Disclosure Log
Document 15 - FOR OFFICIAL USE ONLY
Pricing Reference Group, September 19th, Item 4.1
Matter For Decision:
Price Limits for Disability Related Health Supports From Octobre First, Prepared By David Cullen Chief Economist
Purpose
For The PRG To Agree On The Arrangements Of Disablility Related Health Support As NDIS Is Going to Assume Responsibility For These Supports Starting on october first following a decision made by Council Australian Government’s Disability Reform Council DRC June Second Eighteen Nineteen.
Recommendations
PRG AGREE TO RECOMMEND THE BOARD THAT THE PRICE LIMITS SET OUT IN ATTACHMENT A WILL APPLY FROM OCTOBER FIRST ON DISABILITY RELATED HEALTH SUPPORTS WHERE THEY ARE PART OF THE PARTICIPANT’S DAILY LIFE AND RESULT DIRECTLY FROM THEIR DISABILITIES. ####### Background On June Twenty Eighth nineteen the DRC agreed that starting from October One nine eighteen the NDIS will fund disability related health supports where they are part and parcel with daily life of participants resulting directly form their disabilities. ####### Current Conditions Assisted Include (Not Exhaustive): a) Dysphagia: Participants having trouble eating drinking or swallowing regularly, b) Respiratory: Participants needing help breathing c) Nutrition: Participants requiring assistance in how food is consumed/digested,d) Diabetes: Daily problems managing blood sugar levels,e) Continence: Needing regular toileting support,f) Wound & Pressure Care: Regular wound care needed due pressure wounds/g) Podiatry Footcare: Assistance required for foot/leg management/h) Epilepsy: Managing epilepsy effects brain/nerves,i) Botox Splinting: Short-term relief muscle spasms.
DISCLOSURE LOG
FOR OFFICIAL USE ONLY Pricing Reference Group | Item: Pricing Reference Group | Date: September 19th , Year: 2019
Agency.
Insurance
Disability
National
Released information:
The act that was
Disclosure Log
FOR OFFICIAL USE ONLY
Pricing Reference Group - Item 4.1 | Date: September 19th , Year : [Year]
Figure 1: Components Of Registered Nursing Price Limits
| Weekday | Afternoon Shift | Saturday | Sunday | Public Holiday | Night Shift |
|---|---|---|---|---|---|
| $75$ Worker’s Direct Salary & $30 Allowances & $6 Superannuation & $- WorkCover & $-$ Pre-tax margin | $80 Worker’s Leave Entitlements & $20 Supervisor & $- Utilisation (Breaks Training etc.)& $+ Corporate Overheads | $100 Worker’s Direct Salary & $20 Allowance & $10 Supervisors & $- Utilization (breaks, training) & -$ Pre tax margin | $120 Worker’s Direct Salaries & $20 Allowance & $10 Supers & $Utilization (breaks,training)& $Corporate overheads | $100 Worker’s Direct Salary & $20 Allowance & $Supervisor & $Utilization(breaks,trainings) & $Pre Tax Margin |
Average funding Level for Care = $140 per hour
Figure Legend: Worker’s Direct Salary, Allowances, supervision, payroll taxes. Workcover is a type of insurance that provides benefits to workers who are injured or become ill on the job. It also covers other expenses such as medical bills and lost wages due to injury or illness while at work.
Disclosure Log
FOR OFFICIAL USE ONLY
Pricing Reference Group - Item 4.1 (Date: September 19th)
Disability-Related Health Assistive Technology Supports
New Support Items Created:
Ten new support items were created under Assistive Products for Personal Care and Safety, specifically within Disability-related health assistive technology, which are not currently covered through NDIS.
Types Covered Under These Items Include:
a) Machines assisting disability-related respiratory problems, b) Air-filled garments & compression units managing circulation issues,c) Repairs/maintenance services on disability-related healthcare equipment.
