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Accessible, timely and reliable information to improve market functioning and scheme integrity

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Participants, providers and governments don’t have the information they need

We’ve heard from participants that NDIS markets are not yet working as intended. Current information on what supports can be purchased, what supports are available, and the prices and quality of supports is often hard to find or understand. This affects their ability to exercise informed choice and control over their supports.

[There is an] overwhelming amount of information on website. Not easy to try to understand if you are able to purchase something … there often seems to be conflicting information and I don't want to live in fear of being audited and having to repay or have self-managed revoked which is what some people are claiming.

- Carer 180

Understanding complex information across different sources requires significant time and effort from participants, their families, carers, and their intermediaries (such as Support Coordinators and Plan Managers). Working out how NDIS funding can be used is too confusing and complicated.

How confusing it is … it baffles me that it is so hard for us to use and access because we have troubles with the things we need to do to get help. No one informs you what things are … [including] what you can use those allocated things for.

- Participant 181

It takes a lot of time and effort for participants to find providers.

[It is] too clumsy for participants and too hard to find providers easily - all the info is dumped into complicated documents and [Australia] wide rather than State based and sector based. How are disabled people and their stressed carers supposed to navigate this?

- Carer 182

The current NDIS Provider Finder tool only provides basic information on available, registered providers in a participant’s local area. However, this information can be unreliable and is often not enough for participants to find and choose suitable service providers. Many participants and their decision-supporters rely on word-of-mouth information and advice from other participants, especially people they know and trust, or help from an intermediary (such as a Local Area Coordinator or Support Coordinator) with varying outcomes.

Providers also lack sufficiently detailed, accurate or timely information on what supports and services participants need and where.

This means there are very significant information gaps which undermine the effectiveness of NDIS markets.

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Current NDIS digital systems make it difficult for many participants to make informed purchasing decisions when managing their funding

While the National Disability Insurance Agency (NDIA) has made efforts to improve its processes and systems, managing and monitoring spending is still challenging and administratively burdensome for many participants. Paying providers can take a lot of work, and can be slow. Tracking how much funding participants have and in what budgets, as well as how much funding has been used, can be difficult.

More than half of all participants are choosing to use a Plan Manager where they get more choice over providers (compared to agency-management) and it can be administratively easier (compared to self-management).

Being plan managed means [I] can choose my providers without the hassle of self-management.

- Participant 183

However, there is significant confusion about who should be doing what in helping participants to understand, use and manage funding. As at 30 June 2023, over 65 per cent of all active participants have access to two or more intermediaries, with over half of these participants having funding for support coordination and plan management.

The person who is helping a participant to understand and decide how to use their funding is often the support coordinator, not the plan manager. Confusion in responsibilities has led to variability in what plan managers do and help participants with. There can often be a lack of shared understanding of how funding can be used, delays in payments being made to service providers, and risks to the integrity of the scheme. “It is evident and widely reported that a proportion of intermediaries fail to properly understand their roles and responsibilities, and this is adversely impacting quality and safety.

- SDA Alliance 184

When there is not enough education or support for people who do not have the benefit of having a support coordinator - organizations, plan managers and support workers end up doing the job for them - this is unpaid work and it is also dangerous as they may not have the correct information and often think they are helping people by saying something like 'you can get XYZ because I know someone who got it paid for by their plan'.

– Provider 185
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Current NDIS processes and systems could better enable market stewardship, monitoring and protect the scheme from non‑compliance, sharp practice and fraud

Current NDIS processes and systems don’t provide governments with sufficient information to protect the integrity of the scheme and allow governments to monitor and steward the market.

Governments can only see part of the market based on NDIA and plan managed transactions. Data about whether supports meet participants’ needs and are effective in delivering outcomes is not collected in a coordinated way, to know how the market is working and what support approaches work best. Incomplete data and limited market visibility also make it difficult to understand the nature and scale of non-compliance, sharp practice and fraud occurring across the scheme.

Providers can claim payment from NDIA or Plan Managers without confirmation from participants that the services were provided. Similarly, self-managed participants can submit claims for payment without providing evidence of services provided (although they are expected to retain evidence). These payment arrangements pose a high risk of fraud

- ANAO Report on ‘Effectiveness of the National Disability Insurance Agency’s Management of Assistance with Daily Life Supports’, 2023 186

Without sufficient market visibility, it is difficult for governments to send timely and appropriate market signals to service providers about potential opportunities and supply gaps in the market, or protect scheme integrity.

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