After reading the NDIS Quarterly Report to the COAG Disability Council of 31 January 2020, some highlights are:

• The new “Goal Attainment Framework” will also provide the NDIA with valuable evidence as to the kinds of supports and service providers that are achieving the best outcomes across all participants.

• A tender for independent assessment services by allied health providers is scheduled for release in February 2020, in preparation for the national launch in July 2020.

• There are sustainability concerns – The Scheme continues to face a number of pressures in entry and funding decisions, particularly in relation to how the Scheme interfaces with mainstream services, and community and informal supports. This is testing the boundaries of who can access the Scheme and what constitutes “reasonable and necessary” supports (see my upcoming Blog on “Supporting Complex Needs – The NDIS and mainstream interface”).

• The average plan budget is $94,000 in 5th year plans with a 72% utilisation rate. 18% of all plans are now FULLY self-managed.

• 67% of service providers were active in this last quarter and previously and 29% are still not active (seems to be the smaller providers)

• 32% of all plans have AUTISM as the primary disability and 20% have intellectual disability as the primary disability

This report is a summary of the performance and operations of the National Disability Insurance Agency (NDIA) for the 3 months from 1 October 2019 to 31 December 2019, as required by Section 174 of the NDIS Act 2013. There is also a National Dashboard of 3 pages released for every quarter.

The proportion of approved plans that are self-managed (either fully or partly) has increased over the last two years, from 20% of plans approved in the quarter to December 2017 to 30% of plans approved in the quarter to December 2019, and the proportion of participants that have a plan manager has also increased from 16% to 42%.

Rates of self-management also differ by disability, with the higher rates of self-management for participants with a hearing impairment (49%), autism (42%) and spinal cord injury (41%). The lowest rates of self-managed are for participants with psychosocial disability (5%), acquired brain injury (13%), and intellectual disability (17%). Conversely, participants with psychosocial disability (51%), stroke (49%) and acquired brain injury (47%) are more likely to opt for a plan manager than participants with other disabilities. Participants with multiple sclerosis (46%) and other neurological disability (46%) are also more likely to opt for a plan manager. Plan managers are least common for participants with other sensory/speech disabilities (19%), developmental delay (21%) and global developmental delay (22%).

3.2 Choice and control, utilisation and market concentration (page 61)

Comprehensive data on market effectiveness is being used to improve participant outcomes across all geographies through identifying thin markets. In the first two quarters of the 2019-20 financial year $6.9 billion has been paid by the NDIS for participant supports. This amount will increase further due to the timing delay between when some supports are provided and when they are paid. The majority of these payments were made directly to providers on behalf of participants. Three key indicators outlined in the NDIA Corporate Plan aspiration of a competitive market with innovative supports are: choice and control, utilisation and market concentration. All of these indicators are also market KPIs agreed by the COAG Disability Reform Council.

Choice and control

The NDIS outcomes framework questionnaires collects information from participants on whether they choose who supports them. The percentage who indicate that they choose who supports them was compared across geographical regions to identify the regions comparatively better and worse than others. The ‘benchmark’ in this analysis is the national average after adjusting for the proportion of participants in supported independent living in each region and the length of time participants had been in the Scheme. Overall, 43 of the 76 regions (57%) in the analysis were within 5 percentage points of the national average, 3 regions (4%) were more than 10 percentage points above the national average, and 2 regions (3%) were more than 10 percentage points below the national average. 29 The three comparatively better than other regions were ACT, Barkly in Northern Territory and South West in Western Australia. The regions comparatively worse were Katherine and East Arnhem in the Northern Territory. At 31 December 2019, Katherine has 148 active participants and plan budgets totalling $26 million, and East Arnhem has 161 active participants and $19 million in plan budgets.

Plan budgets and utilisation

On average plan budgets have increased for participants the longer they are in the Scheme, and utilisation of these plan budgets has also increased. For participants who have completed four plans (and have a fifth plan), the average plan budget increased from $64,000 to $94,000 over the first four plans (and is currently at $106,000). Utilisation has also increased from 34% to 72%. Hence, the amount of support participants have received on average has increased substantially from $22,000 in their first plan to $68,000 in their fourth plan (Fig 44). Similar observations can be made for participants who have completed three plans (Fig 45), and this is true of participants in SIL and not in SIL, as indicated in Figures 46 to 49.

2.4 Improving participant experience (page 10 of Executive Summary)

Joint Planning

 In continuing to build a high performing NDIA and to reduce requests for plan reviews, design work is progressing for the implementation of Joint Planning. Joint Planning supports relationship building between the participant, planner and local area coordinator through face-to-face planning meetings where possible. The NDIA will commence the national rollout of joint planning meetings and the provision of draft plan summaries from April 2020. Providing a draft plan summary, which is often asked for by participants, will enable them to review and amend their personal details, goals, living arrangements, informal community supports and other community supports, and social and economic participation prior to a plan being developed. Similarly, joint planning will allow a participant, local area coordinator and NDIA planner to collectively discuss a working version of the plan and included support funding before it is approved as well as leading to a greater understanding for participants about their plan, how it was developed and how to use it.

