• No results found

REPORT ON THE NATIONAL DISABILITY INSURANCE AGENCY’S HANDLING OF REVIEWS

N/A
N/A
Protected

Academic year: 2023

Share "REPORT ON THE NATIONAL DISABILITY INSURANCE AGENCY’S HANDLING OF REVIEWS "

Copied!
31
0
0

Loading.... (view fulltext now)

Full text

Between July 2016 and January 2018, the Office of the Commonwealth Ombudsman received 400 complaints relating, at least in part, to the NDIA's management of assessments. This represents 32.5 percent of all complaints filed with our firm about the NDIA during this period. In February 2018, the NDIA informed our Bureau that it had approximately 8,100 reviews on hand and was receiving approximately 620 new review requests each week.

The NDIA has acknowledged that some reviews take up to nine months to complete. While the NDIA implemented a new dedicated national team in November 2017 tasked with addressing the backlog, this approach to date has not been sufficient to quickly and. While we acknowledge the NDIA's efforts to address review delays, we believe that more can and should be done to ensure that administrative red tape or under-resourcing does not prevent participants from readily exercising their review rights.

Complaints to our Office also highlight other systemic issues such as poor communication about review processes and outcomes.

I NTRODUCTION

B ACKGROUND

If a participant is dissatisfied with the NDIA's decision on an internal review, the participant can appeal that decision to the Administrative Appeals Tribunal (AAT). In each of these briefings, the NDIA acknowledged that its approach to reviews could be improved. The NDIA has accumulated a backlog of reviews, some of which were received up to nine months ago.

In its briefings to our Office on November 25 and 8, 20176, the NDIA outlined a number of new and upcoming initiatives to improve participants' experience with the NDIS more broadly and with the assessment process in particular. The NDIA hopes this approach will improve the quality and communication of plans and, in turn, minimize unnecessary reviews. In February 20189, the NDIA recommended that approximately 8,100 assessments remained in the backlog and that the national backlog team was clearing approximately 200 assessments per week10.

The NDIA also reported that it continues to receive about 620 new review requests per week, which are handled by regional review officers.

H ANDLING REQUESTS FOR REVIEW

Sarah filed a complaint with our office in February 2017 about the time it took the NDIA to complete its review. In addition, Sarah complained that repeated calls to the NDIA Contact Center regarding the progress of her request went unanswered. In its response, the NDIA acknowledged that it had not communicated effectively with Sarah to update her on the progress of her review request.

We recommend that the NDIA establish standard operating procedures that require personnel to confirm review requests within a specified time frame. We recommend that the NDIA establish standard operating procedures to guide the Contact Center, Complaints and Front Line personnel in responding to requests for updates on review requests. The advocacy organization complained to our office in August 2017 that the NDIA had incorrectly handled the request for internal review as a request for.

Following our investigation, the NDIA confirmed that the planner had incorrectly treated the request for an internal review as a request for a plan review.

P ROVIDING NOTICES OF DECISION

We recommend that the NDIA update its operational guidelines for review16 to require staff to clarify with the participant whether they are seeking an internal review of decision or a reassessment of their plan. recommends that decision letter templates be revised to ensure that participants are expressly advised of the type of 'review' undertaken and the resulting review rights. Under the Act, the NDIA is not obliged to give written notice of a decision to carry out a plan review. We recommend that the NDIA implement a standard operating procedure that requires staff to notify participants of decisions to carry out plan review, either by telephone contact or using a letter template.

We have received complaints that the NDIA does not provide a clear and/or sufficient explanation of the reasons for an audit decision. We have reviewed the letter template that the NDIA uses to notify participants of an adverse plan review decision.19 We note that the template provides staff with guidance on the rationale for the decision by presenting three general reasons for staff to choose from, depending on relevant. In the course of investigating Jill's complaint, we also identified that the NDIA had not provided her with an adequate explanation of the reasons for the decision not to accept the offers, particularly in relation to the car modifications.

We have received complaints involving the NDIA advising a participant of incorrect review rights or failing to provide clear advice on review rights. In response to these complaints, the NDIA advised us that its ICT system currently requires staff to enter a plan review decision to execute an internal review decision. We recommend that the NDIA update the template to specify that the review is an internal review of a decision that is reviewable under sections 99 and 100 of the Act.

