3.1
One of the most common issues raised during the course of the inquiry was how plans are funded, and how much funding they include. While the committee is unable to resolve individual disputes with the National Disability Insurance Agency (NDIA), it was able to identify a number of systemic issues. This chapter identifies the most prevalent of these issues in evidence, including:
Lack of transparency in funding decisions.
Funding decreases after plan reviews.
Participants being forced to choose between supports.
Planners recommending cheaper supports.
Limited funding for support coordination.
Issues with funding for assistive technology.
Funding consistently rejected for specific types of supports.
Funding for transport and travel.
Crisis and emergency funding.
Funding for advocacy and assistance with planning.
3.2
The chapter begins by outlining what participants and their support networks said are the impacts of NDIA planning decisions. It then outlines the legislative framework guiding planner decisions about what constitutes a reasonable and necessary support, before examining the issues outlined above concerning plan funding. The chapter ends with the committee view and recommendations.
3.3
Chapter 4 examines plan funding for supports for caregivers, and the role of informal supports, in greater detail.
3.4
It should be noted that the Australian National Audit Office (ANAO) released the results of an audit into decision-making controls for National Disability Insurance Scheme (NDIS) participant plans on 29 October 2020, including what measures the NDIA has in place to ensure supports it approves are reasonable and necessary. This report is referred to where relevant throughout this chapter.
Impacts of reduced funding
3.5
Participants, their families, advocates and providers made the following comments about some of the impacts of NDIA funding decisions where these decisions involved reducing or rejecting supports without a clear reason:
‘I explained I needed more physiotherapy and OT [occupational therapy] hours as in the current plan I had nowhere near enough. [But the planner] suggested the OT hours in the report were not really needed so suggested a lot less than requested in [the OT’s] report...I came away from the meeting very confused and physically ill. I have had many tears since. I didn’t feel like I was important because I have a disability.’
‘Our son is now also limited in accessing the Allied Health Professionals he has been seeing for the past couple of years as the funding is insufficient to carry on with his weekly sessions and provide the reports the NDIS requires but seem to ignore. This puts our son’s progress backwards and will now require more time to get back to where he was before this new plan, that is of course if our review request is not totally ignored as it was last year. The other major impact this process places on us is our ability to work in our full time jobs. Both my husband and I are employed full time and the lack of funding for formal supports through the day means we are unable to go to work which just adds to the pressure we already live with.’
‘The severity and the impact of the gaps in plans are beyond comprehension… Some…participants eat one proper meal for the day while the carer is around. They have to wait until the carer comes back the next day to eat, drink, move bowels, turn or escape from danger. I have heard from some participants that some days they lay in their soiled beds until the carer arrives the next day to clean up. This affects their skin hygiene, pressure ulcers and also creates psychological distress. I believe this is inhumane and unacceptable in a first world country. Since the funding is spent on much needed care, planners should be more compassionate and understanding about basic human needs. These supports and services are not luxuries for a person with a severe disability.’
3.6
The mother of a participant with autism, who herself was an NDIS participant, submitted that her son’s plan did not include funding for ‘a single hour of support time. We were refused a review and the document was altered and back dated.’ She reported that following this decision, she had to relinquish her son and had a mental breakdown and severe depression.
3.7
Healthy Minds provided one example of a participant who was paralysed from the neck down, who lived independently with no immediate family. She was not provided with funding for support coordination and, Healthy Minds argued, ‘her NDIS supports were completely inadequate’:
More than once this resulted in her having to call an ambulance to assist her in going to the toilet as her support worker had not arrived and was not responding to calls…The agency through which this person was employed were unable to find anyone at short notice. Once paramedics arrived they needed to call fire and rescue because while the woman had been provided with funds to install a remote controlled electronic front door lock she had not been provided with sufficient funding to include the battery back-up system. Due to a power failure at the time the front door was inoperable and fire and rescue had to attend on top of the ambulance to assist this woman to go to the bathroom. The indignity involved for her in requiring this amount of attention…for her self esteem and confidence cannot even be imagined by the majority of us who have never been in such a predicament.
3.8
The Australian Services Union reported, in a survey of its members, that only 21.7 per cent of its members who were disability workers believed that participants’ plans were adequately funded under the NDIS, with 52.5 per cent believing that unding was inadequate and the remaining 25.8 per cent being unsure. One Local Area Coordinator (LAC) suggested that NDIA delegates will ‘try and talk you down in hours of support. Plans should not be approved based on dollar value, but on the need’.
3.9
People with Disabilities WA suggested that large funding gaps between what participants were asking for and what the NDIA was agreeing to fund may amount to up to $100,000. It argued that these gaps can place the participant and their family at risk of harming themselves, harming the participant’s family through family breakdowns and burnout, and restricting the participant’s access to the community because it is unsafe for the participant to engage in activities without adequate supports.
3.10
Cara Inc noted that inadequate funds may place pressure on government departments and service providers as emergencies arise. It proposed that the NDIA develop a tool ‘to ensure consistent assessment of reasonable and necessary funding.’
Legislative framework guiding funding decisions
3.11
As outlined in Chapter 1, around 30 per cent of participants, before the commencement of the national roll-out of joint planning, were assigned an employee of the NDIA to develop a plan, while 70 per cent were assigned an LAC or ECEI Partner, who then sent the plan to an NDIA delegate for approval. Joint planning involves a participant meeting face-to-face with the NDIA delegate who will approve funding for their plans, as well as their LAC or ECEI Partner. The national roll-out of joint planning has been paused because of the COVID-19 pandemic.
3.12
NDIA delegates are guided in their decisions of what and how much to fund in a plan by the National Disability Insurance Scheme Act 2013 (NDIS Act) and the National Disability Insurance Scheme (Supports for Participants) Rules 2013 (the Rules). In particular, delegates are required to be satisfied that a support is reasonable and necessary for a participant.
3.13
The phrase ‘reasonable and necessary supports’ appears 22 times in the NDIS Act, but the Act does not provide a clear definition of ‘reasonable and necessary’. However, section 34 outlines that the CEO of the NDIA must be satisfied, when making decisions about funding reasonable and necessary supports, that (among other criteria):
(a) the support will assist the participant to pursue the goals, objectives and aspirations included in the participant’s statement of goals and aspirations;
(b) the support will assist the participant to undertake activities, so as to facilitate the participant’s social and economic participation;
(c) the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;
(d) the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;
(e) the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide;
(f) the support is most appropriately funded or provided through the National Disability Insurance Scheme, and is not more appropriately funded or provided through other general systems of service delivery or support services…
3.14
The NDIS Rules on Supports for Participants also do not define ‘reasonable and necessary’.
