What does the NDIS Review Report mean for your NDIS provider organisation? Although it’s early days, and although they’re just recommendations, we can already predict some reforms with certainty — using a risk-based analysis.
Some recommendations are essential — that is, they MUST happen. From there, we can analyse other reforms. So, what changes are highly likely in the short term? Where might delays occur? And what are the likely consequences?
HIGHLY LIKELY IN THE SHORTER TERM
Registration of all providers: Bill Shorten is talking about a two-year rollout for mandatory provider registration. It’s essential for government oversight, so unlikely to meet serious opposition. (That said, politics is politics, media is media).
Risk-proportionate registration for all providers: This central reform of the NDIS Review is likely to be non-negotiable. Four levels of registration (and compliance monitoring) have been proposed (p.212-214):
- Advanced Registration —in-depth registration for organisations dealing with the highest level of risk. Audits against general standards (Core Module) and support-specific standards.
- General Registration — Audits against general standards (Core Module), ‘graduated’ and ‘streamlined’ audits appropriate to risk levels.
- Basic Registration — ‘light touch’ registration for lower risk supports. Audit replaced by self-assessment and declaration of compliance with the (simplified) NDIS Practice Standards.
- Enrolment — ensures that providers of lowest-risk supports are visible within the system. No audits, but providers are subject to complaints processes.
Registration to deliver high-risk supports — SIL, Early Childhood, and Support Coordination — will be prioritised. The Report suggests a sequenced rollout to avoid impacts on the labour market, “particularly for early childhood therapy providers.”
Changes to audit requirements: Audits will be required only for the high- and moderately high-risk supports. The Practice Standards will be reviewed, and modules added to address high-risk supports: SIL (p.209), Early Childhood (Action 6.5), all supports to children (Action 17.1), and the new Navigator function (p.209).
Mutual recognition of other accreditations: Recognising accreditations, such as Aged Care Standards, is proposed to ease the regulatory burden for some providers.
Worker screening for all: This is a relatively straightforward reform and within the scope of the NDIS Commission, once all providers are registered. Screening will be required for all workers in risk-assessed roles or delivering specified supports. It will require some cooperation from the states and IT upgrades.
New roles / Loss of current roles: Plan Management will be ‘gradually’ phased out and replaced by direct payment from the NDIA. However, the Report mentions that Navigators might perform the Plan Manager role, if needed, by helping participants use different payment channels and check that supports have been delivered.
Support Coordination will be expanded into the Navigator role, with restrictions on their alignment with provider organisations. A staged transition will “provide the opportunity for existing Support Coordinators to become Navigators and to allow continuity of support” (p.102). There are numerous obstacles that might delay the implementation of the Navigator role (see below).
Separation of SDA and SIL supports (Action 9.7 with possibility of limited exceptions — for example, in remote areas). This will be a legal measure preventing providers from delivering both SIL and SDA supports. Providers will have to choose between SDA and SIL.
Pricing Arrangements (Action 11) — The Independent Health and Aged Care Pricing Authority will advise on developing a new NDIS pricing framework. Prices should better reflect the market and may include outcome-based incentives.
WHAT DOES THIS MEAN FOR YOU?
How this looks for your organisation — in terms of audits, Quality, and compliance — depends on the organisation’s structure, size, and the complexity of supports.
- All levels of registration will be subject to the complaints process, some level of risk-based monitoring, and corrective action where breaches are identified. They will all be subject to the NDIS Code of Conduct and Worker Screening requirements.
- Sole traders — household tasks: Enrolment. Providers are expected to comply with worker screening requirements and the NDIS Code of Conduct. No audits, but they’re subject to complaints processes.
- Sole traders — core supports: No clear indication, but probably Basic or General Registration, depending on how support risk is classified. For General Registration, audits to ensure compliance with the NDIS Practice Standards will be graduated proportionate to risk. Streamlining measures may include self-assessments, desktop audits, and recognition of other standards. For Basic Registration, a self-assessment and declaration of compliance should replace audits.
