WA NDIS My Way Support Clusters Lower South West … · 14 October: WA NDIS My Way Pricing Framework for trial in LSW Page 3 The approach In recent years the Commission and Disability

WA NDIS My Way Support

Clusters

Lower South West

2014-15 Pricing Arrangements

Date: 14 October 2014

14 October: WA NDIS My Way Pricing Framework for trial in LSW Page 2

Introduction

On 5 August 2013 the Commonwealth Government and the Western Australian Government signed an agreement for the trial of the National Disability Insurance Scheme (NDIS) in Western Australia. This is a unique agreement for a two trial approach for the introduction of the NDIS in WA. On 1 July 2014 the WA NDIS My Way model – the State Government’s preferred model – commenced in the Lower South West at the same time that the National Disability Insurance Agency’s (NDIA) started operating in the Perth Hills area. The WA NDIS My Way model will be managed and administered by the WA Disability Services Commission (the Commission). One of the key points of difference between the two models is the approach taken to pricing of support and services. While the National Disability Insurance Agency (NDIA) sets to fix prices, the Commission will adopt a more flexible approach, which reflects the prices identified by disability sector providers operating in the Lower South West in a recent panel contract process. The objective is to establish a pricing arrangement that is consistent with the State Government’s Delivering Community Services in Partnership (DCSP) policy while delivering a sustainable operating model for the WA NDIS My Way. A key focus of the NDIS is choice and control in the hands of consumers and the provision of reasonable and necessary support and services. Scheme sustainability and a strong and viable non-government sector are also key considerations. The WA NDIS pricing framework has been developed with providers currently providing or that have indicated their interest in providing services in the Lower South West NDIS My Way trial site. This framework will apply to prices for services in the Lower South West and is being trialled with learnings to inform future directions. Regular monitoring and feedback loops will be part of this trial.


The approach

In recent years the Commission and Disability Sector have worked collaboratively and effectively, within the principles of the State Government’s Delivering Community Services in Partnership (DCSP) policy, to strengthen the sustainability of services to people with disability in Western Australia. The provision of Component I and II funding, indexation to meet wage growth and procurement reforms focusing on outcome attainment through innovative and flexible services, have contributed to a healthy and responsive disability sector in Western Australia. The development and trial of the WA NDIS My Way model in the Lower South West presents many new challenges for both the Commission and service providers. These include increased flexibility and range of services; increased demand and the development of an approach to the pricing of services that ensure service provider viability within the context of NDIS budget parameters. To assist in navigating these challenges, the Commission has analysed the current disability services market operating in the Lower South West. Information provided by disability service organisations responding to the panel contract for individualised services informed the development of a range of broad disability support clusters. These clusters encompass the strategies offered by the providers either operating in or having expressed interest in providing individualised funded services in the Lower South West. This information has been used to develop the price range that the Commission will pay for a service or services identified in each cluster. Each price range is taken from the prices offered by organisations operating in the Lower South West in their panel contract tender responses. Currently the Service Agreement between an organisation and the Commission specifies the strategies an organisation can provide and the maximum price at which these will be provided. For the purpose of the trial, a Variation to Service Agreement will be agreed which identifies the support clusters and associated price ranges that the provider can deliver in the Lower South West. The Commission will negotiate with organisations to align their strategies identified in their current Service Agreement to the WA NDIS My Way clusters used in the trial.


Support Clusters

Support clusters reflect both a global strategy, such as community access or out-of-family living, and the discrete services required to achieve individual’s goals. Providers of services in the trial area will adopt the framework when costing individual My Way plans. The clusters are:

Accommodation

Daily Living

Communication

Wellbeing

Having a break

Episodic coordination of support

Behaviour support and specialist care

Therapy and specialist support The assessment and prescription of equipment to address the needs of individuals in the Lower South West will be coordinated by the individual’s My Way Coordinator. The My Way Coordinator, in consultation with the Allied Health Consultant, will facilitate an individual’s access to existing services and schemes available in the Lower South West. The support cluster ‘price range’ will be used to assess if the cost of a service is

deemed to be fair and reasonable. Organisations may charge higher rates than the

price range for some aspects of service, such as over weekends and public holidays,

and lower rates during standard hours of service. The overall effect should be that

the average cost of support for that support cluster falls within the price range.

