NDIA Accountability Project

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Progress NDIS application in the system

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Standard Operating Procedure

For Internal Use Only

The contents of this document are OFFICIAL.

Progress NDIS application in the system

This Standard Operating Procedure (SOP) will help you decide whether an applicant meets the eligibility requirements, or that you need more information to decide.

1. Recent updates

Date What’s changed
June 2023 Update to guidance in section 3.4 — remind you to search using someone’s legal name.

2. Checklist

Topic Checklist
Pre-requisites You have: * read and understood Our Guideline — Applying to the NDIS. * received a work item to progress an access decision.
Actions * 3.1 Obtain access decision work item * 3.2 Consider a priority eligibility decision * 3.3 Check decision will be made within legislative timeframe * 3.4 Verify age and residence details * 3.5 Check/update Personal Details * 3.6 Determine if age and residence requirements are met * 3.7 Verify Defined Program status * 3.8 Check for integrity issues * 3.9 Review evidence of disability * 3.10 Request additional technical advice (if required) * 3.11 Contact person to clarify existing information (if required) * 4.1 Examples of access integrity issues * 4.2 Access decision diagram

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Standard Operating Procedure

For Internal Use Only

  1. Procedure Note: The Work Load Management (WLM) system allocates access applications according to Agency priorities.
  • Only request one work item at a time.
  • Do not unassign a work item (unless there is a conflict which you should declare to your Team Leader).
  • If you are awaiting technical support, Technical Advisory Branch (TAB) advice, under 25 Psychosocial Review, or a pending reconsideration, leave the record In Progress in your inbox and continue to progress other work until you receive the advice. If you do not receive the advice by the end of the business day, allocate the work item to your Team Leader.

3.1 Obtain access decision work item

  1. In My Inbox: Select Ready for Work. Note: This will allocate a work item to your inbox.
  2. Select the work item:
  • If an Eligibility Reassessment work item is assigned to your inbox:
    • Refer to Standard Operating Procedures – Undertake eligibility reassessment.
  • If the applicant resides in an area that is classified as Remote or Very Remote (MMM6 or MMM7 under the Modified Monash Model):
    • Re-assign the application to Danika Sharpe (DJS497).
  • If you identify that the applicant may be a Younger People in Residential Aged Care (YPIRAC), assign the work item to Blake Sullivan (BS0021).

3.2 Consider a priority eligibility decision

Note: When you receive a priority request, you must decide if the applicant is in an urgent situation that needs a priority eligibility decision. You will need to make a quicker decision in these urgent situations. But the process of considering evidence to make the decision is still the same.

  1. Consider evidence about the applicant’s situation with those listed in When do we make priority eligibility decisions? in Our Guideline – Applying to the NDIS.
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Standard Operating Procedure

For Internal Use Only

  • If Yes – Make a decision or request further information within 2–5 business days.
  • If No – Make a decision or request further information within the 21-day legislative timeframe.
  1. Go to Step 3.3: Check decision will be made within legislative timeframe.

Check decision will be made within legislative timeframe

  1. Refer to Our Guideline – Applying to the NDIS to consider if the decision will be outside legislative timeframes.

Within legislative timeframe

  1. Go to Step 3.4: Verify age and residence details.

Outside legislative timeframe

Add Interaction: Outside Legislative Timeframe
  1. In the NDIS Account screen: Select Pathway.
  2. Select the relevant application.
  3. In the Participant Lifecycle Management Screen: Select Interactions.
  4. Select the Arrow and then select Add Interaction.
  5. In Category 1: Select Pathway.
  6. In Category 2: Select Access.
  7. In Category 3: Select Decision Legislative Timeframe – Decision Not Met.
  8. In Channel: Select Internal Notes.
  9. In Status: Select Completed.

In Notes:

Legislative Timeframe Not Met

An Access Decision was not made in the legislative timeframe of <choose applicable – 14 / 21> days.

Under s21(3) the applicant is taken to not meet the access requirements, and under s100 an internal review of the decision was commenced.

As a Delegate of the CEO, I redacted have reviewed and overturned the decision to avoid further delays for the applicant. The access request will now be re-considered.

