NDIS Issues Register, March 2017

IssuePricesAligning prices with the actual cost of supply is by far the highest ranked issue impacting on providers’ capacity to supply services in 2017.1 The National Disability Insurance Scheme (NDIS) needs to be delivered within a $22B budget, but it can’t be delivered at the current pricing. Inadequate pricing threatens to erode quality of service and generate market failure. No one wants this to happen.

There are warning signals that suggest the gap between demand and supply will grow if providers cease the provision of supports which they believe are under-priced. This is highlighted in the intermediate evaluation report on the NDIS, conducted by the National Institute of Labour Studies (NILS), and explored in greater depth in NDS’s 2016 State of the Sector report.

In response to providers’ concerns about inadequate prices for personal support and community participation during the trial, the 2014 NDIA-NDS Joint Pricing   Project developed a Reasonable Cost Model (RCM). The NDIA lifted prices in July 2014 but these were less than the prices which the model generated. The Agency did however accept National Disability Services’ (NDS) recommendations for a cancellation fee, costing of travel outside the hourly price and the introduction of an establishment fee.

In the subsequent two years, NDS negotiated full indexation and a delay in the transition to the ‘efficient price’, while assumptions underpinning the RCM were tested. This saw increases to the hourly price for one-to-one support by 3.9% in NSW, Victoria, Queensland and Tasmania and 1.9% in other states and territories.

Prices for most other supports increased by 2% in 2016/17. Increases for other supports to note include:

the monthly fee for financial intermediary services rose from $31.49 to $96.25, supported independent living prices in all areas were increased by 3.9%, and remote and very remote loadings increased slightly to 18% and 23%.

The announcement that prices were deregulated for participants who were self-managing their plans was welcomed and NDS continues to encourage the NDIA to extend this flexibility to other participants.

Unfortunately progress on other important pricing matters stalled. Despite interest from the National Disability Insurance Agency (NDIA) in participants with complex support needs, a higher price level has not been established. NDS has also made the case to introduce a weekend and public holiday rate for Short Term Accommodation.

1 NDS State of the Disability Sector Report 2016

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Some providers would like to utilise therapy assistants for a portion of the total therapy budget to maximise value for money, but providers advise it isn’t viable - the current price ($40.92) is below the one-to-one support price ($42.79 in VIC/NSW/QLD/TAS & $43.58 in WA/SA/ACT/NT).

What NDS is seeking

Use of the assumptions underpinning the RCM to set the price for personal support and community participation

A mechanism established for setting group prices Prices set that reflect the complexity of support (based on the skills required) Prices for short term accommodation that reflect increased costs on weekends

and public holidays Review of the therapy assistant price Prices that reflect jurisdictional and geographical difference An improved cancellation policy Extension of price deregulation

Status

The NDIA has released information about the review of NDIS prices for the next financial year . NDS summarised the review process and timeline and highlighted some concerns in a NDS News Update.

NDS launched the Industry Barometer which will provide benchmarking products to service providers that contribute data.

NDS continues to make the case for an increase in the higher intensity rate and the introduction of an additional higher rate for personal support and community participation and has compiled evidence from providers to use in ongoing negotiations.

The intermediate report on the evaluation of the NDIS, conducted by the National Institute of Labour Studies (NILS), highlights the risk that the gap between demand and supply will grow if providers cease the provision of supports which they believe are under-priced. This risk is explored in greater depth in NDS’s 2016 State of the Sector report.

The recent Australian National Audit Office (ANAO) report proposes that the NDIA role in price setting and price regulation is a conflict of interest and should be investigated by the Productivity Commission in its review of scheme costs – summarised in a NDS news update.

The 2016-17 NDIS price guide (effective 1 July) has been released - summarised in a NDS news update.

The Specialist Disability Accommodation Decision (SDA) Paper has been released and outlines prices for capital costs in addition to the supported living prices outlined in the NDIS price guide - summarised in a NDS news update.

NDS has been invited to represent the sector on the steering committee of the NDIA Financial Benchmarking project . 

Price deregulation was introduced to self-managing participants as of July 2016. The NDIA continues to encourage a small number of participants in groups for

community participation as reflected in the 1:2 and 1:3 staff participant ratios.

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IssuePlanningThere is enormous pressure on the National Disability Insurance Scheme (NDIS) to accelerate the development, approval and activation of plans as the scheme expands. Expanding the NDIS from approximately 30,000 active participants in trial to approximately 460,000 at full scheme (typically with each subject to annual review) using the current approach to planning would over-stretch the National Disability Insurance Agency’s (NDIA) capacity.

Under pressure, the Agency is currently approving 450 plans per day, and in 2018-19 it will need to approve 850 plans and review 1,100 plans per day. Experience so far shows that the quality of planning by the NDIA remains inconsistent.

While the NDIA needs to determine eligibility and set individual budgets, life planning and coordination would be more appropriately done outside government. The local knowledge, practical experience and connections necessary for effective life planning and are mostly found in community-based organisations. NDS is pleased the NDIAs Partners in the Community program has outsourced some functions to non-government organisations.

The NDIA has implemented a range of strategies to improve the quality of planning including staff training, internal ‘virtual’ planning expertise task cards and reference packages. However providers continue to report the following concerns:

people are being contacted via telephone for initial information and later informed that this information was used to develop their plan,

participants’ are not given the opportunity to review plans before they are finalised

first plans are often missing essential support items such as supported independent living (SIL) and equipment,

providers lack of opportunity to provide feedback during a first plan/plan review often results in support gaps, and

the delay in funding for quotable items (in some cases taking months).

What NDS is seeking

State/territory governments to provide the NDIA with a list of supports that existing clients currently receive.

Adequate support coordination funding in plans, particularly for participants with complex needs.

Clear explanations of plan content to people with disability and their families to ensure they understand the types and level of support they can purchase.

