NSW Provider Forum Presentation

Slide one: Intro slide: Working with the NDIS.

Slide two:This presentation will cover.

1. Why is the NDIS of interest to my business?2. How does the NDIS create opportunities for my business?3. Understanding the opportunities.4. Steps to get #NDISready.5. Question time.

Slide three:Intro slide: Why is the NDIS of interest to my business?

Slide four:The NDIS is a significant reform.The NDIS is the most significant economic and social reform since the introduction of Medicare in the 1970s which has been agreed to by all governments for the benefit of all Australians.

By 2019, the Scheme will support about 460,000 Australians with disability and once fully operational in 2019-20, the cost of the NDIS would be $22 billion a year.

The Scheme is unique in that it has bipartisan support in government, has grassroots support, and unlike Medicare is a federated approach to implementation.

Costs are shared between the Commonwealth and States/Territories and it makes it the second biggest public investment just under Medicare.

The Scheme balances social policy and competitive market principles to increasing people’s independence and lifting their participation in the community and the workforce.

The NDIS is in the national interest, and is a smart investment. Doing nothing will cost more than implementing the NDIS.

A 2011 PricewaterhouseCoopers report that found that without the NDIS, government expenditures on disability would increase to two-to-three times the projected costs of the NDIS.

Slide five:Big demand growth brings opportunities and challenges.Currently, government service providers dominate the supply of services to people with a disability.Individual non-government organisations each have a tiny proportion of market share.

We expect the NDIS to transform this market landscape significantly because of • the ability of providers to no longer be restrained by grants, targets, and retained revenue

caps• State governments shifting services to the community (e.g. NSW, SA and Victoria)

The transition phase is a unique period for the NDIS. We have a large number of people joining the Scheme during a short period of time.

At the same time as building the scheme, also need to ensure continuity of service for the 280,000 people receiving support and transition of these providers.

Things won’t be perfect immediately, but we will continue to listen, learn and improve as the Scheme grows.

It will take time for the marketplace to develop, which will allow people with disability to have choice and control

Slide six:Strong progress to date.In July 2016 the Scheme officially entered the transition phase.

Each Quarter the Minister releases a report on how the scheme is performing and the numbers of participants with approved plansHere is a snapshot of the 2016-17 Quarter 3 data.

The Report shows that the Scheme grew by 15,000 people between January and March this year. This took the overall number of participants to 75,567.

NSW Highlights• 36,035 participants • 87% of access requests were eligible (15,047 requests received) • 89% of people’s experience either good or very good.• 3,322 registered service providers – 39% are individuals or sole traders

These reports are available on the NDIS website and help organisations understand the number of participants coming into the Scheme and providers registering. The reports also provide useful intelligence about how participants are spending their plan funding.

Slide seven:NSW Market Position Statement.AccFacilitating a vibrant and competitive services and supports market is a core part of the NDIA’s role. To encourage this, the NDIA is committed to providing as much information about the future NDIS market as possible.

The NSW Market Position Statement (MPS) aims to help providers, as well as participants and service intermediaries such as plan management and support co-ordination agencies, to understand the developing local markets they operate in, so they can make informed decisions now and identify future challenges and opportunities.

The NDIS market will expand dramatically in coming years. It will create significant opportunities for the existing service sector and for new entrants and mainstream businesses who make their services accessible and inclusive.

NSW represents the largest market with about 140,000 NDIS participants. It’s almost double the number of people with disability currently receiving funded supports. In dollar terms, the NSW market will grow from approximately $3.4 billion to $6.8 billion in the next three years. Inflated to 2018-19 dollar values.

NDIS-generated growth, combined with the transition of specialist disability services currently provided by the NSW Government to the non-government sector, presents significant opportunities for service provision expansion.

Slide eight:Changes to the funding gives greater control to providersBefore the NDIS funding was provided through grants or contract for specific types of support. This meant that only support you had was determined by government and services were quite standardised. Under the NDIS, a person (participant) is funded to respond to their individual needs and goals. This means a person can buy the support that gets the outcome, that might mean a provider has to design a brand new offering that meets the participant’s needs.Further themes to speak to based on audience

• control to decide who they service; • control to decide how many customers they want; • control to decide to change their products etc

Slide nine:What are the opportunities and benefits for my business?Opportunities for providers wanting to work with the NDIS

• There are significant growth opportunities for existing and new providers who respond to the new demand for services and supports

• Resources and tools are available to help providers understand the NDIS market environment

Benefits of working with the NDIS:• Help participants achieve their goals• Be part of a vibrant, innovative and competitive marketplace• Enjoy new business opportunities• Online systems• Fast claim processing• We will explore this in more detail in the following slides.

