Continuous Glucose Monitoring: NDIS versus NDSS

A continuous glucose monitor (CGM) is a small wearable device that measures glucose levels throughout the day and night. It lets the user know what their glucose level is at any time, and whether it is stable or on the way up or down. It has alarms to let the user know if glucose levels are getting too low or too high.

These devices reduce the frequency of daily fingerprick blood glucose checks. Some devices can work in conjunction with a compatible insulin pump while others send information to a CGM receiver or and app on your smartphone.

The NDSS

Registration with the NDSS is free to all eligible individuals and registration only needs to be done once.

Providing you are eligible to register on the NDSS and your registration form is correctly certified by your doctor, diabetes educator or nurse practitioner, you are eligible to access NDSS products and services.

The NDSS CGM Initiative

On 26 November 2018, Minister Hunt announced that the Government would expand the CGM Initiative through an investment of more than $100 million, effective from 1 March 2019, to also provide fully subsidised CGM products to the following groups of people:

  • children and young people with conditions very similar to type 1 diabetes who require insulin; and
  • women with type 1 diabetes who are actively planning pregnancy, or are either pregnant or in the immediate post-pregnancy phase; and
  • people with type 1 diabetes aged 21 years or older who have concessional status and a high clinical need to access CGM products.

As a result of this announcement, over 37,000 Australians will be eligible to receive fully subsidised CGM products.

Eligibility to Access Subsidised CGM Products through the NDSS

To access CGM products through the NDSS, you need to be assessed by an authorised health professional to determine whether you meet specific eligibility criteria and to ensure that the use of CGM will help as part of your diabetes management.

If you do not meet the specific clinical criteria but your health professional believes that you have an equivalent level of high risk / high clinical need, consideration may be given on a case-by-case basis.

The NDIS

The National Disability Insurance Scheme (NDIS) is Australia’s first national scheme for people with a disability, it provides reasonable and necessary funding to people with a permanent and significant disability to access the supports and services they need to live and enjoy their life. The NDIS is implemented by the NDIA, The National Disability Insurance Agency.

CGM through the NDIS

In some cases you may be able to get CGM through the NDIS, through the following NDIS category: Consumables (Support Category 1.03)

Consumables are a support category available to assist participants with purchasing everyday use items. Supports such as continence and home enteral nutrition (HEN) products are included in this category. More information on these supports can be found in the Assistive Technology and Consumables Code Guide on the Assistive Technology webpage.

Assistive technology is defined in the NDIS as “any device or system that allows a participant to perform tasks that they would otherwise be unable to do, or which increases the ease and safety with which tasks can be performed.” Assistive technologies can also be referred to ‘aids’ or ‘equipment’.

In relation to assistive technology supports, the NDIA must consider whether the support is related to your disability and, before including any assistive technology support in your plan, the NDIA must also be satisfied that the support will assist you to pursue your goals, objectives and aspirations.

If you are looking at applying for CGM through the NDIS it is worthwhile obtaining a letter from your specialist and/or CDE outlining why CGM would benefit the management of your disability and how the diabetes is impacting on your disability. The NDIS states: “Generally, a written report detailing clinical reasoning and justification of recommended assistive technology is required prior to approval of funding for complex, high risk or specialised assistive technology”, such as CGM.

NB: the NDIA may provide “additional funds for a participant to receive necessary expert assessment or assistance with selection, fitting, configuring and training where these services are not otherwise available as part of the purchase price or part of the standard service offering”. This could theoretically include diabetes education, please check with your service provider.

Please talk to your healthcare provider for more details.

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