Timely response and funding allocation for quotes and plan reviews. An alert function to help providers track when a plan has been reviewed.* A reporting function for providers to identify participant plan review dates.*

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Status

NDS continue to be concerned about the quality of plans that are being developed and regularly monitor this.

Bruce Bonyhady, the outgoing Chairman of the NDIA, has acknowledged that the quality of plans is one of several challenges facing the Agency in implementing the NDIS.

The NDIA has indicated they are trying to streamline the quoting (administrative) process.

The NDIA has introduced contingency funding for people with Motor Neurone Disease to minimise the need for a review due

The NDIA developed a Reference Package for people with Multiple Sclerosis. The NDIA has outlined the key roles of LACs and the arrangements in each

state and distinguished the roles of planners, Local Area Coordinators (LAC) and Early Childhood Early Intervention (ECEI) Partners.

From 1 July 2016, the NDIA implemented a streamlined planning process to assist with bringing a large number of people into the scheme. The guided planning process (called First Plan) intends to enable rapid entry to the scheme, with planners using set questions and allocating individual budgets using reference packages as benchmarks.  

Despite the NDIA encouraging participants to share their plans with providers, this is not common practice and requires a form to be manually filled in and sent to the Agency by the participant. NDS is working with the NDIA to simplify the process of sharing plans.

The NDIA is agreeing to longer term plans for some participants. The guarantee remains in place that plans may be reviewed at any time the participant’s circumstances change significantly.

* Also noted in the NDIA Portal Issue

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IssueEmergency ResponseEmergencies arise in everyone's lives; they are unpredictable and cannot be planned for. People with disability and their families need to be able to draw on immediate disability support when these emergencies arise, such as when a family relinquishes responsibility for the care of their child at 9pm at night; or when an elderly parent caring for an adult family member with disability is hospitalised and the person with disability cannot be left alone. While some people with disability will already be a participant of the NDIS, others will not but will still need assistance immediately.

Under state and territory-funded disability systems, arrangements exist for organisations to respond when emergencies arise at any time. While there is capacity for emergency short term accommodation under the NDIS, there is no national 24/7 response system in place and accessing funded support is limited to people with an NDIS plan.

The NDIA has extended its operating hours, however it is closed between 11pm-8am Monday to Friday, weekends and public holidays. Referring people to Lifeline outside these times is inadequate, particularly in response to a significant emergency or crisis.

The NDIA has revised the support coordination role which now involves an expectation that providers are available 24/7 to respond to a crisis, however not every participant has this support funded in their plan.

What NDS is seeking

An emergency response service to be established by the NDIA during the transition period that:

o provides emergency support for people living in NDIS sites regardless of whether or not they are a participant;

o is accessible via a national 24/7 phone line;o can be escalated to a regional response if required (i.e. regional service

providers are identified that can coordinate 24/7 emergency support); ando is tested and refined for full implementation.

Appropriate supports are available immediately, with arrangements for plan reviews or NDIS eligibility to be prioritised by the Agency on the next business day after the emergency response has been implemented.

Status

The NDIA Contact Centre (1800 800 110) has extended its operating hours to 8am - 11pm local times, Monday to Friday.

NDS has prepared an emergency and crisis response system paper to inform the NDIA’s thinking. An important consideration is whose responsibility it is

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when a person presents who is not currently in the service system and is not necessarily eligible for supports.

In its submission to the Independent Review of the NDIS 2013 Act, NDS recommended: o the NDIA establish an emergency response function as the NDIS begins full

implementation from July 2016o the Act should provide for an emergency response for a person with

disability prior to their eligibility as a participant being determined. NDS sought feedback from providers delivering support coordination to identify

implications of the NDIA expectation that they should be available 24/7 to respond to a crisis.

NDS has gathered examples of circumstances requiring an emergency response within trial sites to inform our negotiation with the NDIA.

NDS highlighted the lack of a central coordinated emergency response with the NDIA in May 2015.

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IssueNDIA PortalThe Department of Human Services developed a new ICT system, to be phased in over three years, with the foundations operational on 1 July 2016. Sitting alongside the participant and provider portals will be an e-market, an electronic marketplace where providers and participants can interact. $143M over four years has been committed for the system. 

Well over a thousand providers are experiencing delays with their registration application to provide supports under the National Disability Insurance Scheme (NDIS). Most of these are new registrations (i.e. they are from providers not yet working within the NDIS), with a smaller group trying to extend their existing registration to provide new supports. The delay in resolving the registration backlog is concerning, not least because thousands of registrations are expected as the transition to the NDIS continues across Australia.

Providers are experiencing difficulties arising from the slowness of the portal and regularly getting error messages which often requires logging onto the website again and entering the data again. Adding to providers’ frustration is the inability to get a response or a resolution from the provider support telephone or email contacts.

Providers are also reporting a range of issues around plan errors which requires additional administration for providers and in some cases no certainty of funding. Providers only become aware of these errors either when they are informed of a plan review (often with a different funding amount), or when they receive an error report following a payment request.

The National Disability Insurance Agency (NDIA) has an expectation that providers will continue to deliver supports until the plan (funding) or portal is resolved, which means providers are carrying a debt until the NDIA resolve the issue, and in some cases there is no guarantee the plan (funding) will be adjusted. This issue arises when:

plan dates and/or funding amount on the portal does not match the plan posted to the participant;

some plans are being made inactive during a review and providers are unable to claim; and

some plans are missing funding for key supports.

What NDS is seeking

A new and streamlined registration process is urgently required. An alert function to help providers track when a plan has been reviewed. A reporting function for providers to identify participant plan review dates. Prices to be auto-populated to reduce data input time and minimise errors. Review of the remittance advice format to allow for easier reconciliation.

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Clarity on the scope and functions of the government e-market.

