FOI 24/25-2381 DOCUMENT 6

Complete an eligibility reassessment

referral SGP KP Publishing

Exported on 2025-09-19 04:05:46

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SGP KP Publishing – Complete an eligibility reassessment referral

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

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

3 Create the Eligibility Reassessment case ………………………………………………………………. 6

4 Complete the eligibility reassessment referral ……………………………………………………….. 7

5 Contact the participant about the eligibility reassessment referral …………………………. 8

6 Next steps …………………………………………………………………………………………………………… 10

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SGP KP Publishing – Complete an eligibility reassessment referral

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

•   create the Eligibility Reassessment case
•   complete the eligibility reassessment referral
•   contact the participant about the eligibility reassessment referral.

Note: scheme integrity officers do not need to complete the referral workflow.

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SGP KP Publishing – Complete an eligibility reassessment referral

1 Recent updates

24 February 2025 Guidance updated: • If an Eligibility Reassessment case is created in error or system generated and not required, you won’t have delegation to withdraw the case. Instead, complete the questions in the referral tab. Add an Internal Note stating the eligibility reassessment referral is not required. If a referral is not required, the case will close. • If the participant met access for the NDIS with a primary disability of developmental delay or global developmental delay and a new disability that may meet the disability or early intervention requirements needs to be added, then you must complete an eligibility reassessment referral. • If the participant leaves the NDIS after an eligibility reassessment, they will no longer be a participant, and their plan will end 28 days after the decision or at their plan reassessment date, which every is earlier. • Included link to Our Guideline - Leaving the NDIS to support the conversation.

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SGP KP Publishing – Complete an eligibility reassessment referral

2 Before you start

You have either:

•   followed steps in article [When to refer the participant for an eligibility reassessment](/foi-library/releases/210ccb4f97d1-foi-24-25-2381-disclosure-log-documents/document-003__when-to-refer-the-participant-for-an-eligibility-reassessment/) and
   have decided to make an eligibility reassessment referral
•  been notified via the Omni-Channel that an automatic Eligibility Reassessment referral
   has been generated.

You have read and understood:

•    eligibility in Our Guideline – Applying to the NDIS (external)
•    eligibility reassessment in Our Guideline – Leaving the NDIS (external)
•    article [Guide - Conversation style guide appendix B](/foi-library/releases/d930a0edf246-foi-24-25-1367-documents-disclosure-log-part3/document-025__guide-conversation-style-guide-appendix-a/) section Sensitive Conversations.

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SGP KP Publishing – Complete an eligibility reassessment referral

3 Create the Eligibility Reassessment case

The fields within the referral workflow are dynamic and will update based on the participant’s age, residency, and disability requirements recorded in their Decisions, Justification and Evidence (DJE) framework. To check the DJE, use article When to refer the participant for an eligibility reassessment, section Review the participants original access decision and information.

During the eligibility reassessment process you will:

•   continue to be the my NDIS contact for the participant during this time
•   continue with the plan reassessment if one is in progress
•    let the participant know they can still use the NDIS supports in their plan
•   help them use the NDIS supports in their plan if they need you to.

Go to the participant’s Person Account.
Select Cases tab.

Check for an automatically generated Eligibility Reassessment case. Has a case already been generated? If:

 o  Yes: continue to section Complete the eligibility reassessment referral.

 o  No: continue to next step.

In the top right hand corner, select New.
Select Eligibility Reassessment from the case list.
Select Next.
Select Save.

Note: if an Eligibility Reassessment case is created in error or system generated and not required, you won’t have delegation to withdraw the case, unless you are a team leader in the Scheme Eligibility Branch. Instead, complete the questions in the referral tab. Add an Internal Note stating the eligibility reassessment referral is not required. If a referral is not required, the case will close.

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SGP KP Publishing – Complete an eligibility reassessment referral

4 Complete the eligibility reassessment referral

You must link supporting evidence to support the case when routed to an access delegate.

Check for any information related to the participant’s eligibility in the Enquiry inbox.
In the Eligibility Reassessment case, select Evidence tab. Link any relevant evidence to the case using article Add and link evidence to a case.
Select Referral tab.

