Tender documents show the government is tweaking the National Disability Insurance Scheme to exclude thousands of children with disabilities such as autism. By Rick Morton.
Exclusive: NDIS reforms target children under nine
Sweeping reforms at the National Disability Insurance Scheme designed to constrain growth in budget forecasts are being introduced ahead of the federal election, targeting children under the age of nine with disabilities such as autism and reviving fears of controversial “independent assessments”.
Essentially, the changes increase the age a child needs to be before they can enter the scheme, excluding potentially thousands of children from the higher-cost support available on the NDIS.
In tender documents for new “Partners in the Community”, the National Disability Insurance Agency has revealed plans to increase the age range for early childhood support from seven to nine.
Under current arrangements, the “Early Childhood Approach” is a specially constructed gateway that provides low-cost interventions and therapy to children before they enter the NDIS. It has also been used to divert children and their families away from the NDIS if decision-makers deem the early interventions to have worked.
Even so, in every quarter since full scheme transition in the middle of 2016 the number of children with NDIS plans has grown beyond original expectations and a “continuing high proportion of children and 0-6” are entering the program each quarter, according to the agency.
Currently, 41 per cent of all 502,000 scheme participants are aged under 14 and the four biggest disability types in the program – representing 71 per cent of all participants – are autism, intellectual disability, psychosocial disability and developmental delay.
In a tender document that forecasts workload volumes for organisations that win partner contracts, the NDIA projects significant increases in participant numbers for the Early Childhood Approach (ECA) and Local Area Co-ordination (LAC), which takes in all other disabled people above the age of nine, but only the early childhood cohort features a dramatic increase in the number of “check-ins” relating to the “end of funded supports”.
Over the next five years, the agency estimates, the number of children whose funding will cease will rise from 92,000 to 132,000.
“We reject any suggestion that this change has been made for any other reason than to improve outcomes for children and their families,” a spokesperson for the agency told The Saturday Paper.
“The NDIA is committed to ensuring families, parents and carers can make informed choices for best practice, early intervention. Expanding the age range from under 7 to under 9 years of age will ensure that young children are supported throughout the transition to primary school (a critical life milestone) and align the scheme with the World Health Organization’s definition of young children (zero to eight years).
“It is important to note the NDIA is not changing the age range for young children with developmental delay, the age range would continue to be 0 to 6 years, which is consistent with the NDIS Act and international definitions of development delay.”
Contract requirements for both ECA and LAC providers include a renewed focus on “community and mainstream” supports, which is agency speak for exhausting all other available support options, including from families and carers, before granting “reasonable and necessary” individual support funding under the NDIS.
“For all children with developmental delay (including developmental concerns) and disability, EC Partners will help families or carers to support their child to develop the skills needed to take part in everyday activities,” the tender says.
“EC Partners will work to understand the current support networks and mainstream and community connections in the lives of children and families and provide timely information and referral to other mainstream and community supports and services where appropriate.”
Combined with other changes signposted in the tender documents, the NDIA is developing a way to support more children while also tightly guarding access to the scheme, which could cost $40.8 billion within three years.
When a determined community backlash to the proposed introduction of mandatory “independent assessments” led to the extraordinary dumping of the project at a state and federal disability ministers’ roundtable almost a year ago, Minister for the NDIS Linda Reynolds was contrite.
“Independent assessment are certainly dead. They’re dead,” Reynolds told Patricia Karvelas on ABC Radio National Drive in July last year. When asked if she would resurrect them, the minister responded: “We will not.”
At the core of that proposal was a mechanism to end the reliance on a person’s treating health professionals for expert opinion on a disabled person’s level of function. Instead, private companies with “independent” assessors would use screening tools provided by the NDIA to determine the functional capacity of people applying for or already receiving NDIS support.
In the request for tender, which went live on March 15, there are two major changes for Local Area Co-ordination telegraphed to potential providers, which cast doubt over how far the Commonwealth has walked from the scandal.
“LAC Partners will conduct functional assessments / tools, as directed by the NDIA, to assist the NDIA to determine reasonable and necessary funded supports to be included in [a participant’s] NDIS Plan,” the statement of requirement says.