Status

The NDIA are working with each state/territory government to provide lists of pre-approved providers with the relevant list of supports which aims to speed up the registration process.

The NDIA staff who are responsible for registration are undergoing additional training with the expectation that it will hasten decision-making.

The NDIA acknowledge the staff responding to 1800 number are not skilled up on portal queries and are establishing a specialist provider support group with access to the Client Relationship Management (CRM) system.

The NDIA weekly payment summary report on the information, publications and reports page summarises the NDIA total payment amount to participants and providers, and identifies the three main reasons for unsuccessful payments and information to troubleshoot these issues.

The new NDIS portal, ‘myplace’, was implemented nationally from 1 July 2016. NDS are continuing to push for improved functionality to improve providers’ experience. 

NDS news update highlights continued portal problems since the launch. 

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IssueTransportSocial and economic participation often requires access to transport. Trial site experience shows tensions between individual payments for transport, use of sector vehicles and coordination of community transport. Due to limited community transport options, many providers operate their own fleets. However, the funding included in individual plans is often insufficient to cover the operational cost of this service. 

The Commonwealth Mobility Allowance payments formed the basis of the three levels of transport support in the National Disability Insurance Scheme (NDIS) The Commonwealth is rewriting the Mobility Allowance rules to make it aligned to the NDIS eligibility and rolling it into the NDIS ($46.5 million was provided in extra support through the NDIS to help those receiving it). The new rules mean new claimants must have a significant or permanent disability which prevents them from using public transport without substantial assistance.

About 60,000 people are currently eligible for the mobility allowance with 18,000 eligible for the NDIS. Of these about 4,000 will be over 65 year of age and not eligible for the NDIS. Changes to the mobility allowance will also exclude people with disability who choose not to be part of the NDIS.

Mobility Allowances are set at a maximum $3,456 as a full annual component within support plans. Providers cannot charge for daily transport costs associated with the delivery of support services to a client until the allocated monies in plans are fully expended. Funds allocated for transport cannot be traded off for other supports by NDIS participants.

What NDS is seeking

Participant transport funding that reflects individual needs. Clarity on the guidelines for allocating different levels of transport funding. Recognition that transport offered by a provider can be an effective option for a

participant and cheaper than taxis. A coordinated transport pilot to test different models, drawing on local

knowledge and resources.

Status

NDS has requested information about the NDIA Transport Project. David Bowen announced at the NDS CEO Conference in December 2016 that

the NDIA is reviewing participant transport. NDS has received reports that the transport allowances levels are being

inconsistently applied.

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NDS has raised concerns with the NDIA about the risk of the sector devolving transport assets due to inadequate transport funding.

From 1 January 2017, the Mobility Allowance is only available to new customers who are: under 65 years of age with a significant or permanent disability; engaged in work or vocational training, and not able to use public transport without substantial assistance. This means that Mobility Allowance recipients who are assessed to be eligible will receive NDIS support rather than the Mobility Allowance, once NDIS is available in their own locality.

The NDIS Price Guide 2016/17 clarified some of the arrangements for participant transport by providers as follows;o Transport falls into the core category of NDIS supports. Participants will

have the ability to choose how they spend the funds in the core category.o Transport allowances increased by 1.53 per cent in July 2016, in line with

the increases to the Commonwealth Transport Mobility Allowance.o Where a worker is accompanying a participant on a community outing

and/or transporting a participant from their home to the community, the workers time can be claimed at the hourly rate for the relevant support item for the total time the worker provides support to a participant(s), including time spent accompanying and/or transporting the participant.

o Where a provider is transporting two or more participants on the same trip, the workers time should be claimed at the appropriate group rate for the relevant support.

o If a provider incurs costs, in addition to the cost of a worker’s time, when accompanying and/or transporting participants in the community, they may negotiate with a participant to make a reasonable contribution towards these costs. A participant’s plan may include funding for transport supports and this funding can be used to meet these types of contributions.

NDS submitted a position paper to the NDIA and Governments in July 2015 on participant transport support options, the future market and accessible transport, based on member feedback to an NDS discussion paper.

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IssueContinuity of supportIntergovernmental agreements for the trial sites guarantee continuity of support for people deemed ineligible for the NDIS who are currently receiving disability support services until mid-2016. The Bilateral Agreements for full scheme implementation detail continuity of support arrangements for people currently receiving funded support but do not meet NDIS eligibility requirements, or are receiving support that does not meet the definition of ‘reasonable and necessary’, and their program/service ceases with the introduction of the NDIS. These agreements signal how continuity of support will roll out in other jurisdictions.

Some people with disability are concerned that they will receive less from the NDIS than they do in the current system, even though governments have promised that people will not be disadvantaged by moving into the scheme. 

What NDS is seeking

Renewal of the continuity of support guarantee during full scheme implementation.

Clarity around the funding allocation for people with disability (including people aged over 65 years and those who are not permanent Australian residents) receiving continuity of support arrangements and assurance that the funding will be adjusted according to individual needs.

Clarity around the Continuity of Support arrangements for people who are employed in an Australian Disability Enterprise (ADE) or who receive support from the Personal Helpers and Mentors (PHaMs) program but who are ineligible for the NDIS.

Status

The Federal government has released the Commonwealth Continuity of Support for specialist disability services for older people (people over 65 years) Programme Guidelines (July 2016) and Programme Manual (December 2016)

The Federal government outlined a new Commonwealth Continuity of Support program for aged care and specialist disability services for people aged 65 years and over, and indigenous Australians aged 50 and over.

NDS are awaiting further information on continuity of support arrangements for people under 65 who are ineligible to access the NDIS and are in programs that transfer across.

The bilateral agreements between the Commonwealth and the states/territories outline Continuity of Support arrangements for each jurisdiction, with the aim of ensuring people are not disadvantaged during the transition to the full roll out of the NDIS.  

