Principles of s100 Planning Review

DOCUMENT 29

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Guidance

For Internal Use Only The contents of this document are OFFICIAL.

This guidance is to support an understanding of what is considered for an internal review of a decision for Internal Review Officers (IROs) and Business Support Officers (BSOs).

The NDIA has more than one way to change a plan. Sometimes it is hard to understand which pathway is the right one to address a participant’s request for a review/reassessment or variation. This document can be used in conjunction with the Choose the Right Request Tool.

Note: All references to “participant” in this document also refers to authorised representatives/nominees/child representatives.

1. Recent updates

Date	What’s changed
August 2022	Amended Content:

Terminology change from participant requested plan review to plan reassessment.

Updated heading of what is considered as part of the internal review. Added in section for variation requests and quotes for functional capacity assessment, AT and HM wording.

Updated to link to the Choose the Right request Tool.

Included link to the internal review Our Guidelines of what is to be considered for an internal reviews.

Added Content:

Additional guidance for planning internal reviews.

Section of frequently asked questions for internal reviews.

Removed Content:

What will not be considered section.

Additional evidence or information section.

Withdrawing internal review requests. |

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What’s changed:

Out of scope conversation prompts.
Case examples of an internal review request for planning.

Index

1. What can be reviewed as part of the statement of supports
1. What will be considered as part of an internal review
1. Additional Guidance for s100 planning review
- 5.1 Update to Participant statement of goals and aspirations (section 47)
- 5.2 Update the Severity Indicator and WHODAS
- 5.3 Update Participant Streaming
- 5.4 Updating Listed Primary Disability
- 5.5 Referral for Complex Support Needs (CSN)
- 5.6 Refer Participant for Eligibility Reassessment (ER)
- 5.7 Referral of Participant that may have received a Compensation amount
- 5.8 Appointing a Plan Nominee
- 5.9 Collecting and updating bank details
- 5.10 Make a request for service Support Coordination and Recovery Coach as part of the s100
- 5.11 Participant Critical Incident (PCI) as part of the s100

3. What can be reviewed as part of the statement of supports

The statement of supports includes:

What NDIS-funded supports are included in a participant’s plan.
How those supports are described.
How long the plan goes for.
How the funding in the plan is managed.

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Guidance For Internal Use Only

4. What will be considered as part of an internal review

When reviewing a decision about a participant’s plan, Our Guidelines state we will make our decision based on the facts and circumstances at the time of our internal review decision.

The internal review will consider:

any evidence from the original decision
reasons for the original decision
additional information that has been provided for the internal review
the facts and circumstances of the participant at the time of making the internal review decision (this means we can consider any changes since the original decision was made, which may impact their statement of supports, such as, a change to the participant’s capacity to do things for themselves or an ongoing change to their living situation, which may mean they need more or less supports)
the NDIS Act, Our Guidelines and internal guidance material

The internal review team will seek to review the request based on the support/s in dispute, and confine the scope of the review to those disputes(s) the participant wishes to raise or is dissatisfied with as part of their internal review request as well as any dependencies or related supports.

The participant may request a review of all the funded supports in the plan. They may also identify a specific support they are seeking funding for. While it is preferable for the participant to have raised any specific requests with the original decision maker, it is not compulsory. Therefore there does not have to be an explicit request for a support made, plan management type or length of plan during the planning process for it to be considered as part of the internal review.

During a planning meeting the participant does not have to specifically identify the supports they wish to be included in their plan. It is the planner’s and internal review officer’s responsibility to gather and review all information before making a decision about what funded supports are included in the participant’s plan. In some situations, a participant may prefer to have a plan reassessment or plan variation undertaken first before proceeding with their internal review. In these cases, the Internal Review Officer should seek to understand the circumstances and ensure all options are well understood before enabling the participant’s preferred pathway.

Similarly if new quotes, reports or assessments requested by the original delegate are submitted as part of the internal review process these can be considered if that is the

Guidance

For Internal Use Only

preferred pathway for the participant. This could include functional capacity assessment, assistive technology or home modifications quote or reports that has been provided between the original decision and the internal review request. It is important the participant understands the impact of their decision to their review rights.

5. Additional Guidance for s100 planning review

The following information applies to s100 regarding a participant statement of support and only apples only if there are supports in dispute.

5.1 Update to Participant statement of goals and aspirations (section 47)

The statement of goals and aspirations is not a reviewable decision. Where a participant wants to add or change a goal but no changes are required to the supports funded, they do not need to have a plan reassessment. Changes to the participant statement can be made at any time and can be sent to enquiries@ndis.gov.au. If the requested change also requires a reassessment of their support needs, then a plan reassessment (section 48) is the correct pathway.

5.2 Update the Severity Indicator and WHODAS

Updates to the Severity Indicator and WHODAS may be an in scope task for an IRO and is dependent on the decision outcome.

Confirmed Decision

The IRO cannot complete an update to the severity indicator or the WHODAS as a review application will not be generated. The IRO can provide information regarding future SI/WHODAS updates within the plan implementation interaction.

Vary/Set-aside Decision

As part of the pre-planning tasks the IRO should confirm the relevant tool has been applied correctly using the participant’s primary disability. Updates to the SI/WHODAS may be required. See the Standard Operating Procedure – Complete the Update Severity Tools task.

