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Make a plan change decision

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DOCUMENT 2 FOI 24/25-1942

Make a plan change decision SGP KP Publishing

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FOI 24/25-1942 SGP KP Publishing – Make a plan change decision

Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Make a decision on a plan change request …………………………………………………………….. 6 4 Record an overall plan change decision ………………………………………………………………… 8 4.1 s47A variation decisions ……………………………………………………………………………………….. 8 4.2 s48 reassessment decisions …………………………………………………………………………………. 9 5 Communicate your decision ………………………………………………………………………………… 10 6 Add free text sub-justifications ……………………………………………………………………………. 11 6.1 Plan variation sub-justifications ……………………………………………………………………………. 11 6.1.1 Not to vary – add crisis or emergency funding in the plan ………………………………………………….. 11 6.1.2 Not to vary – correct a minor or technical error in the plan …………………………………………………. 11 6.1.3 Not to vary – add supports to the plan ……………………………………………………………………………. 12 6.1.4 Not to vary – make minor changes to funding in the plan ………………………………………………….. 12 6.1.5 Not to vary – make minor change to supports in the plan ………………………………………………….. 12 6.1.6 Not to vary – change the plan reassessment date ……………………………………………………………. 13 6.1.7 Not to vary – change the plan management type ……………………………………………………………… 13 6.1.8 Vary – add crisis or emergency funding ………………………………………………………………………….. 14 6.1.9 Vary – change the plan management type ………………………………………………………………………. 14 6.1.10 Vary – correct a minor or technical error in the plan …………………………………………………………. 14 6.1.11 Vary – make minor change to the funding in the plan ……………………………………………………….. 14 6.1.12 Vary – make minor change to the supports in the plan ……………………………………………………… 14 6.1.13 Vary – change the plan reassessment date …………………………………………………………………….. 15 6.2 Plan reassessment justifications ………………………………………………………………………….. 15 6.2.1 Not to reassess – change in situation …………………………………………………………………………….. 15 6.2.2 Not to reassess – change to the funding in the plan …………………………………………………………. 15 6.2.3 Not to reassess – change while the plan is suspended …………………………………………………….. 15 6.2.4 Reassess – change in situation …………………………………………………………………………………….. 15 6.2.5 Reassess – change to the funding in your plan ……………………………………………………………….. 15 7 Next steps …………………………………………………………………………………………………………… 16

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FOI 24/25-1942 SGP KP Publishing – Make a plan change decision

This article provides guidance for a planner delegate or review officer to:

• make a decision on a plan change request • record an overall plan change decision • communicate your decision • add free text sub-justifications.

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1 Recent updates

3 April 2025 Updated guidance to include all sub-justifications for when the user needs to add extra sub- justifications in the free text field. 10 March 2025 Updated guidance to: • consider information recorded at the reassessment check-in parent case • introduce the new plan continuation letter. 3 March 2025 Update to include free text justifications for new plan variation and plan reassessment rules.

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2 Before you start

Note: if you have a plan change request over 21 days do not use this article. Instead, go to Progress a plan change (s47A and s48) request over 21 days.

You have:

• been allocated or assigned yourself a plan change case (received less than 21 days ago) • reviewed the plan change request. Go to article Assign and review a plan change case • read and understood Our Guideline – Changing your plan (external).

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3 Make a decision on a plan change request

When making a plan change decision, you’ll need to consider the following:

• the participant’s situation, including any information or evidence provided • the confidence level for the participant to continue using their plan, which can be found under the Decisions tab • the criteria that must be met to decide to vary a plan or complete a plan reassessment • the type of plan change request. For example, if the plan change case is for a s47A, then you’ll need to decide either to vary or not vary. If you think the participant needs a reassessment, then you’ll need to make a decision not to vary for the s47A and make a decision to do a ‘CEO-initiated plan reassessment’ • the information recorded at the reassessment check-in, linked as a parent case to the generated plan change case. For example, the recommendation from the reassessment check-in to vary the participant’s plan and continue the same NDIS supports. Learn more about how to do this in section If the plan change request is generated from a reassessment check-in of article Assign and review a plan change case. • if a variation to change the plan reassessment date will result in the plan not being reassessed for more than 5 years.

To learn more about changing a plan, go to Our Guidelines – Changing your plan (external).

Note: when a participant is eligible for specialist disability accommodation (SDA) but hasn’t located an enrolled dwelling or isn’t ready to move in, a $1 amount is included in the SDA support category as a placeholder. The plan comment is used to let the participant, or their authorised representative know of the SDA decision. Once the participant finds an enrolled SDA dwelling and confirms they can move in, we can consider a s47A to include the SDA funding. In this situation this s47A can only be considered when the request is only for SDA funding.

