Progress a plan change (s47A and s48) request over 21 days

DOCUMENT 16 FOIOFFICIAL23/24-1198 Knowledge Article

For Internal Use Only The contents of this document are OFFICIAL.

Guidance in this document is not approved for use unless you view it in PACE.

This article provides guidance for a planner delegate to:

• understand what happens when a plan change request hasn’t met the PSG timeframe of 21 days
• contact the participant about their request
• update the plan change request to completed
• stop incorrect automated PACE letters being sent
• create an internal review case
• make a decision on the internal review case
• start all correspondence once internal review case completed.

Recent updates

15 April 2024

• Added instructions to manually stop correspondence to prevent incorrect automated PACE letters being sent and restart once the process is complete.

12 February 2024

• New article to support you to progress a plan change request where the Participant Service Guarantee (PSG) timeframe of 21 days hasn’t been met.

Before you start

You have:

• been assigned a participant-initiated plan change request where the PSG timeframe to make a decision in 21 days has not been met.

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• The right Delegations and Validations to submit and approve internal review decisions in PACE. For this you’ll need ‘Validation Delegation Review of Decisions’ and ‘Validation Internal Review Decision Preparation skills’. If needed, use the PACE User Management case to request the skills be added. Refer to intranet page PACE User Management – Troubleshooting guide. • Read and understood relevant sections of Our Guideline – Changing your plan (external) - for example, for variations ‘What is a plan variation?’ and for reassessments ‘What is plan reassessment?’. • Read and understood relevant sections of Our Guideline – Reviewing our decisions (external) - for example, ‘What are internal and external reviews?’. • Reviewed the plan change request. For ‘Participant plan change request’ types, determine if s47A or s48 is most appropriate for the request.

Understand what happens when a plan change request hasn’t met the PSG timeframe of 21 days

The Participant Service Guarantee requires us to make a plan change decision in 21 days. When we don’t meet this timeframe, we are taken to have decided not to reassess or vary the plan. This creates an automatic internal review. Refer to OG – Changing your plan – What happens after I request a change to my plan (external).

You need to: • Attempt to contact the participant or authorised representative about their request if you need more information. • Update the plan change request to completed status. • Create an internal review case. • Make a decision on the internal review case to action the outcome for the participant. This includes sending a manual letter with the outcome of your decision.

Contact the participant about their request

To action the plan change request, you may need to contact the participant or the authorised representative to clarify their request or gather additional details.

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When you contact the participant or authorised representative, consider their preferred contact method. Go to article Check a participant’s preferred contact method. If the participant’s preferred correspondence method is email or letter, you should still attempt to call them to clarify the request.

Note: The exception is if the person has requested no phone calls and to contact them via the National Relay Service, or if they have not provided a phone number.

When you contact the participant or their representative, you should:

• go to article Send an SMS in PACE to understand SMS options in PACE.
• make 3 contact attempts (a maximum of 2 per day, at different times of the day) to the participant or their authorised representative.
• if you reach voicemail and the person identifies themselves, leave a brief message requesting they contact the NDIA on 1800 800 110.
• record each contact attempt on the plan change case. Refer to article Log an activity or internal note.

You should also contact the participant to tell them the outcome of your decision. Go to section Confirm the decision or Set aside the decision in this article.

Update plan change request to completed status

You need to manually change the plan change request over 21 days to the completed status.

1. From the Plan Change case, select the Details tab.
2. Update Closure Details by selecting Edit Closure Comment (pencil).
3. In Closure Comment free text field, record the closure reason as Plan change request decision not made within the required 21 days.
4. Select Save.
5. Select the Closed chevron and then select the button Select Closed Status.
6. Select Completed from the drop-down box.
7. Select Save.
8. Note the Plan Change case number as you need this when creating the Internal Review case.

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9. Add an internal note to record you’ve completed the case without making a decision as the request is over 21 days and will progress as an internal review. Refer to article Log an activity or internal note.

10. From the Decision tab, note the Legislative Review type under the Plan Change Requests heading as you’ll need this when creating the Internal Review case.

11. The chevron will now show as Closed and the plan change case will be closed.

Stop all correspondence

You need to manually stop correspondence from being sent to the participant or their authorised representative while completing this process.

