An Evaluation of NDIS portal issues and increases in administrative burden | External submission

An Evaluation of

NDIS portal issues and increases in administrative burden

Results of a Survey of Children’s

Services Providers in South Australia

South Australian NDS

Children’s Services Subcommittee

February 2018

Executive Summary

This report has been written at the request of the South Australian Children’s Services Subcommittee of National Disability Services (NDS). It provides an overview of a survey conducted of disability service providers operating in the children’s services sector (providing services for children with disability aged between 0 and 18 years).

Following significant and lengthy discussion by the committee, a survey was developed to provide evidence regarding the issues created by the transition to the National Disability Insurance Scheme (NDIS).

The survey was sent to 66 metropolitan and regional providers in South Australia. This included sole traders as well as small and large organisations providing services to NDIS participants under 18 years of age. A total of 49 surveys were completed.

The survey highlighted key ways in which the NDIS Myplace portal is adversely affecting service providers and participants. There is widespread concern that this issue may lead to market failure in the near future. Urgent action must be taken to resolve this before the situation worsens.

Key portal issues as rated by providers included: an inability to identify remaining funds in a plan, flagged by 91 per cent of respondents; while 74 per cent highlighted an inability to place service bookings as required. A total of 86 per cent of respondents reported that their clients experienced delays between plans, with 80 per cent stating that the average length of gap between plans was between two and three months.

The comments indicate that the overwhelming majority of providers continue to provide services to their clients while plans are in the review process, notwithstanding the financial risk. Despite this, providers have indicated that they may have to cease these services once a certain financial limit has been met or an agreed upon time frame has been reached.

Unable to view any ‘rolled up’ information on the portal, providers are required to conduct extensive checks, and with the NDIA tackling concerns claim by claim, the process is extremely difficult and does not offer a big picture view of the issues. The administrative burden on organisations is significant, with over 90 per cent of respondents reporting time spent tracking expenditure against individual plans, and over 85 per cent recruiting at least one new workforce position to process NDIS claims. One organisation reported a total of ten FTE for this task.

A further issue raised by most providers was an inability to contact the NDIA for answers as required. We welcome the recent announcement of a national provider payment team to address this issue, however we believe more can be done in the short term, and that improvements to the Myplace portal must be a priority for the NDIA.

We are hearing that the impact of these issues on participants and their families is significant. Delays between plans have many families reporting a stalling of their child’s progress, or even a regression against goals. Families report a reduction in services, loss of trust in their relationship with the provider, false expectations and a general lack of transparency in the system.

We believe this also contributes to the underutilisation of plans.

NDS and members of the South Australian Children’s Services Subcommittee would like to sincerely thank everyone who completed the survey and contributed to this report.

We look forward to your feedback.

Heidi Limareff Peter Hoppo

Group Chief Executive State Manager, South Australia

Can:Do Group NDS

Chair of the NDS Children’s Sub Committee

Industry representatives on the South Australian NDS Children’s

Services Subcommittee

Chair                    Position                              Organisation

Heidi Limareff           Group Chief Executive                 Can:Do Group

Committee Members

Kristian Bennett           Operations Manager Community       RSB

Services

Rebecca Brett            Access & Liaison Lead Practitioner       Autism SA

Lis Burtnik              NDIS Project Manager                   Carers SA

Louise Davies             Executive Director                      Aeiou

Michael Forwood          Chief Executive Officer                 Cora Barclay Centre

Maureen Lawlor           Chief Executive Officer              Down Syndrome SA

Tracey Pinter               Children’s Service Practice Leader       Cara

Nick Smith                Chief Executive Officer                  Pearson Allied Health

Services

Linda Williams             Executive Manager Therapy              Novita

& Family Services

NDS South Australia

Kylie Hutchinson          Senior Project Officer               NDS

Merrilyn Mitchell           Project Assistant                  NDS

Evaluation of the NDIS Children’s Research Paper Survey on

NDIS Portal Issues and Associated Administrative Burden

There is limited collective evidence of the NDIS-related issues being faced by providers in the paediatric services sector in South Australia. The South Australian Children’s Services Subcommittee of National Disability Services (NDS) created a survey to provide evidence regarding the significant issues being experienced by users of the NDIS portal. During December 2017 and January 2018, 66 providers were emailed a survey based on key issues identified by the Subcommittee.