Independent Assessments to be deployed nationally

Improving the NDIS assessment access and funding process will make the Scheme more fair, consistent and equitable for everyone, ensuring it provides access to eligible participants and the appropriate level of funds for those it was intended to help. In supporting this objective, Minister Stuart Robert announced on 14 November 2019 that the Agency will deploy independent functional capacity assessments nationally. This will commence from 1 July 2020 for prospective participants applying to join the Scheme. Further, the NDIA will pay for these assessments so there is no cost to participants and their families/carers. In addition, the NDIA will provide simple and transparent resources for prospective participants, their representatives, clinicians and others, to give certainty on the types and sources of evidence needed to support an access request.

Community Connectors

On 14 November 2019, Minister Stuart Robert announced the development of a National Community Connector Program (NCCP), which will support individuals with disability from hard to reach communities to access and navigate the National Disability Insurance Scheme.

3.3 Thin Markets (page 11 ES)

Supported by the NDIA Board and management, the December 2019 meeting of the Disability Reform Council (DRC) agreed to use a more flexible approach to address market challenges in the NDIS, recognising that a ‘one-size-fits-all’ approach to delivering the NDIS is not suitable to address market gaps faced by certain geographic locations, particular cohorts or disability support types. Initial projects will address thin markets in all jurisdictions, including in the Anangu Pitjantjatjara Yankunytjatjara (APY Lands), North Queensland, the Top End, Wentworth and Walgett in New South Wales, Fitzroy Crossing in Western Australia, and Tasmania.

Projects will also address specific needs such as disability support types, which includes deepening the behavioural support market in Victoria and the Australian Capital Territory, and professional groups such as allied health.

3.4 NDIS Pricing  (page 12 ES)

The NDIA will allow providers to claim for the non-labour costs associated with transporting participants to social activities. The Price Guide will provide guidance to participants and providers about the level of reasonable costs. The NDIS Annual Price Review 2020–21 is now underway[1] .

Changes to activity based transport (page 62)

The NDIA will allow providers to claim for the non-labour costs associated with transporting participants. Several support line items will be created in the community participation support category (one for each relevant registration group) to allow providers to claim for these nonlabour costs. It is proposed that the activity based transport line items are not price limited but that guidance is provided in the Price Guide to participants and providers about the level of reasonable costs, including that a provider could negotiate with the participant to claim for: – the number of kilometres travelled at up to $0.85 per kilometre for a vehicle that is not wheelchair accessible or a bus; – the number of kilometres travelled at up to $2.40 per kilometre for a vehicle that is wheelchair accessible or a bus; and – other forms of transport or associated costs up to the full amount (such as road tolls, parking and public transport costs) Total costs will be shared between participants where more than one participant is transported at the same time.

4. Sustainability (page 12 ES plus page 81)

The number of participants, payments to providers and the amount of support committed in plans, reflects the rapid rollout of the NDIS. $6.9 billion has been paid by the NDIA for participant supports in the first six months of the year. This compares with $10.2 billion paid in the whole of the 2018-19 financial year. The Scheme is projected to continue to grow and to reach about 500,000 participants within the next three to four years, and is forecast to cost 1.2% of GDP.

Plan budgets and support payments made to participants continue to grow by more than expected. In particular, this is driven by support costs for participants in supported independent living which is a material component of Scheme cost. The NDIS is working on consistent and equitable decisions for those seeking access to Supported Independent Living

The NDIA is also working on better aligning a participant’s support package through the reference package and guided planning process, which works to ensure that the right assessment questions and tools are being used to inform plan decisions. A review has commenced to incorporate new learnings since the reference package and guided planning process was first implemented. In addition, the NDIA is looking at more contemporary options for people who require a high level of support. Traditionally, group homes, congregate living or “supported independent living” are commonly seen as a living arrangement solution for people with a disability who have a high need for ongoing care. However, a number of alternative accommodation options have emerged, and are termed “Contemporary Individual Living Options” or “ILOs”. These ILOs have the potential to create a more tailored solution to care and support needs for the subset of Scheme participants with higher needs. Further, ILOs help to increase choice and control for participants and improve outcomes.

The Scheme continues to face a number of pressures in entry and funding decisions, particularly in relation to how the Scheme interfaces with mainstream services, and community and informal supports. This is testing the boundaries of who can access the Scheme and what constitutes “reasonable and necessary” supports.

