By Neena Bhandari
Sydney, 27.05.21 (Hireup): When Monique Power approached a local private paediatric physiotherapy practice and told them that her daughter, who was born with a rare and sporadic disability, was a National Disability Insurance Scheme (NDIS) participant, they increased their standard consultation fee by $100. When she queried the price gap, the provider couldn’t give any reasonable justification apart from saying, “We thought that is what we were meant to be charging”.
“Their lack of knowledge, moral compass and sheer ignorance of the nuances of the NDIS is unfortunately not an isolated occurrence”, says Power, Founder of RippleAbility, which helps parents and carers to access and optimise their NDIS Plans.
The National Disability Insurance Agency (NDIA) provides funding to NDIS participants to purchase a range of reasonable and necessary supports to increase independence, and social and economic participation. This funding is provided through individual participant budgets and the amount NDIA pays for these supports is set in the NDIS Price Guide, which is updated annually on 1st July.
“The moment the NDIS increases its prices, the service providers treat it as the recommended price and increase theirs. When my daughter was approved for the NDIS, every service provider we were using hiked the price,” says the father of a daughter with intellectual disability and physical challenges, who didn’t want to be named.
The NDIS website clearly states that there is no requirement for providers to charge the maximum price for a given support or service and participants and providers are free to negotiate lower prices.
But as Dominic Golding, Policy and Project Officer with National Ethnic Disability Alliance, who has physical disabilities and cerebral palsy says, “As a participant, you don’t get much choice to negotiate and you typically have to accept what the service provider has charged you or, in practice, charged the NDIS. An occupational therapist (OT) charged me $750 to do a home assessment. This is market value was determined by the NDIS. Before the NDIS, an OT would never charge anywhere near that amount of money. But if the NDIS, for example, puts the cost at $18 for an assistive piece of equipment, it is not in the providers interest to sell it for $15.”
The rate for services can vary depending on the day of the week, time of day, where someone lives, socio-economic demographics of a suburb, and the organisation someone chooses. In remote regional towns and some city suburbs, where there is not much competition and demand exceeds supply, service providers tend to charge the NDIS cap price and participants have no option but to accept.
Many NDIS participants, who spoke to this writer requesting anonymity, vented their frustration at being charged significantly higher rates, invariably the cap fee in the NDIS Price Guide, by some service providers once they were told that they were with NDIS.
“This pricing is even more confusing when it relates to service agreements with different support and care organisations. What is hidden about these prices is that many of these organisations, who provide carers, hire the carers at different rates. For example, hiring a carer from one organisation will cost you $75 an hour, but carer might be paid only $24 an hour,” adds Golding.
While some providers may be being “greedy” or “opportunistic” and bumping up prices, NDIS accreditation does come with additional responsibility, administrative burden, and costs associated with registration and compliance.
“Transforming your business and service model to transition on to the NDIS model comes at a substantial cost. While the service delivery at one end might look the same, what’s happening at the other end is actually very significant,” says Poppy Malone, Director of Sector and Markets at Hireup, which employs all of its disability support workers – unlike a number of other online platforms that use a contractor model.
“Some service providers charge the maximum NDIS stipulated price for a variety of reasons. One of the reasons is that they are at a higher risk of non-payment under the NDIS,” says Dr Kylie Morgan, senior consultant with Disability Services Consulting. “For example, under Medicare, the provider is assured to receive the Medicare rebate for their service even if someone’s credit card defaults on the gap payment. Under the NDIS, a participant doesn’t have to show their plan to a service provider and there is a risk of the entire amount being unpaid. It could be because the participant didn’t realise that they don’t have funding for a certain service or the funds for that service had been exhausted. When a provider submits the invoice to be paid, it gets rejected. As a business, there’s very little that they can do to get paid.”
“Other reasons include the costs associated with regular audits, service agreements, quality and risk control, and extra workers’ checks to abide by the NDIS code of conduct. Some of these things businesses don’t need for Medicare or Work Cover. Besides, there are extra mandatory reporting requirements. For example, if someone gets COVID-19, NDIS registered providers have to report both to Department of Health and NDIA. There is double reporting, which is frustrating because the information is not being shared between government departments,” Morgan adds.
Some organisations, such as not-for-profit Plumtree, are still working out how to make family-centred services compatible with an individualised funding model. “Good early childhood intervention services support families and children within their everyday routines. This may include travel to their home, collaboration with other people to ensure that everyone is working together, and other non-face-to-face activities. These help to ensure children are a part of their communities and living their best life. However, the cost of this type of service cannot be compared to an hour of therapy from a sole provider because it’s not the same service,” says Sylvana Mahmic, Chief Executive Officer of Plumtree Children’s Services.
Hireup is among NDIS-registered service providers that charge below the NDIS recommended rates.
“[First] we use technology to make the cost of delivering one hour of support or service more efficient, effective and cheaper. Second, our philosophy to approaching one-to-one support is different than a traditional service provider, where the recruitment and coordination of the staff is done by the administration team in an office. We ensure that we’ve got safe and verified support workers on our online platform. Participants are able to directly choose and connect with support workers and coordinate the time, place and activities they need them for. This takes off a significant proportion of administrative costs. Both of those things combined allows Hireup to be almost $8 under the NDIS rate,” says Malone.
Participants, who are on a self-managed plan have the option to shop around and negotiate a lower rate from a non-NDIS registered service provider, who can provide a tax invoice. It can help them get more benefit out of their allocated plan funding.
Susan Ellis, who contracted poliomyelitis says, “As I have a self-managed plan, I have been able to negotiate a fair and reasonable price without any problem. For general services, such as personal care and cleaning, the provider usually quotes a price, I then check the NDIS Price Guide. I have usually found the price to be within the prescribed limit so I have accepted their quote.”
She has also had assessments with orthotists, occupational therapists and physiotherapists in private practice. “Their fees were not negotiated. Some were agreed upon by the NDIS prior to my appointment. For example, part of the process of acquiring a new KAFO (knee, ankle, foot orthosis) brace or an OT establishing which power wheelchair was best for my circumstances,” Ellis adds.
Price is one factor, but are you getting a good experience with your service provider? Disability advocates say that be a savvy shopper and make your decision based on getting the best possible service, and if it’s a service that is cheaper and more effective then go for it.
“Currently, it is a volatile space. The government is working on a roadmap to getting the market ready for deregulated pricing. Ultimately you will have providers that would have built their commercial backbone to be competitive and deliver high impact services, which will be focused on supporting participants to reach their goals,” says Malone.
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