Provider Toolkit Module 7: Payments and Assurance
1 July 2016
Contents
Toolkit structure 3
7.1. Payments 4
7.1.1 Payment of supports 4
7.1.2 The Price Guide 4
7.1.3 Payment terms 5
7.1.4 Payment Requests (previously known as claiming) 5
7.1.5 Transitional funding arrangements 5
7.2. Provider Assurance 6
7.3. Documenting support delivery 6
7.4. Retaining documentation of support delivery 7
7.5. Documentation by support type 7
7.5.1 Core supports 7
7.5.2 Capital supports 8
7.5.3 Capacity building supports 8
7.6. Non-compliance 9
7.7. Support log example 10
7.8. Group roster example 11
7.9. Documentation by support type 13
Toolkit structure
This is module 7 of the Provider Toolkit. The Provider Toolkit also contains Modules 1 – 12.
Provider Toolkit
Module 1: Introduction and overview of the Provider Toolkit
Module 2: Registering as a Provider
Module 3: Terms of Business
Module 4: Guide to Suitability
Module 5: Service Agreements
Module 6: Service Bookings
Module 7: Payment and Assurance [this module]
Module 8: PRODA Step by Step guide
Module 9: myplace Provider Portal Step by Step Guide to logging into myplace for the first time – existing providers
Module 10: myplace Provider Portal Step by Step Guide to Registration for new providers
Module 11: myplace Provider Portal Step by Step Guide (excluding registration)
Module 12: Glossary
7.1. Payments
7.1.1 Payment of supports
The National Disability Insurance Scheme (NDIS; the Scheme) provides funding to participants to purchase a range of supports aimed at increasing their independence, inclusion, and social and economic participation. This funding model is designed to be flexible and to allow service innovation. Importantly, the supports delivered will be chosen, and paid for, by individual participants. The range of supports funded by the Scheme will expand over time.
In the NDIS payment system, supports for participants fall into three categories:.
1. Core supports
A support that enables a participant to complete activities of daily living and enables them to work towards their goals and meet their objectives.
2. Capital supports
An investment, such as assistive technologies, equipment and home or vehicle modifications, or funding for capital costs (e.g. to pay for Specialist Disability Accommodation).
3. Capacity building supports
A support that enables a participant to build their independence and skills.
Supports in participant plans are categorised according to these three categories. Within a plan, participant budgets are subject to the rules in relation to these three categories.
7.1.2 The Price Guide
Prices for supports included in participant plans are developed and published by the National Disability Insurance Agency (NDIA; the Agency).
The Price Guide is available on the NDIS website, and includes a price limit for some supports and services.
NDIA will update prices on at least an annual basis, effective 1 July each year, taking account of market trends, changes in costs and wage rates. Changes to prices will be published on this website. Each updated price list will include the date it was published to help providers ensure that they are using the most up-to-date version
Unless stated otherwise, the price levels nominated in the Price Guide are the maximum that providers can charge NDIS participants for their services. Price limits are in place to ensure that participants receive value for money in the supports and services they receive. This is an important measure for many participants, especially in disability support markets that are still developing or where there are fewer service options for participants to choose from.
The exceptions to this rule are benchmark prices for some of the supports and services that are listed as quotable items. These benchmark prices indicate the NDIA’s view of efficient service delivery and should be the highest price charged by most providers. Supported Independent Living uses benchmark prices.
All registered NDIS providers should refer to Module 3: Terms of Business of this Toolkit, which includes details about the application of price limits and other requirements that providers must comply with when offering and delivering services to Scheme participants.
7.1.3 Payment terms
Participants who are self-managing their plan, and related funding, will pay the provider directly and obtain a receipt from the provider in order to acquit their expenditure against their plan. Where required, these participants will receive advance payments from the scheme in order to pay providers.
Providers who are working with participants whose plans are managed by the NDIA will be able to access myplace which supports electronic claiming and payment for supports.
Electronic claims (now referred to as Payment Requests) will be paid within 2 business days of lodgement. Providers who lodge electronic claims will not be required to lodge invoices.
7.1.4 Payment Requests (previously known as claiming)
Registered providers can make a Payment Request once that support has been delivered or provided. Pre-payment is not permitted for supports or services unless, the Agency has given prior approval to the registered provider for those specific supports/services for that participant.
Where price limits apply, prices charged to participants must not exceed the price level prescribed for that support in the Price Guide, though less may be charged. No other charges are to be added to the cost of the support, including credit card surcharges, or any additional fees including any ‘gap’ fees, late payment fees or cancellation fees.
A Payment Request is to be submitted within a reasonable time (and no later than 28 days) after the date of providing the support.
Providers should refer to Module 3: Terms of Business of this Toolkit for further details. In particular, the Terms of Business specify that providers will charge for supports delivered in accordance with the NDIA pricing arrangements and guidelines, after the support has been provided.
In order to receive payment from a participant who is not self-managing their supports, providers are required to submit a Payment Request electronically through myplace.
Providers should claim payments against a support line item that most closely aligns to the service they have delivered.
To successfully claim it is important that you have the following information:
· participant name
· Participant Reference Number (previously NDIS number)
· dates of Support
· Support Item Reference Number
· Support Item Price.
For more information about Payment Requests, please refer Module 11: myplace Provider Portal Step by Step Guide (excluding registration) in this Toolkit.
7.1.5 Transitional funding arrangements
Transitional in-kind funding arrangements between jurisdictions and the Australian Government may exist during the transition to full scheme. Participants coming into the NDIS who already receive serices from a recognised in-kind provider will continue to rceive this service from the provider. This gradual transition allows time for in-kind providers to adjust to the NDIS.
Although in-kind funding existed during the NDIS trial, it will be administered differently during full scheme to align to updated NDIA policies, processes and systems.
