PIR NDIS Transition Standards and Procedures

Transcription

1 PIR NDIS Transition Standards and Procedures Version: 0.4 Issued: May 2018 While the Australian Government Department of Health has contributed to the funding of this material, the information contained in it does not necessarily reflect the views of the Australian Government and is not advice that is provided, or information that is endorsed, by the Australian Government. The Australian Government is not responsible in negligence or otherwise for any injury, loss or damage however arising from the use of or reliance on the information provided herein. Page 1 of 16 Version 0.4

2 Contents 1 Introduction Purpose Scope Context PIR AND NDIS TRANSITION SUMMARY THE PIR NDIS TRANSITION PROCESS Existing PIR Participants Participants new to PIR Consent and PIR NDIS transition Choice and control and the NDIS DETAIL OF THE PIR TRANSITION STEPS Checking eligibility and consent Gathering evidence and the Access Request Form (ARF) Eligibility decision from the NDIA Planning meeting A PIR PARTICIPANT IS NOW A NDIS PARTICIPANT Providing in-kind services Service Agreements Conflict of Interest Reporting to the NDIA FIXUS GUIDE Likelihood of Eligibility NDIS Status (Fixus) Documents Services Provided This is to record in-kind support for an NDIS participant. This functionality will only become available when a participant has a NDIS funded package in place Document Control Version History Page 2 of 16 Version 0.4

3 1 INTRODUCTION 1.1 Purpose The purpose of this document is as a tool to guide Support Facilitators through the transition of Brisbane South PIR to the National Disability Insurance Scheme (NDIS). The document will include changes to processes and procedures. It will also outline procedures to record the transition of participants, as well as the process for recording in-kind support provided to NDIS participants. This document is only a guide for Brisbane South PIR transition. For further information on PIR processes and procedures, please review other documentation in the Brisbane South PIR suite of documents and the Department of Health PIR Guidance Pack, September For details, tips and further guidance on NDIS, please go to the NDIS website and/or attend one of the many training sessions in the region. 1.2 Scope In scope: Out of Scope: Standards and procedures for the Brisbane South PIR region that govern the transition of participants to NDIS and recording information for participants on an NDIS funded package. Internal procedures for individual Partner Organisations that are not governed under PIR Operational Guidelines. 1.3 Context The document will cover the practice and data collection requirements for Brisbane South PIR NDIS transition. It is expected that this document will be subject to ongoing changes as more information is known about the functioning and reporting of NDIS, and the developments of Fixus to support NDIS. Changes between versions will be summarised in the Version History section at the end of this document. 2 PIR AND NDIS TRANSITION SUMMARY The PIR program will be transitioning to the NDIS. The program has been extended to 30 June Prior to this time, some PIR participants will transition to NDIS and those deemed ineligible by the National Disability Insurance Agency (NDIA) will receive continuity of support arrangements until 30 June Brisbane South PIR Partner Organisations are expected to: Ensure continuity of support through the PIR program for participants deemed ineligible by the NDIA Assist participants likely to be eligible for NDIS to transition to the scheme Provide in-scope services to PIR participant who have transitioned to a NDIS Individually Funded Package (IFP) and until 30 June 2019 (via in-kind arrangements). PIR policy and procedures at Brisbane South for PIR participants will continue as usual with additional roles and requirements to assist potentially eligible participants to transition to NDIS. In the Brisbane South PIR (BSPIR) region, participants in Scenic Rim are in an area that has rolled over to NDIS. Participants in the rest of the BSPIR region (including Logan, Redlands and Brisbane South) can apply for NDIS from 1 January 2018, with possible NDIS plans available from the rollover date of 1 July Page 3 of 16 Version 0.4

