Disability Services Commission WA NDIS My...

Disability Services Commission

WA NDIS My Way

Quarterly Actuarial Review: March 2015

Alan Greenfield

Fellow of the Institute of Actuaries of Australia

Ash Evans

Fellow of the Institute of Actuaries of Australia

Kari Wolanski

M.A. Social Development

WA NDIS My Way Quarterly Actuarial Review March 2015

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/

WA NDIS MyWay Quarterly Actuarial Review March 2015

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 ............................................................................................................................... 5

2 Introduction ................................................................................................................... 6

2.1 Background ......................................................................................................................... 6

2.2 Previous reports ................................................................................................................. 6

2.3 Baseline forecast and key cost drivers for the WA NDIS My Way trial .............................. 6

2.4 Glossary .............................................................................................................................. 7

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

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

3.2 My Way trial population: Disability type and demographics ........................................... 12

4 Plans: Scope, Volume and Price .................................................................................. 18

4.1 Planning and approval process ......................................................................................... 18

4.2 Support needs .................................................................................................................. 19

4.3 Committed costs............................................................................................................... 28

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

5 Delivery ........................................................................................................................ 37

5.1 Providing a service ............................................................................................................ 37

5.2 Payments by management type ....................................................................................... 37

5.3 In-kind provision of service .............................................................................................. 38

5.4 Operating expenses .......................................................................................................... 38

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 (“NDIS” or the “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, 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.

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 the trial’s performance on a quarterly basis. This is the third quarterly actuarial report monitoring performance of the WA NDIS My Way trial and covers the three quarters ending 31 March 2015. It complements DSC’s third Quarterly Report to the Commonwealth.

Our quarterly reports use an actuarial approach to monitor WA NDIS 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 WA NDIS 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 our quarterly reports.

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

1.2 Overview

Table 1.1 provides a high level summary of the experience of the WA NDIS My Way trial for the period to the end of the March 2015 quarter compared to the previous period to the end of the December quarter. This shows that the total committed costs have grown in line with the number of active approved plans, increasing since the end of the previous quarter from $14.4M to $15.3M. Increases to the number of individuals and related costs are expected, as the trial extends both access to funded supports, and the nature of those supports.


Table 1.1 Summary of experience1

As at

31 March 2015

As at 31 December

20142

Change since Q2

Total committed costs3 $15,275,043 $14,395,177 6%

Total number of eligible individuals

706 623 13%

Total number of active approved plans

631 595 6%

Total number of funded plans

521 494 5%

Average annualised committed costs4

$24,208 $24,194 0%

1. Committed costs for approved plans 2. Note that there are adjustments to pre-Q3 numbers from those reported previously, reflecting

increased data maturity. Q2 numbers in this report reflect our current view of past experience 3. Committed costs may be understated due to the under-reporting of in-kind committed costs 4. The average annualised and total committed costs may differ to the DSC Quarterly Reports due to a

different treatment of retrospective changes to data.

The total number of eligible individuals has increased from 623 at the end of Q2 to 706 at the end of Q3. Of these, 89% have active approved plans, compared to 96% in Q2. Average annualised committed costs (including unfunded plans) have remained stable over the last quarter, reflecting two offsetting effects:

Lower support requirements and costs associated with new entrants, and

Higher support requirements and costs associated with individuals who had plans prior to the trial, and now have updated plans under the WA NDIS My Way trial parameters.

The number of individuals in the trial, and their average and total costs are all below Productivity Commission estimates, indicating that the trial is on track in terms of financial sustainability.

1.3 Access

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

According to baseline forecasts, 443 individuals were expected to transition from the previous project in the region. Eligibility has been broadened relative to the pre-existing project, and 60 newly eligible individuals were forecast to join the WA NDIS My Way trial in


the first quarter ending 30 September 2014, 274 in the second quarter and 312 in the third quarter ending 31 March 2015. More individuals transitioned from the previous project than expected, and there have been fewer than expected newly eligible entrants in all three quarters to date. The net result is 35% fewer individuals than predicted.

Table 1.2 summarises these results. It is worth noting that many individuals who transitioned from the previous project are receiving funding for the first time. Also, the rate of growth of new entrants has decreased over the last quarter, resulting in the number of new entrants since 1 July 2014 being only 30% of that expected.

Table 1.2 Experience versus forecast for individuals active as at 31 March 2015

Existing New Total

Number of Individuals1 5112 1953 706

Expected 443 646 1,089

Comparison 115% 30% 65% 1. Includes individuals without funding 2. Retrospectively changed since the previous report for late recordings 3. The DSC Quarterly Report Q3 shows individuals that were deemed eligible, which includes one

individual who applied for eligibility regarding a different disability rather than being a new entrant. We do not include that individual in new entrants. Consequently, the DSC report shows a total of 196.

The main demographic features of individuals who transitioned from the previous project can be found in Section 3.2.1 and Table 3.3 and include:

A majority are classified with a primary disability of ‘intellectual disability’ or ‘autism’. Intellectual disability is the most prevalent disability for 51% of all individuals. Combined with autism and related disorders, these comprise 77% of primary disability types for all existing individuals.

38% are under the age of 15, of whom 54% are listed as having autism or related disorders.

Section 3.2.2 shows that the demographic mix is shifting as new entrants make up a growing proportion of total individuals:

The dominance of individuals with an intellectual disability is diminishing. Of the 195 new entrants, only 3% had an intellectual disability, whereas 17% have other psychiatric (including psychosocial) disorders and 13% had other physical disorders as their primary disability.

There are fewer younger individuals amongst the new entrants. Of the new entrants, 15% are under the age of 15 compared to 38% under the age of 15 who transitioned from the previous project.

1.4 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 WA NDIS My Way trial outcomes and financial sustainability. It is also instructive to benchmark plan costs relative to these


needs and to plan costs before the trial commenced, to understand how costs themselves are evolving. This helps to identify emerging cost pressures.

The evolution of the average committed cost of individuals in the scheme can be analysed by separately considering the support needs of individuals’ first plans (including transitioned plans at the beginning of the WA NDIS My Way trial), archived plans, and their subsequent updated plans. In Figure 1.1, the average costs of these subsequent plans are shown in front of the average cost of the plans that they replaced (pink columns). The number of plans approved is shown at the foot of each column.

Figure 1.1 Average committed cost of individuals for first and subsequent plans1,2,3

1. Committed costs may be understated due to the under-reporting of in-kind committed costs 2. Approved in each quarter – viewed retrospectively using current data 3. Includes all approved plans – funded or unfunded

Some important observations can be made:

Average committed costs have remained stable at about $24,000 over the last two quarters (see Table 1.1). This is a result of two offsetting features. On the one hand there are newly eligible individuals with lower support requirements and hence lower average committed costs, while on the other hand existing individuals have updated plans with higher average committed costs than their corresponding previous plans.

