Modified NDIS audit pathway for residential aged care providers supporting NDIS participants

Background

The daily accommodation and care/support costs for NDIS participants living in residential aged care (RAC) are paid for by the National Disability Insurance Scheme (NDIS) through a cross billing arrangement between the Department of Health and the National Disability Insurance Agency. The NDIS funds for these NDIS participants are incorporated within Department of Health payments to RAC facilities. NDIS participants’ plans record that they are supported for daily supports in group living under registration group 0115.

On 1 December 2020, all RAC providers supporting NDIS participants were automatically registered with the NDIS Quality and Safeguards Commission (NDIS Commission). These transitioned providers are registered for class of support 15 (i.e. registration group 0115) under section 20 of the National Disability Insurance Scheme (Provider Registration and Practice Standards) Rules 2018 (the Rules). Providers must subsequently apply to renew their NDIS provider registration before their renewal date and be assessed by an Approved Quality Auditor (AQA) as meeting the relevant NDIS Practice Standards specified in the Rules, in order to maintain that registration.  AQAs must take into account the Quality Indicators set out in the National Disability Insurance Scheme (Quality Indicators for NDIS Practice Standards) Guidelines 2018 in assessing whether an applicant for registration meets the NDIS Practice Standards.

After 1 December 2020, RAC providers commencing delivery of daily accommodation and care/support to an Agency-managed NDIS participant must apply for registration with the NDIS Commission as a new applicant.

Modified NDIS RAC audit

This document sets out the approved modified NDIS audit pathway for RAC providers supporting NDIS participants in their facilities. It should be read in conjunction with the National Disability Insurance Scheme (Approved Quality Auditor Scheme) Guidelines 2018 (AQA guidelines).  

A RAC provider may be eligible for a modified NDIS RAC audit if they are:

1. a ‘transitioned RAC provider’ within the meaning of subsection 12(4) of the National Disability Insurance Scheme (Quality and Safeguards Commission and Other Measures) Transitional Rules 2018; or
2. a person or entity that is:
   1. an approved provider within the meaning of the Aged Care Quality and Safety Commission Act 2018; and
   2. providing residential care on a permanent basis to NDIS participant(s), where the NDIS participant(s) are approved as recipients of residential care under Part 2.3 of the Aged Care Act 1997; and
   3. a NDIS provider providing assistance with daily life tasks in a group or shared living arrangement under participants’ plans.

The modified NDIS RAC audit provides a pathway for an eligible RAC provider to be assessed against the NDIS Practice Standards and Quality Indicators through a review by an AQA of their most recent audit against the Aged Care Standards, undertaken by the Aged Care Quality and Safety Commission (ACQSC). This is in accordance with subsection 5(3) of the Rules which states that, despite subsection 5(1) of the Rules: ‘the Commissioner may, in writing, authorise an approved quality auditor to assess an applicant or a registered NDIS provider against an applicable standard by conducting a review of the outcomes and evidence from a comparable quality audit process undertaken in relation to the applicant or provider, if the Commissioner considers it is appropriate to do so.’

The previous acting NDIS Quality and Safeguards Commissioner considered that the existing aged care audit process through the ACQSC is a ‘comparable quality audit process,’ for the purposes of subsection 5(3) of the Rules.

Mapping of the Aged Care Standards against the NDIS Practice Standards and Quality Indicators (commissioned jointly by the Department of Social Services, the Department of Health, the NDIS Commission, and the ACQSC and undertaken by JAS-ANZ) identified a high degree of alignment between the two sets of requirements. Around half of the NDIS Practice Standards and Quality Indicators were identified as being ‘met’ or ‘equivalent’ to the Aged Care Standards with the remainder ‘partially met’ and a small number identified as a ‘gap’. The modified NDIS RAC audit utilises mapping of the standards to guide auditors’ assessment of the provider against the NDIS Practice Standards and Quality Indicators.

