FOI 24/25-2381 DOCUMENT 2

Understand procedural fairness for

  eligibility reassessments
          SGP KP Publishing

               Exported on 2025-09-19 02:51:13

SGP KP Publishing – Understand procedural fairness for eligibility reassessments

Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4

2 Before you start …………………………………………………………………………………………………….. 5

3 Understand procedural fairness …………………………………………………………………………….. 6

4 Manual procedural fairness checks during the Eligibility Check stage for access delegates …………………………………………………………………………………………………………………….. 7 4.1 Have we been unable to contact (UTC) the participant? …………………………………………… 7 4.2 Review all information and evidence before making a decision ………………………………….. 7

5 Manual procedural fairness check during the ER Outcome stage for access delegates …………………………………………………………………………………………………………………….. 8

6 Understand the procedural fairness checklist in the Eligibility Reassessment case for access delegates ……………………………………………………………………………………………………. 9 6.1 What is the purpose of the Procedural Fairness Checklist? ………………………………………. 9 6.2 How does the Procedural Fairness Checklist work in PACE? ……………………………………. 9

7 Next steps …………………………………………………………………………………………………………… 10

SGP KP Publishing – Understand procedural fairness for eligibility reassessments

This article provides guidance for an local area coordinator, early childhood partner, planner delegate, and access delegate to:

• understand procedural fairness for eligibility reassessments
• complete manual procedural fairness checks during the Eligibility Check stage for access delegates
• complete manual procedural fairness checks during the Eligibility Reassessment Outcome stage for access delegates
• understand the procedural fairness checklist in the Eligibility Reassessment case for access delegates.

SGP KP Publishing – Understand procedural fairness for eligibility reassessments

1 Recent updates

20 January 2025

• Article title changed from Understand procedural fairness and eligibility reassessment requirements.
• Added new section Complete the procedural fairness checklist in the Eligibility Reassessment case.
• Removed section Consider the eligibility requirements. This has been added to article Complete the eligibility reassessment check.
• Changed name of link to article Review the referral information and complete the eligibility reassessment check to Complete the eligibility reassessment check.

SGP KP Publishing – Understand procedural fairness for eligibility reassessments

2 Before you start

You have read:

• Are you eligible for the NDIS? in Our Guideline – Applying to the NDIS (external)
• What happens if we check your NDIS eligibility? in Our Guideline – Leaving the NDIS (external)

SGP KP Publishing – Understand procedural fairness for eligibility reassessments

3 Understand procedural fairness

Procedural fairness is about the process being fair, unbiased and transparent. It’s about making sure we give participants a reasonable opportunity to have their say and provide us with evidence about their situation. To apply procedural fairness during an eligibility reassessment:

•  make sure the participant understands why we have made an eligibility reassessment
     referral, or started an eligibility reassessment
•   give the participant a reasonable opportunity to have their say and provide us with
    information about their situation
•   only ask participants for information you need to make an eligibility reassessment
    decision
•  make sure your decisions are fair and unbiased, and you don't have a conflict of
     interest.

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. For more information, go to the Policy Hub – Conflict of Interest.

Understand procedural fairness – 6

SGP KP Publishing – Understand procedural fairness for eligibility reassessments

4 Manual procedural fairness checks during the

Eligibility Check stage for access delegates

4.1 Have we been unable to contact (UTC) the participant?

A participant must have received NDIS supports for 12 months before we can start an eligibility reassessment.

To make sure this procedural fairness requirement is met, PACE will only move ER cases to the Eligibility Reassessment Routing Queue after 14 months. PACE will move ER cases after 14 months because it can take a few months for participants to set up their supports and start receiving them.

If referred for an eligibility reassessment before 14 months, the eligibility reassessment case will be automatically assigned to the Eligibility Reassessment Hold Queue. It will stay in the queue until they have received 14 months of NDIS supports.

If we’ve been unable to contact (UTC) the participant, you’ll usually progress these ER cases. You’ll need endorsement from an Assistant Director to progress an ER case for a participant who has been UTC.

4.2 Review all information and evidence before making a

decision

1.  Access delegates ensure procedural fairness by thoroughly reviewing existing
    information and evidence.

  Some sources of existing information include:

     o   conversations about the participant's situation that have been recorded

     o  any relevant documents on the participant's Person Account

     o  medical or clinical reports, diagnostic and assessment information

     o   service provider reports and assessments such as progress reports

     o   information provided with the participant's access to the NDIS

     o   early childhood partner documents

     o   information from family members and carers.

Manual procedural fairness checks during the Eligibility Check stage for access delegates – 7

SGP KP Publishing – Understand procedural fairness for eligibility reassessments

5 Manual procedural fairness check during the ER

Outcome stage for access delegates

1.  Access delegates complete a manual procedural fairness check before a participant
   can be revoked during an eligibility reassessment. This involves checking four
   components to ensure they have been completed correctly. Check:

     o  correspondence has been sent to the right person

     o  adequate contact attempts have been made. For more information see article
           [Contact attempts and unable to contact in an eligibility reassessment case](/foi-library/releases/d12c3f3ba399-foi-24-25-0830-documents-documents/document-011__contact-attempts-and-unable-to-contact-in-an-eligibility-reassessment-case/)

     o   for outstanding enquires

     o  any outstanding evidence extension requests

     o  for evidence the participant has made written or verbal requests to leave the
         NDIS.

          Note: If the participant has requested to leave the NDIS you'll need to create a
         Leaving Case using article Create voluntary leaving case. Complete the
         Leaving Case using article Complete voluntary leaving case.

                      If the participant has made a written request to leave the NDIS, you'll need to
         end the Eligibility Reassessment case before you can close the Leaving
         Case.

2.  To learn more about manual procedural fairness checks read article Finalise eligibility
   reassessment decision.

Manual procedural fairness check during the ER Outcome stage for access delegates – 8

SGP KP Publishing – Understand procedural fairness for eligibility reassessments

6 Understand the procedural fairness checklist in the

Eligibility Reassessment case for access delegates

In the Eligibility Reassessment case, both the Eligibility Check and ER Outcome tabs start with a Procedural Fairness Checklist.

6.1 What is the purpose of the Procedural Fairness Checklist?

The Procedural Fairness Checklist has questions to make sure access delegates are independent. This is how we make sure our decisions are fair and unbiased.

To be independent means you:

•   don't have a personal interest in the participant's status
•   don't have a personal relationship with the participant outside the NDIA
•   haven't been involved in the original access decision or any planning decisions.

For more information, go to the Policy Hub – Conflict of Interest.

6.2 How does the Procedural Fairness Checklist work in

PACE?

The Procedural Fairness Checklist in the Eligibility Reassessment case works to check you are an independent delegate for the specific participant. PACE will automatically check for the following questions:

•  Did you create the referral?
•  Have you made an Access Request for the participant linked to the ER?

Note: If the original Access Decision was made in SAP CRM you will need to check SAP CRM to make sure you did not make the original decision.

You will need to consider and respond to the following questions:

•  Have you approved any plan (old or active) for the Participant linked to the ER?
•  Do you have any conflicts of interest?

If Yes is selected for any of these questions, the case will be routed back to the Eligibility Reassessment Hold Queue for another access delegate to action the case.

Understand the procedural fairness checklist in the Eligibility Reassessment case for access delegates – 9

SGP KP Publishing – Understand procedural fairness for eligibility reassessments

7 Next steps

Action the case using the relevant article:

•   for an eligibility reassessment case In Progress use article Accept an eligibility
   reassessment case
•   for an eligibility reassessment case Pending Outcome Complete the eligibility
   reassessment check.

Next steps – 10