FOI 24/25-0368
DOCUMENT 1
Log an activity or internal note
SGP KP Publishing
Exported on 2024-10-09 07:54:26
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Check if there is an open case ........................................................................................... 6
4
Decide if a follow-up action is required ............................................................................. 7
5
Log an activity or internal note to the case ....................................................................... 8
6
Log an activity or internal note to the person account .................................................. 10
7
Tips for JAWS users .......................................................................................................... 11
7.1
Quickly navigate to the activity panel ............................................................................... 11
7.2
Fill in the Log Activity form................................................................................................ 11
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to:
check if there is an open case
decide if a follow-up action or review is required
log an activity or internal note to the case
log an activity or internal note to the person account
understand how to log an activity as a JAWS user.
This could be recording contact with an applicant, participant, authorised representative,
provider, unauthorised person, contact attempt or internal note.
Recent updates – 3
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1 Recent updates
6 May 2024
New section for how to add an activity or internal note to the person account if there is
no relevant open case and no further follow-up action required. You no longer need to
create an enquiry case for this scenario.
Included a step that you must add the person and related contacts to the 'Name' field,
otherwise the activity or internal note will not appear on the person's account.
Update to include reference to 'contact attempt' in the introduction section to support
you to find the correct article when recording a contact attempt.
Update to section 'Before you start' to include scenarios for when you need to log an
activity or internal note.
Emphasised that you must log an activity every time you contact a person and
included additional examples to support this.
Recent updates – 4
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2 Before you start
You either:
contacted a person or they have contacted you
made a contact attempt
need to record an internal note.
Before you start – 5
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3 Check if there is an open case
1. Check if there is a related open case:
o If there is a related open case, go to section Log an activity or internal note
to the case.
o If there is no related open case, go to section Decide if a follow-up action is
required.
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4 Decide if a follow-up action is required
1. Decide if a fol ow-up action or review is required, or if the enquiry is resolved at first
contact:
o If follow-up action is required, create the appropriate case to action the enquiry.
Then go to section Log an activity or internal note to the case.
For example, if the participant is calling to update their address, create an Update
Person Account case.
o If no follow-up action is required, go to section Log an activity or internal note
to the person account.
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5 Log an activity or internal note to the case
You must log an activity every time you contact or meet an applicant, participant, their
provider, or authorised representative, For example, when you:
contact a person about an access or plan decision, information gathering or requesting
more evidence
support a participant to use their plan
arrange or conduct a meeting. For example, information gathering or check-in
provide support to link to community and mainstream supports
update the person's account. For example, updates to their profile, roles or authorities,
or their my NDIS contact
respond to a complaint or incident.
You must also log an activity to create an Internal Note when you contact an NDIS team
member or when leaving information for them to review or action.
1. From the Person Account screen, select Cases.
2. Select the relevant Case.
3. Select Log Activity on the Activity panel on the right.
4. Select Create New or Add.
5. At Name, make sure the person is listed and add related contacts. For example, the
applicant or participant. Do not leave this blank. You must add the person and related
contacts, otherwise this activity or internal note will not appear on the person's account.
6. Select the Activity Type:
o Inbound Phone Call
o Outbound Phone Call
o Inbound Email
o Outbound Email
o Webchat
o Internal Note
o Face to Face
o Virtual
o SMS.
7. Select an Outcome, depending on the Activity Type you choose.
8. Select a Subject:
o Contact with Participant
o Contact with Authorised Person
o Contact with Provider
o Contact with Unauthorised Person
o Contact Attempt
o Internal Communication.
9. Add Comments that are relevant to the case type. To learn more, read articles relevant
to the case type.
10. Select Save.
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Note: When you log an activity, it displays on the Person Account Timeline and the
Activity tab. To learn more, go to article View the Person Account Timeline.
11. After you record comments, continue working through the case using the articles
relevant to the case type.
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6 Log an activity or internal note to the person
account
If there is no related open case and no further follow-up action or review is required, add the
activity or internal note to the person account.
Do not log an activity to the person account if there is a related open case, a new case is
required, or follow-up action is required.
1. Navigate to the relevant Person Account.
2. Select Log Activity on Account from the highlight panel.
3. Select the Activity Type:
o Inbound Phone Call
o Inbound Email
o Webchat
o Face to Face
o Virtual.
4. Select a Subject:
o Contact with Participant
o Contact with Authorised Person
o Contact with Provider
o Contact with Unauthorised Person.
5. Select the Category:
o Information about the NDIS
o Reports and Evidence
o Plan or Budget
o Portal or App
o Provider
o General Question
6. Add Comments that are relevant to the enquiry.
7. Select Save.
Note: When you log an activity, it displays on the Person Account Timeline and the
Activity tab. To learn more, go to article View the Person Account Timeline.
8. No further action required.
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7 Tips for JAWS users
7.1 Quickly navigate to the activity panel
Press Control plus End to go to the end of the screen.
Press Shift plus H to skip to Headings.
Press the down arrow key to go to the Activity tab. The Activity tab is the default.
Continue to use the down arrow key to go to the Log Activity sub-panel.
You can also press B to go directly to the Create New dot dot dot button then press
Enter to activate. The Log Activity form displays.
7.2 Fill in the Log Activity form
The Name field auto-fills the Contact for the case. To change the Contact use the
Name field to search the NDIS number or name.
Select an Activity Type. The Activity Type determines the value in the Outcome field.
If the Outcome field is not active, an Activity Type is not required. For example,
Internal Notes does not need an Outcome.
Select the Subject field from the list of five choices.
When tabbing from the Subject field, JAWS will announce 'Please add additional notes
here'. This is a tool tip. Press Tab again to get to the input area to type your comments
for the activity.
Note: To go back to review information in the form, switch to virtual PC mode and use arrow
keys to navigate. There is a known issue when using Shift Tab to navigate back. If Shift Tab is
used to go back from the Comment field, it will announce 'Insert Quick Text Button'. This button
is not announced when navigating forward. If Shift Tab is used again JAWS reads out the
name of the case and case number.
Tips for JAWS users – 11
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DOCUMENT 2
When to refer the participant for an
eligibility reassessment
SGP KP Publishing
Exported on 2024-10-09 07:58:52
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Consider an eligibility reassessment ................................................................................. 6
3.1
Automatic eligibility reassessment referrals ....................................................................... 6
3.2
Manual eligibility reassessment referrals ........................................................................... 6
4
Complete an eligibility pre-check by reviewing available information ........................... 7
4.1
Check the participant has received funding for 14 months ................................................ 7
4.2
Check for any open ER or Leaving cases .......................................................................... 7
4.3
Review evidence on the participant record ........................................................................ 7
4.4
Review the participants original access decision and information ..................................... 8
5
When to refer the participant for an eligibility reassessment ......................................... 9
5.1
Commence an eligibility reassessment referral.................................................................. 9
Table of Contents – 2
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This article provides guidance for a local area coordinator, early childhood partner or planner
delegate to:
consider an eligibility reassessment
complete an eligibility pre-check by reviewing available information
understand when to refer the participant for an eligibility reassessment.
Recent updates – 3
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1 Recent updates
3 October 2024
Guidance updated:
to reflect legislation changes from 3 October 2024
title has been updated from 'Understand eligibility reassessment referral requirements'
to 'When to refer the participant for an eligibility reassessment'
content from article Complete and eligibility reassessment referral, relating to
referral decisions has been placed here
content on creating the case and contacting the participant has been moved to article
Complete an eligibility reassessment referral.
Recent updates – 4
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2 Before you start
You have read and understood:
Our Guideline – Applying to the NDIS (external)
Our Guideline – Leaving the NDIS (external) section Are you still eligible for the
NDIS?
Early childhood partners have read and understood articles:
EC: Guide – Check-in eligibility conversations for children younger than 6 with
developmental delay
EC: Guide – Evidence sources to demonstrate if an impairment is likely to be
permanent for children who previously met access for developmental delay.
To learn more about leaving the NDIS read:
Our Guideline – Reviewing our decisions (external)
article Understand the leaving case.
Before you start – 5
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3 Consider an eligibility reassessment
We may need to check a participant's eligibility if information shows they may no longer be
eligible, or their disability support needs, or situation has changed. We call this an eligibility
reassessment. For more information see Our Guideline – Leaving the NDIS (external).
If the participant met disability requirements, we don't need to check their eligibility at every plan
reassessment. We only need to check if we get evidence they may no longer be eligible.
If the participant met the early intervention requirements, an automatic referral may be created.
3.1 Automatic eligibility reassessment referrals
An eligibility reassessment case will be generated automatically when the participant:
with developmental delay turns 6
with global development delay turns 7
who is eligible under the early intervention requirement has a primary impairment of
hearing loss and turns 26.
If an automatic case has been generated, the participant's my NDIS contact will be notified via
the Omni-Channel to start an eligibility reassessment checklist. They will consider all
information to determine if an eligibility reassessment is needed.
When completing an automatic referral, check for more information about the participant before
completing the referral.
1. Complete section Review evidence on the participant record.
2. Complete section Review the participants original access decision and
information.
3. Then continue to article Complete an eligibility reassessment referral.
3.2 Manual eligibility reassessment referrals
Sometimes you will need to manually create an eligibility reassessment referral. For example, if
you receive a report from the participant's treating professional that says their disability support
needs have changed.
If the participant's situation has changed and you think they need an eligibility reassessment,
you can manually make an eligibility reassessment referral. This can take place:
as part of the plan reassessment process
at check-in
at any other time.
First you need to complete an eligibility pre-check to confirm whether you need to create an
eligibility reassessment referral. Continue to section Complete an eligibility pre-check by
reviewing available information.
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4 Complete an eligibility pre-check by reviewing
available information
4.1 Check the participant has received funding for 14 months
1. Go to the participant's Person Account.
2. Go to the Account Timeline in the navigation pane.
3. Find the first Plan Approval case in the Timeline.
Note: this will usually be at the bottom of the list.
4. Check the date of the Access Decision date. Is this more than 14 months ago?
Note: If there is no date in PACE, check SAP CRM for this information. If:
o Yes: continue to section Check for any open ER or Leaving cases.
o No: the eligibility reassessment will not continue to be considered until after the
participant has received NDIS funding for 14 months. It will remain in the
Eligibility Reassessment Hold Queue until the 14 months are up. If you choose
to continue with the referral, go to section Check for any open ER or Leaving
cases.
4.2 Check for any open ER or Leaving cases
1. Go to the participant's Person Account, Cases tab.
2. Check Open Cases for an existing:
o Eligibility Reassessment case
o Leaving the NDIS case
3. Is there an existing case in progress? If:
o Yes: they cannot be referred for an eligibility reassessment. End of process.
o No: continue to section Review evidence on the participant record.
4.3 Review evidence on the participant record
1. Check all available information to make sure you give an accurate referral based on the
participant's current situation. Check:
o any relevant documents on the participant's record
o medical, clinical, diagnostic or assessment reports
o provider reports and assessments such as progress reports
o early childhood partner documents
o information from family members and carers, such as a carer impact statement.
Note: You don't need to ask the participant to give any new or additional
information to pre-check eligibility.
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4.4 Review the participants original access decision and
information
The Decisions, Justifications and Evidence (DJE) framework of the Access Decision case
records evidence used. It helps record decisions to meet the requirements of the participant
service guarantee and the NDIS Act (2013).
1. Go to the participant's Person Account, Decisions tab.
2. In the Decision Name column, select Access Decision.
3. Review all information within the Details tab to understand how the participant met the
access criteria for the NDIS.
4. Go to the Decisions tab, and review all Justifications and sub-criterion decisions
made for the access decision.
5. Review all Evidence/explanation, read the type of evidence and documents recorded
to support the access decision.
6. In Sub-decisions, read the Decision Name and how the participant met the access
criteria for the NDIS.
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5 When to refer the participant for an eligibility
reassessment
1. Has the participant's support needs or circumstances changed? If:
o Yes, continue to step 2.
o No, they cannot be referred for an eligibility reassessment. End of process.
2. Check whether the participant that met access under the disability requirements, now
appears to no longer meet residence requirements, or no longer meet the disability and
early intervention requirements. If:
o Yes: continue to section Commence an eligibility reassessment referral.
o No: they cannot be referred for an eligibility reassessment. End of process.
3. Check whether the participant that met access under the early intervention
requirements, and now they are likely to no longer meet residence requirements, or no
longer meet the early intervention requirements, and now meet disability requirements.
If
o Yes, go to section Commence an eligibility reassessment referral.
o No, they cannot be referred for an eligibility reassessment. End of process.
Note: A participant can meet both the disability and early intervention
requirements.
5.1 Commence an eligibility reassessment referral
1. Create a new eligibility reassessment case using article Complete an eligibility
reassessment referral.
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DOCUMENT 3
What evidence of disability is
required
SGP KP Publishing
Exported on 2024-10-09 08:01:42
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Who can provide evidence of disability? .......................................................................... 6
4
What evidence does the NDIA require? ............................................................................. 7
5
How to check evidence ........................................................................................................ 8
6
What if the applicant lives in a remote region? ................................................................ 9
7
Next steps ........................................................................................................................... 10
Table of Contents – 2
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This article provides guidance for a local area coordinator, early childhood partner, or access
delegate to understand:
who can provide evidence of disability
what evidence does the NDIA require
how to check evidence
what to do if the applicant lives in a remote region.
Recent updates – 3
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1 Recent updates
3 October 2024
Linked article title changed from How to complete the access request case form to Complete
form in the access request case.
Updates to improve accessibility and consistency with related articles.
Recent updates – 4
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2 Before you start
You have read and understood Our Guideline – Applying to the NDIS (external) including
section Do you meet the disability requirements?
Before you start – 5
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3 Who can provide evidence of disability?
A person's treating professional must provide disability evidence.
Evidence provided by treating professionals – such as medical reports – needs to consist of
genuine, original documents. The information must also be specific to the person applying.
Before accepting evidence from a treating professional, you should read the article Check
treating professional details.
Who can provide evidence of disability? – 6
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4 What evidence does the NDIA require?
Anyone applying for the NDIS needs to have evidence of disability, regardless of what NDIS
support they are asking for. A person's evidence needs to show they meet all of the disability
requirements.
The person should provide this evidence with their application. This could be either when they
first submit, or during the eligibility check stage.
You can't submit the access request case until you have evidence of disability from the person.
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5 How to check evidence
Before the person's NDIS eligibility decision can be made, you need to check that the person's
disability evidence:
Is from a treating professional registered with AHPRA (the Australian Health
Practitioner Regulation Agency). Use article Check treating professional details.
Provides enough information to show if the person is eligible for priority application
decision. Use article Request priority eligibility decision.
Records any requests for an exemption. Use article: Log an activity or internal note.
Demonstrates that the person has a condition from List A (external), List B (external) or
List D (external).
Shows if the person meets all 5 of the disability requirements. Use article Understand
disability requirements.
If the evidence does not show each of the above, the applicant wil need to provide additional
evidence.
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6 What if the applicant lives in a remote region?
The NDIA makes some exceptions to the evidence requirements for people living in remote
regions of Australia. In such regions it may be difficult to provide evidence – or even obtain it in
the first place.
When you support applicants who live in very remote communities, you must record
information about their:
local health service
consent for the NDIA to talk to the local health service
local community connection contact
Council and/or Department of Social Services contact in the area.
To be eligible for an exemption, the person must live in a Remote or Very Remote location. This
would mean an 'MM6' or 'MM7' region, under the Modified Monash Model (external).
If this is the case, you should talk with your team leader about the application. They can help
you consider options and alternatives for the person's circumstances.
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7 Next steps
If you are completing an access request case, continue following the guidance in article
Complete form in the access request case.
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DOCUMENT 4
Understand disability requirements
SGP KP Publishing
Exported on 2024-10-09 08:04:21
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SGP KP Publishing – Understand disability requirements
Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Overview ............................................................................................................................... 6
4
Disability requirements ....................................................................................................... 7
4.1
Check eligibility for disability requirements ......................................................................... 7
4.2
Additional considerations.................................................................................................... 7
5
How to weigh evidence of disability .................................................................................. 8
6
Next steps ............................................................................................................................. 9
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to understand:
eligibility under the disability requirements
how to weigh evidence of disability.