4 3 THE PIR NDIS TRANSITION PROCESS In order to gain support from PIR to transition to NDIS, a person must be a participant in the PIR program. People in the community who are already on a NDIS Individual Funded Package (IFP) (or NDIS Plan) are not eligible for PIR and cannot enter the program 1. Prior to supporting a participant to transition to NDIS, they must first be assessed as eligible for PIR and become a PIR participant. They can then be assessed as potentially eligible for NDIS and preparations for transition can be made. 3.1 Existing PIR Participants With participants across the entire BSPIR region being able to submit applications to the NDIA from 1 January 2018, it is advised that Support Facilitators begin discussions with existing participants about NDIS now. It is also recommended that SFs use the eligibility questionnaires in Fixus to guide discussions. The NDIS website also includes a range of videos and resources: ndis.gov.au. The website reimagine.today is a highly recommended resource. It is a requirement of Brisbane South PIR that the short 4-question NDIS eligibility questionnaire (under the NDIS tab) be used to assess NDIS likelihood of eligibility. For further information, refer to the Fixus instructions below. This must be done for all existing PIR participants. If you have completed the likelihood of eligibility in the past, it is a requirement of Brisbane South PIR that you complete the short eligibility questionnaire again but under the NDIS tab section. Understanding of the NDIS and processes have changed, and so the questionnaire needs to be completed again. See Fixus reporting below. 3.2 Participants new to PIR Brisbane South PIR has a revised Maximum Client Level of 628 to ensure the transition phase is focused on supporting NDIs rollout and not expansion of the program. Client intake may continue through the transition period but must be balanced by continued application of exit criteria to ensure the MCL is not exceeded. All Partner Organisation will have a set minimum and maximum MCL as part of sub-contractual obligations with the PIR Lead Agency. For new PIR participants, please follow usual PIR processes and procedures as outlined in the PIR Practice Manual. It is recommended that during Phase 2: Assessing Phase, a NDIS eligibility assessment be undertaken by SFs in additional to CANSAS. To guide this, SFs can use the eligibility questionnaire and information survey in Fixus (under the NDIS tab). 3.3 Consent and PIR NDIS transition Brisbane South PIR has three consent forms for completion. The standard PIR consent form is to be completed during the Assessing Phase. It includes information about NDIS. 1 PIR Guidance Pack, Sept 2017, p.15. Page 4 of 16 Version 0.4

5 The second consent form is the Consent to share information and refers to Brisbane South PIR and Department of Health expectations to share details for PIR NDIS transition. This particularly relates to the section 55 request from NDIA 2. The third consent form is for participants soon to exit PIR. It allows agencies to contact a participant again prior to a NDIS rollover date, in order to offer support to access NDIS. Please note that according to the DoH PIR Guidance Pack, participants in the Scenic Rim region can no longer be exited if they have submitted an access request form to the NDIA or if they do not meet age and residency requirements, I.e. are aged over 65 years of age or are a non resident of Australia. This rule will apply to the entire Brisbane South PIR region from July These participants are referred to as PIR inactive. This status change can be made via the NDIS tab within a Fixus case and should only be made in the following instances; 1. The client resides in a rollout region 2. The client has made an application to the NDIA (irrespective of the outcome) 3. The client is aged 65 years or older 4. The client is a non-resident of Australia 3.4 Choice and control and the NDIS It is a participant s choice as to whether they wish to apply for the NDIS. However, open and transparent conversations need to occur and the following taken into consideration: There is no detailed information (at this point in time) around other services available to participants post 30 June PIR clients who meet the age and residency requirements for NDIS but choose not to submit an access request for NDIS supports will not trigger the Continuity of Support commitment 3. The Continuity of Support arrangements are triggered post 30 June Participants who choose not to apply for NDIS but meet the age and residency criteria, can still access PIR supports until the end of the program period 4. It should also be noted that the September 2017 PIR Guidance Pack from DoH states, All PIR clients who meet NDIS age and residency requirements should be supported to seek access to the NDIS (p.31). 4 DETAIL OF THE PIR TRANSITION STEPS All Brisbane South PIR participants are able to apply for the NDIS from 1 January All organisations need to have discussions with participants now, ensure consent process are complete and begin gathering evidence for NDIS applications, for those clients likely to be eligible. For details on reporting in Fixus, please follow the instructions below. SFs are also encouraged to use the following resources (if required) on the PIR secure website: PIR NDIS Transition Step-by-Step Guide PIR NDIS Application Checklist Guide to documenting evidence for NDIS Reimagine.today website 2 For more information on this, refer to the PIR Guidance Pack, September See PIR Guidance Pack, September 2017, p. 6 4 Confirmed by Tania Shelby-James, Transition Support Project, 8 Nov Page 5 of 16 Version 0.4