Slide ten:Varied business opportunities existDisability support is more than personal care – There are lots of opportunities to be involved with the NDIS

• Household supports as people choose to live independently i.e. cleaning and maintenance• Providing equipment• Therapy and assessments• Transport• Skill development and employment of people with a disability• Building and trades

Technology will also play a very important role in helping people with disability access diverse and competitive markets for services and supports.

People with a disability will interact with a wide range of business, not all of it directly through scheme funding.

As employment opportunities and community inclusion increase, people with a disability will also become consumers with disposable income.

Slide eleven:Intro Slide: Understanding the NDIS and how it works?

How does the NDIS create opportunities for my business?

Slide twelve:A new way of providing supportThe National Disability Insurance Scheme (the NDIS) is the new way of providing disability support.

The NDIS will provide all Australians under the age of 65 who have a permanent and significant disability with the reasonable and necessary supports they need to enjoy an ordinary life.

The NDIS will help people with disability achieve their goals. This may include greater independence, community involvement, employment and improved wellbeing.

NDIS not just about funded supports and paying for personal care or equipment. It’s about helping people become included in the community and more independent.

As an insurance scheme, the NDIS takes a lifetime approach, investing in people with disability early to improve their outcomes later in life.

The NDIS also provides people with disability, their family and carers with information and referrals to existing support services in the community.

Slide thirteen:The NDIA delivers the National Disability Insurance SchemeWe are not a service provider. We help empower and inform people with disability to be confident consumers, while also providing service providers with clarity and transparency so they can grow their business and respond to need.

Role of the NDIAThe Agency’s job is to:

• Administer the NDIS• Build community awareness of disability• Ensure financial sustainability of the NDIS• Develop and enhance the disability sector

NDIA will administer the NDISAs described in:

• The Intergovernmental Agreement for the National Disability Insurance Scheme launch; and• The NDIS Act 2013 (legislation)

The NDIA will build community awareness of disability by:• Managing the expectations of people with disability, their families and cares regarding

access to NDIS support in the launch sites• Raising community awareness of disability and the social contributors to capability• Providing grants to organisations to raise awareness and make sure mainstream services or

community organisations become more inclusive of people with disability

The NDIA will develop and enhance the disability sector by:• Successful transitioning of existing sector providers• Identifying and addressing barriers to success• Building a sustainable sector

Slide fourteen:The Scheme is based on three pillars The NDIS is social insurance, not welfare. It is a lifetime approach, investing in people early to improve their outcomes later in life. We know that the best way to reduce long-term costs is to increase a person’s independence and lift their participation in the community and workforce. We carefully measure the medium-and long-term benefits of the NDIS for participants and their families which helps ensure the Scheme is sustainable and participants are building better lives.

We carefully manage the balance between choice and control and reasonable and necessary supports to ensure the Scheme is equitable and sustainable for all Australians.

Slide fifteen:Insurance Principals• Supports economic and social participation.• Mobilises funding for early intervention • Estimates and manages resource allocation based on managing long term costs across the life-

course of individuals • Shares the cost of disability across the community

The risk of disability affects all Australians, and the resulting financial costs may be too much for any individual or family to bare.

The NDIS is a way of pooling these risks.

Each year, all tax payers pay a premium to cover the costs of running the NDIS and providing care and support to participants.

We are all at risk of being affected by disability. We all share the risk and the cost of disability. We are all covered if and when we need it

Slide sixteen:Choice and controlThe NDIS provides people with individualised support and the flexibility to manage their supports to help them achieve their goals and enjoy an ordinary life.

Participants determine how much control they want over management of their funding, supports and providers

Participants receive a budget to purchase reasonable and necessary supports and choose the types of supports they want to receive and how they are delivered.

The Scheme provides assistances for participants to connect and negotiate with services if needed.

The services need to help to achieve the goals in the participant plan and the outcomes the participant wants to achieve.