The price ranges are underpinned by the following assumptions:

Services are able to be delivered by a range of providers in the LSW: o in that they are derived from the 2013-14 and 2014-15 tenders for

individualised services; o include indexation for 2013-14; and o align with the WA State Government’s procurement reforms.

The price range is an average price per unit comprised of units delivered at various times of the week e.g. weekdays, weekends, etc.

The minimum price per hour in a price range reflects the cost of delivering low to medium support during a week day (Monday to Friday) via one to one support. The hourly price for a service delivered in shared activities is anticipated to be less than the minimum price identified in the range.

The maximum price in a range reflects high/complex support needs.

The price ranges are inclusive of all costs associated with delivering the services. The price includes direct and indirect costs, such as coordination, planning, staff training, supervision, administration and some transport costs.

The price ranges apply to the delivery of support and services in the Lower South West WA NDIS trial site. No additional regional loading is applicable.


In very exceptional circumstances higher prices in a price range may be considered. Where people have rapidly changing or very high and complex needs, consideration will be given to funding for increased volume of coordination. The assessment of funding support outside the price ranges will be undertaken by My Way Coordinators and where appropriate in consultation with the Allied Health Consultant, and is subject to approval by the Regional Director. Where an individual can access a service that is within the price range, an individual can choose to co-fund more expensive services. They may also choose to purchase additional services, beyond that identified as reasonable and necessary within their individual plan. The Commission is committed to ensuring organisations are sustainable. The State rate of indexation will be paid during the 2014-15 and 2015-16 financial years, on funds under contract for the trial period. The allocation mechanism will be developed in consultation with the Sector.


Definition of terms

Term Definition

Cancellation Refers to as individual notifying a provider more than 48 hours in advance that scheduled hours of service are not required or are unable to be received.

Where notice is given more than 48 hours in advance the hours of service are to be banked.

Where notice is given with less than 48 hours, the hours of service are forfeited by the individual.

No show Refers to an individual not appearing or being available for a scheduled service that has been arranged with a provider; or where an individual is not at the agreed location for the scheduled service.

Low support needs

An individual who:

who can undertake the majority of daily living tasks independently without one to one support.

may require some support with activities such as shopping, banking, budgeting, social/community access and decision making of a complex nature.

has limited or no mobility restrictions and can manage on their own for considerable periods of time.

Standard support need

An individual who:

can manage activities of daily living with some support, but requires assistance with a number of daily living tasks. The majority of assistance required can be one to one support in nature.

may require support with daily living tasks such as shopping, banking, budgeting, community access, maintenance of social networks and decision making.

may have mobility and physical activity restrictions and may need support due to behaviours that leave them vulnerable, place them at risk and/or prone to self-injury, criminal activity or in danger.

requires support and supervision most of the time and can only be left alone for short periods of time.

High support need

An individual who:

has complex needs and/or challenging behaviour(s). Support is required 24/7 (either an awake or sleep shift) due to significant mobility and physical activity restrictions and/or behaviours that leave them vulnerable, place them at risk and/or prone to self-injury, criminal activity or in danger.

requires full assistance with activities of daily living, community access and decision making.

may require two to one support on some occasions.

Flat rate A single price rate within a cluster that applies to service delivery at any time of the week - i.e. weekdays, weekends, nights, and public holidays.

Variable rate Different price rates within a cluster are applied to services delivered at different times in a week i.e. weekends, nights, weekends and public holiday.


Term Definition

Hour of support

The unit of time for services provided to individuals.

Hourly unit price

The price of an hour of support/service delivered by a provider.

Price range The distribution of pricing indicating both the minimum and maximum price that will be paid for a service within a cluster.

Support cluster

A broad grouping of discrete disability services related to global strategies such as community access and out-of-family living.

