In this episode, Scott Lynch (Managing Director of Community Therapy) discusses proposed changes to the NDIS Act and Rules in response to the Tune Review.
Scott is Chair of the Australian Physiotherapy Association’s NSW Gerontology Committee and Managing Director of Community Therapy; a company he started 5 years ago that has grown to a team of 70 Physios, OTs, Dietitians, Speech Pathologists, and Massage Therapists. Community Therapy delivers values-driven community, aged and disability allied health services across the Hunter and Central Coast regions of NSW.
Today’s Guest
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In this episode, Scott Lynch (Managing Director of Community Therapy) discusses proposed changes to the NDIS Act and Rules in response to the Tune Review.
Scott is Chair of the Australian Physiotherapy Association’s NSW Gerontology Committee and Managing Director of Community Therapy; a company he started 5 years ago that has grown to a team of 70 Physios, OTs, Dietitians, Speech Pathologists, and Massage Therapists. Community Therapy delivers values-driven community, aged and disability allied health services across the Hunter and Central Coast regions of NSW.
Today’s Guest
Things you will learn
Resources
Helloll, and welcome to the community Health podcast powered by community therapy, where we talk all things community health care. I'm your host Scot. lynch, and to day I am flying solo as we speak about proposed changes to the Enddas legislation. To Day's episode may be a little bit more difficult to follow at times as we speak through a little bit of legislation. but the key here is just to get you up to speed with some changes or some proposed changes to the end d i s act in response to the Tune review. So the Australian government is proposing changes to the legislation that underpins the n. d i s. the National disability Insurance scheme. These changes are in response to the twenty nineteen independent review of the Enddiaas legislation by Mister David Tune. This has been referred to as the Tune Review. The Tune review found that the legislation was largely fit for purpose. However, a range of recommendations were made to improve the N D I. S. Twenty nine recommendations in total were made with nineteen of these suggesting necessary amendments where required to the end D I S act. In the Endias rules, the government the Australian government supports or supports in principle or twenty nine of these recommendations, and in today's episode we will be discussing these changes and the proposed changes to the N D I S. Act and rules, with particular focus on what is now called the Participant Service guarantee. So to put these changes in place, the proposal is that the National Disability
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[scott_lynch]:Insurance Scheme Act Twenty thirteen, which is known as the N D A S Act, is changed and there are Enddious rules that go alongside with that act. The act will be amended through the N D I S. amendment, which is their National Disability Insurance Scheme Amendment, Participant Service Guarantee and other measures Bill Twenty twenty one, which is referred to as the bill. Much Easier to a hum, read and refer to of the nineteen of twenty nine recommendations in the Tune Review that required amendments to the N D I S Act and rules. Fourteen of these are addressed in this current bill, and the other five of the nineteen will be addressed in future amendments. It is likely that those five will be part of what is called a Codes design process as the Asraealian government improves its collaboration with people living with disabilities to Codesig. changes to the N Dia. S. Moving forward, So the fourteen changes that are requiring changes to the Endiace Act and rules broadly aim to establish the participant service. Guarantee that's something that you'll start to hear a lot of about if you're a person living with a disability or if you're an organization or professional supporting people living with disabilities. One take away from this episode as get used to hearing the participant's service guarantee. The recommendations also focus on streamlined processes, making plan amendments easier, supporting people better who are living with a psychosocial disability and supporting families better that have children that are living with disabilities. There are three components to the bill. Schedule one speaks to changes relating to establishing the participant service guarantee.