High-Cost Items Requiring Quotation Determination:
six out these ten high-cost items will be priced via quotation when each participant’s plan is built:a) Invasive ventilation respiratorsb) Supplemental ventilator aspiratorc) Cough assistance machinesd) Circulation management air-filteg) Compression unitsa
Other Four Minor, Variable Items Not Subject to Price Controls:
four other minor variable items that do not require price controls due their competitive naturea) Maintenance of disability related health machinab) Respiratory rental servicesc) Filters/humidifiers for respirationsd) Replacement garmentss
Implementation Communication Plan Developed:
an agency-wide communication strategy has been established in preparation for the implementation of disability-related health supports. n The updated or newly introduced support items shall become part of both the NDIS Price Guide and Support Catalogue effective from October 1st. n As per NDIA decision made June 28th regarding NDIS implementation timeline set at Octoberr, this timeframe was deemed insufficient by the Agency to ensure all existing participants are reviewed for any additional reasonable needs.r
Interim Arrangements within Core Disability-Related Health Nursing Supports:
as a result of aforementioned considerations, a capacity-building initiative may need replication among relevant areas within the Agency following discussions with pertinent sections.s
Disclosure Log
FOR OFFICIAL USE ONLY
Pricing Reference Group | Date: September 19th , Year : 2019 | Item Number: Item
assessments and planning (delivered by therapists,dieticiansand early childhood intervention providers) anda new nursing items described above withinthe Core support categoryof Assistance with Daily Living.
5.5 This will allowfor immediate claimingfromOctober,Year: 2019 fora smoother transitionofoexisting participantswithout therequirementforenimediately plan reviewas participantswill be able to utilise unspent core funding until reviews canbe arranged.
5.6 The intentionis forthesereplicated itemstoremain inCore fors a year period thatwillallow fo ra dequate time foreffected plans tob ereviewedto include such supports where reasonablean d necessarywithin Capacity Building budgets.
Sensitivities
6.1The Agency is stillin discussionswith CommonwealthState an d Territory Governments aroundarrangements for disability-related healthsupports,andtheseparation fromHealthsystem.This may affecttherange ofsupportsfundedclaimablefro m the NDIS post October.Year:'2019.OSA has coste din impact o fdisability-relat edhealthsuppor ts [amounttobe advised].
Attachment
A Proposed Disability-Related Health Supports For 1 Octob er Year : ‘2019’
Disclosure Log
FOR OFFICIAL USE ONLY
| Support Item Code | Support Item Name | Support Category | Unit Of Measure | National Price Limit(if applicable) | Quote Required? | Registration Groups |
|---|---|---|---|---|---|---|
| 03_040000111_0103_1_1 | High Cost Disability-Related Health Consumables | Consumables | EA | N/A | Yes-Assistive Products For Personal Care and Safety | |
| 03_040000919_0103_1_1 | Low Cost Disability-Related Health Consumables | Consumables | EA | N/A-No-Assistive Products for Personal Care And Safety | ||
| 03_710400001_0103_1_1 | Disability Related Health EquipmentAnd Consumables Delivery | Consumables | EA | N/A-No-Assistive ProductsforPersonalCareandSafety | ||
| 03_710400002_0103_1_1 | Disability-related health equipment-and consumables - set up/training | consumables | ea | na-no-assistive productsforsafetycarepersonal care safety assistive technology ea n/a no Assistive ProductsForPersonalCareandsafetypersonal care assistance technologynoassistivetechnology ean a yesAssistiveProductsFopersonalcareassistancetechnologyeannayes | ||
| 5_040300159 0103 _1. | Repairs & Maintenance Disabilit yrelated Health Machines Assis t Technology EA N A No Assistive Product s For Person al Car e and Saf ety | |||||
| 05_040312111,0103,_1._Respirators Invasive Ventilation Fo Continuous Use As sist Technol ogy E A N /A Yes Assisti ve Prod ucts for Personal Care And Safety | ||||||
| Powerd Respirator Rental Assistive Technology WK NA No Assistive Products fo r Personal Ca re an d Sa fety | ||||||
| R espi rat ors Supplementa l V entil ation Support (Inclu ding CPAP BP AP) Assist i te chno logy EA N/A Y ess-Assisti veproductsforsafetycaresafety | ||||||
| Filters And Or Humidifiers F or Res pi rats Assist ive T echnotogy Ea Na No assistive productsforsafetycarepersonal ca resafety assitance technology ea n/a no-assistive product sforsafetypersonal care safety assistance technologynoassistivetechnologyea na yesAssistiveProductsFopersonalcareassistancetechnologynoa | ||||||
