(1) Moderate to severe multiple disability or moderate to severe physical disability (including neurological disability) where the child is, or is likely to be, dependent for mobility indoors and outdoors from the age of 3 onwards.
Example:
A child who has cerebral palsy, lower limb deficiencies or spina bifida and is dependent on a stroller, wheelchair, crutches or walking frame.
(2) Severe multiple or physical disability (including uncontrolled seizures) requiring constant care and attention where the child is less than 6 months of age.
(3) Epilepsy (uncontrolled while on medication).
(4) Chromosomal or syndromic conditions that are not specified elsewhere in this Part and where there is moderate or severe intellectual disability and/or multiple, major and permanent physical abnormalities as diagnosed by a paediatrician, paediatric subspecialist or clinical geneticist.
(5) Neurometabolic degenerative conditions including lysosomal storage disorders where there is moderate or severe intellectual and/or moderate or severe physical disability and where the condition is diagnosed by a paediatrician, paediatric sub‑specialist or clinical geneticist.
(6) Neurodegenerative disorders where there is moderate or severe intellectual and/or moderate or severe physical disability and where the condition is diagnosed by a paediatrician, paediatric sub‑specialist or clinical geneticist.
(7) Any of the following neuromuscular conditions:
(8) Moderate, severe, or profound intellectual disability where IQ is less than 55, (including a child with a known syndrome).
(9) The following conditions:
(a) Autism Spectrum Disorder when diagnosed by a psychiatrist, developmental paediatrician, or a registered psychologist experienced in the assessment of Pervasive Developmental Disorders and using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5);
(b) Autistic Disorder or Asperger’s Disorder (not including Pervasive Developmental Disorder not otherwise specified) when diagnosed by a psychiatrist, developmental paediatrician, or a registered psychologist experienced in the assessment of Pervasive Development Disorders and using the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
(10) The following conditions:
(a) Childhood Disintegrative Disorder diagnosed by a psychiatrist using DSM-IV;
(b) Major depression of childhood diagnosed by a psychiatrist using DSM‑IV or DSM-5;
(c) Childhood schizophrenia diagnosed by a psychiatrist using DSM-IV or DSM-5.
(11) Any of the following sensory impairments:
(a) Bilateral blindness where:
(i) visual acuity is less than or equal to 6/60 with corrected vision; or
(ii) visual fields are reduced to a measured arc of less than 10 degrees;
(b) Hearing loss ‑ a 45 decibels or greater hearing impairment in the better ear, based on a 4 frequency pure tone average (using 500, 1000, 2000 and 4000Hz);
(c) Deaf‑blindness ‑ diagnosed by a specialist multidisciplinary team, including a professional audiological and ophthalmological evaluation.
(14) Other inborn errors of metabolism not specified elsewhere in this Part that are treated by medically prescribed diet to prevent neurological disability and/or severe organ damage.
(15) Cystic Fibrosis.
(16) Moderate to severe Osteogenesis Imperfecta with two or more fractures per year and/or significant pain that significantly limits activities of daily living.
(17) Down syndrome.
(18) Fragile X syndrome.
Part 2 Medical Conditions
(1) Chronic or end stage organ failure where the child is receiving organ specific treatment and/or awaiting transplant.
(2) HIV/AIDS where the child is symptomatic (in addition to having lymphadenopathy) and requires treatment with a 3 or more drug antiviral regimen.
(3) Immunodeficiency where the child requires regular immunoglobin infusions.
(4) The following Haematological/Oncological Conditions:
(a) Leukaemia, Haemophagocytic Lymphohistiocytosis and other childhood malignancies where the child is undergoing chemotherapy, radiotherapy or palliative care;
(b) Haemophilia with Factor VIII or Factor IX deficiency (less than 10%);
(c) Thalassaemia or Haemoglobinopathy requiring chelation therapy;
(e) Langerhan Cell Histiocytosis: disseminated (multi‑organ) disease requiring chemotherapy for longer than 6 months;
(f) Severe congenital Neutropenia (Kostman’s variant, dependent on Filgrastin).
(5) The following Chronic Respiratory Conditions:
(a) Chronic Respiratory Disease requiring home oxygen;
(b) A condition where the child is dependent for his or her health on an external apparatus/machine called a ventilator to assist with breathing, either on a continuous or intermittent basis;
(c) Long term tracheostomy where the child is cared for at home.
(6) Severe atopic dermatitis which involves at least 75% of the body surface and which has required two or more hospitalisations of at least 5 days duration in the previous calendar year, and/or the use of immunosuppressive therapy.
(7) Significant burn where more than 30% of body surface area is affected, or a lesser burn where there is significant impairment of function of the hands or feet or assistance is required with feeding or toileting to a greater degree than is age appropriate for the child.
(8) Gastroenterological condition or other medical condition requiring total parenteral nutrition for an extended period, with medical treatment and medical supervision required for at least 12 months.
(9) Final stage of Ulcerative Colitis where the condition is no longer responding to medical treatment and where a sub‑total colectomy and ileo‑rectal anastomosis with formation of a J‑pouch is required.