DES Contractual ComplianceTraining Program

AgendaProgram Introduction Program objectives & learning outcomes

Topic 1: Understanding compliance

Key concepts of complianceDSS approach to program assuranceOverview 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 processStrategies 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

Understanding Compliance

Topic 1

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 Registratio

n Guidelines

Referral and Commence

ment 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• Making it

easier for providers to comply

Deterrence• Making clearer

the risks and penalties of non-compliance

Detection• Maintaining

robust processes to identify non-compliance

Correction• Acting on

detected non-compliance

A risk based frameworkRisk 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

PreventionThe 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 complianceDSS 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

DeterrenceStrategies 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

DetectionRisks 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 continuumAttitude to Compliance

Compliance Strategy Risk Differentiation

Help to comply, lesser degree of sanctions

Actively exploits ambiguity / loopholes

Try to comply but don’t always succeed

Willing to do the right thing

Use full force of sanctions

Deter by detection, moderate degree of

sanctions

Wilful non-compliance or performance

manipulation

Make it easy to comply, minimal or no sanctions

HIGHER RISKRegular

monitoring & review

LOWER RISKPeriodic

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 indicatorsDES 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

Managing Service Quality

Topic 2

The foundations of service quality

Duty of Care Ethical Decision Making

National Standards for

Disability Services

Quality Documentation

Duty of careConsider the

issues - what are they?

Activity Agreement / Employment Plan

/ Individual Plan

Compare possible benefits against possible harm

Develop strategy to minimise risk

Implement and monitor

Review

Balance rights of stakeholders

Consultation with person with disability

& stakeholders

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 modelRE •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

•The service promotes individual rights to freedom of expression, self-determination and decision making and actively prevents abuse, harm, neglect and violence1. Rights•The service works with individuals and families, friends and carers to promote opportunities for meaningful participation and active inclusion in society

2. Participation and Inclusion

•Services and supports are assessed, planned, delivered and reviewed to build on individual strengths and enable individuals to reach their goals3. Individual Outcomes

•Regular feedback is sought and used to inform individual and organisation-wide service reviews and improvement

4. Feedback and Complaints

•The service manages access, commencement and leaving a service in a transparent, fair, equal and responsive way5. Service Access

•The service has effective and accountable service management and leadership to maximise outcomes for individuals6. Service Management

Indicators of practiceThink 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

Quality Documentation Practices

Topic 3

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 practice4. 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

1. Program Entry

2. Assessment and Planning

3. Job Placement

4. Post Placement Support

5. Ongoing Support

1. Program entryFile 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

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 requirementsDES Type Contact RequirementsFor 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 goalAt 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 supportThe 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 feeTo 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

Monitoring and Continuous Improvement of Program Delivery

Topic 4

Monitoring and evaluating complianceProcess

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 improvementPERFORMANCE IMPROVEMENT PLANKPI 3 - QUALITYCurrent State:Improvement Goals (SMART – Specific, Measurable, Achievable, Realistic, Time-bound)

Strategies (actions to achieve goals)

Indicators (measures of improvement)

Responsibility Timeframe (implement – review – report)

What goals have been identified to address the issues?

What will be done to achieve the identified goals?

How will progress towards the goal be measured?

Who is primarily responsible for this action?

What is the timeframe for action and review?

Increase star ratings and percentile rankings

Regularly monitor KPI resultsRegularly review and adjust other strategies (including timeframes) as required in response to KPI results

Upwards trend in KPI resultsReports – DES KPI Measures – Outcomes RatesHealth 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