3.15
The Rules stipulate that when approving each plan, ‘the CEO must have regard to objects and principles of the Act including the need to ensure the financial sustainability of the NDIS and the principles relating to plans’. When deciding whether the costs of a support are reasonable, the Rules require the CEO to consider the following:
(a) whether there are comparable supports which would achieve the same outcome at a substantially lower cost;
(b) whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long‑term benefit to, the participant;
(c) whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports);
(d) for supports that involve the provision of equipment or modifications:
(i) the comparative cost of purchasing or leasing the equipment or modifications; and
(ii) whether there are any expected changes in technology or the participant’s circumstances in the short term that would make it inappropriate to fund the equipment or modifications;
(e) whether the cost of the support is comparable to the cost of supports of the same kind that are provided in the area in which the participant resides;
(f) whether the support will increase the participant’s independence and reduce the participant’s need for other kinds of supports (for example, some home modifications may reduce a participant’s need for home care).
Lack of transparency in funding decisions
3.16
Multiple submitters noted a lack of transparency in NDIA funding decisions and called for more transparency on how the NDIA decides what to fund, how much to fund and what decisions to make after reviews. For example, Cobaw Community Health argued that ‘the concept of reasonable and necessary support is being interpreted inconsistently by planners’. Healthy Minds gave the following example of a lack of transparency in NDIA funding decisions:
[A participant] initially received some eighteen thousand dollars in total which was completely inadequate for the supports she required. Her aged parents contacted their Member of Parliament. Within two weeks and without further enquiry by the NDIA or provision of any information her plan was arbitrarily increased to some nearly fifty thousand dollars with total flexibility as to how it could be spent. The lack of any visible process in arriving at either of these outcomes is surprising and concerning…[A]fter her first year and on review, she was awarded the largest sum for support coordination over a period of a two year plan that has been able to be discovered (through social media) as being awarded to anyone anywhere in Australia.
3.17
One participant outlined the impact of a lack of transparency in how the NDIA decides to fund a plan:
The Planning Meeting is a huge deal. So much rides on the outcome, and yet preparation, if it happens at all, cannot help a participant know how their particular situation will be assessed and understood…The LAC or Planner does not have to be transparent and in the case of the LAC, may be completely ignored (as happened in my case) and a delegate who has never met me, using incorrect information from my file will decide if I can continue building a decent life or if I have to start again.
3.18
Roundsquared argued that planners, under the current system, could rely on the concept of ‘reasonable and necessary’ without being required to provide valid reasons for their decisions:
Without greater transparency it is too easy for planners to hide behind the words ‘reasonable and necessary’, using them as a catch-all to queries about why funds were cut or not provided in the first instance and to hide behind bureaucratic jargon. Even when planners do provide a fuller explanation, participants have said that they have been made feel as though they are trying to rip off the system and have compared this to their experiences when dealing with Centrelink. Participants need to be able to interrogate the reasoning and justification to ensure that it is not based on false assumptions or prejudices such as what a parent should do for their child.
3.19
Mx Ricky Buchanan, a participant, called for ‘more transparency’ from the NDIA, including what funded supports and services need evidence, what that evidence should and should not include, who that evidence should come from, ‘and give us this information well in advance of the planning meeting…We’ll all be much less likely to seek reviews if we can get it right from the start.’ Mx Buchanan argued that there was ‘no consistency’ in how the NDIA decided to fund items, with Mx Buchanan being funded for items that did not have evidence, and other items being denied for which Mx Buchanan had provided ‘lots of high quality evidence’.
3.20
The Tasmanian Office of the Public Guardian suggested that there ‘are a concerning number of occasions’ where planners do not seem to be taking into account ‘well-evidenced support needs and recommendations for support…and reasons as to why the decision to reduce funding was made are not given’. The issue of planners dismissing allied health recommendations when deciding how to fund plans is addressed further in Chapter 6.
3.21
Some submitters suggested that this lack of transparency was driving the number of internal review requests and appeals to the Administrative Appeals Tribunal (AAT) (see Chapter 10 for further discussion on the AAT). Dr Darren O’Donovan argued that ‘one of the most significant drivers of appeals is the tendency of plans to draw upon or reflect opaque financial judgements’.
3.22
The Public Interest Advocacy Centre (PIAC) also argued that ‘lack of transparency impairs the ability of participants, carers and advocates to understand the types and level of supports a participant can seek’ as well as the amount of funding that they could be given and the reasons behind the decisions made. It further contended that this ‘impairs the ability of the community to hold the NDIA to account, to ensure that decision-making under the [NDIS Act] is consistent, accountable and in accordance with the law’.
3.23
The Public Interest Advocacy Centre (PIAC) called for further clarity about how the NDIA takes into account the financial sustainability of the scheme when making decisions on whether to fund a support or not. It suggested amendments to the NDIA guidelines to clarify how it considers the financial sustainability of the NDIS and its relevance to individual eligibility and funding decisions, and how the NDIA determines financial sustainability.
3.24
Queensland Advocacy Incorporated proposed that the NDIA publish clear guidelines about how planners determine which supports are reasonable and necessary.
3.25
Submitters made the following suggestions for how the NDIA could improve its transparency in how it decides to fund supports:
Let participants know what supports will and will not be included, the reasons for these decisions, and at what rate the amounts in their plan will be calculated
Inform participants about policy changes in what supports the NDIS will cover
The Tune Review
3.26
The Tune Review also received feedback from participants seeking more transparency around how the NDIA makes decisions. The Review argued that people ‘with disability have the right to understand the reasons behind decisions the NDIA makes regarding their eligibility for the NDIS and the supports provided in their plans’.
3.27
The Tune Review also noted concerns about a lack of transparency in NDIA decision-making, leading participants to request reviews. ‘People with disability,’ the Tune Review report argued, ‘have the right to understand the reasons why a particular decision was made, and how it was made, including what information was taken into account in making that decision’. Although the NDIA provides participants who have requested an internal review with formal statements of reasons, the Tune Review report suggested that best practice administrative decision-making principles should allow a participant the right to see an explanation of decisions without asking for an internal review.
3.28
The Tune Review recommended that the NDIA publish information about how it determines whether a support is reasonable and necessary, and proposed that this information should include practical examples such as case studies or cameos published on the NDIS website.
3.29
The Australian Government supported this recommendation, stating:
The Government agrees to work with states and territories to implement amendments to the NDIS Act and Rules to clarify the application of reasonable and necessary in the context of an individualised approach to planning and provision of funding for a package of supports, consistent with the scheme’s insurance approach and with the NDIA to clarify operational policies and guidelines as required.