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Standard Operating Procedure

For Internal Use Only

  1. Select Submit.
  2. Go to Step 3.4: Verify age and residence details.

3.4 Verify age and residence details

Note: Do not update the POI verified button. This information is not sufficient to verify Proof of Identity (POI). POI will be verified during planning if the person is eligible for the NDIS. Refer to Our Guideline – Your privacy and information.

  1. In NDIS Account screen: Select Details.
  2. Select > next to Consent.
  3. In Consent to Use:
  • If Centrelink is selected: Go to Step 3.4.2: Check Centrelink record in the Business System.
  • If Consent to Use is blank:
    • Check Interactions for consent to access the applicant’s Centrelink record;
    • and/or
    • Check the Enter the Access Request Form task in the pathway.

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Standard Operating Procedure

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  1. If Centrelink consent has not been provided, go to Step 3.4.4: Check documentary evidence provided.

Note: You can only use the Business System to search for adult applicants. If the applicant is a child, go to Step 3.4.3: Check Centrelink record in Mainframe.

  1. In the NDIS Account screen: Select Centrelink Search.
  2. In Search Type: Select Name and Date of Birth.
  3. Enter the mandatory fields. If you are unsure how to spell a person’s name, complete a ‘wildcard’ search using their date of birth and at least two letters of their last name.

Note: Make sure you use the person’s legal name for this search function. The System can only search for a legal name, and not someone’s preferred name. To support a respectful experience, explain why we need their legal name for this search. Make sure you otherwise use their preferred name in conversation. You should also check their pronouns to make sure you refer to them correctly.

Note: To narrow your search add additional information such as Date of Birth, Phone number or State.

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Standard Operating Procedure

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  1. Select person from search results.

  2. A message indicating ‘100% match’ confirms that the search details are a match for the person’s Centrelink record. It does not indicate that the person meets the age and residence requirements.

  3. View Record Details to verify:

  • CRN
  • Name
  • Date of Birth
  • Current Address
  • Citizenship / Visa status

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Note: If unable to locate the Centrelink record by searching the person’s name and date of birth, search for the record using their CRN.

  1. In the NDIS Account screen: Select Centrelink Search.

  2. In Search Type: Select CRN.

  3. Select Search.

  4. Select person from the search results.

  5. View Record Details to verify: • Name • Date of Birth • Current Address

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Standard Operating Procedure

For Internal Use Only

• Citizenship / Visa Status

Note: Follow this step if the Centrelink Search function in the Business System does not work, or if the applicant is a child.

  1. View Record Details to verify: • Name • Date of Birth • Current Address • Citizenship / Visa status

3.4.3.1 Check Centrelink – Adult

  1. In the PED screen: Enter the following codes into Nxt.
  2. For Home Address: Enter ADH.
  3. For Country of Residence: Enter CRES.
  4. For Citizenship Status: Enter RSLEG.

Note: Refer to Standard Operating Procedure – Verify age and residence details using Centrelink mainframe for detailed instructions, navigation tips and a complete list of approved screen codes.

  1. Go to Step 3.5: Check/update Personal Details.

3.4.3.2 Check Centrelink – Child

Note: If the applicant is a child, you may need to verify their age and residence information using a parent’s record. You must ask the child’s parent if you can access their record verify their child’s age and residence.

  1. In the PED screen: Enter the following details into Nxt.
  2. Enter CHS: Press Hard Enter.
  3. Locate the child’s name: Type S next to it and press Enter.
  4. For child’s Home Address: Enter ADH.
  5. For child’s Country of Residence: Enter CHCRES.
  6. For child’s Citizenship and residence Status: Enter CHRSLEG.

Note: Refer to Standard Operating Procedure – Verify age and residence details using Centrelink mainframe for detailed instructions, navigation tips and list of approved screen codes.

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Standard Operating Procedure

For Internal Use Only

  1. Go to Step 3.5: Check/update Personal Details

3.4.4 Check documentary evidence provided

  1. Refer to Standard Operating Procedure – Verify age and residence using documentary redacted to verify an applicant’s age and residence details in documentary evidence.

