The LSA is still considering options to make self-directed support available in the future and will advise participants when they can access self-directed support.

  • 1.1This Part applies in relation to services under subsection 27(5) of the Act.

Editorial Notes –

Section 53 of the Act provides that to the extent possible, the Scheme is to have extra-territorial effect, in relation to the matters listed in subsection 53 (a), (b) and (c). This means that self-directed support can be offered to Participants who wish to reside permanently at an international residence.

  • 1.2This Part contains the rules with respect to Self-Directed Support and reimbursement arrangements.

  • 2.1Self-Directed Support means TCS services that an eligible Participant or Decision Maker or both, as the case may require, engages, organises and funds themselves, from an amount agreed with, and paid over to the Participant or Decision Maker by the LSA, under a Self-Directed Support Agreement.

Editorial Notes –

Self-Directed Support is sometimes referred to as ‘self-managed funding’ or ‘individualised funding’.

  • 2.2Subject to the Act and these Rules, the LSA, in its absolute discretion, may offer an eligible Participant or Decision Maker or both as the case may require, (the Offeree) the opportunity to enter an Agreement.
  • 2.3The Offeree can refuse or accept the offer.
    • 2.3.1If the Offeree refuses the offer, TCS will continue to be funded in the normal manner consistent with the requirements of the Act and the Rules.
    • 2.3.2Before accepting the offer, the Offeree must obtain competent independent financial and any other advice relevant to their circumstances, for which the LSA will pay the reasonable costs.
  • 2.4The LSA may, in its absolute discretion, but subject to the Act and these Rules, grant or refuse a request by an Offeree to self-direct all or part of their funding for TCS services in an Agreement.
  • 2.5The amount paid by the LSA to the Offeree will satisfy any liability that would otherwise arise in relation to the matters to which the Agreement relates.
  • 2.6The LSA is not liable for any taxation, social security or other financial issues arising from the Offeree accepting the offer.

  • 3.1An offer of self-Directed Support may be made to Interim or Lifetime Participants.
  • 3.2An offer of self-Directed Support must not be made to Interim or Lifetime Participants if they are an insolvent under administration, or if, in the opinion of the LSA, it would create an unreasonable risk.

  • 4.1When evaluating unreasonable risk, the LSA will consider:
    • 4.1.1whether material harm, including material financial harm, to the Participant could result if the Offeree were to manage the funding for supports, taking into account the nature of the supports required; and
    • 4.1.2the vulnerability of the Offeree to:
      • 4.1.2.1physical, mental or financial harm;
      • 4.1.2.2exploitation;
      • 4.1.2.3undue influence.
  • 4.2The LSA will also consider:
    • 4.2.1the ability of the Offeree to make decisions and any decision supports available to the Offeree;
    • 4.2.2the capacity of the Offeree to manage finances;
    • 4.2.3whether a court or a tribunal has made an order under Commonwealth, State, Territory or international law under which the property (including finances) or affairs of the Participant or Decision Maker or both, as the case may require, are to be managed, wholly or partly, by another person;
    • 4.2.4financial and reputation risk for the Scheme; and
    • 4.2.5whether, and the extent to which, any risks could be mitigated by:
      • 4.2.5.1the Offeree’s informal support network;
      • 4.2.5.2any safeguards or strategies the LSA could put in place, which, if required, will be outlined in the Agreement or other relevant documents.
  • 4.3The safeguards referred to above may include, but are not limited to:
    • 4.3.1establishing review periods in the Agreement; or
    • 4.3.2providing funding for supports that would assist the Offeree to manage their TCS.

For example, budgeting training.