Accommodation cluster

Relates to out of family-home supported accommodation. This can include shared living arrangements, host family or an alternative family situation. The price for supported accommodation is inclusive of activities of daily living, skills development in the home and reasonable engagement in the community.

Daily living cluster Services required by individuals to assist personal activities and/or maintain and develop their daily living skills and independence.

Communication cluster

Interpreting and translation services to assist individuals communicate during essential activities where alternative translation is not available. Individual’s day to day communication needs are addressed in the daily living cluster.

Wellbeing cluster Services required by individuals to participate in vocational, recreational, social, civic and physical health activities in their community.

Having a break cluster

Services providing positive experiences for people with disability and strengthen and maintain the capacity of families to provide support and care.

Episodic coordination and planning of support cluster

Time limited coordination of an individual’s option. May relate to a particularly complex situation or where specific and specialised planning is required to stabilise an individual experiencing a significant, and unpredicted or rapid change in their situation/support need.

Behaviour support and specialist care cluster

Provision of services to individuals with either challenging behaviour or complex medical/health needs.

Therapy and specialist support cluster

The provision of a range of strategies aimed at improving adult, children and/or young people’s participation and independence. Strategies may be ‘comprehensive’ (trans/inter disciplinary) or ‘targeted’ (single focus).

Therapeutic support must be provided by people with nationally recognised professional qualifications, who are appropriately trained and currently eligible to practice.

Comprehensive therapy services are multi-focused services delivered using a person centred approach that is focused on an individual’s needs and desired goals. Early childhood and school aged services are provided by an inter/trans disciplinary team, including but not limited to Occupational Therapists, Speech Pathologists, Physiotherapists and Psychologists. They work together to provide coordinated and integrated services. Adult services are provided by a range of qualified professionals, and may include an inter/trans disciplinary team approach.

Targeted therapy services are defined as single focused, highly specified and unique services. For example, specialised equipment consultancy services or human relationship counselling.


Information: Price clusters Transport and travel

Travel to provide support to individual Travel undertaken to provide support to an individual in their place of residence, up to 15 kilometres one way, is included within the prices presented in a cluster price range. Additional transport costs incurred by providers will be considered when they are established and identified in the plan as part of providing services to individuals. Where reasonable and necessary travel is identified in an individual’s plan a kilometre rate will be paid up to $0.76 per kilometre. A kilometre rate for travel for support workers to and from an individual’s place of residence will be considered in exceptional circumstances and will need to be discussed with the individual and their My Way Coordinator when the individual’s plan is established. Other transport services including training or accompanying an individual to travel and the provision of taxis are covered within Support Cluster 2: Daily Living. Travel costs for specialists and therapeutic support will not be charged at

a per kilometre rate. Travel is to be costed from the providers Lower South

West base in the following way:

First 15 kilometres one way is to be included in the hourly business cost.

Travel beyond 15 kilometres, one way, to provide a service to an individual, will be paid at the hourly rate of the service. Up to $1,000 can be charged in the quote per year. This is in addition to the funding band.

Cancellations and “no shows”

Providers must provide individuals with information on their cancellation and no show policy. The policy must specify the required notice period of 48 hours prior to delivery of the schedule service. Individuals notifying the providers within the notice period will not be charged for the service.

Where a service is cancelled with less than 48 hours’ notice or there is a ‘no show’, the individual will forfeit the period of scheduled support and the provider will be paid as if the service had occurred. Where greater than 48 hours’ notice is given the period of support will be banked, and the individual and the provider must reschedule the support hours as soon as practically possible. Support unable to be delivered within a financial year will be recovered by the Disability Services Commission.


