Provider Toolkit
Module 1: Introduction and overview ofthe Provider Toolkit
1 July 2016
Contents
Toolkit structure
Purpose of the Toolkit
1.1.Overview of the Toolkit
1.2.About the NDIS – an introduction for providers
1.2.1Participants
1.2.2Providers
1.2.3How does the Scheme work?
1.2.4Key Principle in NDIS Act: Choice and control
1.2.5Key Principle in NDIS Act: Reasonable and necessary supports
1.2.6Supports funded under the NDIS
1.2.7Supports not funded by the NDIS
1.2.8The NDIS Outcomes Framework
1.2.9The role of providers in delivering supports to participants with different plan types
1.2.9.1Agency management
1.2.9.2Self-management
1.2.9.3Plan management
1.3.What do providers need to consider?
1.3.1Understand how to register and your obligations
1.3.2Consider your business model
1.3.3Terms of Business
1.3.4Guide to Suitability
1.3.5Quality and Safeguards
1.4.Becoming a Registered Provider
1.4.1Authentication (PRODA) & access to myplace
1.4.2Intent to register
1.4.3Completing your registration with NDIS
1.4.4Which supports/ registration groups should I register for?
1.5.Providing supports and managing your registration
1.5.1Service agreements
1.5.2Service bookings
1.5.3How do participants find me once I register?
1.5.4Payment: how do I make a payment request?
1.5.5Pricing limits for supports
1.5.6Provider Assurance
1.5.6.1Documenting support delivery
1.6.Glossary
Toolkit structure
This is Module 1 of the Provider Toolkit. The Toolkit also contains Modules 2 – 12.
Provider Toolkit
Module 1: Introduction and overview of the Provider Toolkit[this module]
Module 2: Registering as a Provider
Module 3: Terms of Business
Module 4: Guide to Suitability
Module 5: Service Agreements
Module 6: Service Bookings
Module 7: Payment and Assurance
Module 8: PRODA Step by Step guide
Module 9: myplace Provider Portal Step by Step Guide to logging into myplace for the first time – existing providers
Module 10: myplace Provider Portal Step by Step Guide to Registration for new providers
Module 11: myplace Provider Portal Step by Step Guide (excluding registration)
Module 12: Glossary
Purpose of the Toolkit
The National Disability Insurance Agency (NDIA; the Agency) values the role of providers and sees them as a critical part of the National Disability Insurance Scheme (NDIS; the Scheme) in terms of delivering high quality, person centred supports to help participants achieve their goals.
The NDIA would like to see the emergence of a new disability market with a diverse array of providers that maximises choice and control for participants but also enables strong links with mainstream services and family and community support to help achieve the overall NDIS aspirations of increased social and economic participation for people with disability.
The purpose of this toolkit is to assist individuals and organisations that want to become a registered provider under the NDIS. The Provider Toolkit includes answers to the most frequently asked questions from providers. It has a focus on the systems / processes used by the Scheme but also covers or references key elements of the Agency’s operational policy which providers also need to understand.
As the Scheme moves from trial into Full Scheme transition, some of the systems and Scheme design are still developing and being applied. As new providers enter the market they bring different perspectives and new questions. The Provider Toolkit will be a dynamic suite of documents that providers can refer toas they establish themselves in the NDIS. The Toolkit will be updated and expanded as Scheme systems evolve, and in response to provider feedback about what is most useful.
The Toolkit contains important information about:
- how the Scheme operates
- how to register as a provider
- how to engage with and manage the supports you provide to participants (including how to claim for payment)
- how to manage your registration including relevant quality and safeguard arrangements
- changes in full scheme to key provider processes for the benefit of providers who have participated in the NDIS during trial.
This Toolkit is complemented by a range of other support material available on the NDIS website, including for example:
- Supported Disability Accommodation Decision Paper on Pricing & Payments
- Market Position Statements
- NDIA Price Guide and Support Item List(s)
- NDIA quarterly reports
- NDIA Annual Reports
- Pilot on the Outcomes Framework
- NDIS Act and Rules
- Operational Guidelines
The NDIS website will continually be updated with the latest information for providers, and providers are encouraged to ensure that they regularly monitor this site. Examples of additional information currently under development are:
- Commissioning Pipeline
- Applied Conflict of Interest principles and practice
- Statement of Opportunity and Intent.
1.1.Overview of the Toolkit
This Toolkit is designed to walk you through the key processes involved in interacting with the NDIA and the important requirements and considerations for doing business under the NDIS.
This Toolkit should be read in conjunction with the ‘Working with the NDIS: your guide to being a registered NDIS provider’ document (available on the NDIS website) which illustrates the typical steps and processes that a provider must undertake to become a registered NDIS provider and supply services to NDIS participants. The information in the Toolkit directly covers, or references supporting documentation, that assists with each of the key steps in this process.
1.2.About the NDIS – an introduction for providers
The NDIS is a new way of providing support for Australians with disability, their families and carers. The National Disability Insurance Agency (NDIA) is responsible for delivering the NDIS.
1.2.1Participants
The NDIS will provide all Australians under the age of 65 who have a disability that is likely to be permanent and significant with the supports they need to live an ordinary life.
