Tasmanian Government
Submission to the Joint Standing Committee on the
National Disability Insurance
Scheme
Transitional Arrangements for the
National Disability Insurance Scheme
September 2017
Department of Premier and Cabinet
17/65775
TABLE OF CONTENTS
1 OVERVIEW …………………………………………………………………………………………………………………………………. 3 2 SCHEME TRANSITION IN TASMANIA ……………………………………………………………………………………. 4 3 SCHEME ELIGIBILITY …………………………………………………………………………………………………………………. 5 4 SCHEME SUPPORTS ………………………………………………………………………………………………………………….. 5 5 BOUNDARIES AND INTERFACES WITH THE NDIS …………………………………………………………….. 7 6 THIN MARKETS …………………………………………………………………………………………………………………………. 7 7 FUNDING ARRANGEMENTS …………………………………………………………………………………………………… 8
Tasmanian Government Submission – JSC NDIS transitional arrangements August 2017 2
1 Overview
The Tasmanian Government welcomes the opportunity to provide input to the Joint Standing Committee’s Inquiry into the National Disability Insurance Scheme (NDIS) transitional issues. The implementation of the NDIS is a key priority for the Tasmanian Government. Over a four-year period Tasmania is contributing $572 million to the scheme. The Government is committed to implementing the full scheme by July 2019. The Government also remains committed to the current funding and governance arrangements as set out in the Heads of Agreement between the Australian and Tasmanian Government on the NDIS.
The NDIS is a major social and economic reform that represents a once in a generation opportunity to improve the social and economic opportunities for Australians with disability. The Tasmanian Government remains committed to the successful implementation of the NDIS.
It is unavoidable in a reform of this scale, being undertaken in an ambitious timeframe, that implementation issues will invariably arise. The challenge for all governments and the National Disability Insurance Agency (NDIA) is to respond effectively to issues as they arise and to ensure that the disruptions to Australians living with disability, both participants of the NDIS and clients of mainstream services, are kept to an absolute minimum.
Broadly speaking, Tasmania’s transition to the NDIS remains on track. Participant numbers and scheme costs in Tasmania are matching closely the estimates made in Tasmania’s transition bilateral agreement. Notwithstanding this, some challenges to service continuity have arisen, as is outlined in this submission. In particular, Tasmania has experienced transitional issues in the transport domain. Transport is a critical enabler of social and economic participation for people living with disability and the resolution of these issues is of high priority for the Tasmanian Government. For this reason, Tasmania has led work to develop national policy in the NDIS transport space, through the Disability Reform Council’s Senior Officials Working Group. The Tasmanian Government looks forward to the timely completion of this work.
Interface issues in the health, psychosocial disability and personal care and support in schools service areas are emerging areas of risk that the Tasmanian Government is closely monitoring.
Many of the issues being considered by this Inquiry are similar to those being examined in the Productivity Commission’s Inquiry into NDIS Costs. The Tasmanian Government made a submission to that Inquiry’s Draft Position Paper, which is available from the PC’s website. While the Tasmanian Government does not support all of the PC’s draft recommendations, the PC has compiled a significant and valuable evidence base to inform a deep understanding of many of the issues being considered by the JSC and consideration of the PC’s detailed work is encouraged. This Tasmanian Government submission makes extensive reference to the PC’s draft report.
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2 Scheme transition in Tasmania
The Tasmanian Government notes the PC’s draft findings concerning the scale and pace of the NDIS rollout (draft finding 2.1); that scheme costs are broadly consistent with the PC’s 2011 modelling (draft finding 2.2); and that, despite early cost pressures, scheme costs are broadly on track based on the NDIA’s long-term modelling of trial and transition data (draft finding 2.3). The Tasmanian Government also notes that the NDIS is improving the lives of many participants and their families, although some participants with complex support needs are not benefitting from the scheme as intended (draft finding 2.4).
