NDIA Accountability Project

Achievements of the National Disability Insurance Scheme

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Joint Standing Committee on the

National Disability Insurance Scheme

Inquiry into Assistive Technology

Joint Standing Committee (JSC) Terms of Reference:

As part of the committee’s role to inquire into the implementation, performance and governance of the National Disability Insurance Scheme (NDIS), the committee will inquire into and report on the provision of assistive technology with particular reference to:

  • the transition to the NDIS and how this has impacted on speed of equipment provision;
  • whether the estimated demand for equipment to be sourced through the assistive technology process in each roll out area was accurate;
  • whether market based issues impact the accessibility, timeliness, diversity and availability of assistive technology;
  • the role of the NDIA in approving equipment requests;
  • the role of current state and territory programs in the assistive technology process;
  • whether the regulatory frameworks governing assistive technology are fit-for- purpose; and
  • any other related matters.

National Disability Insurance Agency

Submission

Introduction

What has been achieved? The NDIS is a world-leading, once in a generation social and economic reform. Based on insurance, not welfare principles, its purpose is to improve economic and social outcomes for Australians with a significant and permanent disability and to provide them with reasonable and necessary supports. A significant achievement is the number of people who are now benefitting from the Scheme. As at 30 June 2018, 183,965 Australians had a plan in place (including children in the Early Childhood Early Intervention gateway). Of those 183,965 participants being supported by the Scheme, 30 per cent (or 54,802) have never previously received supports from existing state/territory or Commonwealth programs. In 2017-18, the Agency achieved 90 per cent of the operational participant intake target, meaning that of the participants who could be contacted, who met the access requirements and whose records were provided to the Agency, 90 per cent received approved plans. At 30 June 2018, 76 per cent of the Scheme-to-date bilateral estimate was reached. The progress against bilateral estimates reflects challenges faced transitioning some participants from state and territory programs into the NDIS. Is occurs particularly where participants are unable to be found, unable to be contacted or are not eligible for the NDIS.

A significant financial commitment is being made through the NDIS to improve people’s lives. In the 2017-18 financial year, $7.7 billion was committed to providing reasonable and necessary supports for people with an NDIS plan. This constitutes a significant investment in providing participants with the ability to exercise choice and control over their lives. Participants are now able to choose the services and supports they need, marking an important shift from the block-funding model that existed before the NDIS. As a result of the NDIS, participants, and their families are saying that the NDIS is helping them in many ways. Participants have reported improved outcomes across multiple life domains, with the highest impact achieved within the domains of choice and control, daily living activities and health and wellbeing. Ninety-one per cent of parents of pre-school aged children say the NDIS has improved their child’s development; 89 per cent say the NDIS has improved their child’s access to specialist services and 82 per cent say the NDIS has increased their child’s ability to communicate what they want. The NDIS is also helping families and carers of people with disability to be able to work. This is good for them and good for the economy. Of those families and carers of participants aged 15 to 24, 48 per cent are working in a paid job. Of these, 74 per cent are in permanent employment. While it is early days, these are impressive statistics. The NDIA is committed to providing participants and their families, carers and providers with a high-quality service. The experience of those participating in the Scheme improved by four percentage points in the last quarter, with 88 per cent of participants rating their overall experience with the NDIA as either ‘Good’ or ‘Very Good’. While more can and is being done to improve people’s experience with the NDIA, the vast majority of people are satisfied with their NDIS experience.

Achieving Choice and Control through Competitive Markets

A vibrant and competitive provider market is integral to supporting participants to achieve choice and control, and their goals. At 30 June 2018, there were a total of 16,755 providers across Australia registered to provide a range of supports, representing a 17 per cent increase on the previous quarter. Around 14 per cent, or 2,383, of these providers were registered to provide Assistive Technology (AT) supports.

What more needs to be done?

While much has been achieved, the roll out of the NDIS remains a work in progress. Lessons have been learned from the speed of the roll-out and the issues that arose in the move from trial to transition on 1 July 2016. The NDIA is now actively working to address these issues.

Improve the quality of the participant experience

The first and most critical priority for the NDIA is being able to deliver quality plans to participants that produce a high-quality outcome for each individual participant and to ensure that it is done in a way that makes the participant feel understood and valued. A new participant pathway has been designed and will be rolled out from October 2018. NDIS participants will have face-to-face planning meetings that deliver easier-to-understand, accessible plans, supported by a consistent, single point of contact. The new pathway was designed with comprehensive input from participants and was successfully piloted in Victoria with more than 1000 participants.

