Future of Australian Hearing and contestability of hearing services under the National Disability Insurance Scheme
This Information Sheet has been prepared by the Departments of Finance, Health and Social Services and the National Disability Insurance Agency in response to questions from stakeholders, and in particular the Deafness Forum of Australia.
The Information Sheet reflects the important work that is underway across multiple Government agencies in the Social Services, Health, Human Services and Finance portfolios to ensure that Deaf and hard of hearing people in Australia will continue to receive valued and high quality hearing services in future, whether as participants of the NDIS or clients of the Hearing Services Program.
The Government has not made any decision to sell or transfer the ownership of Australian Hearing.
The Government has been exploring the right future ownership options for Australian Hearing to ensure that it has the strongest possible future and continues to be in the best possible position to provide high quality valued services to Australians with hearing loss.
In 2015, the Government undertook consultations with stakeholders and provided information regarding the implications of the National Disability Insurance Scheme (NDIS) on hearing services and Australian Hearing, and on the key findings of the scoping study into future ownership options for Australian Hearing. The Government, through the Departments of Health and Social Services, and the National Disability Insurance Agency (NDIA), is continuing to work closely with stakeholders on the transition of hearing services clients to the NDIS.
The Government has not made a decision to sell Australian Hearing. It has not sought proposals from the market and is not undertaking any associated comprehensive due diligence process with potential acquirers of Australian Hearing. It has, however, been approached by a Consortium, led by the Royal Institute for Deaf and Blind Children (RIDBC) alongside Cochlear Limited and Macquarie University, for the transfer of Australian Hearing to non‑Government ownership.
The Government has announced that it will examine the Consortium’s proposal. The assessment process will involve close collaboration between the Finance, Health and Human Services portfolios, and is supported by external specialist business, legal and probity advisers.
The Government will consider whether or not the Consortium’s proposal meets its objectives in relation to Australian Hearing, which are to ensure that it has the strongest possible future and continues to be in the best position to provide high quality and valued services to Australians who are Deaf and hard of hearing. The Government’s consideration will also include optimising client choice and service outcomes (including services provided under the Community Service Obligations (CSO), and continuing world class public research in this area); addressing the major concerns of key stakeholder groups; supporting a viable hearing services industry; and also having regard to the key principles under the NDIS to promote choice and control for clients.
The assessment of the Consortium’s proposal may involve work with the Consortium on the possible terms and conditions for any ownership transfer, should the Government decide to proceed with that approach.
The Government is taking the time to ensure that any decisions in relation to the future of Australian Hearing are the right decisions. At the conclusion of the assessment of the proposal put forward by the Consortium, the Government will consider the best way forward.
The NDIS represents a new way for people to get disability support that takes an individualised and lifelong approach through individual plans. This means that rather than providing support based only on the number of services or type of hearing devices available under the program, the NDIS will provide funding so people can get the reasonable and necessary support they need, based on their individual hearing needs, goals and aspirations. These supports may include linkages to existing services and supports within the participant's community, and/or reasonable and necessary funded supports.
Current hearing services delivery will change as a result of the introduction of the NDIS. By 2019-20, when the NDIS is expected to be fully rolled out, it is anticipated that a significant portion of existing CSO clients under 65 years will have transferred to the NDIS, at which time clients will have a choice of service provider. Government funding for people aged 0 to 65 years who require support to manage their hearing loss, and meet the thresholds for NDIS participation, will be completely managed by the NDIA and the market will become fully contestable. NDIS participants who were formerly CSO clients will be able to choose to receive support for their hearing loss through a range of registered service providers, including Australian Hearing. Clients who currently receive services from Australian Hearing who transfer to the NDIS will be able to choose whether to continue to receive those services from Australian Hearing.
To ensure the ongoing quality of services provided, the Commonwealth and State and Territory Governments are developing an NDIS National Quality and Safeguards Framework. In addition, the NDIS registration process requires providers to make declarations regarding their qualifications and experience. Providers of Specialist Hearing Services (including those for infants and young children) will be required to meet relevant standards which have been endorsed by the sector or the Government.
Health, through the Office of Hearing Services, is also working in partnership with the hearing services sector to develop a ‘Service Delivery Framework for Hearing Care Services’ that would be intended to apply more broadly to the hearing services sector. This framework comprises a number of documents which set out the expected standards of service, including:
- Quality Principles of Hearing Care Services which apply to the settings in which practitioners deliver hearing services;
- National Practice Standards for Hearing Care Practitioners which apply to audiologists and audiometrists;
- The Code of Conduct for audiologists and audiometrists;
- The Scope of Practice for audiologists and audiometrists; and
- Clinical guidelines developed by the professional bodies for audiology and audiometry.
