PowerPoint Stacks - Disability Employment Australia

Report
DES Contractual
Compliance
Training Program
Agenda
Program Introduction
Program objectives & learning outcomes
Topic 1: Understanding
compliance
Key concepts of compliance
DSS approach to program assurance
Overview of core provider obligations to DSS
Topic 2: Managing Service
Quality
The foundations of service quality: duty of care,
ethical decision making, the NSDS and quality
documentation
Topic 3: Quality
Documentation Practices
The principles and practices of quality DES
documentation – from program entry to ongoing
support
Topic 4: Monitoring &
continuous improvement of
program delivery
The compliance monitoring and improvement
process
Strategies to assist monitoring, evaluation &
continuous improvement
Program objectives
• Build capability to understand the legal nature of the DES
Deed and contractual obligations of DES providers
• Understand the transactional element of the Department
of Social Services and Disability Employment Services
provider relationship and documentary evidence for key
employment services milestones
• Understand the importance of the frontline manager role
in terms of DES provider compliance with the DES Deed
• Use support mechanisms, tools and techniques to assist in
effectively complying with the DES Deed
Learning outcomes
• The key legislative and contractual compliance
requirements associated with the provision of disability
employment services
• The relevance of key contractual requirements to your
own role and responsibilities, and those of your
organisation
• How to ensure compliance with the DES Deed and
guidelines via a range of appropriate methods
• How to adjust plans, processes and procedures to
improve performance against key contractual
requirements
Topic 1
Understanding
Compliance
The importance of compliance...
Between October 2013 and January 2014 approximately 200
Eligible School Leaver registrations were subject to a targeted
program assurance activity.
The Department looked at the evidence from 22 providers and
found that 25% of all the claims had the necessary evidence, 25%
were identified as non-compliant by providers and 50% of claims
were unclear, meaning the evidence was ambiguous and required
further clarification.
Of the 22 providers audited, 21 had claims recovered. Key findings
from the activity indicated 72 had no direct registration form, 52
registrations had partial evidence missing and 14 registrations
were out of scope.
Defining compliance
• The Oxford English Dictionary defines ‘compliance’ as “action in
accordance with request, command”
• Section 72.1 of the DES Deed sets out what ‘compliance’ entails
for DES providers:
The Provider must, in carrying out its obligations under this Deed,
comply with:
(a) all relevant statutes, regulations, by-laws and requirements of
any Commonwealth, state, territory or local authority, including
relevant work, health and safety and industrial relations
legislation and any legislation relating to the licensing of
employment agents; and
(b) any Commonwealth policies Notified by DEEWR to the Provider in
writing, referred to or made available by DEEWR to the Provider
(including by reference to an internet site), including any listed in
this Deed.
Defining compliance
DES Deed
Documentary Evidence for Claims
Payment Guidelines
Direct
Registration
Guidelines
Referral and
Commencement
Guidelines
Job Placement &
Job Placement
Fees Guidelines
Contact Guidelines
Ongoing Support
Fee Guidelines
Ongoing support
Guidelines
Service
Fee
Guidelines
Outcome
Guidelines
Key principles of compliance
Value for Money
Accountability
Transparency
Efficiency
Effectiveness
Ethics
DSS approach to program assurance
Prevention
Deterrence
• Making it easier
for providers to
comply
• Making clearer
the risks and
penalties of noncompliance
Detection
Correction
• Maintaining
robust processes
to identify noncompliance
• Acting on
detected noncompliance
A risk based framework
Risk based framework and mechanisms used by DSS includes:
• Employment Services IT System which provides operational
and management data
• Contract management conducted by DSS account
managers and contract managers, including site visits
• Program evaluation
• Stakeholder and client surveys
• Targeted program assurance activities
• Complaints and feedback from users of services
Prevention
The DSS seeks to ensure that DES providers clearly understand:
• their requirements and obligations under the Deed and
guidelines
• the standards of behaviour expected of them
• how to use ES IT System to aid compliance
DSS works with DES providers to:
• raise awareness of correct procedures & appropriate evidence
• identify and remedy areas of deficiency
• provide supporting information
• improve the ES IT System, and
• provide additional tools to assist compliance
Deterrence
Strategies used by the DSS to deter non-compliance include:
• clearly communicating the ways in which providers will be
monitored
• publicising the DSS’s compliance program assurance
activities
• making providers aware of the range of sanctions that can
be applied, and
• publicising the results of program assurance reviews
Detection
Risks are identified / detected through:
• Desktop data analysis, data mining and actuarial modelling
• On-line verification with Centrelink data
• Complaints and feedback received from participants
and/or DES provider staff
• Industry intelligence
• Information sourced by account managers and contract
managers, including from site visits
Correction
Where non-compliance is found, correction strategies used
by the DSS may include:
• Recovering payments which the provider was not entitled
to claim
• Reduction of the provider’s business share
• Suspension of referrals
• Imposing additional conditions of payment of fees
• Imposing additional reporting requirements
Risk level continuum
Attitude to
Compliance
Wilful non-compliance
or performance
manipulation
Compliance
Strategy
Risk
Differentiation
Use full force of sanctions
Actively exploits
ambiguity / loopholes
Deter by detection,
moderate degree of
sanctions
Try to comply but don’t
always succeed
Help to comply, lesser
degree of sanctions
Willing to do the right
thing
Make it easy to comply,
minimal or no sanctions
HIGHER RISK
Regular
monitoring &
review
LOWER RISK
Periodic
monitoring &
occasional
review
The Employment Services Charter of
Contract Management
Partnering
Building a Strong & Vibrant Sector
Working cooperatively
Achieving Outcomes
Continuous Improvement
Supporting Innovation
Site monitoring by DSS contract
managers
• DSS contract managers review the provider’s performance
in each Employment Service Area and at each site
• Section 44 of the Deed – DES providers are required to
provide DSS employees with reasonable access to:
– Their premises and sites
– Their information technology systems
– All material, including that relevant to determining the
provider’s financial viability; and compliance with
relevant work, health and safety and industrial relations
legislation, and its personnel
Core obligations of DES provider
1. High
standards
of service
& conduct
2. Achieve
KPIs
3.
Document
& report
on service
provision
4. Operate
ethically &
prevent
fraud
5. Use ES
IT System
1. Maintain high standards of service
and conduct
• Internal policies and procedures to inform your approach
to your work as a DES practitioner
• The DES Deed and guidelines
• The National Standards for Disability Services
• The Service Guarantee
• Employment Services Code of Practice
Know how to use the system to your advantage so that you
can both comply with DSS requirements and effectively
deliver high quality employment services to participants
2. Achieve key performance indicators
DES Performance Framework:
• Performance assessment and Star Ratings to inform and support
high quality outcomes
• A commitment to quality through compliance with the National
Standards for Disability Services
• A Service Guarantee reflecting the services that participants can
expect from DES providers
• A Code of Practice that reflects the Australian Government’s
expectations of how providers will interact with participants,
employers and each other
• A Charter of Contract Management that reflects what providers
can expect of the Department of Social Services
3. Document and report on service
provision and key milestones
Program Entry
• Direct Registration Guidelines
• Referral and Commencement Guidelines
• Contacts Guidelines
Assessment &
Planning
• Service Fee Guidelines
• Employment Pathway Plan Guidelines
• Participant Compliance Guidelines
Job Placement
• Job Placement and Job Placement Fee Guidelines
• Documentary Evidence for Claims Guidelines
• Outcomes Guidelines
Ongoing Support
• Ongoing Support Guidelines
• Ongoing Support Fee Guidelines
• Ongoing Support Assessment Guidelines
4. Operate ethically and prevent fraud
Section 13 of the DES Deed sets out the requirements in
relation to DES provider conduct:
13.2
The Provider must not engage in any practice that dishonestly or
improperly manipulates Records, Outcomes or the Services with
the intention of maximising payments to, or otherwise obtaining
a benefit for, the Provider or any other person.