6 4.1 Checking eligibility and consent As discussed in section 3, the first part of the NDIS transition is to have an open discussion with PIR participants, carers and family; and to complete assessments and likelihood of eligibility for NDIS questionnaires. 4.2 Gathering evidence and the Access Request Form (ARF) 1. Use the Access Request Form (ARF) template on the PIR secure website to guide the application process and the gathering of evidence for participants. 2. When almost all evidence is collected, SFs are to work with participants to contact the NDIA and gain an official ARF. Applications to the NDIA following the request of an ARF must be submitted within 28 days. It is advisable to gather evidence before requesting an ARF from NDIA. Participants in a defined program If you have a participant in a defined program, an ARF does not need to be completed and a participant is automatically eligible for a NDIS IFP. A defined program is a Disability Services Queensland (DSQ) program, for example HASP. If you have a participant in a defined program, you can contact the NDIA directly to enquire as to the next step. PIR is not a defined program. Please note that a defined program with DSQ is not the Disability Support Pension (DSP). The NDIS is completely independent of DSP and will not impact a person s DSP. However, some evidence used to apply for DSP can be used for a NDIS application. Getting a diagnosis on the Access Request Form As part of the ARF, participants need to gain a diagnosis from a GP or psychiatrist 5. Health professionals can also complete components of functional impairment sections on the ARF. The relationship between a participant and their health professionals will vary across the program cohort, and knowledge about NDIS by professionals also varies. In some cases, it is recommended that SFs attended professional appointments for the completion of the ARF with participants and prepare in advance. Before seeing a health professional to complete an ARF, it is recommended that participants take information, forms, assessments and evidence to assist. Evidence, functional impairment; and reasonable and necessary The decision on whether a PIR participant is eligible for NDIS will be made by someone in the NDIA s National Access Team (NAT). Eligibility decisions are made based on the paperwork provided with the Access Request Form. It is important that enough information is provided for the NAT to make their decision. The cover letter and guiding documents on the PIR secure website can assist. Other important things to note: Any assessments by health professionals, CANSAS, and letters from support workers, carers and family can be included. Other health assessment tools including the HONOS and LSP-16 can be beneficial. Documentation must show the participant s condition is lifelong and permanent. The condition can be episodic but evidence must show it is lifelong. 5 It is not mandatory to have a diagnosis to apply for the NDIS, however experience in other regions that have already transitioned, has shown that a diagnosis can be beneficial for NDIS applications. Page 6 of 16 Version 0.4

7 Impact of the condition on a participant s day-to-day life needs to be shown (i.e. evidence of functional impairment), including detail: - Is a participant able to prepare their meals and/or remember to take medication? - Does a participant need help to get out of the house? - Does a participant need support to attend an event? - Are carers/family members supporting the participant with day-to-day activities and would like the assistance of a support worker or professional? How is the family unit working on a daily basis? What is advocated for and shown as evidence in the application process will be used as a guide in the planning conversation, if a participant is found NDIS eligible. Further information on this is on page 32 of the PIR Guidance Pack, Sept Access Request Form (ARF) listed contact The NDIA will always contact the participant unless advised otherwise. If you have concerns that a participant may not be contactable or if a participant would like the SF to be contacted by the NDIA, please ensure you note this on the ARF. Contact information and representative details are on page 3 of the form. 4.3 Eligibility decision from the NDIA After an Access Request Form is submitted, the NDIA will contact the participant with their decision, or if they require further evidence to make a decision. A decision can take a few months. Participants will continue to receive PIR supports while waiting for a decision on their application. Participants in a defined program If a participant has been in a Disability Services Queensland (DSQ) defined program or listed on the register of need, they should be automatically eligible for NDIS. Participants will receive a call from the NDIA for a planning meeting. This will likely take place after the rollover date, for Logan, Redlands and Brisbane South, this is 1 July A participant is eligible for the NDIS If a participant is deemed eligible by the NDIA, they will receive a call to set up a planning meeting date and time. A planning meeting can occur face-to-face or via telephone. Participants can chose a number of people to attend planning conversations with them. A participant is deemed ineligible for the NDIS If a participant is found not eligible for NDIS, they will continue to receive supports from PIR until 30 June If a participant is not happy with the ineligibility decision by the NDIA, they can appeal. Please go to the NDIS website at: ndis.gov.au for details. 4.4 Planning meeting After a participant is deemed eligible by the NDIA, they will be contacted for a planning meeting. SFs are able to assist participants prepare for their planning conversation and can attend meetings, if requested. A variety of workbooks are available to assist including the NDIS workbook and reimagine today workbook. These are both available on the PIR secure website. As part of the pre-planning process, it is recommended that SFs use the participant s PIR history and experience to guide support needs, include records of direct and indirect time, and any PIR ICB used. Page 7 of 16 Version 0.4