  2. View age and residence documentation to verify:

    • Name
    • Date of Birth
    • Current Address
    • Citizenship / Visa status

  3. Go to Step 3.5: Check/update Personal Details.

3.5 Check/update Personal Details

Note: Enter any information that needs to be entered or updated prior to making an access decision or requesting further information (s26). This information may be located in the Access Request Form, Inbound Documents or Interactions.

  1. In the NDIS Account screen: Select Details.
  2. Select > next to Personal Details:

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Standard Operating Procedure

For Internal Use Only

• View Title, First Name, Preferred Name, Last Name, Gender, Date of Birth, Indigenous Origin.

  1. Select > next to Residence Details: • View Country of birth, Living in Australia permanently, Australian Citizen, and Visa Subclass (if relevant).

  2. Select > next to Addresses: • View Home Address, and Postal Address (if relevant).

Note: If the applicant is a child, also check the address in the parent’s record in the Business System. 5. Select > next to Consent: • View Centrelink consent, authorised representatives and other consent provided (if relevant).

  1. Select > next to Communication Details: • View phone numbers, email address, preferred contact method, and interpreter information (If relevant).

  2. Select > next to Correspondence Details: • View preferred correspondence method, preferred format, and formatting options (If relevant).

  3. Select Edit.

  4. Update or enter any of the above information (if required).

  5. Select Submit.

  6. Go to Step 3.6: Determine if age and residence requirements are met.

3.6 Determine if age and residence requirements are met

Note: The age requirements are assessed based on the date the access request is received as valid (that is, complete). The residence requirements are to be assessed on the date the delegate considers the access request, not the date the valid access request is received.

  1. Assess the evidence against the age (s22) and residence (s23) requirements.
  2. Refer to available resources as required, such as: • Our Guideline – Applying to the NDIS

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Standard Operating Procedure

For Internal Use Only

  • Standard Operating Procedure – Verify age and residence using Centrelink mainframe
  • Standard Operating Procedure – Verify age and residence using documentary evidence
  • Visa list (homeaffairs.gov.au) to consider if a visa is permanent

3.6.1 Age and residence met

  1. Go to Step 3.7 Verify Defined Program status.

3.6.2 Age and residence not met

  1. Go to Standard Operating Procedure – Finalise access not met decision.

3.7 Verify Defined Program status

3.7.1 Check Defined status in the Business System

  1. In the NDIS Account Screen: Select Internal Use.
  2. Select > next to State and Territory Load Data.
    • If Yes next to Defined in Program: The person is from a defined program.

Note: Defined programs in WA are still transitioning to the NDIS (until 30 June 2023). All other applicants are ‘new’ as the state and Commonwealth funding has ceased. If an applicant from a defined program has previously had their access status revoked or ceased, they will still show as defined, but they are considered ‘new’. * If No next to Defined in Program: The person is from a non-defined program or new.

3.7.2 If Non-defined or New

  1. Go to Step 3.8: Check for integrity issues.

3.7.3 If Defined

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Standard Operating Procedure

For Internal Use Only

3.8 Check for integrity issues

3.8.1 Use AHPRA to confirm treating health professional qualifications and registration

  1. For all evidence of disability documents, obtain the treating health professional details.

  2. Refer to the Australian Health Practitioner Regulation Agency (AHPRA) website.

  3. Review the list of professions that can be confirmed in AHPRA.

  4. Search for each treating professional via Name or Registration Number. Note: All evidence from a treating professional with a profession listed in AHPRA, must be verified in AHPRA.

  5. Use the filters if you need to refine the search results.

  6. Select the relevant treating professional.

  7. Review to check they have current qualifications and registration.

3.8.2 Check for other integrity issues

  1. Review the NDIS application and all supporting information to consider if there are any integrity issues.

  2. Review Appendix 4.1: Examples of NDIS application integrity issues for examples. Note: This list is not exhaustive. You may identify a different integrity issue not on this list that needs to be escalated.

  3. Are there any integrity issues? • No – Go to Step 3.9: Review evidence of disability. • Yes – Go to Step 3.8.3 Escalate integrity issue to Team Leader to determine next steps.

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Standard Operating Procedure

For Internal Use Only

3.8.3 Escalate integrity issue to Team Leader

  1. Open Email Template – Escalate potential access integrity issue.
  2. Complete fields in the body of the email.
  3. Select Send.
  4. If you do not receive advice by the end of the day, allocate the work item to your Team Leader.

