letters of denial and excuse:

Dear Ms Yeo and Ms Bowden
I refer to your correspondence to the Minister for Health and Aged Care, the
Hon Mark Butler MP regarding the inclusion of cleft conditions in the National Disability
Insurance Scheme (NDIS), and the inclusion of speech services in the Cleft Lip and Cleft
Palate Scheme (CLCPS). The Minister has asked me to reply. I apologise for the delay in
responding.
The CLCPS provides government funding to assist families with treatment costs for certain
cleft and craniofacial conditions requiring major dental and skeletal treatment. Under the
CLCPS, Medicare benefits provide support for a limited range of orthodontic, oral surgery
and general prosthodontic services for eligible patients. Patient eligibility is defined in
Section 3BA of the Health Insurance Act 1973 which can be found at
www.legislation.gov.au/
Details/C2015G01229.
Medicare Benefits Schedule (MBS) rebated speech pathology services may be available for
patients under Chronic Disease Management (CDM) and Team Care arrangements. These
CDM arrangements are GP-led. Where a patient’s GP determines that a patient has a
chronic or terminal condition, they can write a GP Management Plan for the ongoing
treatment of the patient’s condition. If that condition requires a multidisciplinary team, the
GP will provide Team Care Arrangements and referrals to allied health practitioners, who
can include speech pathologists. Patients can access up to five MBS-eligible allied health
services per calendar year.
In 2018, the Cleft Dental Services Working Group was established to review the CLCPS and
make recommendations to the MBS Review Taskforce on related MBS items. The working
group’s report is available on the Department of Health and Aged Care’s website at
www.health.gov.au by using the search term ‘cleft dental services MBS’. The report made
no recommendations on the inclusion of speech therapy in the CLCPS.
In response to recommendation 3 of the report, changes to patient eligibility to the CLCPS
were announced in the Guaranteeing Medicare – Medical Benefits Schedule new and
amended listings 2022−23 Budget measure. This measure will improve access to cleft and
craniofacial services by removing from the relevant legislation the age requirements
currently restricting these services. Implementation of the removal of age restrictions is
currently scheduled for November 2023.
2
Your suggestion for the inclusion of the cleft palate condition in the NDIS falls outside the
remit of the Health Department’s portfolio. Advice in relation to your suggestion could be
sought from the National Disability Insurance Agency directly on 1800 800 110 or via email
at enquiries@ndis.gov.au.
Thank you for writing on this matter.
Yours sincerely
Nigel Murray
Assistant Secretary
MBS Policy & Specialist Services Branch
Medical Benefits Division
25 July 2022

Dear Ms Morris
Thank you for your correspondence of 23 June 2022 to the Assistant Minister for
Mental Health and Suicide Prevention and Assistant Minister Rural and Regional
Health, the Hon Emma McBride MP, regarding the inclusion of speech therapy services
in the Cleft Lip and Cleft Palate Scheme (CLCPS), and government funding to cover the
cost of speech therapy for people with cleft conditions through the National Disability
Insurance Scheme (NDIS). The Assistant Minister has asked me to reply.
The CLCPS provides government funding to assist families with treatment costs for
certain cleft and craniofacial conditions requiring major dental and skeletal treatment.
Under the CLCPS, Medicare benefits provide support for a limited range of
orthodontic, oral surgery and general prosthodontic services for eligible patients.
Patient eligibility is defined in Section 3BA of the Health Insurance Act 1973
(Prescribed Dental Patients).
MBS-eligible speech pathology services may be available for patients under Chronic
Disease Management (CDM) and Team Care Arrangements. CDM arrangements are
initiated by the patient’s general practitioner (GP). Where a patient has a chronic
condition, a GP can write a management plan for the ongoing treatment of the
patient’s condition. If that condition requires care from a multidisciplinary team, the
GP may initiate team care arrangements and referrals to allied health practitioners,
including for speech pathology services. Patients can access up to five MBS-eligible
allied health services per calendar year via CDM arrangements.
In 2018, the Cleft Dental Services Working Group was established to review the CLCPS
and make recommendations to the Medicare Benefits Schedule (MBS) Review
Taskforce on related MBS items. The working group’s report is available on the
department’s website. The report made no recommendations on the inclusion of
speech therapy in the CLCPS.
In response to recommendation 3 of the report, changes to patient eligibility to the
CLCPS were announced in the Guaranteeing Medicare – Medical Benefits Schedule
new and amended listings 2022−23 Budget measure. This measure will improve access
2
to cleft and craniofacial services by removing from the relevant legislation the age
requirements currently restricting these services. Implementation of the removal of
age restrictions is currently scheduled for November 2023.
Your suggestion for NDIS funding for the cost of speech therapy services for cleft
palate patients falls outside the remit of the Health Department’s portfolio. Advice in
relation to your suggestion could be sought from the National Disability Insurance
Agency directly on 1800 800 110 or via email at enquiries@ndis.gov.au.
Thank you for writing on this matter.
Yours sincerely
Nigel Murray
Assistant Secretary
MBS Policy & Specialist Services Branch
Medical Benefits Division
18 July 2022

