Still Trust your ‘Heathcare’ providers? – Mick Raven
As the NDIS moves to independent assessments, these companies stand to profit from the change
25 March 2021
At first glance, the healthcare company Allied Care Group looks like just another small business trying to make its way in a crowded market.
- The NDIS is moving to a new model of eligibility testing called independent assessments
- Companies are not allowed to carry out assessments in areas where they provide other NDIS services
- Several companies with the same parent company as NDIS service providers have won contracts to carry out assessments
Its headquarters is listed as an office suite above a bank branch in sleepy Kingscliff, just south of Tweed Heads.
The company seems an unlikely candidate for a massive federal government contract worth potentially hundreds of millions of dollars over the next five years.
Yet in February this year, Allied Care Group was one of eight organisations picked to roll out a controversial new eligibility testing regime for the 400,000 participants in the National Disability Insurance scheme.
The company’s contract will likely involve tens of thousands of assessments around the country — a huge undertaking for a firm with no apparent record of delivering major government projects.
But behind Allied Care Group’s humble facade stands an emerging giant of Australia’s disability support industry.
The company is in fact a subsidiary of Zenitas Healthcare, a disability and aged care juggernaut with almost 5,000 staff and more than $250 million in revenue last financial year.
Its chief executive is Rob De Luca, a former head of the National Disability Insurance Agency (NDIA), the agency which runs the NDIS.
Zenitas CEO and former National Disability Insurance Agency CEO Rob De Luca.(Zenitas)
A major question is that given Zenitas Healthcare’s expertise in disability services, why did it decide to apply for the contract to provide so-called independent assessments through a subsidiary rather than directly?
It appears that by tendering through Allied Care Group, Zenitas has not been subject to strict conflict of interest rules designed to prevent existing NDIS providers from conducting independent assessments.
“The NDIA will not issue any work order or referral forms in respect of assessment services in areas whether the tenderer (or any of its subcontractors) is also … a registered NDIS provider,” last year’s request for tender from the NDIA reads.
“Tenderers should not tender for such areas.”
In other words, companies that already provide NDIS services were blocked from tendering for the independent assessment contract in areas where they already operate.
ABC Investigations has spoken to other tenderers for the contract who believe the rule was designed to stop companies acting as both gatekeeper and service provider in the NDIS.
That was potentially a big hurdle for Zenitas, whose NDIS footprint extends across the country.
Its two major businesses, Plena Healthcare and Claro Aged Care and Disability Services, are registered in every state and territory to offer services including physiotherapy, speech pathology, personal care and specialist disability housing.
But because Allied Care Group does not offer any NDIS services, it was not in breach of the conflict of interest exclusion in the tender.
In a letter sent to tenderers in July last year, obtained by ABC Investigations, the NDIA said it would consider tenders from subsidiaries of NDIS providers.
NDIA to consider conflicts of interest
“However, tenderers must set out any actual or potential conflicts of interest in their tender. The NDIA will consider any identified conflicts of interest as part of its evaluation of risk,” the letter said.
An NDIA spokesperson said it was aware that organisations carrying out independent assessments “may also contain other operations within their group that may perform other services as a provider or partner”.
“The organisations within these groups are structured and operate as separate legal entities, with discreet systems, processes, workforce, resources and management structures,” the NDIA spokesperson said in a statement.
Autism Awareness Australia chief executive Nicole Rogerson said the disability community was concerned about potential conflicts of interests among independent assessment contractors.
“We need to get to the bottom [of this] to make sure that all of those conflicts have been investigated and ultimately the NDIS is serving individual Australians with disability and not just lining the coffers of multi-million dollar corporates.”
Nicole Rogerson of Autism Awareness Australia.(Supplied: Nicole Rogerson)
Former NDIA chief executive David Bowen says his former agency must maintain a strong separation between assessors and NDIS providers — especially if they are part of the same parent company.