A person who is eligible to participate in the NDIS is called a participant. Participants develop individualised ‘plans’ which contain reasonable and necessary funded supports that enable each participant to achieve their goals.
Further information on participants and how plans are developed is available under ‘My NDIS Pathway’ on the NDIS website.
1.2.2Providers
NDIS providers are individuals or organisations that deliver a support or product to a participant of the NDIS. Participants have choice and control over the providers they engage to deliver supports in their plan, regardless of how their plans are administered. However,supports provided for participants whose plans are administered by the NDIA (Agency ‘managed’ plans) are claimed directly from the NDIA and must be supplied by an NDIS registered provider. See ‘Plan Management Options’ below.
The NDIS creates new and expanded opportunities for providers to be able to provide innovative and personalised supports to people with disability in an open market.
Historically, disability funding has been provided directly to providers by governments or services delivered by governments directly. Central to the NDIS is a shift to directing funding and resources to NDIS participants who will then drive and shape the market (just as in many other commercial markets)through their individual choices of the providers they choose to deliver the supports in their plans. This fundamentally changes the funding relationships that have characterised the disability support system in the past and delivers purchasing power to consumers.
Nationally, the level of expenditure on disability supports will more than double, reaching approximately $22billion per year supporting 460,000 participants, once the NDIS is fully implemented. This means that the NDIS market will expand dramatically in the coming years, creating significant opportunities for the existing service sector and for new entrants, includingmainstream businesses that make their services accessible and inclusive.
1.2.3How does the Scheme work?
As an insurance scheme, the NDIS takes a lifetime approach to support costs, investing in people with disability early to improve their outcomes later in life. The NDIS supports people with disability to achieve their individual goals and to participate in the community and employment.
The NDIS supports people with disability to:
- Access mainstream services and supports
These are the services available for all Australians from people like doctors or teachers through the health and education systems. It also covers areas like public housing and the justice and aged care systems.
- Access community services and supports
These are activities and services available to everyone in a community, such as sports clubs, community groups, libraries or charities.
- Maintain informal support arrangements
This is help people get from their family and friends. It is support people don’t pay for and is generally part of most people’s lives.
- Receive reasonable and necessary funded supports
The NDIS can pay for supports that are reasonable and necessary. This means they are related to a person’s disability and are required for them to live an ordinary life and achieve their goals.
1.2.4Key Principle in NDIS Act: Choice and control
A key pillar of the NDIS design is the principle of choice and control.
Choice and control means:
- participants have choice over their supports (that are reasonable and necessary) and who will deliver them
- participants determine how much control they want over the management of their funding, supports and providers, and
- the NDIS gives effect to certain obligations under the United Nations Convention on the Rights of Persons with Disabilities - including respect for their worth, dignity and to live free from abuse, neglect and exploitation. It alsoformed part ofthe National Disability Strategy.
Providers operating under the NDIS are expected to act in the best interests of participants, ensuring that participants are informed, empowered and able to maximise choice and control. More information about the obligations of registered providers can be located in the Terms of Business on the NDIS website and in Toolkit Module 3.
1.2.5Key Principle in NDIS Act: Reasonable and necessary supports
The NDIS funds reasonable and necessary supports that help a participant to reach their goals, and to undertake activities to enable the participant’s social and economic participation.
A participant’s reasonable and necessary supports take into account any informal supports already available to the individual— i.e. the support that we would ordinarily expect a person’s friends and family to provide —as well as other mainstream and community supports, such as health, education and other local community services. Where appropriate, a participant will be linked to these services in the first instance.
Reasonable and necessary supports are funded by the NDIS to help a participant to reach their goals in a range of areas, which may include education, employment, social participation, independence, living arrangements and health and wellbeing.
These supports will help participants to:
- pursue the goals outlined in their plan
- increase their independence
- increase social and economic participation, and
- develop their capacity to actively take part in the community.
NDIA staff make decisions as to a participant’s reasonable and necessary supports based on the NDIS Act and the rules made under this Act. The operational guidelines also provide practical guidance for decision makers.
When NDIA staff members make decisions about which supports would be reasonable and necessary for a particular participant, they refer to the particular operational guideline that relates to each specific support.
In order to be considered reasonable and necessary, a support must:
- be related to the participant’s disability
- not include day-to-day living costs that are not related to a participant’s disability support needs
- represent value for money
- not be more appropriately or effectively delivered by another system, such as health or education
- be likely to be effective and beneficial to the participant, and
- take into account informal supports given to participants by families, carers, networks, and the community.
Refer to section 1.2.6 and 1.2.7 to understand which supports are/ aren’t funded by the NDIS.
1.2.6Supports funded under the NDIS
The NDIS provides funding to participants to purchase a range of supports aimed at increasing their independence, inclusion, and social and economic participation.
NDIS service providers should be aware that all supports and services for Scheme participants should contribute to the achievement of a participant’s goals and lead to individual outcomes.
The funding model that underpins the NDIS is designed to be flexible and to allow service innovation. Importantly, the supports delivered will be chosen, and paid for, by individual participants out of an individually allocated budget. The range of supports funded by the Scheme will expand over time and as the NDIS market grows.
Under the NDIS plan and payment system, supports for participants fall into three categories: core, capital and capacity building.
- Core: A support that enables a participant to complete activities of daily living and enables them to work towards their goals and meet their objectives.
- Capital: An investment, such as assistive technologies, equipment and home or vehicle modifications, funding for capital costs (e.g. to pay for Specialist Disability Accommodation).
- Capacity building: A support that enables a participant to build their independence and skills.
More information about the type of supports that the NDIS may fund is available in the Price Guide(s) and Support Item List(s), which are available on the NDIS website in the Provider section.
1.2.7Supports not funded by the NDIS
The NDIS Act and the rules made under the NDIS Act also state which supports will not be funded by the NDIS. A support will not be funded if it:
- is not related to the participant’s disability
- is the same as other supports delivered under different funding through the NDIS
- relates to day-to-day living costs that are not related to a participant’s support needs
- is likely to cause harm to the participant or pose a risk to others
- not be more appropriately or effectively delivered by another system, such as health or education
1.2.8The NDIS Outcomes Framework
Supports delivered by providers should assist participants to achieve outcomes. The NDIA has released an ‘Outcomes Framework’ to measure the medium and long-term benefits of the NDIS for participants and their families.
There are eight Outcome Domains (‘Domains’) in the Framework.
- Choice and Control
- Daily Living
- Relationships
- Home
- Health and Wellbeing
- Lifelong Learning
- Work
- Social and Community Participation
The NDIS Outcomes Framework has been co-designed with the NDIA Independent Advisory Council and other stakeholders to monitor the progress of participants and their families and carers in key life domains.
The purpose of the Outcomes Framework is to:
- assist with planning
- establish indicators of Scheme performance so Scheme progress can be tracked
- identify drivers of good outcomes for individuals.
The Outcomes Framework will help the NDIA to understand what types of supports lead to good outcomes and identify areas that need development. Organisations that intend to provide supports to NDIS participants should understand the Outcomes Framework and be aware of the individual goals the participants they work with have identified in their plans. Supports provided to NDIS participants should be tailored to assist each participant to achieve their goals.These life domains are areas of focus for participants’ goals, objectives and strategies.
The summary report of the Outcomes Framework can be found on the NDIS website at: Outcomes Framework pilot study.
1.2.9The role of providers in delivering supports to participants with different plan types
Participants have choice and control over the providers they engage to deliver supports in their plan and how they manage their plan. Participants may also change how their plan is managed over time, in response to their individual needs and circumstances.
The type of plan management a participant chooses will vary depending on their circumstances. Different options can be chosen for different supports and the types of providers that can deliver supports for each type of plan varies. Plans can be: self-managed, plan managed or agency managed:
1.2.9.1Agency management
Under this arrangement, the NDIA manages the funding included in a participant’s plan. When the participant chooses this option they can only choose service providers from the NDIS registered provider list. Providers must be registered with the NDIS and they will make a payment request for services from the Agency.
1.2.9.2Self-management
A participant who self-manages their plan is responsible for managing the funding for the supports in their plan. If the participant chooses self-management, the NDIS will pay participants directly for the supports in their plan. Self-managing participants are not required to use NDIS registered providers.
1.2.9.3Plan management
Participants can choose to have a registered Plan Management provider manage their NDIS plan. The registered Plan Management provider manages the funding for the supports in the participant’s plan. The Plan Manager is required to be an 'NDIS registered provider', but can connect participants with both NDIS registered providers and providers that aren’t registered with the Scheme.
1.3.What do providers need to consider?
1.3.1Understand how to register and your obligations
Registered providers are required to provide supports to participants consistent with the NDIA Terms of Business, Guide to Suitability and the Quality and Safeguards Working Arrangements (which vary by State/Territory jurisdiction).
To become a Registered Provider it is suggested that you consider/undertake the following:
- Read this module of the Toolkit as an overview[Module 1]
- Read the NDIA Terms of Business[Module 3]
- Review the Guide to Suitability to assess your suitability to provide supports (with consideration to what types of supports you intend to provide) and understand your obligations as a service provider [Module 4]
- Review the relevant jurisdiction Quality and Safeguards, with consideration to registration groups that correspond to the supports you intend to provide, and determine requirements for accreditation where necessary. [Module 4]
- Determine if you want to register, and for which registration groups[Module 2, 3, and 4]
- Read the Price Guides and Support Item List to understand the service definitions and any constraints associated with payments for specific types of service delivery[Module 7 and Pricing section of the NDIS website]
- Create a PRODA account to access myplace[Module 9]
- Access myplace and complete an intent to register[Module 11]
- Complete your registration in myplaceincluding uploading all required supporting documentation[Module 11]
1.3.2Consider your business model
Providers must consider howthe delivery of supports under the NDIS will be incorporated and managed within their organisation as a whole. Providers looking to review their business model are encouraged to use the resources for building provider readiness that have been developed with the assistance of the Sector Development Fund [ which was established to support the disability sector to move to the new NDIS funding arrangements.