Disability Services Commission WA NDIS My Way · 2014-12-19 · Disability Services Commission WA...

Disability Services Commission

WA NDIS My Way

Quarterly Actuarial Review: September 2014

Alan Greenfield

Fellow of the Institute of Actuaries of Australia

Ash Evans

Fellow of the Institute of Actuaries of Australia

Kari Wolanski

WA NDIS MyWay Quarterly Actuarial Review September 2014

CONTACT DETAILS

Sydney

Level 11, 55 Clarence Street Sydney NSW 2000

P 02 9249 2900 P 02 9249 2999

Melbourne

Level 6, 52 Collins Street Melbourne VIC 3000

P 03 9658 2333 P 03 9658 2344

ACN 087 047 809 ABN 29 087 047 809

www.taylorfry.com.au

Taylor Fry Pty Ltd – Consulting Actuaries & Analytics Professionals

http://www.taylorfry.com.au/


TABLE OF CONTENTS

1 Executive summary ......................................................................................... 1

1.1 Introduction .......................................................................................................... 1

1.2 Access ................................................................................................................. 2

1.3 Plans: Scope, Volume and Price .......................................................................... 3

1.4 Delivery ............................................................................................................... 4

2 Introduction ..................................................................................................... 5

2.1 Background ......................................................................................................... 5

2.2 The WA NDIS My Way model .............................................................................. 5

2.3 An actuarial approach .......................................................................................... 6

2.4 Baseline forecast and key cost drivers for the WA NDIS My Way scheme ........... 7

2.5 Glossary .............................................................................................................. 7

3 Access ............................................................................................................. 9

3.1 An individual’s journey ......................................................................................... 9

3.2 Scheme Population: Disability type and demographics ...................................... 12

4 Plans: Scope, Volume and Price ................................................................... 20

4.1 Planning and approval process .......................................................................... 20

4.2 Support needs ................................................................................................... 21

4.3 Committed costs ................................................................................................ 29

4.4 Strategies .......................................................................................................... 33

4.5 Expected lifetime costs ...................................................................................... 37

5 Delivery ......................................................................................................... 38

5.1 Providing a service ............................................................................................ 38

5.2 Payments by management type ......................................................................... 38

5.3 In-kind provision of service ................................................................................ 39

5.4 Operating expenses ........................................................................................... 39

6 Reliances and limitations .............................................................................. 40


1 EXECUTIVE SUMMARY

1.1 Introduction

From 1 July 2013 the Commonwealth Government began the roll out of the National Disability Insurance Scheme with the commencement of various trials around Australia. On 1 July 2014 the Western Australian Government commenced participation in the Scheme via a two-year trial. The trial in WA, known as WA NDIS My Way trial, is managed by the Western Australia Disability Services Commission. Initially the trial will be in the Lower South West (LSW) region. From 1 July 2015 it will be rolled out to a second region—Cockburn-Kwinana.

Taylor Fry has been appointed actuary to the WA NDIS My Way trial. A key requirement of the role as actuary is to carry out an analysis of trial’s performance on a quarterly basis. This is the first quarterly actuarial report monitoring performance of the WA NDIS My Way trial and covers the quarter ended 30 September 2014. It complements DSC’s Quarterly Report to the Commonwealth, released October 2014.

The report introduces an actuarial approach to monitoring My Way trial outcomes and financial sustainability, as agreed in the National Partnership Agreement on Trial of My Way Sites (NPA). The actuarial control cycle compares actual experience to a baseline forecast. This provides insight into key drivers of My Way trial cost, how they are changing over time, and implications for financial sustainability.

Baseline forecasts of numbers of individuals and average plan costs were produced by the Commonwealth for the purpose of funding the WA NDIS My Way trial. We have made minor adjustments to these forecasts for use in this report.

With just a single quarter of experience, and relatively few individuals as yet within the My Way trial, it is to be expected that experience will differ significantly from forecasts for a mature scheme at the national level. As My Way trial experience emerges over time, the baseline will be recalibrated, and future reporting will provide additional insight into My Way trial performance.

Table 1.1 provides a high level summary of the experience of the WA NDIS My Way trial for the September quarter.


Table 1.1 Summary of experience: September 2014 quarter

Total committed costs $10,702,221

Total number of eligible individuals 518

Total number of active approved plans 449

Average annualised committed costs $23,836

1.2 Access

Monitoring access to the My Way trial gives insight into changing needs, demographics and future costs. Section 3 includes a profile of the individuals included in the My Way trial based on characteristics such as age, gender, ethnicity, and disability type.

According to baseline forecasts, 443 individuals were expected to transition from a previous trial in the region. Eligibility has been broadened relative to the pre-existing trial, and 60 newly eligible individuals were forecast to join the My Way trial in the first quarter ending 30 September 2014. More individuals transitioned from the previous trial than expected, and there have been fewer than expected newly eligible entrants. The net result is approximately as many individuals as expected. Table 1.2 summarises these results.

Table 1.2 Experience versus forecast for individuals active as at 30 September 2014

Existing New Total

Number of Individuals1 493 25 518

Expected 443 60 503

Comparison 111% 41% 103% 1. Includes individuals without funding

Of individuals who transitioned from the previous WA disability support system:

A majority are classified with a primary disability of “intellectual disability” or “autism”. Intellectual disability is the most prevalent disability at 51% of all cases. Combined with autism and related disorders, these comprise 75% of primary disability types for all existing individuals.

49% are minors, of whom 43% are listed as having autism or related disorders.

Aboriginal or Torres Strait Islanders (“ATSI”) make up 3.9% of individuals, and there is just one individual from a Culturally and Linguistically Diverse group (CALD).

The majority presence of intellectual disabilities is likely to diminish in future as these individuals were heavily represented in the previous trial. Of the 25 new entrants, none had intellectual disabilities, and 36% have other psychiatric (including psychosocial) disorder as their primary disability.


1.3 Plans: Scope, Volume and Price

Monitoring the breadth and depth of support needs, and changes in these needs over time provides insight that can be helpful in managing the My Way trial outcomes and financial sustainability. It is also instructive to benchmark plan costs relative to these needs, and to understand how costs themselves are evolving to identify emerging cost pressures.

The expected distribution of individuals by individual support rank1 (ISR) is based on NDIA’s expectations for a mature, national scheme. Nevertheless, comparing the actual distribution by functional support needs to the expected distribution – as in Figure 1.1 – gives insight into early development of the My Way trial.

Figure 1.1 Observed and expected distribution of individual support rank for individuals with approved plans as at 30 September 20141,2

1. The expected distribution by ISR is based on forecasts provided to DSC by the Commonwealth Government. These are shown in Table B.4.

2. ‘No score’ includes 35 individuals with active plans that do not have support scores – only 2 of these have funded plans. These scores will be updated when the plans are reviewed.

Early My Way trial population is weighted towards high ISRs because most individuals are transitioning from the previous trial. As the My Way trial matures, we expect the distribution of ISR to move to the left in Figure 1.1.

Based on the average reference package amounts and the distribution of individuals by ISR the expected annual plan cost is $72,0672. In comparison, despite the concentration of

1 We have translated NDIA reference package support groups to a ranking as defined in Section 4.2.3.

2 The expected annual plan cost is explained in Section 4.3


higher needs individuals in the My Way trial, average committed costs are just a third of expected cost, at $23,836.

This prompts two observations, albeit on very limited experience:

It appears that WA NDIS My Way participants currently require funds well below the reference package guidance for all ISRs, but particularly for individuals with the highest support needs

However, the distribution of individuals in the My Way trial suggests that funding at the reference package guideline would approximately double the expected committed cost for the Scheme as a whole ($36,771) and triple the average actual committed cost ($23,836).

1.4 Delivery

Table 1.3 shows the payments made to organisations and self-managed individuals in the quarter. At this stage, these results are not comparable to the initial forecast of payments.

