Record a request for internal review

DOCUMENT 3 FOIOFFICIAL23/24-1198 Standard Operating Procedure For Internal Use Only

The contents of this document are OFFICIAL.

Record a request for internal review

This Standard Operating Procedure (SOP) will help you record a request for internal review of a reviewable decision (internal review). This is also internally known as a s100 review.

Note: Before you create a request for internal review, review the Internal Review Team intranet page and make sure it is the appropriate action. This includes using the Choose the right request tool (CRRT).

1. Recent updates

Date What’s changed

November 2022 Language updated to align with the amendments to the NDIS Act that came into effect on 1 July 2022. Plan Review has been updated to plan reassessment.

Updates also include how to record plan variation (s47A) internal review (s100) requests.

August 2021 New SOP format to align with Operational Guidelines refresh. SOPs include process information only. Use Operational Guidelines to help you make decisions and refer to Related procedures or resources.

The following guidance has been added:

• pre-requisite to refer to the NDIA’s Participant Critical Incident

Framework if there is an imminent risk of harm to the

participant or someone else • guidance to refer to the NDIS Quality and Safeguards

Commission for complaints related to Providers • pre-requisites, section 3.2 and section 3.3 updated to clarify

that you need to confirm, obtain and record express consent • internal reviews lodged via the Feedback Form are now

assigned to CR PED NAT/VIC IRT Planning Incoming, instead

of Scott Graham.

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FOIOFFICIAL23/24-1198 Standard Operating Procedure For Internal Use Only 2. Checklist

Topic Checklist

Pre-requisites You have:

❑ confirmed with the participant they disagree with a reviewable decision and want a review of that decision ❑ identified the participant’s review request relates to a reviewable decision and identified any risks. You have done this using Our Guideline – Reviewing our decisions ❑ if there is imminent risk of harm to the participant or someone else, you have referred to the NDIA’s Participant Critical Incident Framework ❑ established express consent and recorded it in an Interaction if the person requesting the review is not the participant ❑ confirmed the NDIA received the request within 3 months of the day after the person was advised of the original decision ❑ confirmed the participant’s plan was not created as a result of ❑ a previous internal review decision ❑ an external review (Administrative Appeals Tribunal) decision ❑ uploaded any documents to Inbound documents. Examples include request forms, emails, new supporting evidence, documents and materials provided with the review request ❑ found that this is related to a provider complaint, and you have referred the person to the NDIS Quality and Safeguards Commission.

If the reason for the internal review request is a decision about the Statement of Supports, you have confirmed with the participant:

❑ the request is not related to supports no longer meeting their needs because of a change of situation. If their plan is no longer suitable, you can request a plan reassessment using Standard Operating Procedure – Create a plan reassessment (or variation) request (PRR) ❑ the request is because they disagree with the previously approved statement of supports.

Actions ❑ 3.1 Consider active internal review requests

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Topic Checklist

❑ 3.2 Identify whether to record the request using the s100 form or the Feedback form

Either:

❑ 3.3 Record a request for internal review (Feedback form) ❑ 3.4 Record a request for internal review (s100 form)

Then:

❑ 3.5 Next steps

3. Procedure

3.1 Consider active internal review requests

3.1.1 Check for an active internal review request

1. Check the participant record for an active ‘S100 in progress’ Alert.

2. Check for an active internal review (s100) request using the Standard Operating Procedure –View or edit an open request for internal review.

• If there is no active internal review request, go to 3.2 Identify whether to record the

request using the s100 form or the feedback table. • If there is an active internal review request, go to 3.1.2 There is an active internal

review request.

3.1.2 There is an active internal review request

1. Advise the participant that their internal review request remains active and that an internal review officer will be in contact to discuss the next steps.

2. Add an Interaction using Interaction Template – Reassessments and variations – Participant plan reassessment (or variation) request (PRR) – Request escalated.

3. Assign Open Interaction to the Internal Review Team inbox: CR PED NAT/VIC IRT Planning Incoming.

4. Go to 3.5 Next steps.

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3.2 Identify whether to record the request using the s100 form or the Feedback form

Use the tables below to identify which form you need to use to record the request for internal review. The forms are in the System.

1. Go to the relevant table:

• Reviewable decision table – Access and Eligibility Reassessment • Reviewable decision table – Participants and plans • Reviewable decision table – Guardians and nominees • Reviewable decision table – Compensation.

2. Find the reviewable decision for this request in the first column (Reviewable decision). You can use the description in the second column (A decision) to help you identify the relevant reviewable decision.

3. Check the third column (Record the request for internal review using). This tells you which form in the System you need to use to record the request.

