Everything to know about the NDIS plan review process?

Updated: Feb 22

Working within the NDIS space as a quality provider of disability services, we often get to hear this question from our clients and they seem to be very much in the dark when it comes to changing something in their NDIS plan.


So, let’s begin with some basics. I am sure that those who are connected to NDIS in some way definitely know about what an NDIS plan is, but for those who are new to NDIS, it is a document that contains important information for a person with a disability. This includes their personal profile, short-term and long-term goals in life, and the funds that are allocated to achieve those goals. This plan has an expiry date and is typically for a duration of one year.


Once the planning meeting is completed by NDIA, the plan is then activated and a plan copy is sent to you.


So, since we discussed the NDIS plan, let’s move on to our main discussion "how to make a change to your plan - if you are unhappy with the way it is funded. ELS considers it quite important, that a person with a disability or their family member must know how to make a change to their NDIS plan.


Why would a change be needed for a new NDIS Plan?

So true - if the new plan is received, has gone through proper assessment and planning process by NDIA, you may expect that the plan should be accurate based on evidence provided, then why would someone wish to make a change again.


Well, there can be few reasons-


1. We have met participants who have received a new NDIS plan only to find out, that it came about slightly or sometimes widely different to their expectations. We know that this is not a good feeling at all as you and your family or your support coordinator may have put in so much effort in your last planning meeting and it feels so exhausting to go over it again.


It is hard to know the exact cause of why such errors may occur however the information in NDIA often goes through different departments before a plan gets framed and hence a possible reason. Such errors were more prevalent in the early days of NDIA and they have put in much effort to reduce errors since then.


As they say, nothing is ever 100% perfect, and such a situation if arises may necessitate a plan change and a review.


2. There are chances that goals of a person may change quite suddenly, due to some unforeseen circumstances and this occurring soon after the planning meeting leading to a person with disability requiring changes to their plan.


3. NDIA plan is built with an expiry for one year or more. As time passes, it may happen that your needs for support may change and you or your support coordinator may realise that your current plan is no longer supporting you the way you want. This may necessitate making adjustments to your plan prior to its expiry to support your needs.


4. As a person ages, it is expected that the plan may need to be changed over time.


Types of NDIS Plan Review

There can be two types of review in NDIA. One is a scheduled review and another is an unscheduled review.


1. Scheduled review is often referred to a stage where a plan is near to its expiry or has expired. NDIA may contact you 3 months prior to the expiry of a plan in order to discuss with you the changes anticipated in your new plan.


2. Unscheduled review is referred to a stage where a plan is not near to its expiry but a participant or their nominee may require a change due to sudden changes in their support needs.


Types of NDIS plan review process.

NDIS has made plethora of changes to its review process since its start in 2014. Originally it was a one size fit to all sorts of reviews and it was not working. The process was lacking flexibility and was a time-intensive process as every time a person requesting minor changes had to go through a full review and people had to bear with their old plan until a new plan is made after a long 2-3 months wait.


With the current day scenario, NDIA has made it flexible and there are three different review processes based on the size of change expected so that minor changes do not have to go through a full review process.


1. NDIS plan requiring minor changes to your current supports – when there is a slight change in circumstance. Often done quite quickly and may not need a full review or a meeting. (Saves so much hassle and time)


2. Rollover an NDIS plan with the same supports – when there is no change of circumstance. This saves all hassle a person may have to go through to get a new plan with the same support level.

If a participant believes that there may not be significant changes in his life, he may ask for a plan duration of 3 years.


3. A full review – This occurs when circumstances in a person with a disability’s life have changed dramatically. This requires one to go through the entire review cycle including planning meeting done again, documentary evidence required and questions asked. (time-consuming – typically 1 to 3 months depending upon the busy nature of NDIA staff)


Whatever scale of change you are expecting within your NDIS plan, it is often best to discuss your needs and circumstances with your LAC or be in constant communication with your support coordinator so that they can assist you in these processes when you need.


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, there are some handy tips or questions you may answer that may help you prepare for your review.


When you are going for a plan review, you may wish to think about the following:

  • What worked well in your plan

  • What didn’t work well

  • Have you achieved your goals or made progress towards achieving them?

  • Which goals do you need to continue to work on and which goals do you need to change

  • Who can help you achieve your goals?

  • Will you need NDIS support in the future

  • Would you like to change how all or some of your plan funding is managed?


To avoid having a person with a disability left without support while NDIA is reviewing your request, your old plan stays active and you may keep using your existing funds.


We have also seen NDIA rolling over expired plans as it is with the same level of support until a decision is made on a new plan.


What happens if you are unhappy with your new plan outcome?

Well, the answer is simple, you can always request a review. But it is upon NDIA to decide whether they will accept your request for a review or not. This occurs when NDIA based on the new or old information you provided, decides that your request to review is not valid and a change to your plan cannot be made.


How do I know whether or not my review request is accepted or not?

When someone makes a request for review, NDIA must decide whether or not to conduct the review of the plan within 14 days of receiving the request. If review is conducted a new plan is framed and the participant informed or NDIA decides not to review and becomes a reviewable decision, which then after 14 days triggers an internal review automatically.


What is an Internal review?

Such review occurs when NDIA makes a decision on your plan and you are still unhappy about the decision or NDIA refuses to review your plan. In this scenario, you may let NDIA know that you are requesting an internal review.


An internal review is done by a person within NDIA who is not involved in making the first decision but will consider all the facts, law, and policy aspects of a decision and determines what the correct or preferable decision is.


What is an Unspecified review?

This is referred to as a review that occurs when a participant does not let NDIA know what type of review is requested. In this circumstance, NDIA makes a decision of the type of review sought, which is based upon either –


1. The timing when review is requested after the plan has been built. Generally, within the first 3 months of a new plan, if a review is made NDIA considers a review to be a plan review. After 3 months of the new plan made, the review not specified by a participant may trigger an internal review.


2. Satisfaction level of the participant – if a participant expresses satisfaction but only minor changes or challenges, NDIA considers the review to be a plan review.


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 Application for a review of a decision (PDF 471KB) form.


When you ask for a review, explain why you think the decision is incorrect.


What happens if you have gone through an internal review and 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.

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