The NDIS' Assessment Future

Independent Assessments (IAs) are, to borrow a term from Australia’s former Prime Minister, “dead, buried and cremated.” Therefore, at first glance, the Joint Standing Committee (JSC)’s final report from the inquiry into IAs, released in October 2021, appears very late to a party that is really just wrapping up.

But before you dismiss it out of hand, there is an important reason to pay attention to this report. The government has foreshadowed that we can expect a “co-designed” and “person-centred” assessment model to be back on the cards in the near future (which probably means post-election). The JSC recommendations primarily tackle what a new assessment model might look like, along with providing some general advice for a better functioning NDIS.

Moreover, if we’re being honest, we’d probably have to admit that the NDIS’s assessment status quo isn’t too flash hot itself. Anything that requires potential participants to fund their own assessments leaves much to be desired.

Quick recap: the JSC is a multi-partisan committee made up of federal Senators and Members of Parliament which has been investigating IAs since late last year. Given the wide ideological spectrum of the committee members, it’s honestly a rather bizarre miracle that they ever manage to agree on anything. But that broad membership also means the solutions the JSC proposes should, theoretically, be the most likely to garner multi-party support.

Without any more preamble, let’s look at what they recommended.

Recommendation 1:

The committee recommends that the Commonwealth Government implement the National Disability Insurance Scheme Reserve Fund as soon as practicably possible.

It was an open “secret” that IAs were designed to cut costs of the NDIS. Even with IAs gone, the wider conversation about sustainability isn’t going anywhere, as my colleague Chris discussed in his recent article.

While sustainability wasn’t a key focus of this inquiry, the committee did express “surprise and concern” that the government had yet not implemented an NDIS Reserve Fund, particularly since the Commonwealth committed to do so in the bilateral agreements that are now several years old.

The JSC has also set up a separate inquiry into the implementation and forecasting of the NDIS. Honestly, good luck to them. In my experience, that whole topic is the fastest one-way train to Headache Town.

Recommendation 2:

The committee recommends that the Commonwealth Government amend the National Disability Insurance Scheme Act 2013 to include a specific commitment to and definition of co-design, following extensive consultation on what 'co-design' should be.

In what was not exactly a bombshell finding, the committee said it had serious concerns about the lack of community involvement in the development of the IA policy. In fact, the report includes a quite pointed diagram directly comparing good public policy development to what actually happened. It also reminded the government that co-design and consultation are not the same thing and cautioned the NDIA against using expert opinions on best practice to discount evidence of the lived experience of people with disability. This culminated in a recommendation that the government enshrine the importance of co-design into the NDIS Act. On a positive note, the recently released amended version of the Act did update the principles of the legislation to say people with disability should be considered in a co-design capacity.

However, the second part of the recommendation, that co-design also be defined in the Act, was not fulfilled in the version tabled to parliament. The definition of co-design is where the water really gets hot. It is the difference between co-design 😁 and co-design 😉. However, to be fair, as critical as it is to have a definition in the Act, it is perhaps reasonable that the NDIA doesn’t have one ready to go at this stage. The committee supported the notion that NDIA CEO Martin Hoffman raised at DSC’s Where to From Here (WTFH) conference of “co-designing what co-design will look like.” So before putting a definition down in stone, let’s have a thorough conversation about what we want to see in a co-design process.

Recommendation 3:

The committee recommends that consultations with medical and allied health professionals for the purposes of access to the National Disability Insurance Scheme and to support requests for items in NDIS plans be:

• carried out by health professionals nominated by participants and/or their nominees, where appropriate and available;

• holistic, taking into account medical reports and other contextual information as appropriate; and

• multidisciplinary, involving consultation with multiple experts who treat and have treated the person.

The JSC was of the opinion that the majority of assessments for access and planning purposes should be carried out by a professional of the participant’s choosing. The Agency’s previous argument that treating professionals would have a ‘sympathy bias’ was pretty much dismissed. The committee pointed out that allied health practitioners are already bound by professional standards as part of their registration and that we shouldn’t just assume that they would ignore those standards.

Further, the committee said that assessments should always seek to take into account other reports and pieces of evidence about the participant, questioning whether one assessment can be considered valid in isolation.