| As pirat ors Assistance Te c hno lo gy EA N/ANo Assis tive Pro ductsForPersonalCareAndSafety | Cough Assist Machine Assistive Technology EA N/A Yes Assistive Product s For Person al Car e and Saf et y | |||||
| AirFilled Garments Compression Units Managing Circulation Problems Assistive Technology EA N/A Yes Assistive ProductsforPersonallcareresafety as sist ance tecnol ogyeannayesAssi stiveProductsforsafetyc arereasafetyassistantecnolo gyean ayesAss istiveProduc ts for personal car esafety assistant tec hnologyean ay esAssistiveProdu ctssafetypersonalsafetya ssistanttecnologiyanaye | ||||||
| Replacement Garment S Compress Sleeves Cyclic Pressure Unit As si tech notog yEA NA No Assistive Prod ucts Fo r Personal Care And Safety | ||||||
| 15_400 0114 _3 Delivery Of Health Supports By An Enrolled Nurse Weekday Daytime Improved Daily Living Skills H $86.62 No Community Nursing Ca re | ||||||
| Delivery of health supports by an enrolled nurse - weekday afternoon improved daily living skills h$95,55 no community nursing care deliveryofhealthsupportsbyane nrolleddnurse-saturdayimproveddailylivingskills$h123 .57nocommunitynursingcaredeliveryo fheal thsupportsb ya ne nnole ddnur se sunday im proveddailylivingskillsh$142 , |
Disclosure Log
Pricing Reference Group Item 4.1 ATTACHMENT A Date: September 19th, Year: 2019*
Disclosure Log
FOR OFFICIAL USE ONLY Pricing Reference Group Item: Item4 ATTACHMENT A
| Support Item Code | Support Item Name | Support Category | Unit Of Measure | National Price Limit If Applicable | Quote Required? | Registration Groups |
|---|---|---|---|---|---|---|
| DeliveryOfHealthSupportsByAClinicalNurseConsultant - Sunday | Improved Daily Living Skills | H | $240.84 | No | Community Nursing Care | |
| Deliveryofhealthsupportsbyacclinicalnurseconsultantpublicholiday | ImprovedDailyLivingSkills | H | $272.21 | No | Community Nursing Care | |
| Deliveryofhealthsupportsclicalnurseconsultantactiveovernight | ImprovedDailyLivingSkills | H | $164.88 | No | Community Nursing Care | |
| Deliveryofhealthsupporstbanaclinicalnursepractitionerweekdaydaytime | ImprovedDailyLivingSkills | H | $153.39 | No | Community Nursing Care | |
| Delivery of health supports by a nurse practitioner week day afternoon | Improved daily living skills | H | 169,21 | no | community nursing care | |
| deliveryoffhealthsupportsbynursepractitionersaturday | improveddailylivingskills | h | $219 .oo | no | community nuringcare | |
| delivery off health support s b y an urse pr acti oner sund ay | im proved dail y liv ing sk ils | H | $25l ,8 l | No | Community N u r i ng C are | |
| deliv ery o f he alth suppo rt sb ya nr se p rac tio ner pub lic ho liday | I mpro ved D ail Y L iv in g S k il ls | h | S284 .G 1 | N O | C om mu ni ty Nu rsing Ca re | |
| Delive ry Of Health Supports By A Nurse Practitioner - Active Overnight | Improved Daily Living Skills | H | $172.37 | No | Community Nursing Care | |
| Communit y NursingCareForContinen ce Aid | ImprovedDailyLivingSkills | H | $12405 | No | Community Nursing Care |
Disclosure Log
Matter for Endorsement: Implications of SCHADS Award Review for December 30th and January first,
Prepared By David Cullen Chief Economist
Purpose:
The PRG endorses proposed increases in price limits effective Decemberr third.
Recommendations:
Pricing Reference Group recommends that Saturday supports increase be increased from 5% to a total of $476 per week while Sunday support should also see an increase but at different rates.
Agency.
Insurance
Disability
National
Released information:
The act that was
Disclosure Log
Pricing Reference Group - September 19th, Item: Item
Section 4:
The full impact from July first twenty-twenty translates into an increase amounting at two point seven percent on Saturdays while it is one point four percentage points higher than that which applies Sunday. This effect shall also be taken up during consideration within this year’s annual review concerning price controls.
Subsection A (Insert OSA costing when available)
Sensitivities
The current Efficient Cost Model assumes eighty/forty permanent/casual split across all shifts; however, it may not hold true to Saturday and Sunday shifts as well as some providers who have more casual workers; hence these providers might face a greater cost increment compared with what has been proposed in terms of price limits increases. This issue will further be considered upon completion next year’s annual review concernig price control.
