NDIA Accountability Project

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Update to the Supported Independent Living (SIL) Review of Price Controls

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Disclosure Log

Document: Pricing Reference Group - Update to the Supported Independent Living (SIL) Review of Price Controls Prepared By Scott Mitchell Director,

Purpose:

The purpose is For PRG members to discuss updates regarding price controls.

Background:

  • Sil provides funding primarily aimed at participants who have high disability support needs; currently over 24k out of all NDIS participants receive this service which accounts for about $8billion annually on June’6th 2020 representing around thirty percent across total committed supports within NDIS system most also receiving SDA funds. On July first year twenty zero nineteen NDIA replaced previous quotation pricing arrangements with hourly limits based ‘assistance self-care’. These changes designed increase transparency equity simplify administratively complex processes. Consultations were held initially met participant and provider peak bodies where key topics discussed focused whether move hour limit could improve experience engaging service providers services SIL environment. This review forms part larger ongoing program improving way participants supported in Sil there concurrent review focusing improvement participant experience. Differences costs providing attendant care community AC compared those provided under sil model explored potential adaptations cost model. Other schemes paying attendants shared living arrangement consulted Transport Accident Commission Victoria SA Lifetime Support Authority Worksafe Victoria iCare NSW Department Veteran Affairs

Response To Issues Paper In August two thousand an issues paper released seeking submissions sector help inform estimates fully loaded cost delivering one hour attending care arranged.

Disclosure Log

Pricing Reference Group - Item 3.3

FOR OFFICIAL USE ONLY

Date: November 12th Year:*

Section 3.2:

The closing date for submissions from Issues Paper is October 25, year20. As per October 30, year20., There have been ninety-one (91) Submissions. Late submissions are continuing in small numbers.

Section 3.3:

Attached hereunder are the submissions provided by Provider Peak bodies such as National Disability Services (NDS) Alliance twenty*(Alliance-20)* Ability First found at Attachments A-D.*

Disclosure Log

FOR OFFICIAL USE ONLY

Pricing Reference Group - Item 3.3 | Date: November 12, Year:2020

a. Based on benchmark proxies used between efficient providers delivering Services In Lieu and Attendant Care (AC), Deloitte found that some significant adjustments would need for cost models if they wanted them match actual costs. b. Workers’ compensation premiums among Service Providers is higher than AC counterparts with rates being + compared against an average rate in AC.-.7% c. Supervisors receive a premium (+) salary increase over their peers within Community settings due possibly because participants are more intensive in SIsL programs.d. No statistically notable differences were observed regarding overheads, profit margins or span control when comparing SI L versus AC.e. A greater proportion ( extbf{40% extgreater} community care at extbf{30%)})of permanent workers exist which results into slight savings(+). This saving may also rise once weekend penalty rates come effective December.f. Deloitte conducted deep dives of finances from nine willing to share data confidentially but sample size was too small to draw statistical conclusions.g. Vacancy rates noted during the financial analysis showed an average SIL vacancy percentage as extbf5.%`, not available through Financial Benchmarking Survey.h. Further information can be obtained via Attachment E noting provider identities remain under confidentiality by Agency.i. Next Steps

  1. Price Regulation Unit will summarize major concerns received and invite first round consultation participants back again November/December 2 A final report for Pricing Reference Group expected March next year.j. PRG recommendations conveyed Board meeting April following. k. Any pricing changes agreed upon announced May June coming up.l. Providers given notice month before price change implementation July 2020.m. There respondents provided both Services In Lieu (SIL) & Community Attendant Care; weighted analysis done based on ratio between these two services.

MR25/01967 FOI 24/25-2242

FOR OFFICIAL USE ONLY

Pricing Reference Group 12 November 2020 Item 3.3

6. Attachments

A National Disability Services Submission to the SIL Pricing Review
B Ability First Submission to the SIL Pricing Review
C Alliance20 Submission to the SIL Pricing Review
D Alliance20 - PwC Analysis of SIL Pricing
E Deloitte Access Economics Financial Analysis

Update to the Supported Independent Living (SIL) Review of Price Controls Page 412 of 1049 3.3.4

Disclosure Log

Pricing Reference Group Meeting: February 10th and November th , Februray 2023

Minutes

Date: Wednesday & Thursday Febuary 10-11 Time: Wed: 07:00 - Thu: :00 Location: Microsoft Teams Meeting Video Conference

