Update 23 August 2021
Earlier this year the ACCC, NDIA and NDIS Quality and Safeguards Commission released a joint statement on Australian Consumer Law and the NDIS Code of Conduct.
This letter highlighted some specific issues relevant to professional liability in the area of assistive technology (AT) advice, prescription and supply.
The NDIA has noted that if consumer law is breached in relation to advice or prescription of AT, pursuit of replacement or refund of AT costs via the AT advisor's professional indemnity insurance may be made.
There is a growing number of examples of this occurring in practice, and it has also been noted that professional indemnity insurance may not be fit for this purpose, which can in turn mean personal financial liability on the part of a prescribing allied health professional.
Allied Health Professions Australia (AHPA) has met with the NDIA about this issue recently, and several of its member organisations, including OTA, are developing a strategy to ensure the rights of service providers are appropriately acknowledged and protected.
To this end, OTA invites members to forward us examples of an AT prescription where the AT advisor was asked to meet the cost of the item through professional indemnity insurance. These will be treated in confidence and will not be shared with any other party. They can be sent to Madison.firstname.lastname@example.org
In the meantime, OTA strongly advises members to ensure their case documentation is at all times meticulous, but particularly so in those cases where a client is exercising their right to choice and control and, in so doing, overriding the clinical advice and recommendations of the occupational therapist. In these circumstances, you should require participants to sign a disclaimer.
You should also make it abundantly clear when a client’s evolving condition is likely to render a piece of equipment obsolete or inappropriate in less than five years.
You should also regularly review your professional liability insurance arrangements, ensuring they are fit for purpose. At the first indication the NDIA might be seeking to meet the cost of an item of AT by taking action against you, you should immediately notify your insurer.
OTA will continue to fight for your rights as registered health professionals working to ensure the very best outcomes for your clients, and we will keep you informed of developments in this space.
Update 9 July 2021
As a result of sustained lobbying by OTA and other advocates in the sector, the Federal Government has abandoned the implementation of Independent Assessments in their current form. OTA would like to thank the significant support of our members in achieving this outcome, and will continue to advocate for an equitable, evidence-based and clinically appropriate approach to assessing eligibility for the scheme.
Michael Barrett, General Manager of Policy and Government Relations at OTA speaks on the Federal Government’s decision to abandon the push to implement Independent Assessments for would-be participants in the NDIS.
Update 10 December 2020
*OTA & Members Heard by the Australian Parliament*
The Joint Standing Committee on the NDIS has tabled two reports (General Issues Report and NDIS Workforce Interim Report). Of note to members working with the NDIS, the Independent Assessments section in the General Issues Report references the ongoing advocacy efforts of OTA and those of our members (emphasis added):
“OTA observed that since functional assessment is a core skill of occupational therapists, failure to engage with OTA and Allied Health Professions Australia (AHPA) in the development of the independent assessments model represents a 'remarkable oversight' by the NDIA. Another submitter asserted that the NDIA did not adequately consult the allied health sector but only provided 'notice'. The submitter—an occupational therapist—stated that:
…we will not simply be placated by 'adequate notice'. We require extensive, sound reasoning before we are going to support any changes, and to date there is no sound reasoning to be found. We are not arguing or fighting against this for arguments sake. People's lives are on the line.”
OTA would like to acknowledge the significant input of our members. Your ongoing commitment to delivering safe, equitable, and evidence-based care continues to drive and support our advocacy. Learn more here.
Update October 2020
OTA has made a submission to the Australian Parliament Joint Standing Committee on the National Disability Insurance Scheme Inquiry into general issues around the implementation and performance of the NDIS Occupational Therapy Australia. You can download the submission here.
Update 15 September 2020
OTA’s Michael Barrett (National Manager, Government & Stakeholder Relations) presented his advocacy address, ‘The NDIS at Age Four: Promise and Problems’ at the #OTExchange2020 today. Michael speaks to the strong advocacy efforts of OTA and the vexed issue of NDIA Independent Assessments. We have made Michael’s address open to view for all.
Freely view and share the presentation below, you can also download the transcript here.