Note: Your Team Leader will let you know the next steps. The next steps may include:

  • contacting the applicant or authorised representative for further information
  • contacting the treating health professional (if consent is provided) for further information
  • Team Leader requesting advice from the Access Integrity Management Team.
  1. After receiving the advice, you are still responsible for making, documenting and implementing the decision. Seek support from your Team Leader if you require further clarification of the advice.

3.9 Review evidence of disability

  1. Review all available information and evidence attached to the person’s record (Interactions and Inbound Documents), including information and evidence that may have been provided with previous applications.
  2. Assess the evidence against disability (s24) and early intervention (s25) requirements.
  3. Refer to available resources as required, such as:
  • Our Guideline – Applying to the NDIS
  • Appendix 4.2: Access decision diagram
  1. Consider if there is sufficient evidence that the person meets, or does not meet, the disability or early intervention requirements, or whether further information is required.

3.9.1 If Access met decision

  1. If there is sufficient evidence that the person meets the disability or early intervention requirements:
  • Are they under 25 and their primary disability is psychosocial? o If Yes: Mandatory EL1 or Team Leader endorsement is required, go to Step 3.10: Request additional technical advice (if required).
  • Is their primary disability a chronic health condition?

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Standard Operating Procedure

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o If Yes: Mandatory TAB advice required, go to Step 3.10: Request additional technical advice (if required).

  1. If TAB advice or TL/EL1 endorsement is not required, refer to Standard Operating Procedure – Finalise access met decision.

3.9.2 If Access not met decision

  1. If there is sufficient evidence that the person does not meet the disability and early intervention requirements; or
  2. If there is insufficient evidence that the person meets the disability or early intervention requirements, and there are no red flags to indicate these requirements may be met with additional information.
  3. Refer to Standard Operating Procedure – Finalise access not met decision.

3.9.3 For further clarification about existing information

Note: The purpose is not to gather new information, rather to expand on the existing information provided.

  • if there are red flags, and
  • there is insufficient evidence to make an access decision; and
  • more clarity is needed about existing information about permanence, functional capacity and/or need for early intervention before a decision can be made
  1. Go to Step 3.11: Contact person to clarify existing information (if required).

3.9.4 If further information required

  • If there are red flags, and
  • there is insufficient evidence to make an access decision; and
  • it is not appropriate to ask for more information, or
  • you were unable to obtain clarity of existing information by contacting the person
  1. Refer to Standard Operating Procedure – Request further information (s26) for decision.

3.9.5 If technical support or advice required

  • If you require technical support to determine the next step
  1. Go to Step 3.10: Request additional technical advice (if required).

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Standard Operating Procedure

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3.10 Request additional technical advice (if required)

Note: At times, you may need technical advice to progress a more complex decision. This may include technical support from a Quality Development Officer (QDO), mandatory advice from the TAB, or a review of a proposed access met decision for an applicant under 25 years old with a primary psychosocial disability.

After receiving the advice, you are still responsible for making, documenting and implementing the decision. Seek support from your Team Leader if you require further clarification of the advice.

  1. Review available resources.
  2. Before completing any of these requests, consider if the information you require is available in existing resources such as: • Our Guideline – Applying to the NDIS • TAB Digest – Published Advice

3.10.1 If unable to find the information in the available resources

  1. Go to Step 3.10.2: Request technical advice from a QDO.

3.10.2 Request technical advice from a QDO

  1. Open Email Template – Request technical advice from a QDO.
  2. Complete fields in the body of the email.
  3. Select Send.

Note: A QDO will contact you via your preferred method to provide advice. 4. If you do not receive technical advice by the end of the day, allocate the work item to your Team Leader. 5. Review advice to determine the next step: • If you are able to make an access met decision: o Refer to Standard Operating Procedure – Finalise access met decision. • If you are able to make an access not met decision: o Refer to Standard Operating Procedure – Finalise access not met decision. • If you need further clarification about existing information by phone: o Go to Step 3.11: Contact person to clarify existing information (if required). • If you need to request further information in writing: o Refer to Standard Operating Procedure – Request further information (s26) for decision. V10.0 2023-02-17 Progress NDIS application in the system Page 15 of 31 This document is uncontrolled when printed

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Standard Operating Procedure

For Internal Use Only

• If you require a review of a proposed access met decision for an applicant under the age of 25 with a primary disability of psychosocial: o Go to Step 3.10.3: Mandatory EL1 or Team Leader review – proposed access met decision – under 25 Psychosocial. • If you require mandatory technical advice from the Technical Advisory Branch: o Go to Step 3.10.4: Request mandatory advice from Technical Advisory Branch (TAB).