The NDIA’s position
3.30
The NDIA informed the committee in October 2020 that it was refreshing its Operational Guidelines, which inform decisions about what supports to fund, ‘to improve consistency of decision making and to simplify the information available to participants on how decisions are made’, as part of its Participant Service Improvement Plan 2020–21. Through this refresh, it stated, it ‘will make more information publically available about how decisions are made’. It further stated that other commitments it has made as part of its Participant Service Improvement Plan are:
to improve the quality of decision letters to make clearer the reasons for how the NDIA has made a decision (in plain English);
clarify and publish guidelines and procedures so there is consistency in how the NDIA makes decisions and in the information available to planners and participants;
ensure all guidelines will come with plain English descriptions and more examples; and
publish information that clarifies what reasonable and necessary means, with case studies and examples.
Unexplained funding decreases after plan reviews
3.31
Submitters outlined the anxiety that some participants have experienced in the lead-up to plan reviews, for fear that their plan funding will be cut despite them feeling that they still need the same supports as in their previous plan. For example, Mx Buchanan outlined the impact that plan reviews may have on participants’ mental state:
I have no sense of long-term security, and can only hope for short-term security with a good NDIS plan. Even if everything goes perfectly and there are no problems, you have to do the whole thing over again next year so you can never feel safe or secure for long.
3.32
The parent of one participant with cerebral palsy and a visual impairment outlined the stress and anxiety that each planning meeting caused for their family. They argued that each review:
…means starting at the question that occurs at the beginning: will our son continue to get the supports that he has had in order to meet his basic needs? As his needs that are consequential to his cerebral palsy and his visual impairment will not change quickly, why do we have to worry about the threat to the basic supports every year?
3.33
ConnectAbility Australia questioned NDIA decision-making to reduce funding for a participant whose primary carer was his 94-year-old father:
…we had a 94 year old man who has both sons living at home both have disabilities, one more pronounced requiring day programs and visual aids. The participants plan was around $40,000 per annum. On review the planner reduce the plan to around $7,000 per annum. Can you imagine the stress this must have placed on a 94 year single parent? What is the thought process of the planner to think they had done well for the day in removing the supports for this family? Where were the checks and balances to stop this being approved? It took 11 months for the review to occur in order to re-establish a decent plan that should not have gone through a large cut.
3.34
People with Disabilities WA suggested that planners and LACs were making comments to families at planning meetings that increased their anxiety about funding being cut in a future plan, such as ‘well this year you will have this support to build capacity and next year it’s likely not to be included in the plan’. Every Australian Counts similarly noted that some participants who ask for a review ‘are warned that the review may result in a reduction of support in other areas. To many participants and their families, that warning can sound more like a threat’. This contention was echoed by Amaze, which reported that some ‘autistic adults are apprehensive to initiate a plan review because they have been told that their funding could be reduced’.
3.35
Alliance20 also provided an example of a participant whose plan was reduced by $40,000 after a scheduled plan review. They reported that his family had said his needs had not changed, and the family were unsure how they were going to continue to fund his support, with his mother, as his sole carer, being 70 years old.
3.36
Similarly, Spinal Cord Injuries Australia provided an example of a participant who had unexplained funding cuts in a new plan:
..a quadriplegic had their core funding allocation — which provides support for daily personal care amongst other things — slashed by half following the issuing of a new plan. The participant’s circumstances had not changed in any way, yet the dramatic funding reduction left the participant unable to be supported in the home on a daily basis. It was only after many months supporting the participant through the review pathways that changes were made to rectify the problem. But in doing so, the burden is on the individual – they have to prove, through providing evidence at the AAT, that they need a basic level of support.
3.37
Disability Council NSW suggested that there is considerable inconsistency for some participants in how much funding they receive from year to year, noting that such inconsistency ‘negatively affects the ability of these participants to take part in the community’ and leads to financial uncertainty ‘as they attempt to plan their finances for the years ahead’.
3.38
Blind Citizens Australia reported one case where the participant’s support needs had not changed, but after a review, the budget in the participant’s third plan was almost halved:
This person has a family and his wife works fulltime. He is a stay-at-home dad, with three children. After the plan was reviewed, the reasons for the reduction in budget were not detailed, but mentioned family support. It also said that it was due to the plan benefitting others. When questioned, an example was given: If you engage a support worker to drive you and your child to an appointment, it is benefitting the child.
This situation does not consider the role of a parent who has disability.
3.39
Carers NSW reported that unexplained cuts were commonly 30–50 per cent less than a previous plan, and up to 75 per cent. Leadership Plus submitted that it knew ‘of examples of subsequent plans from which $30,000 has been removed without consultation’. People with Disabilities WA argued that there is ‘an assumption by planners, or direction by the agency, that plans should be reduced each year’ and that ‘there appears to be a shift towards an automatic yearly drop in funding’ on the basis that the previous plan has built capacity.
3.40
Contrary to the evidence raised above, Ms Shayna Gavin, a practising physiotherapist, reported that in general, ‘families are experiencing better outcomes on subsequent plans. It appears that the NDIA does not listen to families in the first instance’. Further, Ms Gavin submitted that when she reported that participants had not achieved their goals or had experienced safety issues because of lack of funding, the following plans were generally higher. She suggested that the NDIA was not ‘giving credibility to participants, their families and [allied health professionals] in the first instance when an individual participant’s needs are described’, which meant that they required more funding in future plans.
3.41
The committee heard that where plan reviews are held early and lead to funding cuts, participants may be forced to cancel months of planned supports booked with professionals.
3.42
A further issue raised in relation to funding decreases after plan reviews concerned plan utilisation. Despite difficulties participants may experience finding service providers, People with Disabilities WA submitted, there ‘appears to be an assumption made by planners that if the funding has not been used then it is not needed in the next plan, which is often erroneous’. The Australian Psychological Society echoed this point, noting that for participants with psychosocial disability, immediate plan utilisation may not be straightforward. It also suggested that planners were failing to understand why funding had not been spent, and were subsequently deciding to reduce it in subsequent plans. The issue of plan utilisation is discussed separately in Chapter 12.
3.43
Submitters provided the following proposed solutions to address unexplained funding decreases after plan reviews:
The level of support in a previous plan should be considered the benchmark for what is reasonable and necessary, and plans should not be reduced unless participants’ circumstances have changed and they indicate they no longer need the supports.
The NDIA should examine the reasons for unspent funds, rather than cutting funding automatically in the following plan.
The NDIA should not remove unused amounts from a previous plan in a new plan where the underspend is because of a lack of service providers.
Funding changes should be decided collaboratively and with mutual understanding.
The NDIA should introduce transparent and understandable systems and protocols to guide plan reviews for planers to use when reassessing whether to continue funding for supports.
The NDIA should introduce a ‘red flag’ into its planning system to investigate the appropriateness of a large decrease in funding following a plan review.
A transition period should be provided if the NDIA intends to cut or drastically cut funding so that providers can help develop supports or source supports from other systems.