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IssueRural and Remote RegionsEnsuring that services in rural and remote areas are sufficient and culturally appropriate is important but difficult. Climate, geography, culture, workforce shortages, and safety and social issues all contribute to the complex challenges. The former Federal Minister indicated that a market approach may not be possible in rural and remote areas.

What NDS is seeking

Adequate pricing for rural and remote services, particularly recognising the cost impact of travel and ‘no shows’ and flexible application of the NDIS rules.

Testing of alternative funding and support models for some rural and remote areas such as bulk purchasing.

Sufficient flexibility to allow local decision making without compromising the decision making principles of the NDIS. 

Status

The Rural and Remote Strategy 2016-2019 and Aboriginal and Torres Strait Islander Engagement Strategy has been released.

Northern Territory providers have been advised by the Office for Disability that they will continue to receive funding until they can draw down on the participant plan.

The NDIS Market Approach: Statement of Intent, released in Nov 2016, indicates the NDIA is developing a Rural and Remote Servicing Strategy to address weak/thin markets primarily in rural, regional and remote areas. Related market strategies include the NDIA’s market intervention framework, and provider of last resort approaches being negotiated with each jurisdiction.

The 2016-2017 Remote and Very Remote price guides have been released.  Remote or very remote regions attract the Independent Hospital Pricing

Authority (IHPA) loading using the Modified Monash Model (MMM) classification system.

The NDIA has commenced work on a national provider benchmarking function - one of the aims is to improve understanding of the costs of efficient service delivery in metro, regional, rural and remote areas.

Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women’s Council released a report in January 2015, with recommendations on how the NDIS can be successfully rolled out to the Central Australian Anangu Pitjantjatjara Yankunytjatjara (APY) lands.

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IssueSupports for people with psychosocial disabilityMore than 60,000 people with psychosocial disability are expected to be part of the scheme once it is available across Australia at full roll out. During the trial providers identified a range of uncertainties, including eligibility, planning, pricing, design of supports, workforce, interface with mainstream services and Information, Linkages and Capacity Building (ILC), and continuity of support. 

What NDS is seeking

Development of strategies to help people with psychosocial disability who are deemed ineligible for the NDIS, particularly those who may be at risk without supports.

Effective interaction between NDIS supports and the mental health systems.

Status

Complexity remains an unresolved issue with the need for an increase to the higher intensity price and/or and additional higher price for people with high and complex needs.

The intermediate evaluation report on the NDIS, conducted by the National Institute of Labour Studies (NILS), raised concerns about participants who report feeling worse off tend to be people unable to advocate on their own behalf, including some people with psycho-social disability and "those who struggle to manage complex NDIS processes."

The Joint Parliamentary Standing Committee on the NDIS is calling for submissions on the provision of services under the NDIS for people with psychosocial disability (final report due 22 June 2017). A NDS news update summarises the scope of the inquiry.

The NDIA indicated that some activities funded by ILC that will be targeted to people with psychosocial disability such as information and peer support.

The NDIA has worked with consumers and carers to develop a new psychosocial disability factsheet that talks about how the NDIS works with people with psychosocial disability.

The NDIA has released the Mental Health Sector Reference Group Communique from the October 2016 meeting. 

The Principles to Determine the Responsibilities of the NDIS and Other Service Systems outlines the responsibilities of the NDIS and the mental health system.

The NSW Mental Health Coordinating Council released a publication that described their NDIS trial experience and observations. The Mental Health Commission of NSW also published a summary issues paper.

Psychiatric Disability Services Victoria published a report in June 2015, ‘Learn and Build in Barwon on the impact of the NDIS in the provision of mental health services in the Barwon trial. Key issues for consumers, families and the Victorian mental health service system’.

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IssueMoving from block grants to cash claimsSome intergovernmental agreements have imposed complex and burdensome transition arrangements on providers. This is exacerbated when state funding for existing clients decreases prematurely in relation to the commencement of NDIS funding.

In addition, the move from block grants paid in advance to individualised payments in arrears can cause cash-flow problems for some providers. 

NDS is closely monitoring financial concerns for organisations as the transition to cash claims from block grant funds continues. 

What NDS is seeking

Improved arrangements between state and territory governments and the NDIA on how block grants are reduced as people transition to the NDIS.

Measures to reduce financial risk to providers.

Status

NDS is working with state governments in some jurisdictions to address issues associated with funding from state government ceasing before the provider is aware that the person has an NDIS plan.

NDS has requested that the Agency consider the possibility of planners advising the provider when the plan has been approved, with permission from participants

NDS is pleased to see that under full scheme, governments have agreed to minimise in-kind contributions to the NDIS through the transition.

Some governments have agreed on new, more workable procedures and NDS is meeting regularly with the state government to monitor impacts.

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IssueEmployment supports

To access an updated register of the latest unresolved issues surrounding disability employment support, visit the NDS Disability Employment Issues Register .

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IssueFunding commitments

In the first year of full implementation the NDIS will cost around $22B, 55 per cent of which will come from the Australian Government and the remainder from state and territory governments. A 0.5 per cent increase to the Medicare Levy, introduced in 2014, will collect money quarantined for the NDIS well in advance of that money being spent. However, in the longer-term governments will need to find significant new funding for the NDIS, in conditions of fiscal restraint.

The Federal Government remains committed to fully funding the NDIS, and passed legislation to establish the NDIS Savings Fund. This new fund will quarantine savings for the purpose of funding the NDIS.

NDS is seeking

No reduction to the $22B per year commitment from governments for the NDIS Funding plans from governments that reflect the post-trial implementation

agreements. A clear commitment to fully fund the NDIS in the forward estimates linked to the

Federal Budget papers in 2017.

Status

The Productivity Commission's Issues Paper , released on 22 February, invites feedback on factors influencing NDIS costs. NDS summarised the key areas of investigation. The PC will issue a position paper in May, which will provide a further opportunity for comment.