Participants can change provider if they are dissatisfied, or supports are not meeting their needs or achieving outcomes.

Additional points as required: • Reasonable and Necessary is a set of criteria, detailed in the legislation, that are used to

determine funding for a participant• Participants have choice over their supports (that are reasonable and necessary) and who

will deliver them.• Scheme gives effect to certain obligations under the Convention on the Rights of Persons

with Disabilities - including respect for their worth, dignity and to live free from abuse, neglect and exploitation

• For supports to be reasonable and necessary they must meet all elements of the test set out in s34 of the NDIS Act 2013

• Ordinary life (presentation on intranet)• Types of funded supports (presentation on intranet)

Slide seventeen:Community and mainstreamThe NDIS supports people with disability to build skills and capability so they can participate in the community and employment.

The NDIS is not intended to replace the supports or services provided by other mainstream systems – if it did it would become unsustainable.

Achieving true integration and inclusion in mainstream community, socially and economically, is the NDIS’s ultimate goal.

This is a shared responsibility with the community and all Australian governments.

Effective interface with mainstream and community supports is central to the sustainability of the Scheme.(Discretion to alter information below as required)

HEALTH SYSTEMNDIS will fund supports which help the participant manage ongoing functional impairment that results from their disability. Supports that enable participants to undertake activities of daily living.Non-clinical supports.Aids and equipment.Some exceptions – nursing care that is integrally linked to care and support

The health system is responsible for assisting participants with clinical and medical treatment.• Diagnosis and clinical treatment of health conditions (including ongoing or chronic)• Supports directly related to maintaining or improving health status• Rehabilitation and support after a medical or surgical event• Medications and pharmaceuticals

EDUCATION SYSTEMThe NDIS will fund supports that enable participants to attend school education, where the supports assist the participant engage in a range of community activities. This may include assistance with self-care care at school or specialist transport and aids related to the student’s disability.

The education system is responsible for assisting students with their educational attainment, including:

• employing teachers, learning assistants and facilitating access to educational resources

• learning-specific aids and equipment (e.g. computers and text books) • reasonable adjustments to the school curriculum to enable access by students with

disability • reasonable adjustments to school buildings (e.g. installing ramps) • day-to-day supervision of students

Individuals and families also have a role in funding education-related supports, such as purchasing school uniforms and paying course fees. The NDIS will not fund these costs.

EMPLOYMENT SYSTEMThe NDIS will fund supports to assist with employment where these are beyond the requirements of employment services and employers. This includes assisting participants who are not eligible for Disability Employment Services (DES) or Job Services Australia (JSA) to build their skills and capacity to participate in employment, as well as assistance to find and maintain employment.

The NDIS will also fund supports the participant requires regardless of the activity they are undertaking, including personal care, assistance with transport, aids and equipment.

Employers are responsible for:• reasonable adjustments to enable people with disability to access their workplace• employment-specific aids and equipment (e.g. computers and modified desks)• transportation for work activities (e.g. meetings)

Employment services are responsible for assisting participants to build skills to participate in work and to assist them to maintain employment, including on-going support where required. This includes the services offered by DES and JSA.

Slide eighteen:Establishing the service approachThe approach the NDIS takes to delivering the Scheme harnesses the knowledge of local providers and seeks to build responsive local services to participant needs.

The Scheme has a large investment into Information Linkages and Capacity Building for all people with a disability.

Much of the Scheme functions is delivered by ‘Partners in the Community’ who assist with entry into the scheme, to link participants to mainstream and community services and also implement funded supports.

Funding to participants for reasonable and necessary supports is the largest expenditure of the scheme. This is captured in the participants plan.

As an organisation it is important to understand the participant journey, what is funded by the agency (purple) and what is funded in a participant plan (in green).

Organisations need to identify which part of the service delivery model they seek to establish their business in. For example, a partner in the community is an extension of the Agency and is not able to provide services to participants. Services might be directly to the participant or it might be to support other businesses.

Slide nineteen:Planning and CoordinationThis slide shows the differences in the various roles undertaken by a Local Area Coordinator (LAC), Planner and Support Coordinator.

All have a critical role in supporting the choice and control of participantsLACs and Support Coordinators are external to the Agency and assist participants to connect with providers of their choosing.