Table 1.3 Total payments up to 30 September 2014

Payment month

Payments to:

Total1,2

$ Organisations2

$

Self-managed individuals

$

Jul-14 1,595,280 120,783 1,716,063

Aug-14 0 158,304 158,304

Sep-14 38,771 131,353 170,125

Total 1,634,051 410,441 2,044,492 1. Total does not include in-kind committed costs or strategies 2. Organisation payments adjusted by $77,033 from DSC’s quarterly report

Self-managed payments make up approximately 20% of total payments. This is consistent with the proportion of committed costs that are self-managed.

The operating expense ratio is examined in Section 5.4. For the September quarter it has been estimated at 27%. We expect administrative costs to remain relatively stable over the year. However, the total package costs are likely to increase as the My Way trial matures. Hence, it is likely that the operating expense ratio will decrease, perhaps substantially, in future reviews.


2 INTRODUCTION

2.1 Background

From 1 July 2013 the Commonwealth Government began the roll out of the National Disability Insurance Scheme (the “Scheme”) with the commencement of various trials around Australia. The agency charged with operating the Scheme is the National Disability Insurance Agency (“NDIA”). On 1 July 2014 the Western Australian Government commenced participation in the Scheme via a two-year trial. The WA My Way trial is based on its Local Area Coordinator (LAC) model and is known as WA NDIS My Way. It is managed by the Western Australia Disability Services Commission (“DSC”).

Initially the trial will be in the Lower South West (LSW) region. From 1 July 2015 it will be rolled out to a second region—Cockburn-Kwinana.

A concurrent trial is also underway in the Perth Hills, based on the Commonwealth NDIS model. The National Partnership Agreement on Trial of My Way Sites (NPA) sets out the terms of the trial and objectives for My Way trial performance:

People with disability lead lives of their choice

NDIS is a financially sustainable, insurance-based scheme

Greater community inclusion of people with disability.

Through the NPA, DSC has committed to report quarterly in line with the Integrated NDIS Performance Reporting Framework, and to introduce an actuarial approach to ensure that:

My Way trial performance is consistent with the expectations used to determine the financial envelope

Meaningful performance reporting and actuarial analysis contributes to a continuous feedback loop that informs decision making throughout the DSC; and

My Way trial decision-making is a based on a long-term view.

Taylor Fry has been appointed actuary to the WA NDIS My Way trial. A key requirement of the role as actuary is to carry out an analysis of My Way trial performance on a quarterly basis. This is the first quarterly actuarial report monitoring performance of the My Way trial.

DSC released its first quarterly report to the Commonwealth in October 2014. This quarterly actuarial report is a companion piece, reporting from an actuarial perspective on My Way trial performance.

2.2 The WA NDIS My Way model

The My Way trial builds on the well-established Local Area Coordination (LAC) model, and will further existing knowledge about how best to support people with disabilities to:

Exercise more choice and control over their supports and services

http://www.disability.wa.gov.au/wa-ndis-my-way/wa-ndis-my-way/the-trial/governance/


Achieve a good life in their local community

Build on natural supports such as friendships, neighbours and local community groups.

New features of the trial include:

Increased focus on early planning

Inclusion of new cohorts, such as individuals with psychosocial disability

Changes to the funding approach (localised decision making and flexible, non-programmatic funding)

Actuarial monitoring of financial sustainability.

2.3 An actuarial approach

In social insurance and insurance schemes – such as workers’ and accident compensation schemes – it is a requirement for actuaries to periodically quantify long-term costs. Understanding the future cost of a scheme and identifying emerging risks ensures that schemes are adequately funded so that they remain solvent. These same tools can also be used to provide insight into client behaviour, outcomes, key drivers of cost, and changing trends that tell a performance story about the scheme, and assist in managing its financial sustainability.

The key features of an actuarial approach are:

Analysis of differences between individuals in the scheme and the distribution of support needs and related costs

A long-term view of individuals’ behaviour and related costs

An actuarial control cycle that compares actual scheme experience to what was forecast, in order to understand performance.

The first two points are illustrated above. The third point is illustrated in the figure below. An actuarial control cycle begins by valuing scheme costs to set a baseline based on the mix of individuals involved with the scheme, and forecasting how scheme costs are expected to evolve over the long term. Periodic monitoring identifies how experience differs from forecast, giving insight into emerging changes to the scheme and their implications for its financial sustainability. The forecasts are periodically updated to reflect the changing realities of the scheme.

Very high functional support needs

High functional support needs

Med functional support needs

Med-low functional support needs

Low functional support needs


2.4 Baseline forecast and key cost drivers for the WA NDIS My Way trial

Baseline forecasts of numbers of My Way trial individuals and average plan costs were produced by the Commonwealth for the purpose of funding the WA NDIS trial. We have adapted these forecasts for use in this report. A summary of the forecast and our adaptation can be found in Appendix A.

Assumptions about the mix of individuals are based on NDIA assumptions about the mix of participants in a mature scheme at the national level.

With just a single quarter of experience, and relatively few individuals as yet within the My Way trial, it is to be expected that experience will differ significantly from forecasts for a mature scheme at the national level. As My Way trial experience emerges over time, the baseline will be recalibrated, and future reporting will provide additional insight into My Way trial performance.

In addition to the underlying dynamics discussed above, such as the mix of individuals and the expected duration of their support needs, key drivers of scheme costs identified by NDIA are:

Access

Scope

Volume

Price

Delivery.

The remainder of this report focuses on scheme performance in relation to each of these key cost drivers, with a particular focus on individuals accessing the My Way trial, their support needs, and how committed plan cost compares to expected cost, based on the distribution of support needs.

2.5 Glossary

Table 2.1 provides a glossary of acronyms and terms with specific meanings used in this report.


Table 2.1 Glossary

Term Definition

Approval date Date at which a plan is approved

Consent date Date at which an individual provided consent to perform an eligibility assessment

DSC Western Australia Disability Services Commission

Endorsement date Date at which a plan was submitted by a My Way Coordinator for approval. Note: Endorsement equals approval for unfunded plans and plans less than $10,000.

“Expected” or “forecast” numbers of individuals and amounts of payments

These are forecasts provided to DSC by the Commonwealth Government, adapted by Taylor Fry for comparing against experience of the Scheme. See Appendix A.

ISR Individual support rank

LAC Local Area Coordinator

MWC My Way Coordinator

NDIA National Disability Insurance Agency

NDIS National Disability Insurance Scheme

New entrant or newly eligible individuals

Individuals that have been assessed as eligible on or after the start of the trial; Lower South West on or after 1 July 2014, Cockburn Kwinana on or after 1 July 2015.

New plan Plans that are approved and endorsed after 1 July 2014. Includes existing individuals that have had their plan reviewed.

NPA National Partnership Agreement

Reference package The tool provided by NDIA for assessing the delegation authority of funding

The My Way trial WA NDIS My Way trial (commenced 1 July 2014)

The previous trial WA My Way trial (prior to 1 July 2014)


3 ACCESS

3.1 An individual’s journey

This section examines individuals’ pathways to eligibility. Figure 3.1 displays the various pathways to eligibility. Access to the My Way trial is a key driver of cost. Eligibility has been broadened relative to the previous trial. Monitoring changes to the distribution of individuals within the My Way trial gives insight into changing needs and future costs. This section includes a profile of the individuals included within the My Way trial based on characteristics such as age, ethnicity, and disability type.

Figure 3.1 Individuals’ pathways to eligibility

3.1.1 Expectations

As noted in Section 2, an actuarial approach begins by comparing actual experience to forecast. In this report we compare performance against initial forecasts developed by the Commonwealth that form the basis of the funding envelope agreed in the NPA. We will begin to adapt forecasts to experience at the first annual review.

Figure 3.2 shows the forecast number of participating individuals for the first two years of the trial for both sites: Lower South West; and Cockburn and Kwinana. The initial number of individuals is those transitioning from the previous trial and the subsequent number are those who become eligible during the trial.