8 5 A PIR PARTICIPANT IS NOW A NDIS PARTICIPANT A PIR Participant will be considered to have transitioned from PIR to NDIS if they: Are found eligible for NDIS supports Have finalised the NDIA planning process; and Have an Individual Funding Plan (IFP) in place and are accessing NDIS supports 6. The IFP must contain Support Coordination hours for the participant to remain in PIR and start receiving inkind supports. These hours have been prepaid by PIR block funding. If an IFP does not include Support Coordination hours or the SF believes the hours listed are too low, please contact the Brisbane South PHN PIR Team to gain advice on requesting a review or applying for supplementary support coordination hours from Department of Health. Supports and services listed in the participant s IFP outside of Support Coordination are to be provided by other services external to PIR. BSPIR Partner Organisations are only to provide Support Coordination to NDIS PIR Participants. For details on the support coordination role, refer to the NDIS website, NDIA support coordination documentation and guidance from Brisbane South PIR provided training (Support Coordination Academy) Support Connection If Support Connection is listed in a plan, this is a short-term service generally provided by the Local Area Coordination team (LAC). It could be provided by PIR Support Coordinators in the absence of a LAC in a region. This service should be not be provided by PIR Partner Organisations in Scenic Rim as the LAC is available. Participants with Support Connection are to be directed to the local LAC. In Beaudesert, the LAC contact is: The Beaudesert LAC also holds regular drop-in sessions at local libraries and community centres. 5.1 Providing in-kind services The hours available to provide Support Coordination to participants will be listed in a participant s plan. Hours spent providing support coordination will be recorded in Fixus for reporting. This function is not yet active in Fixus and so organisations in the short term will need to keep manual records. Adjustment to the in-kind Services screen is part of the next Fixus Release Schedule. Partner Organisations will be advised as soon as the in-kind function is working. 5.2 Service Agreements It is a recommendation of the NDIA that a service agreement is established between a participant and a service provider. Partner Organisations are to use their own service agreements when engaging participants in Support Coordination. Brisbane South PHN PIR Team can provide a template, if required. 5.3 Conflict of Interest When a PIR participant has an IFP, services provided will be by a Support Coordinator rather than a Support Facilitator. The Support Coordination role will involve connecting participants to services, assisting with 6 PIR Guidance Pack, Sept 2017, p. 33 Page 8 of 16 Version 0.4

9 NDIS plan budget maintenance and guiding participants in developing relationships with other services and supports. It is possible that a Support Coordinator (SC) may wish to connect a NDIS participant to a service provided by the BSPIR Partner Organisation that employs them. It is important that, in this instance, when doing the service connection, evidence of choice is provided to the participant and documented. For example, Benevolent Society is providing Support Coordination to a PIR NDIS participant in-kind and that participant wants to access another service offered by Benevolent Society, utilising funds from their NDIS Plan. This could be a day activity service, for example. In order to ensure that choice is provided by the PIR Support Coordinator, evidence must be provided to the NDIA that other services and options where discussed with the participant. Evidence can be saved and documented in Fixus. For further details, review business rules and conflict of interest information on the NDIS website. 5.4 Reporting to the NDIA As part of the capacity building component of the NDIS, Support Coordinators will need to report back to the NDIA as part of their role, showing capacity building outcomes for participants. When a participant is provided with an Individual Funded Package (IFP) including Support Coordination, their chosen Support Coordinator will receive a Request Service: Coordination of Supports Form from the NDIA. An example of this form is on the PIR secure website. This is required for reporting outcomes to the NDIA and in the lead up to the 12 month NDIS Plan review. 6 FIXUS GUIDE It is important that reporting during the transition phase is completed so that required data can be provided to the Department of Health and the PIR Consortium can adequately support participants to transition to NDIS. NDIS functionality can be found under the NDIS tab in Fixus. All NDIS reporting is completed in this section. Page 9 of 16 Version 0.4

10 6.1 Likelihood of Eligibility All participants in PIR are required to have the short 4-question NDIS Eligibility Questionnaire completed. This can be found under the NDIS tab. Under Assessments, then add form. It is at the discretion of the SF and the Partner Organisation if they wish also to complete the NDIS Eligibility Information form in the same section. The NDIS Eligibility Information form is longer and more detailed and can assist SFs in gathering evidence and information around functional impairment. For complex cases where residency eligibility is not clear, this longer form can guide decisions and provide information. For the most up-to-date guide on NDIS and eligibility, please go to the NDIS website and refer to the NDIS Act 2013 and NDIS Operational Guidelines. 6.2 NDIS Status (Fixus) Every active client should have an NDIS status as whole of region approaches and beyond. These status options are listed by the Department of Health in the PIR Guidance Pack (Sept 2017). Exceptions to this are "NDIS Criteria Met (Likelihood)" and "NDIS Criteria Not Met (Likelihood)" which have been added as a way to record movement for clients who have not yet begun the NDIS application process. The NDIS Status definitions are as follows: NDIS Status NDIS Criteria Met (Likelihood) NDIS Criteria Not Met (Likelihood) Client declined to apply Definition Initial discussion between SF and participant indicates that the participant is likely to be eligible for NDIS. Initial discussion between SF and participant indicates that the participant is unlikely to be eligible for NDIS. This category identifies the number of clients who meet NDIS age or residency requirements but who decline to seek access to the NDIS. Page 10 of 16 Version 0.4