3.44
The NDIA, in its Quarterly Report to Disability Ministers for the June 2020 quarter, provided data indicating that the average payment of funds for participants has increased the longer they have been in the NDIS, with participants receiving on average $71,000 by their fourth plan (see Figure 3.1). In its response to written questions on notice from the committee, the NDIA argued that NDIS ‘data shows payments to participants have increased, not decreased, over the past four years’, with the average payment per participant increasing ‘from $32,300 in 2016–17 to $50,800 in 2019–20’. It stated that it does not automatically reduce funding for supports at plan reviews.
Participants being forced to choose between supports
3.45
The committee was also informed that planners are asking participants, as a cost-cutting exercise, to choose between some supports. For example, Ms Gail Mulcair from Allied Health Professions Australia outlined an example in which a participant was asked to choose between two services:
[A] grandmother of three deaf children called us on behalf of the mother of the children…—because they had just had a planning meeting where the planner said: ‘Could you cut back on speech therapy? This is very expensive. Could you cut back on the speech therapy or find a cheaper therapist?’ They ended up with a plan that could either have speech therapy or hearing aids, but did not have enough for both and had no support around other assistive devices in the home.
3.46
Speech Pathology Australia suggested that many participants with disabilities affecting swallowing and communication ‘are having to “choose” between accessing supports to be able to eat and drink enjoyably, effectively and safely, or therapy that helps them learn communicative strategies’ because of the implication that the NDIS cannot provide enough funding to address all of their needs.
3.47
The Royal Australasian College of Physicians argued that families are ‘forced to choose between physiotherapy, occupational therapy, speech pathology and psychology’ because of ‘very limited amounts of funding’ for a participant’s therapy budget.
3.48
The NDIA, in answers to questions on notice provided to the committee in October 2020, stated that value for money is only one component in decisions of whether to fund a support, with delegates also being required to take into account whether the supports ‘are likely to be effective and work for the participant’.
Plan inconsistencies
3.49
Submitters drew the committee’s attention to plan inconsistencies, in which they knew of other participants in similar circumstances who had received a different level of funding for their supports. For example, Mx Ricky Buchanan, a participant, argued that consistency ‘is really REALLY lacking’, with some participants able to obtain funded supports, while ‘other people in very similar circumstances are not approved for the same thing’.
3.50
The Rights Information and Advocacy Centre provided an example of two children in the same family with ‘very similar medical reports and needs’. It suggested that because the plans went to two different NDIA planners after meeting with an LAC, the plans had very different allocations of funding, with one having $11,000 for its core budget and the other having no funding whatsoever in its core budget.
3.51
St Vincent’s Hospital Melbourne argued that ‘inconsistencies and lack of transparency of what is or is not included in plans contributes to the volume of appeals’, noting that participants, their families and service providers compare plans from year to year and plans between participants, and identify ‘obvious, substantial inequities’.
3.52
Similarly, Audiology Australia noted that its members had ‘provided examples of funding discrepancies for participants with similar needs and goals’ in the area of assistive technology. It also expressed concern that access to NDIS funding may be inconsistent within and across different regions, and may be dependent on how much advocacy a participant has and the ‘planner’s knowledge of and attitudes towards hearing services’.
3.53
Blind Citizens Australia argued that there ‘is significant funding inequality between similar plans in different states…When assistive technology approval is based on reports and recommendations from…professionals…these inconsistencies shouldn’t be so prevalent’.
3.54
MND And Me Foundation noted that some participants with motor neurone disease had been approved for complex home modifications in particular regions in Queensland, while other participants in other Queensland regions had not, even where the former did not appear to meet the criteria and the latter did. MND And Me proposed that the NDIA implement random auditing of assistive technology requests, approval rates and declines to address this issue.
3.55
The question of how planners deal with recommendations from experts about what to include in reports is discussed in detail in Chapter 6. Issues specific to funding allocation for assistive technology are discussed separately below.
3.56
Another area of concern related to inconsistencies within plans themselves. St Vincent’s Hospital Melbourne submitted that some plans may be allocated funding for therapy hours to prescribe assistive technology, but inadequate funds to actually purchase the assistive technology — or, conversely, no funding for therapy hours, but funding for assistive technology, meaning that participants cannot be prescribed or access it.
3.57
Healthy Minds reported that it had ‘noticed that there is a significant difference in the funding awarded to those who are supported by us in their planning sessions’ and those who take part in planning sessions without support.
3.58
The Public Interest Advocacy Centre suggested the following causes for plan inconsistencies:
Lack of consistent training for planners.
Variation in the experience of planners.
Pressure on planners to keep costs down.
Some participants having access to informal supports that are not available to other participants.
Participants having different aspirations and goals.
3.59
ADACAS Advocacy argued that there should not be extreme variations between the plans of different participants who are in similar situations:
Whilst the scheme needs to be able to tailor responses to individuals (and thus there should be variation between plans of people in similar life circumstances), there should not be situations where two people, in similar situations, asking for the same things, receive wildly different outcomes, depending on which planner is assisting. This level of consistency needs to be achieved, though, by constant review of participant outcomes and packages….
Proposed solutions
3.60
Submitters proposed the following solutions to plan inconsistencies:
Comprehensive training and support for planners.
Clear and transparent processes.
Random audits to determine plan consistency.
The Australian National Audit Office (ANAO) report
3.61
The ANAO in its report on decision-making controls for NDIS participant plans advised that since June 2019, the NDIA has measured planner performance in relation to decision-making about what is reasonable and necessary through an internal key performance indicator (KPI) and a separate quality metric. The ANAO argued that the ‘NDIA’s quality assurance audits have shown low levels of compliance with internal policy’, with these low levels not providing ‘sufficient confidence in the existing controls’ that decisions are made that comply with the NDIS Act. In particular, the ANAO measured compliance results with NDIA end-to-end audits between March 2019 and January/February 2020, with its test question, on whether justifications had been recorded that demonstrated why the support was considered reasonable and necessary, dropping from 72 per cent compliance in March 2019 to 36 per cent in January/ February 2020.
3.62
The ANAO contended that the ‘NDIA does not yet have appropriate oversight mechanisms in place to ensure the supports in participant plans are reasonable and necessary’. Further, current frameworks in place are ‘not systematically leading to enterprise wide actions for improvement and compliance in decision-making’. It recommended that:
The National Disability Insurance Agency align service delivery KPI and quality metric targets for reasonable and necessary decision-making; and review the target on a regular basis with a view to increasing the target to drive greater quality standards in reasonable and necessary decision-making.
3.63
The NDIA agreed with this recommendation and indicated that it had implemented it through recent reforms following the release of the Tune Review.