Individuals receiving their first approved plan in the December 2014 or the March 2015 quarters have significantly lower average committed costs than individuals who transitioned from the previous project. This is consistent with the inclusion of cohorts with lower-complexity support needs in the WA NDIS My Way trial since 1 July 2014.

In the quarters ending 31 December 2014 and 31 March 2015, the average committed costs of previous plans were lower than those of the reviewed and


updated plans – a trend that is largely due to individuals moving from unfunded to funded plans. Growth in plan costs is expected, in that the trial expands the types of supports funded, and extends funding to more individuals. Nevertheless, we are monitoring the rate of growth closely.

Although updated plans are costlier than previous plans, the average committed costs of all approved and active plans is $24,208 – which is lower than the expected cost of $36,771.

1.5 Delivery

Table 1.3 shows the payments made to service providers and self-managed individuals in the quarter.

Table 1.3 Total payments

Payment month

Payments to:

Total1

$ Service

providers

$

Self-managed individuals

$

Jul-14 1,604,125 147,161 1,751,287

Aug-14 0 163,104 163,104

Sep-14 65,201 128,353 193,554

Oct-14 1,836,480 216,848 2,053,328

Nov-14 446,238 155,472 601,709

Dec-14 94,615 232,846 327,461

Jan-15 2,102,148 136,392 2,238,540

Feb-15 349,790 219,279 569,069

Mar-15 384,422 178,651 563,073

Total2 6,883,019 1,578,106 8,461,125 1. Total does not include in-kind committed costs or strategies 2. The totals differ slightly from the DSC Quarterly Report Q3 due to different criteria for inclusion.

Self-managed payments make up approximately 19% of total payments. This is consistent with the 21% proportion of committed costs that are self-managed as shown in Table 4.7.

The operating expense ratio is examined in Section 5.4. For the March 2015 quarter it has been estimated at 23%, down slightly from the December 2014 quarter. Operating expenses are relatively high because of the low average package costs. Low package costs may be attributed to the intensive role of the WA NDIS My Way Coordinator in the planning process and facilitation of informal supports and community based supports and services. We expect administrative costs to remain relatively stable over the year.


2 INTRODUCTION

2.1 Background

From 1 July 2013 the Commonwealth Government began the roll out of the National Disability Insurance Scheme (the “NDIS” or the “Scheme”) with the commencement of various trials around Australia. The agency charged with operating the NDIS is the National Disability Insurance Agency (“NDIA”). On 1 July 2014 the Western Australian Government commenced participation in the NDIS via a two-year trial. The WA State Government 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.

These quarterly reports use an actuarial approach to monitor WA NDIS 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 WA NDIS My Way trial cost, how they are changing over time, and implications for financial sustainability.

This is the third quarterly actuarial report by Taylor Fry as appointed actuary to the WA NDIS My Way trial. It complements DSC’s third quarterly report to the Commonwealth.

Further background on the trial, its performance framework, and key features of an actuarial approach is available in Appendix A.

2.2 Previous reports

Taylor Fry has previously conducted two Quarterly Actuarial Reviews:

“Quarterly Actuarial Review: September 2014” as at 30 September 20141 and,

“Quarterly Actuarial Review: December 2014” as at 31 December 2014 (the “previous report”).2

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

Baseline forecasts of numbers of WA NDIS My Way trial individuals and average plan costs were produced by the Commonwealth for the purpose of funding the WA NDIS trial. We

1 http://www.disability.wa.gov.au/Global/Publications/WA-NDIS-My-Way/Actuary%20reports/Quarterly-

Actuary-Report-2014-15-Q1.pdf 2 http://www.disability.wa.gov.au/Global/Publications/WA-NDIS-My-Way/Actuary%20reports/Q2-Quarterly-

Actuary-Report-2014.pdf


have adapted these forecasts for use in this report. A summary of the forecast and our adaptation can be found in Appendix B.

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 three quarters of experience it is to be expected that experience will differ significantly from forecasts for a mature scheme at the national level. As WA NDIS My Way trial experience emerges over time, the baseline will be recalibrated, and future reporting will provide additional insight into WA NDIS My Way trial performance.

In addition to underlying dynamics 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 WA NDIS My Way scheme performance in relation to each of these key cost drivers. The report focuses in particular on who is accessing the WA NDIS My Way trial; their support needs; and how committed plan cost compares to expected cost, based on the distribution of support needs.

2.4 Glossary

Table 2.1 provides a glossary of acronyms and terms 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

CK Cockburn-Kwinana

DSC Western Australia Disability Services Commission

Endorsement date Date at which a plan was submitted by a My Way Coordinator for approval. Note: Endorsement also 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 B.

ISR Individual support rank

LAC Local Area Coordinator

LSW Lower South West

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 previous project My Way project (June 2012 to 30 June 2014)


3 ACCESS

3.1 An individual’s journey

This section examines individuals’ pathways to eligibility as displayed in Figure 3.1. Access to the WA NDIS My Way trial is a key driver of cost. Eligibility has been broadened relative to the previous project. Monitoring changes to the distribution of individuals within the WA NDIS My Way trial gives insight into changing needs and future costs. This section includes a profile of the individuals included within the WA NDIS 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 reflect actual trial experience at the first annual review.

Figure 3.2 shows the forecast number of individuals expected to participate in the trial over two years. Expected volumes for Lower South West (LSW) are shown in blue over both years. Expected volumes for Cockburn-Kwinana (CK) from July 2015 are shown in orange. The initial number refers to individuals transitioning from the previous project and the subsequent number refers to 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-Kwinana (CK)

We expected 443 individuals to transition from the previous project in LSW and 646 newly eligible individuals to join the WA NDIS My Way trial in the three quarters ending 31 March 2015.

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

3.1.2 Eligibility requests

There were 63 eligibility requests in the March 2015 quarter, reflecting a considerable drop from 102 requests in the December 2014 quarter3. Of these 63 requests, 55 were accepted (two of which were classified as Early Intervention), none were deemed ineligible and eight remain outstanding. In addition, three eligibility requests remain outstanding from the previous quarters4.

Two applicants have been found ineligible to date – one consenting to an eligibility assessment in July 2014 and one in October 2014.

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

3 The number of eligibility requests differs to that in the previous report due to retrospective changes to data.

4 The number of outstanding requests differs to the DSC Quarterly Report Q3 due to our inclusion of three with

status “Documentation Required”.


Figure 3.3 Eligibility requests made by consent month

If the WA NDIS My Way trial access was unfolding as forecast, the accepted requests (dark blue area) would equal the expected newly eligible individuals (orange line); 312 newly eligible individuals were forecast for the March 2015 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.

There are far fewer requests than forecast. The shortfall may indicate that there are fewer eligible individuals than forecast in the trial community, or that there is slower than expected take-up by those eligible to join. As time passes, it seems more likely that the forecasts are high; and the lack of growth since the previous quarter supports this argument.