Grow a competitive market of providers with innovative supports

As the Scheme is rolled out at scale, the well-being of participants requires that there is a vibrant market of safe, quality providers who can supply participants with reasonable and necessary supports at a market price. In AT this has also seen a shift from government mediated procurement to responding to participants who have the ability to choose a provider by exercising choice and control. Choice and control is a fundamental premise of the Scheme.

Notwithstanding the challenge this poses to providers, the number of providers who have registered to provide AT supports has risen by 83 per cent from 1,311 at the end of June 2017 to 2,383 at the end of June 2018.

The NDIA is also building on its work to develop a competitive and innovative provider market. The following initiatives are underway to provide more information to help grow the market of providers:

  • Launch Market Enablement Framework: Work has continued on providing information on how specific markets are monitored for the adequacy of supply. This is particularly important in thin markets where the risk exists that supply will not be sufficient.
  • Establish a Market Insights Team: A market insights team has been established to provide localised insight on where opportunities exist to expand the market.
  • Enhanced Provider Finder: The Provider Finder tool has been enhanced to improve the search functionality, so that providers can be easily found and engaged by participants.
  • Implement the Independent Pricing Review (IPR): Following extensive consultation on the IPR the first phase of changes were implemented on 1 July 2018, along with the annual pricing review. The implementation of the IPR is ongoing.
  • Improve the provider pathway: A new provider pathway will be implemented based on extensive consultation and feedback from providers. This will make it easier for providers to transact with the Scheme and connect with participants. Providers reported they wanted more consistent and clearer information and policy guidance, easier resolution of any issues arising, and improvements to the portal and payment processes.
  • Launch a new online provider toolkit: Designed to improve access to information about becoming an NDIA provider, the first phase of the new provider toolkit was successfully launched in 2017. The toolkit remains in high use, with providers providing positive feedback about ongoing improvements.
  • Expanded National Provider Payments Team: Even though the NDIA’s payments monitoring system showed well over 90 per cent of payments were being paid on a straight through basis, feedback from providers indicated that some providers were unable to lodge payment requests. A dedicated National Provider Payments Team was established and will be expanded to continue working with providers to resolve specific claiming issues while broader improvements are made to the payments system. The establishment of the team in February 2018 has resolved a substantial amount of payment issues and improved communications with providers, leading to an increase in providers’ understanding of the payments system.
  • Enhanced myplace portal: Progressive enhancements to the myplace portal are leading to improved participant and provider experience, plan quality and participant outcomes. Enhancements to date include the ability to create, manage and edit service bookings, a new dashboard for providers that lists all active participants (with participant consent) along with shortcuts to view plans, service bookings and payment requests. Further improvements, including the ability to review and respond to quotes, will be progressively implemented over the next 12 months.
  • Provider Relationship Management Approach: The NDIA recognises the need to ensure providers are effectively supported so they can continue to deliver services that lead to good outcomes for participants. During Q1 2018-19, the NDIA began to pilot a new, tailored way of supporting providers. The NDIA has developed a Provider Relationship Management approach to better engage with providers, guide continuous improvements to the provider experience, and support the development of the NDIS marketplace. The pilot will progressively expand over the next 12 months, with national roll-out expected to commence in Q2 2019-20.

Assistive Technology (AT) and the NDIS Technology is enabling people with disability to reach their potential at home, in the community and the workplace. The NDIS recognises the transformative power of appropriate Assistive Technologies (AT) and offers participants the opportunity to identify and purchase AT to meet their individual needs. The NDIA seeks to ensure participants have access to the individualised AT solutions that enhance their economic and community participation. Delivering a better AT experience Experience during NDIS trial and early transition have identified some areas of the AT implementation and delivery that require improvement. The NDIA has developed a program of AT improvements, including: - short-term changes to streamline and simplify processes and systems; - a central team to address any delays in AT plan approval and implementation; and

Short-term Improvements

A series of improvements are underway to ensure more efficient processes are in place to enable participants to get timely access to AT advice and supports. The short-term improvements include:

  • New low-cost AT policy: Up to $1,500 of funding for AT can be included in a participant’s plan without further assessments or quotes. Around 50 per cent of AT participants are positively impacted by this change, which applies to new and existing AT plans. Implemented Q4 2017-18.
  • Timely replacement: This change will allow replacement items (particularly like-for-like) to be sourced quickly without needing reassessment or a new quote. This will positively impact participants who have outgrown their current AT or where an item has aged. Expected Q2 2018-19.
  • Timely repairs: This change will enable timely repairs and maintenance by calculating an appropriate budget for comprehensive repair and maintenance coverage. Expected Q2 2018-19.
  • Reducing quotes: A new funding tool will calculate appropriate AT funding for reasonable and necessary AT supports, replacing the current reliance on quotes. This is expected to reduce waiting and processing times. The new tool will be introduced progressively starting with the most common AT items. Expected Q2 2018-19.
  • Improved assessment templates: Updated assessment templates will help ensure the right information is provided to inform planning. Expected Q2 2018-19.

National Assistive Technology & Home Modifications (ATHM) team

A central team is being established to investigate and remediate individual delays in AT planning and plan implementation. In addition to remediating individual delays, the team will identify and address any common barriers leading to delays, and design and implement further improvements. Team established and operating during Q2 2018-19.

A new approach to complex AT assessments

Some participants requiring more complex AT supports may experience delays related to receiving and processing assessments. In order to achieve more consistent and efficient assessment of complex AT needs, the NDIA will pilot the use of a panel of specialised AT assessors. Assessments will be provided to the NDIA during pre-planning. Following the pilot, the approach will be refined prior to national rollout. Pilot expected to commence in Q3 2018-19, national rollout expected to commence in Q1 2019-20.

Responses to the terms of reference

Transition to the NDIS and how this has impacted on the speed of equipment provision

In-kind arrangements

Historical arrangements regarding the provision of AT were often complex across different states and territories. During transition, NSW, WA, SA and the ACT have continued to provide AT through their existing aids and equipment programs as an in-kind contribution to the NDIS. In-kind contributions place restrictions on choice but have helped to provide uninterrupted access to AT for participants during transition. Once in-kind arrangements are phased out, participants will receive funding in their NDIS plan that they can use to directly purchase AT supports from the market. Improved clarity around the future of in-kind arrangements will allow the NDIA and the market to better plan for the full implementation of the individualised approach to funding AT under the NDIS.

Mainstream interfaces

Underpinning the successful delivery of the NDIS, is the premise that people with disability must have equal access to all service systems including health, education, transportation and housing. In some cases, these systems are called upon to make ‘reasonable adjustments’ to ensure accessibility for all people. Where an individual participant requires adjustment beyond this level, the NDIS can provide funding for reasonable and necessary supports. Prior to the introduction of the NDIS some disability services were delivered by other systems, such as health or education, for a variety of historical reasons. While it was often difficult to determine which system should fund a service, arrangements could be negotiated locally. The introduction of the NDIS has highlighted the need to better clarify funding responsibilities between systems, including for the provision of certain types of AT. As transition progresses, the NDIA continues to work with state and territory governments and the Commonwealth Government to clarify these interfaces in order to provide clear information to participants, and guidance for planners and the market.

Whether the estimated demand for equipment to be sourced through the assistive technology process in each roll out area was accurate

In 2011, the Productivity Commission estimated an annual cost of between $390 million and $1 billion for AT and home modifications (in 2011 dollars). As the transition to full Scheme continues, the demand for AT supports continues to grow. As at 30 June 2018, 68 per cent of active NDIS participants have AT and/or home modification supports in their most recent NDIS plan. The total amount estimated to be paid in respect of AT for the 2017-18 year is around $180 million. Based on the growing experience, the annual cost of AT is now estimated by the Scheme Actuary to range between $700 million and $1.3 billion in 2019-20. This estimate is not considered to be materially inconsistent with the Productivity Commission’s original estimate once adjusted for inflation.

Whether market based issues impact the accessibility, timeliness,

diversity and availability of assistive technology

The emerging market

As with other supports under the NDIS, the significant increase in funding and demand for AT items will require rapid growth in the market in order to meet participant need. This is particularly the case for items that were not commonly funded under previous systems, such as recreation equipment. The increase in demand also calls on some providers to redesign their supply chains and methods for timely delivery of participant orders.

The range of providers in the developing marketplace is diverse. It includes current disability organisations transitioning from state or territory systems, adjacent services represented by industry or peak bodies, varied allied health professional groups and individuals, and emerging non-traditional services such as financial intermediaries.

The market for lease and hire models for the supply of AT also requires further development. Over time a participant’s needs for AT may change. This includes as children grow, or due to a participant developing a new level of skill leading to the need for an alternate piece of technology. Loan pools and leasing arrangements will assist participants to get the AT they need for the right period of time in a cost effective way.

