Phillip Coorey and Michael Read
The states and the Commonwealth will tip in $10 billion between them to establish a new scheme to treat children with mild autism and early developmental disorders, after the review into the NDIS said it must be reserved for those with significant and permanent disabilities.
“Our reforms recommend a complete rethink of the participant journey,” says the review into the burgeoning National Disability Insurance Scheme that was commissioned to return it to sustainability.
“We must return to the principle that NDIS eligibility is based first and foremost on functional impairment rather than medical diagnosis.”
Government Services and NDIS Minister Bill Shorten commissioned the review to rein in cost blowouts. Alex Ellinghausen
Consequently, the list of medical diagnoses that guarantees access to the NDIS will be scrapped within five years.
The review, released on Thursday morning, also demands higher standards of the service providers and recommends measures to eradicate overservicing and fraud, which are contributing to the scheme’s cost blowout.
Its release follows Wednesday’s national cabinet agreement that so-called foundational issues mild autism and developmental issues, which have swamped the NDIS, should not be supported by the scheme.
Instead, they will be supported through schools, childcare centres and other government service settings under a new Commonwealth-state funded scheme that will be phased in over time.
That scheme, to be phased in from 2024, will cost an estimated $10 billion over five years and be funded 50:50 by the states and the Commonwealth. It will represent how such disorders were treated before the NDIS was established.
Developmental delays and autism now amount for 12 and 35 per cent respectively of NDIS participants, more than ever envisioned. The scheme will cost $42 billion this financial year and $100 billion by 2032.
Tougher eligibility test, new assessment
As the program’s cost escalates because of inconsistent decision-making around access and budgets, the reviewers recommended the National Disability Insurance Agency introduce a “a more consistent and robust approach to determining eligibility for access to the NDIS”.
Once a person is on the scheme, they will be subject to a “new needs assessment process” that will determine how much money they are entitled to receive.
This will involve a person meeting an employee of the NDIA, who will spend “sufficient time with participants, so they feel heard”.
The recommendation may be viewed with hostility from the disability community, which will resist anything resembling the Morrison government’s failed attempt in 2021 to introduce an independent assessment process.
Under pressure from NDIS Minister Bill Shorten, who was then opposition NDIS spokesman, the Morrison government cancelled the rollout of the newly formed independent assessment approach after heavy criticism by the disability community that it was impersonal and heavily rule-bound.
Pre-empting the criticism, the reviewers say “our proposed approach to the participant pathway is fundamentally different to independent assessments”.
As part of the eligibility overhaul, the reviewers say the NDIA should agree to a new definition of “substantially reduced functional capacity” for access to the scheme.
The Albanese government will also need to legislate a new definition of “reasonable and necessary”, which is used to assess which supports are funded under the scheme.
“The whole-of-person reasonable and necessary budget should be based primarily on supports needs and intensity, rather than functional impairments,” the reviewers say.
“People with disability, as well as experts, must be involved in implementing our new approach to ensure budget setting is fair and can be trusted.”
NDIS providers will need to be enrolled or registered and workers will undergo mandatory training. Louie Douvis
As well, NDIS service providers will need to be enrolled or registered, and their workers undergo mandatory training, to weed out shonks and over-servicing.
“The highest-quality service providers should be rewarded, and low-quality service providers must improve,” the review says.
These would be policed by “a new dedicated deputy commissioner for quality in a new National Disability Supports Commission”.
“Continuous improvement will also be enabled through better data and market monitoring.”
Fraud, cash crackdown
The reviewers say it has become difficult to identify fraud in the $42 billion scheme because there is not enough visibility of transactions.
“An enhanced near real-time payment system will improve the transparency of transactions, deter fraudulent and sharp practices and make the scheme less wasteful,” they say.
Cash reimbursements for services should also be phased out over time.
Conceding the transition to real-time digital payments will take time, the reviewers say existing government technologies such as myGov should be built on in the interim.
Also, services and products supplied to NDIS recipients will be subject to price caps set by an independent authority.
Mr Shorten said the review’s recommendations would “restore trust, ensure sustainability and give participants a better experience and more control, by making the NDIS more about people and less about bureaucracy through greater equity, transparency and consistency”.
“The Albanese government has made a commitment to humanise the scheme and ensure every dollar goes to the participants for who it was intended.”
The review also offers greater flexibility for those aged over 65 who, if already on the NDIS, have to choose whether to stay on the NDIS or receive support through the aged care system.
“The Australian government should implement legislative change to allow participants once they turn 65 to receive supports in both the NDIS and the aged care system concurrently and clarify when aged care supports are reasonable and necessary,” it says.
The 338-page review, compiled by scheme architect Bruce Bonyhady and public servant Lisa Paul, makes 26 recommendations with 139 supporting actions.
“It is in the interests of everyone in the disability sector – including people with disability, service providers and governments – to secure the future sustainability of the NDIS,” they say.
“All recommendations and actions must be implemented as a package to achieve a more inclusive and fairer Australia for all people with disability.”
from https://www.afr.com/politics/federal/ndis-autism-carve-out-to-cost-10b-20231207-p5epqc#