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

Consent Qtr

Eligibility requests

Average days

Median days

Minimum days

Maximum days

Q1 Decision made 41 33 17 2 158

Outstanding 2 203 203 197 208


Outstanding 1 104 104 104 104


Outstanding 8 43 46 14 54

Total Decision made 197 25 14 0 158

Outstanding 11 77 48 14 208

For the three quarters to date the average time between consent and an eligibility decision, where an eligibility decision was made, was 25 days. This has increased slightly from 22 days in the previous report. Responses to requests have been steadily speeding up from the first quarter. However, some requests have been added retrospectively to previous quarters, increasing the average response time and opening up the possibility that this quarter’s figure of 14 days will also be retrospectively adjusted upwards. There remain 11 outstanding eligibility requests from the first three quarters with average time since consent of 77 days. If these are accepted the average time to decision will increase.

We intend that these statistics be used to understand average behaviour in the system which depends on both DSC and the individuals involved. These should not be used in isolation as performance measures. For example, delays in eligibility decisions may be due to individuals failing to provide or complete relevant documentation in a timely manner. As the WA NDIS My Way trial matures, decision times by disability type and support ranking may provide an indication of service quality.

3.1.3 Appeals

There have been no appeals since 1 July 2014.

3.2 WA NDIS My Way trial population: Disability type and demographics

Here we examine the characteristics of individuals participating in the WA NDIS 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 project. 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 project.

As the WA NDIS My Way trial matures, this section will provide early warning diagnostics of demographic trends that could affect the effectiveness or sustainability of the scheme.


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 31 March 2015

Existing New Total

Number of Individuals1 5112 1953 706

Expected 443 646 1,089

Comparison 115% 30% 65% 1. Includes individuals without funding 2. Retrospectively changed since the previous report for late recordings 3. The DSC Quarterly Report Q3 shows individuals that were deemed eligible, which includes one

individual who applied for eligibility regarding a different disability rather than being a new entrant. We do not include that individual in new entrants. Consequently, the DSC report shows a total of 196.

More individuals transitioned from the previous project than expected and there have been fewer than expected newly eligible entrants. The net result is 35% fewer individuals in the trial than expected. It is worth noting that many individuals who transitioned from the previous project are receiving funding for the first time. Also, the rate of growth of new entrants has decreased over the last quarter, with the number of newly eligible entrants only 18% of forecast in the March 2015 quarter.

3.2.1 Transitions from the previous project by type of disability

As noted in previous reports, the majority of individuals who have transitioned from the previous project have an intellectual disability or autism.

Table 3.3 shows the 511 individuals by primary disability for each sex and each age group. This table differs slightly from the previous report due to changes in the March 2015 quarter.


Table 3.3 Primary disability of existing individuals by sex and age as at 31 March 20151,2,3

Primary disability All

Sex Age

Mal

e

Fem

ale

0-1

4

15

-24

25

-44

45

-64

65

+

# %

Acquired Brain Injury 10 2 6 4 1 1 2 5 1

Amputations (Single/Multiple) 0 0 0 0 0 0 0 0 0

Autism and Related Disorders 135 26 107 28 105 27 3 0 0

Bipolar Affective Disorder 0 0 0 0 0 0 0 0 0

Cerebral Palsy 11 2 7 4 4 4 3 0 0

Child/Adolescent Onset Psych Disorder 0 0 0 0 0 0 0 0 0

Corneal Disorders/Defects 0 0 0 0 0 0 0 0 0

Cornelia de Lange Syndrome 1 0 0 1 1 0 0 0 0

Deafblindness 1 0 0 1 0 0 0 1 0

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

Dementia 0 0 0 0 0 0 0 0 0

Developmental Delay 8 2 7 1 8 0 0 0 0

Global Developmental Delay 0 0 0 0 0 0 0 0 0

Huntington’s Chorea 0 0 0 0 0 0 0 0 0

Intellectual Disability 261 51 150 111 62 80 71 45 3

Motor Neurone 2 0 1 1 0 0 0 2 0

Multiple Sclerosis 11 2 1 10 0 0 1 7 3

Muscular Dystrophy 1 0 0 1 0 0 0 0 1

Obsessive Compulsive Disorder 0 0 0 0 0 0 0 0 0

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

Other Neurological 14 3 6 8 2 2 4 4 2

Other Physical Disorders 34 7 17 17 6 6 5 16 1

Other Psychiatric Disorders 0 0 0 0 0 0 0 0 0

Other Sight Loss 6 1 1 5 2 0 2 2 0

Parkinson's Disease 0 0 0 0 0 0 0 0 0

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

Schizophrenia 0 0 0 0 0 0 0 0 0

Specific learning4 1 0 1 0 0 0 1 0 0

Spina Bifida 4 1 2 2 3 0 1 0 0

Spinal Cord Injury - Paraplegia 7 1 2 5 0 1 3 3 0

Spinal Cord Injury - Quadriplegia 0 0 0 0 0 0 0 0 0

Spinal Cord Injury - Tetraplegia 0 0 0 0 0 0 0 0 0



Sex Age

Mal

e

Fem

ale

0-1

4

15

-24

25

-44

45

-64

65

+

# %

Stroke 0 0 0 0 0 0 0 0 0

Surgery/Medical Complications 0 0 0 0 0 0 0 0 0

Total

# 511 310 201 194 121 97 88 11

% 100 61 39 38 24 19 17 2

1. These figures do not include new entrants to the WA NDIS 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 due to a slight difference the

formula used to calculate age at any given point. DSC is reviewing the calculation for Q4 report 4. Other than Intellectual disability and attention deficit disorder.

Not surprisingly, the main demographic features of individuals who transitioned from the previous project have not significantly changed since the previous reports. We restate them here to provide a basis for comparison with new entrants, discussed in the next section:

A majority are classified with a primary disability of “intellectual disability” or “autism”. Intellectual disability is the most prevalent disability type at 51% of all cases. Combined with autism and related disorders, these comprise 77% of primary disability types for all existing individuals.

38% are under the age of 15, of whom 54% are listed as having autism or related disorders.

39% of existing individuals within the WA NDIS 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 WA NDIS My Way trial. Amongst WA NDIS My Way trial individuals, 35% of males have autism as the primary disability whereas only 14% of females do. On the other hand there is a much higher prevalence of multiple sclerosis amongst females in the WA NDIS My Way trial.

As at 31 March 2015 there are 11 individuals aged 65 and over. As at 1 July 2014, there were 7 individuals aged 65 and over. These individuals do not meet the eligibility criteria for the WA NDIS My Way trial. However, individuals above age 65 that were already in receipt of DSC provided and funded supports and services at 1 July 2014 are provided with “continuity of support”. DSC is currently considering its policy position on recording of over 65s, and appropriate adjustments will be made to future quarterly actuarial reviews.