A total of 49 organisations completed the survey. 49 per cent of these operate in both metropolitan and regional areas; 37 per cent work solely in regional SA and 9 per cent provide services solely in metropolitan Adelaide. 70 per cent of participants provide services to both children and adults, while those organisations working only with children represent 23 per cent. One respondent works with both adults and children but answered the survey questions based only on their children’s service, and one respondent works with children and young people up to the age of 20.

In order to group the findings and compare different kinds of business, we requested that respondents identified what types of services they provide. Of the 43 respondents who answered the types of services their organisation provides:

86% offer allied health and therapeutic supports
56% offer skills development/capacity building
37% offer in home support including in home respite A number of respondents provide coordination of supports as well as services.

65 per cent of respondents stated that their organisation provide unfunded, pre-planning activities for current customers, while 51 per cent provide one to four hours of unfunded pre-planning or review preparation per person. This equates to unfunded overheads of between $57.71 and $230.841, based on an hourly rate for the NDIS service type ’Support Connection‘. A number of respondents were sole traders, providing therapeutic supports. For providers in this group, hours of pre-planning and review activities equates to unfunded overheads of $175.57 to $702.282.

The second most common response to this question was five to eight hours per person. Using the equivalent figures above, this represents unfunded overheads of between $288.55 and $461.68 for a Support Coordinator, or between $877.85 and $1404.56 per sole trader.

1 This was calculated using the rate for Support Connection as per the 201718 ACT/NT/SA/WA

Price Guide

2 This was calculated using the price for Individual Assessment, therapy and/or training as per the 201718 ACT/NT/SA/WA Price Guide

Eight organisations indicated that they were providing 13 plus hours per person, with two of these recording in excess of 20 hours per person, but these were related to another program (SIL).

Of note is that approximately 87 per cent of respondents were experiencing issues with claiming, billing and the service booking process through the portal. Please note that respondents were asked to identify all issues, so the total figure exceeds 100 per cent.

The key issues identified were:

An inability to accurately identify remaining funds in plans (91%)
Difficulty in placing service bookings in the portal (74% )
Inability to put a service booking against the correct service type (66%)
Reliable access to the portal (46%)
Families booking services that they do not have in their plans (40%)
Timeliness of claims (37%) Additionally, respondents were asked to identify key issues in a free text option. Feedback has been included as follows:
Funds being exceeded where multiple providers are involved.
Unscheduled plan reviews causing service bookings to end prematurely without enough funding in them.
Delays in obtaining new plan numbers and start and end dates to make the service booking.
Continuity of services and viability of NDIS work – plans are not renewed on time. Often gaps of many months. Very hard to stop/restart multiple clients.
Service bookings becoming inactive with no warning and NDIA changing service booking details from their end.
Not being able to see a copy of the plan to know important details (plan dates, goals and funding amounts).
Issues around the claiming process itself, including: – Not being able to amend/edit a claim once submitted – Not being able to return a submitted claim – Not being able to submit claims for services rendered
Timeliness in relation to solving issues with NDIS plans, such as errors made in the planning process and then participants’ frustration at trying to correct errors on portal, and organisation’s subsequent inability to claim.

An issue impacting providers and participants is the gap between plans ending and a new one commencing. Although this has been addressed by the NDIA, there is still some anxiety among both groups around the uncertainty and significant financial risk associated with claims being made against expired plans.

According to our respondents, 86 per cent experience plan gaps, with the most common time frame being two or three months (44 and 36 per cent, respectively).

