Provider Tips

High alert: Allied health providers and participants on edge as NDIS funding for some therapies slashed without notice

David Kinnane · 27 November 2024 · Leave a Comment

What’s happened?

Yesterday, the National Disability Insurance Agency (NDIA) announced that the NDIS Pricing Arrangements and Price Limits will be amended radically with effect from 1 February 2025 to change the way music and art therapies are funded.
Many affected providers appear to have been blindsided, with some expressing real fears about the future of their businesses and jobs.
All allied health providers, and NDIS participants, should be worried about the precedent set by the NDIA’s decision-making process, including the way it announced significant changes.

Context:

Allied health providers can be paid by the NDIA only for services that are ‘NDIS supports’.
‘NDIS supports’ are now defined in section 10 of the NDIS Act 2013 and Schedule 1 of the NDIS (Getting the NDIS Back on Track No.1) (NDIS Supports) Transitional Rules 2024.
For allied health providers, key NDIS supports include:
- early intervention supports for early childhood (0-9 years) (Item 17); and
- therapeutic supports (Item 34).

Zoom in:

Early intervention supports are defined to include: “therapy provided by allied health professionals including speech pathologists and occupational therapists”.
Therapeutic supports include “supports that provide evidence‑based therapy to help participants improve or maintain their functional capacity in areas such as language and communication, personal care, mobility and movement, interpersonal interactions, functioning (including psychosocial functioning) and community living.” (Our emphasis.)

Driving the change:

According to the NDIA:

“While art and music therapy remain permissible, they do not meet the evidentiary standards required to be classified as a ‘therapy’ under the definition of NDIS supports.” (Our emphasis.)
From 1 February 2025, “[p]articipants will be able to access these supports…through their community participation budget:
- At a 1 to 1 rate of $67.56 an hour when delivered by a registered provider.
- At a group rate of $193.99 an hour when delivered to a minimum of 4 participants by a registered provider. This will support participants to have greater opportunities for inclusion and participation in the community.” (Our emphasis.)
“Participants and providers can continue with current arrangements until 1 February when the changes to the price guide come into effect.”
“We understand that the evidence base in relation to art and music therapy is continuing to be developed, as it relates to disability-related support. In recognition of this the NDIA is referring art and music therapy to be assessed by the NDIS Evidence Advisory Committee.” (Our emphasis.)

What we’re watching:

With its announcement, the NDIA:

has asserted that it can determine a recognised therapy is not supported by enough evidence to be classified as a therapeutic NDIS support;
will reduce the real-world choice and control of NDIS participants because:
- it must know that evidence-based music and art therapies cannot be delivered viably by qualified professionals for $67.56 an hour; and
- even at the lowered rates, appears to require that the services can be provided only by registered providers; and
appears to assume group therapy provides NDIS participants with greater opportunities for inclusion and participation in the community (many NDIS participants and advocates dispute this); and
has set a precedent for referring recognised therapies to an advisory committee – that doesn’t yet exist – to determine the legitimacy of their services for funding as therapies.

Bottom line:

Allied health providers and NDIS participants can no longer assume they will be consulted properly about major changes to NDIS funding or service-delivery models.
We should all keep a very close eye on:
- what is happening with the NDIS Evidence Advisory Committee including who will be be on it (expressions of interest close on 17 December 2024) and when it will be set up (potentially not until July 2025); and
- the NDIA’s evolving views on what constitutes evidence-based therapy for the purposes of determining whether a service is an NDIS support.

Go deeper:

NDIA: Statement – NDIS funded music and art therapy

Petition · Save Music Therapy: Keep It Funded Under NDIS – Australia · Change.org

Allied health providers must review services for young participants to ensure they’re NDIS supports

NDIS Evidence Advisory Committee | Department of Social Services

National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (NDIS Supports) Transitional Rules 2024

Allied health clinic owners: avoid chaos by focusing on strategic constants in a time of rapid change

David Kinnane · 20 November 2024 · Leave a Comment

Big picture:

In Australian markets for private allied health services, things are a bit all over the place at the moment:

Some clinics have closed, while new ones launch, and others aggressively expand.
Some clinic owners are going all in on the NDIS and future Foundational Supports, while others are reducing their NDIS work and looking to other markets.
Some clinic owners read every government announcement and paper, then scramble to adapt, while others wait to see what will happen.

Behind the scenes:

Each allied health clinic owner has to decide for themselves how best to respond to rapid changes, including:

new funding realities associated with pricing limits, more-limited NDIS supports, and (as yet undelivered) Foundational Supports;
potential increased professional regulation, e.g. flagged in the Scope of Practice Review and NDIS registration taskforce reports;
changed market dynamics, including frozen price limits and cost of living pressures;
government disability, health and education system overlaps and gaps;
shifting consumer preferences; and
technological advances, like telehealth and AI.

The problem:

“Agility” is a terrible business buzzword. But it’s almost impossible – and dangerous – to try to keep up with every change while running quality practices, helping clients, and managing a team. Attempting to respond to every change:

spreads limited resources too thinly;
weakens the focus on core competencies;
lures us into chopping and changing what we do without enough thought;
fosters a focus on short term opportunities and quick returns; and
can lead to organisational chaos, as we attempt to realign operations, processes, staff and culture to ever changing goals.

A solution:

Filter out transient factors, and instead re-commit to strategic constants, including:

core values;
client relationships;
key competencies; and
brand identity.

Case in point:

When Netflix transitioned from DVD-mailing to streaming, it understood that its key competitive value was derived from its core offering – delivering great content to customers – not from how it did it. This enabled it to make a major change to service delivery while staying true to its mission.

Zoom in:

Liao and Zhu (see link below) recommend a 4-step process for creating a strategically constant business in a time of rapid change. Paraphrased for allied health business owners, our key takeaways are as follows:

Start at the end: What’s your mission? What broad objectives can you set to achieve it in any market conditions?
Identify your strategic constants: What factors are relevant today and are likely to continue to be so in the future?:
1. Demand: The needs and preferences of your clients, e.g. for quality services, safety, convenience, and reputation.
2. Supply: Operational efficiencies, e.g. from workflows, delivery systems, and continuous improvement process in service delivery.
Match constants to capabilities: Review your strengths. Focus your strategy either on your demand or supply constants (not both to start with or you’ll lose focus and run out of resources).
Adapt around constants: Use your constants to set the boundaries for your decisions about how best to adapt to changes, including which services to offer, and which technologies to adopt.

Bottom line:

To create both stability (to take advantage of past successes) and agility (needed to evolve to exploit new opportunities related to your mission), clinic owners should review their business strategy and objectives to identify and prioritise strategic constants, while staying flexible about how to adapt to regulatory, market and other changes.

Go deeper:

Liao, J. and Zhu, F. (2024). How to Avoid the Agility Trap, Harvard Business Review, November-December issue.

Allied health providers: get up to speed on the key NDIS reforms that will affect your practice (a free resource)

Allied health NDIS providers: back yourself to try new things, and help more people: a case study

Paediatric allied health providers: let’s tackle our NDIS worries by improving our services, bit-by-bit, and monitoring general reform trends

Will NDIS reforms and foundational supports trigger the end for many paediatric allied health clinics?

Blood from a stone: What allied health NDIS providers can do to improve their lot

How will allied health NDIS providers survive? Some difficult choices ahead

Paediatric allied health clinic owners: things are not looking great when it comes to Targeted Foundational Supports

David Kinnane · 14 November 2024 · Leave a Comment

Another week, another consultation paper. And, as an independent speech pathology clinic owner who sees many children with developmental delays and/or disability, this one did not speak to my inner optimist.

1. But, first, a bit of context

Back in late September 2024, we wrote about the first Foundational Supports Consultation, looking at a consultation paper and webinar about General Supports.

A second paper – Foundational Supports for children with developmental concern, delay and/or disability and their families, carers and kin Consultation Paper – has been released. It’s dated October 2024. But I only found out about it last week; and only then by accident while looking for something else.

It’s more ambitious than the General Supports paper, and includes a discussion of “Targeted Foundational Supports” for children with developmental delay and their families who need more assistance than General Supports and mainstream services.

2. For strategy and business planning, paediatric allied healthcare providers need to understand what’s proposed

Targeted Foundational Supports are intended to include some allied health services, and so are of interest to paediatric allied health providers (like me), as we look to evaluate our service-delivery models to adapt to new systems of supports made up of three connected tiers:

mainstream early childhood education and school supports;
Foundational Supports, including Targeted Foundational Supports; and
a (yet-to-be developed) new early intervention pathway in the NDIS for children with the highest level of needs.

The idea seems to be that some families will access a combination of these supports, and perhaps different combinations of these supports at different stages as children’s needs change.

The key challenges for allied health providers are how to work within and across such complex systems to deliver quality, evidence-based services to children while keeping staff satisfied with their work – and staying solvent!

3. Reality check: On the ground, funded supports for children with developmental delay and/or disability through the NDIS are shrinking

On a first read, page 9 of the paper caught my eye:

“The recent ‘Getting the NDIS Back on Track” changes to the NDIS Act do not change a child’s participant status or remove their access…Nothing is changing now.”

These statements are hard to reconcile with recent news stories, like this, with journalist Rick Morton reporting that:

the NDIA is sending out more than 1,000 eligibility reassessment letters each week;
in the last six weeks, almost 7,500 eligibility reassessments have been performed – 78% of which are on children aged up to 8 in the early intervention scheme – with 48% of the total being removed from the NDIS, and 20% being asked to provide more information (so-called “general evidence”) within 28 days if they “think they still meet the NDIS eligibility requirements and wish to continue with the NDIS”; and
the NDIA is completing around 1,250 eligibility reassessments per week, aided by 95 new dedicated staff.

“Nothing is changing now”? Many families and health care providers would disagree.

4. Two predictions, and a comment

A. Allied Health Targeted Foundational Supports will not be provided in clinics

According to the authors of the consultation paper:

the 2023 Independent Review of the NDIS found that, under the current system:
- “supports for children with emerging developmental concerns and disability are too focused on a clinic-centred model of support and not enough on functional and support needs”; and
- there was “not enough focus on supporting children in everyday settings where they live, play and learn” (see page 13);
decisions on how to deliver Targeted Foundation Supports are yet to be made by governments. But the options to be considered:
- will look to use existing services and infrastructure to deliver supports to where children live, learn and play;
- may be provided in group settings (helped by an allied health worker or a multidisciplinary team) or individually in a child’s natural environment;
- mark a change of approach that “shifts away from a mostly one-to-one therapy model in clinical settings, which is not seen as best practice early intervention for most children”; and
a child may have access to allied health:
- through a referral to a group with other children getting similar supports “helped by an allied health worker or a multidisciplinary team”; or
- individually in the child’s natural environment (page 18).

B. Allied Health Targeted Foundational Supports:

a. will be more limited than under the ‘former’ NDIS; and

b. may not always be delivered directly by allied health professionals

The paper’s authors state that some children could be eligible to get one or more of:

low intensity or periodic child and and family-centred allied health supports, including from speech pathologists, physiotherapists, psychologists, occupational therapists or other allied health specialists;
more intensive, one-to-one capacity-building from a (not specified) “suitably qualified and experienced worker” who could provide coordination and help families get appropriate supports. This support may be delivered jointly with allied health supports (page 17);
a one-off, low-cost assistive technology consultation to increase independence at childcare, school or home (page 18); and/or
extra supports if the child is “identified” as having concerns across a number of developmental areas, delivered by a “qualified and experienced person with child development expertise”. It’s not clear who will identify the concerns, or what qualifications, experience or child development expertise will be required (page 18).

C. A closing comment

The consultation period appears to end at midnight on 5 December.

Based on what happened with the NDIS supports consultation, a cynic might suggest that the Federal Government has already decided what it wants from Foundational Supports and will now work with the states to make it happen, regardless of what families or allied health providers think or say.

I don’t know. But it’s hard to justify spending significant time or resources responding to consultation papers when we have so many clients needing help, when so many changes are happening at once, as we approach calendar year-end and have already weathered so much change in such a short period.

But we can’t ignore the changes, either.

Paediatric allied health clinic owners must start to think about whether they want to deliver Targeted Foundational Supports, recognising that:

adding Foundational Supports to service-mixes may:
- increase business risks and complexity;
- take away resources from other services and projects; and
- affect staff satisfaction with our workplaces;
one-to-one or in-clinic models are unlikely to work;
therapy dose constraints may reduce outcomes;
service-delivery constraints may reduce control over service quality; and
cost-effective access to mainstream and other ‘natural’ settings may be difficult in some states and regions for logistical, compliance, or financial reasons.

We must also remember that proposed changes will be hard to navigate and deliver for other stakeholders, too, including educators in childcare settings and schools, and governments.

As the authors of the paper note, effective, early child- and family-centred care, through the delivery of strength- and evidence-based services, can lead to significant improvements for children across developmental domains. We all want systems that deliver good outcomes for children and families.

One other thing we must not forget: the stakes of getting this right are life-changingly high for children with developmental delays and/or disability and their families – particularly for children who are (or become) ineligible for the NDIS, but who need more help than is and will be available through mainstream services.

Allied health providers: get up to speed on the key NDIS reforms that will affect your practice (a free resource)

Allied health providers must review services for young participants to ensure they’re NDIS supports

Will NDIS reforms and foundational supports trigger the end for many paediatric allied health clinics?

Allied health NDIS providers: back yourself to try new things, and help more people: a case study

Allied health providers: prepare for NDIS reforms with an updated Incident Management System

David Kinnane · 31 October 2024 · Leave a Comment

The challenge:

To increase safety and quality, NDIS providers should have clear incident management systems to record and manage incidents that happen while providing supports and services to people with disability.
But the rules are complicated, and the guidance is very detailed.

Why it matters:

The NDIS (Incident Management and Reportable Incidents) Rules 2018 require registered NDIS providers to have incident management systems.
The NDIS Quality and Safeguards Commission says that:
- it is good practice for unregistered-providers to have an appropriate and effective incident management system for all participants; and
- having policies and procedures about incident management is a feature of quality practices providing support for children in the NDIS.
NDIS reforms may mean that many unregistered providers will have to implement incident management systems in the near future, and it’s a good idea to prepare.

Yes, but:

Translating the rules and guidance into plain English is time-consuming.
A blank page can be paralysing, and lead to procrastination.
It’s hard to tailor a system to the needs of your participants and operations without a solid base.

Get started:

Check out our updated, plain English Incident Management and Reportable Incidents System Policy and Procedures Template.
Written for small and medium-sized providers who are determined to improve support quality and safety.
Fully editable, so you can tailor it for your needs, and the needs of participants, and workers.

Coming soon:

On-demand worker training for incident management to ensure key personnel and all workers understand the system and their key obligations.

NDIS Incident Management and Reportable Incidents System Policy and Procedures

National Disability Insurance Scheme (Incident Management and Reportable Incidents) Rules 2018

NDIS Commission Guidance on Incident Management Systems Guidance

Quality support for children in the NDIS

Allied health providers: can we increase our productivity without losing service quality?

David Kinnane · 24 October 2024 · Leave a Comment

Big Picture:

Allied health providers are challenged to improve productivity without lowering service quality. To that end, we’ve just read an interesting research note from e61 Institute (link below). Here are our key takeaways:

Why it matters:

We are part of the ‘care economy’ that employs over 15% of the workforce, fueled by the NDIS and an aging population. But our sector has had essentially no labour productivity growth for more than 20 years, contributing negatively to Australia’s overall underwhelming productivity growth since the pandemic.

Barriers:

Limited competition between providers in some areas.
Separation between who uses a service and who pays for it (reducing incentives to control costs and to innovate).
Difficulties measuring service quality.
Overlaps and gaps in state/federally funded government services.

Potential ways to increase productivity

Adjust funding models to pay for outcomes, rather than service quantities.
More focus on preventative care and removing funding for care that is not evidence-based.
Better exchanges of ideas about what works/doesn’t work.
Increased technology adoption, e.g. for administration, assessment tools, and to replace some labour and services.
Better vocational training and wages to increase labour supply.
Getting rid of non-compete clauses in employment contracts to increase mobility.
Review occupational licensing and minimum qualification requirements to increase mobility and supply while maintaining quality.

Bottom line:

Given the nature of our work, productivity gains may be easier to find in continuous quality improvements – providing better quality care with the same inputs – rather than providing the same care with less inputs.