The modified NDIS RAC audit pathway applies only for ‘transitioned RAC providers’ who are providing daily accommodation and care/support to an NDIS participant in their facility under class of support 15, or RAC providers applying to do so after 1 December 2020.

Under section 20 of the Rules, class of support 15 requires assessment against the NDIS Practice Standards in the Core module (Schedule 1 of the Rules).

Some providers may also require assessment against additional modules of the NDIS Practice Standards depending on the nature of supports provided to NDIS participants, such as the following supports:

• class of support 4 (registration group 0104) high intensity health-related supports (Module 1 of the Rules), where such supports are funded under an NDIS participant’s plan;
• implementation of regulated restrictive practices included in a specialist behaviour support plan developed through the NDIS during the delivery of any class of support (Module 2A of the Rules); and
• provision of specialist behaviour support services, where such supports are funded under an NDIS participant’s plan (including behaviour support assessment of the NDIS participant and developing a behaviour support plan for the NDIS participant, noting that only behaviour support practitioners assessed as suitable by the NDIS Commissioner may undertake these activities) (Module 2 of the Rules).

Where the provider is providing daily accommodation and care/support to an NDIS participant in residential aged care and the provider also seeks to be registered to provide other NDIS supports and services to NDIS participants (in residential aged care or otherwise) the modified audit pathway does not apply. Rather, usual audit processes apply under the AQA guidelines.

Steps in the modified NDIS RAC audit pathway and process

Step 1: RAC provider applies for NDIS registration (new or renewal)

As per the NDIS Commission’s usual application process, the provider makes an application online through the Applications Portal (new applicants) or the NDIS Commission Portal (renewing applicants), which generates an Initial Scope of Audit document. This document sets out the details of the provider and its key personnel, type of audit required (i.e. certification audit for RAC providers), the NDIS Practice Standards to be assessed, number of NDIS participants and sites where NDIS participants are supported. The provider uses this document as the basis for seeking quotes and engaging an AQA (refer to section 8 of the AQA guidelines). 

The online application includes a self-assessment by the provider against the relevant NDIS Practice Standards and gives an opportunity for the provider to upload supporting documents (such as policies and procedures).

Step 2: RAC provider engages their preferred Approved Quality Auditor (AQA)

In accordance with section 8(4) of the AQA guidelines, once the provider has selected a preferred AQA, the provider authorises the AQA to link with them in the Applications Portal or the NDIS Commission Portal. This action gives the chosen AQA access to the provider’s online self-assessment and uploaded documents and details of NDIS participant numbers, sites and key personnel. The AQA uses this to confirm the scope of audit with the provider and then plan the audit.

In confirming the scope of audit, the AQA will:

• ascertain whether the provider is a RAC provider supporting an NDIS participant under class of support 15 (0115); and
• discuss with the RAC provider what supports they are providing as part of NDIS participants’ plans to determine whether any additional modules need to be included for assessment in addition to the Core module.

The AQA will request the following information from the RAC provider at the start of their engagement for the purposes of assessing whether a modified NDIS RAC audit may be applicable:

1. evidence of holding current accreditation(s) as a residential aged care service;

2.    the most recent aged care accreditation audit report for each site (facility) where one or more NDIS participant(s) are currently supported, or otherwise received supports, in the past 12 months, written by accreditation assessment teams appointed by the ACQSC. Where there are more than ten sites (facilities), the AQA shall request a sample of ten of these reports;

Key information of interest in seeking these reports is the issuance of any non-compliance notices or application of sanctions in sites providing supports to NDIS participants, where these notices and/or sanctions are potentially relevant to the provider’s conformity to the NDIS Practice Standards.

3.    the current version of the provider’s written plan for continuous improvement, and any feedback on the written plan, from the ACQSC in the past three years;

Key information of interest is if the plan has any areas of non-compliance identified though their audit against the Aged Care Standards as well as continuous improvement requests from the ACQSC.