Note: If the eligibility reassessment case was created before 19 January 2024, you must select Cancel. This will refresh the data allowing you to progress the eligibility reassessment case.
Complete the Residence and Early Intervention or Disability questions.
If the participant met access for the NDIS under the early intervention requirements with a primary disability of developmental delay or global developmental delay, the system will automatically create an eligibility reassessment referral when the participant ages out. If the participant has a new disability that may meet the disability or early intervention requirements that needs to be added, and there is not an existing eligibility reassessment referral, then you must complete an eligibility reassessment referral. As a temporary work around for PACE and for the referral to continue, you must select Yes to Has a disability on List A?, regardless if the disability is on List A.

Note: where the participant you are referring doesn’t have a disability on List A, make an Internal Note to explain the participant doesn’t have a disability on List A and you have selected Yes to Has a disability on List A? as a temporary work around for PACE.
Review the Summary information. Select Next.
Review the Decision information.

If amendments are:

o   required, select Back- Draft decisions list, and make the amendments.

o   not required, select Justification.

Review the Justification. Select Next.
Select Done. The referral is submitted.

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5 Contact the participant about the eligibility

reassessment referral

When contacting the participant, their nominee or child representative, make sure you follow the guidelines in article Guide - Conversation style guide.

Check the person’s preferred communication method and authorisations. For more information about contacting the participant, read article Contact attempts and unable to contact in an eligibility reassessment case.

Contact the participant, their nominee or child representative using article Contact attempts and unable to contact in an eligibility reassessment case. Your actions will be different depending upon if the person answers. If:

 o  Successful: introduce yourself and confirm if this is a suitable time for the call.
   Go to step 3.

 o  Unsuccessful: follow guidance in article Contact attempts and unable to
        contact in an eligibility reassessment case.

      **Note:** the only exception is if a child is 6 or older with developmental delay. You
     can make an eligibility reassessment referral if you were unable to contact the
         family. You still need to make and record your attempts to contact the family.

Complete a security check to verify you’re speaking to the correct person. Read article Consider a request for personal information, section How to complete a security check.

Help the person understand the referral. Select the relevant talking points below:

 o  During a plan reassessment, we may check to see if the participant is still
          eligible for the NDIS.

 o  We checked, and it looks like the participant either: no longer meets the
             eligibility requirements; now meets the early intervention requirements; or now
     meets the disability requirements.

 o  We call this an eligibility reassessment.

 o   Eligibility reassessments are separate from plan reassessments.

 o   Eligibility reassessments are completed by independent delegates.
      Independent delegate means one of our staff who hasn't made decisions about
        the participant's plan or eligibility before.

 o   Participants who are eligible under the early intervention requirements, have
       support needs that are more likely to change.

 o  We'll check each time a participant is due for a plan reassessment, whether
       they still meet early intervention requirements.

 o    If they've benefitted from early intervention supports, they might have built their
            skills and increased their capacity, so they no longer need NDIS supports.

 o  During check ins we'll explain what information we need to decide if they are
                 still eligible.

 o    If the participant no longer meets early intervention requirements, we'll check if
       they meet the disability requirements.

 o   We'll talk to families or carers before a child with developmental delay turns 6 or
         child with global developmental delay turns 7. We'll make sure we explain what
        information we need to decide if the child is still eligible.

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SGP KP Publishing – Complete an eligibility reassessment referral

  o    If the participant no longer meets the residence or disability and early
         intervention requirements, they will leave the NDIS. They will no longer be a
         participant, and their plan will end 28 days after the decision or at their plan
      reassessment date, whichever is earlier.

  o  For more information, refer to Our Guideline – Leaving the NDIS (external). You
      can also refer them to this information.

  o  The next steps are that a delegate will check through and consider if an
            eligibility reassessment is needed. You will be notified if this occurs.

5. Record your conversation in PACE using article Log an activity or internal note, to inform the access delegate that the participant has been notified of the referral. This also means the participant doesn’t have to retell their story when we contact them.

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6 Next steps

Once the referral has been submitted, the case will move to In Progress and route to the eligibility reassessment queue.

An access delegate will start an ER eligibility check.

You can view the details and progress of this case from the Details tab of the participants Account.

If the access delegate decides the change of disability status, you’ll be notified in PACE. You’ll support the person to receive the appropriate supports.

If an access delegate decides the person is no longer eligible, you’ll be notified in PACE. You’ll support the person to:

o   leave the NDIS and understand our eligibility decision, using Our Guideline –
     Leaving the NDIS (external)

o  understand their rights when it comes to reviews and complaints, using Our
      Guideline – Reviewing our decisions (external)

o   start or help maintain connections with community and mainstream supports,
      using Our Guideline – Community connections (external).

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