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[scott_lynch]:Schedule, too speaks to improving endiaious processes, and Schedule Three refers to the N. d a s now being at full scheme and waiting for people to have their puns of full steam ahead. Um. importantly, Scheduled three has no real a material impact on participants and will speak to that briefly later. Importantly, there's no changes to in this bill, independent or functional assessments, which is a really important thing for people to know, because we know that was in the media quite a lot, and rightfully so no changes to reasonable un necessary criteria referred to a section thirty four, and no changes to plan budgeting. It is important to note that all of these proposed changes will require majority approval by the Commonwealth and state and territories to pass into legislation, so let's take a deeper look into the actual changes that people living with disabilities as well as organizations and professionals supporting people living with disabilities need to know. So I, I don't um, claim that this is the exhaustive list of all things to know, but I have um, spent quite a lot of time reading through all of the supporting our material from the department, and Um. this is some of my key takeaways, and hopefully you, um, have some learning out of this. So schedule one, establish the participants service, Guarantee, this means that the National Disability Insurance Agency, which we all refer to as the N. d, I, a Um. Moving forward, I just referred to as the agency by, They must make decisions about Um. a person accessing the scheme. Moving forward under the proposed changes within certain time frames, they must also meet certain levels of Um, or
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[scott_lynch]:qualitative standards, and so service standards and the Commonwealth onbardsmen will have powers to independently monitor and report to the Government regarding the N. D. A performance Against these standards, there's also a range of time frames around participants and the agency interacting with each other around. Um. Changes with plans and reviewable decisions, and will speak to some of those. now. the agency's performance against these standards will be included in a regular report as well Arm that will be tabled by the The Umbardsmen. The agency will have more flexibility to make quick plan changes, and this is actually one of the great Um. proposed changes. In My personal opinion, Arm which will benefit are people living with disabilities and participants of the N. D, A s. so the agency will have the ability to make quick plan changes with a planned variation instead of a full plan review. And this is fantastic in circumstances such as assistive technology and home modifications, as it allowed the agency to not be in a position to have to Um to meet the legislation to do a full plan review, so that if someones circumstances changed and all that was needed was an Assist of technology, Um, assessment and report, and all of this soshaded quoting, and submit the template and um that's approved, that would just be able to have a planned variation and not trigger a full new plan and Um, as a a registered provider ourselves at community therapy. We know the the additional administration burden that that places on the scheme of then always having to update service agreements and that additional administrative burden on participants as well.
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[scott_lynch]:Um, so I think that is a change that most people would support arm with open arms. I'm just reading through my extensive notes here. Um, let's let's have a look a little bit further here about some of these time frames. So in regards to the n. D I. a the agency making decisions about a person living with a disability that is looking to access the scheme and has submitted an access request. The agency has to make a decision within twenty one days. the participant will also have, or the person living with a disability Arm will have up to ninety days to provide any additional information when requested by the agency as well without the agency Um, considering their access request withdrawn due to Um. No response. it's important to have a really clear time frame around that Um. For people living with disabilities to have enough time to gather evidence in response to the agency requesting more evidence, One important thing that you will see through some of these time frames is there is a around the time frames. When the agency asks for additional information, there is a pause of any of these time frames, and once the agency receives that information, there's always a fourteen day response time. So if the time frame essentially lapses while the agency is waiting for the person to provide that information, there's always an additional fouren days that the agency has to respond to that information that's received, and I think that is a reasonable Um component of the legislation, and once again um one of the things that I like most about the
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[scott_lynch]:changes. Though there's always room for improvement. I like to look at the positive in things, and I think this is a great step of increasing transparency around time lines in regards to plan development and approval. After an access decision has been made, a person living with a disability arm that has been approved to be an endious participant by the agency. The agency will have fifty six days for planned development and approval arm. From that date of access being approved, it is important to note once, like what I've just said before around the fourteen day period that the fourteen day period of pausing and awaiting receipt of any further information requested will always apply to all of these time frames, so to make that point even further, let's say somebody has had approval to access the scheme. That fifty six day time period starts where the agency needs to move through their planned development and approval process to support that person. Let's say with thirteen days to go in that fifty six day timeline. the agency requests some additional information. The timeline is on pause. If the person living with a disability then gets that information back to them With two days of the fixed fifty six initial days remaining. the agency will have fourteen days to respond, essentially twelve days past the initial time frame deadline. Hopefully, that will start to make sense, but you will start too. Um. Just as the participants service guarantee is something too, That you'