1. Check the person record to identify authorised representatives who will also receive correspondence. Follow the guidance in article Check consent, nominee, child representative or self-representation authorities.

2. Stop all correspondence for the participant and any relevant authorised representatives by following the guidance in article Manually stop or start correspondence to a person or authorised representative. This will make sure the participant or authorised representative only receives the relevant plan change request over 21 days decision letter.

Create an internal review case

You now need to create an internal review case to make your decision.

From the Person Account:

1. Select Cases tab.

2. Select New.

3. Select Internal Review.

4. Select Next.

5. Check Internal is selected for Case Origin.

6. Select Save. The internal review will now show as Draft.

Create an internal review request

From the Internal Review case, select Request tab.

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1. Select Date review request received. Record the date as 21 days after the plan change request was received.

2. If you’re backdating the request, record a reason for this in the Provide a reason why the request is being backdated and reference evidence record free text. For example, ‘An automatic internal review has been created as plan change request decision was not made in the PSG timeframe of 21 days.’.

3. Select relevant Who is requesting review? option. Record this as the person who initially submitted the plan change request.

4. Select Next.

Complete the Decisions step

1. Select Decision from SAP CRM.

Note: The decision won’t be available from Decision Log as the plan change request has been automatically declined.

2. Select Planning from the Type drop down list.

3. Select New.

4. On the Reviewable SAP CRM decisions popup, select the Decision Name from the drop down list. This will be Lapsed S47 or Lapsed S48.

5. Add Original Decision Date, record this as 21 days after the plan change request was received.

6. Record the Decision Reference as the plan change case number.

7. Select the checkbox Unable to find original decision maker user ID.

8. Record your user ID in the Decision user code field. This is because you’re the person who received the plan change request where the decision was not made within the PSG timeframe of 21 days.

9. Select Save.

10. Select Next.

Complete the Add Request Details step

1. Record the reason in the Capture Reasons for Review Request free text:

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• for a variation: ‘An automatic internal review has been created as plan change request decision was not made in the PSG timeframe of 21 days. The delegate is taken to have decided not to vary the plan’.
• for a reassessment: ‘An automatic internal review has been created as plan change request decision was not made in the PSG timeframe of 21 days. The delegate is taken to have decided not to reassess the plan’.

2. Select Save.
3. Select Next.

Complete the Documents step

1. Link any documents provided in the plan change request, if needed. Select Link Documents to link documents from the plan change case to the internal review case. Learn more on adding or linking documents in article Add documents to a case.
2. Add any new documents provided by the participant or their authorised representative, if needed. Select Add Documents to upload new documents.
3. Select Next.

Complete the Risk Matrix step

1. Under Has there been any risk identified that may impact the participant, nominee or NDIS associated with this request?, select Yes or No.
2. If Yes, you need to select Yes or No to each risk question.
3. For each risk identified, select relevant risk level: LOW, MEDIUM, HIGH or EXTREME.
4. Select Next.

Complete the Request Summary step

1. Review information recorded.
2. If any information needs to be corrected or added, select the relevant step to return and update.
3. Once everything is correct, select Next.

Complete the Submit Internal Review Request step

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1. Record your call notes for conversations with participant or authorised representative in the Call Notes free text field, is applicable.

2. Select Submit.

3. The internal review case stage will change to New. New internal review cases are automatically assigned to the Internal Review Routing Queue and you’ll need to update the case owner to yourself.

4. From Change Case Owner (in the top right corner) in Please select if the case owner is a user or a queue select User.

5. In Select User search and select yourself.

6. Select Change Owner and Finish.

7. The chevron will now move to In Progress.

Make a decision on an internal review case

From the Internal Review case:

1. Select Decision tab.

2. From the Request for PACE decisions table, select the hyperlink under Name heading

3. On the RORD Request screen, select Make a decision on the right-hand side of the screen.

Complete the Decision pop up

1. Within the decision pop up, complete the fields that can be completed. Most of the fields will be automatically populated.

2. From Decision step in Decision Outcome select the relevant option for the plan change request:

   • Set Aside • Confirm.

3. Select Next – Justification.

4. From Justification step, select available Justification.

5. Select available Sub-justification.

6. Select Next – Evidence.

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7. From Evidence step, complete Evidence Name free text.