“It certainly shouldn’t be the case that an assessor employed by a subsidiary company is dealing with a participant from their parent company,” he said.
However it appears there has already been some blurring between Zenitas Healthcare’s NDIS provider companies and Allied Care Group.
Job advertisements posted on seek.com show Plena Healthcare has been advertising for independent assessor positions, even though it does not hold the contract for the assessments.
An online advertisement for an NDIA Independent Assessor position with Plena Healthcare.(Seek.com.au)
Zenitas declined to comment when contacted by the ABC.
David Bowen believes all companies carrying out the independent assessments should disclose any potential conflicts of interest to participants they are dealing with.
“The more information in a participant’s hands, the better that they are able to deal with the circumstances.
“There’s nothing wrong with telling a participant and the whole sector where the assessor comes from and what their other relationships are.”
Former National Disability Insurance Scheme CEO David Bowen believes the new assessment model is designed to cut costs.(ABC News: Sean Warren)
He has also added his voice to criticism of the new independent assessment model, which is expected to be introduced later this year.
“It’s a way of controlling the amount of funds that go into each plan, through determining that plan value through an assessment tool, rather than through a personalised plan.”
Until this year, applicants for the NDIS have relied on evidence from their treating doctors and expert medical reports to prove their eligibility and help determine their funding.
Under the new model, applicants will be examined by private contractors — including Allied Care Group — using questionnaires and other tools designed to assess capacity.
The Minister for the NDIS Stuart Robert insists the model will ensure equity in the scheme.
NDIS Minister Stuart Robert say the move to independent assessments will make the scheme fairer.(ABC News: Matt Roberts)
“The government completely rejects any insinuation of any impropriety of the arms-length process run by the NDIA to appoint independent assessors,” the spokesman said.
The Minister said two weeks ago that the independent assessments were strongly recommended by the Productivity Commission when it built the scheme in 2011.
But Mr Bowen said the Productivity Commission recommended independent assessments as part of a range of assessment tools to measure a participant’s disabilities and support needs.
“This was never a one-size-fits-all model. This was about personalised plans, recognising the individual circumstances of people.”
“Now they’re introducing an assessment where you see someone who has no knowledge of your history [and] no personal relationship with you.”
“I think that’s woeful.”
People will ‘fall through the gaps’
Bianca Rossetti, pictured with her 15-year-old son Matthias, says some NDIS participants will struggle to convey their needs to their assessor.(ABC News: David Maguire)
Bianca Rossetti and her 15-year-old son Matthias have already experienced the new model through a pilot of the independent assessment process currently underway around the country.
An independent assessor came to their Canberra home earlier this month to conduct a capacity assessment with Matthias, who is an NDIS participant with autism.
“Matthias was just not interested in meeting this lady and he didn’t really understand the process of it. He just walked away.”
Ms Rossetti, who is also chair of advocacy group ACT Mental Health Consumer Network, said she was left to answer the assessor’s questions on her son’s behalf.
“It wasn’t a true representation, because it was just my perspective.”
Ms Rossetti believes many NDIS participants will have difficulty communicating their needs during the assessments.
“Because I’m involved in the NDIS as a mental health advocate, I can articulate what is needed,” she said.
One of the organisations running the pilot is Advanced Personnel Management — a Perth-based based company that has also won a tender to carry out independent assessments over the next three years.
APM is already a major NDIS contractor, which according to contract documents has earned more than $86 million from the agency to run its local area coordination services in parts of Western Australia, the Northern Territory and Queensland.
Local area coordinators (LAC) act as a participant’s first point of contact in the scheme, and are supposed to help connect them with disability support providers.
Under the rules of the independent assessments tender, LAC providers are meant to be blocked from contracting for assessments in areas where they already operate.
Yet an APM subsidiary called Konekt won the tender to deliver independent assessments in areas where its parent company is an LAC provider.
For example, in parts of Perth and southern Western Australia where APM is contracted for LAC services, Konekt has been awarded the tender to deliver independent assessments.
