FOI 24/25-1473 DOCUMENT 35

Consider priority eligibility decision

SGP KP Publishing

Exported on 2025-04-02 05:42:18

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FOI 24/25-1473

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Check priority eligibility request ……………………………………………………………………………. 6 3.1 Omni-channel ……………………………………………………………………………………………………… 6 3.2 Check prioritisation details …………………………………………………………………………………….. 6 3.3 Check disability ……………………………………………………………………………………………………. 6 3.4 Check priority evidence ………………………………………………………………………………………… 6 4 Action priority eligibility decision ……………………………………………………………………… 7 4.1 Consider priority eligibility decision ……………………………………………………………………… 7 4.2 Make priority eligibility decision ……………………………………………………………………………… 7 5 Next steps …………………………………………………………………………………………………………….. 9

Table of Contents – 2

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This article provides guidance for an access delegate and quality officer to:

• check priority eligibility request
• action the priority eligibility decision.

Recent updates – 3

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1 Recent updates

3 October 2024

Update to linked article titles. This reflects articles which have had a name update for legislation changes.

Recent updates – 4

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2 Before you start

You have:

• read and understood Our Guideline – Applying to the NDIS (external), including section When do we make priority eligibility decisions? (external)
• received a priority eligibility decision request
• read article Check decision – Legislative timeframes
• been following guidance in article Make an access decision – pre-legislation changes or Make an access decision – post legislation changes.

Note: to request a priority eligibility decision, refer to article Request priority eligibility decision.

Before you start – 5

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3 Check priority eligibility request

3.1 Omni-channel

1. At Home page, select Omni-channel. Screen tip: find the omni-channel in the bottom-left of the screen.
2. A Status message will display. Above this message select from the drop-down menu and set status to Available.
3. Select the tick box to action the case.
4. The Access Decision case will open.
5. Set Omni-channel status to Offline.

3.2 Check prioritisation details

1. Select the open Access Decision case, then select Details.
2. Scroll to Prioritisation section.
3. Review the Prioritisation Reason and Priority Description.
4. Review the information in Prioritisation Comment.

3.3 Check disability

In Person Account, select My Profile tab, select Disabilities tab.

If applicable, also refer to these articles:

• Check eligibility - EI - developmental delay
• Check eligibility - EI - hearing loss 0-25 years of age.

3.4 Check priority evidence

If applicable, also refer to these articles:

• Check eligibility - EI - developmental delay
• Check eligibility - EI - hearing loss 0-25 years of age.

1. In Access Decision case tab, select Documents tab.
2. Review document Category, Sub Category and Description.
3. Open document to review further detail.

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4 Action priority eligibility decision

4.1 Consider priority eligibility decision

1. Check the available evidence about the applicant’s situation.
2. Does the applicant’s evidence match the recommendation?
3. Is there evidence to support at least one situation required for a priority eligibility decision in the section When do we make priority eligibility decisions? (external) in Our Guideline – Applying to the NDIS? (external) These reasons are:
   • imminent risk for example, to self, others, community or Agency where appropriate disability or informal supports aren’t in place
   • unexpected significant deterioration
   • rapid deterioration in functional capacity of a person with one of the following permanent disabilities:
     • Amyotrophic Lateral Sclerosis
     • Brain Cancer
     • Motor Neurone Disease
     • Primary Lateral Sclerosis
     • Progressive Bulbar Palsy
     • Progressive Muscular Atrophy
   • developmental delay, turning 6 years old within 30 days of a valid NDIS application
   • 0-6 years with hearing impairment
   • Agency reputation risk. The Prioritisation Description for this decision must be either, Agency error or High level complaint activity.

Note: this reason isn’t one of the reasons for priority eligibility decision mentioned in When do we make priority eligibility decisions? (external).

4.2 Make priority eligibility decision

1. In Details tab, scroll to Case Information section.
2. The Priority, field is automatically set by PACE. You can’t edit this field.
3. Scroll to Prioritisation section.
4. Record your decision on the recommendation in Prioritisation Comment:
   • Decision: <priority/nonpriority>
   • Assessment: urgent decision requirements are <met/not met>
   • Priority eligibility decision considered from request by on
   • Access request validation on
   • Decision rationale: based on the applicant’s situation, available evidence and information from Our Guideline – Applying to the NDIS (external)
   • Escalation reason: or

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• Priority marked as <None/High/Medium/Low/Overdue> to <not escalate/escalate> for decision via priority queue

  Note: template completion is mandatory to action your decision.

5. At Prioritisation Reason and Priority Description:
   • For priority decision – leave as is.
   • For non-priority decision – select None. If the priority eligibility request is declined based on the evidence provided, you must contact the applicant to explain the reason for the decision. The decision must be made within 21 calendar days of the valid application date.

For more information about requirements for a priority eligibility decision, read Our Guideline – Applying to the NDIS (external), including section When do we make priority eligibility decisions? (external).

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5 Next steps

Continue to follow guidance in article Make an access decision – pre-legislation changes or article Make an access decision – post-legislation changes.

Next steps – 9

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