Definitions

Provider

An individual or organisation that delivers support or services to a participant of the NDIS.

Participant

A person with a disability who is funded by the National Disability Insurance Scheme (NDIS).

Support Coordination

A service that helps connect NDIS participants to support and community services, and helps you understand and utilise your NDIS plan.

Support Provider

An organisation that connects NDIS participants with support workers and helps with the delivery of ongoing support.

Representative

A person or persons who are assisting and/or acting on behalf of the Participant.

Service Agreement

A document that outlines the terms of service between two parties.

Provider Details

Business Name

Emerald Vine Pty Ltd trading as The Improvement Movement Perth

ABN

45 672 243 220

Address

24 Augusta Street, Willetton, WA 6154

Phone

0409 243 074

Rates & Billing

Standard Rates

The Provider will only charge for services completed and for short-notice cancellations. Service rates are billed in accordance with the current NDIS Pricing Arrangements and Price Limits, which outline the pricing limits for particular days and time periods, travel allowances, and establishment fees. This document is updated on July 1st every year and service rates may increase without notice.

You can find it here: https://www.ndis.gov.au/media/7150/

Support services and Level 2 Support Co-ordination services are provided flexibly with the person via face-to-face, video call, phone call, email, text or non-face to face for research and report writing. This includes any communication to and from stakeholders and representatives.

Billing Increments

Support Coordination

Billed in 10-minute increments

Provider Support

Billed in 15-minute increments – we aim for a minimum shift of 2 hours

Time taken to write shift notes, prepare progress reports or other documentation requested by the Participant or their representatives are also billable at the service rates outlined above.

Goods & Services Tax (GST)

While your NDIS plan is in effect the supply of reasonable and necessary supports as defined in your NDIS plan are exempt from Goods and Services Tax (GST).

This agreement confirms that the supply of any goods and services are reasonable and necessary supports as specified in the Statement of Participant Supports included in your NDIS plan.

Please provide written notice as soon as possible if the amount of supports specified in your plan is exhausted as excess supports cannot be supplied GST-free.

Payment

Payment is accepted by direct deposit only. Account details will be included on each invoice for your convenience.

Provider’s Responsibilities

Quality and Compliance

The Provider will:

• Aim to provide support services that are person-centred support, relevant to your unique circumstances or preferences.

• Support social and economic community participation.

• Empower the Participant to exercise choice and control in the pursuit of their goals – including dignity of risk.

• Aim to provide suitable, reliable and on-going support, tailored to your needs.

• Aim to maintain open and timely communication between all parties.

• Always treat you with respect and courtesy.

• Consult you or your representative before making decisions about changes to your support services.

• Have effective processes for reporting and documenting incidents, complaints and disagreements.

• Keep your private information secure and confidential, unless you or your representative agree that particular information may be shared with a third party for required service provision, as per the Consent to Share Information Policy.

• Ensure all confidential information inclusive of the participants personal data, health information, risk assessment and other personal details are stored securely and archived when no longer required.

• Take on feedback and adjust where necessary and applicable.

• Give as much notice as possible if a service date has been cancelled for any reason.

• Understand restrictive practices and not impair your rights and freedoms to dictate your own life and maintain your individual choice and control.

• Have quality safeguards in place to safeguard both parties.

• Maintain the delivery of service in a transparent manner.

• Give you adequate notice of this service agreement’s expiry and discuss whether the agreement will be renewed.

• Keep accurate records of services provided to you.

• Maintain compliance with all relevant legislation and NDIS regulations, throughout all aspects of business and service provision.

• Keep all mandatory checks, compliance documentation and insurances current for all staff, including management.

• Remain updated on changes within the NDIS and Disability Sector to ensure compliance, within a reasonable timeframe of such changes.

Health and Safety

The Provider will:

• Notify emergency services of any incidents that pose a health and safety risk to any participant or staff member when deemed necessary as part of their duty of care.

• Document any reportable incidents that they witness or that they are made aware of within 24 hours.

• Complete a risk assessment for safeguarding purposes.

Participant’s Responsibilities

The Participant will:

• Provide the necessary information to the Provider to complete the agreed-upon services outlined in this agreement.

• Inform the Provider about how you wish to receive support to meet your needs and goals.

• Treat all the Provider’s staff members with courtesy and respect at all times.

• Understand that support services are provided to help you build your capacity and are not to be taken advantage of to complete tasks that you are capable of and responsible for completing yourself.

• Act in accordance with the policies and procedures of the Provider and other associated entities, including the Emerald Vine Drug & Alcohol Misuse Policy.

Communication

The Participant will:

• Communicate openly about concerns or changes to your support needs.

• Communicate clearly, openly and directly with the Provider.

• Communicate funding discrepancies or NDIS plan changes that are relevant to the provision of services described within this service agreement to The Improvement Movement Perth management as soon as possible.