Provision of support on weekends and public holidays

A core feature of the WA NDIS My Way model is the development of an individual’s plan in collaboration with their My Way Coordinator. An individual’s plan identifies their reasonable and necessary support needs; and, where individual requires services, the My Way Costing and Service section will identify the type and level of support required. It is acknowledged that units of support delivered at different times of the day or week vary in cost. Organisations may charge higher rates than the price range for some units of service, such as over weekends and public holidays, and lower rates during standard hours of service. The overall effect should be that the average cost of support for that support cluster will fall within the price range for that support cluster. For example, in Table One, provider A’s cost of an hour of personal care is $43 on a weekday (Monday to Friday) and $72 on a Sunday. If an individual required 12 hours of support per week, 10 hours during Monday to Friday and two hours on Sunday then provider A could provide the support to the individual at an average hourly rate of $47.83. In this example provider A’s costing for support falls within the price range ($41 to $53) for personal care. Table One: Flat rate applied to individual’s quantum of support.

Scenario Period Hours Price rate Cost

Variable rate

Weekday 10 $43 $430

Sunday 2 $72 $144

Total 12

$574

Flat rate

Weekday 10 $47.83 $478.3

Sunday 2 $47.83 $95.66

Total 12 $573.96


2014-15 Price Clusters

1: Accommodation

Cluster Accommodation Price ($)

1

Assistance with daily life tasks in a shared living arrangement

This support cluster incorporates assistance with and/or supervising tasks of daily life in a shared living environment, which is either temporary or ongoing, with a focus on developing the skills of each individual to live as autonomously as possible. The support is provided to each person living in the shared arrangement in accordance with their need and includes all aspects of normal daily living activities

Lower support needs:

This support provides supervision of living arrangements as a whole, with occasional or intermittent prompting to undertake household tasks and/or self- care activities

Supervision is not usually provided 24/7

If the individual has had incidents of challenging behaviour, a behaviour support plan is in place and it is demonstrated that the individual can be supported effectively within the available support

Where an individual has additional support needs, they may be supported in this living arrangement through a mix of additional paid and informal supports

Up to $95,000 per year.

Standard support needs:

Provision of 24/7 support which includes:

Active assistance or supervision of most daily tasks

Regular inactive overnight support (8 hour shift, minimal active support required)

The individual is able to engage family and friends for incidental assistance or companionship

If the individual has episodic or occasional challenging behaviours there is a behaviour support plan in place which has been demonstrated to effectively support the individual within the available support

Up to $130,000 per

year.

Higher support needs:

This support provides:

Highly frequent (at least 1 instance per shift) assistance to manage challenging behaviours that require intensive positive behaviour support

Continual, active assistance with all daily tasks

Active management of complex medical needs such as ventilation

Active support is provided 24/7 usually with an active overnight shift

May include higher staffing ratios at peak periods, for episodic or incidental behaviour supports, or emergency medical needs (e.g. seizure management or discharge from hospital)

Up to $178,400 per

year.

Assistance in a host family or alternative family situation

Agreement for an individual with low to high support needs to stay with a host family. The host family will have the skills and capacity to provide support in the home for the agreed time. The quote will reflect the hours of assistance required and length of stay. Assistance is provided with all aspects of normal daily living activities.

$63,000 to $126,932 per

year.


2: Daily Living

Number Daily living: Independence; personal care and support Price ($)

2

Assistance with daily personal activities

Assisting with and/or supervising personal tasks of daily life to enable the individual to live as autonomously as possible. These supports are provided individually to the person and can be provided in a range of environments, including but not limited to, the individual’s own home. A hierarchy of prices applies to this cluster of supports

Prices are based on the level of support required:

A higher intensity support may be paid where an individual requires assistance from a support worker who possesses additional qualifications and specific training and experience relevant to the person’s complex needs

Very frequent (at least 1 instance per shift) assistance to manage challenging behaviours that require intensive positive behaviour support

High medical support needs requiring continual active support

$41 - $53 per hour.

The time of day and day of the week that the support is provided

See page 5.

Assistance with Travel/ transport arrangements

This focuses on the provision of transport to enable participation in community, social, economic and daily life activities:

Taxis fare component not covered by other relevant taxi subsidy schemes

Fare.

Public transport fare of accompanying provider Fare.

Training for independence in travel and transport

Supports focus on assisting the individual with specific skills development that will enhance the ability of the person to travel and use public transport independently. This includes training in driving, using adapted equipment or vehicle modification.