“Partners will ensure all information captured about the person with disability is recorded in the NDIA IT system, including functional information and evidence gathered.”
This language is not present in earlier agreements for the provision of LAC services. In response, an agency spokesperson told The Saturday Paper it “strongly rejects the suggestion the Partner in the Community program functions are similar to the requirements for independent assessments”.
Although local area co-ordinators will pre-fill this new functional capacity information on behalf of the agency, these third-party organisations will no longer be involved in actually developing NDIS plans. That function is being resumed by the NDIA.
“Over time the NDIA intends to update the Partner role to remove the requirement for Function 9 - NDIS Plan Budget Development, allowing for greater focus on the other eight functions,” the tender document says.
“The NDIA has system enhancements underway to facilitate this shift in function.”
New LAC contractors will not start officially until July next year but will be available for a transition to the new model from April. While the agency says it will take some time for these planning “enhancements” to be complete, the workload volume spreadsheet provided as part of the tender indicates there will be zero engagement from providers on plan budgets.
“Through the NDIA’s planned system enhancements we are streamlining processes that will allow for NDIA planners to build more of our plan budgets,” a spokesperson says. “This was originally a function of the Agency that moved to Partners (in areas where Partners operate) during the large transition of participants from states and territories. The Agency currently performs the plan build task for all participants outside where partners operate, and for all Participants that have complex support needs.”
In order to support this centralisation of control, the agency says its “planner workforce will continue to increase in line with this demand” but added: “System and process enhancements will also play an important part in improving the participant experience and assisting the NDIA to meet the required workload demands.”
Taken together, these critical shifts in the agency approach represent an attempt to gain more control by establishing consistent datasets and metrics and removing third parties from determining how much support a person needs.
Scheme actuary Sarah Johnson has long required planners to seek executive-level approval for NDIS plans that are more than 10 per cent above the value of a benchmark “typical support package” but an October 2020 Australian National Audit Office report found that this was happening as little as 28 per cent of the time.
Internally, part of the agency’s rationale for this workload was that Local Area Co-ordinators were consistently being too “empathetic” in plan budget development, which led to a backlog of manual approvals within the agency itself. These new LAC contracts would go some way to removing this as a concern. On Tuesday, NDIA chief executive officer Martin Hoffman told a senate public accounts and audit committee hearing that a “major” computer systems upgrade within the agency, worth $56 million over the next two years, will have “built-in controls” that “forces or enables the staff member to complete a quality plan every time”.
“You have to remember that in this scheme we have, almost uniquely, in respect of large-scale government entitlement schemes, a very subjective and qualitative set of criteria for the allocation of funding – so subjective and qualitative, in fact, that last year the Federal Court, in the case of WRMF, held that reasonable people can disagree on what is reasonable and necessary,” he said.
“Quite honestly that makes it a very difficult scheme to administer in an effective, equitable and consistent manner, because there is built in this sense of potential for disagreement, even amongst reasonable people, as to what is a reasonable and necessary level of funding.”
Even without these new policies and procedures, the NDIA has managed to clamp down on the growth rate in individual support packages, a scenario that has been used by ministers in the federal government to sound a budget alarm.
In the six months to December, 37 per cent of NDIS plans reviews resulted in an increase in value to that plan of more than 5 per cent. Similarly, 34 per cent of plans were decreased in value by more than 5 per cent, the highest proportion of reductions since 2018-19.
New modelling from Per Capita, commissioned by the campaign group Every Australian Counts, estimates the economic benefit of the NDIS at $58 billion nationally on a $20 billion investment. The analysis suggests 580,000 direct and indirect jobs have been created by the NDIS.
Almost six years since the transition to the full scheme began, the agency management is finally now commissioning research on outcomes.
“We’re looking to collect hard data,” Hoffman told the senate committee hearing this week, “around health, employment and income levels as well as subjective data through surveys – self-reported data from participants and their families – as to whether things are getting better in terms of social participation, economic participation, health outcomes, independence et cetera, and correlating that back with the sorts of supports they were receiving.
This article was first published in the print edition of The Saturday Paper on Mar 26, 2022 as "Age games".
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