You’ll need to record your decision for each plan change request in the Plan Change Case.

Depending on the legislative type selected, some plan change requests may be marked as Not Required. If the status of the plan change request is Not Required, you don’t need to do anything.

  1. In the Plan Change case, select the Decision tab.
  2. Select the correct hyperlink within the Plan Change Requests table.
  3. At Plan Change Request, select the Decision tab.
  4. Select a decision from the What decision do you want to make? drop-down list.

Note: if any of the plan change requests are CEO-initiated, you won’t be able to decline the request.

  1. Select a Justification from the drop-down list.
  2. Select the most suitable Sub-justification from the drop-down list.

Note: If you decide to decline a plan change request or partially vary the plan, the Sub- justification you select will be printed on the plan change decision letter.

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If you:

o need to include additional sub-justifications, go to section Add free text sub- justifications in this article o don’t need to include additional sub-justifications, go to step 7.

  1. Select Save.
  2. If needed, add any supporting evidence for the decision by selecting New.
  3. Select Submit.

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4 Record an overall plan change decision

4.1 s47A variation decisions

For s47A requests, you’ll need to record an overall plan change decision. You’ll need to do this after you’ve recorded your decision on each plan change request in the case.

Note: your overall plan change decision needs to match the decision of each individual plan change request.

  1. In the Plan Change case, select the Decision tab.
  2. Select Overall Decision.
  3. Select Decision from the drop-down list.
  4. Select Justification from the drop-down list.
  5. Enter Justification Details into the text field.
  6. If you need to add evidence to the decision, select New and go to step 7. Otherwise, go to step 11.
  7. To add evidence, select the Evidence Type from the drop-down list:

o If you select Document, go to step 8. o If you select Other, go to step 9.

  1. Enter the Evidence Link name. You can view linked evidence on the Evidence tab of the Plan Approval case. To learn more about linking evidence, go to article Add and link evidence to a case.
  2. Enter the Evidence Explanation into the free text field.
  3. Select Save.
  4. Select Submit.

Note: once the overall decision is made, this can’t be changed.

  1. In the Plan Change case, select the Decision tab.
  2. Select Generate Decision Letter.
  3. Select Yes at Are you sure you want to generate the Decision Letter?
  4. Select Submit.

To view decision letters, go to article Understand and view plan change decision letters.

Notes:

• if the participant has a statutory guardian and the relationship is established with an organisation account, you’ll need to manually send the auto-created Decision letter to the statutory guardian. To do this, go to article Send a letter to a statutory guardian or trustee • if the overall decision is to vary the reassessment date to continue the participant’s current NDIS supports for up to 12 months, you’ll need to send the auto-created Plan

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Continuation letter. This letter is generated when the plan change case is complete and closed • if the overall decision is not to vary because a plan reassessment (s48) is needed, you’ll need to create a CEO-initiated plan reassessment (s48) request. Go to article Create a plan reassessment (s48) request.

4.2 s48 reassessment decisions

The overall decision on a s48 plan change case is determined when making the decision on the individual plan change request.

  1. In the Plan Change case, select the Decision tab.
  2. Select Generate Decision Letter.
  3. Select Yes at Are you sure you want to generate the Decision Letter?
  4. Select Submit. To view decision letters, go to article Understand and view plan change decision letters.

Note: if the participant has a statutory guardian and the relationship is established with an organisation account, you’ll need to manually send the auto-created Decision letter to the statutory guardian. To do this, go to article Send a letter to a statutory guardian or trustee.

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5 Communicate your decision

You’ll need to let the participant know once you’ve made your decision.

You must use the relevant scripting in section Discuss a plan change decision of article Discuss a participant plan change request when contacting the participant or their authorised representative.

To record your contact attempts, go to article Contact attempts and unable to contact in a plan change case.

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6 Add free text sub-justifications

Use the relevant free text sub-justifications by copying and pasting them in the Details field by selecting Edit Detail.

Information in the details field won’t print on the plan change decision letter.

Note: You can select multiple free text sub-justifications listed below.