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[scott_lynch]:hear a lot more about. You will hear a lot more about this pause and fourteen day timee line being applied with regards to a reviewable decision. The agency will have twenty eight days to provide a participant with the reasons behind the reviewable decision if requested, And I think that transparency is wonderful as well. I think a future improveroment under that line there under a codes design process would be for the agency to does always provide a reason arm at thee go, The legislation will also look to removed duplication of the word review, so that a scheduled or unscheduled review of a plan will now be known as a reassessment, and a review of a reviewable decision will remain noted as a review. If a participant wants to vary a plan, the agency and and requests that of the agency, either through local air coordinator or planner, Um. the agency will have up to twenty one days to approve or not approve this request, and in the event that the agency does not make a decision, a plan reassessment will be triggered once a plan reassessment has been completed and the new plan comes into effect, And this is any way that a plan reassessment would be triggered and the new plan comes into effect. A copy of the new plan must be provided to a participant within seven days. That arm time frame Fairly straightforward. The agency must also implement a plan implementation meeting within twenty eight days of an offer of such being accepted by a participant. I think that's fantastic to have a time frame around. Are that plann implementation meaning process as well, and speaking further to plan reassessments? reassessment must commence within
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[scott_lynch]:fifty six days prior to the current plan end date, and finish within twenty eight days of being commenced. If the agency is responding to a participant request to vary a plan and it relates to complex needs or raises complex risks or relates to complex assistive technology or home modifications, then fifty days is allowed arm. for that reassessment to comp, be completed. If not, the timeline is simply that, twenty eight days, so we will start to see and and get clarity around all of these time frames, and I am sure that Um. many organizations will put together some pretty tables around these where more than happy to it community therapy. but I am more than happy for other people to be putting those tables together as well arm. It is important to also note that at this stage if additional information is requested under any of those reassessment timelines, that same fourteen day timeline may apply of Um. waiting for information to be provided back to the agency in regards to decisions made by the administrative appeals tribunal, The A a t. The agency has twenty eight days to give effect to any variation or substitution being recommended in a person's plan, a participant's plan, after being notified by the A A T decision, a time frame has also been provided for the agency to cancel a plan nominee when requested, and that time frame is fourteen days. There's also a time frame being applied for a reviewer of a reviewable decision to complete that review, and that time period is sixty days. Once again, that same pause and Fordine Day response period by the agency requesting additional
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[scott_lynch]:information would apply. So thanks to listening for all that timeline, part will move on to schedule two in a moment. But the important part of I think that first schedule is around the just knowing that the participant service guarantee is something that you're going to hear about. You'll start to hear more, Um, more commentary and more dialogue, whether it's interacting with the planners, the local area coordinator teams coordinators of support, everyone involved with the N. d, I. S at large will start to get used to speaking about or at least having knowledge of these time lines as well. I think overall time lines, time frames, clear expectations and communication are always a step in the right direction. Are there certain things that could be improved under those recommendations in schedule one? Of course, and I think a Codes design process moving forward will be a really important and positive part of further amendments to the Act in the future, so let's move on to schedule two improvements to endiaious processes, And I promise that this section is not as confusing and as farest of me speaking about any time frames. An important amendment to the legislation that comes through under this schedule is replacing psychiatric with psychosocial disability, and in addition to this, also noting that psychosocial disabilities can include episodic and fluctuating psychosocial disability and pairments decisions around such episodes, such episodic or fluctuating impairments in regards to access to the n d s, as well as are reassessments, and and all of the Uh, reviwable decisions et cetera
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[scott_lynch]:will all be based around reasonable and necessary supports, and considered a, by a case by case basis by the agency and based on best evidence. The agency may also set out specific requirements that must be satisfied for an impairment to be considered permanent or likely permanent, and you can expect this to have further clarity on our moving forwards, and there may provide a recom more clarity around recommended outcome measures are more clarity around Um. evidence based interventions and best practice. Um have supporting Um. Different disabilities, which I think is always a wonderful thing to have strong clinical frameworks and wonderful to be supported by Um agency, or Quality Safeguards Commission, as a provider to have access to that additional information as well, Um. And an important part is when we're looking at Um on a case by case basis of people living with psychosotal disabilities, in, in particular, episodic or fluctuating. the supporting documents around these proposed legislation, which was included in the community consultation and feedback process, was, are referencing to that, the the public system and the health system. There would need to be evidence that best practice Um had already been exhausted through normal health channels of being able to look to have improvements of those conditions, and that now the N d i s is the most suitable Um funding mechanism for supporting that person Schedule, too. Also notes that the agency can change how a plan is managed if the way it is being managed presents an unreasonable risk to participants and