The profile above reveals some demographic trends that are likely to continue into the future and others 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 disability is likely to diminish in future as these individuals have


disproportionately high support needs and so were heavily represented among the existing individuals.

3.2.2 New entrants

The increase in scope for eligibility means that new entrants are likely to have different characteristics to those that transitioned. For example, individuals with psychosocial disability are eligible for the first time.

Table 3.4 shows the 195 new entrants during the three quarters by primary disability type 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 3.4 The primary disability of new entrants by sex and age as at 31 December 20141,2


Sex Age

Mal

e

Fem

ale

0-1

4

15

-24

25

-44

45

-64

65

+

# %

Acquired Brain Injury 10 5 7 3 0 0 0 10 0

Amputations (Single/Multiple) 1 1 1 0 0 0 0 1 0

Autism and Related Disorders 11 6 9 2 8 2 1 0 0

Bipolar Affective Disorder 14 7 8 6 0 1 4 9 0

Cerebral Palsy 4 2 3 1 2 0 1 1 0

Child/Adolescent Onset Psych Disorder 1 1 1 0 0 1 0 0 0

Corneal Disorders/Defects 1 1 1 0 0 0 1 0 0

Cornelia de Lange Syndrome 0 0 0 0 0 0 0 0 0

Deafblindness 2 1 0 2 0 0 1 1 0

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

Dementia 1 1 0 1 0 0 0 1 0

Developmental Delay 8 4 6 2 8 0 0 0 0

Global Developmental Delay 1 1 0 1 1 0 0 0 0

Huntington’s Chorea 1 1 0 1 0 0 0 1 0

Intellectual Disability 6 3 3 3 4 1 1 0 0

Motor Neurone 0 0 0 0 0 0 0 0 0

Multiple Sclerosis 11 6 1 10 0 0 3 8 0

Muscular Dystrophy 4 2 4 0 1 0 2 1 0

Obsessive Compulsive Disorder 1 1 0 1 0 0 0 1 0

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

Other Neurological 13 7 9 4 2 1 4 6 0



Sex Age

Mal

e

Fem

ale

0-1

4

15

-24

25

-44

45

-64

65

+

# %

Other Physical Disorders 26 13 11 15 1 0 0 24 1

Other Psychiatric Disorders 33 17 6 27 0 2 12 19 0

Other Sight Loss 5 3 1 4 1 0 0 4 0

Parkinson's Disease 2 1 1 1 0 0 0 2 0

Retinal Disorders or Defects 7 4 4 3 1 0 1 5 0

Schizophrenia 22 11 13 9 0 2 11 9 0

Specific learning4 0 0 0 0 0 0 0 0 0

Spina Bifida 0 0 0 0 0 0 0 0 0

Spinal Cord Injury - Paraplegia 2 1 2 0 0 0 1 1 0

Spinal Cord Injury - Quadriplegia 1 1 1 0 0 0 0 1 0

Spinal Cord Injury - Tetraplegia 1 1 1 0 0 0 0 1 0

Stroke 1 1 1 0 0 0 0 1 0

Surgery/Medical Complications 3 2 1 2 0 0 0 3 0

Total

# 195 95 100 30 10 43 111 1

% 100 49 51 15 5 22 57 1

1. Percentages may not add to 100 due to rounding 2. Numbers of individuals in age bands may differ to DSC’s Quarterly Report due to a slight difference the

formula used to calculate age at any given point. DSC is reviewing the calculation for Q4 report 3. Including psychosocial disability

We observe that:

As expected, the proportion of new entrants with intellectual disability as their primary disability is significantly lower than individuals who transitioned from the previous project. Of the 195 new entrants, only 3% had an intellectual disability. This compares to 51% for existing individuals that transitioned.

In the September 2014 quarter, the largest group of new entrants by disability type was individuals with ‘other psychiatric disorders’ (36%) followed by multiple sclerosis (24%) and autism and related disorders (16%). Composition by disability type has diversified considerably over the following two quarters, as more new individuals have entered the trial. Individuals with ‘other psychiatric disorders’ remain the largest group (17%), followed by individuals with ‘other physical disorders’ (13%), schizophrenia (11%) and bipolar affective disorder (7%).

79% of new participants are aged 25-64, which is a much higher concentration than observed for transitioned individuals. This may reflect the later onset of some newly eligible disability types, a greater range of pre-existing services for children, and/or slower take-up by parents of children with disability relative to adults.

While females make up just 39% of existing individuals, they make up half of new entrants (51%).


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 WA NDIS My Way trial, as well as the price of these supports are key drivers of WA NDIS 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 WA NDIS 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

Of the 195 newly eligible individuals from the first three quarters, 169 have endorsed plans.

Table 4.1 shows the time elapsed between individuals being deemed eligible and having endorsed and then approved plans. ‘Eligibility to endorsement’ and ‘Eligibility to approval’ consider only newly eligible individuals. ‘Endorsement to approval’ includes all plans approved, noting that individuals may have multiple plans in a quarter.

Delegated approval

Approved Plans

Endorsed and

approved

Endorsed and

escalated

Strategy and plan design

Eligible individuals

Replanning

MWC assigned

Approved

Review


Table 4.1 Time to plan approval

Elig

ibili

ty Q

uar

ter

Nu

mb

er o

f p

lan

s1

Ave

rage

day

s

Med

ian

day

s

Min

imu

m d

ays

Max

imu

m d

ays

Nu

mb

er w

ith

sam

e

day

ap

pro

val

Q1

Eligibility to approval

25 79 77 33 168 14

Endorsement to approval

76 4 0 0 23 43

Q2


92 30 12 0 119 82


234 2 0 0 27 163

Q3


17 41 39 2 87 13


181 3 1 0 19 85

Total


134 40 34 0 168 109


491 3 0 0 27 291

1. Endorsement to approval numbers includes first and subsequent plans.

Of the 195 of the newly eligible individuals, 134 have had plans approved. The average time from eligibility to approval for these individuals as at 31 March 2015 was 40 days, which has increased from 31 reported last quarter. However, we advise caution in comparing these statistics across quarters: the Q1 and Q2 figures have changed materially since their respective reports due to retrospective changes. Retrospective changes should diminish in future as the systems are bedded down.

There have been 491 plans approved in total, 334 of which relate to individuals that transitioned from the previous project. Approval time tends to be short, with 59% of plans being approved on the same day as endorsement. This is at least in part because delegation levels have been adjusted and plan funding arrangements are typically coming in below delegation thresholds.

4.2 Support needs

Prior to additional funding being made available in the WA NDIS My Way trial, those with the highest and critical support needs were prioritised for support and funding. 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. Similar to


the previous section, this section will provide early warning diagnostics of demographic trends that could affect the effectiveness or sustainability of the WA NDIS My Way trial.

For reference, Table 4.2 shows the number of active plans as at 31 March 2015 that relate to existing individuals and new entrants.