Dear CleftPALS Victoria
Thank you for your letter of 9 April 2022 to Senator the Hon. Linda Reynolds,
Minister for the National Disability Insurance Scheme, about access to the National
Disablity Insurance Scheme (NDIS) for individuals with the cleft palate condition.
The Minister has asked me to reply on her behalf.
To be eligible to acces the NDIS, a person must demonstrate they meet the age,
residency and disability or early intervention access criteria as outlined in the
National Disability Insurance Scheme Act 2013. Each application to access the NDIS
is based on the applicant’s individual circumstances and the evidence they provide.
Where an individual with a cleft condition applies for the NDIS, their eligibility is not
determined by the diagnosis of their condition. Rather, the National Disablity Insurance
Agency (NDIA) will seek to understand the impairment/s that arise from their condition,
how this impacts their ability to carry out everyday tasks, and whether these impacts
are likely to be lifelong.
A person may meet the disability requirements if they have a disability caused by a
permanent impairment. The evidence must also demonstrate theat the person has
substantially reduced functional capacity to do one or more daily activities, that that
supports will be required for their lifetime.
Page 2 of 3
A person may met the early intervention requirements if they have a permanent
impairment, or if they are a child who has a developmental delay. There must also be
evidence that the provision of early intervention supports will reduce the person’s
future need for supports in relation to disability, and that the early intervention support
is most appropriately funded or provided through the NDIS.
It is important to note that when considering the disability and early intervention
requirements, the NDIA does not assess the permanency of a condition. It is the
permanency of the impairment that is assessed. This means we consider whether any
known, available and evidence-based treatments would be likely to remedy (i.e. cure
or substantially relieve) the impairment, or whether the impairment requires further
medical treatment or review for its likely permanency to be demonstrated. This may
include treatments such as surgical intervention or speech services which are
commonly prescribed for a cleft palate, as you have noted.
The NDIS is not designed to replace existing mainstream services responsible for
providing supports to people with disability, such as the health system. This means
where a support is most appropriately funded by another system, the NDIS will not
fund that support. For example, the NDIS will not be responsible for clinical treatment,
including rehabilitation or post-acute care following a recent medical or surgical event
(rule 7.5 of the NDIS Suppports for Participant Rules 2013).
There are a number of supports and services provided by government and the
community sector for people with disability across Australia. If a person does not meet
the eligibility requirements to access the NDIS, guidance can be provided by Local
Area Coordinators and Early Childhood Partners to engage with other support
systems.
Page 3 of 3
Thank you again for writing.
Yours sincerely
Cassie Hammond
Branch Manager
National Access and Reviews Branch
National Disability Insurance Agency
22 April 2022