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[scott_lynch]:the same applies for changing a planned nominee. So I feel that ma'am there needs to always be clear evidence in transparency around this power, Um, of why it's an unreasonable risk in providing that clear decision. and however, I do believe it is that it's an important component of quality and safeguarding participants to have in place. It will be important, however, to monitor the transparency of that power by the agency reflecting back on schedule one. However, a participant would have the power to then request transparency around the reason behind such decisions, and the agency would have a time frame on being able to provide that reason within that time frame. if it wasn't already provided. The agency was also, will also have the power to direct how supports are provided in Cirum, Certain circumstances, those circumstances being the same around planned budgeting and plan nominee changes, where there is an unreasonable risk to the participant if they do not put that change in place. Now there, in the supporting documents there was an example given to try and describe arm why this exists, and the example given was a person living with multiple sclerosis, and the participant had expressed concern during their plan reassessment with the agency that the physio service is being offered by their support coordination company. So this was a registered provider, providing both support coordination and physiotherapy Clearly didn't have experience in supporting people living with with our multiple sclerosis, but were offering Ing physiotherapy at a discounted rate. if the person has all of their services
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[scott_lynch]:with the one provider to sort of a a marketing strategy. Now, this may not be the clearest example of the application of the rule. However, I do think that it gets the messaging across that. Um. The agency has a strong commitment to best evidence practice, strong clinical frameworks, and what we at community therapy would consider Um, and always refer to of suitability to support. So providers should take away from this part of the proposed changes that they should review and reflect on what policies and procedures do you have to ensure that participants are that you are supporting and that you are providing a commitment to support best evidence practiced to support them to meet their meaningful goals, and what they've expressed to you that you are actually suitable to support. So you always have to be continually monitoring. then overall, I do believe that it's clear that the agency has that high respect for evidence based practice. They know that it results in the best outcomes for people living with disabilities, and also they know that it results then in the best outcome for sustainability in the scheme as well, And I think that's reasonable. I think it's wonderful in health care, and whether it's in a business context or a public health arm or ill government financial contexts, the alignment of the outcome of the financial model and the health care model being very similar of a great outcome for both is fantastic, and in this case, if a person is being supported by best evidence practice, they have the highest likelihood of either improving their capacity, maintaining their capacity, meeting their their meaningful, their meaningful goals, and participating in
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[scott_lynch]:society, and that will result in the greater sustainability for the scheme as well. So I do think that is quite a reasonable commentary arm and a reasonable um risk for the agency to identify once again. However, it's always important to have transparency around the application of that rule and power by the agency or what the supporting literature or documents say, the end, the agency, C, e O and its delegates. So like I said, Keep take away there for professionals and providers to over the coming period, review operations and ensured that you are really working towards suitability to support. So are you? Do you have a thorough referral and acceptance process of ensuring that you do have capacity to support and suitaabilities to support those that you are promising those supports too? In the supporting doccurements as well, there was additional commentary from the agency saying that these are these. Couple of changes are primarily around changing Arm, having the power to direct supports, but also the power to direct around arm. How a plan is managed to theoretically does impact this. What I am about to say now is that the supporting Arm documents noted that the agency notes that an unregulated provider market, so providers that aren't endiaus registered either through a certification or verification pathway, is a double edged sword. That's my words. not theirs. but that's farm. what they're getting to. It has increased participant choice and control of the services and products that they are able to engage with under the endiais
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[scott_lynch]:whether they self or plan, managing. However, it does lead to increased participant risk due to a lack of protection that the certification and verification pathways offer through bringing responsibilities for the provider under the Enddiaious Quality and Safeguard's Commission. I do tend to agree with the agency here. However, I, there would have to be a very thorough codes design process over the medium and long term of how the market would be able to um be supported to have more regulation, and this would be more so around providers that aren't currently are regulated. There was no clear direction in the supporting documentation here that that is the direction that the agency is moving for a fully regulated scheme. However, I think over time if the agency saw increased Arm providers being registered, it would be a positive thing, and I don't think it's too much to ask for businesses to have that aren't regulated to arm, even if the agency was able to look at more of a verification pathway for most businesses that are clearly classified as as low risk, At least having more providers that are currently unregistered having improved incident management, improved complaints and feedback mechanisms and processes, as well as regulation by the Quality and Safeguard's Commission, and some responsibility there would improve outcomes. And in terms of overall risk to participants, however, I do note that that would be quite a lengthy process, and you would have to
