Provider Toolkit Module 1: Introduction and overview of the Provider Toolkit

Transcription

1 Provider Toolkit Module 1: Introduction and overview of the Provider Toolkit 1 July 2016 ndis.gov.au 1 July 2016 Provider Toolkit Module 1

2 Contents Toolkit structure... 4 Purpose of the Toolkit Overview of the Toolkit About the NDIS an introduction for providers Participants Providers How does the Scheme work? Key Principle in NDIS Act: Choice and control Key Principle in NDIS Act: Reasonable and necessary supports Supports funded under the NDIS Supports not funded by the NDIS The NDIS Outcomes Framework The role of providers in delivering supports to participants with different plan types Agency management Self-management Plan management What do providers need to consider? Understand how to register and your obligations Consider your business model Terms of Business Guide to Suitability Quality and Safeguards Becoming a Registered Provider Authentication (PRODA) & access to myplace Intent to register Completing your registration with NDIS Which supports/ registration groups should I register for? Providing supports and managing your registration Service agreements Service bookings How do participants find me once I register? ndis.gov.au 1 July 2016 Provider Toolkit Module 1 2

3 1.5.4 Payment: how do I make a payment request? Pricing limits for supports Provider Assurance Documenting support delivery Glossary ndis.gov.au 1 July 2016 Provider Toolkit Module 1 3

4 Toolkit structure This is Module 1 of the Provider Toolkit. The Toolkit also contains Modules 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 ndis.gov.au 1 July 2016 Provider Toolkit Module 1 4

5 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 to as 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 ndis.gov.au 1 July 2016 Provider Toolkit Module 1 5

6 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. ndis.gov.au 1 July 2016 Provider Toolkit Module 1 6

7 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. ndis.gov.au 1 July 2016 Provider Toolkit Module 1 7

8 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 Participants 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 Providers 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 $22 billion 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, including mainstream businesses that make their services accessible and inclusive. ndis.gov.au 1 July 2016 Provider Toolkit Module 1 8

9 1.2.3 How 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 Key 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 also formed part of the 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. ndis.gov.au 1 July 2016 Provider Toolkit Module 1 9

10 1.2.5 Key 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 and to understand which supports are / aren t funded by the NDIS. ndis.gov.au 1 July 2016 Provider Toolkit Module 1 10

11 1.2.6 Supports 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 Supports 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 The 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. 1. Choice and Control ndis.gov.au 1 July 2016 Provider Toolkit Module 1 11

12 2. Daily Living 3. Relationships 4. Home 5. Health and Wellbeing 6. Lifelong Learning 7. Work 8. 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 The 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: Agency 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. ndis.gov.au 1 July 2016 Provider Toolkit Module 1 12

13 Self-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 Plan 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 What do providers need to consider? Understand 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: 1. Read this module of the Toolkit as an overview [Module 1] 2. Read the NDIA Terms of Business [Module 3] 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] 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] 5. Determine if you want to register, and for which registration groups [Module 2, 3, and 4] 6. 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] 7. Create a PRODA account to access myplace [Module 9] 8. Access myplace and complete an intent to register [Module 11] 9. Complete your registration in myplace including uploading all required supporting documentation [Module 11] Consider your business model Providers must consider how the delivery of supports under the NDIS will be incorporated and managed within their organisation as a whole. Providers looking to review their business ndis.gov.au 1 July 2016 Provider Toolkit Module 1 13

14 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. Features of successful organisations within the NDIS include: a value proposition that is responsive to the new market opportunities and to participants as consumers in a retail environment service offers that meet the needs and preferences of participants, including offers developed as a result of partnerships with other organisations a flexible and increasingly mobile workforce that actively supports participants to achieve independence and inclusion adequate investment in ICT that is aligned to the new business requirements strong financial management and understanding of cost drivers associated with individualised funding commitment to efficient but sustainable service models good governance and customer feedback mechanisms. Providers are also encouraged to read the Market Position Statements on the NDIS website. These are progressively being released by the NDIA and will assist providers to undertake their own market research as part of building readiness for the NDIS Terms of Business The Terms of Business specify a range of conditions that are binding on a Registered Provider of supports in the NDIS. 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. The Terms of Business largely outlines the commercial requirements for doing business as an NDIS Registered Provider. This includes expectations in relation to pricing, service level agreements, reporting and conflict-of-interest management among other topics. It also cross references other substantive documents such as the Working Arrangements, Price Guides and Guide to Suitability It is important to read the entire NDIA Terms of Business. Failure to comply with the Terms of Business may provide grounds for the NDIA to consider revoking a Registered Provider s registration. A copy of the Terms of Business is included within this Toolkit in Module 3. It is also available on the NDIS website Guide to Suitability The Guide to Suitability is a key document that provides detailed information to help providers understand if they are suitable to provide supports, and which types of supports, to ndis.gov.au 1 July 2016 Provider Toolkit Module 1 14