13.3
The Provider must advise its officers and employees:
(a) that they are Commonwealth public officials for the
purposes of section 142.2 of the Criminal Code Act 1995
(Cth); and
(b) that acting with the intention of dishonestly obtaining a
benefit for any person is punishable by penalties including
imprisonment.
What constitutes fraud?
Example 1:
• DES Provider was falsifying job placements and creating
vacancies against a non-existent employer for the
purposes of performance and financial gain
• This scenario demonstrates intent and that deliberate
deception was practiced for financial gain
What constitutes fraud?
Example 2:
•
DES Provider claimed a JPF for a job seeker based on their written statement
that they completed the required benchmark hours over a 10 day period
•
A DSS audit picked up that the job seeker did not get paid for the work hours
according to Centrelink records
•
Upon further investigation, the job seeker later admitted that he
misunderstood his employment arrangements at the time and didn’t realise
that the initial period of employment was only a work trial and therefore he
did not get paid
•
The JPF was recovered, however, no fraudulent activity had occurred as
neither the DES provider or individual practitioner claimed the JPF as a
deliberate act of deception
•
The claim was made based on the information that was provided at the time
which was lead to be believed true and correct
5. Use the ES IT System to aid
compliance
• The ES IT System is used by DES providers and their staff to
document service provision and demonstrate compliance
• Managers need to:
– understand the ES IT System clearly
– ensure staff know how, why and when to use the
system and that they complete training in how to use
the ES IT System
Core obligations of DES provider
1. High
standards
of service
& conduct
2. Achieve
KPIs
3.
Document
& report
on service
provision
4. Operate
ethically &
prevent
fraud
5. Use ES
IT System
Topic 2
Managing Service
Quality
The foundations of service quality
Duty of Care
Ethical Decision
Making
National
Standards for
Disability
Services
Quality
Documentation
Duty of care
Consider the
issues - what are
they?
Review
Consultation with
person with disability
& stakeholders
Implement and
monitor
Balance rights of
stakeholders
Develop strategy
to minimise risk
Activity Agreement
/ Employment Plan
/ Individual Plan
Compare possible
benefits against
possible harm
Ethical decision making
The Commonwealth Procurement Rules describe
ethics and ethical behaviour as:
Ethical relates to honesty, integrity, probity,
diligence, fairness and consistency. Ethical
behaviour identifies and manages conflicts of
interests, and does not make improper use of an
individual’s position.
(Commonwealth Procurement Rules, p.18)
The REFLECT decision making model
RE
• REcognise a potential issue or problem
F
• Find relevant information
L
• Linger at the ‘fork in the road’
E
• Evaluate the options
C
• Come to a decision
T
• Take time to reflect
National Standards for Disability Services
1. Rights
2. Participation and
Inclusion
3. Individual
Outcomes
• The service promotes individual rights to freedom of expression, selfdetermination and decision making and actively prevents abuse, harm,
neglect and violence
• The service works with individuals and families, friends and carers to
promote opportunities for meaningful participation and active inclusion in
society
• Services and supports are assessed, planned, delivered and reviewed to build
on individual strengths and enable individuals to reach their goals
4. Feedback and
Complaints
• Regular feedback is sought and used to inform individual and organisationwide service reviews and improvement
5. Service Access
• The service manages access, commencement and leaving a service in a
transparent, fair, equal and responsive way
6. Service
Management
• The service has effective and accountable service management and
leadership to maximise outcomes for individuals
Indicators of practice
Think about NSDS evidence in the following way:
• Who has been involved in developing your service’s processes
and systems – staff, management, people with disability,
families, friends, carers and advocates?
• What documentation do you have that might provide guidance
on policy, practice or procedures relating to the indicators?