NDS's submission for the 2017 Federal Budget focuses on ensuring that its implementation is sustainable—for taxpayers, for service providers, and for people with disability and their families and carers.

The 2016 Federal Budget saw the deposit of $2.1B in a special savings account to fund the future of the NDIS. A NDS news update provided an analysis.

The 2015 Budget confirmed expected Commonwealth funding regarding the NDIS across forward estimates until 2018/19.

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IssueParticipant deathMany deaths occur suddenly and without warning. There is an anomaly in the National Disability Insurance (NDIS) Act 2013 relating to payments of outstanding NDIS amounts following a participant’s death. Section 182 (2) states that:

‘a person is taken not to have been entitled to the payment of an NDIS amount if the payment should not have been made for one or more of the following reasons:…(c) the participant died before the payment was made.’

While the NDIA does pay for services that were delivered prior to the persons death, NDS argues that this is insufficient because it does not cover costs of necessary and often mandatory, tasks that providers must undertake following the death of a participant. There are substantial cost implications for providers if they are not able to claim for necessary tasks subsequent to a participant’s death.

What NDS is seeking

Adequate funding to compensate providers for undertaking necessary tasks following a participant’s death.

Clarity on the NDIA expectations of providers in response to a participant’s death. 

Status

The Specialist Disability Accommodation (SDA) Rules 2016 refer to funding for an additional period in circumstances when vacancy arises due to participant death (Part 6.3).

The Independent Review of the NDIS 2013 Act did not address the issue of provision of funding following a participant death. Decisions by Government on legislative changes are likely to be needed in order to progress this issue, and NDS is addressing this with the Minister. 

In our submission to the Independent Review of the NDIS 2013 Act, NDS recommended the provision for funding, following a participant death, of up to two months for Shared Supported Accommodation supports and funding for up to one month for group-based supports to cover the associated costs.

Where supports were delivered before the death of a participant, and were provided in accordance with the plan, the provider is entitled to seek and receive the agreed fee.

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IssueExpansion to full scheme

Full scheme roll out commenced in July 2016, supporting the transition of an estimated 430,000 participants. This rapid expansion of the National Disability Insurance Scheme (NDIS) will require the supply of services to increase at a substantial rate, with sufficient diversity to respond to demand among participants.

A patchwork approach to significant, high risk and scalable reform will have consequences. Service providers need a clear plan and coherent investment strategy from government to support the sector’s development and transition to the NDIS market. Such a plan shouldn’t be developed without significant input from the non-government sector.

The operating environment is presenting obstacles for providers and participants – from the malfunctioning of the NDIS portal to inadequate pricing and workforce shortages. The NDIS cannot deliver on its great promise to people with disability and their families unless there is a strong and sustainable disability services sector.

A Productivity Commission review of NDIS costs and cost pressures is not due to report to the Council of Australian Governments (COAG) until the end of 2017.

What NDS is seeking 

Market data made available to providers to inform current and future supply, including:o trends in purchasing supports and productso market gaps and areas of unmet needo patterns of demand based on state government registers and waiting lists.

Problems identified during transition resolved before the NDIS expansion to full scheme.

Investment in sector development to boost provider capacity. Release of the final NDIS evaluation report by the National Institute of Labour

Studies (NILS), initially due in November 2016, and is now expected in the latter half of 2017 (nearly 18 months after the expansion to full scheme).

Status

Governments signed a bilateral agreement on local delivery of NDIS in WA which is detailed in a NDS News Update .

The new Board, led by Helen Nugent, expanded from 1 January 2017 to ensure it has the disability service, financial management, corporate governance and insurance-based expertise needed to guide the $22 billion scheme through its critical three year expansion to 2019-20.

The Government has announced a Productivity Commission review of the sustainability of the NDIS. NDS summarised the terms of reference. We will seek input from members when the Issues Paper is released in February. A

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position paper will be released in May (which will allow the sector to provide further comment) and the final report is due in September 2017.

The NILS evaluation framework, initial report and intermediate report are now available on the Department of Social Services (DSS) website. The final evaluation report, initially due in November 2016, is now expected in the latter half of 2017, more than a year after the end of the trial.

Three independent reports (Price Waterhouse Coopers, Robyn Kruk and the Australian National Audit Commission) over the past six months, which have highlighted problems with the capacity (registration, portal, planning) of the Agency to scale up at a pace to meet the targets in the bilateral agreement, and the capacity of providers to meet the rapid growth in demand.

The ANAO report says that the DSS should produce and publish a disability workforce action plan which includes specific actions, timeframes, accountabilities and monitoring arrangements. It also highlights the need for Government to consult service providers in developing an action plan for the NDIS market, sector and workforce.

The COAG Disability Reform Council Communiqué in September stated, “The Council also expressed concern at broader operational problems and the flow on effect of myplace portal issues leading to a slowdown in the rate of plan approvals for the large number of people that have been deemed eligible for the NDIS since 1 July 2016.”

The NDIA has released Market Position Statements for NSW, Victoria, Queensland, ACT, SA and Tasmania. The data will be published on a regular basis to give an understanding of emerging markets and expected demand growth over time.

The Intergovernmental Agreements are available on the NDIS website.

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IssueInformation, Linkages and Capacity BuildingInformation, Linkages and Capacity Building (ILC), formerly known as ‘Tier 2’, is a key component of the NDIS insurance model. It will contribute to the sustainability of the NDIS by building the capacity of the community, people with disability, their families and carers, and greater community inclusion. Over time, it is intended that these developments will reduce the demand for, and level of specialist disability support required by many people with disability.

Essential services, expertise and social capital could be lost in the transition to the NDIS if the NDIA does not provide ongoing block funding for some activities, such as volunteer co-ordination and information services. 