4.    the status of any complaints received regarding its residential aged care services in the past two years;

5.    a signed declaration of whether it is currently subject to sanctions for non-compliance with aged care responsibilities by the ACQSC;

6.    confirmation of whether the NDIS Commission has specified any requirements for the types and timing of audits it is to undergo (for example, a condition imposed under section 73G(3) of the National Disability Insurance Scheme Act 2013 (Cth) (NDIS Act)); and

7.    clarification of whether it has previously undergone a modified NDIS RAC audit under the NDIS AQA Scheme in the past four years, and, if so, evidence of the decision.

Step 3: NDIS Commission authorises the AQA to undertake modified NDIS RAC audit

Where the AQA is satisfied the RAC provider may be eligible to be assessed using the modified NDIS RAC audit process following a review of the information requested in step 2, the AQA will seek authorisation from the NDIS Commission to proceed to assess the provider using the modified NDIS RAC audit process. AQAs will use an NDIS Commission template for this purpose.

The NDIS Commission authorisation of an AQA to assess a provider against the relevant NDIS Practice Standards by conducting a review of the outcomes and evidence from an audit against the Aged Care Standards using the modified NDIS RAC audit process will be contingent on a RAC provider:

• having undergone an assessment against the Aged Care Standards at least once within the last three years (i.e. within a typical NDIS registration and ACQSC accreditation period);
• not having sanctions imposed against it or one of its facilities for non-compliance with the Aged Care Standards where such sanctions are relevant to supports provided to NDIS participants; and
• not being subject of compliance and enforcement action under the NDIS Act.

Where the NDIS Commission issues a notice of authorisation to the AQA to proceed assessing the provider using the modified NDIS RAC audit process, the AQA will confirm with the provider in writing that its audit can proceed under a modified NDIS RAC audit. The AQA can then move to commence planning to undertake a modified stage one and two audit as detailed in steps 5 and 6 below.

If authorisation is not given, the AQA will undertake a full audit against the NDIS Practice Standards with no modifications and in accordance with the AQA guidelines.

Step 4: The AQA puts an agreement in place with the provider

It is usual practice for AQAs to establish a written agreement with the provider for undertaking the audit. While this is not explicitly included in the AQA guidelines, agreements are referred to at various points of the guidelines (for example, agreement on the audit plan).

In establishing an agreement with the provider for whom the AQA has been authorised by the NDIS Commission to undertake a modified NDIS RAC audit, the AQA will seek agreement that the provider:

1. advise the AQA as soon as practicable where it:
   1. loses its accreditation(s) as a residential aged care service (noting this may be at facility or site level);
   2. is subject to compliance activities, including sanctions, by the ACQSC;

1. make available its written plan for continuous improvement on an ongoing basis; and
2. provide the AQA with access to all information about governance and operational management responsibilities relevant to NDIS supports and services, including where these responsibilities overlap with those for residential aged care services.

The agreement will also establish expectations for the provider to confirm certain information with the AQA, prior to the mid-term audit, required to commence 18 months after the date of registration by the NDIS Commission, in accordance with section 13B of the Rules. This includes:

1. evidence of holding current accreditation(s) as a residential aged care service; and

2.    a signed declaration of whether it is currently subject to sanctions for non-compliance with aged care responsibilities by the ACQSC.

Step 5 – Auditor commences Stage One planning and undertakes Stage One audit

In planning and conducting the modified NDIS RAC audit, auditors will refer to the mapping specified in the document ‘Advisory: Mapping and evidence tool for modified NDIS RAC audit to the NDIS Practice Standards/Quality Indicators’ (the mapping advisory), which is located on the JAS-ANZ NDIS AQA FAQ Service Desk site and as an attachment on the JAS-ANZ Academy NDIS RAC Training site.