• How do you communicate the key principles and concepts
within these documents to staff, people with disability, families,
friends and carers?
• What everyday practice can you describe that might show how
you apply your processes and systems relating to each standard?
• How do you regularly review practices, processes and systems
and who do you involve in these activities?
Quality documentation
• Section 19.4 of the DES Deed states that:
It is a precondition of the Provider’s entitlement to be paid any fees,
funds, reimbursements, wage subsidies, NEIS payments or ancillary
payments that it has, at the time it makes a claim for payment,
sufficient documentary evidence to provide that the provider has
delivered the relevant services in accordance with or otherwise has
relevantly complied with, this Deed.
• Documentary Evidence for Claims Payment Guidelines (p.8):
The Documentary Evidence set out in the Deed and these Guidelines,
together with the information required to be recorded in the
Employment IT Systems is acceptable to the Department as sufficient
proof of service provision.
What constitutes quality documentation?
• Adheres to the DES Deed and recording and reporting
requirements set out in the guidelines
• Comprehensive, well structured, factual and evidence based
• Based around meeting key milestones and evidence
requirements
• Fulfils the outcome requirements to ensure it effectively meets
the claim payment requirements
• Meets all legal requirements
• Uses appropriate language and terms
• Both mandatory and non-mandatory information is entered into
the ES IT System as required
Topic 3
Quality Documentation
Practices
DES program structure & compliance
obligations – documentary evidence
Providers are required to:
• retain evidence of entitlement to fees, funds, reimbursements
and ancillary payments
• retain sufficient and appropriate documentary evidence to prove
that services have been delivered in accordance with the Deed
and to make claims
• create & keep accurate Participant Services Records (i.e. Deed
Records including Customer Feedback Register) about a
participant that are directly created for the purposes of providing
service
• retain records according to the minimum retention periods (see
Attachment C of the Records Management Guidelines)
Keeping good case notes
Case notes should:
• be well structured
• use appropriate language
• be comprehensive
• be cognisant of the outcome requirements
• meet legislative requirements, and
• present appropriate and sufficient evidence
Tips for recording good case notes...
Case notes – best practice
1. Guiding principle for deciding what information you
should include in participant case notes, i.e. is the
information is relevant to the employment service or
support being provided?
2. When recording case notes:
– Include a participant identifier on each page
– Date the case note
– Record the information as soon as possible after the event
– Make sure the notes are legible if they’re handwritten
– Ensure the author of the case note includes their name and signature
3. Understand the outcome requirements and make sure
claim evidence forms meet all these requirements
Case notes – best practice
4. Refer to the additional evidence that ‘should’ be retained
and try to collect and record this evidence wherever
possible
5. Conduct regular internal audits of case notes to ensure
they meet all requirements – where deficiencies are
detected, take immediate steps to rectify them
6. Conduct case conference reviews for quality assurance
purposes and to address any systemic issues
7. Organisational record keeping should align with ES IT
System record keeping requirements
8. Provide regular training and updates for staff members
regarding record keeping and compliance requirements
Quality documentation for each stage
of the employment services process
3. Job
Placement
1.
Program
Entry
2.
