Exceptional circumstances

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)?

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
• The person understands the item is being loaned to them and will return to the EnableNSW Equipment Centre when their long term funding source has commenced (this does not apply to wearables and consumables).

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 qualifies for an Australian Government Home Care Package, can I apply through COEC?

My Aged Care, through The Australian Government, has an escalation process that must be followed before applying to COEC.

Here are a few common scenarios to consider before applying:

1. This person has had an ACAT assessment and is eligible for a home care package, however they are not actively seeking services at this time (this means they have removed themselves from the National Queue)
   • This person would not be eligible for EnableNSW. If you have identified an immediate acute health impact, please contact us to discuss in the first instance.
2. The person is on the national prioritisation queue for a home care package and cannot bring their funding forward?
   • We may consider a request for this person through COEC, where they can demonstrate all other funding sources have been exhausted and there is an acute health impact.
3. The person has accepted an interim package while waiting for a higher package and has exhausted their funding?
   • We may consider a request for this person through COEC, where they can demonstrate all other funding sources have been exhausted and there is an acute health impact.
4. The person is on their allocated package and has exhausted all their funds?
   • We may consider a request for this person through COEC, where they can demonstrate all other funding sources have been exhausted and there is an acute health impact.

We remind prescribers that all applications through COEC must meet the above criteria

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.