• Communicate any intentions to end this service agreement with the Provider as soon as possible.

• Notify the Provider if you have engaged with any other service providers that are providing you with the same services.

• Aim to provide 7 days’ notice for service cancellations.

• Communicate shift cancellations directly to the Provider’s service management team.

Health and Safety

The Participant will:

• Inform the Provider if they or anyone else in their household are sick or have any flu-like symptoms prior to the shift commencing.

• Inform the Provider and/or support worker of any potential risks to health or safety that they are aware of as soon as possible.

• Ensure service locations are safe, tidy and free from potential hazards to the best of their ability and agree to have documented risk assessments performed when necessary.

• Act in accordance with the terms outlined in the Emerald Vine Drug & Alcohol Misuse Policy while engaged in services from the Provider.

Once informed of potential hazards, the Provider will:

• Evaluate the risk to health and safety.

• Take necessary measures to deliver services as to not risk harm to the Participant, support workers or any other party.

• Attempt to assist in the remedy of these risks if it is safe to do so.

• Deliver support services if it is safe to do so, or cease services until the Participant and support location are deemed to be safe.

Billing and Payment

The Participant (or their representative) will:

• Ensure that they have sufficient funding allocated for any services requested from the Provider.

• Allocate additional funding before requesting further services if required.

• Pay any invoices within 7 days of issue, regardless of whether the amount exceeds the total funds allocated to the Provider if additional services are requested.

• Be responsible for the payment of any services provided even if their NDIS funding is unavailable for any reason.

• Communicate promptly and openly with Provider regarding any issues with payment.

The Provider reserves the right to contact professional debt collectors to recoup any overdue accounts.

Mutual Responsibilities

Both parties will:

• Communicate in a clear, concise and timely manner.

• Work to maintain supportive relationships and regular communication regarding changes in circumstances and/or participant goals.

• Ensure safe environments to protect the health and safety of the participant and others during any interactions.

• Act with honesty, integrity and transparency – as per the NDIS Code of Conduct.

• Aim to meet a minimum shift duration of 2 hours.

• Communicate changes or cancellation of shifts or services promptly.

Changes and Cancellations

• Any changes / cessation to this service agreement are to be made in writing, signed and dated by both parties.

• If the participant or their representative changes or cancels a scheduled shift within the 7-day period prior to the shift, the full fee of the shift will be charged.

• If the participant or their representative changes or cancels a scheduled shift more than 7-days prior to the shift, no fee will be charged.

• If any risk to health or safety cannot be rectified and causes a support shift to be ceased or cancelled the Provider reserves the right to charge a late cancellation fee and refuse to provide non-essential services for the effected period of time.

• If the Provider cancels a shift or cannot fill the shift, no fee will be charged.

Compliments, Feedback and Complaints

Participants and their representatives can provide feedback, compliments, or make a complaint by:

• Calling The Improvement Movement Perth on 0409 243 074

• Emailing:

If you are unsatisfied with the outcome you can contact the NDIS Quality and Safeguards Commission by calling 1800 035 544 (interpreters can be arranged) or visiting https://www.ndiscommission.gov.au/about/complaints.

Participant Details

Full Name

Date of Birth

Phone Number

Email Address

NDIS Number

Home Address

Suburb

StatePost Code

Participant Representative

The Participant has an appointed representative to act on behalf of, or make decisions on their behalf:

YesNo

Full Name

Phone Number

Email Address

Relationship

Plan Details

Plan Start Date

Plan End Date

Management Type
Plan ManagedAgency ManagedSelf-Managed

Plan Manager’s Name

Plan Manager’s Phone Number

Manager’s Email Address

Services

This specifies which services you are engaging with the Provider for and for which periods of time.

Support CoordinationHome & Community Support

Support Coordination

Commencing on:

Ending on:

Approximate hours required for the duration of this Agreement:

Home & Community Supports

Commencing on:

Ending on:

Approximate hours required weekly:

Consent to Share Information and Media

The Provider may need to exchange information with other professionals to provide services and benefits to clients. Client information will not be disclosed without consent.

I give consent to the exchange of information between the Provider and the following parties:

Nominated Allied Health ProfessionalsMedical Professionals (e.g. Doctor)Relevant Agencies (e.g. NDIS & NDIA)Relevant Support Networks (e.g. Support Workers)

I give consent for the Provider to use photos and videos for:

Social media sites (e.g. Facebook, Instagram, etc.)The Provider's website

I understand that:

• This consent can be withdrawn in writing at any time; and

• This consent will stay in place until consent is withdrawn; and

• Withdrawal of consent may impair the ability to continue services.

Acceptance

I have read and accept the conditions and responsibilities described in this Agreement.
This form has been completed by a representative authorised by the Participant, with the Participant’s full knowledge and understanding.
Submitted by:

Signature:
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