15 NDIS participants. The document provides guidance on what professions are appropriate to provide certain supports, summarises specific state and territory provider requirements, and outlines the key obligations of providers who are supporting NDIS participants. It is important to read the entire Guide to Suitability, but pay particular attention to the section relating to the State/Territory in which you will be providing supports. Providers are required to comply with the Guide to Suitability as a condition of their registration as a provider. Things to consider as you read the Guide to Suitability include: who is your organisation likely to provide services to (what type of disabilities and locations are you going to cover)? what kind of supports is your organisation likely to provide? what are the profession(s) employed within your business? Only certain professions can provide certain supports can your organisation meet the quality and safeguards requirements of States and Territories? What are the types of services you or your organisation provides? A copy of the Guide to Suitability is included in the Toolkit in Module 4 and is available on the NDIS website Quality and Safeguards Quality and Safeguards refers to a range of supports and mechanisms that ensure the safety and wellbeing of a participant, while supporting that participant to have a good quality of life, to be an active and equal citizen, and to be able to reach their potential. Safeguards include natural safeguards such as personal relationships and community connections, and formal safeguards such as service standards, regulations and quality assurance systems that apply to individuals and organisations providing supports. Quality and Safeguards are important in minimising risk and helping to improve the level of service that organisations provide. In transition, State and Territory Quality and Safeguards requirements will be maintained for new and existing providers. These requirements are outlined in NDIS Quality and Safeguards Working Arrangements with each of the States and Territories, and are contained in the Guide to Suitability. Further detail and information on quality and safeguards (including the Working Arrangements in place at 1 July 2016 for each jurisdiction) can be located on the NDIS website Becoming a Registered Provider If you or your organisation want to provide supports to participants who are not selfmanaging their plan, including if you want to provide Plan Management services, it is necessary to become a Registered Provider with the NDIS. To commence your registration you must obtain access to myplace. ndis.gov.au 1 July 2016 Provider Toolkit Module 1 15

16 myplace is the online portal, used by both providers and participants, to administer the NDIS. myplace allows providers to: undertake the steps required to submit an application for registration with the NDIS view their registration details including which registration groups they are registered to provide and which are still pending decision by the NDIS create and approve service bookings with participants view the details of participants they have service bookings with lodge payment requests for the delivery of supports provided to participants, in line with the participant s service booking and NDIS plan view payments made for payment requests add and manage their outlets and organisational details approve additional user access to their myplace profile. Before you apply to become a Registered Provider, it is important that you read the Guide to Suitability, the NDIA Terms of Business, and your State(s)/Territory(ies) Quality and Safeguard Working Arrangements. There are three key stages of the provider registration process as defined below: 1. authentication (PRODA) and access to myplace 2. intent to register 3. completing your registration with NDIS Authentication (PRODA) & access to myplace PRODA stands for Provider Digital Access (PRODA). PRODA is an online authentication system designed to provide secure access to specific government services. PRODA replaces the previously used authentication process, AUSkey, which was used to access the old Provider Portal. Access to myplace, the online portal for the NDIS, is via PRODA. Every individual who needs to access myplace on behalf of a Registered Provider will need to create their own PRODA account. Further details on the PRODA authentication process is available in Module 2 of the Toolkit, the NDIS website and in Module 9: PRODA Step by Step guide Intent to register If you are a new provider wishing to submit an application to register you will need to complete an intent to register application on myplace. The intent to register requires details about the provider organisation including: ABN legal entity type e.g.(australian Private Company, Sole Trader), legal business name trading name (if relevant) ndis.gov.au 1 July 2016 Provider Toolkit Module 1 16