Table 4.2 Number of active approved plans as at 31 March 2015

Existing

individual as at 1 July 2014

New entrants since 1 July

2014 Total

Active plans 497 134 631

4.2.1 The support needs matrix

Figure 4.2 shows the eight support needs categories with the prevalence of each among the individuals in the WA NDIS My Way trial at 31 March 2015. The chart shows both new and existing individuals and the breadth of support needs by individuals – but not the depth of need under each category.

Figure 4.2 Breadth of support needs of individuals with approved plans as at 31 March 2015

The breadth of support needs has not changed significantly since the previous report. The majority of individuals, both new and transitioning, have support needs in all categories. ‘Working’ is the category in which the fewest individuals who transitioned from the previous project have support needs. Contributing factors include the number of minors, and the number of individuals with very complex needs in this group. ‘Mobility’ is the category in which the fewest new individuals have support needs. Now that 134 of 631 approved plans are for new individuals, we are beginning to see some meaningful trends. As expected, new entrants have lower support needs than existing participants and therefore narrower range of needs across the support categories.


Figure 4.3 examines the level of support needs 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 31 March 2015

Similarly to the breadth of support needs, the level of support needs has not changed significantly since the previous report. We observe that education, community and working are the categories of support needs in which individuals require the highest levels of supervision (blue columns). However, 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 discussed in the previous section. 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 categories5 are:

Mobility

Self-care

General tasks

Learning

Interpersonal

Communication.

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

correspond to the reference package in Appendix C.


We have translated each depth of support needs 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 56.

This ranking allows simple analysis of depth of support needs by disability. Those with no support score are excluded from this analysis.

Figure 4.4 shows the depth of support needs for all individuals with active plans as at 31 March 2015. For example, the cluster of bars for mobility on the left shows the proportion of 100% of individuals with plans that requires each different level of mobility support. This shows that the largest proportion of individuals (28%) never requires mobility support, while the second largest (20%) requires mobility support 1-2 times a day. The depth of support needs across all categories has not changed significantly since the previous report.

Figure 4.4 Depth of support needs of individuals with approved plans at 31 March 20151

1. ‘No score’ includes 12 individuals with active plans that do not have support scores – only 3 of these have funded plans. These scores will be updated when the plans are reviewed.

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.

Table 4.3 shows the average support needs rank by primary disability type. 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. For example, if a certain cohort is entering at a greater rate, this gives an indication of the nature and extent of their likely support needs.

6 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 use an ascending scale here to create more intuitive results.


Table 4.3 The average support needs rank by primary disability for individuals with approved plans as at 31 March 2015

1. Including psychosocial disability

Mo

bil

ity

Self

-car

e

Ge

ne

ral t

asks

Lear

nin

g

Inte

rpe

rso

nal

Co

mm

un

icat

ion

Acquired Brain Injury 19 2.1 2.3 3.2 2.6 2.6 2.3

Amputations (Single/Multiple) 1 0.0 0.0 0.0 0.0 0.0 0.0

Autism and Related Disorders 136 1.3 3.1 3.8 4.1 4.1 3.4

Bipolar Affective Disorder 9 1.3 2.0 2.8 2.1 3.1 2.6

Cerebral Palsy 13 2.6 2.6 3.3 2.6 1.7 1.7

Child/Adolescent Onset Psych Disorder 1 2.0 2.0 2.0 1.0 2.0 2.0

Corneal Disorders/Defects 0

Cornelia de Lange Syndrome 1 3.0 5.0 5.0 5.0 4.0 5.0

Deafblindness 1 2.0 2.0 4.0 1.0 1.0 3.0

Deafness/Hearing Loss 3 1.3 1.3 2.7 3.7 4.0 5.0

Dementia 0

Developmental Delay 15 2.3 4.5 4.3 4.3 4.1 4.7

Global Developmental Delay 0

Huntington’s Chorea 1 2.0 0.0 4.0 4.0 3.0 2.0

Intellectual Disability 259 2.0 3.0 3.9 4.0 3.8 3.5

Motor Neurone 2 3.5 3.5 3.5 1.5 2.5 3.5

Multiple Sclerosis 22 3.3 3.0 3.4 1.7 1.5 1.0

Muscular Dystrophy 4 2.3 2.3 3.0 1.0 1.3 0.8

Obsessive Compulsive Disorder 1 2.0 3.0 3.0 2.0 3.0 3.0

Other Injury/Poison/External Cause 1 4.0 4.0 4.0 1.0 2.0 1.0

Other Neurological 23 3.3 3.1 4.1 3.0 3.0 2.7

Other Physical Disorders 50 3.2 2.7 3.1 1.9 2.2 1.6

Other Psychiatric Disorders1 26 1.6 2.2 2.7 2.1 2.7 2.0

Other Sight Loss 9 2.9 2.1 3.0 1.9 1.9 1.6

Parkinson's Disease 1 4.0 2.0 3.0 3.0 2.0 3.0

Retinal Disorders or Defects 4 3.8 2.0 3.5 0.5 0.8 1.0

Schizophrenia 13 1.6 2.5 3.1 2.5 3.1 2.7

Specific learning - other than Intellectual/ADD 1 0.0 1.0 3.0 2.0 2.0 2.0

Spina Bifida 4 4.3 4.5 4.5 4.0 2.5 2.8

Spinal Cord Injury - Paraplegia 8 4.6 3.6 4.4 1.4 1.6 1.3

Spinal Cord Injury - Quadriplegia 0

Spinal Cord Injury - Tetraplegia 1 5.0 5.0 5.0 2.0 3.0 1.0

Stroke 0

Surgery/Medical Complications 2 3.5 3.0 3.5 2.5 2.0 2.5

Total 631 2.1 2.9 3.7 3.4 3.4 3.0

Q2 595 2.2 3.0 3.7 3.5 3.5 3.1

Q1 449 2.2 3.1 3.9 3.8 3.7 3.3

Primary disability

# a

pp

rove

d p

lan

s

Support category


The colouring illustrates the range of support needs for each Support Category – for example, a dark red value picks out the Primary Disability that has a high support need in that category. General tasks, learning and interpersonal support categories have the highest needs based on the average rank for all disability types.

Despite the changing characteristics of eligible individuals over time, the average support needs over each primary disability type have remained relatively stable in the first three quarters. Nonetheless, there are modest decreases in average support needs for learning, interpersonal and communication support categories, reflecting the shifting age demographic. Only schizophrenia and spina bifida have shown meaningful increases since the previous report. Although this isn’t a major concern, given their relatively low representation among all plans at this early stage of the program, we will continue to monitor the evolution of each disability type against support needs.

These averages show:

Individuals with developmental delay have above average support needs in all support categories, possibly due to the age profile of this group

Individuals with autism or intellectual disability have above average support needs in the self-care, general tasks, learning, interpersonal and communication categories

Individuals with other neurological or spinal cord injury (paraplegia and tetraplegia) have above average support needs in mobility, self-care and general tasks

Individuals with multiple sclerosis have above average support needs in mobility and self-care

Individuals with cerebral palsy, other physical disorders or other sight loss have above average support needs in mobility only.