ILC will be piloted in the ACT commencing July 2017, and is expected to start in SA and NSW from July 2018 and Tasmania, Victoria and QLD from July 2019. The start date for WA and NT is still to be decided. Funding for ILC will reach $132M by 2019-2020, not including Local Area Coordination (LAC). 

What NDS is seeking

Bulk purchasing (block funding) of some services. An ILC program that builds on existing effective community organisation

activities that promote greater community inclusion. 

Status

Applications from organisations wanting to deliver ILC activities in the ACT and beyond closed 8 March. The NDIS website provides ILC program guidelines, a Toolkit, Outcomes Framework discussion starter, the presentation from NDIA information sessions in the ACT and FAQs.

The NDIA has released the ILC Commissioning Framework. NDS is pleased to note that registered providers of NDIS supports will be able to apply for ILC funding. The NDS news update summarises the priority focus areas and the substantial changes that have been made to the outcomes expected for ILC.  

Phasing dates for Local Area Coordination (LAC) and Early Childhood Early Intervention (ECEI) are detailed in the NDIS Partners in the Community Program Guidelines (page 5)

The LAC role and details for each jurisdiction is summarised on the NDIS website

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IssueNDIS and mainstream servicesWhile the Council of Australian Governments (COAG) has agreed to principles that govern the interaction between the NDIS and mainstream services, experience in the trial sites indicates that, in practice, there are demarcation disputes. If these interactions are managed poorly, NDIS participants and support providers may be disadvantaged.  

What NDS is seeking

Clarity and timely resolution of interface issues to enable people with disability to get the most effective combination of support.

Practical protocols between the NDIS, health, aged care, education and other service systems to ensure the availability of coordinated support, particularly for people with complex needs.

Joint plans, where applicable, with health and/or education.

Status

A Senate Committee will examine and report (due 13 September 2017) on the delivery of outcomes under the National Disability Strategy 2010-20. It will consider: o access to the built environment, including commercial premises, housing,

public spaces and amenities; transport services and infrastructure; and communication and information systems

o potential barriers to progress or innovation and how these might be removed

o the participation of people with disability in economic, cultural, social, civil and political life

The ILC Framework states that ILC functions will play an important role in facilitating referral and linkages to and from mainstream service systems for people with disability.

The Senate Education and Employment References Committee report   on the impact of policy, funding and culture on students with disability has found that despite a range of Federal Government initiatives over recent years, the education of students with disability lags well behind that of their peers.

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IssueQuality and Safeguards

The NDIS currently relies primarily on state-based, quality and safeguarding systems, as outlined in Bilateral Agreements, until the national framework is finalised, including agreed roles and responsibilities and any associated impact of funding contributions to the NDIS.

What NDS is seeking

A fit-for-purpose quality and safeguards framework, developed in consultation with the sector, which recognises that:o regulation has a minority role in promoting quality and safeguardso individual planning is a means of managing risko minimum standards should applyo choice is a necessary but insufficient driver of qualityo restrictive interventions should require authorisation by a judicial panelo disability safeguards should enhance not replicate universal systemso co-regulation recognises a shared responsibility for standards.

Government investment in building the capacity of the sector to build human rights-based cultures and prevent and respond to abuse and neglect.

Status

The Disability Reform Council has released the NDIS Quality and Safeguarding Framework, a nationally-consistent approach to quality and safeguarding for NDIS participants. The Framework introduces the following national regulatory components:o An NDIS complaints commissioner to facilitate the resolution of complaints

regarding providers of NDIS-funded supports and investigate both serious incident reports and potential breaches of NDIS Code of Conduct.

o An NDIS registrar to register providers, oversee provider compliance, establish policy settings for nationally-consistent worker screening and take the lead in monitoring the effectiveness of the NDIS market.

o A senior practitioner to oversee approved behaviour support practitioners and providers, review the use of restrictive practices and follow up on serious incidents.

For further information, read the NDS News Update and visit the Department of Social Services website for a factsheet for providers and participants.

The NT Government launched a NT Quality and Safeguarding Framework in November 2016. All providers registering for the NDIS in the NT must complete the NT Quality and Safeguarding assessment process.

NDS has released a series of practical free resources as part of the Zero Tolerance initiative, including an e-learning course for frontline workers and supervisors with accompanying training materials and supports for boards of management to improve prevention, early intervention and responses to abuse, neglect and violence towards people with disability.

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IssueHousingUnless action is taken soon, there will be insufficient suitable housing to meet the demand under the NDIS. Housing in the disability system is already scarce. If nothing changes, more than 100,000 people participating in the NDIS could be without access to adequate, accessible, affordable housing by 2020. 

Announced in December 2015, the Specialist Disability Accommodation (SDA) initiative is designed to help address immediate community need for specialist disability housing. The NDIA will have access to $700M annually at full scheme to stimulate housing development, but housing production has a long lead time and the ongoing delay in the release of a housing options discussion paper is impeding policy debate and action.

SDA pricing will apply to about 28,000 NDIS participants or 6% of people with disability eligible for NDIS by full roll out of the scheme (based on the original Productivity Commission estimate). The current national supply is 14,000. National growth is estimated at 500 units per annum rising to 900 in 2019 and back below 500 in 2022.

The need to stimulate accessible and affordable housing for others remains.

What NDS is seeking

Greater certainty of SDA prices beyond 2021 Nationally consistent approach to vacancy management Nomination rights that ultimately sit with the participant SDA market profile data to stimulate new innovative housing Effective use of the NDIA housing fund to leverage the growth of accessible and

appropriate housing in a timely fashion.  Demonstration projects in the trial phase to stimulate innovative ideas that can

effectively respond to immediate needs. A commitment and clear action plan from governments to work with

stakeholders (such as disability and social housing providers, housing departments etc.) to make sure the broader issues surrounding housing access and affordability for people with a disability are addressed.