Recent updates – 3
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1 Recent updates
3 October 2024
Updates to reflect legislation changes from 3 October 2024:
applicants may now meet both disability and early intervention requirements, instead of
just one
the disability requirement has changed from lifetime supports under the NDIS to NDIS
supports for their lifetime.
Recent updates – 4
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2 Before you start
You have:
read and understood Our Guideline – Applying to the NDIS (external), including section
Do you meet the disability requirements?
read article What evidence of disability is required?
read article Check eligibility – age and residence requirements.
Before you start – 5
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3 Overview
To be eligible for NDIS, the person must meet the requirements for:
age
residence
disability, early intervention, or both.
Overview – 6
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4 Disability requirements
To meet the disability requirements, we must have evidence of all of the following:
their disability is related to an impairment
their impairment is likely to be permanent
their permanent impairment significantly reduces their functional capacity to undertake
one or more of the following activities: moving around, communicating, socialising,
learning, or undertaking self-care or self-management tasks
their permanent impairment affects their ability to work, study or take part in social life
they'll likely need NDIS support for their lifetime.
4.1 Check eligibility for disability requirements
Use these articles to check evidence for a decision:
Check eligibility – DIS – disability caused by an impairment
Check eligibility – DIS – likely permanence
Check eligibility – DIS – significant functional impact
Check eligibility – DIS – social and economic impact
Check eligibility – DIS – NDIS supports for life.
4.2 Additional considerations
Use these articles before you check evidence for a decision.
Check if there is evidence of a condition on List A. Go to Check eligibility – List A condition.
Note: A person is likely to meet the disability requirements if they provide evidence of their
diagnosis.
Check if there is evidence of a condition on List B. Go to Check eligibility – List B condition.
Note: A person is likely to meet some of the disability requirements if they provide evidence of
their diagnosis.
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5 How to weigh evidence of disability
When you weigh the relevance and importance of the provided disability evidence, consider:
who is providing the evidence of disability?
how old is the evidence of disability (particularly relevant for functional capacity
evidence)?
For further information, refer to Our Guideline – Applying to the NDIS (external), including
sections:
What information do we need in your application?
Who can give us evidence of your impairments?
How do we weigh evidence of disability?
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6 Next steps
To consider the early intervention requirements, go to article Understand early intervention
requirements.
If you are an access delegate:
to make an access decision, continue to article Make an access decision – pre-
legislation changes or Make an access decision – post legislation changes.
to make an eligibility reassessment decision, continue to article Finalise eligibility
reassessment decision.
Next steps – 9
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DOCUMENT 5
Check treating professional details
SGP KP Publishing
Exported on 2024-10-09 08:08:30
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Check treating health professional details ........................................................................ 6
4
Next steps ............................................................................................................................. 7
Table of Contents – 2
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This article provides guidance for an access delegate to check treating health professional
details.
Recent updates – 3
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1 Recent updates
November 2023
Title changed from ‘Check treating health professional details to come into line with
companion article ‘Record treating professional details’ and OG – Applying
AHPRA URL added to 2nd instruction to check details of treating health professional.
Recent updates – 4
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2 Before you start
You have read and understood:
Our Guideline – Applying, in particular How do we decide if you’re eligible?
Before you start – 5
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3 Check treating health professional details
When assessing a person’s NDIS application, you must check that evidence regarding a
person’s disability is provided from a suitably accredited and/or registered treating professional.
To check and confirm their details, use the Australian Health Practitioner Regulation Agency
(AHPRA) website.
For all evidence of disability documents:
1. Obtain the treating health practitioner details
2. Refer to the AHPRA website
3. Navigate to the Look up a practitioner section in the top right-hand corner of the page
4. Review the list of professions that can be confirmed in AHPRA
5. Search for each treating health professional via Name or Registration Number
6. Use the filters if you need to refine the search results
7. Select the relevant treating professional
8. Review to check they have current qualifications and registration.
Note: All evidence from a treating professional with a profession listed in AHPRA must be
checked to make sure they are currently registered. For a list of AHPRA regulated professions
visit the AHPRA website.
If you have any concerns about the evidence of the treating professional details, you should
escalate as an integrity issue.
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4 Next steps
1. To learn more about integrity issues, refer to article Escalate application integrity issue.
2. To record the AHPRA registration number of a treating professional refer to article
Record treating professional details.
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DOCUMENT 6
Check eligibility – age and residence
requirements
SGP KP Publishing
Exported on 2024-10-09 08:10:58
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SGP KP Publishing – Check eligibility – age and residence requirements
Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Make a decision on age requirements ............................................................................... 6
4
Make a decision on residence requirements .................................................................... 7
Table of Contents – 2
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This article provides guidance for an access delegate, local area coordinator, early childhood
partner and review officer to understand how to:
make a decision on age requirements
make a decision on residence requirements.
Recent updates – 3
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1 Recent updates
3 October 2024
Article title changed from Check evidence for a decision – Age and residence requirements to
Check eligibility – age and residence requirements.
Recent updates – 4
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2 Before you start
You have read and understood Our Guideline – Applying to the NDIS (external).
Before you start – 5
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3 Make a decision on age requirements
When assessing an application for a person to become a participant of the NDIS, you must first
assess they meet the age requirements.
To learn more, refer to Do you meet the age requirements? (external) In Our Guideline –
Applying to the NDIS.
Make a decision on age requirements – 6
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4 Make a decision on residence requirements
The next step when assessing an application for a person to become a participant of the NDIS,
you must assess they meet the residence requirements.
To verify a person's residence details, if Centrelink consent has been given check the person's
Centrelink record to confirm residence status. If consent has not been given, review the
residence documentation provided to support the person's application.
To learn more, refer to Do you meet the residence requirements? (external) in Our Guideline –
Applying the NDIS.
To learn more regarding evidence of age and residence, see article Understand age and
residence evidence.
Make a decision on residence requirements – 7
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DOCUMENT 7
Check eligibility - DIS – disability
caused by an impairment
SGP KP Publishing
Exported on 2024-10-09 08:13:35
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Evidence an impairment is caused by a disability ........................................................... 6
3.1
How to find evidence a disability is related to an impairment ............................................. 6
3.2
What to consider when making an eligibility decision ........................................................ 6
4
Next steps ............................................................................................................................. 7
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to understand:
how to find evidence showing disability is related to an impairment
what to consider when making an eligibility decision for this requirement.
Recent updates – 3
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1 Recent updates
3 October 2024
Article title changed from Check evidence for a decision – disability caused by
impairment to Check eligibility – DIS – disability caused by an impairment
When we say DIS in a title, we mean disability requirements. We've added this to help
you quickly identity which articles are for disability or early intervention requirements.
Recent updates – 4
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2 Before you start
You have read:
and understood Our Guideline – Applying to the NDIS (external) section Do you meet
the disability requirements?
article Understand disability requirements
article What evidence of disability is required?
Before you start – 5
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3 Evidence an impairment is caused by a disability
3.1 How to find evidence a disability is related to an
impairment
You need to review all available information about the person's impairment and disability before
making a decision. To do this, check their application and evidence in PACE.
3.2 What to consider when making an eligibility decision
To make an eligibility decision about this disability requirement, consider:
the person's impairment
their disability
our legislation and guidance
if we have enough evidence to decide or need more.
The disability requirements are just one of the eligibility requirements. To be eligible for the
NDIS, the applicant must also meet the age and residence requirements. Go to article Check
eligibility – Age and residence requirements.
Evidence an impairment is caused by a disability – 6
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4 Next steps
If you are an access delegate:
to determine eligibility, continue to follow guidance in article Make an access decision -
pre-legislation changes or article Make an access decision – post-legislation changes.
to check the timeframes to make a decision, follow guidance in article Check decision –
Legislative timeframes.
Next steps – 7
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DOCUMENT 8
Check eligibility – DIS – likely
permanence
SGP KP Publishing
Exported on 2024-10-09 08:16:44
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Evidence of likely permanence ........................................................................................... 6
3.1
Review evidence of likely permanence .............................................................................. 6
4
Next steps ............................................................................................................................. 7
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to review evidence of likely
permanence.
Recent updates – 3
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1 Recent updates
3 October 2024
Article title changed from Check evidence for a decision – Disability requirements –
Likely permanence to Check eligibility – DIS – likely permanence.
When we say DIS in a title, we mean disability requirements. We've added this to help
you quickly identity which articles are for disability or early intervention requirements.
Recent updates – 4
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2 Before you start
You have read:
and
understood
Our Guideline – Applying to the NDIS (external) section
Do you meet
the disability requirements?
article
Understand disability requirements
article
What evidence of disability is required?
Before you start – 5
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3 Evidence of likely permanence
3.1 Review evidence of likely permanence
You need evidence an applicant will have the impairment for their lifetime to be eligible for the
NDIS. To confirm their permanent impairment, we need evidence from their doctor or specialist.
The impairment may be episodic or vary in intensity. This means it will still be permanent due to
the overall impact on their life and likelihood they'll be impacted across their lifetime.
Even when their condition or diagnosis is permanent, we'll also check if the impairment is
permanent as well. For example, they may not be eligible if the impairment is temporary, still
being treated or if there are known, available and appropriate evidence-based clinical, medical
or other remaining treatments options that are likely to remedy the impairment.
We'll generally consider if their impairment is likely to be permanent, after all available and
appropriate treatment options have been pursued.
If an applicant gives us evidence they're diagnosed with a List B (external) condition, we'll
usually decide if their disability from an impairment is likely to be permanent.
For more information, go to section
Is your impairment likely to be permanent? In Our
Guideline – Applying to the NDIS (external).
The disability requirements are just one of the eligibility requirements. To be eligible for the
NDIS, the applicant must also meet age and residence requirements. Go to article Check
eligibility – Age and residence requirements.
Evidence of likely permanence – 6
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4 Next steps
If you are an access delegate:
to determine eligibility, continue to follow guidance in article Make an access decision -
pre-legislation changes or article Make an access decision – post-legislation changes.
to check the timeframes to make a decision, follow guidance in article Check decision –
Legislative timeframes.
Next steps – 7
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DOCUMENT 9
Check eligibility – DIS – NDIS
supports for life
SGP KP Publishing
Exported on 2024-10-09 08:19:10
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Review evidence .................................................................................................................. 6
4
Next steps ............................................................................................................................. 7
Table of Contents – 2
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This article provides guidance for an access delegate to review evidence to check if a person is
likely to need NDIS supports for their lifetime.
Recent updates – 3
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1 Recent updates
3 October 2024 Updates to reflect legislation changes from 3 October 2024.
Article title changed from Determine lifetime support eligibility to Check eligibility - DIS – NDIS
supports for life.
When we say DIS in a title, we mean disability requirements. We've added this to help you
quickly identity which articles are for disability or early intervention requirements.
Recent updates – 4
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2 Before you start
You have read and understood:
article
Understand disability requirements
article
Understand early intervention requirements
Our Guideline - Applying to the NDIS (external) section
Will you likely need NDIS
support for your lifetime?
Before you start – 5
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3 Review evidence
To be eligible for the NDIS, a person must likely need NDIS supports for their lifetime. To
approve their application, you need to see evidence showing this. NDIS supports are the
services, items and equipment that can be funded by the NDIS. NDIS supports are investments
that help a participant build or maintain their functional capacity and independence, and help
them work, study or take part in social life.
When we decide if an applicant will likely need NDIS supports for their lifetime, we consider:
their life circumstances
the nature of their long-term support needs
whether their needs could be best met by the NDIS, or by other government and
community services.
When you're deciding if a person is eligible, you need to review:
how old the evidence is
who provided the evidence.
If a person provides more than one piece of evidence, you may need to consider one as more
relevant than others. We call this weighing evidence.
For further information:
read
Our Guideline - Applying to the NDIS (external) section,
How we weigh evidence
of disability?
refer to article What evidence of disability is required?.
Review evidence – 6
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4 Next steps
To consider the other disability requirements, go to article Understand disability requirements.
If you are an access delegate:
to make an access decision, continue to article Make an access decision – pre-
legislation changes or Make an access decision – post legislation changes.
to make an eligibility reassessment decision, continue to article Finalise eligibility
reassessment decision.
Next steps – 7
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DOCUMENT 10
Check eligibility – DIS – significant
functional impact
SGP KP Publishing
Exported on 2024-10-09 08:21:12
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Evidence of significant functional impact ......................................................................... 6
3.1
Review evidence of the impairment that substantially reduces functional capacity ........... 6
4
Next steps ............................................................................................................................. 7
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to review evidence of the
impairment that substantially reduces functional capacity
Recent updates – 3
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1 Recent updates
3 October 2024
Article title changed from article - Check evidence for a decision - Significant functional
impact to Check eligibility – DIS – significant functional impact.
When we say DIS in a title, we mean disability requirements. We've added this to help
you quickly identity which articles are for disability or early intervention requirements.
Recent updates – 4
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2 Before you start
You have:
read
Our Guideline – Applying to the NDIS (external) including the section
Does your
impairment substantially reduce your functional capacity?
read
articles
Understand disability requirements, What evidence of disability is
required? and Make an access decision.
Before you start – 5
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3 Evidence of significant functional impact
3.1 Review evidence of the impairment that substantially
reduces functional capacity
We need to learn about the person's impairment before we can make a decision about their
eligibility.
To do this you need to check their application and evidence in PACE.
You need evidence the person's impairment substantially reduces their functional capacity in
one or more of the following areas:
communication
social
interaction
learning
mobility
self-care
self-management (if older than 6).
A person's needs might vary from time to time. This means they may go up and down each day
or each month. A good example of this can be progressive multiple sclerosis. We consider a
person's ability over time and take into account how their ability fluctuates.
When a person's impairment substantially reduces their functional capacity, they usually need
disability-specific supports to join in or do these tasks and activities.
These disability-specific supports include:
support from other people, such as physical assistance, guidance, supervision or
prompting.
assistive technology, equipment or home modifications prescribed by the person's
doctor, allied health professional or other medical professional.
To decide if a person is eligible, you need to determine their capacity and where they need
more help. To decide if a support is reasonable and necessary, you need to consider what
information you have available to identify if the person meets the NDIS funding criteria
(external).
If a person has more than one permanent impairment, you will need to consider them together
to see if their functional capacity is reduced substantially.
You need to consider:
the person's involvement in different areas of life, like at home, school, work and in the
community
how they carry out tasks and activities
any other factors impacting their everyday life.
The disability requirements are just one of the eligibility requirements. To be eligible for the
NDIS, the applicant must also meet the age and residence requirements. Go to article Check
eligibility – Age and residence requirements.
Evidence of significant functional impact – 6
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4 Next steps
If you are an access delegate:
to determine eligibility, continue to follow guidance in article Make an access decision -
pre-legislation changes or article Make an access decision – post-legislation changes.
to check the timeframes to make a decision, follow guidance in article Check decision –
Legislative timeframes.
Next steps – 7
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DOCUMENT 11
Check eligibility – DIS – social and
economic impact
SGP KP Publishing
Exported on 2024-10-09 08:23:45
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Understanding evidence of social and economic impact of an impairment for
disability requirements ............................................................................................................... 6
3.1
What is evidence of a social and economic impact? .......................................................... 6
4
When you need to ask for technical advice ...................................................................... 7
5
Next steps ............................................................................................................................. 8
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to:
understand what evidence of social and economic impact is
know when to ask for technical advice.
Recent updates – 3
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1 Recent updates
3 October 2024
Article title changed from Check evidence for a decision – Disability requirements –
social and economic impact to Check eligibility – DIS – social and economic impact
When we say DIS in a title, we mean disability requirements. We've added this to help
you quickly identity which articles are for disability or early intervention requirements.
Recent updates – 4
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2 Before you start
You have:
read
Our Guideline – Applying to the NDIS (external) including sections
Does your
impairment affect your social, work or study life? and
Do you meet the disability
requirements?
read
articles
Understand disability requirements and What evidence of disability is
required?