3.64
As noted in Chapter 10, the ANAO also recommended that the NDIA establish mechanisms to track and analyse issues arising from reviews to improve its decision-making on what is reasonable and necessary, including by ‘using outcomes data from internal reviews and AAT reviews, including early resolution outcomes, to inform continuous improvement in reasonable and necessary decision-making’. The NDIA agreed with this recommendation.
The Tune Review
3.65
The Tune Review also examined the issue of plan inconsistencies. It noted that some participants with similar disability support needs had reported that ‘they received very different types and values of supports in their plans, where the differences did not appear to be linked to their goals and aspirations or their informal supports’. This was particularly noticeable, the report stated, ‘in cases of young siblings with the same disability and similar levels of functional capacity’.
3.66
The Review noted that ‘consultation feedback demonstrates there is a clear tension between consistency of decision-making and the individualised planning approach’. It acknowledged that the NDIA is undertaking work in this area to reform its use of typical support packages during planning. However, it argued that tools should never replace the need for trained planners.
The NDIA’s position
3.67
The NDIA informed the committee that as part of its Participant Service Improvement Plan 2020–21, it ‘is refreshing the Operational Guidelines to improve consistency of decision making’, with new guidelines to be released progressively over the 2020–21 financial year. It stated that it is committed to clarifying ‘and publishing guidelines and procedures so there is consistency in how the NDIA makes decisions’.
Issues with funding for assistive technology (AT)
3.68
In 2018, the Joint Standing Committee on the NDIS in the 45th Parliament held an inquiry into the provision of assistive technology under the NDIS. The report made eight recommendations, including that the NDIA should make ‘funding decisions based on outcomes rather on whether the item is considered mainstream, or could be used beyond its AT purpose’. In particular, the committee noted an ‘apparent ban’ on funding iPads which could be used for communication aids. The Australian Government supported this recommendation in principle, arguing that ‘the decision on whether widely used technology…is a reasonable and necessary support for a participant will need to be evaluated on a case by case basis’.
3.69
The committee was informed that participants may be unable to access essential forms of assistive technology because the funds have been allocated to other areas in the plan. Other submitters indicated that plan funding may not include breakage, replacement or insurance for assistive technology devices.
3.70
The National Rural Health Alliance noted that some assistive technology devices were not being funded, and there was no insurance for devices costing more than $20,000. It argued that the ‘mechanisms for insurance and who is responsible for the insurance of these expensive devices is not clear. There is little certainty about the process if you need a replacement device’. It suggested that the approval process, for example, for a participant with motor neurone disease for a device to assist with communication could take ‘so long that their communication in the last stages of life is compromised, which is very distressing for the [participant] and the family’.
3.71
Assistive Technology Suppliers Australia provided several examples of instances where participants needed emergency repairs on pieces of assistive technology but had insufficient funds for the repairs and/or replacement parts. As such, the provider or participants themselves had to pay for the repairs. Assistive Technology Suppliers Australia argued that:
No one plans to have an equipment failure. Therefore, there is a need for understanding, flexibility to deal with the circumstances at hand in a timely manner, to remove disadvantage for the person who greatly relies on AT…[I]t is clear there is a need for a system that the NDIS participant can get authorisation for urgent repairs for life essential [assistive technology] within hours.
3.72
One participant called for the NDIA to provide ‘clear guidelines of what information they are expected to provide when they request a specific form of assistive technology’. The participant argued that ‘by not providing participants, their families and carers clear planning information for assistive technology support requests…[the NDIA] is not allowing us the right to exercise control’ in planning meetings.
3.73
The NDIA stated in January 2020 that after ‘appropriate advice by an [assistive technology] assessor, participants can now purchase items up to $5,000 within nine categories using their plan funding’ without needing a review. Further, the NDIA has announced that most funds in plans ‘will be completely flexible for participants to use on the supports they need when they need them’.
Planners recommending cheaper supports
3.74
Some evidence argued that the NDIA was inappropriately approving cheaper supports to those recommended by experts (see Chapter 6 for further discussion of planners ignoring recommendations from experts).
3.75
Ms Gail Mulcair from Allied Health Professions Australia drew the committee’s attention to ‘clear examples’ of what ‘seems to be a culture around needing to make it cheaper regardless of what the qualified allied health professionals are recommending and regardless of what the participant’ has stated they need. Mr Tom Ballantyne from Maurice Blackburn Lawyers also noted that ‘anecdotally you do see decisions where you suspect it’s been motivated by an internal desire to keep costs down’.
3.76
Speech Pathology Australia provided one example where a planner asked one mother if she could reduce speech therapy or find a cheaper therapist for her three children as the cost of having both speech therapy and all of the necessary equipment was going to be very expensive.
3.77
Mrs Kylie Paull, a participant, reported that a planner had questioned the recommendations of an occupational therapist (OT) that she have a particular wheelchair type:
My OT had in the report that I needed a manual wheelchair. I was told the quote was very expensive so there will be a very long lengthy wait. My OT [had] explained to me with my health and needs, especially being an amputee, that the quote was very reasonable.
[The planner] suggested I go and purchase a cheap wheelchair to get me through – I felt degraded, that she suggested I just have a new chair for $600, I have complex needs and need to make sure I have the correct equipment, so I’m safe at all times.
3.78
Mr David Sinclair of Assistive Technology Suppliers Australia provided the committee an example where a planner rejected a support because they considered a cheaper alternative would be more appropriate:
I’ve had in writing, that’s been given to me in confidence, ‘We don’t provide BMWs here,’ because…as far as the planner is concerned, wheelchairs are only $15,000, so, ‘Why is the supplier trying to rip the government off? We’re not supplying it.’ That is actually missing the point of what that device can deliver.
3.79
The NDIA informed the committee in October 2020 that delegates must be satisfied that supports funded ‘represent value for money’ and ‘are likely to be effective and work for the participant’. It stated that value for money is only one component of decision making when determining whether to fund a support.
Funding for support coordination
3.80
Support coordination involves a support coordinator working with participants to utilise their plans and achieve their goals.
3.81
Submitters questioned whether the NDIA was limiting funding for participants to access support coordination, both initially and in subsequent plans. For example, the mother of an adult participant reported that she was told that her daughter would not be provided with ongoing support coordination:
…because you can do that job yourself. No choice! We are talking about a participant with complex support needs. Where is the parents’ right to work and earn an income themselves or to actually take a break and have a holiday?
3.82
Similarly, Carers NSW stated that its understanding of support coordination was that it must be considered ‘“reasonable and necessary“ on the basis of particular criteria indicating “complexity“ that do not explicitly include the circumstances and the needs of the carers’. Carers NSW reported in some instances that carers had requested support coordination because they did not have the capacity to implement a plan — in some instances because they had their own health issues, were from a culturally or linguistically diverse background, or lacking the skills and confidence to deal with service providers and use the internet — and had been denied it or provided with inadequate funding.
