NDIA Accountability Project

NDIS assessment process inconsistencies and impacts on vulnerable applicants

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Building a Strong, Effective NDIS Review

June 2023

EACH NDIS Access Teams’ Submission to the NDIS General Issues

Review

Introduction

The EACH NDIS Access team welcomes the opportunity to contribute to the NDIS Committee’s General Issues Review. We are committed to improving the journey and outcomes for applicants and Participants.

EACH believes everyone has the power to live well. Our staff are made up of paid employees, volunteers and students, working together to provide a range of health and support services that improve lives and strengthen communities. We achieve this by putting people at the heart and centre of everything we do.

The NDIS Access Project - Mental health and Allied health teams assist people with disabilities access the NDIS. Since 2018, our teams have worked collaboratively with people with disabilities health and community service providers to help people understand, engage in and complete the NDIS access process.

We therefore have a unique perspective of how the application, decision making, review, and initial planning processes impact individuals with disabilities, as well as the wider community and other services providers.

Terms of Reference

What are your three main problems or concerns with the NDIS?

  1. Assessment processes
  2. Planning processes
  3. Communication issues

How do these three main problems affect you and/or others?

1. Assessment processes impact

Assessment process issues contribute to the following adverse outcomes for vulnerable applicants, carers and disability service providers:

(a) Inability to clearly identify access not met rationale. (b) Inability to determine what other evidence may be required for future successful applications. (c) Time, emotional and financial cost burdens. (d) Inconsistencies. (e) Delays. (f) Unfairness. (g) Lack of transparency.

NDIA representatives have advised our team members the NDIA operational process for assessing applications requires assessment of an access request only to the point at which it is decided one legislative requirement or eligibility criterion has not been met. The delegate undertakes no further assessment of the application. This is consistent with our experience assisting clients who receive access not met decisions. Typically, the applicant receives a generic response advising of access not met decision on one of the eligibility grounds, without further elaboration.

Applications are often deemed unsuccessful on the basis impairments are not permanent, or substantial, or the applicant has not exhausted all available and appropriate treatment options. This is the acceptable assessment process. However, our team has encountered many instances of access not met decisions on one or more of those grounds, despite clear and strong evidence from both specialists and general practitioners to the contrary.

Indeed, our team has made many new access requests with identical evidence regarding permanency, impairment, and treatment history criteria. Most of these applications have met access. This suggests delegates inconsistently apply the legislation. Such inconsistency results in unfair outcomes for applicants without the resources to keep trying.

Evidence gathering is time consuming and costly for all applicants and those who support them. Even disability advocates and/or NDIS access workers usually require months of sustained requests to health professionals to obtain relevant evidence. Applicants typically cannot afford the costs of obtaining reports and evidence that may be required/requested.

The NDIS integrity team also frequently seeks to verify access requests submitted by our NDIS access worker teams. This verification process causes significant delays in outcomes of access requests because busy health professionals are contacted to verify supporting evidence provided. Health professionals are often slow and/or unsure how to respond.

Delayed processing of submissions contributes to emotional cost for clients and carers who are vulnerable and left in limbo.

Additional support services may need to support applicants who do ultimately meet NDIS access criteria for longer. This places additional and potentially avoidable pressures on their services, wait lists, employees and vulnerable client and carer cohorts.

In addition, many of our clients have made past applications for NDIS access without our support. In response to new access requests made by our team, subsequent access not met decisions usually consider evidence submitted in prior applications. Given the new access request is based on the current evidence we submit, it is unfair to do this.

Internal reviews are also part of the NDIS assessment process. We have considerable experience assisting clients with internal reviews. Applicants are invited to submit new information at review (which can be time consuming and expensive to obtain). However, the NDIS internal review officer does not provide sufficient detail around what additional/ new information to provide prior to making their decision. In our experience any new evidence submitted does not usually result in an access met decision. Therefore, this process adversely impacts clients’ and carers’ financial, emotional and time resources, without usually resulting in a changed decision. After all this, if an applicant still has the resources to seek help, other typically overburdened service providers must use their limited resources to try and support them. If not, they may inadvertently put an applicant on the referral roundabout, leaving vulnerable clients without adequate support.