In undertaking stage one of the modified NDIS RAC audit, the AQA will refer to the Myagedcareportal (Find a provider (myagedcare.gov.au) ) and the ACQSC website (Home | Aged Care Quality and Safety Commission) to:

1. confirm evidence that the provider holds current accreditation(s) as a residential aged care service for each facility/site supporting NDIS participants, and that it is not currently subject to sanctions for non-compliance with aged care responsibilities by the ACQSC; and
2. evaluate the published performance reports, consumer experience reports, and any other reports available for the provider for any information to indicate the occurrence in the past three years of any ‘critical risk’ as outlined in the definitions in the AQA guidelines. This evaluation will be used to inform the use of the mapping advisory.

Stage one-audit reports shall record:

1. that the NDIS Commission approved the AQA to undertake a modified NDIS RAC audit; and
2. any modifications to the default standards of assumed equivalence in the mapping advisory. This may include additions and/or subtractions of standards in the mapping advisory being considered during the audit activities. All NDIS Practice Standards are still ‘in-scope’ for a modified NDIS RAC audit.

Audit Team

In determining the composition of the audit team in accordance with the AQA guidelines, the AQA will need to include personnel who have demonstrated qualifications and experience in residential aged care service settings. Such personnel will be involved in assessing eligibility for the modified NDIS RAC audit and undertaking stage one and stage two audits under the modified audit.

The audit team composition shall also comply with the requirements of section 11(7) and/or section 32 of the AQA guidelines, as applicable to the scope of audit.

Sampling

Sampling will be conducted as per Annex B of the AQA guidelines.

Aged care residents who are not NDIS participants shall be excluded from the tally of the total number of NDIS participants receiving NDIS supports or services from the RAC provider at that time.

For RAC providers eligible for the modified NDIS RAC audit, sampling for workers in governance, management and service delivery roles excludes those solely contributing to aged care service provision or other activities arising from compliance specifically for the Aged Care Act 1997.

For RAC providers eligible for the modified NDIS RAC audit, sites that only provide services to aged care residents and not NDIS participants, or solely undertake operations to support the delivery of such services, are to be excluded from the tally of the number of sites operated by the RAC provider.

In addition to the head office and high risk registration group site sampling requirements in Annex B, clause B.6, all sites providing supports to NDIS participants that are subject to ACQSC non-compliance notices or sanctions potentially relevant to the NDIS Practice Standards shall be attended as part of the site sampling. Where the combination of this requirement and other risk-based methodology produces a number of site attendances greater than the minimums in clause B.6 (Step 2), the sample shall be considered to have been expanded, and justification recorded.

Note: Where undertaking an audit of a provider who operates RAC and other NDIS supports and services, which is not eligible for the modified NDIS RAC audit, the AQA will include RAC facilities with NDIS participants in the sample.

Step 6 – Auditor commences Stage Two planning and undertakes Stage Two audit

Audit plans for stage two audits shall be modified in the following ways:

1. Unless available information demonstrates otherwise, the NDIS Practice Standards listed in the current in-force version of the mapping advisory:
   1. as ‘equivalent’ or ‘met’ (same or similar) or ‘partial’ (some similarities) shall be listed as likely to be met, with limited additional evidence required to conclude conformity; and
   2. as ‘gap’ or ‘not met’ (different) shall have no presumption of conformity with NDIS Practice Standards upon entering the stage two audit, and objective evidence is to be gathered as per the usual audit requirements under the AQA guidelines.

1. The audit plan shall demonstrate clear regard to, and utilisation of, the available information arising from the RAC provider’s compliance obligations under the Aged Care Act 1997 as documented in assessment report(s) prepared by the ACQSC;
2. The audit plan shall also include terminology and concepts that are familiar to RAC providers in residential aged care settings where practicable, in addition to those used in the NDIS sector, to promote understanding of the interactions between these two areas of compliance; and
3. The titles, dates, and any other relevant identifying information about the RAC provider and its facilities/sites with NDIS participants shall be recorded, together with clarification of whether the RAC provider was subject to a modified NDIS RAC audit.