3.83
The issue of plans over-relying on informal supports is addressed later in this chapter.
3.84
Huntingtons Queensland reported that it had been involved in a number of planning meetings where its staff had coordinated the participant’s attendance, including preparing paperwork on the day, helping the participant to get ready for the meeting, driving them there, taking them to the correct office and sitting in the meeting, ‘only to be told by the planner that the client “did not need Support Coordination” because “they got themselves here”‘. Huntingtons Queensland suggested that planners had not proposed support coordination as an option for participants with Huntingtons disease because of a lack of awareness about impaired executive function.
3.85
The Northern Territory Office of the Public Guardian argued that to ‘a large degree the success of the scheme as well as individual participants relies on the support coordinator function’, and it can help activate thin markets, develop services and improve the lives of participants.
3.86
The Rights Information and Advocacy Centre suggested that at present, ‘only very complex participants appear to be’ granted support coordination, excluding those participants who may need more support than what they can obtain through an LAC but do not fit the category of ‘very complex’.
3.87
National Legal Aid stated that it knew ‘of cases where support coordination is being reduced or removed for clients at plan reviews, including clients with complex needs’. It recommended that previous levels of support in a plan should be taken as the benchmark for what is reasonable and necessary in a new plan, ‘unless and until there is evidence to support a change’. Carers Victoria similarly noted a ‘common complaint’ that support coordination was not continued after plan reviews ‘even though there is still a need for it’.
3.88
Integra proposed that planners and LACs provide participants with more information about plan management, submitting that participants often reported that they are ‘not aware of, or understand they must ask for, this option, and worse, they are often not advised this option exists at all, which limits choice and control’. Even among those who do obtain funding for support coordination, it argued, around 30 per cent lose it after 2–3 years. Similarly, Early Childhood Intervention Australia Victoria/Tasmania highlighted a ‘lack of clarity and guidance around the function, allocation and use of support coordination’, suggesting that planners were incorrectly assuming that the key worker model for children is the same as support coordination.
3.89
Submitters argued for more support coordination, or for it to be included as a standard item, for particular groups, including:
All participants with psychosocial disability.
All participants who are children and young people.
Participants who have Huntington’s disease.
The Tune Review
3.90
The Tune Review suggested that ‘the NDIA could be more generous in its interpretation of when it is reasonable and necessary to provide funded support coordination’. However, it also noted that ‘the market for support coordination is still developing in response to NDIS demand and there are locations where the market would be thin’, and argued a comprehensive market development strategy would need to accompany any moves to increase the use of funded support coordination.
3.91
The Tune review recommended that the NDIS Rules be amended to ‘set out the factors the NDIA will consider in funding support coordination in a participant’s plan’.
3.92
The Australian Government supported this recommendation, stating that it ‘supports reinforcing the active consideration of support coordination in the process of developing a participant’s plan and identifying reasonable and necessary supports’.
Funding rejected for specific types of supports
3.93
The committee was informed that plans may not be including specific types of supports, despite requests from participants and experts to include these. Such supports included:
Dietitian services and nutrition support products.
Behaviour support and training for behaviour support.
Some forms of assistive technology.
Some behaviour-based therapies for children with autism.
Assistive technology, with one plan manager reporting that they had seen plans for wheelchair-bound participants that did not include funding for assistive technology or wheelchairs in their plan.
Orthotic/prosthetic services.
Physiotherapy and occupational therapy.
3.94
For example, the Australian Psychological Society suggested that while plans had not included psychological interventions since the beginning of the NDIS, ‘on the basis of recent evidence…it may be becoming increasingly common’. It suggested that planners may be denying participants’ requests for psychological interventions, ‘downscaling the amount funded’ in plans that do include these interventions ‘to the point where such interventions are unlikely to provide the anticipated outcomes’ and suggesting participants access these interventions under other schemes, such as under Medicare.
3.95
Dr Tony McHugh, a Senior Policy Adviser at the Australian Psychological Society, told the committee that the Australian Psychological Society had ‘clear evidence’ of ‘active advocating by planners against the inclusion of psychology interventions in plans’. He further mentioned an email he had received from one of the Society’s members, which stated:
I am concerned that many NDIS participants are now being told that psychology is not being funded by the NDIS and has been removed from participant plans. A local area coordinator confirmed that this was the case the other day on the phone, saying that they had received an internal email, which they could not share, saying they were to not include any psychology in participant plans anymore.
3.96
The Australian Music Therapy Association reported that despite repeated engagements with the NDIA, and assurances from the NDIA that the NDIS supports music therapy, ‘NDIS planners have repeatedly told participants that they cannot access music therapy with their funding, and have refused to include music therapy funding in their plans’. It reported that planners had said things like ‘music therapy isn’t funded’ or ‘only funded in very rare circumstances’, that it is not evidence-based, that a participant should find an occupational therapist who uses music instead of a qualified music therapist, or that participants who self-manage their funds will probably have to pay back any funds they use for music therapy.
3.97
Miss Michelle Fisher from the Australian Music Therapy Association suggested that a directive may have been provided to planners instructing them not to fund music therapy:
…they’ve given a verbal directive at a team meeting that music therapy isn’t funded, but they’re not able to back that up with any evidence, so they’re not telling us who the person is who has given that directive. They’ve also said they had a survey that showed that music therapy wasn’t evidence based, but then they couldn’t say where that survey was or who made it and where it came from.
3.98
Mr Philipp Hermann, the Manager of Policy and Communications at Allied Health Professions Australia, indicated the efforts that allied health bodies have gone to so as to establish whether these decisions were a result of directives from senior members of the NDIA:
…it feels like we spend most of our time trying to get to the source of the issue, trying to determine if it was an individual planner who had made that decision, perhaps on the basis of incorrect understanding, or if it’s something that a team leader or a region has made as a decision for their region, or whether this is in fact NDIA policy. At times we’ve certainly had massive contradictions between the formal NDIA position that we get from engaging with the executive and very senior leaders and what we’re experiencing on the ground. I think that’s where our fundamental challenge is…I’m not aware that anyone from the allied health professions has ever been able to actually directly engage with the planning branch.
NDIA response
3.99
In its answer to a written question on notice from the committee, provided in October 2020, the NDIA stated that it does not have an informal policy to reject supports for specific therapy types, including music therapy, physiotherapy, art therapy and occupational therapy. The NDIA further outlined that delegates assess supports against the criteria outlined in sub-section 34(1) of the NDIS Act, the NDIS Rules and the NDIS Operational Guidelines. Further, NDIA delegates must be satisfied the supports ‘are related to the participant’s disability’, ‘are likely to be effective and work for the participant’ and ‘take into account support given to the participant by other government services, family, carer networks and the community’.