Attendees

Chair Gerrie General Manager Provider Market Development Division Pricing Reference Group Members: deborah Independent Member Graeme AM Independent Member Jim PSM Independent Member Julie PSM Independent Member Lynne Independent Member Secretariat David Director Pricing Operations Price Regulation Unit Other Attendee Scott Director Policy Economics,Price Regulatation Unit Apologies David Cullen Chief Economist Sarah Johnson Scheme Actuary

Disclosure Log

FOR OFFICIAL USE ONLY

DOCUMENT 40

ndis Delivered by the National Disability Insurance Agency

Pricing Reference Group Provider Peak Feedback Sessions

Date: Wednesday 10 February 2021 Time: 0900 - 1230 Microsoft Teams

Attendees

Disclosure Log

Pricing Reference Group | October 16th, 2019 Meeting Agenda

Notes:

  • National Disability Service (NDS) • NDS supports 1,[1] members; majority active support under NDIs incorporate TTP into their prices. • Cynical about achieving this in most providers due mostly not being able achieve that level. • Highly transactional scheme where people have been there up-to decades making finding new participants difficult suggesting less influx future. • Spanning may reduce quality & safety: 1:1 vs 1:1.5 • Planners will fund actual number public holidays as only funded when Vic has thirteen. • It was suggested Participants should be able purchase all R&Ns so plans should at TTP levels. • Price needs consider cost innovation. • Philippa Angley advised major problem with SIL is how apply individual funding group situations many require more than R&Ns for individuals maybe all house members develop same time? • Community participation inflows expected. New groups are adopted Providers exit or supply a ratio of one to one. • Community participation varies whereas Aged Care happens location. • Concerns behaviors moderated during Covid some prefer stay home but still need worker. • NF2F charged directly the individuals big administrative burden shared equally incident charge then individual Group pricing inadequate $7 makes work costs admin exceed NF2F. • When Scheme rolled out no complex administration expected adjusting every hour support ratios NDS concerned perverse incentives current model larger large suggest ceiling 1:.5 Stated overhead magic numbers which minimal infrastructure services example small medium business – work from home, shop front low Overhead realistic (open service site included enthusiasm expand) Meeting stakeholders would positive Would like retain level PRG Comments:
  • Some what considers overhead allocated particular activities better way get on top Costs position contradicted by own methodology uncomfortable TTP there does focus improving efficiency Other Schemes use rewards providers improve their Efficiency Ability First:

Notes -

National Disability Service(NDS)

• NDS supports 1,[1] members majority active under NDIs incorporate TTP into prices. • Cynical about achieving this in most due mostly not being able achieve that level. • Highly transactional scheme where people have been up-to decades making finding new participants difficult suggesting less influx future. • Spanning may reduce quality & safety: 1:vs 1.5 Planners will fund actual number public holidays as only funded when Vic has thirteen It was suggested Participants should be able purchase all R&Ns so plans at levels Price needs consider cost innovation Philippa Angley advised major problem with SIL is how apply individual funding group situations many require more than R&Ns for individuals maybe all house members develop same time Community participation inflows expected New groups are adopted Providers exit or supply a ratio of one to one Community variation whereas Aged Care happens location Concerns behaviors moderated during Covid some prefer stay home but still need worker NF2F charged directly the individuals big administrative burden shared equally incident charge then individual Group pricing inadequate $7 makes work costs admin exceed NF2F When Scheme rolled out no complex administration expected adjusting every hour support ratios NDS concerned perverse incentives current model larger large suggest ceiling 1:. Stated overhead magic numbers which minimal infrastructure services example small medium business – work from shop front low Overhead realistic (open service site included enthusiasm expand) Meeting stakeholders would positive Would like retain TTP there does focus improving efficiency Other Schemes use rewards providers improve their Efficiency

Ability First:

  • Ability supports $ billion, years disability participants perspective focused on end Workforce challenging NDIS learning listen respect service Efficiencies suggested Clear rules families have different interpretations supports streamline claiming process Innovation priced in DHL industry works margin considered % Need invest attract younger participants they don’t can create vacancies Key groups resident participant age/type Disability landlord others House Wanted aligned? Aligning and difficult high level vacancy No high SIL Quality Safety Compliance an administrative burden lot reporting required people now looking at restricted practice reporting It easy if all was Portal managed other plan managers Rosters agreeing ROC good setting core hours Struggling with system of having to record every participant every hour sort irregular Takes away choice control workers find it too hard do anything outside agreed routine.

