Nov 20, 2024

The PACE Problem: How Safeguarding NDIS Funds is Leaving Providers in Limbo

The PACE Problem: How Safeguarding NDIS Funds is Leaving Providers in Limbo

The National Disability Insurance Agency (NDIA) rolled out the PACE (Provider and Customer Experience) system to modernise its NDIS operations. Built on Salesforce CRM technology, PACE aimed to offer a more streamlined experience for both participants and service providers.

The goal of this portal was to replace the older MyPlace system and address shortcomings that have plagued providers and participants alike since 2016. However, the transition has been far from smooth, and for many providers, PACE is proving more problematic than its predecessor.

Dr Rodney Jilek, an aged care specialist and founder of Community Homes Australia (CHA), recently shared his experiences with PACE, highlighting significant flaws in the system.

CHA operates four disability and aged care homes embedded within Australian communities and has expanded internationally with the Aashaya Jasri Resort in Bali, which recently welcomed guests, including two individuals with younger-onset dementia.

Despite these impressive achievements, the challenges of dealing with the new portal are causing Dr Jilek and his team significant frustration.

“PACE was established as the new all-consuming portal for NDIS,” said Dr Jilek. “They drew a line in the sand and said, ‘Okay, anyone approved after this date or anyone who has a plan reviewed will go into the PACE system.’ But the system just doesn’t work as intended. It’s supposed to list all the participants we care for, but according to PACE, I have ten participants. In reality, we have around 100.”

Visibility Issues and Unpaid Bills

One of the most glaring issues with the PACE system is its lack of visibility regarding participant funding.

Under the previous MyPlace portal, providers could see funding allocations and make service bookings to ensure that funds were quarantined for their services. This transparency allowed providers to plan care appropriately and address funding shortfalls proactively.

“With MyPlace, you could create a service booking,” Dr Jilek explained. “I’d say, ‘I’m looking after Jim; he needs this amount of care over this period, and it costs this much.’ That money would then be quarantined for us, giving us the confidence to deliver services and bill accordingly. Now, with PACE, there’s no such thing. All we see is a big bucket of money, and anyone can draw from it. We have no visibility of what’s left.”

This lack of transparency has led to CHA being stuck with unpaid invoices, sometimes for months. “At the moment, we’re owed $400,000, spread across 97 invoices. It’s not sustainable,” Dr Jilek said.

The problem is compounded by the NDIA’s safeguards against price gouging. In response to instances where unscrupulous providers drained participants’ funds, the agency removed providers’ access to detailed budget information.

While the intention was to protect participants, it has inadvertently created a system where providers are left in the dark about whether they will be paid.

“I recently provided months of care for a gentleman with Huntington’s disease, totalling $40,960. When I submitted the invoices, I was told there was no money left in his plan. I had no idea because I’m not privy to that information,” Dr Jilek said.

When he queried the NDIA about the unpaid amount, the response was frustratingly unhelpful. “Their reply was, ‘Your payment query has been referred to the appropriate section. This payment query is now closed.’ That’s it.”

The Provider’s Dilemma

The lack of visibility leaves providers with limited options: deliver substandard care, provide adequate care and absorb the costs, or stop providing care altogether. None of these options are acceptable, particularly for participants with complex needs.

“These are vulnerable people,” Dr Jilek emphasised. “What am I supposed to do? Either I pay for their care out of pocket, or I refuse to continue and send them to hospital. It’s a horrible choice to have to make.”

The issue isn’t just limited to NDIA-funded participants. Providers who work through plan managers often encounter the same problems. “Plan managers are supposed to alert us when funds are running low, but they rarely do. Managing the fund should mean proactively addressing shortfalls, not telling us after the fact that there’s no money left.”

For Dr Jilek and other providers, the stakes are high. Without urgent fixes to the PACE system, the risk of providers leaving the NDIS market increases. This could leave many participants without essential services, undermining the very purpose of the scheme.

The Way Forward

To address these issues, Dr Jilek suggests reintroducing some of the features of the MyPlace portal, such as service bookings and transparent budget information, while maintaining safeguards against abuse. He also advocates for better communication between the NDIA, plan managers, and providers.

“Providers want to do the right thing,” he said. “We’re not asking for unrestricted access to funds; we just need to know what’s available so we can deliver the care these people need.”

The NDIA must act swiftly to resolve these challenges before the PACE system creates more harm than good.

As it stands, the current situation risks not only the financial viability of providers, but also the quality of life for the participants who rely on their services

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  1. They should just implement a system that copies Medicare. All this is a consequence of providers over servicing participants. NDIS is there to help people in need, not to create millionaires

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