Recommendation 4:

The committee recommends that, where consultations with medical and allied health professionals for the purposes of access to the National Disability Insurance Scheme or to support requests for items in NDIS plans cannot be carried out by appropriate professionals nominated by a participant and/or their nominee:

• The National Disability Insurance Agency implement an accreditation process for appropriate professionals to carry out consultations for those in the circumstances described above;

• The National Disability Insurance Agency ensure that these assessments are holistic and multidisciplinary; and

• The National Disability Insurance Agency implement specific, targeted strategies to ensure that particular cohorts are not disadvantaged by such a process.

With this recommendation, the committee is trying to address the concern that people who do not have treating professionals or the ability to select a practitioner will be disadvantaged by the new system. If we acknowledge that treating professionals are likely to have a significantly more profound understanding of a person’s support needs, that implies that people without treating professional networks will be at a disadvantage.

The solution proposed by the committee is implementing an accreditation system of allied health professionals who have been comprehensively trained in providing evidence to the NDIA. There aren’t many details as to what this program might look like, but it appears to be similar to what the Tune Review recommended last year, where the Agency has a list of allied health professionals it can call on to complete an assessment. The JSC did specify that these assessments should be subject to intensive consultation with the disability community and reviewable.

Recommendation 5:

The committee recommends that the Australian Government consider funding bulk-billed consultations with medical and allied health professionals for the purposes described in Recommendation 3 and Recommendation 4.

I absolutely love this recommendation. In a country that is meant to have a social safety net, why are we still expecting NDIS applicants to fork out cash for assessments? A new Medicare line item would be such a simple solution, and it is a system that doctors, allied health professionals, and members of the public already know how to use. The JSC commissioned the Parliamentary Budget Office (PBO) to investigate adding an NDIS assessment item to the Medicare Benefits Schedule (MBS). Based on two to eight one-hour sessions billed for the first year at $320 each, they explored the cost of three different options:

• One-off assessments for NDIS applicants between 2021–22 and 2024–25: $80.5m–$450m.

• Regular assessments for all NDIS participants for planning purposes over the same period: $1.63bn–$2.04bn.

• Regular assessments for participants with psychosocial disability over the same period (people with psychosocial disability were selected for these calculations before IAs were scrapped over concerns that this cohort would find IAs particularly traumatic): $125.5m–$150m.

This can be compared to the $339m that IAs were estimated to cost over three years.

At present, changes to the MBS are subject to multiple reviews and considerable quality assurance processes before they are implemented. This process can take several years, so don’t get too excited about bulk-billed NDIS assessments just yet, though apparently a recent taskforce has recommended Medicare speed up the process a tad.

In recent media interviews, NDIS Minister Linda Reynolds has repeatedly expressed concern that the NDIS is on track to being more expensive than Medicare. Could the obvious solution be to just make Medicare more expensive?

Recommendation 6:

The committee recommends that all assessment tools that the National Disability Insurance Agency proposes, for the purposes of funded assessments to access the National Disability Insurance Scheme and to help inform funding decisions, should be subject to rigorous consultation with people with disability, Disability Representative Organisations, and relevant health and allied health practitioners before the National Disability Insurance Agency decides to implement them.

The committee managed to be quite passive aggressive in its use of italics in this recommendation. Basically, it heard a lot of evidence from allied health professionals about the limitations of all the assessment tools the in the NDIA’s IA toolkit. The JSC felt it would have been more ideal if the Agency had heard this kind of evidence before they green-lit these tools and began the pilots.

The committee also developed a table (in Appendix 1 of the report) that summarises some of the limitations it heard about for each of the tools, which is a useful resource for anybody conducting, undergoing, or consulting on functional assessments.

Conclusion

You can read the full JSC report here. Many of the earlier chapters simply summarise the opposition to IAs, which is not hugely relevant to our present situation. Still, if that’s your idea of entertainment, definitely check out the whole thing – you’ll get not judgement from these quarters.

We are still waiting for the government response to the JSC recommendations. Based on its track record, we can probably expect it either next week or next decade.

After the IA ordeal, the idea that the NDIS assessment process is about to change is likely to trigger many a panic attack. But if the government is serious about their commitment to co-design, then maybe, maybe, maybe we could get this right – and create a better NDIS as a result.