The Tasmanian Government remains committed to the agreed rollout timeframes for the NDIS. Despite some delays early in the transition, Tasmanians are entering the scheme largely in line with agreed targets. Tasmania’s statewide rollout approach was designed to ensure that participant intake reflects community expectations about timely access to the NDIS and is sustainable for the NDIA, providers and the Australian and Tasmanian Governments. Each year of the transition, the number of Tasmanians in the NDIS will double as new age cohorts enter every six months, meaning that:
an estimated 1,117 people became participants in 2016-17;
an estimated 2,632 people will become participants in 2017-18; and
an estimated 5,713 people will become participants in 2018-19.
Although Tasmania’s transition is tracking well, there are concerns with the NDIA’s planning approach, its impact on the participant experience and the quality of NDIS plans, and the consequences for the overall financial sustainability of the scheme.
The Tasmanian Government notes the NDIA’s review of its planning approach and strongly encourages the implementation of its proposed revisions, particularly increasing the availability of face-to-face planning options and a return to a stronger focus on participants’ life goals.
There are several key outstanding policy issues currently being addressed nationally, which affect the cashing out of State-run programs that are in-scope for the NDIS1 and, as a consequence, affect the implementation of the transition. These are covered in more detail later in this submission.
While scheme costs remain in line with expectations, the Tasmanian Government continues to be concerned about the levels of use of participants’ plans. It remains unclear whether plan use levels (cited at 74 per cent in 2015-16) are a result of supply issues, inadequate planning or participant capacity. Plan use compared to committed supports, market responsiveness and participant outcomes are inextricably linked and require rigourous analysis and monitoring to ensure the scheme is performing as intended.
These issues notwithstanding, it is noted that Tasmanian participant satisfaction remains consistently high and participants report positive experiences with respect to the planning process2.
1 NDIS in-scope programs are defined in the Council of Australian Governments’ Principles to Determine the Responsibilities of the
NDIS and Other Service Systems
2 NDIS COAG Disability Reform Council Quarterly Report - 31 March 2017
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3 Scheme eligibility
Scheme eligibility is a critical lever in ensuring that the NDIS covers the people it is intended for and that it remains financially sustainable. NDIS eligibility also has significant impacts on state funding contributions and mainstream service systems. The requirement for states’ agreement to the eligibility criteria in the NDIS Rules reflects the financial and service risks borne by the states, as well as the policy objectives of a national system for disability supports based on insurance principles. The Tasmanian Government supports the need for ongoing analysis and monitoring of scheme eligibility parameters to ensure the NDIS is working as intended. The Tasmanian Government notes that the PC has found that the existing NDIS eligibility criteria reflect the PC’s original proposed NDIS target population, noting the two additional criteria which were identified by governments in the development of the scheme following the PC’s 2011 report. The two criteria were the inclusion of people with substantially reduced functional capacity to undertake learning or social interaction and children with developmental delay was not part of the PC’s original costings, and further analysis is required to understand the impact on scheme sustainability.
The Tasmanian Government supports the PC’s observation that people with psychosocial disability require a tailored approach in respect of scheme access, and notes the proposal for a specific gateway for people with psychosocial disability to ensure that the appropriate expertise is available at the first point of contact with the NDIS. The Tasmanian Government will carefully consider any final recommendations made by the PC in this regard.
A key feature of the scheme’s insurance approach is early intervention which enables upfront investment to support the maintenance or development of an individual’s functional capacity and contributes to improved outcomes and reduced costs over the long term. The Tasmanian Government considers that ongoing data collection and analysis of the effectiveness of the scheme’s early intervention function is a vital performance indicator.
The NDIS Early Childhood Early Intervention (ECEI) approach commenced in Tasmania on 1 July 2017, as children aged four to 11 gained access to the NDIS under the Tasmanian phasing rules. It is therefore too early to provide a view on the effectiveness of the approach in Tasmania, although the Tasmanian Government notes that the model is based on best practice and other jurisdictions, notably New South Wales, have reported positive results. The challenging implementation timeframes for ECEI in Tasmania remain a concern, as does the need to ensure that the ECEI partners have appropriate early childhood development expertise to deliver quality outcomes for children and their families.
