Rumour Has It… Should Plan Management Funding Come Out of My Plan?

There is no shortage of NDIS policy. Alongside the Act, we have Operational Guidelines, the Price Guides, fact sheets, supporting legislation, Rules, Tribunal decisions and much, much more. Yet despite this, over the last five years, the disability community has learnt that sometimes no amount of policy is enough. On an almost daily basis, policy is misapplied, misinterpreted or just plain missing.

As DSC, we are increasingly hearing that there is a significant gap between what is written on paper and what is happening on the ground. In this series, we will be focusing on these discrepancies in the Planning process, exploring questionable decisions that Planners appear to be repeatedly making. We look into why they are happening and what Participants can do about it.

First off the rank, why are so many Participants being told that Plan Management comes out of their Plan?

The situation is this: A Participant decides they want part or all of their Plan to be plan managed. The Planner says this is possible but would result in a reduction in funding for their other supports.

For example, a Participant might have been given $8425 in funding for Improved Daily Living. This is designed to cover the cost of assessments with allied health professionals and twice-weekly sessions with a therapy assistant.  If the Participant wishes to plan manage this support, they might be told that they will have to reduce their therapy hours to cover the expense of compensating the Plan Manager. The Participant is then forced to choose between a reduction in the supports they are entitled to or electing another form of fund management.

 

Why do we think it is happening?

Unfortunately, this appears to be occurring far too consistently to be the work of a couple of misinformed planners. Our best guess is that this is an unintended consequence of the Agency’s approach to typical support packages (TSPs).

A TSP is the Agency’s estimation of the package size a Participant should have, based on factors like their disability, life stage and level of functional impairment.

During the Planning process, each draft Participant Plan is compared to this TSP and found either to be within the expected range or not. Where it is above the TSP, our understanding is that the Planner needs to either find ways to reduce the Plan size or demonstrate why this Plan is higher than the reference package.

So how does this relate to the problem? Well, we suspect what is happening is that the TSPs do not adequately account for different choices of funds management. So while a person’s Plan may fit within the acceptable range if their Plan were agency managed, the additional $1,425.01 that Plan Management costs may push their Plan above what the TSP suggests.

And with pressure to keep package sizes down, we are guessing that this is the point where Planners start saying that the additional $1,425.01 has to come from somewhere else.

 

What can you do?

This a straight down the line dodgy decision. Section 13 of the NDIA's Operational Guidelines on Planning details the rules surrounding the management of plan funds. It emphases a Participant’s right to choose their management type and lists the circumstances under which the planner can refuse the Participant’s request. But nowhere, even under creative reading, can you find anything about the funding for Plan Management resulting in a reduction of the Participant’s other supports.

If a Participant elects to plan manage some or all of their supports, then this funding should appear under the “Improved Life Choices” category of a Plan. It does not impact any other category or line item.

We encourage Participants who have this experience to challenge the Planner’s decision. They can do this by referencing the Operational Guidelines and asking the Planner to produce policy to justify their decision. They might also like to point the Planner towards the NDIA’s recently published Q&A on Plan Management, which specifically states that Plan Management funding does not come out of the Plan.

If necessary, the Participant might be required to go to internal review. However, hopefully this can be avoided given that the timeframe of internal reviews is currently akin to the gestation period of most mammals.

As a service provider, you play the important role of informing Participants of their rights so that they can challenge incorrect planning decisions as early as possible. As the old saying goes- “the only thing necessary for bad planning to triumph is for good service providers to do nothing.” Now is not the time to do nothing.

There is a reason we have titled this series “Rumour Has It.” Unfortunately the NDIS doesn’t publish a list of all the bad decisions they’re making so we have to go sleuthing and rely on our sources. If you know of cases where Planners have acted in a way that contradicts policy, or is based on unclear policy, please let us know.