Latest Update 31 August 2020
On Friday 28 August, the Minister for the National Disability Insurance Scheme, the Hon. Stuart Robert MP, issued a media release outlining reforms to the scheme. All of these reforms, with one significant exception, implement recommendations arising from a review of NDIS legislation conducted by Mr David Tune AO PSM in 2019. The other reform is the proposed rollout of Independent Assessments for those seeking to join the NDIS. This proposal has raised concerns among members of Occupational Therapy Australia (OTA).
Significantly, the Minister went into no detail about the Independent Assessments in his media release, merely announcing that they will be rolled out. This is most probably because the final shape of the model is still to be determined.
OTA has a representative on the working group, commissioned by the National Disability Insurance Agency (NDIA) and led by Allied Health Professions Australia, which is developing the training module for the new Independent Assessor service.
OTA holds considerable concerns about aspects of the project, and were preparing to write to the CEO of the NDIA about these when the Minister issued his media release. Accordingly, that letter has now been addressed to the Minister and was sent this afternoon.
The correspondence addresses clinical considerations in some detail, as well as concerns about the future viability of those smaller occupational therapy practices which have been involved in NDIS assessment processes to date and may potentially lose work as a result of the proposed reforms. We specifically ask that any new arrangements not prejudice longstanding and hugely beneficial clinical relationships between highly experienced clinicians working in a small practice and often with very complex client needs.
We can also advise members that Friday’s media release has aroused considerable concern among other allied health professions and consumer groups, particularly those working with people with a psychosocial disability. OTA is not fighting alone.
We will, of course, keep you informed upon receipt of a response from the Minister’s office.
While the NDIS represents an historic opportunity to ensure certainty of support for some of Australia’s most vulnerable people, the rollout of the scheme has been less than ideal. OTA members and their clients report long and frustrating delays in the approval of plans and, as a knock-on effect, long and dangerous delays in the delivery of supports, including vital assistive technology.
In addition, some OTs and allied health professionals are required to undergo certification and auditing as part of the scheme, entailing a significant financial and administrative burden. Unfortunately, some providers are finding these demands unsustainable and as a result are walking away from the scheme, leaving clients with less choice of providers. Given that consumer choice is a central tenet of the NDIS, the current situation is far from ideal. Unless these shortcomings are urgently addressed, the NDIS runs the risk of leaving participants with little choice of provider across significant parts of the country.
- OTA continues to advocate for a standardised fee rate for all allied health professionals working under the NDIS.
- OTA continues to advocate for certification and verification requirements that are sustainable for providers, whilst delivering a robust safeguarding mechanism for consumers.
OTA continues to advocate forcefully in this space, proposing constructive solutions to the many problems besetting the scheme. Along the way there have been some important wins.
In early 2018, the Independent Pricing Review commissioned by the National Disability Insurance Agency (NDIA) recommended significant cuts in the fees paid for most NDIS services. A tiered pricing structure, based around the highly problematic concept of the client’s “complexity”, would have seen some services attract payments of as little as $110 per hour. OTA played a leading role in vocal and protracted efforts to overturn a proposal which threatened the viability of OTs’ businesses and was potentially disastrous for their clients. As a result of these efforts, an increase in the hourly rate paid by the National Disability Insurance Agency (NDIA) from $179 to $193.99 per hour took effect on 1 July 2019.
OTA representatives Anita Volkert and Andrea Douglas gave evidence at the Parliamentary Joint Standing Committee on the NDIS hearing held in Melbourne on 7 November 2019.
Submissions and Correspondence
- OTA Submission: NDIS Act Review and PSG Discussion Paper
- NDIS Thin Markets Project
- NDIS Annual Price Review
- OTA Letter to Joint Standing Committee on the NDIS
- NDIS Planning Inquiry
How You Can Help
OTA welcomes feedback about your experiences working with the NDIS, and your ideas as to how the scheme can be improved. OTA takes this feedback to government and key stakeholders to advocate for better outcomes for OTs, and their clients.
To provide your feedback on this important issue, please contact OTA.