Ineligible

Eligibility assessment

New

Eligibility appeal

Eligible individuals

Found eligible

Existing

Ineligible without appeal

Ineligible with appeal

Ineligibility upheld

Ineligibility overturned


Figure 3.2 Forecast participating individuals: Lower South West (LSW) and Cockburn and Kwinana (CK)

We expected 443 individuals to transition from the previous trial and 60 newly eligible individuals to join the My Way trial in the first quarter ending 30 September 2014.

For the remainder of this section, comparisons to “expected” are in respect to these forecasts.

3.1.2 Eligibility requests

There were 27 eligibility requests in the September quarter, 25 of which have been accepted and 2 which remain outstanding. No applicants have been found ineligible to date. This is fewer requests than forecast but it is too early to determine the cause. The shortfall may indicate that there are fewer eligible individuals than forecast in the trial community, or there may just be slower take up by those eligible to join.

Figure 3.3 shows the breakdown of the status of eligibility requests (eligible, ineligible, outstanding) as at the end of the September quarter. In addition, it shows the forecast newly eligible individuals for each month.


Figure 3.3 Eligibility requests made by consent month in 30 September 2014 quarter

If My Way trial access were unfolding as forecast, the accepted requests (dark blue area) would equal the expected newly eligible individuals (orange line), 60 new eligible individuals were forecast for the September 2014 quarter. Note that as there is a delay between consent and decision, the outstanding requests (light blue) could contribute to accepted requests in future reviews.

As noted there have been fewer than expected newly eligible individuals during the September quarter. It is too early to judge the reason for this difference. It may be that as awareness of the My Way trial grows in the community and processes are bedded-down in the organisation, the actual number of newly eligible individuals per month may catch-up to expectations.

This comparison is useful for detecting changes in the behaviour of applicants and assessment of eligibility. However, at this stage there is too little experience to draw definitive conclusions. Nevertheless, it is notable that no individuals have been found ineligible in the first quarter of the My Way trial.

Table 3.1 summarises the time elapsed from consent to decision. Note that the summary statistics are shown separately for those requests with decisions made and those outstanding.


Table 3.1 Time elapsed between consent and eligibility decision for the September quarter

Decision made Outstanding

Eligibility requests 25 2

Average days 11 80

Median days 9 80

Minimum days 2 69

Maximum days 31 90

The average time between consent and a decision was 11 days. That said, there are two outstanding eligibility requests from July 2014 with average time since consent of 80 days. If these are accepted the average time for September quarter consents would increase substantially. The Commission is reviewing the reason for these delays.

As the My Way trial matures, decision times by disability and support will provide an indication of service quality.

3.1.3 Appeals

There have been no appeals since 1 July 2014.

3.2 My Way trial population: Disability type and demographics

Here we examine the characteristics of individuals participating in the My Way trial to understand demand and future support needs. At this early stage, it is informative to divide the individuals into new entrants and those who transitioned from the previous trial. We expect that this distinction will be useful for the duration of the trial as new entrants are expected to have different needs to those who were eligible under the previous trial.

As the My Way trial matures, all individuals will be combined and this section will provide early warning diagnostics of demographic trends that could affect the effectiveness or sustainability.

Table 3.2 compares the number of new entrants and existing individuals versus expectations. We discuss each further below.

Table 3.2 Actual versus expected for individuals active as at 30 September 2014

Existing New Total

Number of Individuals1 493 25 518

Expected 443 60 503

Comparison 111% 41% 103% 1. Includes individuals without funding


More individuals transitioned from the previous trial than expected, and there have been fewer than expected newly eligible entrants. The net result is approximately as many individuals as expected.

3.2.1 Transitions from the previous Scheme by type of disability

We observe that the majority of individuals who have transitioned from the previous trial have an intellectual disability or autism.

Table 3.3 shows the 493 existing individuals by primary disability for each sex and each age group.


Table 3.3 Primary disability of existing individuals by sex and age as at 30 September 20141,2,3

Primary disability All

Sex Age

Mal

e

Fem

ale

0-5

6-1

2

13

-18

19

-30

31

-64

65

+

# %

Acquired Brain Injury 10 2 6 4 0 1 1 0 7 1

Attention Deficit Disorder 0 0 0 0 0 0 0 0 0 0

Autism and Related Disorders 118 24 96 22 15 62 28 12 1 0

Cerebral Palsy 8 2 5 3 1 1 1 4 1 0

Deaf/blindness 1 0 0 1 0 0 0 0 1 0

Deafness/Hearing Loss 3 1 2 1 0 0 0 0 3 0

Developmental Delay 21 4 15 6 11 10 0 0 0 0

Intellectual Disability 253 51 146 107 6 39 50 62 94 2

Motor Neurone 2 0 0 2 0 0 0 0 2 0

Multiple Sclerosis 10 2 0 10 0 0 0 0 7 3

Muscular Dystrophy 1 0 0 1 0 0 0 0 0 1

Other Injury/Poison/External Cause 1 0 0 1 0 0 0 0 1 0

Other Neurological 13 3 5 8 0 1 1 4 6 1

Other Physical Disorders 32 6 16 16 1 4 3 4 20 0

Other Psychiatric Disorders4 0 0 0 0 0 0 0 0 0 0

Other Sight Loss 7 1 1 6 1 1 0 1 4 0

Retinal Disorders or Defects 0 0 0 0 0 0 0 0 0 0

Specific learning5 1 0 1 0 0 0 0 1 0 0

Speech Impediment6 0 0 0 0 0 0 0 0 0 0

Spina Bifida 5 1 2 3 1 2 1 1 0 0

Spinal Cord Injury - Paraplegia 7 1 2 5 0 0 0 1 6 0

Total

# 493 297 196 36 121 85 90 153 8

% 100 59 41 7 25 17 18 31 2

1. These figures do not include new entrants to the My Way trial since 1 July 2014 2. Percentages may not add to 100 due to rounding 3. Numbers of individuals in age bands may differ to DSC’s Quarterly Report because this report measures

age as at 30 September 2014 whereas the DSC Quarterly Report measures ages as at 1 July 2014 4. Including psychosocial disability 5. Other than Intellectual disability and attention deficit disorder 6. And other speech difficulties.

We observe that:

Intellectual disability is the most prevalent disability at 51% of all cases. Combined with autism and related disorders, these comprise 75% of primary disability types for all existing individuals.


41% of existing individuals within the My Way trial are female. The minority of females is likely to be driven by the lower prevalence of intellectual disability and autism amongst females in the general population but the high proportion of these disability types within the My Way trial. Amongst My Way trial individuals, 32% of males have autism as the primary disability whereas only 11% of females do. On the other hand there is a much higher prevalence of multiple sclerosis amongst females in the My Way trial.

49% of existing individuals are minors (aged 18 and under). For minors, 43% are listed as having autism or related disorders.

As at 30 September there are 8 individuals aged 65 and over. As at 1 July 2014, there were 7 individuals aged 65 and over. These 7 individuals do not meet the eligibility criteria for the My Way trial. However, individuals above age 65 that are already in receipt of existing supports at 1 July 2014 are provided with “continuity of support”. DSC is currently considering its policy position for over 65s, and appropriate adjustments will be made to the December 2014 quarterly actuarial review.

The demographic profile above reveals some demographic features that are likely to continue into the future and some that are likely to dissipate. For example, multiple sclerosis, particularly relapsing-remitting multiple sclerosis, affects females disproportionately and so the demography is likely to reflect this going forward. On the other hand, the majority presence of intellectual disabilities is likely to diminish in future as these individuals have disproportionately high support needs and so were heavily represented in the previous trial. We show how changing demographics affect costs in Section 4.2.3.