Before you start – 5
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3 Understanding evidence of social and economic
impact of an impairment for disability requirements
3.1 What is evidence of a social and economic impact?
We need evidence of how an impairment affects a person's ability to work, study or take part in
social life.
This means evidence of the impact on how the applicant can find and keep a job, contribute to
the community, or join social activities because of their permanent impairment.
For children with evidence of social or economic impact or both, go to article Understand early
intervention requirements.
Understanding evidence of social and economic impact of an impairment for disability requirements – 6
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4 When you need to ask for technical advice
You
must request advice from the Technical Advice and Practice Improvement Branch (TAPIB)
if you are considering an access met decision for a person with a chronic health condition. Go to
article Create a technical advice case.
To learn more, read Requesting TAPIB Advice on the NDIA Intranet.
The disability requirements are just one of the eligibility requirements. To be eligible for the
NDIS, the applicant must also meet the age and residency requirements. Go to article Check
eligibility – Age and residence requirements.
When you need to ask for technical advice – 7
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5 Next steps
If you are an access delegate:
to determine eligibility, continue to follow guidance in article Make an access decision -
pre-legislation changes or article Make an access decision – post-legislation changes.
to check the timeframes to make a decision, follow guidance in article Check decision –
Legislative timeframes.
Next steps – 8
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DOCUMENT 12
Check eligibility - EI - Developmental
delay
SGP KP Publishing
Exported on 2024-10-09 08:25:43
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
How to find developmental delay evidence ....................................................................... 6
3.1
How to find developmental delay evidence ........................................................................ 6
3.2
What to consider when checking eligibility ......................................................................... 6
4
Next steps ............................................................................................................................. 7
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to understand how to find
developmental delay evidence.
Recent updates – 3
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1 Recent updates
3 October 2024
Updates to reflect legislation changes from 3 October 2024.
Article title changed from Check evidence for a decision – developmental delay to
Check eligibility – EI – Developmental delay.
When we say EI in titles we mean early intervention requirements. We've added this to
help you identify articles about early intervention or disability requirements.
Recent updates – 4
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2 Before you start
You have read and understood:
Our Guideline - Applying to the NDIS (external),
what about children younger than 6
with developmental delay?
Our Guideline - Early childhood approach (external)
article
Understand early intervention requirements
article
Check eligibility – age and residence
Before you start – 5
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3 How to find developmental delay evidence
3.1 How to find developmental delay evidence
You need to review all available information about the child's impairment and developmental
delay before you make an access decision. To do this, check their application and linked
evidence in PACE. To find linked evidence in PACE select the
Documents tab. This will
provide a list of the documents that have been linked as evidence. For example, the completed
Form – Evidence of development delay.
3.2 What to consider when checking eligibility
When you review evidence to check if the child is eligible under this
early intervention requirement, consider:
the child is younger than 6
the child's impairment
the child's developmental delay
the recommended early intervention supports
if the early intervention supports recommended are NDIS support
recommendation have been made by the right early childhood professional
our legislation and guidance
if we have enough evidence to decide or need more.
How to find developmental delay evidence – 6
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4 Next steps
To consider the other early intervention requirements, go to article Understand early
intervention requirements.
If you are an access delegate:
to make an access decision, continue to either article Make an access decision – pre-
legislation changes or Make an access decision – post legislation changes.
to make an eligibility reassessment decision, continue to article Finalise eligibility
reassessment decision.
Next steps – 7
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DOCUMENT 13
Check eligibility - EI - hearing loss 0-
25 years of age
SGP KP Publishing
Exported on 2024-10-09 08:27:26
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Check evidence .................................................................................................................... 6
4
Consider eligibility for hearing loss ................................................................................... 7
5
Priority eligibility decision – child younger than 7 ........................................................... 8
6
Next steps ............................................................................................................................. 9
Table of Contents – 2
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This article provides guidance for an access delegate and review officer to:
check for an eligible hearing impairment for a person aged between 0 and 25
consider NDIS eligibility under early intervention requirements
make a priority eligibility decision for children younger than 7.
Recent updates – 3
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1 Recent updates
3 October 2024 Article title changed from Check evidence for a decision - Hearing Loss 0-25 years of age to
Check eligibility – EI - hearing loss 0-25 years of age.
Recent updates – 4
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2 Before you start
You have
read and understood Our Guideline - Applying to the NDIS (external) including sections:
Do you need early intervention?What about people aged between 0 and 25 with a
hearing impairment?
read
article
Understand early intervention requirements
followed guidance in article Make an access decision.
Before you start – 5
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3 Check evidence
1. From
Access Decision case, select
Decision tab to view
Dashboard.
2. At
Key Information, check
Age to confirm the person is 25 or younger.
3. Scroll
to
Disability Evidence.
4. Select
View link to open auditory, neuropathy or hearing loss evidence, which must:
o be from a specialist audiological assessment
o be a hearing loss at least 25 decibels in either ear at 2 or more adjacent
frequencies
o show the hearing loss is likely to be permanent.
5. Review their hearing loss level with the current eligible standards for early intervention.
If required, request further information.
Check evidence – 6
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4 Consider eligibility for hearing loss
A person aged 0 to 25 with an eligible hearing impairment will meet early intervention
requirements.
Consider eligibility for hearing loss – 7
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5 Priority eligibility decision – child younger than 7
If a child younger than 7 is identified by Hearing Australia or an Early Childhood Partner as
newly diagnosed with a hearing impairment, a priority eligibility decision must be made within 2
business days once the evidence has been validated.
For more information about action to take in this circumstance refer to article Consider priority
eligibility decision.
Priority eligibility decision – child younger than 7 – 8
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6 Next steps
To determine eligibility, continue to follow guidance in article Make an access decision -
pre-legislation changes or article Make an access decision – post-legislation changes.
The sub-criterion decisions will be made based on these evidence selections.
For a person aged 26 or older with hearing loss, they may be eligible under disability or
early intervention requirements. For further information read Our Guideline - Applying to
the NDIS (external).
Next steps – 9
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Check eligibility – EI – Impairment is
likely permanent
SGP KP Publishing
Exported on 2024-10-09 08:29:21
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Evidence the impairment is likely to be permanent ......................................................... 6
3.1
Review evidence of a permanent impairment .................................................................... 6
4
Next steps ............................................................................................................................. 7
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to:
review evidence of a permanent impairment
use this information to support the person to understand the eligibility requirements.
Recent updates – 3
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1 Recent updates
3 October 2024
Article title changed from (EI) Check evidence for a decision – Impairment is likely to be
permanent to Check eligibility – EI – Impairment is likely permanent.
When we say EI in a title, we mean early intervention requirements. We've added this to
help you identity which articles are for disability or early intervention requirements.
Recent updates – 4
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2 Before you start
You have:
read and understood Our Guideline – Applying to the NDIS (external) section
How will
early intervention benefit you?
read
article
Understand early intervention requirements.
Before you start – 5
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3 Evidence the impairment is likely to be permanent
3.1 Review evidence of a permanent impairment
Review the available evidence to consider if the person has one or more impairments that is
permanent or is likely to be permanent.
You will need to review the available evidence that says they are likely to have the impairment
for their lifetime.
They might have some periods in their life where there is a smaller impact on their daily life,
because their impairment may be episodic or fluctuate in intensity. Their impairment can still be
permanent due to the overall impact on their life, and the likelihood that they will be impacted
across their lifetime.
Even when their condition or diagnosis is permanent, you need to check if the impairment is
permanent too. For example, a person may not be eligible if their impairment is temporary, still
being treated, or if there are known, available and appropriate evidence-based clinical, medical
or other remaining treatments options that are likely to remedy the impairment.
Generally, you'll consider whether an impairment is likely to be permanent after all available and
appropriate treatment options have been pursued.
For more information, go to section
Do you have an impairment that's likely to be
permanent? in Our Guideline – Applying to the NDIS (external).
Early intervention requirements are just one of the eligibility requirements. To be eligible for the
NDIS under early intervention, the applicant must also meet the age and residence
requirements. Go to article Check eligibility – Age and residence requirements.
Evidence the impairment is likely to be permanent – 6
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4 Next steps
If you are an access delegate:
to determine eligibility, continue to follow guidance in article Make an access decision -
pre-legislation changes or article Make an access decision – post-legislation changes.
to check the timeframes to make a decision, follow guidance in article Check decision –
Legislative timeframes.
Next steps – 7
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DOCUMENT 15
Check eligibility – EI – likely to
improve or reduce deterioration of
functional capacity or strengthen
informal supports
SGP KP Publishing
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or strengthen informal supports
Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Review evidence of functional capacity or informal supports ........................................ 6
4
Next steps ............................................................................................................................. 7
Table of Contents – 2
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or strengthen informal supports
This article provides guidance for all NDIA staff and partners to understand how to:
review evidence of functional capacity or informal supports
use this information to support the person to understand the eligibility requirements.
Recent updates – 3
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or strengthen informal supports
1 Recent updates
3 October 2024
Article title changed from '(EI) Check evidence for a decision – Likely to improve or
reduce deterioration of functional capacity or strengthen informal supports' to 'Check
eligibility – EI – likely to improve or reduce deterioration of functional capacity or
strengthen informal supports'.
When we say EI in a title, we mean early intervention requirements. We've added this to
help you identity which articles are for disability or early intervention requirements.
Recent updates – 4
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or strengthen informal supports
2 Before you start
You have read:
and
understood
Our Guideline - Applying to the NDIS (external), section,
How will
early intervention help you?
article
Understand early intervention requirements.
Before you start – 5
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or strengthen informal supports
3 Review evidence of functional capacity or informal
supports
Review the available evidence to consider if early intervention supports are likely to help the
person with at least one of the following:
address the impact of their impairment on their ability to move around, communicate,
socialise, learn, look after themselves and organise their lives
prevent their functional capacity from getting worse
improve their functional capacity
support their informal supports, which includes building their skills to help them.
Before making an eligibility decision, you
must find out about the person's functional capacity
and informal supports. You do this by checking their application and evidence.
To make an eligibility decision about this early intervention requirement, you
must consider:
how early intervention will help the person
their functional capacity
their informal supports
our legislation and guidance
if we have enough evidence to decide or need more.
Early intervention requirements are just one of the eligibility requirements. To be eligible for the
NDIS under early intervention, the applicant must also meet the age and residence
requirements. Refer to Check eligibility – Age and residence requirements.
Review evidence of functional capacity or informal supports – 6
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or strengthen informal supports
4 Next steps
If you are an access delegate:
to determine eligibility, continue to follow guidance in article Make an access decision -
pre-legislation changes or article Make an access decision – post-legislation changes.
to check the timeframes to make a decision, follow guidance in article Check decision –
Legislative timeframes.
Next steps – 7
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DOCUMENT 16
Check eligibility – EI – likely to
reduce future support needs
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Review evidence to determine the likelihood that future supports may be reduced ... 6
4
Next steps ............................................................................................................................. 7
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to understand to understand how
to:
review evidence to determine the likelihood that future supports may be reduced
use this information to support the person to understand the eligibility requirements.
Recent updates – 3
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1 Recent updates
3 October 2024
Article title changed from '(EI) Check evidence for a decision – Likely to reduce future
support needs' to 'Check eligibility – EI – likely to reduce future support needs'.
When we say EI in a title, we mean early intervention requirements. We've added this to
help you identity which articles are for disability or early intervention requirements.
Recent updates – 4
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2 Before you start
You have:
read and understood Our Guideline – Applying to the NDIS (external) in section,
How
will early intervention help you?
read
article
Understand early intervention requirements.
evidence early intervention is likely to reduce future support needs
Before you start – 5
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3 Review evidence to determine the likelihood that
future supports may be reduced
Review the available evidence to consider if early intervention supports will mean the person is
likely to need less NDIS supports in the future.
To determine if early intervention will help reduce the person's need for future supports, you
need to look at:
how their impairment might change over time
how long they have had their impairment
if there's been a significant change to their impairment
if their needs are likely to change soon, such as if they are finishing school.
Early intervention requirements are just one of the eligibility requirements. To be eligible for the
NDIS under early intervention, the person must also meet the age and residence requirements.
Go to article Check eligibility – Age and residence requirements.
Review evidence to determine the likelihood that future supports may be reduced – 6
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4 Next steps
If you are an access delegate:
to determine eligibility, continue to follow guidance in article Make an access decision -
pre-legislation changes or article Make an access decision – post-legislation changes
to check the timeframes to make a decision, follow guidance in article Check decision –
Legislative timeframes
.
Next steps – 7
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DOCUMENT 17
Check eligibility - EI - Supports will
be NDIS supports
SGP KP Publishing
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Review evidence .................................................................................................................. 6
4
Next steps ............................................................................................................................. 7
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to review evidence to check if early
intervention supports that are likely to benefit the person will be NDIS supports.
Recent updates – 3
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1 Recent updates
3 October 2024
Updates to reflect legislation changes from 3 October 2024.
Article title changed from (EI) check evidence for a decision – Support most
appropriately funded by NDIS to Check eligibility - EI – Supports will be NDIS supports.
When we say EI in a title, we mean early intervention requirements. We've added this to
help you identity which articles are for disability or early intervention requirements.
Recent updates – 4
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2 Before you start
You have read and understood:
Our Guideline - Applying to the NDIS (external) section,
Will the support you need be
NDIS supports?
Article
Understand early intervention requirements
.
Before you start – 5
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3 Review evidence
To decide if early intervention supports that will benefit the person will be NDIS supports, you
must consider:
the recommended early intervention supports
if an appropriate treating professional has made the recommendation
what is provided by mainstream and community supports
if the supports are the services, items and equipment that are NDIS supports
our legislation and guidance
if we have enough evidence to decide or need more.
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4 Next steps
To consider the other early intervention requirements, go to article Understand early
intervention requirements.
If you are an access delegate:
to make an access decision, continue to article Make an access decision – pre-
legislation changes or Make an access decision – post legislation changes.
to make an eligibility reassessment decision, continue to article Finalise eligibility
reassessment decision.
Next steps – 7
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DOCUMENT 18
Check eligibility - List A condition
SGP KP Publishing
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Overview ............................................................................................................................... 6
4
Check for a List A condition ............................................................................................... 7
4.1
How to find evidence of a List A Condition? ....................................................................... 7
4.2
If the person has a List A condition .................................................................................... 7
4.3
If the person doesn't have a List A condition ...................................................................... 7
5
Next steps ............................................................................................................................. 8
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to check for a List A condition.
Recent updates – 3
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1 Recent updates
3 October 2024 Updates made to improve the knowledge article and merge information from the archived article
Evidence Guide – List A conditions.
Article name changed from 'Check evidence for a decision – List A condition' to 'Check eligibility
– List A condition.'
Recent updates – 4
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2 Before you start
You have:
read
Our Guideline – Applying to the NDIS (external)
read
article
Understand disability requirements
read
article
Understand early intervention requirements
considered the age and residence requirements using article Check eligibility – Age and
residence requirements
.
Before you start – 5
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3 Overview
To be eligible for the NDIS, the person must meet the requirements for:
age
residence
disability, early intervention, or both.
When a person gives us evidence that they've been diagnosed with one or more conditions on
List A: Conditions that are likely to meet the disability requirements (external) they'll likely meet
the
disability requirements.
Overview – 6
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4 Check for a List A condition
4.1 How to find evidence of a List A Condition?
A person may inform us that they have a
List A condition, or we might identify it when reviewing
their disability evidence.
Before making an eligibility decision, make sure you review the application and any provided
disability evidence for any diagnosed List A: Conditions that are likely to meet the disability
requirements (external).
4.2 If the person has a List A condition
If there's evidence of a List A condition, the disability requirements are met.
You also need to think about the early intervention requirements. Go to article Understand early
intervention requirements.
4.3 If the person doesn't have a List A condition
If the person
doesn't have a List A condition, think about all the disability and early intervention
requirements using articles:
Understand disability requirements
Understand early intervention requirements.
Check for a List A condition – 7
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5 Next steps
If you're an access delegate:
to make an access decision, continue to article Make an access decision – pre-
legislation changes or Make an access decision – post legislation changes.
to make an eligibility reassessment decision, continue to article Finalise eligibility
reassessment decision.