3.10.3 Mandatory review from EL1 or Team Leader – proposed access met decision – under 25 Psychosocial

Note: Access met decisions for applicants under the age of 25 with a primary disability of psychosocial require Team Leader or EL1 endorsement.

  1. Open the relevant email template: • Disability o Email Template – Mandatory EL1/TL review: Under 25 Psychosocial – Disability. • Early Intervention o Email Template – Mandatory EL1/TL review: Under 25 Psychosocial – EI
  2. Complete the fields in the body of the email.
  3. Select Send.
  4. A QDO will review your request: • If endorsed, the QDO will forward the request to the Team Leader or EL1 on your behalf. o Team Leader endorsement for applicant 18–24 years with a psychosocial disability and the primary disability is not a high prevalent mental health condition. o EL1 endorsement for applicant under 18 years with a psychosocial disability, or 18–24 years with primary disability of high prevalent mental health condition (that is, anxiety, depression, OCD or PTSD). • If not endorsed, the QDO will discuss with you what action is required
  5. If you do not receive a response by the end of the day, allocate the work item to your Team Leader.
  6. Review advice to determine the next step: • If you are able to make an access met decision:

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Standard Operating Procedure

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o Refer to Standard Operating Procedure – Finalise access met decision. • If you are able to make an access not met decision: o Refer to Standard Operating Procedure – Finalise access not met decision. • If you need further clarification about existing information by phone: o Go to Step 3.11: Contact person to clarify existing information (if required). • If you need to request further information in writing: o Refer to Standard Operating Procedure – Request further information (s26) for decision. • If you require technical advice from the Technical Advisory Branch: o Go to Step 3.10.4: Request mandatory advice from Technical Advisory Branch (TAB).

3.10.4 Request mandatory advice from Technical Advisory Branch (TAB)

The TAB provides specialist support for more complex cases.

You must request mandatory advice from TAB before making an Access Met decision for applicants with a chronic health condition. Refer to Step 3.10.2: Request technical advice from a QDO for all other technical advice requests.

For more information about TAB, refer to Technical Advisory Team – Requesting Advice.

Note: You must obtain QDO endorsement before requesting mandatory TAB advice.

  1. Open Email Template – Request QDO endorsement for mandatory TAB Advice.

  2. Follow the instructions listed at the top of the email.

  3. Complete the fields in the body of the email.

  4. Press Send.

  5. A QDO will review your request: • If endorsed, the QDO will reply to your email and provide endorsement for you to contact TAPS, go to Step 6. • If not endorsed, the QDO or Team Leader will discuss with you what action is required

  6. Phone the TAPS line on 1800 956 342 to discuss your case.

  7. Consider the information discussed in your call: • If you are satisfied with the information received from the TAPS representative and can proceed to the next step.

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Standard Operating Procedure

For Internal Use Only

  • For an access met decision, refer to Standard Operating Procedure – Finalise access met decision.
  • For an access not met decision, refer to Standard Operating Procedure – Finalise access not met decision.
  • To clarify existing information, go to Step 3.11: Contact person to clarify existing information (if required).
  • If you need to request further information (s26), refer to Standard Operating Procedure – Request further information (s26) for decision.

• If you require further clarification of the information provided by the TAPS representative, discuss with your QDO or TL. • If you were unable to receive TAPS advice by the end of the day, allocate the work item to your TL and follow up the next business day.

3.11 Contact person to clarify existing information (if required)

Note: Only make a phone call when you need to clarify or expand on existing information. If new information is obtained, you cannot rely solely on this. If the new information indicates the person may meet the eligibility requirements, you may need to send a letter requesting further evidence (s26).