We do not provide comment on primary disability types where there are 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 WA NDIS My Way trial, such as outcomes and average package costs, relative to complexity of support needs.

Table 4.4 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 receive a ‘no score’ ISR.


Table 4.4 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 4.5 shows the number of individuals with approved plans at 31 March 2015 for each ISR. Figure 4.5 shows the distribution of these individuals compared to the forecast distribution7.

Table 4.5 Individual support rank of individuals with approved plans as at 31 March 2015

Individual support rank

Plans Observed

distribution Expected

distribution

9 91 14% 2%

8 113 18% 7%

7 176 28% 5%

6 38 6% 10%

5 40 6% 6%

4 76 12% 15%

3 44 7% 14%

2 13 2% 12%

1 6 1% 22%

0 22 3% 7%

No score 12 2%

Total 631 100% 100%

7 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.


Figure 4.5 Observed and expected distribution of complexity rank for individuals with approved plans as at 31 March 20151

1. ‘No score’ includes 12 individuals with active plans that do not have support scores – only 3 of these have funded plans.

As noted in section 1.4, the expected distribution of individuals 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 WA NDIS My Way trial.

For example, the lightest shade of blue columns add up to 100% of individuals whose plans were approved in the March 2015 quarter. The largest share (28%) had a relatively high ISR of 7. Whereas the orange line shows that ultimately it is expected that the largest share (22%) will have a relatively low IRS of 1. NDIA’s forecasts anticipated that, at maturity, a lesser proportion of individuals would have high support needs, and a greater proportion of individuals would have low support needs.

Observed distribution of ISR is weighted more heavily towards high needs individuals than the expected eventual distribution, based on the expected national average. In the early stages of the WA NDIS My Way trial, we expect that the population will be weighted towards high ISRs because most individuals transitioned from the previous project, which typically had a higher entry level of support for eligibility due to resource constraints. Figure 4.5 supports this expectation. As the WA NDIS My Way trial matures, the observed distribution of ISR seen in Figure 4.5 should move to the left. Indications of this shift can already be seen, with 46% of approved plans in the third quarter having ISRs below 6, compared with 28% of old plans and 39% of plans approved in the first two quarters.

Figure 4.6 shows the mean, median and inter-quartile range (IQR) of ISR for each primary disability type. This helps to compare the assessed level of needs within and between primary disability types. We show the number of individuals in each group alongside the disability type.


Figure 4.6 Distribution of individual support rank by primary disability of individuals with approved plans as at 31 March 2015

We observe that since the previous report, individuals with developmental delay or schizophrenia have had an increase in the range of their ISRs – their interquartile range increasing in width by 1.0 – which may be due to a wider range of disability types falling into these primary disability categories.

Individuals with other psychiatric disorders have particularly low ISRs, with an average of 4.2 and an interquartile range of 2; whereas individuals with spina bifida or spinal cord injury have particularly high ISRs, with averages of 8.3 and 7.4, respectively, and relatively small interquartile ranges of 1.3 each.


Individuals with acquired brain injury, bipolar affective disorder, multiple sclerosis, muscular dystrophy, other physical disorders and other sight loss have the widest range of ISR, indicating significantly different needs within these cohorts.

4.3 Committed costs

Table 4.6 shows committed costs8 for individuals with active and approved plans. These figures include unfunded plans. We have calculated that the average annualised committed cost is $24,208; below the forecast average annualised cost of $36,771.

Table 4.6 Committed costs1

As at

31 March 2015

As at 31 December

2014

As at 30 September

20142,3

Total committed costs 15,275,043 14,395,177 11,443,921

Observed average annualised committed costs

24,208 24,194 25,431

Expected average annualised committed costs

$36,771

Comparison: Observed / Expected 66% 66% 69%

1. Committed costs may be understated due to the under-reporting of in-kind committed costs 2. Active as at previous reporting points – viewed retrospectively using current data. These numbers may

differ from the previous reports due to retrospective changes in the underlying data 3. The total and average annualised committed cost amounts may differ to the DSC Quarterly Reports

due to a different treatment of retrospective changes to data.

Average committed costs per individual are 34% lower than forecast. This result is promising 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 (compared to expected) for those with the highest support needs.

Average committed costs have barely changed since the previous quarter. This should not be interpreted as stability: all else being equal, we expect average committed costs to decrease because new entrants have lower support needs than existing individuals. However, although new entrants in the March quarter do have lower than average committed cost, this has been offset by updated plans for existing individuals which are higher than their previous plans. We discuss this further below.

Table 4.7 shows the allocation of committed costs between strategy types: service provider, self-managed and in-kind. In-kind committed costs are currently under-reported.

8 Average committed costs are comparable across reports and between segments. However, these do not

show the complete average cost of a plan because in-kind commitments are only partly recorded.


However, the reporting of in-kind cost has improved substantially over the previous quarter and is expected to improve further over the coming quarter.

Table 4.7 Allocation of committed costs by strategy types for individuals with approved plans as at 31 March 2015

Service

provider Self-managed In-kind Total

Committed costs ($) 11,291,942 3,196,280 786,821 15,275,043

Committed costs (%) 74% 21% 5% 100%

4.3.1 Plan costs over time

Table 4.8 shows the total funding, number of plans and the average annualised committed costs for all individuals with active and approved plans.

Table 4.8 Funding and average annualised committed costs of individuals with approved plans as at 31 March 20151,2

Plans

Committed costs

$

Numbers Average annualised

committed costs

All Funded Percentage

funded

All

$

Funded

$

Approved prior to 1 July 2014

4,663,530 179 149 83% 26,053 31,299

Approved in the Sep 2014

quarter 1,777,687 64 57 89% 27,776 31,187

Approved in the Dec 2014

quarter 5,154,940 210 160 76% 24,547 32,218

Approved in the Mar 2015

quarter 3,678,886 178 155 87% 20,668 23,735

All 15,275,043 631 521 83% 24,208 29,319 1. Committed costs may be understated due to the under-reporting of in-kind committed costs 2. Plans approved after 1 July 2014 include 317 for existing individuals who have transitioned from the

previous project and 135 for new entrants.

The average committed cost is $24,208 over 631 approved plans at 31 March 2015. At $20,668, the average committed costs for plans approved in the March 2015 quarter is lower than for plans approved in previous quarters. Further, the average funded committed cost for plans approved in the March 2015 quarter is lower than previous quarters.

Figure 4.7 shows the distribution of committed costs for all active plans. The columns for each approval time period sum to 100%. For plans approved in all time periods, the largest


share of plans have committed costs between $10,000 and $30,000 – overall this makes up 34% of approved plans.