Status

The Specialist Disability Accommodation (SDA) Rules 2016 has been released and summarised in a NDS News Update

The NDIA has published a FAQ sheet for service providers, which has information on topics including the myplace portal, service bookings, claims for payments (payment requests) for pre July 1 services, and the Price Guide.

SDA operational guidelines which provide guidance in relation to the preparation and review of a participant’s plan when SDA is to be considered.

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Registrations opened for providers of SDA in June 2016. Registration information and dwelling enrolment for SDA is available on the NDIS website. There are two steps: registration as a provider; and enrolment of dwellings. Registration is similar to registration to provide supports with some additional requirements outlined as an addendum to the Terms of Business for SDA.

The SDA Pricing and Payments Decision Paper (the Decision Paper) was published on 1 June 2016. The paper sets out the NDIA’s final decisions in relation to initial SDA Benchmark Pricing and Payments.

The SDA Price Guide is designed to assist disability support providers to understand the way that pricing and payments work for SDA. o The NDIA has a SDA price calculator for existing and new dwelling stock .

Annual base prices for existing housing stock range from $4,076 to $77,213 per participant, depending on the configuration, number of residents, robustness of the building, presence of on-site overnight assistance and other factors.

o Prices for new housing (including substantially refurbished housing) are higher. These prices are separate from the prices for accommodation support which are outlined in the 2016-17 NDIS price guide. 

The NDIA held Housing Innovation Showcases in Sydney (April 2016) and Melbourne (May 2016). Transcripts from the sessions are available on the NDIS website. 

NDS’s submission into the Federal Parliamentary Joint Standing Committee on the NDIS in March 2016 canvassed housing issues for the wider population of people with disability as well as those eligible for SDA.

The Commonwealth Government released a Request for Tender (RFT) for SDA using $10m of the Sector Development Funds in February 2016. NDS summarised the initiative in a NDS News Update.

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IssueSector DevelopmentThe 2012 Federal Budget allocated $122.6M over four years for sector development. Less than half of this has been committed so far and most of that has been focused on the trial sites. Broad sector development is required to enable the sector to prepare for, and grow in response to the rapid escalation of demand when the trial phase concludes. 

What NDS is seeking

Commitment of the remaining 2012 Budget funding allocated to sector development and significant new investment, especially outside trial sites.

Findings from the evaluation of the Industry Development Fund in NSW to inform future investment in the Sector Development Fund (SDF).

Successful projects funded by state governments should be made available nationally.

Status

The Integrated Market, Sector and Workforce Strategy has been released by the Department of Social Services (DSS) – it was developed by the Commonwealth, states and the NDIA. NDS summarised the three action areas and key directions in workforce development.

SDF projects will be funded through grants selection processes and advertised on the NDIS and DSS websites - guidelines and projects are available.

The 2015 Budget indicated that over the next two years $1.3M of the remaining funds will be transferred to the Department of Human Services to support the delivery of NDIS trials, and $2.6M will support the delivery of the WA My Way trial in Western Australia.

Administration of the SDF shifted from the NDIA to DSS at the end of 2014. NDS has been funded to develop and deliver national projects:

o NDIS Provider Toolkit o Community Inclusion Initiative

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IssueWorkforceA skilled, sufficiently large and diversified workforce is central to making the NDIS goals of increased choice and control a reality for people with disability. To meet the demand for services the disability support workforce will need to double in size and be capable of providing high quality support. The key stakeholders – participants and their families, employers, government agencies and workers – need to work together to facilitate the NDIS workforce needed by 2019. This means:

negotiating multiple interests in relation to job quality, service quality and the cost of supports

testing and building innovative, workable solutions to market and NDIS pressures.

What NDS is seeking 

Development of a disability workforce action plan by the Department of Social Services (DSS), recommended by the Australian National Audit Office's (ANAO) report, which is co-designed by the sector and people with disabilities.

Establishment of an Industry Advisory Group on workforce sustainability – the groups have been flagged by the Government as the forum for considering specific areas of action toward implementation of the Integrated Market, Sector and Workforce Strategy.

Status

The ANAO’s report on the NDIS, tabled in Parliament in November 2016, indicated the DSS should produce and publish a disability workforce action plan which includes specific actions, timeframes, accountabilities and monitoring arrangements.

The release of the National Institute of Labour Studies (NILS) intermediate report evaluating the NDIS highlights early concerns regarding recruitment (particularly amongst support workers, therapists, allied health and support coordinators) and retention.

The Minister for Social Services Christian Porter announced on 6 October 2016 that National Disability Services will administer a $4m Innovative Workforce Fund (IWF) to support providers innovating in key areas of work design and workforce arrangements over two years, starting in 2017. A total of $4 million will be available for innovative workforce related projects over the next two years, with $1 million allocated towards researching and developing different workforce models that can be applied to the disability sector.

The IWF will be guided by an Innovation Advisory Group representing stakeholders in the disability and mental health sectors, including Mental Health Australia. NDS will provide further information about the timing and process for eligible individuals and organisations which are interested in applying for grants in the first quarter of 2017.

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NDS, together with Jobs Australia, made representations to the Fair Work Commission in July on the impact of the NDIS on workforce sustainability matters and the modern award. NDS Chief Executive Ken Baker provided a witness statement, and along with several NDS members, provided advice to the commission in person. 

The NDIS Provider Toolkit Module 4: Guide to Suitability outlines the qualification requirements for the different professions providing services under the NDIS. NDS has raised concerns with the Agency about the requirement listed for Disability Support Worker requiring a minimum of Certificate 3 and is actively pursuing resolution.

NDS is working with Jobs Australia to provide supportive evidence for the Modern Award Review. Both ‘common issues’ relevant to all industries and SCHADS-specific issues were the subject of conciliations and hearings in July and August 2016. In its submissions, NDS highlighted the workforce implications of the NDIS and argues for greater flexibility for providers whilst supporting good quality, sustainable employment.