There is also increasing interest from participants in buying second hand AT (often refurbished), to get even greater value from their funding. The NDIA expects second hand markets to further develop over time alongside lease and hire markets.

In addition to providing reasonable and necessary funding to participants through the NDIS, The NDIA also has a role as Market Steward where it can facilitate the growth of new market responses. The NDIA’s work with the market on flexible equipment packages for participants with degenerative conditions is an example of where appropriate funding methods and performance standards can facilitate a more timely supply response and better outcomes for participants.

The NDIS has already seen the emergence of innovative providers that are delivering value for participants. Some new models include employing online platforms and international providers. Other providers have begun linking services and products to offer a more complete solution for participants or involve participants in the supply process itself through open source design.

For participants living in remote and some rural settings, there may be fewer provider options for the provision of AT. Fewer providers can impact availability, timeliness of delivery and dilute some of the power of competition.

In many cases, the AT required by a participant is not immediately available in a local store. Some providers may only be able to arrange for an item upon receipt of an order. Increasingly stock is not held in Australia. Higher cost and more complex AT is often made- to-order which can add more time to manufacturing delays. The NDIA will continue to improve its information provision to the market in order to encourage AT providers to adjust and innovate in order to reduce these delays.

The NDIA has developed a series of Market Insights, which include information into specific submarkets, designed for providers looking to understand key trends and market opportunities. The Market Insights focus on areas in the marketplace that need to grow substantially, change to reflect participant choices and be created to meet participants’ eeds in the NDIS.

The Market Insight on AT sought input from key leaders in the AT market and was published in December 2017 (see https://ndis.gov.au/providers/market-information-useful-links/market-insights.html).

The role of the NDIA in approving equipment requests

The NDIA draws on its Partners in the Community and planners to help build plans for participants that include funding for AT. Planning and delegate approval of AT supports must follow the same reasonable and necessary decisions as all other funded supports in a participant’s plan.

As explored above, the NDIA has commenced a program of improvements to reduce the need for assessments and quotes where possible during the AT planning process and to improve the efficiency and quality of assessments where they continue to be required.

The role of current state and territory programs in the assistive technology process

Many state and territory AT programs still retain a focus on AT use within the home. However, NDIS programs generally support access to the broader community.

Under these state and territory programs, professional assessment of key clinical and functional measures is required to determine a person’s need for AT prior to authorising supply. Additionally, AT provided generally remains the property of the program and is issued on long-term loan.

While the NDIS seeks to build markets to improve on existing systems, the NDIA has sought to draw on the capabilities of state and territory AT programs in two key areas: - established procurement approaches to achieve value for money on some items, as well as repair and maintenance services - quality assurance methods to improve the integrity of assessments.

In preparation for transition, the NDIA negotiated with each of the state and territory AT programs to determine their ability to offer these services.

Many participants have chosen not to utilise the established procurement approaches within these state and territory programs, and very few have chosen to utilise the pools of refurbished AT that are often available.

Where available, state and territory quality assurance processes have helped ensure basic checks were done on assessments prior to submission to the NDIA. However, the NDIA remains responsible for all decisions on funding for reasonable and necessary AT.

While the transition arrangements with state and territory programs have proven beneficial for some participants and the NDIS, they will be phased out over time. Some state and territory programs will choose to continue as registered providers available to participants.

Whether the regulatory frameworks governing assistive technology are fit-for-purpose

While the NDIA does not take a direct role in regulation of AT, the NDIA has cooperated with the Australian Competition and Consumer Commission (ACCC) on the development of consumer and market resources to highlight the place of Australian Consumer Law in market regulation and consumer protection. Similarly, the NDIA is assisting the Therapeutic Goods Administration (TGA) to reform the way AT is handled under the Therapeutic Goods Act (1989) and establish sound and consistent practices for both product regulation and surveillance.

Some aspects of AT provision will be under the oversight of the NDIS Quality and Safeguards Commission as it assumes quality and safeguarding responsibilities from state and territory governments.

The National Disability Insurance Agency

Light-Touch Regulation Approach

The NDIA supports light-touch regulation for most providers in the AT sector. Many providers are small incorporated organisations. It is important the costs associated with regulation are proportional to the risks involved in the supply and use of AT, and do not unduly constraint the viability of this diverse sector.

Nil.