Figure 4.7 Distribution of committed costs of individuals with new and old approved plans as at 31 March 2015

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

Figure 4.8 shows the average committed cost for plans approved since the start of the WA NDIS My Way trial. We show the average committed costs of the first plans for all individuals – for individuals who transitioned from the previous project, the “first plan” is the plan with which they transitioned. Also, we show the average committed cost of updated plans (i.e. not the first plan) in each quarter that these plans were approved. The average costs of these updated plans are shown in front of the average cost of the previous plans (pink columns). The number of plans approved is shown at the foot of each column.


Figure 4.8 Average committed cost of individuals for first and subsequent plans1,2,3

1. Committed costs may be understated due to the under-reporting of in-kind committed costs 2. Approved in each quarter – viewed retrospectively using current data 3. Includes all approved plans – funded or unfunded

Figure 4.8 demonstrates two key observations:

Individuals receiving their first approved plan in the December 2014 or the March 2015 quarters have significantly lower average committed costs than individuals who transitioned from the previous project. This is consistent with the inclusion of cohorts with lower-complexity support needs in the WA NDIS My Way trial since 1 July 2014.

Continuing the trend observed last quarter, the subsequent plans approved in the December 2014 and the March 2015 quarters have higher average committed costs than the plans which they replace. The increase (about $6,000) is largely due to the many previously unfunded plans now being funded. As the scheme stabilises, the transition of individuals from unfunded to funded plans will become less frequent. All else being equal, this will narrow the difference between their average committed costs.

Growth in plan costs is expected, in that the trial expands the types of supports funded, and extends funding to more individuals. We will continue to monitor the change in committed costs that individuals experience as part of the plan review process. Particularly, careful attention will be given to how an individual’s annualised committed costs change over their funding lifetime.


4.3.2 Actual package costs versus reference package guidance

The analysis in this section provides an indication of whether plan costs are tracking as expected when the complexity of individuals’ support needs is taken into consideration. Table 4.9 uses the individual support ranks to compare the average committed costs to the average reference package amounts. The average reference package column shows, hypothetically, the amount that would have been committed on the basis of the benchmark reference package “median cost”. That is, based on the actual volume of plans and actual distribution of client needs, what would committed costs have been if plans were actually funded at the reference package levels? This hypothetical analysis reveals the source of the lower than expected average committed cost: trial package costs are below the reference package levels, particularly for individuals with greater support needs.

Table 4.9 Comparison of average committed costs to average reference package amount by individual support rank of individuals with approved plans as at 31 March 20151

Individual support rank

Number of plans Average

committed costs $

Expected average

committed costs2

$

Comparison

9 91 58,254 170,192 34%

8 113 34,054 106,460 32%

7 176 20,061 61,770 32%

6 38 22,230 52,105 43%

5 40 10,064 33,863 30%

4 76 12,824 24,809 52%

3 44 5,583 13,688 41%

2 13 5,525 8,800 63%

1 6 0 3,867 0%

0 22 160 0

No score 12 4,355 0

Total 631 24,208 70,283 34%

Total Q23 595 24,194 71,404 34%

Total Q13 449 25,431 72,407 35%

1. Committed costs may be understated due to the under-reporting of in-kind committed costs 2. Average reference package amounts differ to the headline reference package averages because of age

adjustments 3. Active as at end of quarter – viewed retrospectively using current data. These numbers may differ from

the previous report due to retrospective changes in the underlying data.

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 WA NDIS My Way trial. This is due to the prevalence of individuals with high support needs automatically transitioning in from the previous project, and the slower-than-expected entry of newly eligible individuals with less complex support needs.


The expected committed costs using the benchmark reference package should be used for comparison over time only. This is because the reference package is no longer being used by NDIA as its reliability is considered questionable. We continue to produce the expected annual plan cost for monitoring over time until a viable alternative to the reference package is established, either by ourselves or NDIA.

Based on the average reference package amounts and the distribution of individuals by ISR the expected annual plan cost is $70,283. 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 4.9, which shows this average over all individuals with approved plans by ISR, prompts the following observations:

The average committed as a proportion of expected cost has remained stable, indicating that the reference package may be systematically overestimating support needs for approved plans.

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. Even after accounting for the 17% of plans receiving no direct funding, the average committed costs are below reference package guidelines. This could be due to a number of factors including the immaturity of the trial, lesser funding requirements, lower costs of purchased plan components, the planning and facilitation role of the My Way Coordinator in the WA model, or greater use of community supports and networks compared to forecast for a mature, national scheme.

4.4 Strategies

This section provides analysis of the type of strategies that are being funded to assist individuals in achieving their plan goals, and the nature of the outcomes those strategies are intended to achieve. An individual can have multiple strategies in the same plan. The strategies for any given plan belong to support ‘clusters’, although many strategies can belong to one ‘cluster’. Consequently, there are 2,614 funded strategies.

Table 4.10 is a matrix of the number of funded strategies by WA NDIS My Way support cluster and outcome. We do not include unfunded strategies, even if the plan is funded.


Table 4.10 Number of funded strategies by Support Cluster and Outcome for individuals with approved plans as at 31 March 2015

Support Cluster

Outcome

Total1

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 3 2 0 5 1 1 0 12 0

Daily Living 189 224 82 46 155 25 98 819 31

Wellbeing 98 163 439 14 208 45 24 991 38

Family and Carer Support 5 12 6 2 4 22 120 171 7

Behaviour Support and Specialist Care 1 13 1 4 8 0 6 33 1

Therapy and specialist support 17 136 14 13 79 7 3 269 10

Self-management 0 0 0 0 0 0 0 0 0

Communication 5 1 1 1 0 0 3 11 0

Equipment 86 127 9 46 20 1 4 293 11

Other 2 2 0 1 0 1 3 9 0

Episodic Coordination of Support 3 3 0 0 0 0 0 6 0

Total # 409 683 552 132 475 102 261 2614 100

% 16 26 21 5 18 4 10 100 1. These totals include all funded strategies for funded plans. This differs from the comparable measure

used in DSC publications where all strategies (funded and non-funded) are included for funded plans.