The documented process for calculating stage two-audit duration (section 15(7) of the AQA guidelines), mid-term audits, and recertification audits, shall also include the following factors:

1. Starting reduction of up to 20% for each site of the provider that is accredited as a residential aged care facility, and which is selected for site sampling.

This is an acknowledgement of the proportion of NDIS Practice Standards that are in principle equivalent or partially equivalent to the Aged Care Standards.

2.    For facilities that operate residential aged care and NDIS supports and services as a multi-site organisation:

1. reductions of up to a further 30% of the total audit duration for the head office may be applied;
2. such reductions are to be denoted on the audit plan to pertain to one or more of:
   1. Information Management
   2. Complaints Management and resolution
   3. Incident Management
   4. Human Resource Management
   5. Medication Management
   6. Emergency and Disaster Management
   7. Mealtime Management

This is an acknowledgement of the greater efficiencies for gathering audit evidence imparted by the highly uniform, well-developed complaints, incident reporting, and HR systems utilised by RACs as a mandatory condition of aged care accreditation.

3.    That the total extent of reduction in audit time for the entire facility:

1. does not exceed 50% relative to the starting default for NDIS providers (i.e. prior to applying reductions), and
2. does not afford less than a planned 30 minutes per interview with each NDIS participant, or family/friend/advocate, as according to sample number minimums in Annex B.4 of the AQA guidelines unless written permission to do so has been obtained from the NDIS Commissioner.

Note: Where undertaking an audit of a provider who operates RAC and other NDIS supports and services, and is not eligible for the modified NDIS RAC audit, the audit duration requirements in the AQA guidelines will apply.

Step 7: Auditor completes audit report and submits to the NDIS Commission

In addition to the requirements for audit reporting in section 16 of the AQA guidelines, including guidance for audit reporting issued by the NDIS Commission, stage two, mid-term, and recertification audit reports for RAC providers undergoing a modified NDIS RAC audit shall also include a description of:

1. The equivalence rating applied for each NDIS Practice Standard in accordance with the mapping advisory and any modifications to the default standards of assumed equivalence in the mapping advisory;

2.    The extent to which evidence in available information arising from the RAC provider's compliance obligations under the Aged Care Act 1997 as documented in assessment report(s) prepared by the ACQSC was relied upon in gathering audit evidence;

3.    Whether any standards or other requirements in the NDIS Act and associated legislation that was considered to be equivalent with aged care requirements prior to the audit was found through objective evidence to be an area(s) of nonconformity with NDIS standards or requirements, and if so:

1. the grade(s); and
2. the timing for corrective action and closure, if differing from defaults in Annex C of the AQA guidelines

1. Whether there is any information of apparent concern regarding the RAC provider’s obligations to comply with requirements under the Aged Care compliance framework. The NDIS Commissioner may consider the need for such information to be disclosed to the ACQSC or other government authorities, as appropriate; and
2. Whether eligibility for the modified NDIS RAC audit should continue.

Step 8: The NDIS Commission assesses the application for registration and makes a decision in relation to the application

This step is not part of the audit process but follows the submission of an audit report by an AQA to the NDIS Commission.
 

Once an application is complete with the submission of an audit report, the NDIS Commission completes an assessment of the suitability of the applicant and the key personnel in accordance with sections 9 and 10 of the Rules.

Applicants are notified by the NDIS Commission of the outcome of their application once the NDIS Commissioner (or their delegate) has made a decision on the application.

Successful applicants will receive a certificate of registration outlining the services they are registered to provide, the period of registration, and any conditions they must follow to keep their registration.

Unsuccessful applicants are provided with reasons in writing for the decision to refuse the application. Applicants can request a review of the decision within three months of the decision. If the application is still unsuccessful following the review, applicants may seek a further review by the Administrative Appeals Tribunal.