Given the significance of timeliness of claims and resultant plan gaps, it was important to gain an insight into how each organisation handles the delays they experience. The responses are as detailed:

Send invoices to Finance at NDIA and try to obtain additional funding added to the coming plan for these invoices.
Continue to provide services and claim from next plan. In this instance, the provider has stated that they are taking a risk they will ’lose out‘ if there is no plan.
Contact family and continue current level of support until a new plan is in place, as well as tightening service agreements.
Claiming from surplus funds from the previous plans (back dated) where available. Have ceased seeing participants until receiving confirmation their services will be funded.
Four to six weeks prior to the end of the plan, remind families to book meeting with planner. Discuss outcomes of review meeting and may continue to provide some services but will not provide additional support (depending on level of clinical risk to the child).
Need to seek manual payment in gaps.
Continue to provide the service and bill later. When plan gaps become too long, cease services and restart when they have a new plan.
Continue to deliver services in some cases but cease others until new plan. The comments provided show that the overwhelming majority of providers are continuing to provide services to their clients while their plans are in the review process, despite the financial risk. Regardless of this, providers have indicated that they may have to cease these services once a certain financial limit has been met or an agreed time frame has been reached.

A number of organisations have reported that they are still experiencing some difficulties contacting the NDIA when they require assistance. 79 per cent of providers indicated difficulty in this area, with 22 per cent saying they experience difficulty most of the time. Reported difficulties include the following:

78% report that inconsistency of information is an issue.
65% report having to describe the issue to multiple NDIS representatives before action occurs.
62% report that the NDIA staff providing support were not well-versed on problem solving portal issues.
62% report that replies, particularly by email, were not timely; with some taking a month.
59% state that if the query was made by phone, the wait time was too long.
57% reported that their issue/s do not get resolved. One respondent stated that, although the issues were resolved, there was no notification to advise the organisation of the resolution.

Respondents were asked to provide solutions where possible for any of the issues that were raised. These included:

Readily transparent material such as fact sheets, best practice examples and detailed FAQs should be available on topics where difficulties are being experienced. Suggested topics included: – Transport – Equipment eligible under the low risk category – The review process
To alleviate the issues with the provider portal, a swipe card system similar to the Medicare system was proposed, especially for services billed under therapeutic supports.
Clear guidelines around entering service bookings in the portal, particularly relating to duration, and the ability to amend service bookings following participant feedback of alterations to duration. – One respondent suggested that planners or the agency should be responsible for service bookings and work with families around the number of sessions and setting up the associated service bookings.
A finance hotline for providers based in each jurisdiction with expertise in the provider portal.
Real time monitoring of funds spent so that participants, their families and approved service providers can access information about remaining funds.
A series of trouble shooting workshops in which experts from the NDIA work through common problems.
An increase in staffing in regional areas was identified, and due to inconsistent access to the internet, providers in regional SA have proposed training of local staff in issue resolution, a dedicated regional hotline and a key contact model for each region for providers based on the key worker model for participants.

Another key issue faced by providers is the increased administrative burden associated with claiming and administering the NDIS. Respondents were asked to identify any workforce increase and the number of staff in their organisation whose role was specifically related to the NDIS. The number of staff varied significantly depending on the size of the organisation. A total of 56 per cent of respondents stated that their ratio of face-to-face staff to administrative staff had increased and 21 per cent of respondents noted a specific increase ranging between 0.5FTE to 10FTE, a potential cost to organisations of between $24,008 and $480,168 per annum.3

3 Note: This has been calculated on a Social, Community, Home Care and Disability Services Industry Award as an employee of the Social and Community Services Stream at a level 2.1. This figure will vary depending on the award the administration staff are paid under.

Of the additional tasks undertaken by service providers since the introduction of the NDIS:

92% have implemented processes to track expenditure against individual plans;
86% have introduced an additional or redeployed staff member to internally process claims;
72% have implemented processes to perform reconciliation of individual plans against income;
64% have had to introduce debt management policies and procedures; and
33% reported increased rostering tasks. Respondents were asked to provide some innovative solutions to the increased administrative burden. Their solutions included:
Increase of the price guide rate to reflect increased administrative burden; and
Development of localised computer systems that interact with the portal in real time.