  • 5.1The Agreement will be in a form determined by the LSA.
  • 5.2Subject to Rule 5.3, the LSA must take a Person-Centred Approach when determining the content of each individual Agreement.
  • 5.3The Agreement must contain the following clauses:
    • 5.3.1The term of the Agreement;
    • 5.3.2The amount of the funds to be provided to the Offeree, which will be determined in accordance with Rule 5.5;
    • 5.3.3The TCS services agreed between the parties as being necessary and reasonable based on the Person-Centred Approach;
    • 5.3.4The TCS services covered by the Agreement;
    • 5.3.5An obligation on the Offeree, which shall be a fundamental term, to spend the funds on, and only on, the agreed services;
    • 5.3.6The circumstances when the Offeree (or other authorised person) must return unexpended funds to the LSA including but not limited to:
      • 5.3.6.1If the Participant dies (where the authorised person would be the executor of their will); or
      • 5.3.6.2If the LSA cancels, suspends or changes the Agreement;
    • 5.3.7A clause providing that the LSA may seek recovery of funds under Rule 5.3.5 as a debt due to the Crown.
    • 5.3.8A clause requiring the Offeree to provide financial reports to the LSA (including agreed information, reconciliations and accounts) sufficient for the LSA to effectively review and support the Offeree and ensure they meet the LSS Rules.
    • 5.3.9The circumstances in which the Agreement may be altered, suspended or terminated by the Offeree;
    • 5.3.10A clause giving the LSA power to cancel, suspend or change the Agreement in the event of:
      • 5.3.10.1fraud by the Offeree or a person for whom the Offeree is responsible;
      • 5.3.10.2undue influence by third parties over the Offeree;
      • 5.3.10.3death of the Participant or Offeree;
      • 5.3.10.4the emergence of risk that the LSA considers to be unreasonable in the circumstances; or
      • 5.3.10.5the Offeree no longer having decision making capacity; or
      • 5.3.10.6the Participant’s Decision Maker no longer having authority to act on the Participant’s behalf.
    • 5.3.11A regime for giving notice of alteration, suspension and termination;
    • 5.3.12Any applicable clauses usually contained in Crown agreements.
  • 5.4The Agreement may contain clauses:
    • 5.4.1Whether the Offeree is authorised to lend or invest the amount paid over, and if so, on what terms or in what asset classes as the case may be; and
    • 5.4.2Such other provisions as the individual case requires.
  • 5.5The LSA will determine the amount to be paid over pursuant to the Agreement, based on an independent actuarial calculation and taking into account, including but not limited to, the following factors:
    • 5.5.1The Participant’s age at the time of injury and their current age;
    • 5.5.2The nature and severity of the Participant’s injury;
    • 5.5.3The current objective assessment of the Participant’s functional status;

For example, using the FIM™ or WeeFIM® and ASIA Impairment Scale Score.

  • 5.5.4Objective assessments of the Participant’s previous and current TCS needs;
  • 5.5.5The nature, frequency and duration of services used to meet TCS needs, including any variations in needs during periods of transition;
  • 5.5.6The term of the Agreement; and
  • 5.5.7Relevant discounting of the amount, as related to the term of the Agreement.

  • 6.1Subject to the Act and these Rules, the LSA, in its absolute discretion, may enter into a Reimbursement Arrangement with a Participant or Decision Maker or both, as the case may require.
  • 6.2The LSA will not reimburse any payment unless there is a valid Reimbursement Arrangement in place.
  • 6.3A Reimbursement Arrangement must contain the following clauses:
    • 6.3.1The term of the Reimbursement Arrangement:
    • 6.3.2The specific TCS services or activity to which the Reimbursement Arrangement will apply;
    • 6.3.3A clause providing that reimbursement will only be made on the presentation of receipts or other evidence that the Participant or Decision Maker have paid for the service in question.
    • 6.3.4A clause providing that receipts submitted more than 12 months after the service occurred will not be considered for reimbursement.
    • 6.3.5The circumstances in which the Reimbursement Arrangement may be altered, suspended or terminated by the Participant or Decision Maker or both as the case may require.
    • 6.3.6A clause giving the LSA power to cancel, suspend or change the Reimbursement Arrangement in the event of:
      • 6.3.6.1fraud by the Participant or Decision Maker or both as the case may require or a person for whom they are responsible;
      • 6.3.6.2undue influence by third parties over Participant or Decision Maker or both as the case may require;
      • 6.3.6.3death of the Participant or Decision Maker;
      • 6.3.6.4the emergence of risk that the LSA considers to be unreasonable in the circumstances; or
      • 6.3.6.5the Participant or Decision Maker or both as the case may require no longer having decision making capacity; or
      • 6.3.6.6the Decision Maker no longer having authority to act on the Participant’s behalf.
    • 6.3.7A regime for giving notice of alteration, suspension and termination;
    • 6.3.8A clause providing that the LSA may seek recovery of funds under Rule 6 as a debt due to the Crown.

Page last updated: 7 December 2022