3.11.1 Contact person: clarify existing information

  1. Refer to Standard Operating Procedure – Send SMS using Whispir messenger to send ‘Contact attempt SMS template’ to advise you will be calling. Note: Only complete this step before your first attempt to call the person. Do not contact the person by SMS if the person has told the agency they do not consent to this form of communication.

  2. Prepare for your phone call by considering the following:

    • What specific information do you need?
    • What specific questions will give you this information?
    • Who is the best person to provide this information?

  3. If required, refer to the Conversation Style Guide to help support your conversation.

  4. Make 3 telephone contact attempts (a maximum of 2 calls per day, at different times of day) to the person, their representative or treating health professional (with consent). If you reach voicemail and the person identifies themselves, leave a brief message requesting they contact the NDIA on 1800 800 110.

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Standard Operating Procedure

For Internal Use Only

Note: If you are unable to contact the person on the first day, assign the application to your Team Leader at the end of the day. If delaying the request by one day will result in the legislative timeframe for decision not met, refer to Standard Operating Procedure – Request further information (s26) for decision to request further information on the same day.

3.11.1.1 Record an Interaction following each unsuccessful call attempt

  1. In the Participant Lifecycle Management screen: Select Interactions.

  2. Click Arrow and then select Add Interaction.

  3. In Category 1: Select Pathway.

  4. In Category 2: Select Access.

  5. In Category 3: Select Access Request.

  6. In Channel: Select Internal Notes.

  7. In Status: Select Completed.

  8. In Notes: <First/Second/Third> phone call attempt made to to gather further information to make a decision on their application.

    Call not answered.

  9. Select Submit.

3.11.2 If all three contact attempts are unsuccessful

  1. Refer to Standard Operating Procedure – Send SMS using Whispir messenger to send ‘Unsuccessful contact attempt’ SMS to advise you tried to call. Note: Only send this SMS after you make all required call attempts. Do not contact the person by SMS if the person has told the agency they do not consent to this form of communication.
  2. Refer to Standard Operating Procedure – Request for further information (s26) for decision.

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Standard Operating Procedure

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3.11.3 If the call is answered

  • Explain that you are calling to gather further information to assist in making a decision on <their / Applicant’s> NDIS application.
  • Check if they are happy for you to ask questions in relation to <their / Applicant’s> disability to clarify the information provided.
  • Use open-ended questions. Avoid closed questions where possible.
  • In relation to their disability, ask questions like:

Example questions to determine permanence (treating health professional only)

  • Are there any treatments that are likely to improve impacts of <Applicant’s> disability?
  • Are there any treatment that have not been explored that may improve the impacts <Applicant’s> disability?
  • If yes, what are the expected results of the treatments?

Example questions to determine functional capacity

  • Are there any specific tasks <you / Applicant> are/is having difficulty completing without support?
  • What specific supports are currently in place?
  • How often are these supports required?
  • What does a typical day or week look like?

Example questions to determine need for early intervention (treating health professional or Early Childhood Partner only)

  • Are there any recommended interventions that are likely to reduce <your / Applicant’s> need for disability supports in the future?

  • If yes, what is the duration and frequency of the recommended interventions?

  • If yes, what are the expected results of the recommended interventions?

  • If you obtain sufficient information to make an access decision: Advise the person that you will be making a decision shortly and will be in contact to inform them of the outcome.

  • If further information is still required to make an access decision: Advise the person that you will send them a letter requesting further information (s26) in writing.

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Standard Operating Procedure

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• Explain what information is required. They will have 90 days to respond to the request. If they do not provide the requested information, the person is taken to have withdrawn their access request. • If new information has been provided which will be used to form the decision (rather than expanding on current information): Advise the person that information over the phone is only to expand on existing information. Any new information received (including from a treating professional), must be provided in writing from the appropriate treating professional. • If you need to review the new information before deciding on the next step: Advise the person that you will review the information they have provided and will be in contact to advise of the next step.