Conclusion

The findings of the survey highlighted a range of issues where NDIS system failures are adversely affecting service providers and participants. Of these, the most problematic concerns plan gaps – specifically, their average length and the inability to place service bookings.

The Subcommittee members have raised the abovementioned key issues as requiring immediate attention, and have highlighted the need for the establishment of a new portal as a priority area for the NDIA.

Overall, the impact of the issues on families is significant. Delays between plans have many families reporting a stalling in their child’s progress or even a regression against goals. Families report reduction in services, loss of trust in their relationship with the provider, false expectations and a general lack of transparency in the system. This is contributing to the underutilisation of plans.

The administrative burden on organisations is significant, with over 85 per cent bringing in at least one new position to process NDIS administration, and some employing up to ten new employees for these tasks.

The overwhelming majority of providers continue to provide services to clients whose plans are in the review process, notwithstanding the financial risk and burden this puts on organisations that are often not well placed to do this.

Children’s Services

and the NDIS

Thursday 8 February 2018

49 Total Responses

Date Created: Tuesday 7 November 2017

Complete Responses: 37

Q1: Does your organisation provide services to…

Answered: 47 Skipped: 2

Q1: Does your organisation provide services to…

Answered: 47 Skipped: 2

Q2: My organisation provides services in…..

Answered: 43 Skipped: 6

Q2: My organisation provides services in…..

Answered: 43 Skipped: 6

Q3: What types of services does your organisation provide….

Answered: 43 Skipped: 6

Q3: What types of services does your organisation provide….

Answered: 43 Skipped: 6

Q4: Is your organisation providing unfunded, pre-planning activities for current customers?

Answered: 43 Skipped: 6

Q4: Is your organisation providing unfunded, pre-planning activities for current customers?

Answered: 43 Skipped: 6

Q5: What is the average length of time per person/ family that you are providing? Answered: 37 Skipped: 12

Q6: Are you experiencing issues with the claiming, billing and service booking process through the MyPlace Portal?

Answered: 38 Skipped: 11

Q6: Are you experiencing issues with the claiming, billing and service booking process through the MyPlace Portal?

Answered: 38 Skipped: 11

Q7: What are the key issues with which you are experiencing difficulty? Answered: 35 Skipped: 14

Q8: Are you experiencing delays between a previous plan ending and the new one commencing?

Answered: 37 Skipped: 12

Q8: Are you experiencing delays between a previous plan ending and the new one commencing?

Answered: 37 Skipped: 12

Q9: What is the average length of the plan gap you have experienced?

Answered: 36 Skipped: 13

Q9: What is the average length of the plan gap you have experienced?

Answered: 36 Skipped: 13

Q10: Does your organisation experience difficulty with contacting the NDIS to troubleshoot problems with the portal?

Answered: 37 Skipped: 12

Q10: Does your organisation experience difficulty with contacting the NDIS to troubleshoot problems with the portal?

Answered: 37 Skipped: 12

Q11: What kind of issues do you experience when contacting NDIS to troubleshoot the portal? Choose all that apply

Answered: 37 Skipped: 12

Q11: What kind of issues do you experience when contacting NDIS to troubleshoot the portal? Choose all that apply

Answered: 37 Skipped: 12

Q13: Has your organisation experienced an increase in the ratio of non client facing staff to client facing staff since you commenced NDIS transition?

Answered: 36 Skipped: 13

Q13: Has your organisation experienced an increase in the ratio of non client facing staff to client facing staff since you commenced NDIS transition?

Answered: 36 Skipped: 13

Q16: What additional administration tasks occur since your organisation commenced working under the NDIS?

Answered: 36 Skipped: 13

Q16: What additional administration tasks occur since your organisation commenced working under the NDIS?

Answered: 36 Skipped: 13