Table 3.4 examines the 493 existing individuals by primary disability for Aboriginal or Torres Strait Islander status (ATSI) and Culturally and Linguistically Diverse status (CALD).


Table 3.4 Primary disability of existing individuals by ATSI and CALD as at 30 September 20141,2,3


ATSI CALD

No

Ye

s

No

Ye

s

# %

Acquired Brain Injury 10 2 10 0 10 0

Attention Deficit Disorder 0 0 0 0 0 0

Autism and Related Disorders 118 24 114 4 118 0

Cerebral Palsy 8 2 7 1 8 0

Deaf/blindness 1 0 1 0 1 0

Deafness/Hearing Loss 3 1 3 0 3 0

Developmental Delay 21 4 20 1 21 0

Intellectual Disability 253 51 240 13 253 0

Motor Neurone 2 0 2 0 2 0

Multiple Sclerosis 10 2 10 0 9 1

Muscular Dystrophy 1 0 0 1 1 0

Other Injury/Poison/External Cause 1 0 1 0 1 0

Other Neurological 13 3 13 0 13 0

Other Physical Disorders 32 6 32 0 32 0

Other Psychiatric Disorders4 0 0 0 0 0 0

Other Sight Loss 7 1 7 0 7 0

Retinal Disorders or Defects 0 0 0 0 0 0

Specific learning5 1 0 1 0 1 0

Speech Impediment6 0 0 0 0 0 0

Spina Bifida 5 1 5 0 5 0

Spinal Cord Injury - Paraplegia 7 1 7 0 7 0

Total

# 493 473 20 492 1

% 100 96 4 100 0

1. These figures do not include new entrants to the My Way trial since 1 July 2014 2. Percentages may not add to 100 due to rounding 3. Numbers of individuals in age bands may differ to DSC’s Quarterly Report because this report measures


Currently, 3.9% of individuals are Aboriginal or Torres Strait Islander. The distribution of disabilities for the ATSI group is similar to the whole group. That is, intellectual disability and autism and related disorders are most prevalent.


ATSI make up 2.2% of the general population in the South West compared to 3.9% of the My Way trial population. At this stage it is too early to comment on whether this is a significant difference. There is only one existing individual within the My Way trial from a CALD group.

3.2.2 New entrants

The increase in scope for eligibility means that new entrants are likely to have different characteristics to those transitioning from the previous trial. E.g. psychiatric disorders including psychosocial disorders are eligible for the first time.

Table 3.5 shows the 25 new entrants during the September quarter by primary disability for each sex and each age group. We do not provide an equivalent table for new entrants by ATSI and CALD because there have been no ATSI entrants and only one CALD entrant (who has a psychiatric disorder) since 1 July 2014.


Table 3.5 The primary disability of new entrants by sex and age as at 30 September 20141,2


Sex Age

Mal

e

Fem

ale

0-5

6-1

2

13

-18

19

-30

31

-64

65

+

# %

Acquired Brain Injury 0 0 0 0 0 0 0 0 0 0

Attention Deficit Disorder 0 0 0 0 0 0 0 0 0 0

Autism and Related Disorders 4 16 3 1 1 2 1 0 0 0

Cerebral Palsy 0 0 0 0 0 0 0 0 0 0

Deaf/blindness 0 0 0 0 0 0 0 0 0 0

Deafness/Hearing Loss 0 0 0 0 0 0 0 0 0 0

Developmental Delay 2 8 2 0 2 0 0 0 0 0

Intellectual Disability 0 0 0 0 0 0 0 0 0 0

Motor Neurone 0 0 0 0 0 0 0 0 0 0

Multiple Sclerosis 6 24 0 6 0 0 0 0 6 0

Muscular Dystrophy 1 4 1 0 0 0 0 0 1 0

Other Injury/Poison/External Cause 0 0 0 0 0 0 0 0 0 0

Other Neurological 2 8 1 1 1 0 0 0 1 0

Other Physical Disorders 0 0 0 0 0 0 0 0 0 0

Other Psychiatric Disorders 9 36 2 7 0 0 0 3 6 0

Other Sight Loss 0 0 0 0 0 0 0 0 0 0

Retinal Disorders or Defects 0 0 0 0 0 0 0 0 0 0

Specific learning2 0 0 0 0 0 0 0 0 0 0

Speech Impediment3 0 0 0 0 0 0 0 0 0 0

Spina Bifida 0 0 0 0 0 0 0 0 0 0

Spinal Cord Injury - Paraplegia 1 4 1 0 0 0 0 0 1 0

Total

# 25 10 15 4 2 1 3 15 0

% 100 40 60 16 8 4 12 60 0

1. Percentages may not add to 100 due to rounding 2. Numbers of individuals in age bands may differ to DSC’s Quarterly Report because this report measures


We observe that:

No new entrants have intellectual disability as their primary disability. At first glance, this result appears remarkable given that this was the majority disability among transitioning individuals. However, it is understandable in the context that individuals with an intellectual disability would have very high support needs and so


are more likely to have been in the previous trial. This observation supports our expectation that the percentage of individuals with an intellectual disability is likely to diminish as the My Way trial matures and diversity increases.

36% of new entrants have other psychiatric disorder as their primary disability. Since eligibility has recently been broadened to this group, it was expected that they would make up a significant share of new entrants. Of these, 78% are female.

Those with multiple sclerosis remain exclusively females over 31 years old.

Further analysis will be possible once there are more new entrants to the My Way trial, in subsequent reports.


4 PLANS: SCOPE, VOLUME AND PRICE

4.1 Planning and approval process

This section examines each aspect of the planning process from identifying support needs to approving plans. Figure 4.1 displays the plan design, approval and review process. The scope and volume of funded plans for individuals who access the My Way trial, as well as the price of these supports are key drivers of My Way trial cost. Monitoring the breadth and depth of support needs, and changes in these needs over time provides insight that can be helpful in managing the My Way trial outcomes and financial sustainability. It is also instructive to benchmark plan costs relative to these needs, and to understand how costs themselves are evolving to identify emerging cost pressures.

Figure 4.1 Plan design, approval and review process

4.1.1 Design and approval

Only 5 of 25 newly eligible individuals have endorsed plans. This reflects the My Way planning model which is focussed on the development of a relationship with the individual and an understanding of their community and personal situation prior to commencing the planning process. This suggests that plan design for new entrants can be a time consuming task. We will monitor this on an ongoing basis. Once endorsed, plans have been approved quickly.

Table 4.1 shows the time elapsed between individuals being deemed eligible and having endorsed and then approved plans. The first two columns consider only newly eligible

Delegated approval

Approved Plans

Endorsed and

approved

Endorsed and

escalated

Strategy and plan design

Eligible individuals

Replanning

MWC assigned

Approved

Review


individuals. The final column contains all plans approved in the September quarter, noting that individuals may have multiple plans in a quarter.

Table 4.1 Time to plan endorsement and approval in the September quarter

New individuals All

individuals

Eligibility to plan

endorsement

Eligibility to plan

approval

Endorsement to plan

approval

Number of plans 5 4 70

Average days 36 40 3

Median days 33 35 0

Minimum days 24 33 0

Maximum days 55 55 23

Number with same day approval1 4 42 1. The number of plans that are endorsed and approved on the same day

There were 5 plans endorsed for the 25 newly eligible individuals. Of these, 4 were approved. On average, it has taken 36 days for a plan for a newly eligible individual to be endorsed. All plans for newly eligible individuals have been approved on the same day they were endorsed.

There were 70 plans approved in total – 66 in relation to individuals transitioning from the previous trial. These plans were approved quickly. In fact, 60% of endorsed plans were approved on the same day.

In future, once there is sufficient data, we will examine escalations for approval and replanning in more detail.

4.1.2 Reviews

At this stage there is insufficient data to analyse the review process. In future, we will compare the number of scheduled versus early reviews, and examine how committed costs change upon review.