$41 - $53 per hour.

Development and support with daily living and life skills

Development of daily living and life skills focusing on training, and where appropriate ongoing support, for an individual or their carer to increase their ability to live as autonomously as possible. Support can be provided either individually or through shared activities and can include skills development and support with daily life activities, communication, social skills, tenancy, budgeting and problem solving. Training can include: Training for Parents – Delivering training to parents of children with disabilities to

assist them in their parenting role or delivering training to parents with a disability to assist them in parenting their children. Training for carers – Delivering training to carers in matters related to caring for a person with

disability.

$41 - $53 per hour.


3: Communication

Number Communication Price ($)

3

Interpreting and translation

Interpreting and translation focuses on assistance to the individual to enable independent communication in essential personal, social or community activities where translation is not available from a mainstream service and can include: Auslan one, Auslan two training - Training in the use of Auslan and other communication techniques; TAFE course fee or equivalent.

TBC

4: Wellbeing

Number Wellbeing: Recreation, education and employment Price ($)

4

Assistance to access and maintain employment – Support with specialised open employment

job searching – Time limited provision of pre vocational skills, training, advice, coordination with employers, workplace orientation to assist an individual to get a job and/or induction to assist someone into open employment. Post school employment assistance – Time limited provision of pre vocational skills training,

advice, coordination with employers, workplace orientation to assist a person to get a job and/or induction to assist someone into open employment.

$44 - $54 per hour.

Post school employment assistance – shared support* – In a shared setting, build capacity

of persons to get a job post school by providing skills training such as transport, time/ financial management and self-care.(*Assumes a shared service for three or more individuals).

$14 - $18 per hour.

Participation in community, social and civic activities

Assisting an individual to participate actively in community, social and civic activities; includes supporting people during these activities and developing the persons’ ability to partake in these activities. These prices do not cover the cost of standard expenses related to recreational pursuits, such as entry fees, ticket prices or sporting game fees.

$41 - $53 per hour.

Physical wellbeing activities

Physical wellbeing activities that promote and encourage physical well-being, including exercise and healthy diets. These supports are provided and relate to the additional requirements due to the disability to assist the individual to participate in physical wellbeing activities.

$41 - $53 per hour.

5: Having a Break

Number Supporting positive care relationships Price ($)

5

Having a break - Breaks can be provided through a wide range of activities and services offered

to people with disability and their families. The break provides positive experiences for people with disability, and strengthens and maintains the capacity of families to provide support and care. Services are tailored to meet the needs of the person with disability and family, and may include the following types of activities:

In-home assistance for the carer to undertake typical family activities

In-home respite which gives the carer a break

Out-of-home respite, which may include centre-based or shared living settings, alternative family setting or other flexible respite options.

Respite accommodation in time of immediate need.

$41 - $53 per hour.

5

Having a break - Respite, either in-home or out-of-home, for periods 12 hours and over.

$300 - $530 per day/night.


6: Episodic coordination of support

Number Episodic coordination and planning of support Price ($)

6

Assistance in coordinating or managing life stages, complex situations, transitions and supports

This includes short term (time limited- up to three month per year) supports focused on developing an individual’s capacity to coordinate their supports, and to assist them to live at home and in the community. It includes time limited support to assist the person to resolve a crisis, and develop capacity and resilience in the person’s network. It may also include time limited support to assist the person, their family and carers to develop a vision for a meaningful life and plan for their changing needs and particularly complex circumstances. Planning is limited to the episodic provision of support to assist in stabilising an individual’s situation and reducing their at-risk status. Planning may be required during instances where there is breakdown or withdrawal of informal care, significant escalation in behaviour or medical support needs and/or in relation justice related matters.

$52 - $62 per hour.