- Small companies delivering core supports, high-intensity supports, psychosocial supports: General or Advanced Registration. For General Registration, see above. For Advanced, in-depth observational audits against the relevant Standard. For both, streamlining measures may include self-assessments, desktop audits, and recognition of other standards.
- Any organisation delivering SIL, SDA, Support Coordination, Early Childhood, Behaviour Support (planning or implementation): Advanced Registration. New standards to address high-risk supports. In-depth observational audits to ensure compliance with the relevant NDIS Practice Standard. Streamlining measures may include self-assessments, desktop audits, and recognition of other standards.
- Allied Health — therapeutic supports: Enrolment or Basic Registration.
- Allied Health — early childhood supports: Advanced Registration. In-depth observational audits to ensure compliance with the relevant NDIS Practice Standard. Streamlining measures may include self-assessments, desktop audits, and recognition of other standards.
- Large organisations: General or (most likely) Advanced Registration. Streamlining and audit proportionality should apply, as described above.
MAJOR CHALLENGES TO OTHER REFORMS
The NDIS Review Report lists ten tasks that must be completed in the initial phase (Action 26.1) — eight of which could delay the full rollout. However, they are unlikely to affect registration reforms:
- Establish three committees: NDIS Review Implementation Advisory Committee; NDIS Review Implementation Working Group; NDIS Experience Design Office.
- Negotiate a new Disability Intergovernmental Agreement and associated funding arrangements. With all Labor governments, this should be easier than ever before. But the proposed foundational supports would require a significant commitment by the states.
- Pass legislation and rules necessary to implement a range of reforms. The most basic reforms could be delayed while waiting for relevant legislation to be passed.
- Improvements to the availability, quality, and effectiveness of (community level) foundational supports must be in place before a range of other reforms, including for the ‘Navigated’ participant pathway, can be put in place. However, they are not essential to the reforms that allow government oversight for of the NDIS.
- Design and test reforms to the participant pathway, including consulting with people with disability, which will require a significant increase in government design capability.
- Attract and train workers — requiring joint action across the care and support sector. This might meet resistance from aged care and hospitals, which are already short of staff and funding.
- Substantial IT upgrades — Develop appropriate digital and data infrastructure, key to delivering a range of proposed reforms.
- Introduce the Navigator function, which helps people with disability navigate the new system of supports. This will require a consultative design process, adequate resourcing, and delivery by appropriately trained staff. In short, the Support Coordinator role could be with us for a while yet.
- Reforms to quality and safeguarding “will require sustained effort over a number of years, moving with urgency to address most-significant areas of risk” (including addressing the Disability Royal Commission’s recommendations).
WHAT ARE THE POSSIBLE CONSEQUENCES?
The NDIS Review reforms, achievable in the shorter term, have the following possible consequences:
- Changes to Registration
- Many unregistered providers will exit the Scheme. Greater demand for services on top of year-to-year growth.
- Some unregistered providers will seek registration before the mandate. No predicted consequence.
- Change in compliance burden. Providers of aids will not have a compliance burden and will be able to compete more equally with mainstream providers.
- Advantages available to non-registered providers will no longer exist. Possible changes in service consumption.
- Change in pricing arrangements. Positive consequences: pricing to include cost of training, reflection of market price, and possible incentives for better outcomes.
- Mutual recognition of other accreditations — reduced compliance burden for providers accredited under other standards.
- Worker screening — potential significant reduction of workforce on political or personal grounds.
- Support Coordinators — Consequences depend on how the Navigator role is administered. The need to protect the participant pathway should ensure changes are clearly signposted with ‘adequate’ notice.
- Plan Managers — Significant consequences: business model time limited to around 3 years.
- SDA / SIL — providers delivering both supports will have to choose.
CONCLUSION
We acknowledge that the NDIS Review could mean significant changes for some providers. Some positive, some challenging. We encourage you to use risk-based planning to make the best of the coming changes.
The National Cabinet should publish a roadmap to developing and implementing the reforms — which should soon provide more concrete data.
We’ll keep an analytic eye on the situation. We’d love to hear what you think too. So, keep in touch!