Providers will be interacting with LAC’s and support coordinators during the implementation of participant plans.

Slide Twenty:Introduction slide: Steps to getting NDIS Ready

Slide Twenty one:Steps to get #ndisreadyUnderstand the big picture

• Understand the scheme: objectives and principles• Broader environment politically, regulation, socially

Understand the customers• What do (existing) customers say works well and not so well• The participant pathway• What is funded via the Scheme (current expenditure, gaps, prediction of change)

Take stock of your business• Unbundle the elements of service delivery • Know your unit costs and model options of service delivery• Competency and market advantage i.e. quality, price, scale, remote

Know the rules and systems• Operating in a marketplace i.e. ACCC, regulation, quality & safeguards• Policies relating to Conflict of Interest, Pricing, Specialist Accommodation• Systems to work with Agency and Participants incl. compliance and reporting

Build your roadmap• Having the right infrastructure, governance, workforce• Taking everyone on the journey

Slide twenty two:Step 1 – Understand the big pictureIt is important to understand the big picture as the points above are what underpins the scheme.

• Understand the scheme: objectives and principles• Broader environment politically, regulation, socially

Slide twenty three:Step 2 – Understand your customers

• What do (existing) customers say works well and not so well• The participant pathway• What is funded via the Scheme (current expenditure, gaps, prediction of change)

Customers now have a choice about where they shop, how they shop and what goods and services they shop for.

If the service that is wanted is not provided by a participants current supplier they will take their money and buy elsewhere! Attracting new customers is tempting and an exciting opportunity, however don’t forget to look after the existing customers, in may cases it is easier to keep existing customers than attract new ones, so investing in building better service to existing customers makes good business sense.

Slide twenty four:Step 3 – Take stock of your business

• Unbundle the elements of service delivery • Know your unit costs and model options of service delivery• Competency and market advantage i.e. quality, price, scale, remote

Success will be driven by understanding person centred and individually funded service delivery. Participants over time will ultimately choose the value of your service.For providers this is a very different operating environment and critical that understand the environment.

Key questions.• How are you going to run your business?• Who are your customers and how will you engage them? (do you know that most people in

the scheme have a intellectual or neurological disability)• What does it cost you to run your service – do you know your unit cost? • Where and what do the best opportunities look like for your organisation?• Does my current staffing, meet the needs of the customer?• What strengths do the current staff have and what are the areas of opportunity?

Also – what does it mean to enter the NDIS marketplace:• What points of interface• What are my obligations and responsibilities as a provider• How does the service add value to the persons goals, also through creating new service

models to achieve outcomes

Slide twenty five:Step 4 – Understand the rules and systems

• Businesses need to make informed decisions about their obligations when deciding to provide supports under the NDIS

• You need to feel confident that you can comply with any rules or requirements, such as general consumer law obligations and any NDIS specific rules

• Operating in a marketplace i.e. ACCC, regulation, quality & safeguards

Under the Australian Consumer Law, participants have rights when buying products or services, whether they buy something in-store, online, at home or over the telephone.

They include:• the right to be treated fairly• the right to be given accurate information before purchase • the right to cancel a faulty service• the right to a repair, replacement or refund if something goes wrong.• Policies relating to Conflict of Interest,

If a provider seeks approval to operate in relation to both coordinating and providing supports (incl. the managing the funding for supports under plans), providers need to have mechanisms in place for dealing with conflicts of interest. More information can be found under rule 3.15 of the Registered

Providers of Supports Rules and in the NDIA Terms of Business• Potential providers need to review the NDIS website to understand the other types of rules,

such as pricing and specialist disability accommodation

The website provides the most up to date public information

For instance, recent publication of the SDA rules was announced on the NDIS website

Slide twenty six:Step 5 – Build your roadmapNow that you:

1. Understand the big picture2. Understand the customers3. Have taken stock of your business and4. Know the rules and systems

It’s time to build your road map!

To give the best opportunity for success your road map should determine; • what the right infrastructure, governance and workforce for your business looks like.• how your business will take everyone on the journey (staff, local business etc).• what connections with enabling services to you might need to help your business grow and

thrive within the NDIS.

