The Australian Government has committed to developing an NDIS Participant Service Guarantee to support positive participant experiences with the National Disability Insurance Scheme.
From 1 July 2020, the Guarantee will set new standards for the time it takes for key steps in the NDIS process. This means there will be shorter, agreed timeframes for people to receive a decision on whether they will be covered by the NDIS, to receive an NDIS plan and to have a plan reviewed.
To develop the Guarantee, the Government commissioned a review of the NDIS Act to identify opportunities to make NDIS processes simpler and more straight-forward, and remove legislative barriers to positive participant and provider experiences with the NDIS.
The review was undertaken by an independent expert, Mr David Tune AO PSM. People with disability, family members, carers, advocates and providers from around Australia shared their experiences and ideas through community workshops, an online survey and by making submissions.
The review report was handed to Government in December 2019 and is now available to the public.
What the review found?
The NDIS is improving social and economic outcomes for many of its participants while increasing their ability to achieve their goals and aspirations. However, the review found that the rollout of the NDIS has not been smooth for all participants
The review acknowledged the work that the Australian Government and the National Disability Insurance Agency are already doing to improve the NDIS participant experience. This work will help enhance existing systems, services, decision-making and the overall experience for NDIS participants, families and carers
The review includes 29 recommendations (see full list below) which aim to cut wait times, improve services, enhance flexibility in the use of funds, and clarify access for people with a disability.
Key recommendation for Plan Management
Recommendation 19:
“The NDIS Act is amended so a participant who requests to ‘plan manage’ their NDIS funding be subject to the same considerations that apply when a participant seeks to ‘self-manage’.”
This recommendation aims to provide clarity to providers and the market that any agreement/commercial arrangement is with the participant and not the plan manager.
This recommendation beings Plan Management closer to Self Management, effectively making Plan Management an abridged form of self-management and subject to the same safeguards and risk assessment as self-managing participants, as set out in section 44 of the NDIS Act.
By making Plan Management subject to the same risk assessment requirements as Self-Management it would also mean that the price control arrangements that currently exist for Plan Management Participants would also be lifted and in alignment with Self Management.
Key recommendation for Support Coordination
Recommendation 16:
“The NDIS Rules are amended to:
a. set out the factors the NDIA will consider in funding support coordination in a participant’s plan
b. outline circumstances in which it is not appropriate for the providers of support coordination to be the provider of any other funded supports in a participant’s plan, to protect participants from provider’s conflicts of interest.”
DIA welcomes this recommendation, clarifying and clearly defining the reasonable and necessary process outlining when a participant will receive Support Coordination funding.
What happens next?
A formal Government response to this review report will be released shortly. DIA will summarise and publish their response on the DIA website.
DIA will continue to work with the Federal and State Governments, NDIA, NDIS Quality and Safe Guards Commission and other key stakeholders on how these recommendations with flow into Legislation, the Participant Service guarantee and ultimately implemented, including any funding and structural implication.
Full List of Recommendations
Recommendation 1: Disability Reform Council Agenda
The Disability Reform Council (DRC) adds the resolution of the following outstanding policy matters to its forward work program:
a. the treatment of chronic health conditions under the NDIS
b. the role of nominees, guardians and supported-decision making under the NDIS, including the intersection between the NDIS and state and territory guardianship legislation
c. the role of the NDIA in undertaking fraud detection and enforcement activities, in consultation with the NDIS Quality and Safeguards Commission
d. the operation of compensation provisions under the NDIS Act.
Recommendation 2: Joint Planning Meetings
The NDIA trials an arrangement where all planning related functions are undertaken with a person who has delegation to approve the plan, and compares the benefits of that approach with the roll out of Joint Planning Meetings.
Recommendation 3: Funds to navigate the NDIS
The Commonwealth provides additional funding to support people with disability to navigate the NDIS, with a review of demand to occur as part of the next review of NDIS costs, currently scheduled for 2023.
Recommendation 4: Reasonable and Necessary Clarity
Governments and the NDIA provide more clarity around the definition of ‘reasonable and necessary’, with:
a. the NDIA publishing information, in accessible formats, about how it determines when a support is reasonable and necessary
b. updating the NDIS Rules to reflect the DRC’s agreements on the boundaries between the NDIS and mainstream service systems
c. the DRC working to resolve the interface between the NDIS and ordinary living costs
d. amending the NDIS Act to clarify that reasonable and necessary supports are considered together as a package
e. amending the NDIS Act to clarify that the NDIS is not responsible for funding supports in the absence of that support being provided through another more appropriate service system.
Recommendation 5: ICT Upgrade Focus
The NDIA gives priority to ICT upgrades to enable online access processes and allow people with disability to track the status of NDIA processes relating to them.
Recommendation 6: Accessible Versions of NDIS Act & Rules
The Commonwealth publishes accessible versions of the NDIS Act and NDIS Rules, to help people with disability understand the legislative basis of the NDIS.
Recommendation 7: Prospective Participants NDIS Act Amendments
The NDIS Act is amended to:
a. allow evidence provided to the NDIA about a prospective participant or participant to be used for multiple purposes under the NDIS Act, including access, planning and plan review processes
b. provide discretionary powers for the NDIA to require a prospective participant or participant undergo an assessment for the purposes of decision-making under the NDIS Act, using NDIA-approved providers and in a form set by the NDIA.