4.2 Support needs

Given the previous trial funded only those with the highest support needs, we expect that, all else being equal, new entrants will have lower average support needs. Therefore, we intend to examine support needs by comparing new and existing individuals. Similarly to the previous section, this section will provide early warning diagnostics of demographic trends that could affect the effectiveness or sustainability of the My Way trial.

However, with only one quarter of experience, the low number of new entrants with approved plans means these diagnostics should be treated as illustrative of potential future analysis rather than evidence of My Way trial performance.


4.2.1 The support needs matrix

Figure 4.2 shows the 8 support needs categories with the prevalence of each among the individuals in the My Way trial at 30 September 2014. We split this by new and existing individuals. The figure shows the breadth of support needs by individuals – not the depth of need under each category.

Figure 4.2 Breadth of support needs of individuals with approved plans as at 30 September 2014

Most existing individuals have a support need in all categories with the exception of support need for working. The lower proportion of individuals with working support needs is due to the age profile of the group with many individuals too young to work.

In general new entrants have a lower breadth of support needs compared to existing individuals. Further, we expect that existing participants have higher support needs. While we expect new entrants to have lower support needs, there are too few plans to make an assessment at this stage.

Figure 4.3 examines the level of support need for all individuals. That is, this graph divides the individuals with current approved plans into high needs, low needs and no needs for each type of support.


Figure 4.3 Level of support needs of individuals with approved plans as at 30 September 2014

We observe that education, community and domestic life have the highest prevalence of individuals who need a high level of supervision (blue bars).

The depth of support needs is better illustrated by examining support scores shown in the following section.

4.2.2 The support scores

The support scores are numerical translations of the support needs. The support score categories differ slightly from the support needs matrix in line with the reference package tool supplied by NDIA. These categories may be reviewed in future.

Currently, the six support score categories3 are:

Mobility

Self-care

General tasks

Learning

Interpersonal

Communication.

Figure 4.4 shows the depth of support need for all individuals with active plans as at 30 September 2014.

3 The reference package does not consider all support categories as equivalent. We discuss how these

correspond to the reference package in Appendix B.


Figure 4.4 Depth of support needs of individuals with approved plans as at 30 September 20141

1. No score includes 35 individuals with active plans that do not have support scores – only 2 of these have funded plans.

The figure above shows that support with general tasks, learning and interpersonal needs is the most essential, with almost all individuals requiring at least daily assistance. Communication and self-care are the next most prominent needs. Fewer individuals have daily mobility needs.

We have translated each depth of support need into a numerical rank from 0 to 5. “Never” has been mapped to 0 and “More than six times a day” has been mapped to 54. This ranking allows simple analysis of depth of support needs by disability. Those with no support score are excluded from this analysis.

Table 4.2 shows the average support needs rank by primary disability. The analysis helps to identify patterns in support needs, which may be helpful in planning for service provision to address support needs, and evaluating consistency in assessment practice.

We expect the characteristics of eligible individuals in the trial may change over time. However, the average support needs over time of a particular segment of individuals – such as those of a specific primary disability – should be more stable.

4 The DSC data warehouse and the reference package use a descending scale, where “Never” maps to 6 and

“More than six times a day” maps to 1. We have moved to an ascending scale here to create more intuitive results.


Table 4.2 The average support needs rank by primary disability for individuals with approved plans as at 30 September 2014

Primary disability

# ap

pro

ved

pla

ns

Support category

Mo

bili

ty

Self

-car

e

Gen

eral

tas

ks

Lear

nin

g

Inte

rper

son

al

Co

mm

un

icat

ion

Acquired Brain Injury 10 1.9 2.6 3.8 3.7 3.7 3.4

Attention Deficit Disorder 0

Autism and Related Disorders 106 1.4 3.1 3.8 4.0 4.1 3.4

Cerebral Palsy 8 2.3 2.1 3.0 2.7 2.3 2.1

Deaf/blindness 1 2.0 2.0 4.0 1.0 1.0 3.0

Deafness/Hearing Loss 3 1.3 1.7 2.3 2.7 4.7 4.3

Developmental Delay 19 1.7 4.2 4.4 4.4 4.1 4.4

Intellectual Disability 227 2.1 3.0 3.9 4.1 3.9 3.6

Motor Neurone 1 5.0 5.0 5.0 5.0 5.0 5.0

Multiple Sclerosis 10 3.9 3.6 4.0 1.7 1.8 1.4

Muscular Dystrophy 1 3.0 2.0 3.0 0.0 0.0 0.0

Other Injury/Poison/External Cause 1 5.0 5.0 0.0 0.0 0.0 0.0

Other Neurological 13 3.6 3.2 4.2 2.6 3.4 2.0

Other Physical Disorders 30 3.8 3.0 3.8 2.9 2.8 2.3

Other Psychiatric Disorders1 0

Other Sight Loss 7 3.6 2.7 3.9 2.4 2.6 1.6

Retinal Disorders or Defects 0

Specific learning2 1 0.0 1.0 3.0 2.0 2.0 2.0

Speech Impediment3 0

Spina Bifida 5 4.0 4.2 4.2 3.8 3.0 1.8

Spinal Cord Injury - Paraplegia 6 4.5 3.5 4.2 1.3 1.0 0.8

Total 449 2.2 3.1 3.9 3.8 3.7 3.3

1. Including psychosocial disability 2. Other than Intellectual disability and attention deficit disorder 3. And other speech difficulties

General tasks, learning and interpersonal support categories have the highest needs based on the average rank for all disability types. This is corroborated by the average support needs across all primary disabilities.

These averages show:

Individuals with autism, developmental delay and intellectual disability have above average support needs in the learning and interpersonal categories


Individuals with developmental delay, multiple sclerosis, other neurological, spina bifida and spinal cord injury have above average support needs in general tasks

Individuals with acquired brain injuries, autism, developmental delay and intellectual disability have above average support needs in communication

Individuals with developmental delay, other neurological spina bifida and spinal cord injury have above average support needs in self-care

Individuals with cerebral palsy, multiple sclerosis, other neurological, other physical disorders, other sight loss, spina bifida and spinal cord injury have above average support needs in mobility.

We do not provide comment on deaf/blindness, deafness/hearing loss, motor neurone, muscular dystrophy, other injury/poison/external cause as these categories each have fewer than four individuals.

4.2.3 The reference package

The reference package, originally developed by NDIA, has been adapted by DSC for the WA context. It provides guidance in terms of expected funding ranges for various support needs. In doing so, this tool provides a consistent way to map the support scores for each support score category into a single rank based on overall complexity of support needs. Disentangling the reference package rank from the funding ranges assists in the analysis of the distribution of support needs of individuals against expectations without involving the committed costs. Thus, volume of assessed need can be viewed separately from the volume and price of funded supports. This provides insight into performance of the My Way trial, such as outcomes and average package costs, relative to complexity of support needs.

Table 4.3 lists the reference package groups as used by NDIA. We have translated these groups into a single individual support rank (ISR). Note that these ranks are not linear (e.g. rank 8 is not twice as severe as rank 4). The individuals without support scores also receive a ‘no score’ ISR.


Table 4.3 Mapping support score categories to individual support ranks

Reference package group Individual

support rank

At least six times a day for three or more support score categories 9

At least three times a day for three or more support score categories 8

At least daily for three or more support score categories (including Self-care) 7

At least daily for three or more support score categories (excluding Self-care) 6

At least six times a day for two or more support score categories 6

At least three times a day for two or more support score categories 6

At least daily for two or more support score categories (including Self-care) 5

At least daily for two or more support score categories (excluding Self-care) 4

Self-care once a day 4

Mobility, communication or cognition daily 3

Weekly for two or more support score categories 2

Weekly for one support score category 1

None 0

The ISR allows a closer examination of variation in support needs between and within segments.

Table 4.4 shows the number of individuals with approved plans at 30 September 2014 for each ISR. Figure 4.5 shows the distribution of these individuals compared to the forecast distribution.