APM declined to respond to questions about whether this meant it was in breach of the conflict of interest provisions.
In its statement, the NDIA said there was “no instance” in which an organisation could carry out independent assessments in areas where it provided support services.
It said organisations carrying out independent assessments could contain other operations within their group that may perform other services, but the organisations with these groups operated as separate legal entities.
The global medical assessment company Medhealth also successfully tendered for the independent assessment contract through its workplace injury rehabilitation subsidiary, Ipar.
Medhealth also owns Ability Action, an NDIS provider that offers services around the country.
Arriba Group, which owns NDIS provider LiveBig, also successfully tendered to provide independent assessments through its other company, Rehab Management Australia.
The ABC contacted Medhealth and Arriba Group for comment, but both referred the questions to the NDIA.
And the Plot thickens – Mick Raven
Liberal senator Hollie Hughes criticises NDIS independent assessments
7 June 2021
Liberal senator Hollie Hughes criticises NDIS independent assessments
The New South Wales Liberal senator says the NDIS has changed her son’s life.(ABC News: Ian Cutmore)
A Liberal senator has joined a growing number of critics of her government’s controversial plan to introduce independent assessments for the National Disability Insurance Scheme (NDIS).
- Senator Holly Hughes has added her voice to growing criticism over independent assessments
- The Liberal senator has urged her own party to look at providers, rather than people, for savings
- Ms Hughes says the changes to assessments are invasive and inappropriate
Hollie Hughes, whose 11-year-old son Fred has autism, told RN Breakfast on Monday the changes would put allied health professionals, some with no knowledge of the particular condition a client has, in charge of assessing funding needs.
“Quite frankly, my senior behavioural therapist who has been with us for over 10 years has a much better idea of what Fred can and can’t do than a speech therapist who has never known anyone with autism before,” Senator Hughes said.
The NDIS has been trialling the use of independent assessors, instead of relying on an individual’s medical advice, when considering new applications for funding under the scheme.
Under the change, independent allied health professionals spend one to four hours with a person to assess their needs and eligibility.
Senator Hughes said the assessment process included a set list of questions, but NDIS participants needed to be treated as individuals.
“It’s been people going in and asking a very set list of questions or a series of tasks; peeling a piece of fruit over the sink,
making a cup of tea, taking the bin out,” Senator Hughes said.
“Then there are questions like, ‘In the past 30 days have you needed support to maintain a friendship, conduct sexual activity?’
“The questions are invasive, inappropriate, but on top of that they had nothing to do with what a person’s goals were.”
Senator Hughes said the NDIS had been a “game changer” for her son Fred and the whole family.
“I’m a massive fan of the NDIS. When Fred was diagnosed it didn’t exist,” Senator Hughes said.
The government has marketed the changes as a method of making the system fairer and more responsible.
The cost of the scheme is expected to reach more than $30 billion by the middle of this decade.
Liberal senators Hollie Hughes and Linda Reynolds do not see eye to eye on independent assessments.(ABC News: Matt Roberts)
Focus should be on providers, Hughes says
Senator Hughes said the government and the agency in charge of the scheme needed to look at providers rather than participants for savings.
“The people most focused on the sustainability of schemes are the parents of kids with disability or people with a disability because they need it to succeed
more than any bureaucrat needs a job. We need it,” Senator Hughes said.
“No-one is looking at the providers, who are charging obscene amounts of money in some cases for appointments.”
The Minister for the NDIS, Linda Reynolds, said the government was committed to improving the experience of participants, while ensuring ongoing sustainability.
“We need to give genuine flexibility, choice and control to participants so we can deliver the NDIS as it was originally intended,” Senator Reynolds said.
“The scheme is deeply inequitable in its application and I am deeply committed to introducing some form of functional assessment to bring fairness and equity to the process.
“The final form will be decided as a result of the consultation process underway.”
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