Currently, the only avenue for applicants who are dissatisfied with the outcomes of a review is

to appeal to the Administrative Appeals Tribunal (AAT). In our experience the complexity of this process and lengthy wait times deters applicants from undergoing this adversarial process regardless of the merits of their case. For those not deterred, they usually require the assistance of specialist disability advocates and/or lawyers to help them navigate these legal processes. This therefore places additional burdens on other services.

Planning Process Impact

Planning process issues contribute to the following adverse outcomes for vulnerable applicants, carers and service providers:

  • Distress
  • Inconsistency
  • Inability to effectively engage with and utilise NDIS Plan
  • Underfunded supports
  • Putting pressure on other disability service providers required to fill the support gap

In preparation for planning meetings, access workers often email a completed “Planning booklet 2” to planners to increase the time efficiency of the meeting. It appears planners do not always review the booklet, and all previously submitted supporting evidence. Consequently, Participants are required to re-explain their circumstances and support needs. On some occasions, this can result in distress, where the Participant will require additional debriefing after the meeting.

There is an inconsistency in the level and the types of support that Local Area Coordinators(LAC) and NDIA planners are willing to advocate for. In most cases, funding for psychological therapies has been provided to our clients, however, there have been some occasions where this has been declined, even for participants with a psychosocial disability. We understand the difference between clinical treatment and capacity building therapies. It appears that some LACs/planners will defer the responsibility of therapies to Medicare, even when capacity building therapies are recommended by treating professionals.

There have also been instances where support coordination and/or recovery coaching have been declined for participants with impaired self-management skills. Furthermore, those without support coordination or recovery coaching have reported being unable to utilise their plan.

Following planning meetings only some participants are given implementation meetings to help with their understanding of how to implement their NDIS plan. Some participants who do not get these meetings have reported feeling unsure what their plan entails, which has led to increased stress.

Overall, these inconsistencies contribute to the underfunding of plans, and impact the participants ability to engage with the support provided. This negatively impacts participants, carers, and other service providers involved.

3. Communication Issues Impact

Communication issues contribute to the following adverse outcomes for vulnerable applicants, carers and service providers:

(a) Confusion (b) Distress (c) Inconsistencies (d) Inability to identify relevant further information required (e) Delays (f) Relationships negatively impacted

NDIS delegates sometimes contact applicants directly without respecting their preferred method of contact. This can cause distress and confusion to applicants, particularly those with psychosocial disabilities. As their representative, we have assured them we will be their primary contact and advocate regarding the application.

In our experience, access not met letters vary considerably in the clarity and usefulness of information provided. Using a standard template, they generally contain insufficient information to assist applicants understand the specific reasons their application has been unsuccessful.

It’s also been our experience that requests for further evidence vary considerably from requests for specific information to more generic requests for broad information that has usually already been supplied. Time to respond to requests where the information has been already provided causes further delay.

Given the lack of clear explanations for access not met decisions provided to applicants, it’s difficult for them to understand what additional evidence would assist at an internal review or is needed for a possible future application.

Access workers regularly attempt to contact delegates on the applicants’ behalf to clarify reasons or gather further information regarding access not met decisions. These requests are made via the NAT enquiry line. While delegates may return our call, in many instances, despite several calls, no response is received.

There have been occasions where an applicant has been included in the integrity verification email directed to a health professional. Consequently, the applicant receives a copy of the medical document as it is attached to the email for the health professional’s viewing. Whilst we understand the applicant has a right to access their information, there may be some circumstances where sensitive information that may be detrimental to the applicant’s wellbeing, may be viewed by them.

Language used in integrity verification emails to health professionals can result in apprehension for health professionals to respond. This may potentially damage relationships between EACH and health providers, who work collaboratively with clients.

The two-week timeframe given to health professionals to verify documents is often too short. This means our teams regularly need to follow up and encourage the provider to complete the checklist and/or request an extension of the NDIA deadline.

What do you think are possible solutions to those problems?