Funding inflexibility
3.100
A number of submitters drew the committee’s attention to limited funding flexibility. In practice, participants may still have money for one category of supports but no money for other supports, with no ability to move the money around.
3.101
The Tune Review proposed that the NDIS Rules be ‘amended to clarify that supports in a participant’s plan should be used flexibly, except in limited circumstances’. The Australian Government supported this recommendation, noting that:
The Government recently announced its intention to provide participants with greater flexibility in using their NDIS funding… The Government supports amending the NDIS Rules to enshrine flexibility as a key principle underpinning the delivery of NDIS supports.
3.102
The CEO of the NDIA informed the committee that under forthcoming changes due to be implemented to planning, ‘most funds will be completely flexible for participants to use on the supports they need when they need them’. Instead of funds being split into 15 categories, there will be two categories’, with participants able to use most funds flexibly for ‘the supports they need when they need them’.
Funding for transport and travel
3.103
A number of submitters raised concerns that current transport funding does not meet the needs of participants, or is not provided at all. For example, Carers NSW reported that it had ‘heard from many carers that the levels of transport funding being allocated represent only a fraction of the transport expenses’ that participants have in any given year. It acknowledged that state funded taxi subsidies and the Companion Card helped to cover these costs ‘but are themselves grossly inadequate compared to the drastic increase in costs that is reported, especially from people living in regional, rural and remote areas’.
3.104
Early Start Australia provided an example of a single mother who had had a stroke and received no support to get her child to and from therapy.
3.105
The Tasmanian Government argued that funding assessments for transport had led to many participants having reduced capacity to travel to work or place of study, to access funded supports, and to participate in community events or recreational activities.
3.106
Vision Australia suggested that because some planners do not understand how participants who are blind or have low vision can safely navigate the community at different times of the day, funding for travel may be inadequate to take into account the different strategies that participants might use to travel at various times. Vision Australia further argued that at present, providers are unable to see how much funding has been allocated in a plan for provider travel, and that there is no clarity in the way the amount of travel is calculated during planning.
3.107
The issue of funding for transport for participants in regional, rural and remote areas is discussed in Chapter 9, while issues raised about funding for transport in state systems are outlined in Chapter 5.
3.108
The Australian Government in its response to the committee’s interim report stated that ‘the Government and the NDIA have…committed to providing greater NDIS plan flexibility between core and capacity building supports’ from 1 July 2020, with interim measures for greater flexibility available in the intervening period.
3.109
As noted above, the CEO of the NDIA announced in October 2020 that under forthcoming changes due to be implemented to planning, ‘most funds will be completely flexible for participants to use on the supports they need when they need them’.
Crisis and emergency funding
3.110
Another issue raised in evidence concerned participant access to crisis and emergency funding. For example, Disability Council NSW stated that it had encountered ‘too many’ reports of NDIS participants ‘requiring a plan to be reviewed because of an emergency situation only to be held up by excessively slow reviews carried out by NDIS planners’. St Vincent’s Hospital Melbourne provided an example of the impact of delays in obtaining funding to cover unforeseen circumstances:
A…client who is a wheelchair user required unforeseen essential surgery which changed the positioning needs of the client. The client required timely expert advice and changes to their previous wheelchair to ensure adequate positioning and safe mobility. The NDIS Plan does not include funding for clinical assessment or assistive technology modifications. While waiting for funding to be considered and approved, the client developed new preventable health conditions including contractures.
3.111
ADACAS Advocacy noted that some state/territory governments have initiatives to assist NDIS participants with crisis and emergency funding. It proposed that all states and territories have a service equivalent of these systems and that they be provided with funding to assist NDIS participants with crisis situations.
3.112
The Victorian Office of the Public Advocate (Victorian OPA) noted the flexibility of funding in plans issued under the Complex Needs pathway. It suggested ‘some form of expedited process for reassessments and reviews’ for all participants who may need funding urgently because of a sudden change in circumstances. It further proposed that the NDIA ‘enable contingency funding to be immediately accessible to participants when crises arise’, along with designated liaison and emergency contact points and procedures within the NDIA.
3.113
The Victorian OPA further recommended funding for short-term accommodation and assistance in participants’ plans ‘to facilitate access to safe accommodation or respite in the event of a crisis’ that threatens a participant’s safety or wellbeing. It noted that the absence of NDIS funding for short-term accommodation was leading to participants remaining ‘in situations of unnecessary detention, in the health, mental health or criminal justice system, at great cost and impact to these systems’, while others were forced to remain in abusive situations or become homeless.
3.114
Carers Victoria suggested that all participants who have carers regularly providing daily support should have plans that take into consideration the possibility of the carer being unavailable at short notice because of issues such as the sudden illness or death of the carer and the need for them to support other family members.
NDIA response
3.115
The NDIA informed the committee in October 2020 that it has a two year national program—the Exceptionally Complex Support Needs Program (ECSNP)—which includes an after-hours crisis referral service for adult participants ‘who present to key emergency services because of a breakdown of their disability supports’. The referral phone line, it stated, is only available for approved referrers including emergency services, such as police, hospitals and ambulance, as nominated by the states and territories. After a referral:
ECSNP providers…determine the next steps. This may include contacting NDIS providers for additional support or short-term accommodation assistance…If NDIS services are not available, or are not the appropriate response, program providers coordinate with approved referrers to support participants during the crisis period. Program providers notify the NDIA by the following business day and the NDIA initiates an appropriate response to the crisis which may include a plan review if appropriate.
3.116
As noted above, the CEO of the NDIA, Mr Martin Hoffman, also told the committee at the hearing on 12 October 2020 that the NDIA is introducing new, ‘flexible, personalised plan budgets.
Funding for advocacy and independent assistance with planning
3.117
Multiple sources informed the committee that many, if not most, advocacy organisations have long wait lists and are in urgent need of more funding. For example, Every Australian Counts suggested that advocacy groups ‘are stretched beyond breaking point’ with limited funding meaning that ‘they are only able to help those most in crisis’. Similarly, the Victorian OPA also noted ‘reductions in funding’ and stated that it was ‘aware that many organisations are struggling and have reported being strained, operating with reduced or uncertain funding, and dealing with increasing waitlists’.
3.118
One participant reported that after asking an advocacy group for help with a complaint and a review in late 2018, they were told that the advocacy group was unable to help because of limited funding and staffing. The participant argued that participants ‘are told there are advocacy agencies out there to help you but when you seek them out, they’re all full up and do not have the…resources to help you’.
3.119
The Queensland Office of the Public Guardian noted that funding for a pilot program for advocacy organisations to provide decision-making support for people engaging with the NDIS was due to end at 30 June 2020. It argued that the ‘need for advocacy and decision-making support services is an ongoing demand’ and needed for plan reviews. It also suggested that the Australian Government provide long-term funding for the pilot and expand it to include support for plan reviews.
