NDIS Service Agreement

A Service Agreement can be made between a Client or their Authorised Representative (e.g. a parent, guardian or other nominated person) and a Provider.

In this Service Agreement, the term "Party" or "Parties" refers to Enable Occupational Therapy (Enable OT) and the Client/Client's Authorised Representative who is making this Agreement.

Client Details

Client First Name *

Client Surname *

The Person that is Authorised to sign this Service Agreement is:

The Client? *

The Authorised Representative? *

Clients Authorised Representative *

and Practice Name

The NDIS and this Service Agreement

This Service Agreement is made for the purpose of providing supports under the Client's National Disability Insurance Scheme Plan.

The Parties agree that this Service Agreement is made in the context of the NDIS, which is a scheme that aims to:

Support the independence and social and economic participation of people with disability, and
Enable people with a disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports.

Contact Details

Client First Name

Client Surname

Client Date of Birth *

NDIS Number

Phone

Email

Address *

Client's Representative's Name

Client Representative Phone *

Client Representative Email *

Client Representative Address

Relationship to Client

Consent

At times, it may be helpful for us to talk with other people involved in your care. Only information relevant to the service we are providing will be discussed. We will not talk with anyone that you do not want us to speak with.

The Client/Client Representative consents to Enable OT liaising with:

Schedule of Supports

Update on Current Service Agreement for this Plan Period

Previously used hours

Service Start DateThese are the dates in which Enable Occupational Therapy will be providing supports

Service End Date

Please prepare my funding in

Total Dollars *

Total Hours *

Budget Allocation Hours

Budget Allocation Dollars

Occupational Therapist

Email

Type of Support:

Clinical assessment and treatment
Clinically relevant communications including phone calls/written programs/communication with other health professionals (any task that takes more than 6 minutes will be invoiced)
Attendance at team meetings/case conferences
Assessment and trial of equipment as required
Any reports, forms, or letters as required by the NDIS or requested by the client / client representative
Cancellation charges for late notice or no show appointments

Enable OT reserves the right NOT to provide service or to cancel any future appointments for the client if you do not have sufficient funds in your plan or the plan expires. Any service fees not met by NDIS will be covered by your client / client representative.

Price and Payment Information:

The hourly rate is in accordance with the conditions stated in the NDIS Pricing Arrangement. The hourly rate, travel rates and guidelines for services included (including cancellation policy) will be subject to change, in accordance to changes to the NDIS Pricing Arrangement. The fees are:

Occupational Therapy: $193.99 per hour plus $193.99 per hour for any associated therapist travel.
We may charge an additional travel - non labour travel cost: $0.97/km for any associated travel.

If any Enable OT Therapist arrives to a confirmed appointment, and the Participant declines service, is not present or does not show up after contact attempts, then both non-attendance of the appointment and any relevant travel will be charged.

Travel

Travel will be charged in accordance with NDIS guidelines for Capacity Building Supports. Guidelines currently specify travel to and from appointments is billable at an hourly price limit in the following increments:

Up to 30 minutes (each way) for MMM1-3 areas and

Up to 60 minutes (each way) for MMM4-5 remote areas

Payments

Please note: this is an updated Service Agreement to include both previously used hours and further requested hours for this Plan period.

Enable OT will seek payment for their provision of supports after the supports have been delivered in accordance with the clients plan funding type noted below:

Funding Management Type *

SELF MANAGED - The client / client representative has chosen to self-manage the funding for NDIS supports provided under this Service Agreement. After providing those supports, Enable OT will send the client / client representative an invoice for those supports for the client / client representative to pay. PLAN MANAGED - The client has nominated a Plan Management Provider to manage the funding for NDIS supports provided under this Service Agreement. After providing those supports, Enable OT will claim payment for those supports from:

Email for billing *

Plan Manager *

Plan Manager Email *

Copy of Client's NDIS Plan

It is helpful for the Therapist to have a copy of the My Profile and Goals sections of the NDIS Plan. This ensures we are working towards your stated goals. It also helps when applying for funding and completing reports for the NDIS when needed. It is helpful to include the Funding Sections of your Plan, especially if you need to apply for Assistive Technology; Home Modifications or Home and Living Supports.

It is your choice whether or not to provide a copy of all or parts of the NDIS Plan.