11 Client found eligible for the NDIS Client eligibility decision pending Client with an NDIS IFP Client receiving inkind services from organisation Client has chosen an alternate NDIS service provider Client has submitted an application but are now inactive Client found not eligible for the NDIS This category includes PIR clients who have been found to meet NDIS Access requirements, but are yet to commence the assessment and planning meeting to determine the level of services and supports to be included in an IFP. This category identifies the number of clients where an Access Request Form has been submitted to the NDIA and an outcome has not yet been determined. This category includes PIR clients found eligible for NDIS supports who have finalised the assessment and planning process. This category includes PIR Clients as NDIS participants receiving NDIS supports from the PIR Organisation. I.e., at this time, the PIR Organisation is providing services to NDIS participants that are contributing to the program in-kind commitment. This category includes PIR clients who have successfully transitioned to the NDIS, and due to relocation or extenuating circumstances are now seeking services and support from alternate service providers. This category identifies the number of clients where an application has been submitted but contact has been lost with the client. The client s contact details should be maintained in the event they re-renter the PIR program. This category identifies the number of clients where an application has been unsuccessful Client statuses should be updated each time a client s circumstances change. Each change is date stamped and the history can be tracked under the 'Status History' section of the NDIS tab. When selected, some status options will automatically generate a drop down list with mandatory reason selections. A brief comment should also accompany this change to demonstrate that the correct status has been selected. Review / Appeal Process: Additionally, if a client undertakes a review or appeal, this must also be recorded in Fixus. The Fixus April 2018 release amended this process so that review and appeal processes could be monitored 'alongside' the NDIS status rather than 'instead of' as previously recorded. Once a review or appeal is selected, Fixus will record a start date. When an outcome is finalised, the user should select Complete which will date stamp the end of the process. Fixus will record a history of all reviews and appeals undertaken by a client with start and end dates, allowing for BSPHN to record and monitor the average length of time these processes take. Page 11 of 16 Version 0.4

12 Case overview search screen: 6.3 Documents Documents are uploaded to Fixus via the Documents tab as usual. When uploading a NDIS supporting documentation navigate to the Category field and select NDIS. Documents that should be stored here would be the evidence collected as part of the NDIS application and may include: Confirmation of diagnosis Clinical assessments Allied health reports Carer support letters, etc. Page 12 of 16 Version 0.4

13 Uploaded documents that have the NDIS category selected will appear under the Documents heading on the NDIS Tab. 6.4 Services Provided This is to record in-kind support for an NDIS participant. This functionality will only become available when a participant has a NDIS funded package in place. Page 13 of 16 Version 0.4

14 To begin adding services, a service configuration must first be entered. Service configurations should be set up in hours. This will ensure that when the actual service entries are recorded in minutes, the correct breakdown of this figure is auto-calculated. To create a service configuration, Parent must be selected. If I participant has their plan reviewed and a change to their funding occurs, this can then be amended and in this instance, Variation would be selected. Page 14 of 16 Version 0.4

15 To remain consistent with how direct and indirect time is recorded in Fixus, NDIS service hours should be recorded in minutes. The hourly Coordination of Supports rate of $94.06 will be broken down and automatically calculated by Fixus. As each service is added, it is deducted from the overall balance. 7 DOCUMENT CONTROL 7.1 Version History Version Date Issued Author Comments June 2017 Rebecca Mitchell Initial Draft issued to L Ross, E Kerr and B Stevens for review July 2017 Rebecca Mitchell Incorporating feedback from L Ross and E Kerr Issued to SSFs 0.3 November 2017 Elizabeth Kerr Major changes and adjustments to cater for Fixus changes. Information on PIR NDIS transition added. Page 15 of 16 Version 0.4

16 Version Date Issued Author Comments 0.4 May 2018 Julie Blake Changes to reflect updates regarding NDIS inactive status (3.3) Fixus NDIS status entry(6, 6.2) and services provided (6.4) Page 16 of 16 Version 0.4