Next steps – 8
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Check eligibility - List B condition
SGP KP Publishing
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Overview ............................................................................................................................... 6
4
Check for a List B condition ............................................................................................... 7
4.1
How to find evidence that a person has a List B condition? ............................................... 7
4.2
If the person has a List B condition .................................................................................... 7
4.3
If the person doesn't have a List B condition ...................................................................... 7
5
Next steps ............................................................................................................................. 8
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to check for a List B condition.
Recent updates – 3
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1 Recent updates
3 October 2024
Updates made to improve the knowledge article and merge information from the archived article
Evidence Guide – List B conditions.
Article name changed from Check evidence for a decision – List B condition to Check eligibility
– List B condition.
Recent updates – 4
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2 Before you start
You have:
read
Our Guideline – Applying to the NDIS (external)
read
article
Understand disability requirements
read
article
Understand early intervention requirements
considered the age and residence requirements using article Check eligibility – Age and
residence requirements.
Before you start – 5
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3 Overview
To be eligible for the NDIS, the person must meet the requirements for:
age
residence
disability, early intervention, or both.
When a person gives us evidence that they've been diagnosed with one or more conditions on
List B: Conditions that are likely to result in a permanent impairment (external), they'll meet
some of the
disability requirements and
early intervention requirements.
Overview – 6
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4 Check for a List B condition
4.1 How to find evidence that a person has a List B condition?
A person may inform us that they have a
List B condition, or we might identify it when reviewing
their disability evidence.
Before making an eligibility decision, make sure you review the application and any disability
evidence for any diagnosed List B: Conditions that are likely to result in a permanent impairment
(external).
4.2 If the person has a List B condition
If the person has evidence of a list B condition,
only some of the disability and early
intervention requirements are met.
The following disability requirements are met:
the person has a disability that us caused by one or more impairments (s24(1)(a)).
the person's impairment or impairments are likely to be permanent (s24(1)(c)).
The following early intervention requirement is met:
the person has one or more impairments that are likely to be permanent (s24(1)(a)).
You'll need to then think about the remaining disability and early intervention requirements
using articles:
Understand disability requirements.
Understand early intervention requirements.
4.3 If the person doesn't have a List B condition
If the person
doesn't have a List B condition, think about all of the disability and early
intervention requirements using articles:
Understand disability requirements
Understand early intervention requirements.
Check for a List B condition – 7
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5 Next steps
If you're an access delegate:
to make an access decision, continue to article Make an access decision – pre-
legislation changes or Make an access decision – post legislation changes.
to make an eligibility reassessment decision, continue to article Finalise eligibility
reassessment decision.
Next steps – 8
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DOCUMENT 20
Check eligibility - List D condition
SGP KP Publishing
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Overview ............................................................................................................................... 6
4
Check for a List D condition ............................................................................................... 7
4.1
How to find evidence if a child younger than 7 has a List D condition? ............................. 7
4.2
If the person has a List D condition .................................................................................... 7
4.3
If the person doesn't have a List D condition ..................................................................... 7
5
Next steps ............................................................................................................................. 8
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to check for a List D condition
(children younger than 7 only).
Recent updates – 3
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1 Recent updates
3 October 2024 Updates made to improve the knowledge article and merge information from the archived article
Evidence Guide – List D conditions.
Article name changed from Check evidence for a decision – List D condition to Check eligibility
– List D condition.
Recent updates – 4
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2 Before you start
You have:
read
Our Guideline – Applying to the NDIS (external)
read
article
Understand disability requirements
read
article
Understand early intervention requirements
considered the age and residence requirements using article Check eligibility – age and
residence requirements
.
Before you start – 5
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3 Overview
To be eligible for the NDIS, the person must meet the requirements for:
age
residence
disability, early intervention, or both.
When a family or carer gives us evidence that a child younger than 7 has been diagnosed with
one or more conditions on List D (external), they will meet the
early intervention requirements.
Overview – 6
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4 Check for a List D condition
4.1 How to find evidence if a child younger than 7 has a List D
condition?
A family or carer may inform us that a child younger than age 7 has a
List D condition or we
might identify it when reviewing their disability evidence.
Before making an eligibility decision, make sure you review the application and any provided
disability evidence for any diagnosed List D conditions (external).
4.2 If the person has a List D condition
If there is evidence of a list D condition, the early intervention requirements are met.
You also need to consider the disability requirements. Go to article Understand disability
requirements.
4.3 If the person doesn't have a List D condition
If the person is
not a child younger than 7 with a List D condition, consider all of the disability
requirements and early intervention requirements using articles:
Understand disability requirements.
Understand early intervention requirements.
Check for a List D condition – 7
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5 Next steps
If you are an access delegate:
to make an access decision, continue to article Make an access decision – pre-
legislation changes or Make an access decision – post legislation changes.
to make an eligibility reassessment decision, continue to article Finalise eligibility
reassessment decision.
Next steps – 8
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DOCUMENT 21
Check eligibility – Terminal illness
SGP KP Publishing
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Priority access pathway for people with terminal illness ................................................ 6
4
Identify if the applicant may have a terminal illness ........................................................ 7
5
Check for evidence the applicant needs palliative care supports .................................. 8
6
Make an eligibility decision for an applicant with a terminal illness .............................. 9
7
Next steps ........................................................................................................................... 10
Table of Contents – 2
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This article provides guidance for an access delegate and review officer to:
understand the priority access pathway for people with terminal illness
identify if the applicant may have a terminal illness
check for evidence the applicant needs palliative care supports
make an eligibility decision for an applicant with a terminal illness.
Recent updates – 3
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1 Recent updates
3 October 2024
Article title changed from Check evidence for a decision – terminal illness to Check eligibility –
Terminal illness
Recent updates – 4
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2 Before you start
You have read and understood:
Our Guideline – Applying to the NDIS (external) including section
Will you likely need
NDIS supports for your lifetime?
Our Guideline – Mainstream and community support (external)
article
Understand palliative care
article
Understand disability requirements
article
Make an access decision - pre-legislation changes or article Make an access
decision – post-legislation changes
article
Guide – Conversation style guide and appendix B in sections
Sensitive
conversations and
Explaining your access or planning decisions.
You have reviewed:
any evidence of informal, mainstream or community palliative care supports.
Before you start – 5
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3 Priority access pathway for people with terminal
illness
NDIS applications from people with terminal illness are submitted through the priority access
pathway. For more information, read article Request priority eligibility decision.
The Priority Health Access Team will make the eligibility decision within 5 days.
If an access met decision is made, the new participant will be streamed to the Aged Care and
Hospital Interface branch if they have palliative support care needs. The Aged Care and
Hospital Interface branch will develop the participant's plan within 30 days.
Priority access pathway for people with terminal illness – 6
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4 Identify if the applicant may have a terminal illness
In a person's NDIS application, their primary disability may indicate there is an underlying health
condition which may reduce their quality or expected length of life. For example, if their disability
is described as an acquired brain injury.
The person may also specify that they have a terminal illness. Terminal illnesses may include
many different types of cancers, chronic obstructive pulmonary disease (COPD), or end-stage
kidney or liver diseases.
Other illnesses may also be terminal but have a relatively long life expectancy. Conditions
including Huntington's Disease, Parkinson's Disease and dementias may be terminal, but
applicants with these conditions may not require palliative care supports at the time of their
access application.
Note: These conditions do not automatically mean the applicant is suitable for the priority
planning pathway.
Information in an NDIS application may indicate the person has a terminal illness and may need
palliative care supports funded by the health system. This information might include:
a prognosis category, such as 'guarded' or 'poor'
time-framed prognosis, for example 3 to 18 months to live
terminal or end-stage illness
staged health condition, for example stage 3, 4 or 5
no longer suitable for active treatment – treatment is for symptom management
reference to pain management related to comfort
references to past treatments, for example chemotherapy, immunotherapy,
radiotherapy
organ failure, for example lung, heart, liver, or kidney
high levels of nursing support
specialist or community palliative care team involvement.
Identify if the applicant may have a terminal illness – 7
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5 Check for evidence the applicant needs palliative
care supports
Before making an eligibility decision for a disability caused by a terminal illness, you must make
sure the applicant meets the age and residence requirements. Learn more in article Make an
access decision - pre-legislation changes or article Make an access decision – post-legislation
changes.
You then need to understand any evidence of palliative care support needs.
Information about current treatments, goals of care, and stage of illness can help you
understand the applicant's support needs. A suitably qualified treating health professional must
provide this evidence.
Evidence may include information about:
current and future treatments designed to make people comfortable or slow disease
progression rather than make them better
anticipated outcomes of the treatments
evidence of the stage of disease progression
level of care and clinical supports required
current and future goals of care.
You may need to request further information from a treating health professional.
Talking about dying and terminal illness can be hard. But it's important to talk about it so people
can be prepared.
To help you prepare to talk with an applicant with a terminal illness, go to article Navigate
conversations about life-limiting conditions.
Check for evidence the applicant needs palliative care supports – 8
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6 Make an eligibility decision for an applicant with a
terminal illness
A specialised access team, called the Priority Health Access Team, makes decisions about
access eligibility for people with terminal illness and disability.
If you identify an applicant may have a terminal illness, you must request advice from the
Technical Advice and Practice Improvement Branch (TAPIB). This is regardless of the proposed
eligibility decision. To learn more, go to Requesting Advice or article Create a technical advice
case.
Before an eligibility decision is made, we'll need to understand the applicant's disability and its
impact on their life.
Information in the technical advice case helps TAPIB understand the applicant's situation.
This could include information about if the applicant:
is applying to the NDIS because of an identified terminal illness
is applying to the NDIS because of another reported impairment that's a direct result of
a terminal illness or treatment
has declining function because of the progression of a terminal illness
has palliative support needs, for example supports intended for quality-of-life purposes
rather than improving social and economic participation
requires a high level of skilled clinical support, for example palliative pain management
or specialist nursing care.
Note: The free-text field in the technical advice case has a limit of 255 characters. You can use
these as examples to provide a brief summary of the participant's situation. Follow the guidance
in article Create a technical advice case to complete the case and provide supporting
information.
Make an eligibility decision for an applicant with a terminal illness – 9
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7 Next steps
1. To determine eligibility after you have received advice from TAPIB, continue to follow
guidance in article Make an access decision - pre-legislation changes or article Make
an access decision – post-legislation changes.
2. If the participant is eligible for the priority pathway and an access met decision is made,
the participant will be streamed to the Aged Care and Hospital Interface branch. The
Aged Care and Hospital Interface branch will develop the participant's plan within 30
days.
Next steps – 10
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DOCUMENT 22
Understand early intervention
requirements
SGP KP Publishing
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Overview ............................................................................................................................... 6
4
Early intervention requirements ......................................................................................... 7
4.1
Check eligibility for early intervention requirements ........................................................... 7
4.2
Additional considerations .................................................................................................... 7
5
Next steps ............................................................................................................................. 8
Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to understand eligibility under the
early intervention requirements.
Recent updates – 3
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1 Recent updates
3 October 2024 Updates to reflect legislation changes from 3 October 2024:
applicants may now meet both disability and early intervention requirements, instead of
just one.
the requirements for early intervention have changed from early intervention you need
is most appropriately funded by the NDIS to Early intervention supports that are likely to
benefit you will be NDIS supports.
Recent updates – 4
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2 Before you start
You have:
read
Our Guideline – Applying to the NDIS (external) including section,
Do you need
early intervention?
read
article
What evidence of disability is required?
read
article
Check eligibility – age and residence requirements
Before you start – 5
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3 Overview
To be eligible for NDIS, the person must meet the requirements for:
age
residence
disability, early intervention, or both.
The purpose of early intervention is to lessen the impact of a person's impairment by providing
support at the earliest possible stage.
Early intervention support is intended to benefit a person by reducing their future need for
supports and by strengthening informal supports. For example, building the capacity of their
carer.
Early intervention is for both children and adults and may be required only for a short time.
A person may not need supports for life, so their treating professional or early childhood partner
will advise us how early intervention could benefit the person or child.
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4 Early intervention requirements
To meet the
early intervention requirements, we must have evidence of
all of the following:
they have an impairment that's likely to be permanent, or they're a child younger than 6
with developmental delay
early intervention supports are likely to reduce their future support needs
early intervention supports are likely to benefit them
the early intervention supports they need are NDIS supports.
4.1 Check eligibility for early intervention requirements
Use these articles to check evidence for a decision:
Check eligibility – EI – impairment is likely permanent.
Check eligibility – EI – likely to reduce future support needs.
Check eligibility – EI – likely to improve or reduce deterioration of functional capacity or
strengthen informal supports.
Check eligibility – EI – supports will be NDIS supports
.
4.2 Additional considerations
Use these articles before you check evidence for a decision:
if the child is younger than 7, check if there is evidence of a condition on List D. Go to
article Check eligibility – List D condition.
Note: A child is likely to meet the early intervention requirements if they provide
evidence of their diagnosis.
check if the person is diagnosed with a condition on List B, Go to article Check eligibility
– List B condition.
Note: A person is likely to meet
one of the early intervention requirements if they
provide evidence of their diagnosis.
if the child is younger than 6, check if they have a developmental delay. Go to article
Check eligibility – EI – developmental delay
if the person if aged between 0 and 25 with a hearing impairment, go to article Check
eligibility – EI – hearing loss 0-25 years of age.
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5 Next steps
To consider the disability requirements, go to article Understand disability requirements.
If you are an access delegate:
to make an access decision, continue to article Make an access decision – pre-
legislation changes or Make an access decision – post legislation changes.
to make an eligibility reassessment decision, continue to article Finalise eligibility
reassessment decision.
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Finalise eligibility reassessment
decision
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Complete a check for procedural fairness ........................................................................ 6
4
Finalise the eligibility reassessment decision .................................................................. 7
5
Complete a manual procedural fairness check ................................................................ 8
5.1
Check correspondence ....................................................................................................... 8
5.2
Check contact attempts ...................................................................................................... 8
5.3
Check for outstanding enquiries ......................................................................................... 8
5.4
Check evidence extension requests ................................................................................... 8
6
Complete the ER Outcome tab and contact participant to let them know the eligibility
reassessment decision ............................................................................................................. 10
7
Next steps for access met, disability change outcomes, or once the QDO approves a
revoke outcome ......................................................................................................................... 12
8
Next steps ........................................................................................................................... 13
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This article provides guidance for an access delegate to:
complete a check for procedural fairness
finalise the eligibility reassessment decision
complete a manual procedural fairness check
complete the eligibility reassessment (ER) outcome tab and contact participant to let
them know the eligibility reassessment decision
next steps for access met, disability change outcomes, or once the QDO approves a
revoke outcome.
Recent updates – 3
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1 Recent updates
3 October 2024 Guidance updates:
to reflect legislation changes effective from 3 October 2024
new section added Complete a manual procedural fairness check when the decision is
to revoke
additional detail added to Finalise the eligibility reassessment decision
removed section Create a reminder to revoke access on SAP CRM in 28 days, as this
is completed by a quality development officer.
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2 Before you start
You have:
read about eligibility in Our Guideline – Applying to the NDIS (external) and Our
Guideline – Leaving the NDIS (external)
checked if there is a request to voluntarily leave the NDIS. If so, close out the Eligibility
Reassessment case and create a Leaving the NDIS case. For more information see
article Understand the leaving case. Assign this to the My NDIS contact.
accepted
an
eligibility reassessment case
You have read articles:
When to refer the participant for an eligibility reassessment
Understand procedural fairness and eligibility reassessment requirements
Contact attempts and unable to contact in an eligibility reassessment case.
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3 Complete a check for procedural fairness
1. Go
to
ER Outcome tab.
2. Complete
the
Procedural Fairness Checklist.
Note: You can't commence the eligibility reassessment decision until the
Procedural
Fairness Checklist has been completed. For more information see article Accept a
case from the eligibility reassessment queue and complete the procedural fairness
check.
Note: If the eligibility reassessment outcome is to revoke access, the manual procedural
fairness check will also need to be completed. See section
Complete a manual procedural
fairness check.