5.3 Update Participant Streaming

If the IRO identifies streaming factors from information provided during the internal review then the IRO should review and update the participants streaming. Refer to the Update participant streaming Standard Operating Procedure.

5.4 Updating listed Primary Disability

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If the IRO identifies evidence or information provided during the internal review or the participant has advised their disability is recorded incorrectly, then the IRO should review and change the listed disability information on the record.

Where the funding included within the Participant’s Statement of Supports is being disputed, the supports being requested are reviewable under s100 of the NDIS Act (2013). The review should consider the information available regarding the disability the participant has met access to the NDIS for and resulting impairments. Any other additional impairments can also be considered and a decision made under s34 of the NDIS Act (2013). A request to change or update the list of disabilities with supports in dispute can be part of the internal review.

Note: If you require assistance determining if a participant secondary impairment/s would meet the access requirements, please speak to your Line Manager and/or seek ECS/TAB advice where required.

For more information on updating or changing disability types refer to the Add or Change Disability Standard Operating Procedure.

5.5 Referral for Complex Support Needs (CSN)

If the IRO identifies CSN referral criteria is met from information during the internal review, the internal review officer should note this when creating the plan implementation interaction.

5.6 Refer Participant for Eligibility Reassessment (ER)

If the IRO identifies the participant may not meet the access requirements for the NDIS, the IRO can provide a brief summary of this information within the plan implementation interaction.

5.7 Referral of Participant that may have received a Compensation amount

No plan with compensation identified should be rolled over, reviewed, or approved without first contacting the Compensation Recoveries Branch for advice.

The Compensation Recoveries (CR) team is in the process of removing old CRM alerts that provide instruction to proceed with plan development without regard to compensation.

All s100 internal review requests relating to Compensation will be allocated to and completed by the IRT Escalations Team.

5.8 Appointing a Plan Nominee

Tasks for recording and/or appointing a nominee are out of scope tasks for an IRO. If the IRO identifies the participant has requested or may benefit from the appointment of a V4.0 2022-08-17 Principles of s100 Planning Review Page 5 of 8

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nominee, the IRO can provide a brief summary of this information within the plan implementation interaction.

If the IRO identifies consent has lapsed during the internal review, then the IRO should obtain necessary consent for the purposes of conducting the internal review. Any further follow up of the plan nominee requirements for review is to be added as part of the plan implementation interaction.

5.9 Collecting and updating bank details

Participants are encouraged to update this information via the My Place Portal.

If this option is not suitable for the participant, the IRO can update the details as per the participant request. Refer to the Collect and update bank account details Standard Operating Procedure.

5.10 Make a request for service for Support Coordination and/or Recovery Coach as part of the s100

Any requests for service for Support Coordination and/or Recovery Coach can be included as outstanding tasks in the plan implementation interaction. Information for the interaction should include:

Purpose of referral (Support Coordination or Recovery Coach)
Participant context
Referrals for assessments required for example, Functional Capacity Assessment, Exploring Housing Options
Other additional comments such as, expected outcomes for SC funding and how to best support the participant

5.11 Participant Critical Incident (PCI) as part of the s100

If a PCI occurs during the s100 or the IRO has information that meets the criteria for completing a PCI, this should be completed as soon as IRO has this information. It is our duty of care to report any allegations about incidents which may cause harm to a participant.

All staff must ensure the participant and others are safe when first notified of a potential PCI.

If the participant or another person is in immediate danger or requires urgent assistance, please call Triple Zero (000) immediately.

You will need to:

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fill in the PCI notification form (DOCX 74KB)
email the form to ndis.gov.au within 24 hours
Include detailed and factual information, without drawing conclusions.

Please do not record details on the participant’s CRM record.

Once the PCI team receive the completed form, they will investigate incidents quickly, appropriately and in line with legislative requirements.

The Agency acknowledges these issues can be triggering. Please seek support when you need to.

You can find out more about supports for Agency staff and leaders on our Well+ Hub. Find out more on the Participant critical incidents intranet page.

6. Feedback

If you have any feedback about this Standard Operating Procedure, please complete our Internal Review Team Quality and Continuous Improvement Form and email it to the Business Improvement Team. In your email, remember to include the title of the product you are referring to and describe your suggestion or issue concisely.

7. Version Control

Version	Amended by	Brief Description of Change	Status	Date
1.0	DII394	Class1 approval	APPROVED	2021-02-03
2.0	CAP525	Class 1 approval	APPROVED	2021-07-23
	DLL320
	SWO065
3.0	KMM575	Removed out of scope change of preference example.
Move to new template. Class 1 approval.	APPROVED	2021-11-23
4.0	LW0022	Review of flow of document. Feedback provided from SW0065.	APPROVED	2022-08-17

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Principles of s100 Planning Review

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Guidance

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Version	Amended by	Brief Description of Change	Status	Date
		Deleted section about additional information. Updated information about what is part of internal review and added in OG link. Updated conversation to contact and communication. Updated based on feedback SW0065. Inclusion of appendix information — guidance information for progression of s100 planning decision tasks. Additional guidance information added.
		Removed withdrawn section and conversation prompts. Minor updates to index and example wording based on feedback provided SW0065.

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