Slide twenty seven:It is never too early or too late to start.Time for providers to become very focused: Be well informed as can about how scheme works, Think about your services how they will be offered in the NDIS environment, talk to people who are accessing your services how would they like them offered in the future? talk to the NDIA local staff talk with other providers

In additional, range of new resources available on the website to help providers get ready for the NDIS.

Factsheets and guides on how to work with the NDIS.

Videos featuring current Providers and how they are working to get NDIS ready.

Webinars on Provider readiness and registration.

Interested in feedback & additional support you need in these processes.

Slide twenty eight:Introduction slide: Interested in working with the NDIS?

Slide twenty nine:How do I become a registered provider?

1. You don’t need to register with the NDIS until you are ready to do business and the NDIS is about to be rolled out in your area.

2. To become a NDIS provider, Register for a PRODA (Provider Digital Account) through the myplace provider portal via the NDIS website.

• Create a myplace account• Submit an ‘intent to register’ through myplace• Select the registration groups to register for (types of services or supports you will

offer)• Read and sign the ‘Declaration of Suitability’ and upload to myplace• Provide supporting evidence and documentation (as required) and upload to

myplace

Slide thirty, thirty one and thirty two:The most common issues with providers and resolutions detailed.The Agency publishes weekly an update on payments made and issues encountered and provides recommended resolution.Providers should review this information regularly.

Common issues ResolutionCommunity Participation

• Ensure service bookings reflect true cost of service (1-1, 1-2 , 1-3 etc)

• Must link to goals and plan outcomes• Keep accurate service records

OT and Home Modifications

• Must be registered OT provider• Reasonable & Necessary test

Building service from the plan budget

• Check what are the goals and services to meet the plan outcomes• Don’t build service booking from what provider wants to deliver• Don’t add additional services not included in the plan• Core (Daily Activity) budgets can be used flexibly

Problems with Service Booking

• Service Agreement is first step• Ensure “agreed with participant” box checked• Ensure booking current• Ensure amount claimed is in line with booking • Dates – use calendar icon to select dates• No Service bookings for self-managed participants

Quotes not approved • Upload quote onto the participant portal• Send email to local office advising quote submitted • Include GST in quote

Payment Requests • Separate requests for successive plans in bulk uploads• Check data and formatting for bulk uploads• Payment requests after services delivered, not as up-front claim

Plan Reviews • Service Agreement is first step• Ensure “agreed with participant” box checked• Ensure booking current• Ensure amount claimed is in line with booking • Dates – use calendar icon to select dates

Transport Payments • Price guide information• Social Participation - not a km basis• Reasonable contribution by participant

Plan Management • Plan Manager service bookings• Establishment Fee and Monthly processing Assurance• They create service bookings for the providers to deliver services

based on plan

Slide thirty three:NDIA approach to pricing The National Disability Insurance Agency (NDIA) is the Commonwealth agency responsible for the sustainability of the NDIS.

The supports funded through the NDIS must represent value for money.Until the market matures, the NDIA will set the value for some funded supports in a participant’s plan.

Prices are reviewed annually, effective 1 July each year, taking account of market trends, changes in costs and wage rates.

Changes to prices will be published on the NDIS website. Each updated price list will include the date it was published to help providers ensure that they are using the most up-to-date version.

The price guide can be found at www.ndis.gov.au/providers

Slide thirty four:Quality and safeguards NDIS participants must have access to high quality services that will support them to achieve their goals.

Until the NDIS is rolled out in full, existing Commonwealth, State and Territory quality and safeguard systems will continue to apply to registered providers.

The NDIA is working with State and Territory governments to develop a national approach to quality and safeguards that will apply to providers registered with the NDIS.

Information about the current arrangements are available on the NDIS website.

Information on the national framework is available online.

Slide thirty five:NDIS readyGetting NDIS ready is not a one off activity

Many organisations who have been delivering supports and services since trial are re-looking at their business model

They are moving from thinking about what services and supports to deliver to ensure their business survived to thinking about what their customers want and how they might be able to provide that.

With this change of focus they are also rethinking all these 5 elements.

When businesses start to think about new supports customers might want, they naturally think about new customers, new ways of doing business, new systems to make it happen and what this means for their current workforce profile.

Like every business in every other marketplace, businesses need to be constantly looking at how they stay relevant to their current customers or attract new customers. Disability businesses are no different.

Slide thirty six:Questions?