We are often approached by ndis participants to gain clarity around the types of ndis plan review processes. This article aims to demystify different types of NDIS reviews and supports available for participants seeking a review of their plan.
NDIA has recently introduced new terms and processes for ndis reviews to not just better clarify different types of ndis plan reviews but also to shorten the delays faced by ndis participants when the review is for a small change.
You would see a table at the later part of this article, where you can read out all the new terms and changes NDIA have published and what they mean for each type of review.
When it comes to ndis plan review processes - It is obvious that your support coordinator can help you with the process as its part of their role. If support coordination is not funded in a participant's plan, then we have seen that your service provider may be able to guide you volunteerily but they cannot claim the support time in the participant’s plan.
An important thing to note is that Support coordinators and providers cannot lodge a review on behalf of the nids participant but can only assist with it by getting the forms completed and to make sure that all needed supporting evidence is attached to your application. So, it is important that carers and/or ndis participants take some time understanding the review process themselves and build their capacity if they can.
If you are a new NDIS participant and came across this article on the internet because you received your first plan and are unhappy about the funding given to you in the first plan, then let me tell you that first plans are often not perfect, and NDIA expects to receive feedback to build the next plan even better. Of course, You may have to provide adequate supporting evidence from your medical and/or therapy professionals so that NDIS can understand your needs better and make a better plan for you next time.
For most first plans, NDIS also provides additional funds in the capacity building part of your plan, for a functional capacity assessment by an Occupational therapist (OT); so that an OT functional assessment report can help NDIA understand the impact of a person’s disability in different areas of life.
So, lets jump in to the type of reviews in bit more detail. When it comes to distinguishing the type of reviews, you would see that the below two terms are used very often –
NDIS Plan Scheduled Review –
This type of review will occur routinely as a plan is near to its expiry date. NDIA team members may contact you a month prior to the expiry of a plan to discuss with you the changes anticipated in your new plan.
At this stage, if you wish to make any changes to your current plan and if there are things that needs to be changed with your current funding scenario, then you can let the NDIA person know, and before your plan review meeting, be able to provide medical or other required evidence to support the requested change of funding and ndis will make a decision to based on the information provided.
NDIS Plan Unscheduled Review –
If you have received your NDIS plan recently, and you believe that any of the below is true, then you can request NDIA to review your plan. This is called an unscheduled Review.
the plan is not appropriately funded or
therapy reports/professional recommendations were not properly considered.
your informal support’s ability to provide you with the appropriate support is unsustainable.
You may also apply for an unscheduled review of your plan if your situation has suddenly changed, and your existing support arrangements can no longer be able to meet your support needs.
Now, to clarify the unschedule reveiw process further, there are three different subtypes or categories of it, as follows -
Request for plan review (S48 review) – change of circumstance.
S100 review – review of a reviewable decision
AAT review – external agency
The information below can simplify these different types of unscheduled reviews.
1. Request for plan review (S48)
Also referred to as “change of circumstance”.
When would such a review be required?
This unscheduled review is lodged by a participant when –
There is a change in circumstance before their plan is due for the originally scheduled review date and/or
The plan no longer meets their expected support needs.
What is the time frame to lodge the review?
This can occur at any time and participants may choose to lodge the application for unscheduled review at any time.
Where to find the Application form?
Here is the link - Plan Review Request Form
Example scenario for review type S48 –
The participant’s primary carer provides informal (unpaid) care became unwell or is unable to care for other reasons and the participant had to use additional support from a formal paid carer for an extended period. As a result of using increased funding during this time, they may not have enough funding remainder to last until the original plan expiry date. to meet their needs and achieve their goals. They request a plan review.
2. Internal review of a decision made by NDIA (S100)
When would such a review be required?
This review can be lodged after the first review, and this is when the participant is unsatisfied with a decision made by NDIA after the review that was lodged earlier (for example – NIDA refused to fund extra supports or NDIA decided not to review a plan).
What is the time frame to lodge the review?
You have 3 months to lodge this review after receiving the decision (for example, 3 months from ndia for the review outcome and/or revised plan approval date).
Where to find the Application form?
Here is the link - Application for Review of a Reviewable Decision
Example scenario for review type S48 –
The participant received a new plan last month. Participants requested funding for extra 1:1 support due to mental health issues and informal carers not being able to support them. The overall plan had reduced funding in capacity building and support coordination areas. The client lodged a request for review (S48) and received an outcome that based on the review of facts and documents, ndia decided that the current plan funding is appropriate. Client unhappy with the review outcome, lodges internal review of the reviewable decision.
3. AAT review
Also known as external review done by a tribunal (AAT stands for Administrative appeals tribunal)
When would such a review be required?
If the participant is not happy with an internal review decision made by NDIA; and,
An internal review has been completed, and the disputed decision is related to the internal review.
What is the time frame to lodge the review?
Within 28 days of receiving the decision made by NDIA following an Internal Review.