4. Record the request for internal review using the:

• feedback form go to 3.3 Record a request for internal review (Feedback form) • s100 form go to 3.4 Record a request for internal review (s100 form).

3.2.1 Reviewable decision table – Access and Eligibility Reassessment

Reviewable A decision: Record the request for internal Decision review using:

Access not met that a person does not meet the s100 form access criteria

Not to specify a not to specify a period. This Feedback form period relates to when an Access Delegate doesn’t have enough information to make a decision about eligibility and requests more information from the applicant. The reviewable decision relates to when the Access Delegate

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Reviewable A decision: Record the request for internal Decision review using:

doesn’t specify the date the information is required.

Access revoked to revoke a person’s status as a s100 form participant (eligibility reassessment)

3.2.2 Reviewable decision table – Participants and plans

Reviewable A decision: Record the request for internal Decision review using:

Statement of to approve the statement of s100 form supports supports in a participant’s plan

Not to extend a not to extend a grace period Feedback form grace period

Not to reassess a not to reassess the participant’s s100 form plan plan (s48)

Plan variations to vary or not to vary a s100 form participant’s plan (s47A)

3.2.3 Reviewable decision table – Guardians and nominees

Reviewable A decision: Record the request for internal Decision review using:

A determination to make, or not to make, a Feedback form in relation to a determination. This is in relation to person a person (State or Territory Minister parental responsibility for a child).

Do not apply to a to make, or not to make a Feedback form child determination that subsections

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Reviewable A decision: Record the request for internal Decision review using:

74(1) and (2) of the NDIS Act 2013 do not apply to a child

Parental to make, or not make, a Feedback form responsibility for determination that person has a child parental responsibility for a child

Appoint a plan to appoint a nominee Feedback form nominee

Appoint a to appoint a correspondence Feedback form correspondence nominee nominee

Cancel/suspend a to cancel or suspend, or, not to Feedback form nominee cancel or suspend, the appointment of a nominee

3.2.4 Reviewable decision table – Compensation

Reviewable A decision: Record the request for internal Decision review using:

Claim or obtain to give notice to require a person Feedback form compensation to take reasonable action to claim or obtain compensation

Claim or obtain to refuse to extend a period Feedback form compensation (compensation)

Claim or obtain to take action to claim or obtain Feedback form compensation compensation

Claim or obtain to take over the conduct of a claim Feedback form compensation

Recover an to give a notice that the CEO Feedback form amount proposes to recover an amount

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Reviewable A decision: Record the request for internal Decision review using:

Compensation not to treat the whole or part of a Feedback form payment compensation payment as not having been fixed by a judgement or settlement

3.3 Record a request for internal review (Feedback form)

1. From the NDIS Account screen select Add items and then Feedback.

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2. The Feedback form displays.

Complete the following fields:

• Description: s100 Internal Review. • When was the Feedback received: the date the NDIA received the request for

internal review. • Feedback Type: select Appeal: Internal Review from the drop down list. • Feedback details: copy and paste the template below into the feedback field.

Update the details and remove the examples.

Template for s100

Consent given: Yes or No. If yes, detail where you recorded the express consent. For

example, ‘Yes, express consent given over the phone and recorded as an interaction,

interaction number: xxxx’. If the person making the request is not the participant or

affected person, you must record express consent here.

Subject of review request: Describe what the participant disagrees with and wants the

NDIA to review. Be specific by describing what decision they disagree with or points that

are subject to review. For example, ‘a compensation reduction amount was applied to

my plan that I disagree with’.

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Considerations: What information does the affected person want the NDIA to

consider? For example, additional evidence or supporting information, correspondence/

interactions that form part of the request for the review.

Risks: Describe any risks. For example, risk of homelessness, relinquishment, care

arrangements breaking down, media involvement, ministerial involvement.

Additional documentation provided: Yes or No. If yes, list documentation.

• Primary Category: select the reason for the internal review from the drop down list. • Desired Resolution: select Reconsider Decision from the drop down list. • Desired Resolution details: briefly state what the person would like the NDIA to

decide. For example, ‘I want the nominee I selected appointed’. • Acknowledgement Date: add the date the NDIA received the request. This may be

different from the date you enter the request, or the date on a letter.

3. Select People.

4. The People Information selection displays.

Complete the following fields:

• How was the Feedback received: select from the drop down list. • What is the source of the Feedback: select from the drop down list. Depending on

the option you select, additional field/s will show. Complete all fields.

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5. Select Save.

6. A confirmation message displays. Select OK.

7. Select Re-assign.

8. Re-assign to Team Responsible CR PED NAT/VIC IRT Planning Incoming.

9. Select Assign.

10. The success message displays. Select Close.

11. Select Edit.

12. Select Attachments.

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13. Select Add (plus sign) to add attachments. Include any request forms, emails, new supporting evidence, documents and materials provided with the review request.