7: Behaviour support and specialist care

Number Behaviour support and specialist care Price ($)

7

Behaviour support

This is time limited behaviour support which is based on planned strategies that aim to limit the likelihood of behaviours of concern developing and /or increasing. Behaviour support provides assistance to a person, their family and support persons to identify behaviours of concern, including behaviour(s) that cause harm to the person or others, and to design specific positive behaviour support strategies to support the person. Specialist care for persons with high care needs (includes nursing care in the community for people with high care needs)

This is the provision of specialist care for persons who have high care needs. This involves support from someone with a high level of expertise, knowledge and/or training to respond to the person’s complex needs. It does not include acute nursing care as delivered by the health system. It includes support for individuals who require assistance from a support worker with additional qualifications and experience relevant to the complex high medical support needs that require continuous and active support.

$63 - $73 per hour.

$63 - $90 per hour.


8: Therapy and specialist support

Number

Therapy and specialist support

Therapeutic supports funded by NDIS My Way Lower South West are specialist interventions not available in local mainstream services. Therapeutic supports are delivered by allied health professionals and others who have specialist skills to achieve the individuals My Way Plan goals.

Price ($)

8

Comprehensive – Inter/trans disciplinary therapy supports and strategies for early childhood 0 – 8 years of age.

Provision of a combination of therapies, coordinated by a key worker together with the family, to support a child’s independence and participation. Therapies are expected to fall into one of the three categories:

Low Band is generally for a child with developmental delay, or mild disability, who is developing slower than

their peers. Medium Band is generally for a child with disability or developmental delay who either has:

moderate single or multiple areas of needs/concern;

behavioural concerns; and/or

some family complexities, that require specific interventions and for those interventions to be coordinated with other agencies. High Band is generally for a child with a disability, who has complex needs that may also include complex

health and medical needs.

Up to $9,000

per year.

$9,001 to $11,500 per year.

$11,501 to

$15,500 per year

Comprehensive – Inter/trans disciplinary therapy supports and strategies for school age children 9 – 17 years of age.

Provision of a combination of therapies, coordinated by a key worker together with the family, to support a child and/or young person’s independence and participation. Therapies are expected to fall into one of the three categories: Low Band is generally for a child/adolescent with a disability, who requires either minimal supports or a short

term intervention strategy. Medium Band is generally appropriate for a child/adolescent with a disability who either has:



some family complexities, that require specific interventions and for those interventions to be coordinated with other agencies. High Band is generally appropriate for a child/adolescent with a disability, who has complex needs that may

also include complex health and medical needs.

Up to $4,500

per year.

$4,501 to $7,000

per year.

$7,001 to $8,500

per year.

8

Comprehensive – Inter/trans disciplinary therapy supports and strategies for individuals 18 years of age and over.

Provision of a combination of therapies, coordinated by a key worker together with the family, to support an adult’s independence and participation. Therapies are expected to fall into one of the three categories:

Low Band is generally for an adult with disability, who requires either minimal supports or a short term

intervention strategy. Medium Band is generally for an adult with disability who either has:



some family complexities, that require specific interventions and for those interventions to be coordinated with other agencies. High Band is generally for an adult with disability, who has complex needs that may also include complex

health and medical needs.

Up to $6,000

per year.

$6,001 to $8,000

per year.

$8,001 to $13,000 per year.

8

Targeted Therapy Services (single focused supports and strategies for all ages)

These services are defined as single focused, highly specified and unique services that are client centred and complementary to other services’, for example specialised equipment consultancy and human relationships. Individual strategies form part of a holistic approach to services required to achieve the individual’s identified goals/outcomes detailed in their WA NDIS My Way Plan. Collaboration with other community services that are involved with the individual is an integral part of ensuring successful outcomes are achieved and best practice approaches to service delivery are employed. Therapeutic supports are provided to assist the person to apply their functional skills to improve participation and independence in daily, practical activities. Targeted services also include the provision of a range of counselling services which may include relation, family, grief, family and/or group counselling. Counselling services support an individual to develop their capacity to work towards their personal goals.

Up to $169 per

hour.

Documents

WA NDIS My Way Support Clusters Lower South West … · 14 October: WA NDIS My Way Pricing Framework for trial in LSW Page 3 The approach In recent years the Commission and Disability