Table 4.4 Individual support rank of individuals with approved plans as at 30 September 2014

Individual support rank

Plans Observed

distribution Expected

distribution

9 73 16% 2%

8 80 18% 7%

7 135 30% 5%

6 26 6% 10%

5 18 4% 6%

4 41 9% 15%

3 27 6% 14%

2 6 1% 12%

1 4 1% 22%

0 4 1% 7%

No score 35 8%

Total 449 100% 100%


Figure 4.5 Observed and expected distribution of complexity rank for individuals with approved plans as at 30 September 20141

1. No score includes 35 individuals with active plans that do not have support scores – only 2 of these have funded plans.

As noted in section 2.4, the expected distribution of clients by ISR is based on NDIA’s expectations for a mature, national scheme. Nevertheless, comparing the actual distribution by complexity of functional support needs to the expected distribution gives insight into early development of the My Way trial.

Observed distribution of ISR is weighted more heavily towards the high needs individuals than the expected eventual distribution, based on the national average. In the early stages of the My Way trial, we expect that the population will be weighted towards high ISRs because most individuals are transitioning from the previous trial, which implicitly had a higher entry level of support for eligibility due to resource constraints. Figure 4.5 supports this expectation. As the My Way trial matures, the observed distribution of ISR seen in Figure 4.5 should move to the left.

Figure 4.6 shows the mean, median and inter-quartile range (IQR) of ISR for each primary disability. This helps to compare the assessed level of needs within and between primary disabilities.


Figure 4.6 Distribution of individual support rank by primary disability of individuals with approved plans as at 30 September 2014

We observe that individuals with cerebral palsy have lower assessed support needs in general, with the interquartile range of the complexity rank spanning from 1 to 4.8 and an average of 3.6. Individuals with autism and related disorders and with other physical disorders have the widest range of complexity score, indicating significantly different needs within the cohorts. On the other hand, neurological disorders (multiple sclerosis and other neurological) have a relatively narrow complexity range.

There are too few approved plans for individuals with deaf/blindness, deafness/hearing loss, motor neurone disease, muscular dystrophy and specific learning disabilities to make a meaningful comment.

4.3 Committed costs

Table 4.5 shows committed costs for individuals with active and approved plans. These figures include both funded and unfunded plans. We have calculated that the average annualised committed cost is $23,836 compared to the forecast average annualised cost of $36,771.


Average committed costs per individual are 35% lower than forecast. This result is surprising given the higher support needs of the trial group compared to the forecast as shown in Figure 4.5. This result is driven by low committed cost for those with the highest support needs as well as a significant volume of unfunded plans. However, at this stage experience is too limited to judge whether this result is representative of the My Way trial or distorted by the initial development phase.

Table 4.5 Committed costs for individuals with approved plans as at 30 September 2014

Total committed costs $10,702,221

Observed average annualised committed costs $23,836

Expected average annualised committed costs $36,771

Performance 65%

The remainder of this section examines this result in further detail.

4.3.1 New versus old plan costs

Table 4.6 shows the total funding, number of plans and the average annualised committed costs for all individuals with active and approved plans. Figures for old plans (those carried over from the previous trial) and new plans (those plans endorsed since 1 July 2014 including those for existing individuals and new entrants) are shown separately.

Table 4.6 Funding and average annualised committed costs of individuals with new and old approved plans as at 30 September 2014

Plans

Committed costs

$

Numbers Average annualised

committed costs

All Funded Percentage

funded

All

$

Funded

$

Old 9,153,473 379 291 77% 24,152 31,455

New1 1,548,748 70 61 87% 22,125 25,389

All 10,702,221 449 352 78% 23,836 30,404 1. New plans consist of 66 existing individuals and 4 new entrants.

The average committed cost is $23,836 over 449 approved plans at 30 September 2014. Of these plans, 97 are unfunded.

There are two key observations that we will monitor over time:

The average committed cost is slightly lower for the 70 new plans – $22,125. It is too early to assess the significance of this difference

Previously unfunded plans are now being funded


The percentage of plans that are funded has increased since 1 July 2014. Of the 19 reviews for existing individuals with unfunded plans, 10 of these are now being funded.

The average committed cost for funded plans is much lower for new plans.

These observations together indicate that plans that may have otherwise received no funding are now receiving lower-than-average funding. This is consistent with the recent inclusion of lower-complexity cohorts under the new eligibility parameters for funded plans.

Figure 4.7 shows the distribution of committed costs for new and old approved plans.

Figure 4.7 Distribution of committed costs of individuals with new and old approved plans as at 30 September 2014

The figure highlights that unfunded plans are less prevalent amongst new plans, but low cost plans (committed costs < $10,000) are more prevalent.

4.3.2 Actual package costs versus reference package guidance

Table 4.7 uses the complexity ranks to compare the average committed costs to the average reference package amounts. This provides an indication of whether plan costs are tracking as expected when the complexity of individuals’ support needs is taken into consideration.

The average reference package column shows the amount that would have been committed on the basis of the benchmark reference package “median cost”. This reveals the source of the low average committed cost.


Table 4.7 Comparison of average committed costs to average reference package amount by individual support rank of individuals with approved plans as at 30 September 2014

Individual support rank

Number of plans Average

committed costs $

Expected committed

costs1

$

Comparison

9 73 49,142 165,753 30%

8 80 32,119 107,813 30%

7 135 20,345 61,767 33%

6 26 24,394 50,769 48%

5 18 16,394 32,500 50%

4 41 12,872 24,220 53%

3 27 7,176 12,500 57%

2 6 781 7,600 10%

1 4 29,470 3,400 867%

0 4 0 0

No score 35 726 0

Total 449 23,836 72,067 33%

1. Average reference package amounts differ to the headline reference package averages because of age adjustments

Recall, Figure 4.5 showed that among active individuals with approved plans, there is a much greater share with high ISRs than is expected in the mature My Way trial. This is due to the prevalence of individuals with high support needs automatically transitioning in from the previous trial, and the slower-than-expected entry of newly eligible individuals expected to have less complex support needs.

Based on the average reference package amounts and the distribution of individuals by ISR the expected annual plan cost is $72,067. Each individual’s expected committed cost is determined by:

Mapping individual support need ranks to ISR

Mapping ISR to the expected committed cost in the Reference Package

Adjusting the expected committed cost based on the age of the individual.

Table 4.7 shows this average over all individuals with approved plans by ISR.

In comparison, despite the concentration of the My Way trial towards high-needs individuals, average actual committed costs are just a third of expected cost, at $23,836.

This prompts two observations, albeit based on very limited experience:

It appears that individuals accessing support through WA NDIS My Way currently have funding packages below the reference package guidance for all support ranks, but particularly for individuals with the highest support needs. This could be due to a number of factors including the immaturity of the trial and lower funding packages required by trial individuals compared to expected.


However, the distribution of individuals in the My Way trial suggests that funding at the reference package guideline would approximately double the average committed cost for the My Way trial as a whole.

On a minor note, on average, individuals with ISR 1 have committed costs much higher than the reference package guidance. However, it is worth noting that this is entirely due to a single individual with support costs of $117,880 who is due to have an early plan review to re-assess their support needs. The other 3 individuals have unfunded plans.

4.4 Strategies

We examine the funding by strategy. An individual can have multiple strategies in the same plan. These strategies can belong to the same support “cluster”. Consequently, there are 1,384 funded strategies, but 1,011 funded strategies with a unique My Way support cluster.

Table 4.8 is a matrix of the number of funded strategies by My Way cluster and outcome.


