Self-managed Participants audit and compliance assessment criteria
Dear National Disability Insurance Agency,
When a self-managed participant undergoes an audit review in line with section 46 of the NDIS Act, which criteria do the Compliance Branch assess Participants claims against to assess whether a participant has spent their funding in accordance with their plan.
Does the audit assessment use:
1. The Reasonable and Necessary criteria set out in section 34?
2. National Disability Insurance Scheme (Supports for Participants) Rules 2013?
3. The Operational Guidelines?
3. The self-management checklist?
4. Booklet 3 - Using your plan?
5. Any other documents or criteria?
Of these documents above which one is granted more weighting?
If any documents or additional criteria is identifed in point 3 & point 5, a release of this information is requested.
Yours faithfully,
Mr Bradley
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Dear Richard Bradley,
Thank you for your email.
As your correspondence raises questions about procedure within the NDIA
and is not a request for documents under the Freedom of Information Act
1982, we have forwarded your email to the National Disability Insurance
Agency’s compliance team for them to provide you with a response.
Many thanks,
Freedom of Information Team
Government Division
National Disability Insurance Agency
E [1][NDIA request email]
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Dear Mr Bradley
I apologise for the delay in responding to your request.
The Agency undertakes a range of compliance activities and conducts
targeted compliance actions to address identified risks and emerging
issues. These compliance activities are also designed to
assist self-managed participants and their nominees, plan management
agents, and registered providers to understand their obligations and
requirements.
Different business areas of the Agency conduct compliance and business
assurance programs. The Compliance Program Branch undertakes compliance
activity where possible instances of non-compliance are identified. This
compliance activity includes reviews of payments against participant plans
in line with legislative requirements, standards, and other obligations of
the Scheme.
In some cases, we may request documentation to evidence that payment
requests are compliant and that NDIS funds have been used in line with an
approved plan as set out in section 46 of the NDIS Act.
The supports funded in a plan must meet the Reasonable and Necessary
criteria set out in section 34 of the NDIS Act. Each support must meet
these criteria individually, but the supports must also meet the criteria
when considered as a package. This section of the Act affects the
development of a plan only and is not applied directly to assessment of
individual payment requests by the Compliance Program Branch.
Under the law for the NDIS, there are things we cannot fund or provide. We
cannot fund or provide supports that:
· are not legal
· are income replacement
· are likely to cause harm to you, or pose a risk to other people
· are not related to your disability
· relate to a ‘day-to-day living cost’, such as groceries, rent or
utilities, that are not attributable to your disability support needs.
These are costs that are not caused by or as a result of your disability
support needs.
· duplicate other supports provided by the NDIS under alternative
funding.
To help participants identify what supports may be in line with their plan
the Agency provides guidance, such as the “Would We Fund It?” guide, the
“Guide to Self-Management", our Operational Guidelines, and other
documents.
Compliance reviews assess if NDIS funds were used in a way that satisfies
these requirements and is in line with the plan, including any general and
stated descriptions.
Kind regards
Mel
Melissa Woodburn
Chief Risk Officer
National Disability Insurance Agency
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