We observe that, as was the case in the previous reports, 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 4.11, Table 4.12 and Table 4.13 show a breakdown of committed cost by outcome, WA NDIS My Way support cluster and NDIS cluster. Each table shows the split for service provider 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 4.11 Average committed cost per funded strategy by Outcome for individuals with approved plans as at 31 March 2015

Outcome

Strategy

Service provider

$

Self-managed

$

All1

$

Learning new skills 8,342 2,362 5,330

Community participation 10,952 4,109 8,081

Supporting family friends and carers 11,668 3,373 5,705

Wellbeing 16,591 2,203 7,839

Family and relationships 8,014 2,410 4,317

Safety and security 22,423 2,580 12,134

Choice and control over life 10,704 3,916 7,791

All 12,000 2,960 7,169

Average number of strategies per plan 1.49 1.71 3.20 2. All does not include in-kind committed costs or strategies

Table 4.12 Average committed cost per funded strategy by Support Cluster for individuals with approved plans as at 31 March 2015

Support cluster

Strategy

Service provider

$

Self-managed

$

All1

$

Accommodation 79,112 6,150 65,846

Daily Living 15,387 2,391 9,227

Wellbeing 9,105 3,413 6,593

Family and Carer Support 9,208 5,193 6,482

Behaviour Support and Specialist Care 12,157 3,657 7,253

Therapy and specialist support 3,006 2,135 2,290

Communication 3,948 1,000 3,211

Equipment 1,657 1,888 1,882

Other 20,149 1,196 5,934

Episodic Coordination of Support 7,488 2,500 4,994

All 12,000 2,960 7,169



Table 4.13 Average committed cost per funded strategy by NDIS Cluster for individuals with approved plans as at 31 March 2015

NDIS Cluster

Strategy

Service provider

$

Self-managed

$

All1

$

Accommodation/tenancy assistance 1,750 1,750

Assistance in coordinating or managing life stages transitions and supports 7,488 2,500 4,994

Assistance to access and maintain employment 10,587 4,695 9,114

Assistance with daily life tasks in a group or shared living arrangement 29,209 3,882 17,337

Assistance with daily personal activities 33,459 5,646 18,765

Assistance with personal care and transitions in educational settings 3,869 3,060 3,253

Assistance with travel/transport arrangements 4,349 1,353 3,310

Assistive equipment for recreation and leisure 1,178 1,178

Assistive products for household tasks 679 679

Assistive products for personal care and safety 2,022 2,022

Assistive tech specialist assessment set up & training 576 852 817

Behaviour support 2,062 1,631 1,866

Communication and information equipment 965 965

Development of daily living and life skills 10,461 2,488 7,580

Early intervention supports for early childhood 3,453 3,453

Home modification design and construction 6,650 6,650

Household Tasks 11,848 4,485 9,839

Interpreting and translation 1,000 1,000

Management of funding for supports under an individual's plan 2,068 600 1,334

Not applicable 20,149 919 7,329

Participation in community social and civic activities 9,210 4,097 6,929

Personal mobility equipment 2,508 2,342 2,357

Physical wellbeing activities 7,786 2,757 5,345

Specialist care for individuals with high care needs 24,270 18,720 23,345

Therapeutic supports 3,006 2,048 2,228

Training for independence in travel and transport 4,796 640 3,498

Training for the provision of specialist care 3,109 3,109

Vehicle modifications 1,034 3,430 2,232

Workers' Compensation & Superannuation 14,375 817 899

All 12,000 2,960 7,169



5 DELIVERY

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

Plan execution by disability and mental health service providers, and/or individuals who self-manage

Planning, coordination and other WA NDIS 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 WA NDIS My Way trial is not mature enough to gain any insight from the payments to date. As such, this section provides only high-level summary of experience to date. However, the acquittal reporting process has been implemented by DSC so analysis of the delivery process will be possible in future.

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.

5.2 Payments by management type

Table 5.1 shows the payments made to service providers 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

Payment month

Payments to:

Total 1

$ Service

providers2

$

Self-managed individuals

$

Jul-14 1,604,125 147,161 1,751,287

Aug-14 0 163,104 163,104

Sep-14 65,201 128,353 193,554

Oct-14 1,836,480 216,848 2,053,328

Nov-14 446,238 155,472 601,709

Dec-14 94,615 232,846 327,461

Jan-15 2,102,148 136,392 2,238,540

Feb-15 349,790 219,279 569,069

Mar-15 384,422 178,651 563,073

Total2 6,883,019 1,578,106 8,461,125 1. Total does not include in-kind committed costs or strategies 2. The totals differ from the DSC Quarterly Report Q3 due to different criteria for inclusion.

Self-managed payments make up approximately 19% 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 in detail. DSC has commenced allocating in-kind committed costs to payment quarters in the DSC Quarterly Report Q3.

5.4 Operating expenses

Table 5.2 shows the WA NDIS My Way trial operating expense ratio for the financial year to date.


Table 5.2 WA NDIS My Way trial operating expense ratio

Total payments made1 (including administration costs) 11,528,020

Administration costs:

Direct costs of WA NDIS My Way coordination 1,739,412

Indirect costs including operations and funding 492,077

Corporate overheads 375,768

Total 2,607,257

Operating expense ratio2 23%

1. Total payments made includes $459,638 for the approximate discharge of in-kind payments based on a prorata allocation of each individuals in-kind committed costs in the nine months to 31 March 2015.

2. Administration costs divided by total payments made.

The operating expense ratio is 23%, which is a decrease from the result of 26% at the end of the December 2014 quarter. However, this decrease is entirely due to the introduction of approximate in-kind payments into the determination of total payments made. Operating expenses are relatively high because of the low average package costs. Low package costs may be attributed to the intensive role of the WA NDIS My Way Coordinator in the planning process and facilitation of informal supports and community based supports and services. We expect administrative costs to remain relatively stable over the year.


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 third quarterly review carried out for the DSC in relation to the WA NDIS My Way trial. While there has been significant effort expended by both Taylor Fry and DSC to produce and understand the data extracts, there remains a small chance that we have misunderstood some aspect or other of the data.

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 trial 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 BACKGROUND

A.1 Introduction

From 1 July 2013 the Commonwealth Government began the roll out of the National Disability Insurance Scheme (“NDIS” or 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 NDIS 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 WA NDIS 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:

WA NDIS 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

WA NDIS 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 WA NDIS My Way trial performance on a quarterly basis. This is the third quarterly actuarial report monitoring performance of the WA NDIS My Way trial.

DSC presented its third quarterly report to the Commonwealth on 1 May 2015. This quarterly actuarial report is a companion piece, reporting from an actuarial perspective on WA NDIS My Way trial performance.

A.2 The WA NDIS My Way model

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

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


Exercise more choice and control over their supports and services

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.

A.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


A.4 Baseline forecast and key cost drivers for the WA NDIS My Way trial

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

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

Quarterly reports focus on scheme performance in relation to each of these key cost drivers, with a particular focus on individuals accessing the WA NDIS My Way trial, their support needs, and how committed plan cost compares to expected cost, based on the distribution of support needs.


APPENDIX B EXPECTATIONS

B.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 schedules agreed between the State and Commonwealth provide guidance to the expected demand and costs of the WA NDIS 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.


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

Table B.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 B.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 B.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


B.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 WA NDIS 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 B.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 C REFERENCE PACKAGE AND INDIVIDUAL SUPPORT RANK

C.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 WA NDIS My Way trial while expectations regarding funding are still developing.


C.2 Support scores

Table C.1 Support scores

Support score category

Mobility

Self-care

Communication

General tasks

Learning

Interpersonal

Table C.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

C.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 C.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

C.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 4.9, is affected.

Table C.4 Age group

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%

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