14. The success message displays, select OK.

15. Select Save.

16. The success message displays, select OK.

17. Complete the Interaction using Interaction Template – Internal Review – s100 – Internal review requested.

Note: You must record this interaction in the Interactions tab. Record all other interactions through Feedback.

18. Go 3.5 Next steps.

3.4 Record a request for internal review (s100 form)

Follow these steps to record a request for internal review. If you need to raise a request for internal review of a decision to vary or not vary a plan (s47A), go to 3.4.1 Record a request for internal review of a decision to vary or not vary a plan (s47A).

1. From the NDIS Account screen, select Add items and then select s100 Request.

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2. The Create s100 Request screen displays.

Complete the following fields:

• Reviewable Decision: select from the drop down list. • Requested By: select the person requesting the internal review from the drop down

list. People with an active contact record associated with the participant or affected

person will appear in this list. The person requesting the review may work for an

organisation listed in the contact list but don’t have their own active contact record.

If this happens:

• go to the My Organisations tile

• check if they are recorded as a primary contact for their organisation

• if not, you will need to establish express consent and record it in Supporting

Information.

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• Date of Request: add the date the NDIA received the request. This may be

different from the date you enter the request. • Supporting Information: copy and paste the template below into the field, update

the details and remove the examples. You must complete all the fields in the

template. This is so the internal review officer can assess the request in a timely

manner.

Template for s100

Consent given: Yes or No. If yes, explain where you recorded express consent. For

example, ‘Yes, express consent given over the phone and recorded as an interaction,

interaction number: xxxx.’ If the person making the request is not the participant or

affected person, you must record express consent here.

Subject of review request: Describe what the participant or affected person disagrees

with and wants the NDIA to review. Be specific by describing supports or points that are

subject to review. For example:

‘At my planning meeting I was told my request for funding for in home support would be

included but it isn’t’

‘I do not want my funding to be Agency managed’.

Considerations: What information does the affected person want the NDIA to

consider? For example, additional evidence or supporting information, correspondence/

interactions that form part of the request for the review.

Risks: Describe any risks. For example, risk of homelessness, relinquishment, care

arrangements breaking down, media involvement, ministerial involvement.

Additional documentation provided: Yes or No. If yes, list documentation.

• Channel: select how the request was received from the drop down list. • Reason for Request: select from the drop down list. The options in the list will be

different depending on which Reviewable Decision you have selected. • Available Decision: select the look-up tool (two overlapping boxes) and for:

• Access Not Met, select the most recent access decision

• Access Revoked, select the most recent access decision

• Statement of Supports, select the current plan

• Not to Review a Plan, select the current plan.

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• Expected Outcome: briefly state what the person would like to happen. This helps

the internal review officer assess the request in a timely manner. Be specific by

describing any supports they want funded or their preferred outcome. For example,

to have level 2 transport funding included or increase in Support Coordination to 2

hours per week.

3. Select Add (plus sign) to add any attachments. Include review request forms, emails, new supporting evidence, documents and materials provided with the review request.

4. Select Submit.

5. Success message displays. Select OK.

6. Complete the Interaction using Interaction Template – Internal Review – s100 – Internal review requested

7. Go to 3.5 Next Steps.

3.4.1 Record a request for internal review of a decision to vary or not vary a plan (s47A)

A request for an internal review of a plan variation (s47A) request can be made for either:

• a decision not to vary a plan. The s100 form will be linked to the rejection of the

s47A request not to vary a plan. • a decision to vary a plan but the participant is still not satisfied. The s100 form will

be linked to the approved statement of supports decision.

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1. From the NDIS Account screen, select Add items and then select s100 Request.

2. The Create s100 Request screen displays.

Complete the following fields:

• At the Reviewable Decision: select from the drop-down list: • Statement of Supports: for s47A decision where the plan has been varied and the

participant is not happy with the variation included in the plan and has requested an

s100 review of the varied plan. • Not to Review a Plan: for s47A decision not to vary the plan and the participant

has requested an s100 review.

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• Requested By: select the person requesting the internal review from the drop-down

list. People with an active contact record associated with the participant or affected

person will appear in this list. The person requesting the review may work for an

organisation listed in the contact list but don’t have their own active contact record.

If this happens:

• go to the My Organisations tile

• check if they are recorded as a primary contact for their organisation

• if not, you will need to establish express consent and record it in Supporting

Information. • Date of Request: add the date the NDIA received the request. This may be

different from the date you enter the request. • Supporting Information: copy and paste the template below into the field, update

the details and remove the examples. You must complete all the fields in the

template. This is so the internal review officer can assess the request in a timely

manner.