6.1 Plan variation sub-justifications

6.1.1 Not to vary – add crisis or emergency funding in the plan • There is funding available in the participant’s plan which can be used flexibly to meet their support needs. • The participant’s plan cannot be changed as it is suspended. • The participant’s plan cannot be varied as their situation has changed significantly. The participant’s plan needs to be reassessed. • Not enough information has been provided to support the participant’s request. • The support the participant has requested can be met by informal, mainstream, or community supports. • The evidence provided does not show a significant change in the participant’s support needs that needs urgent crisis or emergency funding. • The funding requested does not meet the conditions in the rules for the NDIS. • The information provided does not show the participant’s NDIS support needs have changed significantly. • The funding requested does not meet the conditions in the NDIS rules. The information provided does not show a significant change in the participant’s support needs is due to a change in situation. • The funding requested does not meet the conditions in the NDIS rules. The information provided does not show a significant change in the participant’s support needs is due to a change in functional capacity. • The funding requested does not meet the conditions in the NDIS rules. The information provided does not show a significant change in the participant’s support needs is due to a change in informal supports. • The funding requested does not meet the conditions in the NDIS rules. The information provided does not show a significant change in the participant’s support needs is due to a change in living arrangements. • The funding requested does not meet the conditions in the NDIS rules. The funding cannot be provided by the NDIS as it is best funded or provided by another commonwealth, state or territory program.

6.1.2 Not to vary – correct a minor or technical error in the plan • There are no errors that need to be fixed in the participant’s plan. • The participant’s plan cannot be changed as it is suspended. • The participant’s plan cannot be varied. The plan needs to be reassessed to fix an error and look at other supports in the plan.

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• The participant’s plan cannot be varied. The plan needs to be reassessed, as the participant’s request relates to a significant change in situation and not a technical error. • The participant’s request is to understand how a previous decision was made and not to fix an error. To request a change to the previous decision, the participant needs to ask for a review of the original decision.

6.1.3 Not to vary – add supports to the plan • The participant’s plan cannot be changed as it is suspended. • The support the participant requested does not meet the NDIS funding criteria.

6.1.4 Not to vary – make minor changes to funding in the plan • The participant’s request relates to a previous decision. To request a change to the previous decision, the participant needs to ask for a review of the original decision. • The participant’s plan cannot be varied. The plan needs to be reassessed, as the participant has used their funds quicker than expected. • The information provided shows that the participant can use their funding flexibly to meet their needs. • The participant’s plan cannot be varied as their situation has changed significantly. The participant’s plan needs to be reassessed. • The participant’s plan cannot be changed as it is suspended. • Not enough information has been provided to support the participant’s request. • The increase in funding requested does not meet the conditions set out in the rules for the NDIS. • The increase in funding requested does not meet the conditions set out in the rules for the NDIS as it is not for a home modification, vehicle modification or assistive technology support. • The increase in funding requested does not meet the conditions set out in the rules for the NDIS. Additional funding is not required as there’s available funding in the plan to pay for the support. • The increase in funding requested does not meet the conditions set out in the rules for the NDIS. The support can still be provided in the same way as expected in the plan. • The increase in funding requested does not meet the conditions set out in the rules for the NDIS. The support in the plan can be provided without additional information, services or materials. • The participant’s plan cannot be varied. The plan needs to be reassessed to make a minor change to the plan and look at other supports in the plan.

6.1.5 Not to vary – make minor change to supports in the plan Note: you’ll need to add this free text sub-justification into the Details field for ‘Make minor changes to funding in the plan’.

• The participant’s request relates to a previous decision. To request a change to the previous decision, the participant needs to ask for a review of the original decision. • The participant’s plan cannot be varied. The plan needs to be reassessed to look at other supports in the plan. • The request is for a support that is not in line with what the NDIS rules say we can fund.

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• The information provided shows the support requested is the same as a support already in the plan. • The request is for a support that is not in line with what the NDIS rules say we can fund. The support isn’t for a set period of time or a one-off support. • The request is for a support that is not in line with what the NDIS rules say we can fund. The support requested isn’t to replace, repair or maintain assistive technology funded in the current or previous plan. • The request is for a support that is not in line with what the NDIS rules say we can fund. The support requested isn’t urgently needed to support economic participation for a set period of time. • The request is for a support that is not in line with what the NDIS rules say we can fund. The support requested isn’t urgently needed to help build skills or support a life change over a set period of time. • The request is for a support that is not in line with what the NDIS rules say we can fund. The support requested is the same as or has the same outcome as a support already provided in the plan. • The information provided shows the support requested can be met by informal, community and mainstream supports. • The participant’s plan cannot be varied. The plan needs to be reassessed as the changes the participant has asked for are too significant to consider in a variation. • The participant’s plan cannot be changed as it is suspended. • Not enough information has been provided to support the participant’s request.

6.1.6 Not to vary – change the plan reassessment date • A plan cannot go for more than 5 years without a reassessment. This means we’ll work with you to create a new plan before your plan’s current reassessment date. • The participant’s plan cannot be changed as it is suspended. • The participant’s plan cannot be varied. The plan needs to be reassessed, to change the reassessment date and look at other supports in the plan. • The participant’s plan cannot be varied as their situation has changed significantly. The participant’s plan needs to be reassessed. • The information provided shows that the participant can use their funding flexibly to meet their needs.