During the first half of 2016, NDS held a series of meetings with unions, attended also by Jobs Australia. Convened by the Fair Work Commission under the ‘cooperative workplaces’ power, the aim was an exchange of views and mutual understanding regarding the changes required to operate successfully under the NDIS.

The release of market position statements   by the NDIS indicates broad workforce needs based on demand for services at a local district level..

The Integrated Market, Sector and Workforce Strategy   was published by the DSS in July 2015. Although the directions indicated are brief and general, the language, priorities and initiatives flagged reflect those in the NDS Roadmap to a Sustainable Workforce. The following areas are flagged as a priority:o Rural and remote workforce solutionso Allied health capacityo Unpacking the support worker role e.g. complex support, mental healtho Training needso Transformation/innovation (see above Innovative Workforce Fund).

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IssueResearchPolicy-relevant research is required to support the implementation of the NDIS and the National Disability Strategy. The NDIS’s basis in insurance principles and the long-term benefits of early intervention needs to be underpinned by evidence.

The most recent comprehensive Australian audit of disability research concluded that the current disability research base is ‘not fit for purpose’ for the reform agenda and is fragmented and diversified across topics and study designs. In particular, there is an absence of timely, relevant and practical research for immediate use to policy makers, providers and consumers. 

What NDS is seeking

Increased investment in disability research, including the establishment of an ongoing disability research fund to drive service innovation and quality improvement.

Implementation of the recommendations of the 2014 disability audit undertaken by the University of Sydney.

Better coordination and collaboration among researchers, providers, consumers and government agencies around agreed research priorities.

Increased support for providers to develop their applied research capacity and evaluation evidence, including translating high-quality research into sector practice.

Exploration of the potential of Assistive Technology to stimulate sector development.

Status

The National Institute of Labour Studies (NILS) at Flinders University are evaluating the NDIS and the evaluation framework, initial report and intermediate report are now available. The final report (NDIS Evaluation Consolidated Report), initially due in November 2016, is now not expected until the latter half of 2017.

NDS is preparing a submission on the delivery of outcomes under the National Disability Strategy 2010-2020 to build inclusive and accessible communities (due 17 March 2017). This matter was referred by the Senate to the Community Affairs References Committee for inquiry and report by September 2017.

Baseline information on outcomes for people who are entering the scheme were introduced in the NDIA Quarterly report for quarter one 2016-17 and the outcomes will be measured longitudinally.

New entrants to the scheme are being asked questions at the initial contact from the Agency to provide baseline measures for outcomes measurement throughout their plans. 

The NDIS Outcomes Framework pilot report, released December 2015, provides insight into the kind of information the NDIA will be collecting from participants to track progress on medium-term to long-term outcomes.

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The NDIA released the report Autism spectrum disorder: The evidence-based/evidence-informed report on good practice for supports provided to preschool children, their families and carers .

The NDIA announced the first nationally consistent approach to early childhood intervention in February 2016.

The NDIA has established specialist reference groups, including in early intervention, autism, indigenous and rural and remote service delivery and mental health. 

NDS’s Centre of Applied Disability Research (CADR) is assisting providers to increase their ‘research mindednesses’ through initiatives including a new Disability Knowledge Clearing House, the ‘Lines of Inquiry’ email news service and Research to Action one day forums.

Through CADR, NDS continues to work with its research partners on the following projects; o Better Mental Health Outcomes for People with Intellectual Disabilities o Business Confidence Survey o Disability Entrepreneurship o Financial Sustainability of the Disability Supply Side o Improving employment outcomes for Australians with disability o Independent Supported Living (ISL) arrangements and outcomes for adults

with ID/DDo Organisational models that promote community participation o Quality of life outcomes measurement for employment services o Relationships and Recognition o Survey of Blindness, Low Vision and Rehabilitation

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IssueChildren & Young People

The NDIS’s commitment to early intervention support funding in the first few years of a child’s life is fundamental. Improved access to therapeutic supports and assistive technology will help prevent or arrest problems in a child's early life and will ultimately boost their capacity to participate in education, employment and to live a good life in their community. It will also reduce the need for long-term support services and ongoing assistance from families and carers.

During the NDIS trials, concern has been raised about the higher than expected numbers of children becoming participants in the scheme. During 2016 and 2017, the National Disability Insurance Agency (NDIA) is introducing Early Childhood Partners for children aged 0 to 6 years to see whether some children can be assisted with relatively low levels of support. This would divert them from becoming participants of the scheme. For children aged 7 years and older who meet access requirements, an NDIA planner or an NDIS Local Area Coordination partner will work to develop an individualised support plan for the child.

For children with disability, the interaction between the National Disability Insurance Scheme (NDIS) and mainstream services such as health, education and early childhood services must work well. Shared planning across services may improve outcomes and simplify arrangements for families and children.

What NDS is seeking

A trial of joint planning between the NDIS and mainstream services such as health and education

An evaluation of the new Early Childhood Partners program An equitable approach to selecting providers to deliver the Early Childhood

Partners program Continual release of evidence about interventions (and the level of intensity)

benefit children with particular disabilities Monitoring of access to therapeutic supports Acknowledgement that, for some children, standard transdisciplinary support is

sufficient and higher initial investment is required.

Status

The NDIS has released early childhood resources . The NDIA has released a report on a nationally consistent approach to early

childhood intervention. Early childhood access partners have been trialled in the Nepean Blue

Mountains area and will be extended across Australia. Access the NDIA report Autism spectrum disorder: Evidence-based/evidence-

informed good practice for supports provided to preschool children, their families and carers is now available

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The Outcomes Framework Pilot   includes children, young people and their families.

The NDIA has a factsheet on the mainstream interface with early childhood services.

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