New price for art and music therapy

Today, the NDIA (finally) released Dr Stephen Duckett’s independent report into the role of art and music therapy in the NDIS. Dr Duckett handed in the report in April, and we’ve been dying to see it ever since. We learned today that the NDIA has accepted all the recommendations in full.

The most substantial recommendation concerned the price limit for art and music therapy. Late last year, the NDIA made a surprise announcement that the price limit for art and music therapy would be reduced from $193.99 to $67.56 per hour. Under the NDIA's proposed changes, art and music therapists could only charge $193.99 per hour if delivering the support in a group setting to 4 or more people. The Agency stated that this was because there was insufficient evidence to demonstrate that these supports were beneficial enough to be considered a therapy. Instead, it planned to align the price limit with Participation in Community, Social and Civic Activities. Following a public uproar, this plan was paused pending the results of this independent review.

For art and music therapists, and the 13,400 NDIS participants who use these services, it's a bit of a good news/bad news situation.

• The good news: This rate is still higher than the $67.56 the NDIA proposed last year.
• The bad news: Dr Duckett recommended aligning the price limits of art and music therapy to the counselling rate. This means the new price limit for art and music therapy will be $156.16, which is a $37.83 cut.

Dr Duckett’s review had two terms of reference:

• To evaluate the NDIA’s own ‘review of evidence’ that found there was limited evidence that art and music therapy were effective and beneficial for people with disability.
• To make recommendations on the price limits for art and music therapy compared to other allied health services.

Let’s explore what he found in more depth. Note, the views expressed below are Dr Duckett’s, not DSC’s.

Evidence base for art and music therapy

Broadly, Dr Duckett concluded that there is evidence to suggest that art and music therapy provided by a qualified therapist can be effective and beneficial for some participant cohorts. Dr Duckett agreed with the NDIA’s evidence review which found there was limited evidence when it came to art and music therapy, but said that limited evidence is not the same as no evidence. He said there is a growing amount of evidence that demonstrates the effectiveness of these therapies in some circumstances.

Because art and music therapy are self-regulated professions, and not registered professions under the Australian Health Practitioner Regulation Agency (AHPRA), anyone can technically call themselves an art and music therapist. But to be registered with the NDIS Quality and Safeguards Commission, an art therapist must be a member of the Australian, New Zealand and Asian Creative Arts Therapies Association (ANZACATA) and a music therapist must be a member of the Australian Music Therapy Association (AMTA). Both these peak bodies require members to have a masters degree.

Dr Duckett also differentiated between art and music therapy and activities. The difference being:

• Art and music therapy is provided by a qualified therapist who uses evidence-based practices to work towards achieving the participant’s goals.
• Art and music activities for leisure and social interaction. Even if these activities are provided by a qualified therapist.

Consequently, the report recommends:

• The NDIA should strengthen its oversight to ensure all therapies are effective- not just art and music therapy.
• If there is no research for a specific cohort, the NDIA shouldn’t assume that means these therapies are not effective. Dr Duckett suggests the new NDIS Expert Advisory Committee (EAC) (which was recently set up to advise government on the evidence base for different NDIS supports) should develop a process for making decisions in these cases.
• The NDIA should provide participants with specific, cohort-based information (e.g., by disability type or age group) to help them make appropriate therapy decisions and only fund art or music therapy where there is evidence of benefit for people with similar disabilities and goals.
• The NDIS EAC should outline which participant cohorts art and music therapy is effective for. Dr Duckett said this work was outside of the scope of his review.
• The EAC should consider the concept of a ‘minimal clinically important difference’ when making decisions. This is an academic concept that looks at not whether a support is effective or not, but if it makes enough difference in people’s daily lives to justify the intervention.
• The NDIA should collect data from therapists about how effective therapies have been at helping the people they support achieve their goals. This data could be used as an evidence base for whether the therapies are likely to be effective for people in similar circumstances.

Pricing

As mentioned above, Dr Duckett recommended the NDIA align to price limits for art and music therapy with the price limits for counselling. This was because like art and music therapy, counselling is not a profession regulated through AHPRA. Dr Duckett also noted that art and music therapy costs an average of $40 less outside of the NDIS, though he conceded it was not a completely fair comparison, as the services provided to non-NDIS participants might be different.

While Dr Duckett found the maximum rate for art and music therapy to be too high, he did conclude that it should be funded as a therapy, not a social and community participation support.

Dr Duckett also recommended the NDIA:

• Enhance invoicing verification, to ensure only eligible providers can use the art and music therapy line item.
• Ensure that art and music therapists can’t claim under the higher ‘other professionals’ rate.
• Consider establishing different price limits for allied health professionals depending on their skills and experience.
• Ensure that funding for art and music therapy for self-managed participants can only be delivered by a therapist who is appropriately qualified and meets the NDIS Commission's requirements for registration. Otherwise the support should be considered a Community, Social Civic activity.
• Monitor the market to ensure there are enough art and music therapists to meet the demand. The price limit should be set so as not to discourage people from working in the profession.
• Consider alternative methods for funding early intervention services consistent with best practice which encourage holistic evidence-based and outcomes-focused provision.
• Consider whether a differential pricing approach is better suited to larger providers including whether fee-for service is the best way of paying for their services.

The Report also said the NDIS Commission should introduce a way to verify the qualifications of an art or music therapist.

Learn more

You can find Dr Duckett’s full report here: Independent review into art and music supports

The NDIA has also released a statement on the review: Dr Duckett review confirms art and music therapy to continue

If you want to read more about the art and music therapy saga to date, check out our previous article: Art and music therapy update