Table 4.8 Number of funded strategies by My Way Support Cluster and Outcome for individuals with approved plans as at 30 September 2014

My Way Support Cluster

Outcome

Total

Ch

oic

e an

d c

on

tro

l

ove

r lif

e

Wel

lbei

ng

Co

mm

un

ity

par

tici

pat

ion

Safe

ty a

nd

sec

uri

ty

Lear

nin

g n

ew s

kills

Fam

ily a

nd

re

lati

on

ship

s

Sup

po

rtin

g fa

mily

frie

nd

s an

d c

arer

s

# %

Accommodation 4 0 0 3 0 1 0 8 1

Daily Living 98 74 25 14 108 8 25 352 25

Wellbeing 85 89 277 11 150 38 14 664 48

Family and Carer Support 2 10 3 2 3 17 93 130 9

Behaviour Support and Specialist Care

0 2 0 1 2 0 3 8 1

Therapy and specialist support 1 19 0 0 12 1 2 35 3

Self-management 13 39 9 1 12 11 31 116 8

Communication 3 1 0 0 0 0 2 6 0

Equipment 14 26 2 8 5 0 0 55 4

Other 5 1 0 1 0 1 2 10 1

Episodic Coordination of Support

0 0 0 0 0 0 0 0 0

Total # 225 261 316 41 292 77 172 1,384 100

% 16 19 23 3 21 6 12 100

We observe that the majority of strategies are related to wellbeing and daily living support clusters. The most prevalent outcomes related to these support clusters are community participation, learning new skills, wellbeing and choice and control over life.

Table 4.9, Table 4.10, and Table 4.11 show a breakdown of committed cost by outcome, My Way cluster and NDIS cluster. Each table shows the split for organisation and self-managed strategies. These are average committed cost per funded strategy rather than for whole plans. They are intended to provide an illustration of the costs that are being included in plans, and an indication of component price.


Table 4.9 Average committed cost per funded strategy by Outcome for individuals with approved plans as at 30 September 2014

Outcome

Strategy

Organisation

$

Self-managed

$

All1

$

Learning new skills 10,282 2,444 6,786

Community participation 11,262 5,033 8,758

Supporting family friends and carers 13,481 3,610 6,250

Wellbeing 17,148 2,699 8,960

Family and relationships 8,384 3,371 5,064

Safety and security 14,714 2,704 8,563

Choice and control over life 11,316 5,205 9,438

All 12,072 3,580 7,946 1. All does not include in-kind committed costs or strategies

Table 4.10 Average committed cost per funded strategy by My Way Support Cluster for individuals with approved plans as at 30 September 2014

My Way Support cluster

Strategy

Organisation

$

Self-managed

$

All1

$

Accommodation 68,309 6,600 52,882

Daily Living 15,256 5,140 12,958

Wellbeing 9,125 3,853 6,854

Family and Carer Support 11,550 4,939 6,719

Behaviour Support and Specialist Care 5,775 5,775

Therapy and specialist support 2,749 2,349 2,388

Self-management 7,155 1,235 1,337

Communication 3,788 1,000 3,323

Equipment 1,034 2,647 2,616

Other 18,033 1,300 10,596

Episodic Coordination of Support



Table 4.11 Average committed cost per funded strategy by NDIS Cluster for individuals with approved plans as at 30 September 2014

NDIS Cluster

Strategy

Organisation

$

Self-managed

$

All1

$

Therapeutic supports 2,749 1,849 1,949

Participation in community social and civic activities 8,990 4,446 6,958

Development of daily living and life skills 11,414 2,977 9,018

Workers Compensation & Superannuation 4,533 1,235 1,264

Household Tasks 11,963 7,113 10,985

Development of daily living and life skills 400 400

Assistive products for personal care and safety 3,916 3,916

Assistance with daily personal activities 29,067 5,318 15,957

Assistance with daily life tasks in a group or shared living arrangement

33,795 3,850 19,610

Specialist care for individuals with high care needs 18,720 18,720

Physical wellbeing activities 5,153 4,146 4,729

Assistance to access and maintain employment 11,041 4,120 9,515

Assistance with travel/transport arrangements 5,732 1,257 4,427

Assistance with personal care and transitions in educational settings

4,809 2,949 3,266

Interpreting and translation

Home modification design and construction 1,567 1,567

Training for independence in travel and transport 4,465 1,440 3,961

Communication and information equipment 560 560

Assistance in coordinating or managing life stages transitions and supports

Accommodation/tenancy assistance 1,750 1,750

Vehicle modifications 1,034 1,140 1,087

Early intervention supports for early childhood 5,020 5,020

Specialist care for participants with high care needs 4,876 4,876

Assistive products for household tasks 825 825

Assistive technology specialist assessment set up and training

1,874 1,874

Personal mobility equipment 3,211 3,211

Management of funding for supports under a participants plan

9,776 9,776

Other 18,033 850 13,123

Assistive equipment for recreation and leisure 1,979 1,979

Behaviour support 1,550 1,550



4.5 Expected lifetime costs

At this stage there is insufficient information to analyse expected lifetime costs of individuals. Over the course of the first year we expect to incorporate analysis and results in relation to lifetime costs as the information becomes available.


5 DELIVERY

Service delivery is also a key driver of My Way trial costs, and an important dimension of performance. This section examines service delivery, including:

Plan execution by disability service organisations, and/or individuals who self-manage

Planning, coordination and other My Way trial administration costs.

Delivery of individuals’ plans can include regular care, temporary help or irregular intervention.

At this stage detailed analysis of payments and the provision of supports are not possible: the My Way trial is not mature enough to gain any insight from the payments to date, and the acquittal reporting processes are still under development. As such, this section provides only high-level summary of experience to date.

5.1 Providing a service

Figure 5.1 Delivery process

Figure 5.1 displays the service delivery process. When adequate information becomes available, we will examine the timing and success of the related funding amounts. In addition, we will examine the time elapsed between acquittals, deliveries and reporting.

5.2 Payments by management type

Table 5.1 shows the payments made to organisations and self-managed individuals in the quarter. At this stage, these results are not comparable to the initial forecast of payments.

Organisation

Approved Plans

Service delivery

Self-management

Funds acquittal

Service receipt

Funds acquittal


Table 5.1 Total payments up to 30 September 2014

Payment month

Payments to:

Total1,2

$ Organisations2

$

Self-managed individuals

$

Jul-14 1,595,280 120,783 1,716,063

Aug-14 0 158,304 158,304

Sep-14 38,771 131,353 170,125

Total 1,634,051 410,441 2,044,492 1. Total does not include in-kind committed costs or strategies 2. Organisation payments adjusted by $77,033 from DSC’s quarterly report

Self-managed payments make up approximately 20% of total payments. This is consistent with the proportion of committed costs that are self-managed.

5.3 In-kind provision of service

It is not yet possible to consider in-kind payments.

5.4 Operating expenses

Table 5.2 shows the My Way trial operating expense ratio for the September 2014 quarter.

Table 5.2 My Way trial operating expense ratio

Total payments made (inc administration costs) 2,810,534

Administration costs:

Direct costs of My Way coordination 544,570

Contracting 108,838

Corporate overheads 112,634

Total 766,042

Operating expense ratio5 27%

The operating expense ratio is 27%. We expect administrative costs to remain relatively stable over the year. However, the total package costs are likely to increase as the My Way trial matures. Hence, it is likely that the operating expense ratio will decrease, perhaps substantially, in future reviews.

5 Administration costs divided by total payments made.


6 RELIANCES AND LIMITATIONS

In developing this report Taylor Fry has relied upon historical data and other quantitative and qualitative information supplied by DSC, without audit or independent verification. We have, however, reviewed this information for reasonableness and internal consistency. The accuracy of our results is dependent upon the accuracy and completeness of these underlying data; therefore, any material discrepancies discovered in this data by DSC should be reported to us and the report amended accordingly.

This is the first such review carried out for the DSC in relation to the WA NDIS. Thus, although there has been significant effort expended by both Taylor Fry and DSC to produce and understand the data extracts, there is a chance that we have misunderstood some aspect or other of the data. We expect that in a short period of time such misunderstandings will be cleared up. However, we emphasise that at this early stage it is more difficult to be certain of the reliability of the results.