Disclosure Log

FOR OFFICIAL USE ONLY Pricing Reference Group | October 16th, 2019 Meeting Agenda

  • Discussed points:*
  • 18% considered more realistic overheads.
  • Simplified Independent Living (SIL) at weekly funding was easier for organizations with less manual processes involving filing cabinets instead of going through complex coordination chains using technology monitoring rather than relying solely on human resources investment trends towards attracting younger people who are mobile and may leave traditional independent living settings over time due primarily because they prefer greater mobility but also because these individuals often require specialized care that is not always available within such facilities.

Disclosure Log

Pricing Reference Group - For Official Use Only | Date: 16 October 2019 | Meeting Agenda

  • 1/3 SIL High Intensity vs 1/5 Community AC
  • SIL Lot More Complex Behavioural And Medical Care Needs*
  • *SIL Working Within Operational Guidelines Of Roster Of Care RoC Designed To Cover Whenever Not In External Community Activities Groups Or Employment

Disclosure Log

Pricing Reference Group Provider Peaks Feedback Session

Date: Wednesday 10 February 2021 Time:* Microsoft Teams \n \n| Time | Provider Peaks | Presenters | |-|-|-| | redacted - personal privacy | National Disability Service (NDS) | David 647F- CEO Philippa 647F : Head of Policy | | Ability First Australia | Andrew 647F- personall p:CEO | | Alliance redacte d: s33 - national security, defence or international relations| Drew 647F-personal pr: CEO Possibility Leanne 647F-personal pr: CEO Sylvanvale Foundation Heath 647F-personal pr:Head of Stakeholder Relations-Diability Services Australia (DSA) Also present for the presentation will be the Alliance Secretariat support Chris 647F-personal priv, Steve Slone and myself(Nelson from Life Without Barriers John 647F-personal pr:from Possibility |

Disclosure Log

FOR OFFICIAL USE ONLY

DOCUMENT 42

ndis Delivered by the National Disability Insurance Agency

Pricing Reference Group Participant Peaks Feedback Session

  • Date: Thursday 11 February 2021
  • Time: 11:00 - 13:30 Microsoft Teams | Attendees | |-| || Chair || Gerrie | General Manager Provider and Market Development Division | Pricing Reference Group Members | Independent Member | Deborah | | Independent Member | Jim PSM | | Independent Member | Julie PSM AMM | | Independent Member | Graeme AMMM | | Independent Member | Lynne MMAMM | Secretariat | Director, Pricing Operations Price Regulation Unit | David personal pmmm | Other Attendees | Director Policy Economics Price Regulatation Unit Scott personalmammmm | Apologies Davin Cullen Chief Economist Guest Speakers – Participant Peaks Inclusion Australia Catherine CEO Carers Australia Lisa CEO Carers ACT

DISCLOSURE LOG

FOR OFFICIAL USE ONLY Pricing Reference Group | Participant Peak Feedback Session - February 11th , Year: 2019

Notes

Inclusion Australia

  • SIL Participants (especially those who suffer from intellectual disability and are proportionally large) lack negotiating power over their Roster Care; they end up living with individuals whom they do not want.
  • Changes made regarding pricing within SIL appear blunt instruments causing stress among people involved;
  • SLES appears inflexible towards keeping participants confined indoors rather than engaging them into jobs or on-the-job training which could be more beneficial,
  • What measures can we implement preventatively against enrolling someone under SIL? Not everyone suffering Intellectual Disability needs such enrollment. Prevention strategies should divert attention away from this option requiring substantial support systems if implemented successfully.
  • Example given involving couples residing separately but wanting together—arrangements have been made for cohabitation however, what happens when relationships break down is unclear as there’s no legal holdover to previous locations.
  • Neither SLES nor DES follow evidence-based practices in helping intellectually disabled adults secure employment opportunities despite TAFE Certifications not leading directly toward job acquisition. The Scheme relies heavily upon the ability of these individuals securing work post-schooling without prior experience except possibly ADEs (Able-bodied Employees). Sustainability depends significantly whether young adults with ID can function independently at home provided adequate supports exist.