17 if the provider or parent company is a Not for Profit entity address details. Further information on the intent to register process is available in Module 2 and Module 8 of the Toolkit Completing your registration with NDIS Once your organisation is established in myplace, you need to update your profile in myplace to: nominate profession(s) select the registration group(s) for which you wish to register to provide supports for upload the relevant supporting information. This includes: o declaration of suitability and, where required o proof of compliance with State/Territory quality and safeguard arrangements, issued either by the relevant State(s) and/or Territory(ies) in which you wish to register or an authorised Third Party Verifier (refer to Guide to Suitability). Descriptions of the Registration Groups, the required suitable professions to deliver them, and other evidence of experience required can be found in the Guide to Suitability which is in Module 4 of this Toolkit. Once all of the required supporting information is provided, the registration application will be assessed by NDIS and the outcome of your registration communicated to you via Which supports/ registration groups should I register for? The NDIS aims to facilitate a vibrant and competitive market for services services in order to maximise the potential benefits, value for money and choice and control for people with disabilities. The NDIA recognises that it will take some time for providers to adapt to the new market environment of the NDIS, and for new and innovative supports and services to emerge in response to consumer demand. Providers should register against the registration group that most closely aligns to the service/support they want to deliver Providing supports and managing your registration Service agreements A participant who chooses to engage someone to provide supports under an NDIS plan will generally enter into a written agreement with the provider (a Service Agreement). A service ndis.gov.au 1 July 2016 Provider Toolkit Module 1 17

18 agreement will help to ensure that the participant and provider have an agreed set of expectations of what supports will be delivered and how they will be delivered. A service agreement should set out each party s responsibilities and obligations and how to resolve any problems that may arise. Developing a service agreement is to be a collaborative process between the participant, any other person (such as a participant s family member or friend) and provider. For further information on creating service agreements with participants, including where to find an example template for a service agreement refer to Module 6: Service Agreements of this Toolkit and the NDIS website. Also refer to Module 3: Terms of Business of this Toolkit Service bookings A service booking is the way a participant engages with their chosen provider(s) online. A service booking nominates the type of service, dates of support, and funding to be allocated to a given provider. A service booking ensures that both parties are aware of the requirements for service, the length of time the service is required for, and that the participant will be able to pay for the service. A service booking must be accepted by both parties. Confirmation of the service booking is dependent on the provider accepting the request within 21 days. Once this occurs the allocated funding is locked to that provider for the given support category for which it relates. The service booking does not replace the service agreement which should continue to cover the nature and quality of supports to be provided and expected outcomes for the participant. There may be many service bookings for each type of service within a plan. For further information on service bookings refer to Module 5: Service Bookings of the Toolkit How do participants find me once I register? Choice and control is a central pillar of the NDIS design. Participants are able to find a provider who is registered to deliver the supports in their plan by searching in Provider Finder in myplace. To ensure participants are successfully able to locate your service it is important that your registration and contact details are correct. Providers may identify their outlet location(s) and details within myplace once registered. These can be updated at any time. Participants may choose to search for providers via other means, without using myplace, in much the same way as they may seek any other goods or services outside of the NDIS. This includes via the internet, word-of-mouth, advertising and marketing, or via other brokers and markets which may emerge under the NDIS. The NDIA is not seeking to be the only source of information about potential NDIS providers. ndis.gov.au 1 July 2016 Provider Toolkit Module 1 18

19 The NDIA does not assist providers to advertise their services directly to participants. Providers are responsible for the development of their business and for attracting participants as potential consumers of their supports and services Payment: how do I make a payment request? In order to receive payment from a participant who has an Agency managed plan, providers are required to submit a claim, called a payment request, electronically through myplace. In order to successfully claim it is important that you have the following information: participant name participant reference number (previously NDIS number) dates of support support item reference number support item price. It is also important to be familiar with the Provider Assurance Programme and the level of recommended documentation to keep as evidence to support your claims for payment. Some information on this is covered under provider assurance in this Module of the Toolkit and in Toolkit Module Pricing limits for supports The NDIS Act states that a funded support must represent value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support. The NDIA currently sets price limits for some services. The levels of these price limits broadly reflect efficient service delivery costs, to ensure that NDIS participants get good value from their support packages. The Agency s approach is designed to ensure that efficient providers will be able to recover their costs, and therefore deliver sustainable, high quality services to participants. Consistent with the following principles: prices are adjusted (indexed) annually to account for increases in input costs for providers notably, increases in wages for support workers prices paid to service providers are also higher for services and supports delivered in remote (18 per cent higher) and very remote (23 per cent higher) areas, to reflect differences in the cost of service delivery in those areas. Where price limits apply, prices charged to participants must not exceed the price level prescribed for that support in the Price Guide, though less may be charged. No other charges are to be added to the cost of the support, including credit card surcharges, or any additional fees including any gap fees, late payment fees or cancellation fees. Although many disability supports do not have explicit price controls, prices must still be negotiated between providers and participants in a Service Agreement. For many supports (e.g. Assistive Technology supports), the first step in this process is for providers to supply a ndis.gov.au 1 July 2016 Provider Toolkit Module 1 19

