KR-5 Implement processes that support “rolling” adjustments for service and Provider changes to a Plan during operation, together with greater flexibility in setting Plan review periods. Policy Change Process Change 3.7.A KR-6 Enable responsive access to agency and Provider support, operational flexibility and adaptability of Plans in order to enable and maintain ongoing, responsive Participant choice and control. Policy Change Process Change 4.3.A Key Rec# Recommendation Action Section WA NDIS NDIA Ref KR-7 The viability of all funded services in a Plan is to be proven prior to approval. In Place Policy Change 3.4.B KR-8 The activation of Provider services, following Plan endorsement, is to incur a minimal delay in Participant access to supports. In Place Process Change 3.5.C KR-9 Implement processes to ensure all committed services in a Plan are effectively and fully delivered to the Participant with appropriate incentives and monitoring procedures. In Place Policy Change 3.6.C Key Rec# Recommendation Action Section WA NDIS NDIA Ref KR-10 Engage with the WA disability services sector to ensure adequate availability and capacity of services for WA rollout and a healthy relationship that fosters good-will and cooperation. In Place Process Change 4.1.A KR-11 Adopt an “open pricing” approach whereby price book components are negotiated in an open industry consultation process, inclusive of WA. In Place Process Change 4.1.D Key Rec# Recommendation Action Section WA NDIS NDIA Ref KR-12 Ensure a reliable, functional, scalable and sustainable financial system is implemented. Process Change Process Change 4.3.E
Sources of Information An extensive set of reference materials has been collated and together with information from workshops and surveys has been incorporated into the data warehouse. Each category of source information includes multiple individual component sources. Source Source Description S1 Agency Policies and Business Practice Rules and Guidelines applicable to the formulation and operation of Participant Plans published by the agencies (including relevant Acts) Agency business process workshops were held Oct-Dec 2014 and ongoing interviews to Jul 2016. Up to Jul 2016 S2 Agency Risk Workshops Agency operational management risks and issues workshops Mar 2015 S3 Agency Planner & Coordinator Workshops #1 Agency Planners and Coordinators operational staff interviews and workshop records Feb 2015 S4 Service Provider Survey #1 Responses to the Service Provider survey in April 2015. (Initial interviews in Nov 2014) Apr-May 2015 S5 Agency Quarterly Reports Agency management and actuarial Quarterly Reports Sep14 to Jul16 Jun 2016 S6 Bilateral Agreements Trial Site scheme agreements between WA State & Commonwealth Governments Up to Jul 2016 S7 Agency Quantitative Survey #1 Responses to Agency Quantitative Survey in August 2015 May-Aug 2015 S8 External Sources Other sources including JSC NDIS inquiries and Senate hearings held in WA and Canberra in 2015. Published articles. Up to Jul 2016 S9 Participant Plan Survey 300 Participant Plans sampled from each trial site for Nov 2014, Feb 2015 and Nov 2015. Feb 2016 S10 Agency Planner & Coordinator Workshops #2 Agency Planners and Coordinators operational staff interviews and workshop records Feb 2016 S11 Agency Quality Management Workshops Review of Agency quality management approach and practices in the trial sites Mar 2016 S12 Agency Quantitative Survey #2 Responses to Agency Quantitative Survey #2 completed in May 2016 Feb-May 2015 S13 Participant Conversation Program Structured interviews with selected Participants from each trial site. Jun 2016 S14 Service Provider Survey #2 Structured interviews and Service Provider survey updates in July 2016. Jul 2016
CS01 (WA NDIS) Coordinators commented that all Plans are peer reviewed as part of the development procedures for Plan consistency and Coordinator training purposes. This included comparison with “Norms” for cohort consistency assessment and consideration of any appropriate adjustments. Clarification may be sought from the regional director as required. CS01: (NDIA) Planners commented that they made efforts to avoid getting a “Please Explain” when putting a Plan together. A “Please Explain” involved a time consuming detail review to justify the assessment and pricing of every component of a Plan and implied they had made an error in the assessment of the Participant and their needs. CS01: (NDIA) A Participant case was cited by Provider PPP where a severely autistic individual was assessed to have a low level of disability by the Planner on the basis that XXX had “a happy demeanour”. Provider PPP’s therapist asserted that this “demonstrated a gross lack of understanding of the characteristics of the autistic disability”. The situation was compounded by the family not having English as a first language and feeling intimidated at the meeting and agreeing to any support they could get. Comprehensive information from XXX’s therapists was available but not accessed by the Planner. CS09: (NDIA) Participant XXX’s podiatry supports were removed from the new plan. The funding of podiatry was transferred to Medicare. However, complications with XXX’s disability caused XXX’s GP to insist that treatment for the complication took priority over XXX’s podiatry needs. Because the family has limited capacity to pay the total gap payments under Medicare, a family member stated “we have to wait ….which is causing a major problem for XXX”.
proposed service booking procedures and the ability of Participants to comply with the changes. Further assessment of this new system is out of the scope of this evaluation. A reliable, scalable and sustainable financial system needs to be implemented without delay. The summary of the issues be resolved in the replacement system includes: Integrity issues with Participant service accounts, Multiple access by Providers to Participant service accounts, Budget correlation between Plan and Participant account, Claim rejection procedures and resolution: Transparency of decisions, Expedite resolution of issues and anomalies. Plan transitions and rollover account management: Continuity of support for Participants when Plan review is delayed, Account adjustments to comply with Plan extensions, Claim processing for gap periods between Plan expiry and recommencement. Exception handling where Participant services are disrupted. CS13: (NDIA) Provider PPP said “The old system had issues. … The replacement is not cause for optimism”. CS13: (NDIA) Provider PPP tried for 7 months to have claims paid that were lodged for services provided for a Participant after their Plan expired and before the new Plan was commenced. PPP said “after all this time they finally said no, it is not negotiable” Process Improvement The Plan lifecycle stages in this document cover the assessment of business processes that can benefit from improvement and those where a process review is necessary. This section addresses areas where overall improvements may be made in the interest of Plan quality, improved choice and control for Participants and cost effective services by Providers. Process flexibility and improvement Greater use of flexible Plan durations to suit observed stability or rate of change of Participant requirements. Improved and more responsive processes for minor adjustments to Plan service specifications and budgets during Plan operation. Service initiation and Provider engagement efficiencies: WA NDIS: more streamlined quoting and commencement processes,