Recommendation 8: Psychosocial NDIS Act Amendments
The NDIS Act and Rules are amended to:
a. provide clearer guidance for the NDIA in considering whether a psychosocial impairment is permanent, recognising that some conditions may be episodic or fluctuating
b. remove references to ‘psychiatric conditions’ when determining eligibility and replace with ‘psychosocial disability’.
Recommendation 9: 90 Days for Participants to Provide Information
The NDIS Act is amended to give a prospective participant up to 90 days to provide information requested by the NDIA to support an access decision, before it is deemed they have withdrawn their access request.
Recommendation 10: SIL Review
The NDIA undertakes a review of its operational guidelines when funding Supported Independent Living, with an emphasis on increasing the involvement of participants, families and carers in the decision-making process and the principles of choice and control.
Recommendation 11: Participant Plan Funds Flexibility
The NDIS Rules are amended to clarify that supports in a participant’s plan should be used flexibly, except in limited circumstances, such as capital supports.
Recommendation 12: Aboriginal and Torres Strait Islander Outreach
The NDIA develops a comprehensive national outreach strategy for engaging with people with disability who are unaware of, or are reluctant to seek support from the NDIS, with a dedicated focus on Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse communities, and people with psychosocial disability.
Recommendation 13: Participant Service Guarantee Added to NDIS Act
The NDIS Act is amended to reflect that a plan must be facilitated and approved in accordance with the timeframes outlined in the Participant Service Guarantee.
Recommendation 14: Reasonable and Necessary for Children
The NDIS Rules are amended to reinforce that the determination of reasonable and necessary supports for children with disability will:
a. recognise the additional informal supports provided by their families and carers, when compared to children without disability
b. provide families and carers with access to supports in the home and other forms of respite and
c. build the capacity of families and carers to support children with disability in natural settings such as the home and community.
Recommendation 15: Increased Flexibility in Early Intervention
The NDIS Act is amended to provide more flexibility for the NDIA to fund early intervention support for children under the age of seven years outside a NDIS plan, in order to develop family capacity and ability to exercise informed choice and control.
Recommendation 16: Support Coordination Funding Clarity
The NDIS Rules are amended to:
a. set out the factors the NDIA will consider in funding support coordination in a participant’s plan
b. outline circumstances in which it is not appropriate for the providers of support coordination to be the provider of any other funded supports in a participant’s plan, to protect participants from provider’s conflicts of interest.
Recommendation 17: NDIA Market Intervention
The NDIS Rules are amended to give the NDIA more defined powers to undertake market intervention on behalf of participants.
Recommendation 18: Evidence-based Best Practice Approaches
The NDIA works with governments, researchers and experts in the provision of disability support to establish an accessible source of publically available information about evidence-based best practice approaches, to assist participants in exercising informed choice and control.
Recommendation 19: Plan Management Subject to Risk Assessment
The NDIS Act is amended so a participant who requests to ‘plan manage’ their NDIS funding be subject to the same considerations that apply when a participant seeks to ‘self-manage’.
Recommendation 20: Unscheduled Review Considerations
The NDIS Act is amended to introduce a new Category D rule-making power that sets out the matters the NDIA must consider when deciding whether to undertake an unscheduled plan review.
Recommendation 21: Plan Amendments
The NDIS Act is amended to introduce a new Category D rule-making power giving the NDIA the ability to amend a plan in appropriate circumstances.
Recommendation 22: Multiple Meanings of the Word ‘Review’
The NDIS Act is amended to remove the duplicate use of the word ‘review’.
(i.e participants can seek different types of a ‘review’ under the NDIS Act: a review of their plan (in accordance with section 48), an internal review of a reviewable decision (in accordance with section 100), and a third type of review is created when the participant appeals an internal review decision to the AAT.)
Recommendation 23: AAT Jurisdiction
The NDIS Act is amended to clarify the Administrative Appeals Tribunal’s (AAT) jurisdiction, including the power for a plan to be amended while a matter is before the AAT.
Recommendation 24: IAC to Develop Independent Participant Satisfaction Survey
The NDIS Independent Advisory Council develops a new independent participant satisfaction survey, with reporting included in the NDIA’s quarterly reporting to DRC.
Recommendation 25: Participant Service Guarantee to Cover
That the NDIS Act is amended to legislate a Participant Service Guarantee as a Category C rule, to be updated from time to time, with:
a. new timeframes for decision-making, engagement principles and performance metrics, as set out in Chapter 10 of this report
b. relevant existing timeframes for decision-making moved from the NDIS Act to the new rule
c. prospective participants and participants being empowered to request an explanation of an access, planning or plan review decision made by the NDIA
d. participants being empowered to receive a full draft plan before it is approved by the NDIA
e. a review within two years of the rule being enacted.
Recommendation 26: Clarify the Commonwealth Ombudsman’s Powers
The NDIS Act is amended to clarify the Commonwealth Ombudsman’s powers to monitor the NDIA’s performance in delivering against the Participant Service Guarantee.
Recommendation 27: NDIS Act Drafting Tidy Up
The NDIS Act and Rules are amended to:
a. remove trial and transition provisions
b. reflect agreed recommendations arising from the 2015 review of the NDIS Act
c. reflect current best practice drafting standards, and other amendments as proposed in this report.
Recommendation 28: NDIS Act to Reference National Disability Strategy
The NDIS Act is amended to reference the National Disability Strategy as in force from time to time.
Recommendation 29: The National Disability Strategy
The new National Disability Strategy being developed for beyond 2020 makes reference to how it complements and builds on the NDIS.