The Tasmanian Government has made a separate submission to the JSC’s inquiry into the provision of services under the NDIS ECEI approach. 4 Scheme supports
As with scheme eligibility, the scope of supports available in the NDIS underpins both the effectiveness of the scheme in supporting individual outcomes and its future sustainability. The concept of “reasonable and necessary” supports is still relatively new and represents a significant change in the way resources are allocated to people with disability. The allocation of supports is highly dependent on the quality of the planning processes, and can result in varied outcomes for individuals who may have similar support needs. NDIS supports also affect the interfaces between the scheme and other service systems, and impacts on governments’ continuity of support obligations. Maintaining a role in setting the policy for the scope of
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NDIS supports through the NDIS Rules therefore remains critically important to state and territory governments.
While the PC has found that many people are benefiting from the NDIS and have greater support, choice and control than previously, there is also evidence of some gaps in support for participants, particularly as funding for NDIS in-scope state and Australian Government programs is cashed out to the NDIS. The Tasmanian Government would welcome further clarity on the application of reasonable and necessary criteria in the NDIA’s decision-making and notes that the current Federal Court appeal3 in respect of partial funding of reasonable and necessary supports has direct implications for Tasmanian participants.
The Tasmanian Government commenced cashing out its taxi subsidy program for NDIS participants in September 2016, under the expectation that former taxi subsidy program members would receive reasonable and necessary transport supports in their NDIS plans. NDIS reasonable and necessary transport supports may include transport training to assist participants to travel independently, vehicle modifications and funding for taxi travel or other private transport for participants who cannot travel independently or use public transport due to the impact of their disability. The Tasmanian taxi subsidy program is only available for individuals who cannot travel independently due to the impact of their disability or mobility impairment4. When the Tasmanian Government commenced cashing out taxi subsidies for NDIS participants, many participants reported that their NDIS plans did not have sufficient transport supports to enable them to achieve the same outcomes prior to becoming NDIS participants. A lack of transport supports may limit participants’ access to other NDIS funded activities and may be contributing to the under-use of plan supports. For some participants there is confusion about the quantum of transport support in their NDIS plans as it may be represented as a separately identified item, or “bundled” into other items such as core supports, capacity building or capital. Part of this confusion may relate to identified deficiencies in the NDIA planning and review process. The Australian Government had previously commenced cashing out its Mobility Allowance for NDIS participants and transport assistance funding is represented in participants’ plans at levels which appear to equate to the top two Mobility Allowance funding rates5. However, the NDIS transport assistance funding does not appear to include any additional funding that may have been accessed through state taxi subsidies, leading many participants to conclude that the funding had been cut.
In November 2016, in response to stakeholder concerns, the Tasmanian Government established a temporary taxi subsidy safety net for approximately 130 NDIS participants who were former members of the State’s taxi subsidy program and who reported that their NDIS plans do not provide adequate funding for transport supports6. The temporary safety net was established to enable NDIS participants time to work with the NDIA to ensure that their transport needs were adequately reflected in their plans and to adjust to the new/different supports in their plans. As there continues to be uncertainty about the adequacy of transport supports in NDIS plans, the temporary safety net will extend to all State taxi subsidy cardholders who become NDIS participants during 2017-18 to ensure that Tasmanians are not disadvantaged in the transition to the NDIS. This gap in support effectively means that the Tasmanian Government is paying
3 McGarrigle v National Disability Insurance Agency [2017] FCA 308 4 Transport Access Scheme eligibility and guidelines http://www.transport.tas.gov.au/_data/assets/pdf_file/0004/109651/PT200-_TAS_Guidelines_and_Application.PDF 5 NDIA Transport Funding https://www.ndis.gov.au/document/participant-transport-funding-informati.html and Australian Government Mobility Allowance https://www.humanservices.gov.au/customer/services/centrelink/mobility-allowance 6 Media releases http://www.premier.tas.gov.au/releases/government_to_act_on_taxi_subsidy and http://www.premier.tas.gov.au/releases/taxi_subsidy_safety_net_scheme_extended
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twice for this cohort of NDIS participants, and in-kind recognition of expenditure on taxi subsidies for relevant participants is currently being negotiated with the NDIA. National policy work to analyse the adequacy of NDIS transport supports is currently underway and is expected to inform future decisions about how the NDIA allocates reasonable and necessary transport support.