6.1.7 Not to vary – change the plan management type • The plan nominee is bankrupt or insolvent under administration. • There is evidence that the participant is bankrupt or insolvent under administration. • The participant has been convicted of an offence punishable for 2 or more years in prison or involves fraud or dishonesty. • The plan nominee has been convicted of an offence punishable for 2 or more years in prison or involves fraud or dishonesty. • The participant’s plan cannot be changed as it is suspended. • The participant’s plan cannot be varied. The plan needs to be reassessed, to change the plan management type and look at other supports in the plan. • The type of plan management requested poses an unreasonable risk, even with supports, safeguards and strategies in place.

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• The rules for the NDIS say these supports cannot be self-managed. • There is evidence of non-compliance with requests to provide required information or documents. • There is evidence of conduct involving fraud or mismanagement or misuse of funds or other assets. • There is evidence of the participant or the person managing the funding being subjected to legal or financial exploitation or coercion. • There is evidence the participant or the person managing the funding does not have capacity to make decisions or appropriately manage finances. • The funding is unlikely to be spent on NDIS supports. • The funding is unlikely to be spent in line with the plan. • The funding is unlikely to be spent on NDIS supports and in line with the plan.

6.1.8 Vary – add crisis or emergency funding • Urgent crisis or emergency funding is needed for a period of time or one off due to the significant change in support needs.

6.1.9 Vary – change the plan management type • The participant’s plan can be self-managed by the participant. • The participant’s plan can be self-managed by their nominee. • The participant’s plan can be agency-managed as requested. • The participant’s plan can be plan-managed by a registered plan management provider as there is no evidence of unreasonable risk to the participant.

6.1.10 Vary – correct a minor or technical error in the plan • The participant’s plan is being varied to correct the error in how their funded supports are calculated. • The participant’s plan is being varied to correct an error. • The participant’s plan is being varied to correct the error in how their funding is managed.

6.1.11 Vary – make minor change to the funding in the plan • The information provided shows a minor change to the funding in the plan will meet the participant’s needs and the conditions in the NDIS rules.

6.1.12 Vary – make minor change to the supports in the plan Note: you’ll need to add this free text sub - justification into the Details field for ‘Make minor changes to funding in the plan’.

• The information provided shows a minor change to the supports in the plan will meet the participant’s needs and the NDIS funding criteria.

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6.1.13 Vary – change the plan reassessment date • The participant’s plan is being varied to change the reassessment date as the evidence shows the current plan is likely to continue to meet the participant’s needs.

6.2 Plan reassessment justifications

6.2.1 Not to reassess – change in situation • The information provided shows that the participant can use their funding flexibly to meet their needs. • Not enough information has been provided to support the participant’s request. • The information provided does not show a significant change in the participant’s need for NDIS supports due to a change in situation. • There is no new information which shows the participant’s need for NDIS supports has significantly changed.

6.2.2 Not to reassess – change to the funding in the plan • There is no new information which shows the participant’s need for NDIS supports has significantly changed. • Not enough information has been provided as to why the participant needs the support. • The support the participant has requested does not relate to their disability. • The changes requested can be considered when the plan is due for reassessment. • The support the participant has requested should be met by informal, mainstream, or community supports. • There has been no change to the participant’s entitlement to compensation. • There has been no change to the participant’s right to personal injury supports under a scheme of insurance or commonwealth, state or territory law.

6.2.3 Not to reassess – change while the plan is suspended • The participant’s plan cannot be changed as it is suspended.

6.2.4 Reassess – change in situation • The participant’s plan will be reassessed. • The information provided shows that a minor change will meet the participant’s needs and the NDIS funding criteria.

6.2.5 Reassess – change to the funding in your plan • The information provided shows that a minor change to the supports in the plan will meet the participant’s needs and the NDIS funding criteria. • The change the participant has requested meets the NDIS funding criteria. We will contact the participant to make a time to work with them to create a new plan.

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7 Next steps

You or another delegate may complete the next steps. This will depend on the routing of the case.

• For a variation, from the Plan Change case, select the Budget Update tab. To complete the plan variation, go to article Action a budget update. • For a reassessment, from the Plan Change case, select the Reassessment tab. Select the Case hyperlink to open the Plan Approval case to complete the reassessment. Go to article Change the draft budget. • For decisions not to vary or reassess, no further steps are needed. Correspondence has been generated, and the plan change case will move to the Completed stage. The plan change case is now closed.

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