NDIS Plan for the current period

Browse

Rights & Responsibilities

Enable OT agrees to;

Provide Therapy services as per this agreement and in accordance with NDIA procedures.
Work in collaboration with you to achieve your goals.
Communicate openly and honestly with you.
Be polite and friendly and treat you with respect at all times.
Explain things clearly so you understand every step of the process.
Include you in all decisions about your supports.
Listen to your feedback and act quickly upon any complaints you report to us.
Store your information carefully and maintain your privacy

You agree to;

Notify Enable OT about any changes you wish to be made to this Service Agreement.
Notify Enable OT if your NDIS plan changes (e.g. if you have a booked plan review).
Provide at least 24 hours notice if you wish to cancel a booked service.
Provide at least 24 hours notices if you wish to terminate our services. You will be billed for the hours of service provided to the date of termination.
Pay invoices by the due date.

Cancellation Policy

Short notice cancellations or non-attendance, where notice is given with less than 1 clear business day before the scheduled appointment, may result in 100% of the appointment fee being charged (except in extenuating circumstances), including any travel (or part thereof) already undertaken.

The NDIS allows for the Client's Plan to be charged for late cancellations/failure to attend by Clients. If there are frequent cancellations, Enable OT will contact you to try to understand why they are occuring and see if anything needs to change in the delivery of the therapy services to support the Client. Clients must pay for any cancellation fees not covered by the NDIS.

Outstanding Fees

Outstanding fees need to be paid prior to further services being provided. If fees are not paid, Enable OT may contact the following (where applicable) to recover the outstanding debt:

Plan Manager
Support Coordinator
LAC/ECEI Partner
NDIA
Debt collector
The Client/Client's Representative will be liable for any outstanding debts that are not payable by the NDIA and also the costs associated in recovering such debts

Goods and Services Tax (GST)

For the purposes of GST legislation, the Parties confirm that:

a supply of supports under this Service Agreement is a supply of one or more of the reasonable and necessary supports specified in the statement included, under subsection 33 (2) of the National Disability Insurance Scheme Act 2013 (NDIS Act), in the Client's NDIS plan currently in effect under section 37 of the NDIS Act;
the Client's NDIS plan is expected to remain in effect during the period the supports are provided; and
the Client/Client's Authorised Representative will immediately notify Enable OT if the Client's NDIS plan is replaced by a new plan, or if the Client stops being a client within the NDIS.

Making a Complaint

We will strive to ensure that your experience with Enable OT is a positive one, however in any instance where you are unhappy with our service, feel free to discuss this with us as soon as possible. Please be assured that we welcome all feedback and will endeavour to resolve any issues or concerns in a timely manner.

If you have a concern, you can speak directly to the Enable OT director:

Janelle Brumpton
T: 03 4310 1340
E: janelle@enableoccupationaltherapy.com.au

If you don’t wish to discuss your complaint with Enable OT, or if you feel that your issue is not being resolved satisfactorily, you can contact your NDIS Support Coordinator or Plan Manager. Alternatively, you can contact the NDIA who can provide you with information on what you can do.

NDIA T: 1800 800 110 http://www.ndis.gov.au

Changes to this Service Agreement

If changes to the supports or their delivery are required, the Parties agree to discuss and review this Service Agreement. The Parties agree that any changes to this Service Agreement will be in writing, signed, and dated by the Parties.

Ending this Service Agreement

Should either Party wish to end this Service Agreement they must give 48 hours notice.

If either Party seriously breaches this Service Agreement the requirement of notice will be waived.

Signatures

Are all details correct? *

Yes - proceed to signing Service AgreementNo - please review and update

Review Note

I consent for my Signed Service Agreement to be provided to:

my Plan Manager (if appropriate)my Support Coordinator

Plan Manager Email

Support Coordinator Name *

Support Coordinator Email *

By signing this Agreement, you agree to all of the information included.

Please note, if we do not receive back a signed copy of this Agreement and the Client continues to attend appointments after receiving, it is implied the Client / Client's Authorised Representative have accepted the terms within this Agreement.

I have read & understood this Service Agreement and understand each item listed within. I understand Enable OT will be engaged to provide services that it is entitled to receive payment in return.

I confirm that authority has been delegated to me the undersigned, to represent the Client and execute this Agreement as the Client's Authorised Representative.

Signature *

Draw signature|Type signatureClear

Date

Client

Signed on behalf of:

Client

Date

Thank you - we will review your response promptly and return an updated form for you to approve.

Please hit "Submit" button below to proceed.

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