You may be able to find organizations out there - that are funded to provide advocacy assistance throughout this process.
Where to find the Application form?
Here is the link - Online Application
Example scenario for review type S48 –
A participant submitted a request to review their plan, as their plan no longer met their needs.
NDIA decided not to review the plan.
The participant submitted an internal review of the decision not to review the plan.
The NDIA internal reviewer again decided not to review the plan.
The participant then goes to AAT by submitting an application for the outcome from NDIA decision - not to review their plan.
NDIS has been improving its review process since the start of the scheme in 2014 to make the process easier, more flexible and less time intensive, so that participants do not have to wait longer and can get the review outcomes quicker.
In that pursuit, NDIA has recently introduced a light touch review process to make the process faster if the full plan review is not required, and so that participants do not have to wait longer while waiting for the outcomes of the review lodged. Surely, one may keep using their existing plan funding until they hear about the outcome of the review unless the plan has fully been used up.
Following information below lists the new changes that were introduced, and NDIA also changed terms to differentiate these new review processes –
New name for a review type | Old name to refer to a review type | What does this review mean for you as ndis participant |
Reassessment of participant’s plan dates | Review date of a participant’s plan End date of a participant’s plan | All NDIS plans have a ‘reassessment date’. At this date, NDIA will re-look at the plan with you and decide if any changes are needed. If a plan reaches its reassessment date before the reassessment is completed, the current plan will be varied to extend it by 12 months so you can continue accessing support. |
Plan reassessment – this could be initiated by Participant or NDIA |
Change of Circumstances (CoC) review -S48 review | You can ask for a reassessment at any time.
You can read more about plan reassessments below |
Plan variation |
|
|
Internal review of decision |
|
|
How to prepare for a plan review?
A request can be made to NDIA to conduct a review by a participant, or a participant’s plan nominee at any time.
A change occurring within the participant’s statement of goals and aspirations does not automatically trigger a review of the plan. However, it may prompt the participant or the nominee to request a review.
NDIS can also do a review on their own initiative, and you may receive a new plan.
Depending upon your circumstance and the type of review you may have to go through, answering some of the below questions may help you prepare for your review.
Which of the supports in your ndis plan is working well for you?
Are you willing NDIA to increase or change part or all of your plan as your support needs have increased or changed?
Are there any changes to the short-term, and medium-term life goals that you wish NDIA to update?
Would you like to change the way the funding is managed in your plan example: from agency-managed to plan-managed or self-managed?
Would I still be able to get support while I am waiting for the review outcome from NDIA?
if you are in the process of seeking a review, you will not be left without support funding while NDIA is reviewing your request, your old plan will still stay active, and you may keep using your funds in the current plan or if your plan is at the expiry / re-assessment date NDIA will roll over the expired plan with the same level of support until the review is finalised.
How does ndia make review decisions?
NDIA considers all current supporting evidence including medical reports (GP, Psychiatrist report, and other Medical Specialist report); therapy professional letters (psychologists or other allied health practitioners including OT & Speech therapy) before making a review decision.
If you are dissatisfied with the decision made by NDIA, you can contact NDIA back and they will explain to you the reasons for the decision made.
You can further ask for an internal review of the decision already made, and a new staff member from NDIA who was not involved in the first review decision will then have another look and decide if the first decision was right.
How to make a request for a review to NDIA?
You can make a request for a plan review or an internal review of a decision by:
submitting a written request to - Chief Executive Officer National Disability Insurance Agency GPO Box 700 Canberra ACT 2601
talking to someone at an NDIA office
calling 1800 800 110
sending an email to: enquiries@ndis.gov.au.
Or
Download the Request for a review of a decision form.
When you request a review, you must explain why you think the decision is incorrect and attach the most recent supporting evidence. If NDIA may need more evidence, they will contact you.
How long does it take for NDIA to review a decision?
NDIA aims to review all decisions within 60 days from the day the review request is made. NDIA will provide reasons in writing for the decision outcome made.
What if you do not want Internal review anymore and wish to withdraw your request? You can withdraw your information anytime before NDIA makes an internal review decision. You can do this by contacting NDIA in person, writing a letter, or making a phone call to 1800 800 110. NDIA personnel will make a note of your request.
When can an internal review happen without me asking?
When someone makes a request for plan reassessment or plan variation, and if NDIA is unable to decide within 21 days of whether or not they will do plan reassessment or variation, an internal review will occur, and NDIA calls it an automatic internal review.
What happens if you have gone through an internal review and are still unhappy with the decision made by NDIA?
If you are still not happy after the internal review of the decision, you can apply for an Administrative Appeals Tribunal (AAT) review. This is a tribunal outside the NDIA.
You cannot ask the AAT to review an NDIA decision until the NDIA has internally reviewed it.
ELS Disability Services - Western Sydney, Australia | Ph: 1300 323 399 | www.elsaustralia.org
Comments