The Quality Principles and National Practice Standards are expected to be released by the Department of Health for broad consultation shortly.
While the ‘Service Delivery Framework for Hearing Care Services’ applies to the delivery of hearing services to all members of the community, it is expected that the key components will be further refined to incorporate requirements that are specific to particular Hearing Service Program clients such as infants and young children, before any such services were to be opened to competition.
Health will be working with the sector to take this work forward from mid-2016 as it recognises that stakeholders are keen to understand the way in which this framework is to be implemented (including the governance arrangements). It is expected that any working group that may be established to guide this project would include consumer representation. It will be critical to the success of this work that stakeholders are able to have confidence in organisations which are certified under this framework for the types of services they deliver and to whom.
The Government acknowledges that a particular concern to stakeholders is the protection and maintenance of the hearing services provided to infants and young children, noting Australia’s international reputation for very low loss to follow-up rates following the newborn screening programs run by the States and Territories. It is recognised that the early months for newborns diagnosed with hearing loss can be critical for the whole family, and that the existing referral pathways work well in ensuring that there is a minimal delay between the time of diagnosis and the delivery of hearing services.
The Government has also previously acknowledged that it is important that the NDIS does not act as a barrier to this referral pathway. The NDIA will be working closely with Health and stakeholders on how this can best be achieved and will also draw on the client experiences from the NDIS trial sites.
The Government remains committed to ensuring that infants with hearing loss identified through the newborn screening programs along with children diagnosed at any age will receive responsive and timely access to hearing services.
The delivery of services to infants and young children (as a specified support cluster) would not be made contestable until appropriate third party certification arrangements are in place under the NDIS Quality and Safeguards Framework. These arrangements may be based on the implementation of the Department of Health’s Service Delivery Framework as a self-regulatory scheme endorsed by the sector (noting that if the hearing services sector was to take a self‑regulatory approach to certification, assurance would be required that action would be taken for any serious breaches of relevant standards) or as an arrangement developed and implemented by the NDIA.
The NDIA has published a paper, titled NDIS Early Childhood Early Intervention (ECEI) Approach (26 February 2016), which sets out a strategy for helping all children with developmental delay or disability and their families achieve better long-term outcomes through support services in their local community, regardless of diagnosis.
Under the approach, the NDIA would source experienced early childhood intervention service providers to work with it as access partners to ensure the NDIS supports all children as early as possible. To become an access partner, service providers would need to demonstrate strong clinical expertise and utilise best-practice approaches. The NDIA would closely monitor service provider performance and outcomes to ensure all children receive the appropriate quality and level of support. Initially, families would meet with an access partner to discuss their needs. The access partner would draw on their specialised early childhood knowledge to determine appropriate supports for the child and family, including information, emotional support and specialised early intervention supports.
Under the NDIS Early Childhood Early Intervention Approach (February 2016), Australian Hearing could make a submission to the NDIA (regardless of ownership) to be an access partner based on being able to demonstrate strong clinical expertise and utilising best-practice approaches for services to children. As a potential access partner, families of children with diagnosed permanent hearing loss would meet initially with Australian Hearing to discuss their needs and, if appropriate, complete an NDIS support plan for approval by the NDIA.
Australian Hearing currently provides services to designated CSO client groups as one of its functions under the Australian Hearing Services Act 1991 (the Act). As a Government agency, there is a Memorandum of Agreement (MoA) in place between Australian Hearing and the Health, through the Office of Hearing Services. This sets out how the respective agencies will work together to achieve agreed objectives and arrangements for reporting, including performance measures.
Whilst no decision has been made to transfer ownership of Australian Hearing, should that be contemplated in future, Health would need to work through the specific mechanisms and the details of any potential contract would need to be negotiated to ensure no lowering of the range or quality of hearing services provided to CSO clients. The relevant clauses of the current MoA with Australian Hearing would provide a sound starting point.
The Government’s commitment is that Australians with hearing loss who currently receive CSO services will continue to receive those services.
Contracting is an integral part of the way the Australian Government conducts business. The Australian Government is a significant purchaser of goods and services, and each year the public sector enters into a large variety of contracts worth billions of dollars (including in the health sector, dealing with clients in vulnerable circumstances). The Australian National Audit Office’s (ANAO) Better Practice Guide provides guidance on effective development and management of contracts for public sector entities.
In this context, it is standard practice for Commonwealth contracts to include detailed provisions which relate to delivery of the services required, compliance with relevant standards, performance measurements, reporting, monitoring, data collection and access to data, financial expenditure and payments against deliverables. It is also standard for Commonwealth contracts to require a financial statement of income/expenditure or auditor’s reports to confirm that funds have been expended for the purpose provided for in the contract.
