Please be aware that the eligibility criteria for consideration of exceptional circumstances will be reviewed periodically and may change dependent upon demand and available budget. Any updates will be provided on this page.
- What is Consideration of Exceptional Circumstances (COEC)?
- Why is this option available?
- What factors do I need to consider before submitting an application through COEC?
- What is an acute health risk?
- The person is a confirmed National Disability Insurance Scheme (NDIS) participant and does not have any funds, can I apply through COEC?
- What evidence do I need to provide that I have looked at other funding options?
- What equipment can I request?
- Will EnableNSW repair equipment that has been provided through COEC?
- Can I apply for equipment that EnableNSW would not normally fund?
- Is the person required to return the equipment?
- What other options should I consider or explore?
- Why am I requested to contact EnableNSW before I submit an application?
- If an application has been declined through COEC can I appeal the decision?
- How long will COEC be in place?
What is Consideration of Exceptional Circumstances (COEC)?
In exceptional circumstances, discretion may be exercised by the Manager, EnableNSW to approve an application that otherwise does not meet the eligibility criteria for accessing our supports.
Why is this option available?
This discretionary pathway was introduced to help people access one off funding for aids and/or equipment to manage an immediate health risk.
We understand the challenges many prescribers face when navigating long term funding sources for people who need assistance immediately.
What factors do I need to consider before submitting an application through COEC?
Each application received through this discretionary process is assessed on a case by case basis. To help us make the decision you must be prepared to demonstrate the following:
- The application does NOT meet the EnableNSW eligibility guidelines and
- The person has an immediate and acute health need that is impacting their ability to manage their condition safely within the home/community setting. We may also consider the impact to the health system more broadly i.e. equipment needed for hospital discharge or readmission to hospital and/or the risks to the carer and
- There are lengthy delays in accessing support through the relevant long term funding source and
- You have escalated appropriately to the relevant long term funding source (please be prepared to tell us the outcome of this) and
- Alternate funding sources have been explored (please be prepared to tell us what you have done and the outcome of this) and
- The equipment request meets EnableNSW funding criteria.
What is an acute health risk?
Typical examples include pressure injuries, infections, high risk of immediate falls or a high potential for carer injury. We may also consider applications that demonstrate a person is at high risk of being admitted into a facility for care, readmission to hospital or unable to discharge from hospital.
The person is a confirmed National Disability Insurance Scheme (NDIS) participant and does not have any funds, can I apply through COEC?
The NDIS has an escalation process that must be followed before applying to COEC. If you are a private prescriber please escalate to your Local Area Coordinator. If you are a NSW Health Prescriber, you need to escalate to the Local Health District NDIS transition lead.
We understand a plan review for additional funds may not happen immediately. To be able to make our decision, we need information about the steps you have taken to have this matter resolved (including the response from the National Disability Insurance Agency) and when the person’s plan review is scheduled.
We remind prescribers that all applications through COEC must meet the above criteria
What evidence do I need to provide that I have looked at other funding options?
We can accept written correspondence such as emails or letters from the relevant organisation. We can also accept summary of conversations you may have had with relevant people.
What equipment can I request?
We keep a broad range of equipment in stock for immediate use that is clinically suitable for at least 80 per cent of applications. Where this equipment may not be appropriate you should contact us to discuss alternative options, including contract items. Please be prepared to tell us why stock items do not meet the person’s clinical needs.
Will EnableNSW repair equipment that has been provided through COEC?
Yes. We will repair the equipment until the persons long term funding source has commenced.
When the person’s long-term funding is due to commence they should talk to their service provider to ensure funds are available for ongoing repairs and maintenance.
Can I apply for equipment that EnableNSW would not normally fund?
We will only consider applications for equipment that is covered by the EnableNSW funding criteria for each program. We cannot consider items that EnableNSW would not normally fund, even in exceptional circumstances.
Is the person required to return the equipment?
Yes. When the person’s long-term funding is due to commence they should ensure funds are available for equipment. The person should contact EnableNSW and we will collect the equipment, refurbish items as required and add them back to our equipment pool where suitable.
What other options should I consider or explore?
- Use funds from a person’s Australian Government Home Care Package (HCP) to hire the equipment
- For all matters relating to a HCP, the National Aged Care Advocacy line (1800 700 600) may also be able to assist
- Use the appropriate escalation channels to appeal the wait time of the person’s long term funding source
- If your client is a NDIS participant:
- Private prescribers should escalate to their Local Area Coordinator (LAC)
- NSW Health should escalate to their Local Health District NDIS transition lead
- Check availability from your local equipment loan pool in a hospital or other health facility.
Why am I requested to contact EnableNSW before I submit an application?
From the information you provide us over the phone we will let you know if the COEC process is right for the person. We understand your time is valuable and where possible we want to avoid asking you to complete additional paperwork if we know the circumstances do not meet the COEC criteria. Relevant forms are sent following phone consultation.
If an application has been declined through COEC can I appeal the decision?
The decision to decline an application through COEC cannot be appealed. We remind Prescribers the importance of ensuring the request for discretionary consideration demonstrates the above criteria before submitting the application.
How long will COEC be in place?
It is important to know COEC is a discretionary process and is being reviewed periodically based on demand and available budget.
We strongly encourage you to explore alternate funding sources as it is unlikely this discretionary process will be available long term.