Implementation Issues
It proposes existing plan budgets alongwith typical support packages guiding new plans should remain unchanged due to increased price limitations. The majority participants are affected minimally because supports aren’t usually delivered over weekends & thus any influence of weekend support prices remains minimal too.In many cases though ,participants can choose their timing for receiving the services thereby managing such increments extentively. 6 It suggests monitoring utilisation rates proactively where participants consume their plans faster than expected, aligns closely wth changes made regarding Disability Related Health Supports and Temporary Transformation Payment. 7 Service bookings shouldn’t change based on altered price limitations since they reflect agreements between service provider and participant parties which must only be modified after mutual agreement by both sides. 8 Once approved by Board,the suggested increase within price limits shall then communicated to respective providers and implemented effective from December 1st twenty nineteen. 9 As previously mentioned above second round loading enhancements would also form part this years annual review concerning price controls.
Disclosure Log
Pricing Reference Group Minutes of the 16 October 2019 Meeting
Members present:
- Liz [Chair A/g Head of MPSD]
- Deb [proxy Scott]
- Jim PSM Independent Member
- David Cullen
- Graeme AM Independent Member
- Sarah
- Victor
- Melissa
Apologies: Oliver
Presenters Greg
Secretariat Scott Item 1.2 – Conflicts of interest: The PRG noted that Graeme was a member of Board Life Without Barriers; The Summer Foundation Joblife Employment Attitude Foundation and s47F - personal privacy irrelevan material. **Item 1.3–Minutes meeting September item 1.3) time 2019 endorsed minutes previous meeting (PRG-20190919 Item). Item Proposed dates 2020 meetings 2020 proposed meeting dates (PRG-20190919 Item).) Review Terms reference membership update PRG discussed options strengthen clarify role through amendments to its terms of reference Membership Update.) Temporary Transformation Payment Implementation TTP Benchmarking Survey key milestones timings for Temporary Transformation Payment implementation survey.
Disclosure Log
FOR OFFICIAL USE ONLY National Disability Insurance Agency - Pricing Reference Group Minutes of the Meeting of October 16th,
Item 2.3 —Short-Term Accommodation Price Limits
- The PRG notes NDIA intends changing “Short-term accommodation assistance”(STAs) name into ’short term accomodation & Assistance(Including Respite)’and amending descriptions in NDIS guide.
- PRG recommends Board: future all limits derived components set based on component parts’limits rather than indexation. 8.- Option D under paragraph: current STAs should have individual components amended for appropriate sustainable costs levels used consideration given introduction new STA items standard level prices usage participants requiring less supervision while using them. 9.- **Board recommendation: existing plans not automatically increased because most use overnight basis plan utilisation monitored with necessary reviews to ensure high users are disadvantaged service bookings unchanged as they reflect agreements between providers participant express agreement needed both parties.
Item 2.4 – Medium Term Accommodation Price Limits
to include MTA support line item from December, intended transitional care before permanent setting proposed price limit covers only accommodation cost participant responsible usual living and other supports delivered through existing items further work required regulation fees charged by MTAs providers. 10.- The PRG noted that further work is required around the regulation of the fees that MTA providers may charge participants their contribution everyday living. 11.- The PRG agreed extend short-term accommodation (STA) days risk entering Voluntary Out Of Home Care(VOOHC).
Item 2.5 —Supported Employment Services
The PRG notes: a)-price controlled Supported employment support items will be introduced into NDIS guide effective March,
DISCLOSURE LOG
FOR OFFICIAL USE ONLY National Disability Insurance Agency - Pricing Reference Group Minutes of the Meeting of 16 October 2019 (b) the new price control framework for Supported Employment is broadly inline with previously principle agreement of the PRG on March 14, 2019 [PRG – Item]. This exception includes single pricing controls per support ratio rather than differentiating community centers.
Item 2.6 — Coordinated Commissioning
The PRG noted establishment of cross-NDIA working group considering coordinated commissioning limited cohorts thin market circumstances identification would complement PRGs other actions such as price controls inclusion quotable packages supports first projects addressing NDIA Board direction Independent Pricing Review IPR.
Item 3.1—Annual Review Terms Of Reference And Timeline
The PRG agreed to recommend annual review terms reference and draft timeline (Item A) and B).
Item 4.1–October Publication Price Guide Support Catalogue
The PRG discussed publication NDIS Price Guide effective from Oct. The PRG reclassified locality Merriden in WA category outer regional remote category comprehensive review MMM system status all localities part Annual Review Price Controls .