The introduction of the NDIS, along with the various forms of payment types (Agency, Plan Management and Self-Management) has limited guidance on many aspects of governance for the industry. This has left organisations to develop their own processes, which can often leave gaps and fall short of best practice.
Let’s look at the three payment types below and how governance (or sometimes lack of) comes into play for each.
NDIS plan self-management has natural governance built in for participants, provided they understand the allowable deductions, are capable, honest and are organised to keep NDIS funds quarantined from personal expenditures.
The acts of an individual personally paying an invoice, necessitates looking at the value and mostly reviewing the hours, units and price that make up the expenditure. Governance and approval are complete.
Agency managed NDIS plans are those whereby payments are only made to registered providers with the NDIS. The NDIA manages payments using a mixture of NDIS participants (or their representatives) and agency staff, via a service request booking system.
Where a provider creates a service booking and this is accepted, future payment requests of the provider can smoothly be submitted and paid. Governance is reasonable where the service booking is accepted, and the provider honestly performs the services invoiced.
The level of transparency here helps with governance - the participant or the NDIS can see what has been charged at any time, and there is a complaint system for when charges do not look appropriate. The NDIA is reliant on:
- Honesty of registered providers
- A complaints and investigations team – to scrutinize when, after payment, invoices are questioned
Where the participant cannot approve service requests, providers need to liaise with the NDIA to get the requests approved, which can limit governance as the NDIA are mostly reliant on the honesty of registered providers.
The agency managed system is far from perfect, with fraud in the millions by registered providers. This has required the development of the NDIS Fraud Taskforce - a multi-agency partnership between the Australian Federal Police (AFP), the NDIA and the Department of Human Services.
Plan Management Governance
Plan Managers have had to figure out levels of adequate governance for themselves. Considering the dual roles of:
- ensuring claims are appropriate with very independent clients; and
- the need to ensure their clients are being fairly invoiced.
Generically, Plan Managers work directly with clients and their support coordinators regarding “Responsible and Necessary” expenditure, and on claiming to the plan. Largely this works well, Plan Managers value add and add in an element of client coaching to the payment service.
Ensuring clients are fairly invoiced has its challenges.
Firstly, self-management effectively represents best practice, whereby very capable participants are reviewing and making payments themselves.
Agency managed is far from best practice. It would be equivalent to a Plan Manager accepting a “service agreement” and paying whatever is invoiced within that request. There are also different variations of this, including “standing orders” where a set amount is paid, without verification that the service took place.
In managing such, Plan Managers (depending on the software they use and size of the organisation) have different approaches and will:
- SMS or email approval to pay (Capital Guardians)
- get clients to forward invoices to them, its effectively an approval to pay; or
- require proof of service or delivery on invoice
- ensure providers copy clients on invoices;
- just pay if within service agreement, and tackle the service operator after payment if issues arise (agency payment approach)
Recently, the Capital Guardians policy of ensuring that every client has someone who takes responsibly and accountability for services provided and invoices authorised under their plan, has involved the fraud taskforce and saved our clients plans.
Essentially if an NDIS participant cannot approve their own invoices and has no nominee, then it is up to the NDIS planner to provide Support Coordination funding that ensures the scheduled service providers invoice correctly to their service agreement. They get paid for this. Outside support coordinators, there is no one else.
NDIS Governance Scorecard
|Eligible Claims||Low Risk: Service Provider Fraud|
|Self-Management Governance||✓ Participants claim direct||✓ Participants process themselves|
|Agency Governance||✓ Registered providers only access correct categories||✗ Limited approval process, only visibility after the fact|
|Plan Management Governance||✓ Plan Managers can only process claims in right categories||✓ With participant or support coordinator approving what they schedule|