Disclosure Log

FOR OFFICIAL USE ONLY

DOCUMENT 43

ndis Delivered by the National Disability Insurance Agency

Pricing Reference Group Provider(Group Supports) Feedback Session

Date: Thursday 11 February 2021 Time: 1400 - 1600 Microsoft Teams

Attendees:

Disclosure Log

Pricing Reference Group - Participant Peak Feedback Session (11 February 2019)

Notes:

  • Knoxbrooke: Fair to say organisations stagnated under state govt; group funding diminished and innovation eroded. Crisis helped focus organizations’ core fundamentals: shifted model from Birdsville centralised hierarchical structure towards decentralized smaller units closer home for clients & increased freedom among staff making decisions; NDIS pricing so lean rendered services unviable unless well-funded as states had been, made same model viable but needed understanding participants/families. during COVID closed group supports did not reopen. The majority getting no support stayed at home or got limited one-on-one support their plans can fund.Medium-to-high risk clients are receiving help through our ‘365 service’, even if workers were less qualified.Retrenched workers mostly highly skilled.Conditions more favorable – six weeks leave higher pay levels.Cross-subsidizing via op shops remains necessary.Unstable prices forcing disability services move business footing, becoming selective about who they take on.Having local accountant review each of businesses because eating into cash reserves.NF2F is an admin burden seeking guidance on what constitutes this. Some Agency guidance would be helpful.Group ratios change during the day hard administerable.

MiLife: Worked outcomes-based programs since 2002.All aimed capacity building with a wide range in durations times.We spent time thinking NF2F time research planning beforehand setup writing reports journal notes diary notes.Came around to 12%.In Cost Model there’s utilisation component Disability Consulting said every hour expected between and minutes.From price point unfair charge for single plan complex ones.Split routine standard/moderate/complex.Program viability spreadsheet determines optimal number people per activity.In some cases cross-subsidised only minor loss Overall feedback positive now first block out of twelve Clients don’t want do families selected them always.During COVID those just sat TV front nine weeks went backwards quickly.No one complaining much same overall; some expensive but demonstrate complexity or high ratio.Some have gone overboard picking up everything run funds We find choices not participants family staff at SIL house.

PRG Feedback:

GM- Will give you feedback how PoS are going general.

Stride: Aftercare Mental Health, hundred staff half revenue from NDIS previously academic analysis charity data PhD math.The NDIA has made great steps forward transparency Price Model Argues agency prices according market response cost model.

Disclosure Log

MR25/01967 FOI 24/25-2242 FOR OFFICIAL USE ONLY DOCUMENT 44

ndis Delivered by the National Disability Insurance Agency

Pricing Reference Group Meeting: April 15th , 2021

Minutes Date : Thursday .April 15 th 2021 Time : 3 PM - Noon Location NDIA Offices Level Elizabeth Street Surry Hills NSW Members Chair Gerrie General Manager Provider and Market Development Division Present Pricin gReferenceGroupMembers Deborah Independent Member Present Graeme AM Independent Member Present Jim PSM Independent Member Julie PSM Independent Member By Teams Lynne Independent Member Participating Observer nominatedby CEO David Cullen Chief Economist Present Sarah Scheme Actuary Apology Secretariat David Director, Pricing Operations Price Regulation Unit DeclarationofConflictsOfInterest The PRG NOTED that Graeme Innes is:
  • a member Board Life Without Barriers; a member of Joblife Employment; *a member Attitude Foundation; an Advisory Probono News ;and s47F personal privacy s(1)(ii) irrelevant material The PRG NOTEDthatDeborahCopehas relatives who deliver services to NDIS participants. ConfirmationPreviousMeeting’sMinutes ThePRGEDORSEDthe minutes previous meeting PRG Minutes February 10 – 11 2021

Disclosure Log

Pricing Reference Group - For Official Use Only | Meeting: April 15, 2021 Minutes

Update By The Chair

  • A process consultation has begun around future Supported Independent Living(SIL) development projects different models represent.

Sil Review

Paper Item 3.2 presented to PRG: David Cullin Chief Econmist PRG discussed paper agreed reconsider at next meeting when results current financial benchmarking survey available. The PRG indicated that it broadly supported conclusion evidence did not reveal significant differences operational costs structures SIL non-SIL providers noted collected for purposes comparing so subject qualification; considered value waiting until result years 2019–20 financial benchmark study data specifically collecting purpose compare and would like see further analysis these costs distribution preference issues associated vacancies resolved pricing level (but unit price rather than disruption remaining residents dwelling); considers opportunities reducing administrative burden on SIL providers undertake work this issue.

Therapy Review

An update preliminary findings review given David Cullen Chief EconomistThe PRG DISCUSSED raised in presentation. Next Meeting Thursday May via videoconference using Microsoft Teams hours. — Page of —

Agency.

Insurance

Disability

National

Released information:

The act that was