Template for s100 form for s47A

Consent given: Yes or No. If yes, explain where you recorded express consent. For

example, ‘yes, express consent given over the phone and recorded as an interaction,

interaction number: XXX.’ If the person making the request is not the participant or

affected person, you must record express consent here.

Subject of review request: Describe what the participant or affected person disagrees

with and wants us to review in terms of our s47A decision. Where our decision was to

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vary the plan be specific by describing supports or points that are subject for the

variation request for the review.

For example: s47A internal review requested in relation to: • changes to correct a minor or technical error in the plan that may relate to wording or

funding • replacement assistive technology (AT) equipment that has broken and needs

replacing quickly and was not funded • changes to living or care arrangements or other circumstances that presents as an

urgent risk to the participant and they require crisis or emergency supports • changes to goals and aspirations that require different supports • changes to the reassessment date of the plan • requests that are a minor variation that results in an increase to the funding, this may

be for a single support that can be considered in isolation of the rest of the plan.

Considerations: What information does the affected person want us to consider? For

example, additional evidence or supporting information, correspondence/ interactions

that form part of the request for the review.

Risks: Describe any risks. For example, risk of homelessness, relinquishment, care

arrangements breaking down, media involvement, and ministerial involvement.

Additional documentation provided: Yes or No. If yes, list documentation.

• Channel: select how the request was received from the drop-down list. • Reason for Request: select from the drop-down list. The options in the list will be

different depending on which Reviewable Decision you have selected. • Expected Outcome: briefly state what the person would like to happen. This helps

the internal review officer assess the request in a timely manner. Be specific by

describing any supports they want funded or their preferred outcome. For example,

to have level 2 transport funding included or increase in Support Coordination to 2

hours per week.

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3. Select Add (plus sign) to add any attachments. Include review request forms, emails, new supporting evidence, documents and materials provided with the review request.

4. Select Submit.

5. The success message displays, select OK.

6. Complete the Interaction using Interaction Template – Internal Review – s100 – Internal review requested.

7. Go to 3.5 Next Steps.

3.5 Next steps

1. You must seek guidance from your Team Leader if you identify any risks. Including whether you should add a priority request for internal review.To add the priority request, use Standard Operating Procedure – Add a priority request for an internal review.

2. The System will send the request for internal review to the internal review team for assessment. They will:

• action the internal review. This may include contacting the participant or authorised

representative to assess the request • record the outcome of the internal review in the System. You can expect this to be

done within 60 days.

4. Related procedures or resources

• Section 99 of the NDIS Act 2013 • Standard Operating Procedure – Check third party consent or authority • Standard Operating Procedure – Record third party consent • Standard Operating Procedure – Withdraw or change third party consent • Interaction Template – Internal Review • Standard Operating Procedure – Add a priority request for an internal review

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FOIOFFICIAL23/24-1198 Standard Operating Procedure For Internal Use Only 5. Feedback

If you have any feedback about this Standard Operating Procedure, please complete our Feedback Form.

6. Version control

Version Amended Brief Description of Change Status Date by

1.0 CW0032 Class 2 approval. Our Guidelines APPROVED 2021-03-04 transition. Content transferred from SOP – Review of decisions – procedure 6.2 and 6.7

The following guidance has been added:

• pre-requisite to refer to the NDIA’s Participant Critical Incident Framework if there is an imminent risk of harm to the participant or someone else

• guidance to refer to the NDIS Quality and Safeguards Commission for complaints related to Providers.

2.0 CW0032 Class 2 approved APPROVED 2021-04-14

Pre-requisites, section 3.2 and section 3.3 updated to clarify that the consent you need to confirm, obtain and record is express consent.

3.0 CW0032 Added a note to refer to the IRT page APPROVED 2021-05-19 and the Choose the right review tool at the start of the SOP.

4.0 BL0012 Class 1 Approved APPROVED 2021-08-10

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Version Amended Brief Description of Change Status Date by

Minor changes: Changed ‘What’s changed’ date from April to August. Highlighted 2 templates.

5.0 CW0032 Class 1 Approved APPROVED 2021-08-25

Minor changes: reassign Internal review via the Feedback form to CR PED NAT/VIC IRT Planning Incoming, rather than Scott Graham. This includes a new screenshot.

Minor language and protective marking update.

6.0 CW0032 Class 2 Approved APPROVED 2022-11-09

BC0038 New sections added on how to check for an active internal review request and MFN896 what to do if there is an active internal LS0042 review request. AGV957 New section added on how to record and process a request for internal review of a decision to vary or not to vary a plan (s47A)

Language updated to align with legislation amendments, including plan review to plan reassessment or plan variation.

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