20 quote to the NDIS participant. Approval from an NDIA delegate may be required for these quotable items. NDIA will update prices on at least an annual basis, effective 1 July each year, taking account of market trends, changes in costs and wage rates. Changes to prices will be published on the NDIS website. Each updated price guide will include the date it was published to help providers ensure that they are using the most up-to-date version. In the long run, the Agency expects that prices will be increasingly deregulated. Pressure from active, informed participants exercising choice, and from competition between service providers, should reduce or remove the need for price controls Provider Assurance The Provider Assurance Programme ensures accuracy of claims submitted by registered providers. Support providers are assessed only in so far as their invoicing activities relating to participants of the Scheme and to validate claims as to existence, quantity and rate. Quality and safeguard issues are outside the scope of this compliance programme Documenting support delivery Module 7: Payment and Assurance of this Toolkit provides information and guidelines on how providers should document the delivery of supports to NDIS participants. The guidelines recommend that, in addition to a service agreement, the minimum information to be captured includes: name of the participant relating to the claim date(s) and total hours delivered or quantity of the support provided, and the support type. Further information on the provider assurance program and requirements for preparing and retaining evidence and documentation can be found in Module 7: Payment and Assurance. ndis.gov.au 1 July 2016 Provider Toolkit Module 1 20

21 1.6. Glossary Term ABN ABR Agency Managed Plan Best Fit Choice and Control Declaration of Suitability Funded Supports Goal Informal Supports Intent to Register Legal Entity Type Mainstream/ Community Supports myplace Definition Australian Business Number. It is a unique identifier issued by the Australian Business Register (ABR) which is operated by the Australian Taxation Office (ATO) Australian Business Register A method of plan management whereby a provider receives payment for services from the NDIA via myplace and must be a Registered Provider Providers should refer to the Support Item List to obtain the appropriate Support Item Reference Number when making claims for payments. Where a specific support type is not listed in the Support Item List, providers should refer to the support which best describes their service. If unsure please contact your local NDIA office. Providers should note that the NDIS Price Guide does not list all support items. The Price Guide only lists support items that have a price control The NDIA principle which outlines a participant s right to determine who, how and when their supports are delivered A legally binding document by which a provider acknowledges they have the necessary skills, experience, policies, procedures, facilities and/or equipment to deliver the support(s) they are registering for These are monetary supports which assist the participant to meet the goals in their plan which have been deemed to meet Reasonable and Necessary criteria (see NDIS Act 2013). These are just a component of a participant s overall plan The aspirational outcome which a participant has set for themselves Supports delivered by a participant s networks such as their friends and/or family An expression of interest from a provider to become an NDIA Registered Provider. In myplace, a validation is performed during this process to ensure that the ABN and other business information is valid. Completion of the Intent to Register is the first step for new providers wishing to register with NDIS The term which best describes your business type (e.g. sole trader, partnership etc.) Existing supports which are typically available to every person in Australia (e.g. Health, Education) Previously known as the Provider Portal, this is the online portal through which providers manage their registration, connect and make service bookings with participants, submit, and monitor claims for payment ndis.gov.au 1 July 2016 Provider Toolkit Module 1 21

22 Term myplace Dashboard NDIA NDIS Notice period Operational Guideline(s) Outcome Domain Outlet Participant Participant Plan Participant Portal Pending State Approval (registration status) Plan Goal Plan Management Agency (PMA) Plan Management Provider Plan Nominee Price Definition This is the opening page of myplace. A provider can be directed to other parts of myplace from here National Disability Insurance Agency; Agency. The NDIA is the statutory authority responsible for delivering the NDIS National Disability Insurance Scheme; Scheme A period of time before a Service Agreement ends. This may be 1 month or more Operational Guidelines set out some of the NDIA s operational information. Operational information means information held by the NDIA to assist the NDIA perform or exercise its functions or powers in making decisions or recommendations affecting members of the public (or any particular person or entity, or class of persons or entities) (see sections 8(2)(j) and 8A of the Freedom of Information Act 1982 (FOI Act)) The NDIA Outcomes Framework comprises eight domains: daily living, home, relationships, health and wellbeing, lifelong learning, work, social and community participation and choice and control The point at which goods and/or services are sold or distributed. A provider can have multiple outlets which they specify on their profile in myplace A person eligible to receive support from the NDIS The document which outlines a participant s context, goals and supports. The online system whereby participants in trial could view relevant information, the status of their supports and lodge claims for reimbursement if they are self-managing their plan. Like the Provider Portal, it is now replaced by myplace Evidence of compliance with quality and safeguard requirements from the State Government or authorised Third Party Verifier is required before a registration group can be approved for registration The measurable outcome which a participant aims to achieve throughout the duration of their plan/s A third party (registered provider) who assists the participant to manage the funded supports in their plan. A PMA pays the provider directly and then claims for services through myplace A third party (registered provider) who assists the participant to manage the funded supports in their plan. Refer also to PMA. A PMA pays the provider directly and then claims for services through myplace A family member, carer, friend or other person. If the NDIA gives approval, this person can manage your NDIS funding and support you to make other decisions The Agency provides guidance on the price to be paid for each support item. For some items, such as personal care and ndis.gov.au 1 July 2016 Provider Toolkit Module 1 22