These provisions act together to reassure Government and the community that expected outcomes are being met and the contracted organisation is being held accountable. Should Health enter into a contract for the provision of CSO services with Australian Hearing, the contract would be expected to comply with the ANAO Better Practice Guide and include relevant provisions to demonstrate that there was no lowering of quality or standards to those expected of Australian Hearing as a Commonwealth agency. This would be similar to any other contracts entered into by the Health for the provision of other health services.
The Government recognises the importance in retaining existing linkages between hearing research and hearing service delivery activities. The Government’s consideration of the Consortium’s proposal will be against its stated objectives of ensuring that Australian Hearing continues to be in the best possible position to provide high quality valued services to Australians who are Deaf and hard of hearing, which includes quality outcomes for public research in this area. It will therefore be important to consider any specific requirements to ensure that appropriate protections are put in place in respect of important elements of government hearing services, including in respect of the NAL which is an important element of the national health infrastructure.
Any change in Australian Government ownership would not impact on voucher program eligibility. Voucher services would be provided on a ‘business-as-usual’ basis, noting that these services have operated on a contestable basis since 1997.
Regardless of whether current arrangements remain in place or new arrangements are agreed, Health will need to be satisfied that clients continue to have access to a range of quality devices. This includes hearing aids that are clinically suitable for CSO clients to manage their hearing loss and provided at a cost to Government which represents value for money.
Options for the supply of cost effective government-funded hearing devices are also to be considered as a work package under the Hearing Services - NDIS Transition Plan. Any proposed changes resulting from this work would be subject to stakeholder consultation and would be expected to commence from mid-2019.
The Government is committed to maintaining service levels, irrespective of whether the client is located in a metropolitan, regional or remote location. Should Australian Hearing be transferred into non-Government ownership, there would be a range of possible contractual mechanisms that could be used to ensure the continued delivery of high quality services in less economically viable settings such as rural and remote areas, consistent with the Government’s intention that there is to be no lowering of the range or quality of hearing services provided to CSO clients.
Under the NDIS, the NDIA will monitor market performance nationally, including in regional and remote locations to ensure that these clients have access to hearing services. Close surveillance of possible market failure and service gaps will help ensure that risks to service delivery can be addressed.
The NDIA will also work on building strong and effective relationships with communities, drawing on mainstream, Indigenous and culturally diverse organisations to ensure that people with disability have access to suitable community based services or organisations.
A Rural and Remote, Aboriginal and Torres Strait Islander Reference Group has been established to provide expert advice to the NDIA. The NDIA is also developing a Rural and Remote Servicing Strategy which will be critical to the success of the NDIS and is building on the lessons from trial sites in delivering rural and remote services and developing mechanisms to grow, engage, sustain and lead local service delivery initiatives. The NDIA is also working closely with the States and Territories to progress this work.
Should Australian Hearing be transferred into non-Government ownership, any new owner would be required to comply with the stringent privacy and confidentiality arrangements, in addition to the Privacy Act 1988, that currently apply to other non-government contracted hearing service providers.
Under NDIS transition arrangements, any service provider contracted to provide voucher services (including Australian Hearing) can now provide services to referred NDIS participants in the 27‑ 65 age group, a new client group. The number of clients in this category will continue to grow as the NDIS roll out ramps up. Private clients would be able to access services from Australian Hearing at the time of any transfer of Australian Hearing into non-Government ownership, should such a decision be made.
Under the NDIS, all diagnostic hearing assessments for children will take place in the public or private healthcare system. Any child diagnosed with permanent hearing loss after mid-2019 will potentially be able to receive rehabilitation services as an NDIS participant (based on the diagnosis). The Government has previously confirmed its commitment that children and young adults under the age of 26 with a permanent or long term hearing loss who currently receive (or are eligible to receive) CSO services will continue to receive those services, either as NDIS participants or clients of the Hearing Services Program.
Medicare provides a rebate with a standard doctor’s referral for audiological diagnostic services, including where the referral is part of a Chronic Disease Management Plan. A rebate can also be claimed where the patient is referred to an audiologist (who has a Medicare provider number) by an Ear/Nose/Throat specialist or neurologist. As is the case with most other Medicare services, the client may incur gap fees for audiology consultations, noting that any out-of-pocket costs for eligible services will count toward the Medicare Safety Net for the patient. Some private health insurance funds also provide rebates on audiological testing (which may be used instead of the Medicare rebate).
Should Australian Hearing be transferred into non-Government ownership, audiologists employed by Australian Hearing would be able to apply for a Medicare provider number to access relevant Medicare items (consistent with the Medicare claiming rules).
Some larger public hospitals have their own audiology departments for referral of patients which means that there is no out of pocket cost. However, access to these services is often limited to younger patients or in-patients.
Last updated: 04 May 2016