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[scott_lynch]:take a codes design process to move through that. but I do as I read through Um legislation and supporting documentation. You're always looking for that overall theme And that was one theme that I pulled out of all of the reading that I've done the takeaway for providers. There continues to be a strong reason to remain registered or to consider being registered. If you aren't already, there are also proposed changes around plan administration and old. To speak to two of those, there is an extension to the grace period for participants accessing end dious supports while they are overseas, which is really important to provide those time frames there. If somebody goes overseas and they being funded for for support from a support worker or their hiring equipment, there's clear a transparency of how the participants responsibilities interact with the agency and the n. d a s. While they're overseas, there is also a requirement, a clear requirement now around the time frame that providers and participants must maintain records, and that time frame is five years, and it commences on the day that services or products were delivered or provided quite a reasonable expectation. That's normal when you haveve been on interacting with most funding schemes. Normal under you know, a for tax in terms of an accounting purposes, So for most providers, this should cause no alarm and no real change to processes. It may um. It does impose Um, additional administration requirements and Um organization requirements for participants that are self managing. However, that would be an important take away if I was a coordinator of support and I
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[scott_lynch]:have participants that are self managing. That would be one point that I would discuss with them and ensure that they have supports in place to meet that requirement of the Faate, five year records. Okay, let's move on to schedule three, which is significantly quicker. Scheduled three is referred to as N d i s at full scheme, and changes the legislation. Changes to the legislation under this schedule have no real impact on participants, which I mentioned at the start of the podcast, and the primary change or proposed changes to be aware of here is removing reference to trial and transfer phases of the n d i s within Act, as the N d I s is now at full scheme, full steam ahead across all states and territories, So that's the primary component of schedule three and you can see it has real, no, no material impact at all, more of a um, technical or administrative change to the. Legislation, so that's a bit of an overview of some of the key components of the changes or proposed changes to the endiest act in rules, in response to fourteen of the twenty nine recommend chain recommended changes following the tune review. Remember, at the start of this podcast, I mentioned that five additional changes taking that fourteen to nineteen do require changes to the Endiace Act and rules. However, they will require further work through codes, design with participants and people living with disabilities. The remaining ten of the twenty nine recommendations in total require more operational improvements to the agency or scheme without subsequent changes to the Act. So whereto from now the government has committed previously to legislate the participants, service group are guaranteed by the first Arm of July Twenty twenty. I believe it was Um. However, as consultation proceeded, and
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[scott_lynch]:parliamentary processes have been delayed due to covern nineteen, this was not possible. and then obviously there was all of the Arm trials and tribulations around the Independent Arm assessments as well. further consultation has just been completed and that is what I am. I have been reading through some of the community consultation and feedback and additional Arm documentation provided by the department, and that is was ending at September twenty twenty one. The government will now consider and respond to the submissions and feedback provided, and make any necessary changes to the proposed bills and rules prior to taking that through to Parliament, as noted in the episode At the start. However, these changes do require a majority of states and territories and the Commonwealth to approve. These changes are prior to be able to pass parliament. So, I hope this episode has been helpful, and I'm sure there willll be plenty of further commentary and further podcast episodes on and related to these proposed changes, including when they are implemented. My major takeaways that I spoke through Arm was primarily getting used to this increased transparency around time frames are when interacting with the agency, and I think that is very positive and a step in the right direction of, have always having clear expectations in time frames. I think it's positive to see increased commentary and dialogue around a codes design process, and I would hope that that becomes a normal part of changes to the act. moving forward. I think it's positive to also see increased quality in safeguarding arm oversight, especially over evidence based practice, something that we're very committed to and very proud of at community therapy as well as that, Um. clear,
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[scott_lynch]:focus on suitability to support as well. So once again, if you are a provider, take the time to consider how are you working towards strong clinical frameworks, a strong culture and focus on evidence based practice and suitability to support as well. It's wonderful as well to see that recognition of psychosocial disabilities, and with particular focus to fluctuating or episodic disabilities and the functional impairments and impact that that has on people's lives as well. All right, thank you so much for listening through to the episode. Feel free to send through any questions that you have or commentary. After listening to this, you could send that through via direct message on any of our social media platforms, or you're always welcome to ha, hop on the website and get under the contact page and send us a message as well. Will always respond to those messages. So feel free to ask any questions that you have around arm to Day's episode. If any of the information that I provided to Day was clearly incorrect, We also love to hear that as well. we, um, reading through all this legislation, Definitely difficult. Sorry if I muddled any of the information there, but I feel that I gave quite a good representation of all of the proposed changes and some of the clear things to focus on until next time. take care of everyone, and I look forward to speaking to you in the next episode. they.