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4 Finalise the eligibility reassessment decision
It is the participant's responsibility to provide evidence that they continue to meet the eligibility
requirements.
1. Review
the
Eligibility Check tab to understand the background of the eligibility
reassessment, including:
o why the previous access delegate progressed the eligibility reassessment case.
o the eligibility criteria we were checking the participant continues to meet.
2. If
the
Eligibility Check tab indicates the participant may not meet the:
o
residence requirements – assess the residence, disability and early
intervention criteria.
o
disability and early intervention requirements – assess the disability and
early intervention criteria.
Note: If the participant joined the NDIS under a NSW prescribed program, only
consider the disability and early intervention requirements. Do not consider the
residence requirements.
3. To finalise the eligibility reassessment decision, review all information and evidence on
the participant's
Person Account, relating to eligibility. If there isn't clear evidence the
person continues to meet all eligibility criteria, their eligibility needs to be reassessed.
4. Check for outstanding evidence related to the participant's eligibility including in the:
o
Enquiry inbox. Check and action any relevant emails
o eligibility reassessment case under
Evidence or
Documents tabs
o
Person Account under
Document or
My Profile then
Evidence tabs
o related enquiry case (if relevant)
o participant's
SAP CRM record
Inbound Documents (if relevant).
5. If the evidence isn't already in the eligibility reassessment case, you must link it to the
case. Use article Upload evidence to support an eligibility reassessment (ER) case
section
Upload evidence to support the eligibility reassessment case.
Note: You don't need to upload documents in
SAP CRM to
PACE.
6. There will be three possible outcomes for the eligibility reassessment. Use Our
Guideline – Applying to the NDIS (external) section
Appendices, to either:
o maintain the participant's status as eligible for the NDIS. Continue to section
Complete the ER Outcome tab and contact participant to let them know
the eligibility reassessment decision.
o change the eligibility criteria. Continue to section
Complete the ER Outcome
tab and contact participant to let them know the eligibility reassessment
decision.
o revoke the participant status. Continue to section
Complete a manual
procedural fairness check.
Note: you cannot revoke a participant due to a
lack of information or evidence if they have not been given reasonable
opportunity to respond.
Note: Decisions for participant's who are living with
terminal illness must only be
completed by delegates in the Priority Health Access team.
Note: If TAPIB advice is required, go to article Create a technical advice case.
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5 Complete a manual procedural fairness check
If the outcome is to revoke the participant status, you
must complete a manual procedural
fairness check. Start at section
Check correspondence. If you are not revoking the participant's status, go to section
Complete the ER Outcome tab
and contact participant to let them know the eligibility reassessment decision.
5.1 Check correspondence
Check the participant, their nominee or child representative was sent correspondence to notify
them about the eligibility reassessment.
1. Check whether the participant has a correspondence nominee or child representative.
Go to the participant's
Person Account. Select
Relationships, then
Authorised Reps.
Any child representative or nominee roles will appear here. For more information go to
article Check consent, nominee, child representative or self-representation authorities.
2. If the participant has a child representative or correspondence nominee, navigate to the
representatives
Person Account. Otherwise stay in the participant's
Person Account.
3. Select
Documents tab.
4. Review the eligibility reassessment correspondence sent to the participant. Check
either the
Letter - Eligibility Reassessment Evidence Request or
Letter – Eligibility
Reassessment opportunity to respond were sent. If a letter was not sent, notify your
team leader.
5. Open the correspondence and review whether the participant had at least 28 days from
the date of the letter to provide information.
5.2 Check contact attempts
1. Go to the
Eligibility Reassessment case.
2. Select
Case Activity tab. Select
Activity History.
3. Check the correct number of contact attempts were made to notify the participant of the
eligibility reassessment. See article Contact attempts and unable to contact in an
eligibility reassessment case.
4. If one or more phone call attempts have not been completed, discuss this with your
team leader.
5.3 Check for outstanding enquiries
Check if the participant has any outstanding eligibility reassessment enquiries.
1. Go
to
Person Account,
Cases tab.
2. Select
Cases, then
All Cases.
3. In
the
Case Record Type column, check for any open
Enquiry cases created after the
eligibility reassessment commenced.
4. Action any eligibility reassessment enquiries before proceeding.
5.4 Check evidence extension requests
Check if the participant has any outstanding evidence extension requests.
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1. Go
to
Person Account,
Cases tab.
2. Select
Cases, then
All Cases.
3. In
the
Case Record Type column, check for extension of time requests by reviewing
Enquiry and
Evidence Extension cases created after the eligibility reassessment
commenced.
Note: NCC may create enquiry cases for extension requests.
4. If there is an outstanding evidence extension request, continue to article Action
evidence extension request for eligibility reassessment case.
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6 Complete the ER Outcome tab and contact
participant to let them know the eligibility
reassessment decision
Make sure you're confident in your final decision and enter it accurately into the
ER Outcome tab.
Do not select
Back at any point, as this may prevent the case from progressing. If you need to
make changes to the decision after you have entered it into the
ER Outcome tab, contact your
team leader for support. They will check whether
Back can be selected, and if not, raise an ICT
ticket to resolve this.
1. Check the participant has a my NDIS contact assigned in PACE using article Update
the My NDIS Contact. A PACE task won't begin if there isn't a my NDIS contact
assigned, which means any updates won't be picked up until their next check-in.
2. Select
ER outcome tab and complete the steps.
3. At
Impairment assessment select the primary and secondary impairments.
4. At
Residence Section 23 Sub Criterion answer all questions.
Note: At
Is the applicant currently living in Australia? and
Is the applicant an
Australian citizen or a current eligible visa holder? Select
N/A when the participant
may not meet the residence requirements
and they joined under a NSW prescribed
program.
5. If the participant is 7 years or older complete
Disability Section 24 Sub Criterion. If
not, go to step 7. The questions will automatically generate from the answer to the
earlier question
Does the reassessment impairment belong to List A, B or D?
6. All eligibility criteria sections must be answered. If you select
No for any criteria, select
the correct justification from the dropdown options. If section 24(1)(b) is
not met, then
the remaining criteria will not be met.
Note: Due to NDIS Amendment (Getting the NDIS Back on Track No. 1) Bill 2024, section
25(3) and section 24(1)(e) will not be correctly reflected in PACE. You will still need to
select whether this requirement is met or not by selecting Yes or No in the System. You
will be advised later in this article to record an Internal Note explaining that you have
applied the correct legislation.
7. At
The participant is likely to require lifetime supports under the NDIS select
Yes
or
No.
Note: Due to NDIS Amendment (Getting the NDIS Back on Track No. 1) Bill 2024, section
24(1)(e) will not be correctly reflected in the System. You will still need to select whether
this requirement is met or not by selecting Yes or No in PACE. You will be advised later
in this article to record an Internal Note explaining that you have applied the correct
legislation.
8. If the participant is younger than 7 complete
Early Intervention Section 25 Sub
Criterion. All eligibility criteria sections must be answered. If you select
No for any
criteria, select the correct justification from the dropdown options. If section 25(1)(a) is
not met, then the remaining criteria will not be met.
Note: Due to NDIS Amendment (Getting the NDIS Back on Track No. 1) Bill 2024, section
25(3) will not be correctly reflected in PACE. You will still need to select whether this
requirement is met or not by selecting Yes or No in the System. You will be advised
later in this article to record an Internal Note explaining that you have applied the
correct legislation.
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9. At
The participant has one or more identified intellectual, cognitive, neurological,
sensory or physical impairments that are, or are likely to be permanent; or one or
more identified impairments that are attributable to a psychiatric condition that
are, or are likely to be, permanent select
Yes or
No.
Note: If you answer Yes, sub criteria 2, 3, sub criteria 4 will not appear.
10. Review the recorded
Sub Criterion and Overall Criteria Summary. Depending on
whether the outcome is maintain, change or revoke, additional pages will populate.
Note: If the decision is not correct, contact your team leader for support.
11. If you are updating the primary impairment, complete
Access Disability Change.
Updating the
Primary Impairment will update the person account automatically. The
existing primary impairment will become a secondary impairment in the person account.
If you need to update the secondary impairment, update this in the person account. See
article Update a person account. Select
Next.
12. If the outcome is to:
o
revoke, continue to step 13.
o
access met or
disability criteria change, continue to step 14.
13. Record the evidence used to make the revoke decision using article Log an activity or
internal note. Use the below template.
Template for evidence considered for revoke outcome
I have reviewed the following documents as part of the eligibility reassessment.
The following documents are available in the person's PACE record:
<Type of document> <from/with> <Title and person's name> <Profession or
relationship> dated
<date of document>. Evidence located in
<SAP CRM/SAP CRM
and PACE>.
14. Review the
Summary information. Select
Next.
Note: If the decision is to
revoke, then the
ER Outcome cannot be completed by the
delegate. When you select
Next at the
Summary screen, the case will route to the
ER
Revocation Queue for a quality development officer (QDO). The QDO will review the
case and either approve to revoke access or request an adjustment. The QDO will send
the case back to you to finalise the revocation process or adjust the decision.
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7 Next steps for access met, disability change
outcomes, or once the QDO approves a revoke
outcome
1. For
a
revoke outcome, if the QDO send an adjustment request, continue with article
Review the quality feedback (QDO). Otherwise continue to step 2.
2. In
the
ER Outcome tab, review the
Decision. Select
Next.
3. Review
the
Justification. If the justification is:
o not correct, contact your team leader for support.
o correct,
select
Next, then
Evidence.
4. Review
the
Evidence. Select
Next and complete the
ER Outcome.
5. Record an internal note using article Log an activity or internal note. Use the below
template:
Eligibility Reassessment legislative decision
The Eligibility Reassessment was valid for a decision on
<DD/MM/YYY>. The
<Eligibility
Check/ER Outcome> decision has been made under NDIS Amendment (Getting the
NDIS Back on Track No. 1) Bill 2024. Section 24(1)(e) and section 25(3) of the sub
criterion questions incorrectly reflect the NDIS Act 2013 legislation. All external
communication including letters and phone calls reflect the correct 2024 legislation.
6. Contact the participant to let them know the
Eligibility Reassessment Decision, and
send them a letter with the decision. Use article Contact the participant to explain the
outcome of their eligibility reassessment.
7. If the participant's status is:
o
maintained or changed, they will continue to be a NDIS participant. No further
action is required.
End of process.
o
revoked, they are no longer eligible for the NDIS. A
Leaving the NDIS case
will automatically be created and routed to the my NDIS contact to complete the
final checklist. The letter will inform the participant that this will take effect in 28
days. Continue to step 8.
8. Where the participant has an active record you
must check for a person record in
SAP
CRM and revoke access in
SAP CRM if there is. You can only complete this 28 days
after the decision is made as revoking access in SAP CRM will immediately cease
access to funded supports.
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8 Next steps
1. If the participant has been revoked, revoke access on SAP CRM after 28 days.
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Understand procedural fairness and
eligibility reassessment
requirements
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Table of Contents
1
Before you start .................................................................................................................... 4
2
Understand procedural fairness ......................................................................................... 5
3
What is procedural fairness? .............................................................................................. 6
4
What is the purpose of the procedural fairness checklist? ............................................. 7
5
What about manual procedural fairness checks? ............................................................ 8
6
Has the My NDIS contact been able to contact the participant? ..................................... 9
7
Review information and evidence .................................................................................... 10
8
Consider the eligibility requirements ............................................................................... 11
9
Consider residence requirements .................................................................................... 12
10
Consider early Intervention requirements ................................................................... 13
11
Consider disability requirements ................................................................................. 14
12
Consider the participant’s impairment ......................................................................... 15
13
Consider the assessment summary ............................................................................. 16
14
Next steps ....................................................................................................................... 17
Table of Contents – 2
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This article provides guidance for an
access assessor to:
understand procedural fairness
consider the eligibility requirements
consider the participant’s impairment
consider the assessment summary.
To complete the
Eligibility Check in PACE, you need to understand these requirements.
When we talk about contacting a participant, we mean the participant or their authorised
representative.
Before you start – 3
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1 Before you start
You have read:
Are you eligible for the NDIS? in Our Guideline – Applying to the NDIS
What happens if we check your eligibility? in Our Guideline – Leaving the NDIS.
You have been asked to:
draw down an eligibility reassessment referral
complete an eligibility check
decide if an eligibility reassessment should commence
decide if the participant needs an access status change.
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2 Understand procedural fairness
You will complete an
Eligibility Check in PACE. The Eligibility Check will help you decide if an
eligibility reassessment should commence. The
Procedural Fairness Checklist is the first part
of the check.
The procedural fairness check will automatically check who has progressed the case and
created the referral. If you approved the participants access, you must select Yes when
prompted and the case will be routed back to the eligibility reassessment queue.
Understand procedural fairness – 5
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3 What is procedural fairness?
Procedural fairness is about making sure we give participants a reasonable opportunity to have
their say and provide us with evidence about their situation. It is also about making sure our
decisions are fair and unbiased. When we say fair and unbiased, we mean our decisions are
made by someone who wouldn’t benefit from the decision or be impacted by it.
What is procedural fairness? – 6
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4 What is the purpose of the procedural fairness
checklist?
The checklist has questions to make sure you are an independent delegate. This is how we
make sure we our decisions are fair and unbiased.
You aren’t an independent delegate if you have:
a personal interest in the participant’s status, or
a personal relationship with the participant (outside the NDIA), or
been involved in making the original eligibility decision or any planning decisions.
What is the purpose of the procedural fairness checklist? – 7
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5 What about manual procedural fairness checks?
Procedural fairness is also about:
being transparent with the participant
giving them reasonable opportunity to provide information, and to present a case to
support their continued eligibility.
There are steps you will take to make sure we follow procedural fairness. That is what we mean
when we say manual procedural fairness checks.
What about manual procedural fairness checks? – 8
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6 Has the My NDIS contact been able to contact the
participant?
This is an important manual procedural fairness check. The My NDIS contact will record their
contact with the participant in PACE. You will check PACE. If the My NDIS contact is unable to
contact the participant, do not make an eligibility reassessment referral.
If the My NDIS contact made an eligibility reassessment referral without contacting the
participant:
do not commence an eligibility reassessment
close the eligibility reassessment case – read article
Action if ER not required to learn
more.
If the My NDIS contact was able to contact the participant, continue with the eligibility
reassessment. Do this even if
you are unable to contact them.
Has the My NDIS contact been able to contact the participant? – 9
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7 Review information and evidence
You will make sure we follow procedural fairness by thoroughly reviewing existing information
and evidence.
Some sources of existing information include:
conversations about the participant’s situation recorded in PACE
any relevant documents on the participant’s record
medical or clinical reports, diagnostic and assessment information
service provider reports and assessments such as progress reports
information provided with the participant’s access to the NDIS
early childhood partner documents
information from family members and carers.
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8 Consider the eligibility requirements
After you complete the
procedural fairness checklist, you will consider the eligibility
requirements to complete the
impairment assessment. PACE will pre-populate responses for
each eligibility requirement based on the:
Referral checklist
Impairment assessment.
This means some responses will already be pre-populated in PACE.
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9 Consider residence requirements
Read
Do you meet the residence requirements in Our Guidelines – Applying to the NDIS.
This will help you consider the residence requirements if you need to.
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10 Consider early Intervention requirements
Read
Do you need early intervention in Our Guidelines – Applying to the NDIS to learn more.
This will help you consider the early intervention requirements if you need to.
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11 Consider disability requirements
Read
Do you meet the disability requirements in Our Guidelines – Applying to the NDIS.
This will help you consider the disability requirements if you need to.
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12 Consider the participant’s impairment
An
impairment assessment is another part of the
eligibility check. The
impairment
assessment asks you to consider if the reassessment impairment belongs to List A, B or D.
You will use the
Appendices in Our Guidelines – Applying to the NDIS to consider if the
impairment belongs to List A, B or D.
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13 Consider the assessment summary
The last part of the
eligibility check is the
assessment summary. This part of the eligibility
check asks you to consider:
Has the participant’s primary impairment changed?
