What is the issue with requiring all providers to be registered?

One of the most controversial suggestions coming out of the NDIS Review was recommendation Number 17; Develop and deliver a risk-proportionate model for the visibility and regulation of all providers and workers, and strengthen the regulatory response to long-standing and emerging quality and safeguard issues.

This recommendation is all about “risk-proportionate regulation,” and suggests that all NDIS service providers be registered. The independent panel believes this regulatory response can strengthen quality and safeguarding issues, with concerns over the unexpected rise of unregistered providers in the NDIS market.

According to the report, in the last financial year, there were 16,000 NDIS registered providers, compared to 154,000 unregistered providers in the NDIS market.

The NDIS review said they are concerned that the uptick in using unregistered providers shifts the responsibility for managing the quality and safeguards onto the participant, as there is little visibility of unregistered providers under the current framework.

The reviews’ concerns with unregistered providers:

• Lack of oversight of unregistered providers, especially for high-risk supports. 

• Visibility of payments made by self-managed participants.

• Measures to intervene to prevent harm and promote quality; for example, it’s optional but not essential for unregistered providers to complete the NDIS workers screening check.

• Unfair service agreements and transparency of services.

• The potential vulnerability of participants not fully understanding of the risks involved.

The review believes requiring NDIS providers be registered will result in greater visibility and scrutiny. The review stated: 

‘We are proposing greater use of preventative measures applied to all providers and participants to make the system work better for everyone and prevent harm to those most at risk. We need to strike a better balance between preventing harm, supporting choice and control, encouraging innovation and enabling the market to thrive.’

The review acknowledged requiring NDIS providers to be registered doesn’t guarantee safety or quality, but does show a provider has, at least, engaged with a process asking them to demonstrate their ability to deliver services professionally, competently and in a way consistent with quality standards, whilst being more visible in the registered market.

So what is the issue then?

For many people with disabilities, their supports and advocates, the suggestion to require all NDIS providers be registered raises significant concerns. The scheme’s doctrine is participant choice and control, and allowing NDIS participants to use unregistered providers for their supports and services allows this.

Where access to NDIS services may be limited, such as rural and remote areas (read more on that here) or services for participants from culturally and linguistically diverse backgrounds, the ability to tap into the unregistered and mainstream markets enables access to a broader network of support. For other participants utilising low-risk supports, like gardening and cleaning, only being able to use registered providers increases the chance of the “NDIS tax” As highlighted in this episode of Reasonable and Necessary with Dr George Taleporos, not all participants may want a service provider to know they are on the NDIS; people don’t necessarily want to always disclose their disability status.

Ultimately, people are concerned if their providers don’t want to transfer to the new registered or enrolled system, they could lose their known and trusted supports.

Dr George highlighted fears in the disability community right now over losing their unregistered supports, as it’s not clear in the NDIS Review how the proposed graduated registration system will work, what supports will fall under which category and how the registration process will be improved.

‘This is something many NDIS participants have fought hard to avoid, as the use of unregistered providers is crucial for their experience of choice and control in the scheme,’ he said.  

The conversation Deep Dive into the NDIS Review - Part 1: What happened to participant choice and control? with Australia's leading disability advocates and academics, highlighted that people often use unregistered providers following negative experiences with registered providers who didn’t respect their choice and control.

‘The number of people who are using unregistered providers is really high. To me that says maybe that's because that's what is working for people. So why would you want to stop what the people want?’

The desire for every NDIS provider to be registered or enrolled is also a bid to put providers on an equal footing, so all providers are subject to similar audits and registration processes. These can be expensive and time-consuming, and the reason why some providers have de-registered to save on costs.

Helen Dickinson, Professor of Public Service Research at the University of NSW, said forcing participants to use registered providers, particularly those with significant and complex supports, will subject them to service provision and policy frameworks that are inflexible, focused on provider's needs and not on outcomes that meet the individual's needs. Helen said,

‘It doesn't follow the question “What does this person require from the service?” Is not the question that's asked, it is “This is what we're going to deliver.”’

In his National Press Club address, Shorten said this means the NDIS would no longer pay unregistered providers. A proportional regulation system will be introduced, with the registration level dependent on the level of risk observed and where the services are delivered. 

Under this process, NDIS Minister Bill Shorten intends all service providers to be visible to the NDIA and NDIS Quality and Safeguards Commission to give participants a range of safe, quality services. Payments will be reported in real time to prevent fraudulent practices and over-servicing.

‘For providers delivering low-risk services, such as mowing the lawn, registration or enrolment would be simple. For providers delivering more personal and complex services, such as in-home services, there would be greater oversight,’ he said.

‘We don’t want people to lose support. But we also don’t want people to be at unnecessary risk. Those are the big changes being suggested… But nothing is going to change overnight.’

How the new registration model will work

The review asks for more proportionate regulation, proposing more broad categories of regulation based on risk. They have outlined these categories as:

Advanced registration for high-risk supports: ‘intensive’ approach to regulatory requirements and oversight for high-risk supports, or high-level technical compliance, such as group homes.

General registration for medium-risk supports: ‘graduated’ approach depending on factors impacting the level of risk. For example high intensity supports, supports requiring additional skill and training and supports with significant 1:1 contact with participants.

Basic registration for lower-risk supports: ‘lighter-touch’ approach, a self assessment of compliance rather than an audit while still allowing regulatory oversight. Such as providers with limited 1:1 contact with participants, including sole traders and smaller organisations.

Enrolment of all providers of lowest-risk supports: ‘lightest-touch’ approach to requirements through a simple online process. This will apply to supports where general protections under Australian consumer law are sufficient, such as consumables, equipment, technology and home and vehicle modifications.

Ruby Wheeler