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It’s finally here! The document that group service providers have been waiting for has landed. But before you read the ‘Group-Based Supports Transition Guidance’, I’ve got bad news: it’s posed more questions than provided answers. For the last few years providers have been working only off the general rules in the Pricing Arrangements, and we had black, white and a bit of grey. This new guidance has given us 50 Shades of Grey except this is more painful for everyone involved (and this time not in the fun way).
A quick recap for those who haven’t been following this closely: in June 2020 the NDIA announced a fundamental change in the way group services (specifically Group & Centre Based Activities) were structured and billed. The deadline for this change was pushed back, then back again, then back again. In December last year the sector was promised a Transition Handbook to guide providers through the practicalities of the changes. This handbook was publicly released last week.
The handbook was heralded as; supporting providers to understand the new pricing mode, would work in practice, and be able to be implemented. We’ve digested it and, frankly, we now have more questions and concerns than answers. If you weren’t sure whether a single sentence could be both clarifying and confusing, no need to wonder any more. It can be #confusifying #clarifusing.
These are the headlines.
Transitional pricing moving to legacy payments
A technical point that will allay the fears of many: the NDIA have confirmed that on 1 January 2024, the transitional pricing (the ratios) will be moved from ‘active’ in the Support Catalogue to ‘legacy’, until 31 March 2024. This means providers and Plan Managers will still be able to process claims for services delivered up to 31 December 2023 using this pricing model. Good news.
“Running and maintenance costs” in Centre Capital Costs
Centre Capital Costs should be one of the simplest components of the new pricing model. But one confusing addition is that Centre Capital Cost is designed to cover “the costs of running and maintaining a centre”. This detail is a new addition to the Centre Capital Cost rules, but it’s left some questions unanswered - what about rental or lease arrangements where running and maintenance costs aren’t outlined? Or are covered in an all-in rental agreement? What about sub-leasing arrangements where running and maintenance costs are shared? Will providers have to show evidence of these running and maintenance costs to be able to claim Centre Capital Costs in an audit-safe way? These are all valid questions that are unanswered.
A ratio by any other name would smell as sweet
Another huge clarification was that all group supports under the new pricing model must be apportioned equally i.e., if four people are at a group activity being supported by one worker, all four participants must be charged 25% of the worker’s time. This now seems to apply even where some members of the group require more support than the others. For example, a 70-10-10-10 split across the four people is not permitted when following this new guidance. This is especially bizarre when the NDIA has spent three years telling providers that they should take this opportunity to rethink and redesign how they deliver services, to accurately bill for what they actually deliver. This is a central part of the new pricing model - participants don’t have to be pushed into inflexible ratio-based boxes. The NDIA guidance even refers to ratios when talking about billing in the new pricing model - I thought we were leaving ratios behind?! #confusifying #clarifusing
The guidance even went as far as to say if there are three participants in a group and one of them requires High Intensity supports, that the provider should bill all three people the High Intensity support rate. Can you imagine communicating that to participants: “bad news John, Claire is going to start coming to this group next week, so your bills are going up as a result”. Not likely to create a harmonious group dynamic.
Averaging NF2F supports
The Pricing Arrangements update from 5 May has removed all wording around providers not being able to charge an average additional fee (the rules previously stated that each NF2F fee must be individualised to each participant). It has also removed the need to work out NF2F on a case-by-case basis, and this seemed to be reinforced by this new guidance. Page 18 of the Pricing Arrangements now states that “the fee charged for Non-Face-To-Face supports must be reflective of the needs of the participant in the context of the relevant support, and in agreement with the participant”. This suggests that group-based supports can now charge an additional fee if it is relevant to the direct services delivered, but NF2F doesn’t need to be truly individualised to the person. Maybe I need more time playing Scrabble but I’m not clear of the difference between a NF2F cost being calculated individually compared to a requirement that a NF2F cost reflects the individual needs of the participant.
This is a game changer for many providers who have spent weeks individualising NF2F supports that are substantially the same for everyone in a group setting. There are also some references added to documenting and recording all billed NF2F activities, including a link to the NDIA ‘Getting Paid’ resource which outlines what records need to be kept for services from different Support Purposes. So, we may expect further scrutiny of NF2F claims and billing records.
One system or the other
A point of confusion that will have major implications is that the NDIA has communicated to some providers that it’s ok to run a mixed model until 31 December 2023. This communication indicates that providers can run some groups in the transitional pricing model, and other groups using the apportioned pricing model. Great! This is a very sensible decision that will make the transition much more structured and organised. Except! The Pricing Arrangements released on 5 May state the opposite of this. On page 62 it clearly states, “a provider must use the same approach (transitional or new) for all the group and centre-based supports that they deliver”. I hope we see a very prompt update to the Pricing Arrangements, given operating in the rules set out by the Pricing Arrangements is a condition of registration for providers.
1:1 supports within a Program of Support
The new guidance seems to state that 1:1 supports can be delivered in a Program of Support model, provided that the services are billed from Group & Centre Based Activities. This is in contradiction to advice given by the Provider Support team on numerous occasions, and in the Pricing Arrangements (page 29 says Programs of Support are eligible for “a provider of group-based supports” in the relevant support types). Providers that have spent several years creating the transparent systems to bill their 1:1 supports separately from the groups supports delivered in a POS model are now faced with the choice between following guidance in this addendum or following the exact wording in the Pricing Arrangements. I also feel for providers delivering Programs of Support from other Support Categories as well - they must be asking “why do Group & Centre Based Activities get different POS rules to us?”.
This update seems to be ripe for sharp practice, as well - what is stopping a provider moving all 1:1 Assistance with Social Economic and Community Participation supports into 1:1 Group & Centre Based Activity supports and building a six-month Program of Support so there are no Short Notice Cancellation rules? Not exactly ideal for choice and control.
Providers between a rock and a hard place
Of course, we hoped for more practical examples and concrete guidance from this Provider Handbook. I also understand that it’s a complex area, with evolving and emerging trends and practices, and that we’re all breaking new ground with this transition. But the fundamental problem with this resource is that it puts providers into an impossible position: follow the advice in the handbook (some of which will lead to a smoother transition for participants and workers), or follow the rules outlined in the Pricing Arrangements that are the foundation of NDIS service delivery. That’s a position I would have expected the Agency to put providers in five years ago, not in 2023.
Let me zoom out a bit: like many others in the sector, I appreciate the clarification (where it’s actual clarification and not confusion). And I empathise with the tiny and under-resourced internal NDIA team having to work through this monster of a change.
But tens of thousands of participants and families, thousands of providers, and many millions of dollars are tied up in this transition, all of them from a part of our sector that was hit so hard by the impacts of Covid. Providers have waited three years for this guidance and to have it contradict things we thought were set in stone is so disappointing. Everyone involved deserves better.
We don’t just want to shout into the wind, these inconsistencies are too important - we've sent this list of questions and queries to the NDIA (as many others have). My advice to providers right now is to digest this additional guidance from the NDIA, check out our updated self-paced elearnings for managers and support workers, and use these to keep your team updated, have a cuppa, and continue to plan your transition while building a degree of flexibility into your plans with the hope the NDIA gives some more concrete clarity to some of these questions.