Assessment
and
Planning
4. Post
Placement
Support
5. Ongoing
Support
1. Program entry
File must be set up on the ES IT System for the participant and, as a
minimum, the following information must be entered into the
System:
• Participant registration information (including identification of
the participant as a Special Class Client where applicable)
• A record of attendance at the initial interview
• A record of completion of the initial interview
• An Employment Pathway Plan (including individualised contact
schedule)
• Confirmation of identity where it is a Direct Registration
(Note: A CRN [Customer Reference Number] must be recorded
and where the person does not have a CRN, a shell record must
be created by DSS)
Direct registration eligibility requirements
Complete Direct Registration Form, obtain proof of identity and determine whether participants meets the eligibility
requirements
Confirm that the participant is not currently registered with another provider and that they meet the eligibility requirements
by inputting the information into the Employment Services IT System
DES provider confirms that the participant has a valid ESAt or JCA and commences
(Note: where the participant does not have a valid ESAt or JCA, they are to be referred to DSS assessment services for an
assessment)
Conduct an initial interview with the participant and commence the participant in the appropriate DES program services
Complete the appropriate resume summary fields of the EPP in the employment IT systems
2. Assessment and planning
Assessment, planning and employment assistance focuses on:
• Establishing an individualised contact schedule and
regularly meeting with the participant in accordance with
the contact schedule and completing participation
reporting requirements
• Developing and maintaining an EPP to achieve
employment goal
• Identification of and referral to appropriate services
• Keeping up to date file notes advising of contacts,
progress, outcomes and review and update of the EPP
• Addressing the barriers and interventions identified in the
ESA/JCA over the period of service
Contact requirements
DES Type
Contact Requirements
For participants receiving
Employment Assistance and
Extended Employment
Assistance
• Six contacts over each period of three
months
For participants receiving Post
Placement Support
• Regular contact, as deemed appropriate
by the DES provider
For participants receiving
Ongoing Support in
employment
• Flexible Ongoing Support: As required,
but only six contacts / instances of
support over six months in a 12 month
calendar period are claimable
• Moderate Ongoing Support: Six contacts
over each period of three months
• High Ongoing Support: Twelve contacts
over each period of three months
Employment Pathway Plan
The EPP should include:
• The frequency of contacts
• The timing and details of vocational activities
• The timing and details of non-vocational activities
• Details of mandatory obligations
• An identified employment related goal
At each contact appointment:
• participant progress should be reviewed to identify
strengths, build employability skills & overcome barriers
• the EPP must be reviewed & updated
Identification of and referral to services
For identification of and referral to appropriate activities and
services, review the EPP and consider:
• Is the participant undertaking an activity?
• Is the service or activity appropriate to the participant’s
individual needs?
• Would the participant benefit from participating in other
activities?
3. Job placement
• Can claim a Job Placement Fee for placing a participant into a Job
Placement, in which the participant achieves their Job Placement
Hours within the required timeframe
• The following information must be entered into the ES IT System within
28 days of the Job Placement Start Dates record:
– The Job Placement Start Date
– Details of the DES provider’s confirmation with the employer that the
participant has started the Job Placement
• Also within 28 days of the Job Placement Fee Date the following
information must also be entered into the ES IT System:
– The Job Placement Fee Date
– Details of the DES provider’s verification with the employer that the
participant has achieved the relevant Job Placement Hours in the Job
Placement
4. Post placement support
The DES provider must retain documentary evidence which
indicates that the participant:
Full
Outcome
Remained employed each fortnight of the 13 Week Period
or 26 Week Period and earned sufficient income for the
participant’s basic rate of any income support payment to
cease; or
Remained employed each week and worked the minimum
required hours in a 13 Week Period or 26 Week Period
according to the participant’s Employment Benchmark
Pathway
Outcome
Remained employed each week and worked the minimum
required hours in a 13 Week Period or 26 Week Period
according to the participant’s Employment Benchmark
Claiming the outcome fee
To claim fee, evidence must include a file note or a signed & dated
written statement or email from the employer or participant and
must contain:
• The name of the employer
• The period of employment