This review relies on forecasts for comparison with experience. Those forecasts were produced prior to the implementation of the NDIS by the Commonwealth. We do not know the exact manner in which those forecasts were derived and we are therefore unable to provide comment on their suitability or accuracy. In any case, given that they were produced prior to implementation it is reasonable to accept that they would be highly uncertain.

Over time, as the experience matures, the analysis and review of experience will become more reliable.

Detailed judgements about the analyses, assumptions and results from this actuarial report should be made only after considering the report in its entirety.

This report has been prepared for the DSC for the specific purposes stated in Section 2. No reliance should be placed on this report for any other purpose without confirming with us that such a purpose is appropriate.


APPENDIX A EXPECTATIONS

A.1 Introduction

Forecasts of numbers of individuals and average committed costs – “expectations” – are based on estimates outlined in the National Partnership Agreement, Productivity Commission report, “phasing schedules” and tools provided by the Commonwealth e.g. reference package tool. The phasing schedulesagreed between the State and Commonwealth. They provide guidance to the expected demand and costs of the My Way trial. We have not conducted an independent actuarial review of the forecasts.

As a new trial, experience is likely to deviate from these expectations. However, these will remain the best estimate of future demand and cost until the first annual financial sustainability report. Upon the first review, these expectations will be adjusted in light of the experience to date.


A.2 Phasing schedules for individuals agreed between the State and Commonwealth

Table A.1 Projected eligible individuals at months end

Ju

l-1

4

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

LSW initial 443 443 443 443 443 443 443 443 443 443 443 443

LSW subsequent 10 30 60 130 232 334 436 541 646 751 856 961

LSW total 453 473 503 573 675 777 879 984 1,089 1,194 1,299 1,404

CK initial 0 0 0 0 0 0 0 0 0 0 0 0

CK subsequent 0 0 0 0 0 0 0 0 0 0 0 0

CK total 0 0 0 0 0 0 0 0 0 0 0 0

Total 453 473 503 573 675 777 879 984 1,089 1,194 1,299 1,404

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

LSW initial 443 443 443 443 443 443 443 443 443 443 443 443

LSW subsequent 963 964 965 966 967 968 970 971 972 973 974 975

LSW total 1,406 1,407 1,408 1,409 1,410 1,411 1,413 1,414 1,415 1,416 1,417 1,418

CK initial 959 959 959 959 959 959 959 959 959 959 959 959

CK subsequent 14 43 87 189 377 574 771 968 1,165 1,362 1,558 1,755

CK total 973 1,002 1,046 1,148 1,336 1,533 1,730 1,927 2,124 2,321 2,517 2,714

Total 2,379 2,409 2,454 2,557 2,747 2,945 3,143 3,341 3,539 3,737 3,935 4,133


Table A.2 Projected average annualised committed cost per individual

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

$ $ $ $ $ $ $ $ $ $ $ $

LSW 36,771 36,771 36,771 36,771 36,771 36,771 36,771 36,771 36,771 36,771 36,771 36,771

CK - - - - - - - - - - - -

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

$ $ $ $ $ $ $ $ $ $ $ $

LSW 38,686 38,686 38,686 38,686 38,686 38,686 38,686 38,686 38,686 38,686 38,686 38,686

CK 38,686 38,686 38,686 38,686 38,686 38,686 38,686 38,686 38,686 38,686 38,686 38,686


Table A.3 Projected payments

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Tota

l

$’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000

LSW 1,373 1,420 1,497 1,650 1,913 2,226 2,538 2,856 3,177 3,499 3,821 4,143 30,113

CK 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 1,373 1,420 1,497 1,650 1,913 2,226 2,538 2,856 3,177 3,499 3,821 4,143 30,113

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Tota

l

$’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000 $’000

LSW 4,529 4,533 4,537 4,541 4,545 4,548 4,552 4,556 4,560 4,563 4,567 4,571 54,602

CK 3,114 3,184 3,301 3,535 4,004 4,626 5,260 5,895 6,529 7,164 7,798 8,433 62,843

Total 7,644 7,717 7,838 8,076 8,549 9,174 9,812 10,451 11,089 11,727 12,366 13,004 117,445

Grand total 1 July 2014 – 30 June 2016 147,558


A.3 Expectations by Individual Support Rank

The Reference Package v1.1 supplied by NDIA contains an expected distribution of average annualised committed costs by individual.

We adjust this distribution so that that the implied expected committed cost is equal to the Commonwealth forecasts underpinning the cost of the My Way trial. This is achieved by introducing unfunded individuals (7% of final population). This is a simplistic adjustment but is commensurate with the accuracy of the forecasts at this early stage and consistent with the prevalence of unfunded plans in the WA NDIS My Way trial.

Table A.4 Population by average committed cost1

Average committed cost Commonwealth percentage of

population

Adjusted percentage of population

$250,000 2% 2%

$150,000 8% 7%

$85,000 6% 5%

$60,000 11% 10%

$45,000 6% 6%

$30,000 16% 15%

$15,000 15% 14%

$8,000 13% 12%

$4,000 23% 22%

- - 7%

Total 100% 100%

Implied expected committed cost

$39,4922 $36,771

1. Average committed costs and Commonwealth percentage of populations based on The Reference Package (v1.1) tool supplied by NDIA

2. Calculated by weighting the average committed costs by the Commonwealth percentage of population.

We expect this distribution to evolve as experience emerges and as the Reference Package is improved.


APPENDIX B REFERENCE PACKAGE AND INDIVIUDAL SUPPORT RANK

B.1 Introduction

The Reference Package (v1.1) is a tool supplied by NDIA that includes a mapping between support needs and expected committed cost.

We adapt the Reference Package to provide the Individual Support Rank (ISR). The ISR disentangles an individual’s support needs from their expected committed cost. This will help comparisons over time: while individuals’ expected committed costs will vary due to external factors such as inflation and funding arrangements, ISR will only vary if the individuals support needs change. This consistent ISR is particularly useful in the early years of the My Way trial while expectations regarding funding are still developing.


B.2 Support scores

Table B.1 Support scores

Support score category

Mobility

Self-care

Communication

General tasks

Learning

Interpersonal

Table B.2 Frequency of need

Frequency of need Reference package

support score

Never 6

Less than weekly 5

Weekly (but not daily) 4

1-2 times a day 3

3-5 times a day 2

More than six times a day 1

B.3 Support scores to ISR

The six support scores are rationalised to four for determining the ISR (and average committed cost). That is, the maximum if the general tasks, learning and interpersonal scores becomes a single cognition score.


Table B.3 Mapping support score categories into individual support ranks

Reference package group Individual

support rank

At least six times a day for three or more support score categories 9

At least three times a day for three or more support score categories 8

At least daily for three or more support score categories (including Self-care) 7

At least daily for three or more support score categories (excluding Self-care) 6

At least six times a day for two or more support score categories 6

At least three times a day for two or more support score categories 6

At least daily for two or more support score categories (including Self-care) 5

At least daily for two or more support score categories (excluding Self-care) 4

Self-care once a day 4

Mobility, communication or cognition daily 3

Weekly for two or more support score categories 2

Weekly for one support score category 1

B.4 Age adjustments

A loading is applied to average committed costs based on the age group. Younger age groups are expected to have lower annualised committed costs than comparably disabled older age groups. This does not affect ISR as this is based on support scores only. However, the expected committed cost for each individual, as cited in Table 4.7, is affected.

Table B.4 Frequency of need

Age group Loading

0 - 16 years 40%

17 - 24 years 80%

25 - 34 years 90%

35 - 44 years 100%

45 - 54 years 110%

55 - 64 years 120%

65+ years 120%

Disability Services Commission WA NDIS My Way · 2014-12-19 · Disability Services Commission WA...

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