, we are able to allocate this time to another child’s care.

If you are unable to attend a session, you are required to contact reception as soon as possible via phone or email correspondence with our friendly reception team. If you are calling outside office hours, you are required to leave a message on our voicemail, and we will retrieve this message along with the time the message was left on voicemail. Rescheduling or cancelling therapy sessions without adequate prior notice will result in a cancellation fee being issued.

If notice is provided the day before the appointment or on the day of the appointment, a cancellation fee will be issued if you are unable or unwilling to choose from the alternative sessions offered. No cancellation fee will be charged where notice is given two or more days before the appointment. The fee will be waived for late cancellations due to the child or their immediate family member being hospitalised (hospital discharge papers must be provided to reception).

If you cancel your child's offsite session (school visit or home visit) within 48 hours’ notice, the cost will be charged as this time has been set aside for your child's session. If cancelling an offsite visit with 48 hours’ notice, you will only be charged for the session time.

You will receive an invoice for late cancellations via email and payment is required prior to the following session. If your regular services are paid for by a third party (such as NDIS Plan Managed clients) the invoice will be sent to the plan manager. If the plan manager or third party payer does not pay the invoice, you will be liable for payment.

You will be provided with alternative options to replace your usual session such as telehealth consultation, reschedule or home program (maximum of one home program per discipline per school term). Your therapist will be able to assist to determine the most appropriate alternative session at the time.

Frequent disruptions to therapy: Regular attendance to therapy is integral to your child’s goals being achieved. If your child does not attend 3 out of 5 sessions in within a 3 month period (60% attendance), you will forfeit your recurring appointment. This may result in returning to the waiting list or being scheduled for single appointments.

Long-term cancellations: For periods of extended leave from therapy, your child's ongoing appointments are unable to be held. We welcome you to contact the clinic upon your return and you will be prioritised to be

offered the next available ongoing appointment time. The more notice you are able to provide prior to your planned leave, the more we will be able to work with you to organise a plan for your child's therapy upon your return.

Travel

Travel costs from De Silva Kids Clinic will be determined based on the NDIS travel terms. The time travelled will claimed up to 30 minutes of time each way, at the rate of the relevant support item. Each individual instance of travel will be claimed based on the time travelled, which may vary due to heavy or light traffic conditions, up to a maximum of 30 minutes.

Non-labour travel costs (total kilometres travelled) will be claimed at the rate of the relevant support item

Suspension of Services The Provider may suspend the delivery of services in the event that:

• The Participant/ Representative fails to pay the amount required for the service delivered.
• The Participant/Representative does not comply with the responsibilities outlined in this agreement.
• The Participant/Representative regularly fails to attend sessions with or without notice (attendance rate falls below 60%).
• The Participant/Representative has any unpaid invoices
• The Participant/Representative fails to rectify any issue identified by the Provider that may hinder the effective delivery of services.
• The Provider determines that the delivery of services poses a risk to the safety of the Participant or an employee of the Provider; and/or
• The Provider receives a directive from the NDIA (or another Government body) to suspend the delivery of services.

Feedback, Complaints and Disputes

If the participant wishes to give the provider feedback, the participant can talk directly to their therapist or to the practice manager on 8418 8544.
If the participant is not happy with the provision of supports and wishes to make a complaint, the participant can talk to the practice manager on 8418 8544.
If the participant is not satisfied or does not want to talk to this person, the participant can contact the NDIS Quality and Safeguards Commission by calling 1800 035 544 or visiting www.ndiscommission.gov.au for further information.

The Participant/Participant’s representative can be contacted on:

Mobile:

Email:  

Address:  

Alternative Contact Person's Contact Details:  

Agreement Signatures

The Parties agree to the terms and conditions of this Service Agreement.

Provider Representative

I, Trudy De Silva, confirm that I have explained the Service Agreement schedule and terms to the Participant/Participant’s representative, and on behalf of the Provider, agree to abide by them.

Signature of Participant/Participant’s representative: