For allied health NDIS providers, significant regulatory changes are coming:
- The Independent NDIS Review recommended significant reforms, including the development of a risk-proportionate model for the visibility and regulation of all providers (including us).
- An NDIS Provider and Worker Registration Taskforce is providing advice to the Government on how to deliver it.
Uncertainty abounds. We don’t know what the new rules will look like. We don’t know how they will apply to allied health providers.
At the same time, we’re grappling with pricing limits, worker shortages, inflation, and other business risks. It’s no surprise that many of us complain about upcoming regulatory changes in terms of mandatory registration, increased compliance costs, and more red tape.
The danger of all this negative talk about costs and risks is that it sounds defensive and even self-indulgent. But, when it comes to regulation, allied health providers have an overwhelmingly positive story to tell and an important role to play in advocating against changes that could reduce NDIS participant choice and control in the real world.
Allied health professionals are already well-regulated. Most allied health providers work hard to deliver evidence-based supports to participants, and to improve their service quality in response to participant feedback. Like participants, we want the NDIS to work. We want the NDIS to deliver for participants.
What do we want?
We want participants to have more choice and control over the supports they purchase and the providers they work with. We want the NDIS to be safer for participants. We want the NDIS to be sustainable. We want the NDIS to be cost-effective for participants and taxpayers. We want to stamp out abuse, fraud and other criminal, unethical and bad behaviours. We want more innovation, competition, and investment to increase productivity, service quality, value for money, and options for participants.
What do we not want?
We don’t want to return to the bad old days of pre-NDIS block funding with no participant choice or control. We don’t want market failure caused by a lack of providers. We don’t want anti-competitive behaviours or markets dominated by a few big providers. We don’t want more thin markets or market failures. We don’t want to drive quality providers out of business with increased compliance costs that are disproportionate to the risks or the size of their activities.
We’re arguing with each other about the wrong things, based on wrong assumptions
In the wider provider sector, too much time and energy is expended arguing about the pros and cons of registered versus unregistered NDIS providers, and their eligibility to deliver different support types to participants. Generalisations infect the debate on both sides.
Despite the work of the NDIS Provider and Worker Registration Taskforce to allay concerns, some providers assume that mandatory registration will mean the imposition of expensive quality compliance processes and external audits on all providers. Some assume that participants want to work only with registered providers; or that unregistered providers are unregulated cowboys and girls; or that the services of registered providers are guaranteed to be safer and of higher quality than the services of unregistered providers. All these assumptions are false.
Key points we need to communicate better to participants, the Government, and taxpayers
- Allied health providers are a diverse bunch. Some of us are big, multidisciplinary, multisite practices, and some of us are part-time sole traders offering mobile services. Some of us are 100% disability-focused, while others provide services to participants and people without disabilities. Some of us work in clinics, while others work in participants’ homes, in schools, workplaces, and a whole range of community and other settings.
- Allied health professionals are already well-regulated. For example:
- Practising physiotherapists, occupational therapists and psychologists are regulated by the Australian Health Practitioner Regulation Agency (AHPRA) in partnership with each profession’s National Board and are subject to AHPRA standards.
- Certified practising speech pathologists, dietitians, exercise and sports science practitioners, and audiologists are regulated by their professional peak bodies who, themselves, are members of the National Alliance of Self Regulating Health Practitioners (NASRHP), and therefore subject to NASRHP standards closely modelled on AHPRA standards.
- All these allied health professionals are subject to standards on scope (areas) of practice, codes of ethics/practice and/or professional conduct, complaints procedures, competency standards, course accreditation, continuing professional development, English language requirements, mandatory declarations, professional indemnity insurance, practitioner certification and recency and resumption of practice requirements.
- All allied health providers delivering NDIS-funded services are regulated by the NDIS Quality and Safeguards Commission to some degree:
- Some allied health providers are registered with the NDIS Quality and Safeguards Commission, including some of the larger providers, and providers who provide behavioural supports and/or use (high risk) restrictive practices. Among other things, registration involves providers implementing quality compliance processes to meet NDIS Practice standards and undertaking regular external audits. (In practice, it is time consuming and expensive for providers to get and maintain registration.)
- Some allied health providers are not registered with the NDIS Quality and Safeguards Commission, including many sole traders, other small providers, and providers who offer their services to both NDIS participants and other clients, and/or service mixes that include disability specific services and other services. These providers are often referred to as “unregistered providers”. However, they are subject to the NDIS Code of Conduct and can be fined and banned by the regulator.
- All allied health provider services are subject to the Australian Consumer Law, including consumer rights and guarantees.
- Many participants prefer to work with (generally smaller) unregistered allied health providers or a mix of providers. For example, Professor Helen Dickinson and her colleagues found that many of their interviewed participants spent funds on allied health services and that, “while many allied health providers and therapists are not NDIS registered, these providers typically hold registration or accreditation with their appropriate professional bodies…[and] that NDIS registration would not provide any additional level of safety or quality”.
- The evidence from the Royal Commission was clear: registration doesn’t guarantee safety. As Disability Sector Leader Dr George Taleporos states in no uncertain terms: “Registration does not keep people safe.” Dr Taleporos has also warned of several possible adverse consequences of mandatory registration, including service shortages, reduced competition, and less choice and control for participants.
Best world outcomes
If things go well, we’ll end up with:
- a proportionate and graduated regulatory system that takes into account the diversity of allied health provider businesses and services and their existing regulatory frameworks;
- clear rules that don’t conflict with or duplicate existing rules;
- a minimum of red tape so we can focus our limited time and resources on service delivery to participants and improving quality;
- clear communication of the rules to everyone affected;
- external monitoring of compliance with rules;
- enforcement when noncompliance is identified;
- proper adjudication of disputes about regulator decisions;
- sanctions for non-compliance; and
- continuous evaluation and adjustment of the regulatory system as things change.
Final thoughts
For many allied health providers, the real debate is not about mandatory registration, but about what ‘registration’ will actually mean under the new rules for different allied health providers. To make decisions about the future of our businesses and disability services, we need to know how much it will cost to comply with new rules, how long it will take to obtain registration (whatever that means for a given provider), and how much time (and how many management and worker resources) will be needed to maintain it. An important open question is whether, under the new system, price limit controls will extend to services purchased by self-managed participants.
The devil will be found in the details. If the government gets this wrong, we’ll see an exodus of allied health providers from the sector, reducing participant choice and control over who they work with for their supports.
Allied health providers should engage with participants to ensure this doesn’t happen.
Breaking (potentially good) news update
As so often happens, immediately after publishing this article, the NDIS Provider and Worker Registration Taskforce published its Advice. While this will take some time to read through in detail, a quick read of the registration recommendations looks promising for allied health providers:
- For AHPRA-registered allied health professionals (such as physiotherapists and occupational therapists), the Taskforce has recommended that the registration by AHPRA be recognised as registration for the purposes of NDIS where this can be achieved. (This recommendation is in relation to registration only and does not apply to worker screening.)
- For self-regulated allied health professions whose peak bodies are members of NASRHP (such as speech pathologists and dietitians), the Taskforce has recommended “consideration be given to the appropriateness of extending a recognition of those registration schemes to self-regulating allied health professionals, noting that any such assessment would need to consider the requirements of the self-regulated environment and other relevant matters”. Again, this recommendation is in relation to registration only and does not apply to worker screening.
If this advice is accepted, it has the potential to considerably reduce the regulatory burden associated with reporting to two regulators (e.g. the NDIS Commission and AHPRA/peak bodies) and to streamline the process for practitioners. As the Taskforce notes, “it would remove the main barrier to registration which has been raised with the Taskforce by allied health practitioners who are currently not registered NDIS providers”.
But, of course, a lot will depend on specifics, and the Government’s response to the recommendations.
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