More information on how these transitional arrangements will be administered in transition will be available from the NDIA and jurisdictions in the near future.
7.2. Provider Assurance
The NDIS is set up on unique principles, including individualised funding of support packages and providing choice and control for participants who can select individual service and support providers. For Participants who aren’t seld-managed, the Scheme relies on registered support providers to lodge Payment Requests through myplace on behalf of these participants for services provided.
The Provider Assurance Programme ensures the accuracy of claims submitted by registered providers. Support providers are assessed on their invoicing activities relating to participants of the Scheme and to validate the existence, quantity and rate of claims. Quality and Safeguard issues are outside the scope of this compliance program.
When registering as a support provider with the NDIA your organisation agrees to be bound by the Agency’s Terms of Business. This includes that registered providers may be reviewed by the Agency in relation to supports funded for a NDIS participant. As part of any review you must keep full and accurate records of supports delivered.
7.3. Documenting support delivery
· The following documentation guidelines have been developed for Registered Providers to provide guidance on the records that, at a minimum, should be prepared and retained:the participant’s name
· the date(s) and total hours or quantity of the support delivered
· the support type.
Depending on the nature of the support being delivered, additional documentation guidelines may apply.
For guidance, the following templates are included in the later sections of this module of the Provider Toolkit:
· 7.7 Support log example
· 7.8 Group roster example
· 7.9 Documentation by support type.
Further explanation of their use is identified in the sections below.
7.4. Retaining documentation of support delivery
The following documentation should be kept on file (either electronically, or paper based) and easily accessible as evidence of support delivery:
· a service agreement containing the schedule, cost, type and quality of supports to be delivered; as well as the expected outcomes for the participant
· approved quotes as appropriate
· evidence of support quantity
· evidence of support type.
Logs for 1:1 support (section7.8) and rosters for group supports (section 7.9) are the best method of documenting the quantity of supports delivered. Wherever possible, these logs should be signed by the participant, a parent/guardian, nominee or carer, as confirmation the support was delivered as claimed. Rosters should also capture the ratio/intensity of group supports.
A log or roster may be sufficient evidence of both quantity and support type for some simple supports. More complex supports will require additional information to evidence the support type. In these instances a case note should be completed. Effective case notes document the activities engaged in and how they relate to the support type claimed. Depending on the support type a case note may also document progress and plans for future sessions.
7.5. Documentation by support type
A chart of individual support items organized by Support Category (plan budgets) is available atsection 7.10 of the Provider Toolkit. The chart is not intended to be a comprehensive list of support types or documentation requirements. Providers should use their judgement to make sure they are able to fully evidence all claims and are maintaining documentation that is fit for audit.
7.5.1 Core supports
Core supports include the following support categories:
· Assistance with Daily Life
· Transport
· Consumable*
· Assistance with Social & Community Participation**
Core supports are episodic with the exception of Supported Independent Living. Episodic supports have a distinct daily start and end time. While most episodic core supports are adequately evidenced through a service agreement and roster or log, some complex core supports may also require a case note.
Supported Independent Living supports extend 24 hours or more at a time such as:
· assistance in a shared or independent living arrangement
· short term accommodation and assistance
· assistance from a live in carer.
These types of supports will be primarily documented through a service agreement detailing the duration, ratios and cost of the accommodation or carer as well as specifying any daily supports to be provided as part of the supported living.
Additional documentation of staff to participant ratios, timesheets, group rosters and case notes detailing activities and skill building should be maintained as appropriate.
*Consumables should be documented in line with Capital supports (below).
**Assistance with social and community participation should be documented in line with capacity building supports (below).
7.5.2 Capital supports
Capital supports include the following support categories:
· continence products
· home enteral nutrition (HEN)
· selection and/or manufacture of customizable or wearable technology
· all assistive technology
· vehicle and home modifications.
These supports (as well as consumables) should be invoiced to the participant. Invoices with the participant’s name, NDIS number and the date of delivery may not require additional evidence of quantity or support type.
7.5.3 Capacity building supports
Capacity building supports include the following support categories:
· coordination of supports
· improved living arrangements
· increased social and community participation
· finding and keeping a job
· improved health and wellbeing
· improved learning
· improved life choices
· improved daily living.
These types of supports (as well as assistance with social and community participation) will typically require both a log or roster and a case note as evidence of quantity and type.
Where the delivery of these supports results in the delivery of a report or assessment to the participant, additional documentation may not be required if the participant name and NDIS number, date(s), times and quantity of the support type are documented within the final report/assessment.
If a provider is delivering coordination of supports to a participant in conjunction with any other support delivery the provider must retain documentation of the following:
· organisational arrangements in place to keep information separate between teams
· a participant’s options for their coordination of supports
· documentation that there is no remuneration provided to staff for participant volume
· documentation confirming that there are no trailing commissions or percentages on funds managed
· confirmation that the conflict of interest and above information was disclosed to the participant.
7.6. Non-compliance
Failure to adhere to the Terms of Business could result in evaluation and revocation of your status as a registered provider.
Claims which are found to be unsupported by the documentation retained by providers may need to be repaid to the Agency.
ndis.gov.au 1 July 2016 | Provider Toolkit Module 7 8
7.7. Support log example
Participant Name: Click here to enter text.
Participant Reference #: Click here to enter text.
Period Start Date (dd/mm/year): Click here to enter text.
Period End Date (dd/mm/year): Click here to enter text.
Claims:
Start Date(dd/mm/year) / Start Time
(hr:mi) / End Date
(dd/mm/year) / End Time
(hr:mi) / Total Hrs
(hr:mi) / Support Type / Participant/Nominee Signature
(if applicable) /
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Staff printed name: Click here to enter text. Staff signature: Click here to enter text. Page: Click here to enter text.of Click here to enter text.