In light of the example provided above, the Tasmanian Government strongly supports proposals for a range of improvements in the NDIA’s planning processes. It is noted that the NDIA is already working to address stakeholder concerns about the quality of the planning processes. The Tasmanian Government further notes that performance data in respect of participant outcomes is still emerging and ongoing monitoring of the adequacy of NDIS plans, as well as the planning process itself, is required. 5 Boundaries and interfaces with the NDIS
Effective, consistent, and clear interfaces between the NDIS and other service systems is critically important to positive outcomes for NDIS participants. The Council of Australian Governments (COAG) committed, through the Principles to Determine the Responsibilities of the NDIS and Other Service Systems (the COAG Principles), to the interactions of people with disability with the NDIS and other service systems being as seamless as possible. It also committed to the NDIS and other systems working together to ensure integration, coordination and optimal transition between systems for participants. This area of the scheme’s operation has the greatest scope for cost-shifting to the states. The Tasmanian Government, in its submission to the PC’s draft findings supported the concerns raised by the South Australian and ACT Governments in their submissions to the PC about the budget risks of effectively paying twice for participants who continue to access state services that were expected to be in-scope for the NDIS. It is noted that the NDIA’s operational documents for interpreting the COAG Principles have not yet been finalised, which contributes to the uncertainty in this area.
The Tasmanian Government supports the appropriate resourcing of Information Linkages and Capacity Building (ILC), particularly during the transition period. ILC commissioning will not occur in Tasmania until 2019 and there remains a level of uncertainty among providers and participants about how ILC will function. In addition, the national approach to ILC commissioning could potentially disadvantage Tasmanian based providers who may be best placed to provide local solutions that more effectively interface with local mainstream services, particularly in regional areas. 6 Thin markets
Performance indicators for the NDIS market will be critical tools for monitoring readiness and anticipating supply shortages and provider failure. The Tasmanian Government remains concerned about thin markets, particularly for regional and remote areas, cohorts with complex, high intensity needs or very challenging behaviours, or in acute need. In these circumstances, it is appropriate that consideration be given to direct commissioning in order to ensure that supports are guaranteed, especially where participant safety is concerned. The Tasmanian Government notes that the NDIA’s “Provider of Last Resort” arrangements have not yet been negotiated for Tasmania.
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7 Funding arrangements
State funding contributions to the NDIS during transition and at full scheme are fixed and capped, in recognition of states’ need for budget certainty and their limited capacity to raise additional funds. The Tasmanian Government notes that the DisabilityCare Australia Fund (DCAF) was established to reimburse governments for expenditure incurred in relation to the NDIS, and to fund the implementation of the NDIS in its initial period of operation. Although DCAF was established in July 2014, payments to the states have not yet commenced. Ongoing delays to Tasmania’s access to its DCAF allocation is a significant budget risk for Tasmania during transition, and the Tasmanian Government is seeking urgent finalisation of the DCAF National Partnership Agreement.
Similarly, the current agreed arrangements for bearing the risk of cost overruns appropriately reside with the Australian Government as the level of government that is best able to fund this liability. The Tasmanian Government notes that the Australian Government stands to benefit if actual scheme expenditure continues to fall short of committed expenditure. Cost overruns outside the scheme largely remain the liability of the states and the shared responsibility for agreeing key scheme cost drivers, such as eligibility and reasonable and necessary supports, reflects the shared funding risks.
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