Have changes been made to the secondary impairments listed in the Participant’s
record?
You will answer
Yes or
No and
select the reassessed impairment, if needed. Your
responses will be based on your thorough review of the participant’s information and evidence.
PACE will pre-populate
Yes or
No for
primary disability change or
access status change.
The pre-populated response is based on the answers you entered about the participant’s
impairment and eligibility.
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14 Next steps
You will:
make a decision about the participant’s eligibility
use
the
eligibility check tab in PACE to record your decision making.
To learn more about using the
eligibility check tab in PACE read articles:
Draw down a referral and check procedural fairness for an ER case
Review and link participant evidence to the eligibility reassessment case.
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DOCUMENT 25
Make an access decision - post
legislation changes
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Check legislative timeframes .............................................................................................. 6
4
Complete disability evidence .............................................................................................. 7
5
Request further information ................................................................................................ 8
5.1
Check correspondence ....................................................................................................... 8
5.2
Notify the justice liaison officer (JLO) (if relevant) .............................................................. 9
5.2.1
Create the enquiry case ................................................................................................................ 9
5.2.2
Assign the enquiry case ................................................................................................................ 9
6
Approve or override the streaming case ......................................................................... 10
7
Record access decision .................................................................................................... 11
7.1
Age and Residency Sub Criterion .................................................................................... 11
7.1.1
Age Criterion 1: (Section 22(1)(a)) .............................................................................................. 11
7.1.2
Residency Criterion 1: (Section 23(1)(a)) .................................................................................... 11
7.1.3
Residency Criterion 2: (Section 23(1)(b)) .................................................................................... 11
7.2
Early Intervention Sub Criteria ......................................................................................... 12
7.2.1
Early Intervention Criterion 1: (Section 25(1)(a)) ......................................................................... 12
7.2.2
Early Intervention Criterion 2: (Section 25(1)(b)) ......................................................................... 12
7.2.3
Early Intervention Criterion 3: (Section 25(1)(c)) ......................................................................... 12
7.2.4
Early Intervention Criterion 4: (Section 25 (d)) ............................................................................ 12
7.3
Disability Sub Criterion ..................................................................................................... 13
7.3.1
Disability Criterion 1: (Section 24 (1)(a)) ..................................................................................... 13
7.3.2
Disability Criterion 2: (Section 24 (1)(b)) ..................................................................................... 13
7.3.3
Disability Criterion 3: (Section 24 (1)(c)) ..................................................................................... 13
7.3.4
Disability Criterion 4: (Section 24 (1)(d)) ..................................................................................... 13
7.3.5
Disability Criterion 5: (Section 24 (1)(e)) ..................................................................................... 13
7.4
Evidence Used for Decisions (access not met only) ........................................................ 13
7.5
Decision Main Criteria ...................................................................................................... 14
7.5.1
If access met for applicant with chronic health condition............................................................. 15
7.5.2
If access met and the applicant resides in hospital ..................................................................... 15
8
Submit decision for quality check .................................................................................... 16
8.1
Submit proposed decision for potential quality check ...................................................... 16
8.2
Review quality check feedback ........................................................................................ 16
8.3
Approve access decision .................................................................................................. 16
9
Complete access decision correspondence ................................................................... 17
9.1
Automated Access Met letter ........................................................................................... 17
9.1.1
Check correspondence ............................................................................................................... 17
9.2
Manual Access Not Met letter........................................................................................... 17
10
Notify early childhood partner of access not met decision (developmental delay
only) 18
11
Check disabilities tab (access met only) ..................................................................... 19
12
Assign plan approval case (Motor neurone disease only) ......................................... 20
13
Next steps ....................................................................................................................... 21
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This article provides guidance for an access delegate (assessor) to:
check legislative timeframes
complete disability evidence
request further information
approve or override the streaming case
record access decision
submit decision for quality check
complete access decision correspondence
notify early childhood partner of access not met decision (developmental delay only)
check disabilities tab (access met only)
assign plan approval case (Motor neurone disease only).
The legislation you need to use automatically populates in the access decision case based on
what is selected in the access request case.
Go to article Complete pre-assessment of access decision to decide which version of the
legislation and article you need to use to make an access decision.
Use this article if you need to use the
post-legislation changes version of the legislation to
make an access decision.
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1 Recent updates
3 October 2024 Updated guidance to:
reflect legislation changes from 3 October 2024
Update title from Make access decision to make it clear to use this article when making
a decision using the post-legislation changes version of the legislation.
Remove step to consider if the person is from a defined program as defined programs
no longer apply.
To be eligible under the disability requirements, there must be evidence the person
requires NDIS supports for their lifetime. NDIS supports are the services, items and
equipment that can be funded by the NDIS.
To be eligible under the early intervention requirements, there must be evidence that
supports that are likely to benefit the person will be NDIS supports.
If the age and residence requirements are met, you must consider both the disability
and early intervention requirements. The person may meet both, rather than only one or
the other.
If eligible, you must select the impairments that met the requirements for disability, early
intervention requirements or both. Impairments include intellectual, cognitive,
neurological, sensory, physical, or impairments to which a psychological disability is
attributable. Or you can select developmental delay, and you do not need to select
impairments.
New step to advise the justice liaison officer (JLO) when requesting more evidence (if
relevant)
New step to notify early childhood partner of access not met decision (developmental
delay only)
New step to assign plan the approval case (Motor neurone disease only).
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2 Before you start
You have:
completed the pre-assessment and checked you need to use the
post-legislation
changes version of the legislation to make an access decision using article Complete
pre-assessment for an access decision
checked there is evidence of identity or an internal note to explain why it can't be
provided
checked the application is complete with evidence of consent to apply, age, residence
and disability
read
article
Check eligibility – age and residence requirements
read
article
Understand disability requirements
read
article
Understand early intervention requirements.
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3 Check legislative timeframes
You have
21 days to make a decision or request further information.
When a request for further information has been made, you have
14 days from the date that the
last information or report was received to make a decision.
1. Use
article
Check decision – legislative timeframes to check if your decision or request
for further information will be outside legislative timeframes. If:
o inside legislative timeframes: go to section
Complete disability evidence.
o outside legislative timeframes: use article Check decision – legislative
timeframes to record an internal note. Then go to section
Complete disability
evidence.
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4 Complete disability evidence
Links to evidence documents in the access request case will display here.
1. At
Have you verified the Evidence of Disability?, select
Yes. This is based on
section
Check evidence of disability in article Complete pre-assessment of access
decision.
2. At
Select assessed Impairment, enter text into the field and a list will display. Select
relevant option.
3. Make a note of the assessed impairment name and ICD code. You will need this for
section
Decision Main Criteria.
4. At
What evidence was used to confirm the Impairment?, select the appropriate
option.
Note:
Defined Program no longer populates the access decision.
5. At
Does the applicant's impairment belong to List A, B or D?, select the appropriate
option.
Note: This no longer populates the access decision.
6. For more information about list conditions, go to articles:
o Check eligibility – List A condition
o Check eligibility – List B condition
o Check eligibility – List D condition.
7. Select
Add next to
Impairment Assessment to record additional impairments. If an:
o
access met decision, add all impairments that meet eligibility requirements
o
access not met decision, add all reported impairments.
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5 Request further information
1. Decide if you need more information to make an access decision. Only request more
information if:
o the application is complete
o you need more evidence after receiving the applicant's disability evidence.
2. If the applicant is a child with developmental delay turning 6 within the next 90 days,
ask your team leader before requesting more information.
In this situation, it may be more appropriate to make an access not met decision. For an
access request, the child must be younger than 6 on the day the access decision is
made. For an internal review, the child must have been younger than 6 at the time of
the access not met decision. This reduces the risk of the child turning 6 before an
access decision is made.
3. At
Do you require further information from the applicant?, select
Yes or
No. If:
o
No, select
Next, then go to section
Approve or override streaming case.
o
Yes, continue to next step.
4. At
Enter the Required Information below, copy relevant templates from Templates for
requesting further information to make a decision – Post-legislation changes.
5. Select
Next.
6. Select one or more of the criteria for the requested information from the provided tick
boxes.
7. Select
Next.
8. Select
Done.
9. Select
Next.
10. At
Do you want to preview the document before sending it?, select
Yes.
11. Complete
Select a Recipient for preview to preview the letter.
12. If correct, select
Next. If incorrect, select
Previous to update the fields that populate the
letter.
13. Select
Submit Correspondence.
14. Select
Next. A letter will automatically be sent to the applicant or their authorised
representative to request further information. The access decision case is automatically
closed.
5.1 Check correspondence
1. From
the
Person Account case, select the
Documents tab.
2. Check
for
Further Information Requested letter.
Category will be
Outbound
Correspondence. If:
o
Yes, if there is a justice liaison officer, go to section
Notify the justice liaison
officer (JL) (if relevant). If not, go to section
Next steps.
o
No, go to next step.
3. Submit
a
Report a defect with PACE, my NDIS Provider or Participant Portal, or my
NDIS App ticket
4. Share the ticket with your team leader and assistant director.
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5. If there is a justice liaison officer, go to section
Notify the justice liaison officer (JL) (if
relevant). If not, go to section
Next steps.
5.2 Notify the justice liaison officer (JLO) (if relevant)
5.2.1 Create the enquiry case
1. Create
an
Enquiry case and reassign to the
MyNDIS Contact using article Create an
enquiry case.
2. At
Requested By, select
General Enquiry Only.
3. At
Case Origin, select
Internal.
4. At
Enquiry Type, select
Access.
5. At
Category, select
Access Request.
6. At
Sub Category, select
Escalation Enquiry.
7. In
Enquiry Notes, use the following template:
Further information requested to support
<Applicant's name> NDIS application.
More information is needed about <permanency/functional capacity/lifetime supports/future
support needs/whether the NDIS is the most appropriate service> of
<Impairment/Impairments>. <Reason this information is being requested>.
Refer to Request for More Evidence letter in the person account for more information.
Support the applicant to provide more evidence by
<Date> (90 days).
8. At
Enquiry Outcome select
Keep enquiry open - Do not re-assign. This will allow
you to assign the case to the JLO later with an email notification.
5.2.2 Assign the enquiry case
1. From
the
Enquiry case, select the
Change Owner icon next to the current
Case
Owner.
2. At
the
Search Users free text field, search for the
MyNDIS Contact.
3. Select the tick box next to
Send notification email.
4. Select
Change Owner.
5. Go to section
Next Steps.
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6 Approve or override the streaming case
The streaming case is critical to make sure the Typical Support Package (TSP) is generated for
eligible applicants, and they're assigned to the correct team. This is important to make sure they
receive the support level they need to engage with the NDIS.
Generally, the streaming case is completed by a local area coordinator, early childhood partner
or planner and the case routes to an access delegate for approval.
1. Check for a streaming case. A streaming case
must be completed and approved
before completing the access decision case. If:
o
Yes, continue to next step.
o
No, create a streaming case. Go to article Complete a streaming case
(Streaming and Restreaming). Then continue to next step.
2. Go to article Approve or override a streaming case (Streaming and Restreaming) to
approve or override the streaming case.
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7 Record access decision
7.1 Age and Residency Sub Criterion
1. Use
article
Check eligibility – age and residence requirements to help you decide if the
age and residence requirements are met.
7.1.1 Age Criterion 1: (Section 22(1)(a))
1. At
Is the applicant under the age of 65 years old? select
Yes or
No. If
o
Yes, go to section
Residency Criterion 1: (Section 23(1)(a)) to consider the
next criteria.
o
No, continue to next step.
2. Select
Next.
3. Select
N/A for all early intervention and disability requirements. You don't need to
consider the remaining eligibility requirements.
4. Go to section
Evidence Used for Decisions.
7.1.2 Residency Criterion 1: (Section 23(1)(a))
1. At
Is the applicant currently living in Australia? select
Yes or
No. If:
o
Yes, go to section
Residency Criterion 2: (Section 23(1)(b)) to consider the
next criteria.
o
No, continue to next step.
2. Select
Next.
3. Select
N/A for all early intervention and disability requirements. You don't need to
consider the remaining eligibility requirements.
4. Go to section
Evidence Used for Decisions.
7.1.3 Residency Criterion 2: (Section 23(1)(b))
1. At
Is the applicant an Australian Citizen or a Current Eligible Visa Holder? select
Yes or
No. If:
o
Yes, select
Next and go to section
Early Intervention Sub Criteria to consider
the next criteria.
o
No, continue to next step.
2. At
Why does the applicant not meet the sub criteria?, select the relevant option.
3. Select
Next.
4. Select
N/A for all early intervention and disability requirements. You don't need to
consider the remaining eligibility requirements.
5. Go to section
Evidence Used for Decisions.
6. Select
Next.
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7.2 Early Intervention Sub Criteria
1. Use
article
Understand early intervention requirements to help you decide if the early
intervention requirements are met.
2. Consider if the applicant has an impairment on List B or D. This no longer populates in
the access decision. You need to select the relevant criteria manually. If:
o
list D and the child is younger than 7, select
Yes to all early intervention
requirements and select
Next.
o
list B, select
Yes to
Early Intervention Criterion 1: (Section 25(1)(a)) and
Early Intervention Criterion 2: (Section 25(1)(b)). Then consider the
remaining early intervention requirements based on the evidence.
3. If none of the above, consider each early intervention requirement based on the
evidence. All early intervention requirements must be answered.
4. If you select
No for any criteria, select the reason the early intervention requirement is
not met.
7.2.1 Early Intervention Criterion 1: (Section 25(1)(a))
1. At
Is there one or more identified intellectual, cognitive, neurological, sensory or
physical impairments that are, or are likely to be permanent (section 25(1)(a)(i) or
is there one or more identified impairments that are attributable to a psychiatric
condition that are, or are likely to be, permanent (section 25(1)(a)(ii))?:
o Select
Yes or
No.
o If
No and the applicant is younger than 6, there will be questions to consider if
the child has a developmental delay that meets the early intervention
requirements.
7.2.2 Early Intervention Criterion 2: (Section 25(1)(b))
1. At
Is the provision of early intervention supports likely to benefit the person by
reducing the person's future needs for supports in relation to disability?
1.
o Select
Yes or
No.
7.2.3 Early Intervention Criterion 3: (Section 25(1)(c))
1. At
Is the provision of early intervention supports likely to improve, or reduce
deterioration, of functional capacity or strengthen sustainability of informal
supports?:
o Select
Yes or
No.
7.2.4 Early Intervention Criterion 4: (Section 25 (d))
1. At
Are any early intervention supports that would be likely to benefit the person
as mentioned in paragraphs 25(1)(b) and (c) NDIS supports?:
o Select
Yes or
No.
2. Select
Next.
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7.3 Disability Sub Criterion
1. Use
article
Understand disability requirements to help you decide if the disability
requirements are met.
2. Consider if the applicant has an impairment on List A or B. This no longer populates in
the access decision. You need to select the relevant criteria manually. If:
o
list A, the disability requirements are met. Select
Yes to all disability
requirements and select
Next.
o
list B, select
Yes to
Disability Criterion 1: (Section 24 (1)(a)) and
Disability
Criterion 2: (Section 24 (1)(b)). Then consider the remaining disability
requirements based on the evidence.
3. If none of the above, consider each disability requirement based on the evidence. All
disability requirements must be answered.
4. If you select
No for any criteria, select the reason the disability requirement is not met.
7.3.1 Disability Criterion 1: (Section 24 (1)(a))
1. At
Are the impairment(s) attributable to one or more intellectual, cognitive,
neurological, sensory or physical impairments or to psychiatric condition(s)?:
o Select
Yes or
No.
7.3.2 Disability Criterion 2: (Section 24 (1)(b))
1. At
Are the impairment(s) permanent, or are they likely to be permanent?:
o Select
Yes or
No.
7.3.3 Disability Criterion 3: (Section 24 (1)(c))
1. At
Does the impairment(s) result in substantially reduced functional capacity?:
o Select
Yes or
No.
7.3.4 Disability Criterion 4: (Section 24 (1)(d))
1. At
Does the impairment affect the person's capacity for social and economic
participation?:
o Select
Yes or
No.