1. Assessment Process proposed solutions

(a) We recommend the NDIA changes its current assessment approach and instead provides a complete assessment of all the evidence provided in each application. (b) Evidence provided in the current application should be the sole basis of the assessment and decision making, as past evidence may not reflect the applicant’s current health. (c) Evidence received from a treating professional who is suitably qualified to determine the permanency of impairment and available treatment options, should be accepted by the delegate. Our understanding is the NDIS practice guidelines require that the “treating clinician will decide on appropriate treatment and/or interventions for an individual”. (d) Mental health, trauma informed training be provided to NDIA delegates assessing access requests. (e) Development of consistent NDIS procedures, across each stage of the assessment process that is made publicly available for transparency and educative purposes. (f) Development of a Functional Impairment Rating table, akin to Centrelink’s Disability Support Pension process. This table is best made publicly available so all applicants can determine the level of impairment required. The specific impairment rating could also be provided to the NDIS applicant upon internal review, as occurs in DSP reviews. (g) Developing a less adversarial decision review system. For example, two levels of internal review of cases could occur. First, by a review officer and then by a senior review officer. This would likely reduce barriers to review and reduce the number of Tribunal based reviews. Tribunal hearings are costly to all parties. A more robust internal review system would also provide applicants with a better understanding of the original decision.

2. Planning Process proposed solutions

(a) Provide all participants with implementation meetings to help with understanding of next steps and support all participants with connection to recovery coach or support coordinator, so they can start using supports efficiently. (b) Mental health, trauma informed training be provided to NDIA delegates and LACs. (c) More consistency regarding the provision of funding for psychological therapies. It would be helpful to have some clarity regarding who is eligible for capacity building therapies. This would allow for more realistic expectations from applicants and newly approved participants.

3. Communication Issues proposed Solutions

(a) More consistent communication at all levels of the assessment and planning process including tailored letters regarding decisions made. For example, more detailed access not met letters explaining the reasoning behind the decision. (b) NDIA enquiries staff, LACs and Planners checking applicants preferred method of contact before contacting applicants and participants and being respectful of ‘choice’ of having representative as their contact. This is an option clearly stated in the access request form. (c) Ensuring all staff communicating with applicants and participants have undertaken disability specific training and trauma informed care to avoid potential distress. This includes training for LACs and Planners for improved understanding of how mental

health and other disabilities can impact daily functioning to identify and make appropriate support recommendations to delegates for approval. (d) Following procedural guidelines and making this more transparent to the public and all who could be supporting people with accessing the NDIS, such as health professionals. (e) Transparency in tailored responses from the NDIS regarding access not met decisions and requests for further information. (f) If NDIS Integrity needs to verify reports from health care professionals, they could simultaneously send the requests to all relevant health professionals. (g) Further, a practical option to avoid potential distress from applicant viewing sensitive information is to not include the applicant in the email for verification sent to a health professional. If applicants want to access their personal information, it seems reasonable that this would be initiated via the Freedom of Information Act 1982, where the formal process of release can take place, which helps ensure safety of the applicant. (h) Rewording of emails from the integrity team to health professionals could be considered to provide more information about what they do and why reports/ information needs to be verified. It’s important health care professionals understand they can collaborate with others in preparing their reports.

What parts of the NDIS are working well for you?

Our team has had the following positive experiences with the NDIS:

(a) Live Chat is a helpful function to obtain information. (b) The majority of access decisions are appropriate. (c) Some assessors are willing to verbally provide more information than in standard access not met letters, to help guide future applications. (d) Most LACs communicate well with access workers as representatives. (e) Some LACs ask more specific questions in planning meetings to draw out information needed, to justify a request for support that clients need. (f) Some clients who meet access have felt their NDIS plans have supported their needs, at least initially. (g) Internal reviews generally provide detailed feedback to help understand access not met decisions. However, we consider this information is best provided to the applicant without going through a review process. (h) Some LACs and planners follow up with participants regarding engagement with NDIS supports and help address barriers to engagement if needed.

Conclusion

As a community service team operating within finite and limited budgets, we understand the NDIA cannot support all people with disabilities. However, we hope our experiences, feedback and proposed solutions outlined above provide the NDIA with guidance to bring about improved processes and outcomes for the benefit of all stakeholders.