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DES Contractual Compliance Training Program. Agenda Program IntroductionProgram objectives & learning outcomes Topic 1: Understanding compliance Key concepts.

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Presentation on theme: "DES Contractual Compliance Training Program. Agenda Program IntroductionProgram objectives & learning outcomes Topic 1: Understanding compliance Key concepts."— Presentation transcript:

1 DES Contractual Compliance Training Program

2 Agenda Program IntroductionProgram 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

3 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

4 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

5 Understanding Compliance Topic 1

6 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.

7 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.

8 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

9 Key principles of compliance Value for MoneyAccountabilityTransparencyEfficiencyEffectivenessEthics

10 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

11 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

12 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

13 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

14 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

15 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

16 Risk level continuum Attitude 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 RISK Regular monitoring & review LOWER RISK Periodic monitoring & occasional review

17 The Employment Services Charter of Contract Management PartneringBuilding a Strong & Vibrant Sector Working cooperatively Achieving OutcomesContinuous ImprovementSupporting Innovation

18 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

19 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

20 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

21 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

22 3. Document and report on service provision and key milestones Direct Registration Guidelines Referral and Commencement Guidelines Contacts Guidelines Program Entry Service Fee Guidelines Employment Pathway Plan Guidelines Participant Compliance Guidelines Assessment & Planning Job Placement and Job Placement Fee Guidelines Documentary Evidence for Claims Guidelines Outcomes Guidelines Job Placement Ongoing Support Guidelines Ongoing Support Fee Guidelines Ongoing Support Assessment Guidelines Ongoing Support

23 4. Operate ethically and prevent fraud Section 13 of the DES Deed sets out the requirements in relation to DES provider conduct: 13.2The 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. 13.3The Provider must advise its officers and employees: (a)that they are Commonwealth public officials for the purposes of section 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.

24 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

25 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

26 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

27 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

28 Managing Service Quality Topic 2

29 The foundations of service quality Duty of Care Ethical Decision Making National Standards for Disability Services Quality Documentation

30 Duty of care Consider 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

31 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)

32 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

33 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 violence 1. 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 goals 3. 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 way 5. Service Access The service has effective and accountable service management and leadership to maximise outcomes for individuals 6. Service Management

34 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?

35 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.

36 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

37 Quality Documentation Practices Topic 3

38 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)

39 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...

40 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

41 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

42 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

43 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)

44 Direct registration eligibility requirements Complete the appropriate resume summary fields of the EPP in the employment IT systems Conduct an initial interview with the participant and commence the participant in the appropriate DES program services 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) 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 Complete Direct Registration Form, obtain proof of identity and determine whether participants meets the eligibility requirements

45 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

46 Contact requirements DES TypeContact 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

47 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

48 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?

49 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

50 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

51 Claiming the outcome fee To claim fee, evidence must include a file note or a signed & dated written statement or 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

52 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

53 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

54 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

55 Monitoring and Continuous Improvement of Program Delivery Topic 4

56 Monitoring and evaluating compliance ProcessFrequencyApproachDocumentationTaking Action

57 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

58 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

59 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

60 4. Documentation What compliance monitoring and improvement documents does your organisation use? What compliance monitoring and improvement records does your organisation keep?

61 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

62 Continuous improvement PERFORMANCE IMPROVEMENT PLAN KPI 3 - QUALITY Current State: Improvement Goals (SMART – Specific, Measurable, Achievable, Realistic, Time- bound) Strategies (actions to achieve goals) Indicators (measures of improvement) ResponsibilityTimeframe (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 results Regularly review and adjust other strategies (including timeframes) as required in response to KPI results 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)

63 Workshop close Workshop recap Questions Please complete the workshop evaluation form Thank you for your participation


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