8. Select Evidence Type from the drop down options.

9. If selecting Document, complete Evidence Link. The Evidence Link name can be found in the Evidence tab under the Document Type heading. The evidence linked must relate to your justifications.

10. Complete Explanation free text.

11. Select Next.

12. From the Confirmation step, select Done which will move the decision to the drafted decision status in the Requests for PACE decisions table.

Submit the internal review decision:

From the Internal Review case:

1. From the Decision tab select Submit Decisions.

2. From the Confirmation step, select Next.

3. From the Summary step, select Done.

4. Select Confirm manual letter has been sent.

5. From the Confirmation step, select an appropriate option from Did you speak to the participant about decision. Select Next

6. From the Decision Letter Sent step, select Next.

7. You’ll now be returned to the Internal Review case.

8. You send the letter when you either:

   • Confirm the decision by following the steps in section Confirm the decision. • Set aside the decision by following the steps in section Set aside the decision.

9. Once you’ve made the decision, you’ll need to turn all correspondence back on. Follow the steps in section Start all correspondence.

10. You may need to manually close the Internal Review case. For information on closing the Interal Review case, go to article IRT – Complete remaining closure tasks for an internal review.

Confirm the decision

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1. Advise the participant or authorised representative you’ve decided to confirm the automatic decline of their request. You’ll need to explain what this means. Confirm you’ll send them a letter with the outcome of your decision. Tell them that they have AAT rights and if they want a review in the AAT they will need to lodge an application within 28 days.

2. Follow the guidance in article [Send a manual letter](/foi-library/releases/0f965ec93d25-foi-24-25-0883-disclosure-log-documents/document-010__send-a-manual-letter/) to send the participant the Letter – s47A and s48 decision outside 21 days manual decline.

Set aside the decision

1. From the Decision tab, select either:

   • Create Budget Update Case, if you decided to vary the plan. • Create a Plan Approval Case, if you decided to reassess the plan.

   Note: Only the option relevant to your decision will be available to select.

2. A child case will now be created.

3. Select View Child Case to either:

   • progress the Create Budget Update Case, go to article Action a budget update • progress the Create a Plan Approval Case, go to article Change the draft budget.

4. Once the plan has been updated, or a new plan is approved, you need to advise the participant or authorised representative of your decision.

5. Explain to the participant or authorised representative that you’ve decided to vary or reassess the plan. Tell them:

   • how the plan will be provided • what has changed in the plan and offer them support to implement their plan • advise them that you’ll send a letter with the outcome.

6. Use the article Send a manual letter to send the manual decision outcome letter:

   • for a variation send the participant Letter – s47A and s48 decision manual vary. • for a reassessment send the participant Letter – s47A and s48 decision outside 21 days manual reassess.

Start all correspondence

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For Internal Use Only You need to manually start correspondence to the participant or authorised representative to make sure they receive future correspondence once the process is complete.

1. Confirm whether authorised representatives should also receive correspondence for the participant. Follow the guidance in article Check consent, nominee, child representative or self-representation authorities.

2. Start all correspondence to the particiapnt and any relevant authorised repreentatives by following the guidance in article Manually stop or start correspondence to a person or authorised representative.

Article labels – internal use only

PACE user role names

Add: User role name label

Delete: User role name label

Topics

Add: t_correspondence

Delete: Topic label

Case names

Add: Case name label

Delete: Case name label

Ownership

Add: Ownership label

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Version control

Version	Amended by	Brief Description of Change	Status	Date
1.1	UFEX8	Include knowledge to apply stop all correspondence flag	DRAFT	2024-03-06
1.2	BTM847	Peer review	DRAFT	2024-03-12
1.3	UFEX8 RPK268	Actioned peer review comments. Initial AD review	DRAFT	2024-03-12
1.4	UFEX8	Action AD feedback	DRAFT	2024-03-18
1.5	RPK268	AD review	DRAFT	2024-03-24
1.6	UFEX8	Action AD feedback. Create clean version for Stakeholder review.	DRAFT	2024-03-25
1.7	UFEX8	Action Stakeholder feedback	DRAFT	2024-04-02
1.8	RPK268	EL1 review	DRAFT	2024-04-03
1.9	JS0082	EL2 review	DRAFT	2024-04-04
2.0	CW0032	Class 2 approval	APPROVED	2024-04-09

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