7.3.5 Disability Criterion 5: (Section 24 (1)(e))
1. At
Is the person likely to require support under the NDIS for their lifetime?:
o Select
Yes or
No.
2. Select
Next.
7.4 Evidence Used for Decisions (access not met only)
1. For any access criteria the person does not meet, record:
o
Evidence type
o
Evidence (if required) – start to enter the linked evidence name, then select
relevant document.
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o
Explanation – record Criteria not met – see linked evidence.
2. Select
Next.
7.5 Decision Main Criteria
1. These questions will automatically be completed with
Access Met,
Access Not Met or
N/A:
o
Does the person meet Age Criteria
o
Does the person meet Residency Criteria
o
Does the person meet Disability Criteria
o
Does the person meet Early Intervention Criteria
o
Overall decision.
Note: An applicant may meet both the disability and early intervention
requirements.
2. If
Overall decision is:
o
Access Not Met, go to step 9.
o
Access Met, go to next step.
3. Open
the
Impairment Categories Guide to complete the next steps.
4. Search
the
ICD 10 Code or
Condition name for
all impairments that meets the
requirements for disability, early intervention, or both.
5. Note
the
Required impairment category column.
6. Consider if any of the
Optional impairment categories in the guide apply based on
the evidence provided:
o
Intellectual – such as how they speak and listen, read and write, solve
problems, and process and remember information.
o
Cognitive – such as how they think, learn new things, use judgment to make
decisions, and pay attention.
o
Neurological – such as how their body functions.
o
Sensory – such as how they see or hear.
o
Physical – such as the ability to move parts of their body.
o
Psychosocial - This means they have reduced capacity to do daily life
activities and tasks due to your mental health.
7. If the early intervention requirements are met, at
Which of the following meet the
eligibility criteria for access?, select options that apply for
all eligible impairments
that met the early intervention requirements:
o
Intellectual
o
Cognitive
o
Neurological
o
Sensory
o
Physical
o
One or more impairments to which a psychological disability is
attributable
o
Developmental Delay.
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8. If the disability requirements are met, at
Which of the following meet the eligibility
criteria for access?, select options that apply for
all eligible impairments that met the
disability requirements:
o
Intellectual
o
Cognitive
o
Neurological
o
Sensory
o
Physical
o
One or more impairments to which a psychological disability is
attributable.
Note: This is important as we only fund NDIS supports for eligible impairments that
meet the requirements for disability, early intervention or both.
9. If the decision isn't correct: Select
Back.
o Re-check and update
previous criteria as per above steps.
10. If the decision is correct:
o
Select Save for later.
7.5.1 If access met for applicant with chronic health condition
You
must request technical advice from the Technical Advisory and Practice Improvement
branch (TAPIB).
1. First send a technical support request to SEB.QUALITY to request Quality
Development Officer (QDO) feedback.
2. If the QDO agrees, request technical advice from TAPIB using the following articles:
o Create a technical advice case
o Complete the risk matrix for a technical advice case
o Review and action returned technical advice case.
Note: You can review relevant article in the TAPIB Digest to help you refine
your request.
If access met for applicant younger than 25 with primary psychosocial disability
You
must receive endorsement from your team leader or assistant director.
First send a technical support request (Review Request: Under 25 Psychosocial) to
SEB.QUALITY to request QDO feedback.
If the QDO agrees, they will email your team leader or assistant director to request
endorsement.
7.5.2 If access met and the applicant resides in hospital
You
must ask for QDO feedback.
1. Send a technical support request to SEB.QUALITY to request QDO feedback. They will
decide if TAPIB advice is required.
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8 Submit decision for quality check
8.1 Submit proposed decision for potential quality check
1. Complete
the
Access Assessor Outcome Form to submit the proposed access decision
for a potential quality check. An email will advise you if the proposed decision is sent for
quality check. If:
o
not sent for quality
check, go to section
Approve access decision
o
sent for quality check, go to section
Review quality check feedback.
8.2 Review quality check feedback
1. Review quality check feedback when received by email. If:
o
no adjustment required and
you agree with the feedback, go to section
Approve access decision
o
adjustment required and you
agree with the feedback, continue to next step.
2. Re-assess and amend access decision in line with the feedback.
3. From
the
Decision Main Criteria screen, select
Save for later.
4. Go to section above
Submit proposed decision for potential quality check to re-
submit for a potential quality check.
Note: For technical support to understand the legislative criteria, please send a technical
support request to SEB.QUALITY.
If you
don't agree with the feedback, contact your team leader about the
reconsideration process.
8.3 Approve access decision
1. Return
to
Decision Main Criteria view.
2. Select
Approve to submit decision.
3. Go to section
Complete access decision correspondence.
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9 Complete access decision correspondence
9.1 Automated Access Met letter
1. Check the correspondence preferences of the applicant are correct. Select
Next.
2. At
Do you want to preview the document before sending it? select
Yes or
No.
3. If you select
Yes, you need to
Select a Recipient for preview?. Select the applicant
you wish to preview the correspondence for and select
Next.
4. A letter preview will generate.
5. If correct, select
Next. If incorrect, select
Previous to update the fields that populate the
letter.
6. Select
Submit Correspondence. An automatic access met decision letter will be sent
to the person or authorised representative.
7. At
Correspondence Summary select
Next.
8. Select
Done to close the access decision case.
9.1.1 Check correspondence
1. In
the
Access Decision case, select the
Documents tab.
2. Check
for
Outcome of Application – Eligible letter.
Category is
Outbound
Correspondence. If:
o
Yes, go to section
Check disabilities tab
o
No, go to next step.
3. Submit
a
Report a defect with PACE, my NDIS Provider or Participant Portal, or my
NDIS App ticket,
4. Share the ticket with your team leader and assistant director.
5. Go to section
Next steps.
9.2 Manual Access Not Met letter
PACE
won't generate an automatic
Access Not Met letter. You need to complete and send a
manual letter.
1. Select
Done to close the access decision case.
2. Complete the manual access not met letter using these articles:
o Letter –Access not met decision
o Template – Access not met decision – post legislation changes.
Note: Only the letter text is required from this resource.
Interactions are not
required.
3. Use
article
Send a manual letter to complete this process.
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10 Notify early childhood partner of access not met
decision (developmental delay only)
If the child is younger than 6 with a developmental delay, you need to notify the early childhood
partner of the access not met decision.
1. Create
an
Enquiry case and reassign to the
MyNDIS Contact using article Create an
enquiry case.
2. At
Requested By, select
General Enquiry Only.
3. At
Case Origin, select
Internal.
4. At
Enquiry Type, select
Partner Supported Access.
5. At
Category, select
General Information.
6. In
Enquiry Notes, use the following template:
7. Access not met decision for developmental delay made on
<Date>.
Evidence provided does not support the developmental delay criteria because <provide a
summary of the justification for the decision e.g. the applicant does not have a
significantly lower ability to do everyday activities, when compared to children of the
same age>.
<If the child is turning 6 within 90 days: The child is turning 6 within 90 days. It may be
more appropriate to support the applicant with an internal review, rather than a new
access request. For an access request, the child must be younger than 6 on the day the
access decision is made. For an internal review, the child must have been younger than
6 at the time of the access not met decision. This reduces the risk of the child turning 6
before an access decision is made.
>
Access request outcome will be communicated to the applicant's authorised
representative – refer to case activity for updates.
Please support applicant with next steps such as early connections.
8. At
Enquiry Outcome select
Re-assign this enquiry to another user.
9. At
Case Re-assignment Reason select
Referral to Partner.
10. At
Select User or Queue select
User.
11. At
Case Owner enter the applicant's
MyNDIS Contact.
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11 Check disabilities tab (access met only)
The
Disabilities tab
must include all impairments that meet the requirements for disability,
early intervention or both as this affects planning.
There may be impairments that you need to add or remove.
1. From
the
Person Account, select
My Profile.
2. Select
the
Disabilities tab.
3. Review
Active status to see what impairments are current.
4. If required, use article Update a person account to:
o add
impairments that meet the eligibility requirements
o
remove any impairments that don't meet the eligibility requirements by adding
an
End Date.
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12 Assign plan approval case (Motor neurone disease
only)
If you are in the Priority Health Access Team and have made an access met decision for an
applicant with Motor neurone disease (also known as Lou Gehrig's disease or Amyotrophic
lateral sclerosis), assign the
Plan Approval case to the
Aged Care Referral Routing Queue.
In all other situations, a plan approval case will automatically route to the relevant queue.
1. In
the
Plan Approval case, select the
Change Owner icon next to the current
Case
Owner.
2. Select
the
Users icon (on the left of the search bar) then select
Queues.
3. At
the
Search Users free text field, search and select
Aged Care Referral Routing
Queue.
4. Select
Change Owner.
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13 Next steps
1. After you complete the access decision case, an automatic contact applicant task will
create. Contact the applicant or their authorised representative. If:
o
Access met or
access not met, go to article Contact to advise outcome of
access decision.
o
Further information requested, go to article Contact to request further
information for access decision.
2. For an access met decision, a plan approval case will automatically route to the
relevant queue for a planner to develop their first participant NDIS plan.
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Table of Contents
1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Check legislative timeframes .............................................................................................. 6
4
Complete disability evidence .............................................................................................. 7
5
Request further information ................................................................................................ 8
5.1
Check correspondence ....................................................................................................... 8
5.2
Notify the justice liaison officer (JLO) (if relevant) .............................................................. 9
5.2.1
Create the enquiry case ................................................................................................................ 9
5.2.2
Assign the enquiry case ................................................................................................................ 9
6
Approve or override the streaming case ......................................................................... 10
7
Record access decision .................................................................................................... 11
7.1
Age and Residency Sub Criterion .................................................................................... 11
7.1.1
Age Criterion 1: (Section 22(1)(a)) .............................................................................................. 11
7.1.2
Residency Criterion 1: (Section 23(1)(a)) .................................................................................... 11
7.1.3
Residency Criterion 2: (Section 23(1)(b)) .................................................................................... 11
7.2
Early Intervention Sub Criteria ......................................................................................... 12
7.2.1
Early Intervention Criterion 1: (Section 25(1)(a)) ......................................................................... 12
7.2.2
Early Intervention Criterion 2: (Section 25(1)(b)) ......................................................................... 12
7.2.3
Early Intervention Criterion 3: (Section 25(1)(c)) ......................................................................... 12
7.2.4
Early Intervention Criterion 4: (Section 25(3)) ............................................................................. 12
7.3
Disability Sub Criterion ..................................................................................................... 13
7.3.1
Disability Criterion 1: (Section 24(1)(a)) ...................................................................................... 13
7.3.2
Disability Criterion 2: (Section 24(1)(b)) ...................................................................................... 13
7.3.3
Disability Criterion 3: (Section 24(1)(c)) ...................................................................................... 13
7.3.4
Disability Criterion 4: (Section 24(1)(d)) ...................................................................................... 13
7.3.5
Disability Criterion 5: (Section 24(1)(e)) ...................................................................................... 14
7.4
Evidence Used for Decisions (access not met only) ........................................................ 14
7.5
Decision Main Criteria ...................................................................................................... 14
7.5.1
If access met for applicant with chronic health condition............................................................. 14
7.5.2
If access met for applicant younger than 25 with primary psychosocial disability ....................... 15
7.5.3
If access met and the applicant resides in hospital ..................................................................... 15
8
Submit decision for quality check .................................................................................... 16
8.1
Submit proposed decision for potential quality check ...................................................... 16
8.2
Review quality check feedback ........................................................................................ 16
8.2.1
Approve access decision ............................................................................................................ 16
9
Complete access decision correspondence ................................................................... 17
9.1
Automated Access Met letter ........................................................................................... 17
9.1.1
Check correspondence ............................................................................................................... 17
9.2
Manual Access Not Met letter........................................................................................... 17
10
Notify early childhood partner of access not met decision (developmental delay
only) 18
11
Check disabilities tab (access met only) ..................................................................... 19
12
Assign plan approval case (Motor neurone disease only) ......................................... 20
13
Next steps ....................................................................................................................... 21
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This article provides guidance for an access delegate (assessor) to:
check legislative timeframes
complete disability evidence
request further information
approve or override the streaming case
record access decision
submit decision for quality check
complete access decision correspondence
notify early childhood partner of access not met decision (developmental delay only)
check disabilities tab (access met only)
assign plan approval case (Motor neurone disease only).
The legislation you need to use automatically populates in the access decision case based on
what is selected in the access request case.
Go to article Complete pre-assessment of access decision to decide which version of the
legislation and article you need to use to make an access decision.
Use this article if you need to use the
pre-legislation changes version of the legislation to
make an access decision.
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1 Recent updates
3 October 2024
Updated guidance to reflect legislation changes from 3 October 2024
Update title from Make access decision to make it clear to use this article when making
a decision using the pre-legislation changes version of the legislation
New step to advise the justice liaison officer (JLO) when requesting more evidence (if
relevant)
New step to notify early childhood partner of access not met decision (developmental
delay only)
New step to assign plan the approval case (Motor neurone disease only).
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2 Before you start
You have:
completed the pre-assessment and checked you need to use the
pre-legislation
changes version of the legislation to make an access decision using article Complete
pre-assessment for an access decision
checked there is evidence of identity or an internal note to explain why it can't be
provided
checked the application is complete with evidence of consent to apply, age, residence
and disability
read
article
Check eligibility – age and residence requirements
read
article
Understand disability requirements
read
article
Understand early intervention requirements.
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3 Check legislative timeframes
You have
21 days to make a decision or request further information.
When a request for further information has been made, you have
14 days from the date that the
last information or report was received to make a decision.
1. Use
article
Check decision – legislative timeframes to check if your decision or request
for further information will be outside legislative timeframes. If:
o
inside legislative timeframes, go to section
Complete disability evidence.
o
outside legislative timeframes, use article Check decision – legislative
timeframes to record an internal note. Then go to section
Complete disability
evidence.
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4 Complete disability evidence
Links to evidence documents in the access request case will display here.
1. At
Have you verified the Evidence of Disability?, select
Yes. This is based on
section
Check evidence of disability in article Complete pre-assessment of access
decision.
2. At
Select assessed Impairment, enter text into the field and a list will display. Select
relevant option.
3. At
What evidence was used to confirm the Impairment?, select the appropriate
option.
Note:
Defined Program no longer populates the access decision.
4. At
Does the applicant's impairment belong to List A, B or D?, select the appropriate
option.
Note: This no longer populates the access decision.
5. For more information about list conditions, go to articles:
o
Check eligibility – List A condition
o
Check eligibility – List B condition
o
Check eligibility – List D condition.
6. Select
Add next to
Impairment Assessment to record additional impairments. If an:
o
access met decision, add all impairments that meet eligibility requirements
o
access not met decision, add all reported impairments.
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5 Request further information
1. Decide if you need more information to make an access decision. Only request more
information if:
o
the application is complete
o
you need more evidence after receiving the applicant's disability evidence.
2. If the applicant is a child with developmental delay turning 6 within the next 90 days,
check with your team leader before requesting more information.
In this situation, it may be more appropriate to make an access not met decision. For an
access request, the child must be younger than 6 on the day the access decision is
made. For an internal review, the child must have been younger than 6 at the time of
the access not met decision. This reduces the risk of the child turning 6 before an
access decision is made.
3. At
Do you require further information from the applicant?, select
Yes or
No. If:
o
No, select
Next, then go to section
Approve or override streaming case.
o
Yes, continue to next step.
4. At
Enter the Required Information below, copy relevant templates from Templates for
requesting further information to make a decision – Pre-legislation changes.
5. Select
Next.
6. Select one or more of the criteria for the requested information from the provided tick
boxes.
7. Select
Next.
8. Select
Done.
9. Select
Next.
10. At
Do you want to preview the document before sending it?, select
Yes.
11. Complete
Select a Recipient for preview to preview the letter.
12. If correct, select
Next. If incorrect, select
Previous to update the fields that populate the
letter.
13. Select
Submit Correspondence.
14. Select
Next. A letter will automatically be sent to the applicant or their authorised
representative to request further information. The access decision case is automatically
closed.