• The name of the person who confirmed the employment details
and their contact details
• The date the information contained in the file note was
confirmed and the name of the DES provider staff member who
recorded the information;
OR
• Copies of payslips covering the whole of the 13 Week Period or
26 Week Period
Anchoring the PPS phase
• The DES provider may select a date to anchor the PPS
at any time after the Job Placement Start Date
• Once the participant has been moved into PPS in the
ES IT System, this then become the start date / anchor
date of the 13 Week Period
• The anchor date may be the same date as the Job
Placement Start Date or may be any date after the Job
Placement Start Date, once it’s been determined that
the participant is likely to meet the requirements of an
outcome
5. Ongoing support
The Documentary Evidence Guidelines lay out the information
that must be entered into the ES IT System:
The decision and the reasons for making the decision
where the DES provider:
• assesses a Participant for entry into Ongoing Support
• performs a Provider Exit from Ongoing Support
• changes the level of Ongoing Support for Employment
Support Service Participants
Documenting ongoing support
• Where Ongoing Support is provided, after each contact the
participant’s EPP must be updated
• File notes must also be completed where:
– The level of Ongoing Support changes – each change must be discussed
with the participant and recorded in the ES IT System
– The Ongoing Support provided to the participant is temporarily suspended
– Ongoing Support is no longer required
• Where further periods of Ongoing Support are required after the initial
period, a notice board message will appear in the ES IT System when a
participant has reached:
– 48 weeks from the Anchor Date of the 26 Week Employment Outcome, or
– It has been 48 weeks or 74 weeks since the participant’s last Ongoing
Support Assessment
Topic 4
Monitoring and
Continuous Improvement
of Program Delivery
Monitoring and evaluating compliance
Process
Frequency
Approach
Documentation
Taking Action
1. Compliance process
• The compliance testing / monitoring process should check
to see whether the policies, procedures and business
practices are working as intended
• The monitoring process should also identify where there
are issues or deficiencies
• By testing the veracity of policies, procedures and business
practices on a regular basis you will be able to build a
compliance profile and demonstrate to auditors that your
organisation is endeavouring to comply with all rules,
regulations and requirements
2. Frequency of monitoring
• How often should compliance monitoring and review be
conducted? Monthly? Every six months? Annually?
• Conduct a risk assessment to help you determine the
required frequency of compliance monitoring
• Through understanding the nature, likelihood and impact
of risks / non-compliance you will gain a better
understanding of whether the risk is high, medium or low –
this in turn will help determine just how regularly the
risks need to be monitored
3. Approach
• Adopt a rigorous, methodical and documented
approach to compliance monitoring and
improvement:
– Use a checklist of compliance tests / monitoring
requirements
– Categorise the tests into various DES program delivery
areas or according to DES Deed requirements and
guidelines prescribed by DSS
• Above all, make sure the approach you select is
suitable to your organisation’s operations
4. Documentation
• What compliance monitoring and
improvement documents does your
organisation use?
• What compliance monitoring and
improvement records does your organisation
keep?
5. Taking action
As a result of the monitoring of compliance, it is good
practice to:
• Document any actions and improvements required
• Prioritise these follow up actions and improvements
• Assign appropriate persons to take action / make
improvements
• Establish a timeframe in which the actions /
improvements will be undertaken
• Take necessary action as required and follow up as
needed
Continuous improvement
PERFORMANCE IMPROVEMENT PLAN
KPI 3 - QUALITY
Current State:
Improvement Goals Strategies (actions
(SMART – Specific,
to achieve goals)
Measurable,
Achievable,
Realistic, Timebound)
What goals have
What will be done
been identified to
to achieve the
address the issues? identified goals?
Increase star ratings Regularly monitor
and percentile
KPI results
rankings
Regularly review
and adjust other
strategies
(including
timeframes) as
required in
response to KPI
results
Indicators
(measures of
improvement)
Responsibility
Timeframe
(implement –
review –
report)
How will
progress towards
the goal be
measured?
Who is
primarily
responsible for
this action?
What is the
timeframe for
action and
review?
Upwards trend in
KPI results
Reports –
DES KPI
Measures –
Outcomes Rates
Health check
report
DES Manager
(Action Lead)
DES Team
Leader
Strategies
implemented
by (DATE)
Indicators to be
reviewed by
Action Lead
(FREQUENCY)
Improvement
to be reported
by (DATE)
Workshop close
• Workshop recap
• Questions
• Please complete the workshop evaluation form
• Thank you for your participation

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