Prosthetic limbs and the NDIS.

We are often asked questions about specific supports and whether they are funded through the NDIS.

One specific support that we have been hearing a lot about lately is prosthetic limbs, so we thought we’d outline some of the key information and share it with everyone.

What exactly is a prosthetic limb?

Prosthetic or artificial limbs are devices that aim to, in some capacity, replace the functions of a natural arm or leg which may have been lost due to an accident or illness or is absent at birth. For the people in this situation, a prosthetic limb can help improve their quality of life.

A prosthetic limb is fit to a person’s residual limb with a custom made socket. There are a wide range of prosthetic limbs available that vary in function as well as appearance and cost.

Are prosthetic limbs covered under the NDIS?

Prosthetic limbs are covered but as is the case with all supports, the NDIS must be satisfied that the cost of the support is reasonable and necessary. Generally, funds for a prosthetic limb will be provided when:

• The prosthetic is prescribed by health professionals who are designated and accredited by the artificial limb service in the state or territory where you reside
• The prosthetic specifications meet the minimum level of components required related to:
  • Your weight
  • Your goals and aspirations
  • Your ability to use, put on and remove the prosthetic
  • Your ability to care for the limb
  • Your other medical needs like the residual limb shape, skin integrity and alignment-relevant conditions where one or more conditions exist at the same time.

The prosthetic should also take into consideration your needs and requirements to make sure it’s as useful as possible.

This means thinking about what you need the limb to do and whether the prosthetic provides a good match for those needs by considering:

• Your functional level (based on the K classification or other standard measure)
• The environment where you will use your prosthetic (indoor or outdoor surfaces, stairs or ramps)
• The impact of daily activities on your limb.

The NDIS will also review the total cost of materials, parts and labour to ensure the prosthetic limb represents value for money.

So what will the NDIS fund?

In general, the NDIS will fund:

• Entry level or standard grade prostheses for participants up to K2 classification
• Higher grade prosthesis will be considered for K3 and K4 classification
• Osseointegrated implants
• Repairs, maintenance, adjustments
• Additional costs related to prosthetic limbs such as limb socks and sheaths (typically 6 per year)
• Upper limb myoelectric prosthesis in specific cases
• Replacement limbs when needed (typically every 3 years for adults and as needed for children under 18 years).

In general, the NDIS won’t fund:

• A spare prosthetic limb
• Repairs needed due to use outside what was recommended
• A microprocessor joint or computerised components for K4 level, unless the functional benefit is warranted.
• For more information on what the NDIS will and won’t fund, take a look at the operational guidelines on prosthetic limbs and the NDIS.

[Image description: Kurt Fearnley, wearing a suit and smiling. Source: AAP / Mick Tsikas]

BREAKING NEWS!

Kurt Fearnley has been appointed as the new chair of the National Disability Insurance Agency.

Fearnley, a disability advocate and three-time Paralympic gold medallist, was appointed chair of the agency’s board on Monday, the first time a person with disability has held the position.

Read more.

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If you have more questions or would like help getting started on your NDIS journey or preparing for a NDIS Plan meeting, call us on 1300 05 78 78 to ask any questions or sign up to Leap in! plan management today.

Further reading