We have also reviewed the letter template that the NDIA uses to give written notice of decisions. We recommend that the NDIA consider including the AAT website address and telephone number in its letter template. We also recommend that the NDIA consider adding links to the relevant parts of the Operational Guidelines (such as section 6 of Review of Decisions) and the Act, relevant to the external review process.

We recommend that the NDIA revises its operational guidelines and relevant job cards to require personnel to issue assessment decision letters by the date of the decision or within a specified period of time following the decision. The NDIA has advised these complainants that if they remain dissatisfied, they may resort to internal review rights.

T IMELINESS

We recommend that the NDIA review any script, task card or other material that guides staff and contracted providers' discussions with participants about their notification rights to ensure that they require staff to: (a) make clear to participants that they have the right to request a review. if they are not satisfied with a decision or their circumstances have changed, and (b) guide staff to explain that all elements of the participant's plan will be considered in an unscheduled plan review. When the NDIA briefed our office24, it stated that it assigns priority to cases involving security risks. We recommend that the NDIA refer to the triage and prioritization principles in sections of the operational guidelines or in task maps that specifically focus on triaging.

When asked about time frames for allocating review requests to a member of staff for decision,28 the NDIA advised that it was 'accepted best practice' to do so within 14 days of the decision to carry out a plan review. Under s 48(3) of the Act the NDIA is required to facilitate a plan review within 14 days of the decision to carry out a review. We recommend that the NDIA revise its operational guidelines and task cards to make it clear to staff that plan review must be granted (at least) within 14 days of being accepted for review, to ensure that the agency meets its legislative obligations.

In some cases, the participant's existing plan has expired before the NDIA has made a decision on their review request. The NDIA should do everything it can to ensure that participants' rights to a review are not affected by administrative delay. The NDIA's briefings and responses to our inquiries have acknowledged that the NDIA has a significant backlog of review requests, receiving several hundred new requests each week.

By law, the NDIA must carry out plan reviews and internal reviews "as soon as reasonably practicable" (s 48(3) and s 100(6) respectively). However, the NDIA currently has no formal timeliness standards for completing unscheduled plan reviews or internal reviews. In our view, the lack of timeliness standards or even recognized average timeframes for completion is problematic for both the NDIA and participants.

As already noted, this lack of security is a major driver of complaints to the NDIA and our office. We also accept that the current number of reviews means that the NDIA may not wish to publish the actual average timeframes for reviews.

C ONCLUSION

We note that the Operational Guidelines-Planning (section 15.2) provides four (4) general assessment criteria to determine whether the NDIA will accept a request and each criterion has several parts. The NDIA acknowledges issues raised in the issue document and appreciates your recognition of the unique operating environment during the period of transition to full scheme. The NDIA is committed to improving its administration of reviews and recognizes the review mechanisms under sections 48 and 100 of the National Disability Insurance Scheme Act 2013 are an important feature of our legislation which provides participants with the right to request a review of a decision that by the NDIA.

The NDIA considers the elements and recommendations in the review management issues document. The NDIA accepts the merits of each of the recommendations and has begun to identify the most practical way to implement responses, including timeframes for resolution. The NDIA will continue to liaise with your office to provide visibility and updates on the progress of these measures.

The NDIA is currently reviewing letters and resource material relating to reviews. The NDIA recognizes that assistive technology and home modification requests drive a significant proportion of review requests. The NDIA is currently piloting road improvements with a view to rolling out improved processes nationally.

The Office of the Commonwealth Ombudsman (OCO) provided 20 primary recommendations in relation to the NDIA's handling of reviews. Work has begun which will address some of the recommendations made by the OCO, and the NDIA intends to undertake further work as an immediate priority to address the remainder of the recommendations. The NDIA appreciates the work of the OCO, the report and the value it brings to delivering a more robust National Disability Insurance Scheme.

Undertake a process to improve letters sent by the NDIA to participants about reviews to ensure clarity and accessibility of information. The NDIA is also improving guidance for planners and internal reviewers to support the production of consistent, high quality decision letters. 6 We note that the Operational Guidelines – Planning (section 15.2) provide four (4) general assessment criteria to determine whether the NDIA will accept a request and each criterion has several parts.

Add links to the relevant parts of the Operational Guidelines (such as section 6 of Review of Decisions) and the Act, relevant to the external review process.

References

Related documents

Page 4 RECOMMENDATION That the Council resolves to: 1 Consent to the proposal by the Department of Planning, Lands and Heritage to excise a portion of Reserve 29037 being a seven 7