23 Term Price Guide Primary Contact PRODA Profession Provider Provider Finder/E- Market Provider Portal Purpose of Support RA (Registration Authority) number Registered Provider Registration Group Definition community access, the amount indicates the maximum price that the Agency will pay for that support The document which outlines the support items for which price controls currently apply, and their price, which are funded by the NDIS. It is not a definitive list and providers should use a principle of best fit. A list of support items can be found in the Price Guide(s) This is the person who, for each organisation, can approve additional users to access myplace. They should be the first person to set up a PRODA account for the organisation and to link to the organisation or submit an intent to register (new providers) Provider Digital Access (PRODA) account. It is an online authentication service. A PRODA account is required in order to access the new provider portal called myplace This is the role that a provider demonstrates they can perform by providing relevant documentation in order to be able to add a registration group (e.g. Occupational Therapist, Accountant etc) A provider is an individual or organisation delivering a support or a product to a participant of the NDIS The online tool which a participant in trial used to identify and choose a provider to deliver services. This is now replaced by a new function in myplace which is called Provider Finder. This will be expanded on, and new functionality built, to grow into the emarket. The online system providers used during trial for registration and claims for services prior to July Like the Participant Portal, it is now replaced by myplace post 1 July 2016 The written intent of funded supports in a plan to assist the participant to attain their goals The RA number is a reference number for your PRODA account. You may need to quote this number when you call the NDIA Customer Service Centre to ask questions about your PRODA account. Organisations or individuals that have been approved (under section 70 of the NDIS Act) to be a Registered Provider with the NDIA. Registered Providers of supports have met requirements regarding qualifications, approvals, experience and capacity for the approved supports A Registration Group is a collection of support items. Registration Groups have been established to help simplify the registration process so that providers do not have to register for individual support items. The Guide to Suitability criteria are catalogued by registration groups. A provider submits documentation against registration groups in order to meet Quality Assurance guidelines ndis.gov.au 1 July 2016 Provider Toolkit Module 1 23

24 Term Registration Name Responsibilities Rules (NDIS rules) Self-Management Service Agreement Service Booking Specialist Disability Registration Group State Issued Certificate Support Categories Support Item Support Item List Terms of Business Username and Password Definition The name by which your organisation will be called by the NDIS (note this may differ from your Organisation Name and/or Trading Name) The things that are expected of you or the service provider, for example, compliance with the Terms of Business, NDIS Act and Rules Legislative instruments made under the NDIS Act. They set out the more detailed operation of the NDIS and should be read in conjunction with the NDIS Act A method of managing a plan whereby the participant is responsible for managing, negotiating with, and paying a provider directly The documented agreement between a participant and provider highlighting the nature, quality and expected outcomes of a support The online agreement between a participant and provider detailing the timeframe and cost of supports. It is completed in myplace A Registration Group comprising specialised disability supports where specific jurisdictional prerequisites, professional requirements, and ongoing quality and safeguard arrangements apply. Providers must demonstrate they meet State/Territory quality and safeguard requirements for Specialist Disability Registration Groups. Certificate issued by a State or Territory government or authorised Third Party Verifier These are the 15 categories by which funding will be allocated to an NDIS participant. Refer to the Price Guide for more detail Support items are used by providers to request payment for services/supports that have been delivered by a provider (Previously, Support Catalogue ) A comprehensive listing of support line items that are recognised in the NDIS payment system, including definitions and Support Item Reference Numbers (codes for payment requests). This listing can change from time to time and is kept up to date on the NDIS website A document which outlines the obligations that must be met by an NDIA Registered Provider in order to maintain their registration Required to log into PRODA and myplace ndis.gov.au 1 July 2016 Provider Toolkit Module 1 24

25 Term (Quality and Safeguard) Working Arrangements Definition Quality and Safeguards refers to a range of supports and mechanisms that ensure the safety and wellbeing of a participant. In transition, State and Territory quality and safeguards requirements will be maintained and these are outlined in the NDIS Quality and Safeguards Working Arrangements with each of the States and Territories, and are contained in the Guide to Suitability. ndis.gov.au 1 July 2016 Provider Toolkit Module 1 25