3.120
Family Advocacy called for state and territory governments to ‘provide funding in perpetuity for disability advocacy, representation and information services for people with disability’.
3.121
The Department of Social Services informed the committee that disability advocacy activities are funded by the Commonwealth and states and territories, with the exception of South Australia. The Commonwealth, it reported, had committed to over $46 million for disability advocacy in 2019–20, and ‘has actively been working with states and territories to agree to a shared and ongoing funding arrangement for independent disability advocacy’.
3.122
The Department of Social Services further outlined that it funds the NDIS Appeals program so that participants affected by reviewable decisions of the NDIA have free access to support when appealing decisions to the AAT (see Chapter 10 for further discussion of AAT appeals). The program currently funds 42 advocacy organisations and eight Legal Aid Commissions.
3.123
The Disability Reform Council in its pre-COVID-19 Communique on 13 December 2019 acknowledged the importance of independent disability advocacy and agreed that further work will be done to understand the demand for advocacy and decision-making support.
3.124
The Tune Review noted consultation feedback that suggested ‘people with disability who have support to navigate the NDIS from initial entry to being able to fully access and implement their plans tend to achieve better outcomes’ than people with disability who do not have assistance to navigate the NDIS. The Review reported:
This review has heard that this is driving a higher demand for advocacy support, both to help people navigate the NDIS and to deliver capacity-building supports that were intended to be delivered by the Partners in Community, but may have been lost due to a focus on planning. Indeed, anecdotal evidence suggests that many advocacy organisations across the country are reporting they have had to establish or expand waiting lists because of the NDIS, with evidence some people with disability are being turned away.
3.125
The Tune Review suggested that ‘there is a need to provide additional support to help people with disability navigate the NDIS’, understand and implement their plans, exercise informed choice and control and have their voice heard. It argued that this type of support is usually referred to as ‘supported decision-making’ and called for the Australian Government to ‘consider providing additional funding to third parties who are sufficiently independent from the NDIA to undertake these functions’, to an amount of around $45 million over three years.
3.126
The Australian Government in its response to the Tune Review supported this recommendation in principle and stated that it was undertaking the following initiatives:
Reviewing the LAC framework to ensure that LACs are ‘providing appropriate information and connection to community and mainstream supports’;
Opening round two of the Individual Capacity Building grants program later in 2020 for organisations ‘to implement programs which would empower people with disability, their families and carers to access information, build capacity and link in with existing community supports’;
Making more than $94 million available in further grant opportunities in 2020; and
Committing $20 million to expand the NDIS Community Connectors Program to help hard to reach communities navigate the NDIS.
3.127
The Australian Government also noted that disability ministers have ‘agreed to review national disability advocacy and decision-making supports…to ensure funded advocacy organisations are effectively supporting and delivering outcomes for NDIS participants’ and people with disability who are not eligible for the NDIS.
Other issues
3.128
A number of other issues were raised in evidence provided to the inquiry about funding, among them:
The absence of funding for case management, a function that involved managing supports across sectors and service systems in some jurisdictions before the introduction of the NDIS.
The costs involved for participants to obtain expert reports to support their requests for supports.
Participants being funded for supports they had not requested or that providers and/or experts considered were inappropriate (see Chapter 6 for further discussion of planners making inappropriate recommendations).
Planners choosing not to fund supports that they know are unavailable in a region, impacting market demand (see Chapter 9 for further discussion of thin markets in rural and remote areas).
Plans only including funding for supports for one disability type.
Participants receiving less funding than under some former state systems.
Plans favouring group supports rather than individual supports.
Planners suggesting that a support for participants with motor neurone disease was not value for money if the participant was likely to die soon.
Lack of clarity around whether the NDIA will reimburse participants for costs incurred for supports that the NDIA has varied or set aside that are later determined following review to be reasonable and necessary.
Committee view
3.129
Most of the issues outlined in this chapter concern insufficient funding and/or unclear reasons given by the NDIA for why it has chosen to provide particular funding amounts, including where these may be inconsistent between plans and between participants with similar circumstances.
3.130
For the financial year ending 30 June 2020, participant plan expenses in the NDIA’s Statement of Comprehensive Income in its annual report amounted to $17.590 billion, while in its annual report for the year ending 30 June 2019, participant plan expenses amounted to $10.460 billion. This represents an increase in spending of 59 per cent on participant plan expenses in a year. The committee notes recent reforms that the Australian Government has taken or has announced in relation to plan funding, including:
Flexibility in how participants can use their plan funding, meaning participants may be able to use funding for transport, crisis and emergency situations, and assistive technology repairs.
The introduction of independent assessments, which, if planners are required to follow the recommendations contained in independent assessments, may improve:
Consistency in decision-making;
The issue of planners asking participants to choose which supports they need more;
Unexplained decreases in funding after plan reviews;
Planners rejecting specific support types; and
Planners proposing inappropriate supports because they are cheaper; than those proposed by experts.
Increased transparency, with commitments made as part of the NDIA’s Participant Service Improvement Plan 2020–21 including that the NDIA will clearer reasons for decisions.
3.131
The committee remains concerned about a number of issues raised about plan funding. For example, the committee notes that funding flexibility is only helpful to participants if they have unspent funds elsewhere. A further issue of concern, as identified by the Australian National Audit Office, is inconsistencies in how the NDIA decides whether a support is reasonable and necessary. However, given the wide-ranging reforms that are currently underway, including in response to other reviews, the committee considers that making any further recommendations would be premature until it is clear whether a) independent assessments are fair and reasonable; and b) the reforms will fully address concerns that participants, their support networks, advocacy groups and providers have about transparency and consistency in decision-making. The committee therefore will maintain a watching brief and address outstanding issues in future reports if it considers this appropriate.
3.132
However, there is one issue that the committee considers must be urgently addressed that has not been adequately covered in the reforms announced: funding for advocacy services. The committee echoes the recommendation of the Tune Review that the Commonwealth provide additional funding for people with disability to navigate the NDIS, with a review of demand to occur as part of the next review of NDIS costs, currently scheduled for 2023. The Australian Government in its response to this recommendation stated that it is funding the Community Connectors Program, reviewing the LAC framework, and opening round two of the Individual Capacity Building grants program later in 2020. The committee also notes that disability ministers have committed to reviewing national disability advocacy and decision-making supports. Nonetheless, the committee recommends that the Australian Government commit to providing additional funding over three years to third parties who offer supported decision-making services.
3.133
The committee recommends that the Australian Government implement Recommendation 3 of the Review of the National Disability Insurance Scheme Act 2013 (the Tune Review).