5.1 Check correspondence
1. From
the
Person Account case, select the
Documents tab.
2. Check
for
Further Information Requested letter.
Category will be
Outbound
Correspondence. If:
o
Yes, if there is a justice liaison officer, go to section
Notify the justice liaison
officer (JL) (if relevant). If not, go to section
Next steps.
o
No, go to next step.
3. Submit
a
Report a defect with PACE, my NDIS Provider or Participant Portal, or my
NDIS App ticket.
4. Share the ticket with your team leader and assistant director.
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5. If there is a justice liaison officer, go to section
Notify the justice liaison officer (JL) (if
relevant). If not, go to section
Next steps.
5.2 Notify the justice liaison officer (JLO) (if relevant)
5.2.1 Create the enquiry case
1. Create
an
Enquiry case and reassign to the
MyNDIS Contact using article Create an
Enquiry case.
2. At
Requested By, select
General Enquiry Only.
3. At
Case Origin, select
Internal.
4. At
Enquiry Type, select
Access.
5. At
Category, select
Access Request.
6. At
Sub Category, select
Escalation Enquiry.
7. In
Enquiry Notes, use the following template:
Further information requested to support
<Applicant's name> NDIS application.
More information is needed on
<permanency/functional capacity/lifetime
supports/future support needs/whether the NDIS is the most appropriate service> of
<Impairment/Impairments>.
<Reason this information is being requested>.
Refer to Request for More Evidence letter in the person account for more information.
Support the applicant to provide more evidence by
<Date> (90 days).
8. At
Enquiry Outcome select
Keep enquiry open - Do not re-assign. This will allow
you to assign the case to the JLO later with an email notification.
5.2.2 Assign the enquiry case
1. From
the
Enquiry case, select the
Change Owner icon next to the current
Case
Owner.
2. At
the
Search Users free text field, search for the
MyNDIS Contact.
3. Select the tick box next to
Send notification email.
4. Select
Change Owner.
5. Go to section
Next Steps.
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6 Approve or override the streaming case
The streaming case is critical to make sure the Typical Support Package (TSP) is generated for
eligible applicants, and they're assigned to the correct team. This is important to make sure they
receive the support level they need to engage with the NDIS.
Generally, the streaming case is completed by a local area coordinator, early childhood partner
or planner and the case routes to an access delegate for approval.
1. Check for a streaming case. A streaming case
must be completed and approved
before completing the access decision case. If:
o
Yes, continue to next step.
o
No, create a streaming case. Go to article Complete a streaming case
(Streaming and Restreaming). Then continue to next step.
2. Go to article Approve or override a streaming case (Streaming and Restreaming) to
approve or override the streaming case.
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7 Record access decision
7.1 Age and Residency Sub Criterion
1. Use
article
Check eligibility – age and residence requirements to help you decide if the
age and residence requirements are met.
7.1.1 Age Criterion 1: (Section 22(1)(a))
1. At
Is the applicant under the age of 65 years old? select
Yes or
No. If
o
Yes, go to section
Residency Criterion 1: (Section 23(1)(a)) to consider the
next criteria.
o
No, continue to next step.
2. Select
Next.
3. Select
N/A for all early intervention and disability requirements. You don't need to
consider the remaining eligibility requirements.
4. Go to section
Evidence Used for Decisions.
7.1.2 Residency Criterion 1: (Section 23(1)(a))
1. At
Is the applicant currently living in Australia? select
Yes or
No. If:
o
Yes, go to section
Residency Criterion 2: (Section 23(1)(b)) to consider the
next criteria.
o
No, continue to next step.
2. Select
Next.
3. Select
N/A for all early intervention and disability requirements. You don't need to
consider the remaining eligibility requirements.
4. Go to section
Evidence Used for Decisions.
7.1.3 Residency Criterion 2: (Section 23(1)(b))
1. At
Is the applicant an Australian Citizen or a Current Eligible Visa Holder? select
Yes or
No. If:
o
Yes, select
Next and go to section
Early Intervention Sub Criteria to consider
the next criteria.
o
No, continue to next step.
2. At
Why does the applicant not meet the sub criteria?, select the relevant option.
3. Select
Next.
4. Select
N/A for all early intervention and disability requirements. You don't need to
consider the remaining eligibility requirements.
5. Go to section
Evidence Used for Decisions.
6. Select
Next.
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7.2 Early Intervention Sub Criteria
1. Use
article
Understand early intervention requirements to help you decide if the early
intervention requirements are met.
2. Consider if the applicant is from a defined program in WA or has an impairment on List
A, B or D. This no longer populates in the access decision. You need to select the
relevant criteria manually. If:
o
defined program in WA, all the disability requirements are met. Select
N/A to
all early intervention requirements and select
Next. If the applicant is from a
defined program not in WA or was a former participant, this is no longer
relevant to the decision. They need to meet all eligibility requirements.
o
list A, all the disability requirements are met. Select
N/A to all early intervention
requirements and select
Next.
o
list D and the child is younger than 7, select
Yes to all early intervention
requirements and select
Next.
o
list B, select
Yes to
Early Intervention Criterion 1: (Section 25(1)(a)) and
Early Intervention Criterion 2: (Section 25(1)(b)). Then consider the
remaining early intervention requirements based on the evidence.
o applicant
is
7 or older, first consider the disability requirements. If the disability
requirements are met, select
N/A to all early intervention requirements and
select
Next.
3. If none of the above, consider each early intervention requirement based on the
evidence. All early intervention requirements must be answered.
4. If you select
No for any criteria, select the reason the early intervention requirement is
not met.
7.2.1 Early Intervention Criterion 1: (Section 25(1)(a))
1. At
Is there one or more identified intellectual, cognitive, neurological, sensory or
physical impairments that are, or are likely to be permanent (section 25(1)(a)(i) or
is there one or more identified impairments that are attributable to a psychiatric
condition that are, or are likely to be, permanent (section 25(1)(a)(ii))?:
o Select
Yes or
No.
7.2.2 Early Intervention Criterion 2: (Section 25(1)(b))
1. At
Is the provision of early intervention supports likely to benefit the person by
reducing the person's future needs for supports in relation to disability?:
o Select
Yes or
No.
7.2.3 Early Intervention Criterion 3: (Section 25(1)(c))
1. At
Is the provision of early intervention supports likely to improve, or reduce
deterioration, of functional capacity or strengthen sustainability of informal
supports?:
o Select
Yes or
No.
7.2.4 Early Intervention Criterion 4: (Section 25(3))
1. At
Are early intervention supports most appropriately funded or provided through
the NDIS, and not through another service system?:
o Select
Yes or
No.
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2. Select
Next.
7.3 Disability Sub Criterion
1. Use
article
Understand disability requirements to help you decide if the disability
requirements are met.
2. Consider if the applicant is from a defined program in WA or has an impairment on List
A, B or D. This no longer populates in the access decision. You need to select the
relevant criteria manually. If:
o
defined program in WA, all the disability requirements are met. Select
Yes to
all disability requirements and select
Next. If the applicant is from a defined
program not in WA or was a former participant, this is no longer relevant to the
decision. They need to meet all eligibility requirements.
o
list A, the disability requirements are met. Select
Yes to all disability
requirements and select
Next.
o
list D and the child is younger than 7, the early intervention requirements are
met. Select
N/A to all disability requirements and select
Next.
o
list B, select
Yes to
Disability Criterion 1: (Section 24 (1)(a)) and
Disability
Criterion 2: (Section 24 (1)(b)). Then consider the remaining disability
requirements based on the evidence.
o the
applicant
is
younger than 7 and meets the early intervention requirements,
select
N/A to disability requirements and select
Next.
3. If none of the above, consider each disability requirement based on the evidence. All
disability requirements must be answered.
4. If you select
No for any criteria, select the reason the disability requirement is not met.
7.3.1 Disability Criterion 1: (Section 24(1)(a))
1. At
Are the impairment(s) attributable to one or more intellectual, cognitive,
neurological, sensory or physical impairments or to psychiatric condition(s)?:
o Select
Yes or
No.
7.3.2 Disability Criterion 2: (Section 24(1)(b))
1. At
Are the impairment(s) permanent, or are they likely to be permanent?:
o Select
Yes or
No.
7.3.3 Disability Criterion 3: (Section 24(1)(c))
1. At
Does the impairment(s) result in substantially reduced functional capacity?:
o Select
Yes or
No.
7.3.4 Disability Criterion 4: (Section 24(1)(d))
1. At
Does the impairment affect the person's capacity for social and economic
participation?:
o Select
Yes or
No.
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7.3.5 Disability Criterion 5: (Section 24(1)(e))
1. At
Is the person likely to require support under the NDIS for their lifetime?:
o Select
Yes or
No.
2. Select
Next.
7.4 Evidence Used for Decisions (access not met only)
1. For any access criteria the person does not meet, record:
o
Evidence type
o
Evidence (if required) – start to enter the linked evidence name, then select
relevant document.
o
Explanation – record Criteria not met – see linked evidence.
2. Select
Next.
7.5 Decision Main Criteria
These questions will automatically be completed with
Access Met,
Access Not Met or
N/A:
Does the person meet Age Criteria
Does the person meet Residency Criteria
Does the person meet Disability Criteria
Does the person meet Early Intervention Criteria
Overall decision.
1. If the decision isn't correct: Select
Back.
o Re-check and update previous criteria as per above steps.
2. If the decision is correct:
o Select
Save for later.
7.5.1 If access met for applicant with chronic health condition
You
must request technical advice from the Technical Advisory and Practice Improvement
branch (TAPIB).
1. First send a technical support request to SEB.QUALITY to request Quality
Development Officer (QDO) feedback.
2. If the QDO agrees, then request technical advice from TAPIB using the following
articles:
o Create a technical advice case
o Complete the risk matrix for a technical advice case
o Review and action returned technical advice case.
Note: You can review relevant
article in the TAPIB Digest to help you refine your
request.
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7.5.2 If access met for applicant younger than 25 with primary
psychosocial disability
You
must receive endorsement from your team leader or assistant director.
1. First send a technical support request (Review Request: Under 25 Psychosocial) to
SEB.QUALITY to request QDO feedback.
2. If the QDO agrees, the QDO will email your team leader or assistant director to request
endorsement.
7.5.3 If access met and the applicant resides in hospital
You
must ask for QDO feedback.
1. Send a technical support request to SEB.QUALITY to request QDO feedback. They will
decide if TAPIB advice is required.
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8 Submit decision for quality check
8.1 Submit proposed decision for potential quality check
1. Complete
the
Access Assessor Outcome Form to submit the proposed access decision
for a potential quality check. An email will advise you if the proposed decision is sent for
quality check. If:
o
not sent for quality check, go to section
Approve access decision
o
sent
for quality check, go to section
Review quality check feedback.
8.2 Review quality check feedback
1. Review quality check feedback when received by email. If:
o
no adjustment required and you agree with the feedback, go to section
Approve access decision
o
adjustment required and you
agree with the feedback, continue to next step.
2. Re-assess and amend access decision in line with the feedback.
3. From
the
Decision Main Criteria screen, select
Save for later.
4. Go to section above
Submit proposed decision for potential quality check to re-
submit for a potential quality check.
Note: For technical support to understand the legislative criteria, please send a technical
support request to SEB.QUALITY.
If you
don't agree with the feedback, contact your team leader about the reconsideration
process.
8.2.1 Approve access decision
1. Return
to
Decision Main Criteria view.
2. Select
Approve to submit decision.
3. Go to section
Complete access decision correspondence.
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9 Complete access decision correspondence
9.1 Automated Access Met letter
1. Check the correspondence preferences of the applicant are correct. Select
Next.
2. At
Do you want to preview the document before sending it? select
Yes or
No.
3. If you select
Yes, you need to
Select a Recipient for preview?. Select the applicant
you wish to preview the correspondence for and select
Next.
4. A letter preview will generate.
5. If correct, select
Next. If incorrect, select
Previous to update the fields that populate the
letter.
6. If all is correct, select
Submit Correspondence. An automatic access met decision
letter will be sent to the person or authorised representative.
7. At
Correspondence Summary select
Next.
8. Select
Done to close the access decision case.
9.1.1 Check correspondence
1. In
the
Access Decision case, select the
Documents tab.
2. Check
for
Outcome of Application – Eligible letter.
Category is
Outbound
Correspondence. If:
o
Yes, go to section
Check disabilities tab
o
No, go to next step.
3. Submit
a
Report a defect with PACE, my NDIS Provider or Participant Portal, or my
NDIS App ticket
4. Share the ticket with your team leader and assistant director.
5. Go to section
Next steps.
9.2 Manual Access Not Met letter
PACE
won't generate an automatic
Access Not Met letter. You need to complete and send a
manual letter.
1. Select
Done to close the access decision case.
2. Complete the manual access not met letter using these
articles:
o Letter – Access not met decision
o Template – Access not met decision - Pre-legislation changes.
Note: Only the letter text is required from this resource.
Interactions are not
required.
3. Use
article
Send a manual letter to complete this process.
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10 Notify early childhood partner of access not met
decision (developmental delay only)
If the child is younger than 6 with a developmental delay, you need to notify the early childhood
partner of the access not met decision.
1. Create
an
Enquiry case and reassign to the
MyNDIS Contact using
article Create an
Enquiry case.
2. At
Requested By, select
General Enquiry Only.
3. At
Case Origin, select
Internal.
4. At
Enquiry Type, select
Partner Supported Access.
5. At
Category, select
General Information.
6. In
Enquiry Notes, use the following template:
Access Not Met decision for developmental delay made on
<Date>.
Evidence provided does not support the developmental delay criteria because <
provide a
summary of the justification for the decision e.g. the applicant does not have a
significantly lower ability to do everyday activities, when compared to children of
the same age>.
<If the child is turning 6 within 90 days: The child is turning 6 within 90 days. It may be
more appropriate to support the applicant with an internal review, rather than a new
access request. For an access request, the child must be younger than 6 on the day the
access decision is made. For an internal review, the child must have been younger than
6 at the time of the access not met decision. This reduces the risk of the child turning 6
before an access decision is made.
>
Access request outcome will be communicated to the applicant's authorised representative
– refer to case activity for updates.
Please support applicant with next steps such as early connections.
7. At
Enquiry Outcome, select
Re-assign this enquiry to another user.
8. At
Case Re-assignment Reason, select
Referral to Partner.
9. At
Select User or Queue, select
User.
10. At
Case Owner, enter the applicant's
MyNDIS Contact.
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11 Check disabilities tab (access met only)
The
Disabilities tab
must include all impairments that meet the requirements for disability,
early intervention or both as this affects planning.
There may be impairments that you need to add or remove.
1. From
the
Person Account, select
My Profile.
2. Select
the
Disabilities tab.
3. Review
Active status to see what impairments are current.
4. If required, use
article Update a person account to:
o add impairments that meet the eligibility requirements
o remove any impairments that don't meet the eligibility requirements by adding
an
End Date.
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12 Assign plan approval case (Motor neurone disease
only)
If you are in the Priority Health Access Team and have made an access met decision for an
applicant with Motor neurone disease (also known as Lou Gehrig's disease or Amyotrophic
lateral sclerosis), assign the
Plan Approval case to the
Aged Care Referral Routing Queue.
In all other situations, a plan approval case will automatically route to the relevant queue.
1. In
the
Plan Approval case, select the
Change Owner icon next to the current
Case
Owner.
2. Select
the
Users icon (on the left of the search bar), then select
Queues.
3. At
the
Search Users free text field, search and select
Aged Care Referral Routing
Queue.
4. Select
Change Owner.
Assign plan approval case (Motor neurone disease only) – 20
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13 Next steps
1. After you complete the access decision case, an automatic contact applicant task will
create. Contact the applicant or their authorised representative. If:
o
Access met or
access not met, go to
article Contact to advise outcome of
access decision.
o
Further information requested, go to
article Contact to request further
information for access decision.
2. For an access met decision, a plan approval case will automatically route to the
relevant queue for a planner to develop their first participant NDIS plan.
Next steps – 21
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