6. A disability sector informed by data insights (page 12 of ES)

The NDIA continues to release worldleading disability data to improve market innovation and inform participant outcomes. In December 2019, the NDIA released its third update to the Data and Insights pages on the NDIS website. This release included additional deep-dive reports on Aboriginal and Torres Strait Islander participants and Culturally and Linguistically Diverse participants and new data tables and data visualisations. This builds on extensive market and participant outcomes data released in the previous two tranches

Employment Taskforce (page 37)

In November 2019, the NDIA released the NDIS Participant Employment Strategy (the Strategy), which sets out the NDIA’s vision, commitment, and action plan for supporting NDIS participants to find and maintain meaningful employment over the next three years. This will guide the NDIA toward achieving the goal of having 30 per cent of working age participants in paid work by 2023. The Strategy will be delivered through five focus areas:

– Participant employment goals and aspirations in NDIS plans

– Participant choice and control over pathways to employment

– Market developments that improve the path to paid work and support the career development of NDIS participants

– The confidence of employers to employ NDIS participants – NDIA leading by example as a government employer.

Goal Attainment Framework (page 42)

A Goal Attainment Framework is being implemented to help participants develop goals that are meaningful to them, to measure the extent to which they are achieved, and understand the supports and services that help them reach their best outcomes. Participants already discuss their personal goals with Local Area Coordinators and Planners before and during planning meetings. The Goal Attainment Framework will provide structure to support these conversations, to assist participants in developing goals that are clear, realistic and measurable. At the end of any given time period the participant can then score the extent to which a goal was met, providing a point of reflection on how well the services and supports they are employing are working to meet their needs. The Goal Attainment Framework will also provide the NDIA with valuable evidence as to the kinds of supports and service providers that are achieving the best outcomes across all participants. Together with the Agency’s research program and growing body of other data, the Framework will over time provide the structure and information participants need to make well informed, evidence-based decisions about their services and supports. The Framework is currently being tested in a single service delivery area in NSW and is scheduled for national implementation in Q4, 2019-20 (April).

Increasing the number of staff to make planning decisions (page 52)

During the second quarter of the 2019-20 financial year, the number of service delivery staff increased by 179 (9,234 to 9,413 workforce increase). This has allowed more planning decisions to be made at a faster rate. Further, the NDIA has concluded the rollout of a new Workload Manager tool that is now available to staff nationally. This will enhance the participant experience through an efficient workload distribution across the service delivery network.

Making decisions more consistent, equitable and fair (page 53)

Independent assessments

Improving the NDIS assessment process will make the Scheme more reliable, consistent and equitable for everyone, ensuring it provides access to eligible participants as well as the appropriate levels of funding for the people it was intended to help. In supporting this objective, Minister Stuart Robert announced on 14 November 2019 that the Agency will deploy independent functional capacity assessments nationally. This will commence from 1 July 2020 for prospective participants applying to join the Scheme. In addition, the NDIA will provide simple and transparent resources for prospective participants, their representatives, clinicians and others, to give certainty on the types and sources of evidence needed to support an Access request. An expanded pilot has been running since late November 2019 in a single service delivery area of NSW, testing functional capacity assessment tools across the full range of disability types, ages, cultural backgrounds and circumstances. This pilot will inform the national implementation of assessments from 1 July 2020. As with the initial pilot, participation is voluntary and assessments are completed by independent allied health professionals at no charge to the participant. There are opportunities throughout for open discussion and feedback, giving those who participate the chance to shape future improvements to NDIS processes.

A tender for independent assessment services is scheduled for release in February 2020, in preparation for the national launch in July 2020.

Enhanced planning to better respond to the episodic nature of psychosocial disability (page 56)

The NDIA continues to rollout improvements for people with a psychosocial disability. These have included the implementation of a streamlined access process, the development and sharing of key documents to support access, and delivering training and education regarding NDIS access requirements to the mental health sector. The NDIA commenced this implementation of improvements in Tasmania, South Australia, ACT, New South Wales and Queensland with remaining States/Territories to follow by June 2020. Indicative of this focus, 10.5% of participants who received a plan in the quarter had a psychosocial disability, compared to 9.0% in the previous quarters combined. Further, the NDIA is developing a proposed psychosocial disability capability framework with the assistance of experts to define the capability required for NDIA staff and its partners. This framework was initiated to directly address the recommendations made in the Mental Health Australia Pathway Consultation report for the need to build psychosocial capability in the NDIA. Lastly, a commitment from the Disability Reform Council (DRC) to improve access and experiences for participants with a psychosocial disability was announced following the 10 October 2019 DRC meeting.

[1] This review will examine whether the existing pricing framework and other pricing related policies under the NDIS continue to be appropriate, or whether modifications are required.