7.2 Provider Payment Assurance Program

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The Provider Payment Assurance Program confirms the accuracy of payment requests submitted by registered providers.

When registering as a support provider with the NDIA, your organisation agrees to be bound by the Agency’s Terms of Business (PDF) (DOC) that includes the requirement that registered providers may be reviewed by the NDIA in relation to supports funded for an NDIS participant. As part of any review under the Provider Payment Assurance Program you must keep full and accurate records of supports delivered as outlined in Section 7.2.1. Failure to do so may result in monies having to be repaid to the NDIA. 

See Section 7.2.4 for further information on consequences of non-compliance.

    7.2.1 Documenting support delivery

    Guidelines have been developed for registered providers about the basic documentation requirements needed to support the Provider Payment Assurance Program. Records, at a minimum, should be prepared and retained that include:

    • the participant’s name
    • the date(s) and total hours or quantity of the support delivered
    • the support type.

    Depending on the nature of the support being delivered, additional documentation guidelines may apply.

    For guidance, the following templates are included for providers to use or adapt:

    Further explanation of their use is identified in the sections below.

    7.2.2 Retaining documentation of support delivery 

    The following documentation should be kept on file (either electronically or paper based) and easily accessible as evidence of support delivery:

    • a Service Agreement containing the schedule, cost, type and quality of supports to be delivered; as well as the expected outcomes for the participant

    • approved quotes as appropriate

    • evidence of support quantity

    • evidence of support type.

    Logs for 1:1 support (see Support Log example (PDF) (DOC)) and rosters for group supports (see Group Roster example (PDF) (DOC)) are the best method of documenting the quantity of supports delivered. Wherever possible, these logs should be signed by the participant, a parent/guardian, nominee or carer, as confirmation the support was delivered as claimed. Rosters should also capture the ratio/intensity of group supports.

    A log or roster may be sufficient evidence of both quantity and support type for some simple supports. More complex supports will require additional information to evidence the support type. In these instances, a case note should be completed. Effective case notes document the activities engaged in and how they relate to the support type claimed. Depending on the support type a case note may also document progress and plans for future sessions.

    7.2.3 Documentation by support type

    A chart of individual support items organised by Support Category (plan budgets) is available at Section 2.3 of this Provider Toolkit. The chart is not intended to be a comprehensive list of support types or documentation requirements. Providers should use their judgement to make sure they have suitable evidence for all claims and are maintaining documentation that is fit for audit.

    7.2.3.1 Core supports​

    Core supports include the following support categories:

    • assistance with daily life

    • transport

    • consumables (which should be documented in line with Capital supports – see 7.2.3.2) 

    • assistance with social and community participation (which should be documented in line with Capacity building supports – see 7.2.3.3) 

    Core supports are episodic, with the exception of Supported Independent Living. Episodic supports have a distinct daily start and end time.  While most episodic core supports are adequately evidenced through a service agreement and roster or log, some complex core supports may also require a case note.

    Supported Independent Living supports extend 24 hours or more at a time such as:

    • assistance in a shared or independent living arrangement

    • short term accommodation and assistance

    • assistance from a live-in carer.

    These types of supports will be primarily documented through a formal Service Agreement detailing the duration, ratios and cost of the accommodation or carer as well as specifying any daily supports to be provided as part of the supported living. 

    Additional documentation of staff to participant ratios, time sheets, group rosters and case notes detailing activities and skill building should be maintained as appropriate.

    7.2.3.2 Capital supports

    Capital supports include the following support categories:

    • continence products

    • home enteral nutrition (HEN)

    • selection and/or manufacture of customisable or wearable technology

    • all assistive technology

    • vehicle and home modifications.

    These supports (as well as consumables) should be invoiced to the participant. Invoices with the participant’s name, NDIS number and the date of delivery may not require additional evidence of quantity or support type.

    7.2.3.3 Capacity supports

    Capacity supports include the following support categories:

    • coordination of supports

    • improved living arrangements

    • increased social and community participation

    • finding and keeping a job

    • improved health and wellbeing

    • improved learning

    • improved life choices

    • improved daily living.

    These types of supports (as well as assistance with social and community participation) will typically require both a log or roster and a case note as evidence of quantity and type. 

    Where the delivery of these supports results in the delivery of a report or assessment to the participant, additional documentation may not be required if the participant name and NDIS number, date(s), times and quantity of the support type are documented within the final report/assessment.

    If a provider is delivering coordination of supports to a participant in conjunction with any other support delivery, the provider must retain documentation of the following:

    • organisational arrangements in place to keep information separate between teams

    • a participant’s options for their coordination of supports

    • documentation that there is no remuneration provided to staff for participant volume

    • documentation confirming that there are no trailing commissions or percentages on funds managed

    • confirmation that the conflict of interest and above information was disclosed to the participant.

     

    7.2.4 Non-compliance 

    Failure to adhere to the Terms of Business (PDF) (DOC) and the Provider Payment Assurance Program could result in review of your status as a registered provider.

    Claims which are found to be unsupported by the documentation retained by providers may need to be repaid to the NDIA.

    Providers concerned that they may be in breach of, or at risk of breaching, their responsibilities under the Provider Payment Assurance Program should contact their local NDIS office.

     


    Last modified 29/11/2017

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