3.11.4 Add Interaction: clarify existing information

  1. In the Participant Lifecycle Management screen: Select Interactions.
  2. Select Arrow and then select Add Interaction.
  3. In Category 1: Select Pathway.
  4. In Category 2: Select Access.
  5. In Category 3: Select Access Request.
  6. In Channel: Select Phone.
  7. In Status: Select Completed.
  8. In Notes:

Phone call made to <Name of Applicant/Authorised Representative/Treating Professional> to clarify information about the impact of the person’s disability. The information provided confirms <Applicant> has disability/s – <list all disabilities>.

`` advised ``. Mobility: ``. Communication: ``.

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Standard Operating Procedure

For Internal Use Only

Social Interaction: <Impacts related to Social Interaction. Write “No Assistance Required” if no impacts>. Learning: <Impacts related to Self-Care. Write “No Assistance Required” if no impacts>. Self-Care: <Impacts related to Self-Care. Write “No Assistance Required” if no impacts>. Self-Management: <Impacts related to Self-Care. Write “No Assistance Required” if no impacts>.

New information provided during phone call. Advised redacted this is required in writing. A s26 will be sent requesting this information.

advised `redacted` specific information gathered relating to need for Early Intervention).
  1. Consider the information provided in the phone call to determine the next step.
  • If you are able to make an access met decision, refer to Standard Operating Procedure – Finalise access met decision.
  • If you are able to make an access not met decision, refer to Standard Operating Procedure – Finalise access not met decision.
  • If you need to request further information (s26), refer to Standard Operating Procedure – Request further information (s26) for decision.
  • If technical advice is required go to Step 3.10: Request additional technical advice (if required).

End of process – no further steps in this SOP to be completed.

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Appendix

4.1 Examples of access integrity issues

NDIS Application consent

• Applicant does not have capacity to provide consent and they do not have a legally authorised representative. • Applicant signed the ARF, however evidence indicates they do not have capacity to provide consent.

Treating professional information

• Unable to confirm all treating professional’s qualifications and registration in AHPRA. • Error in the treating professional’s title. • Contact information for the treating professional is the same as the applicant.

o For example, phone number, email address.

• Contact information for the treating professional is personal, rather than business.

o A treating professional should not be using personal email addresses (for example: Gmail, Hotmail, Outlook etc) due to privacy and security concerns.

• Address for treating professional is not a legitimate address.

o For example, address appears as another business when you search online through open-source information.

• Treating professional is not listed in AHPRA (evidence of disability indicates they have a profession that should be listed in AHPRA). • Diagnosis provided by the treating professional does not align with their qualification. • Impairment is self-reported.

o For example, applicant has approached a new GP and reported an impairment, however the GP has not confirmed the impairment with another treating professional, or completed their own assessment.

• Use of outdated terminology and/or assessment tools.

o For example, a recent report references the DSM-4.

Standard Operating Procedure

For Internal Use Only

Signs evidence of disability may not be genuine

  • No difference in handwriting in the ARF in Section 2 (Parts A-F) between:
    • applicant section
    • treating professional section.
  • The treating professional completed Part E of the ARF to provide evidence of disability and Part G was not signed or dated.
  • Evidence of disability is all self-reported.
  • Documents are unprofessional.
    • For example, spelling errors, inappropriate use of grammar, language, lack of appropriate detail or change in language style within the document.
  • Name of another applicant appears in the document and/or misspelled names.

Signs of altered documents

  • Signs of text being removed, added, or changed within document.
    • For example, white out used to remove important information.
  • Inconsistent fonts, sizes, misalignment of text or paragraphs in documents.
  • Poor character quality due to repeated scanning and photocopying.
    • For example, document is hard to read.
  • Partial documents from a treating professional.
  • Documents can be edited.

Signs of conflict of interest

  • Provider that gave evidence of disability may benefit from the applicant becoming a participant.
  • Interactions indicate excessive and repeated contact from provider, and provider may benefit from the applicant becoming a participant.
  • Treating professional may be related to the applicant.
    • For example, the treating professional has a similar name.
  • Applicant has made more than 2 applications to access the NDIS and changed the primary disability each time.

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Access decision diagram

Step through the process below to determine what information you need to consider in order to make a correct access decision. The access tool on the next page provides details for each step. Numbered boxes are hyperlinked to the appropriate text, press CTRL + Click to follow link.

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Standard Operating Procedure

For Internal Use Only

Start

Assess evidence of impairment

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Standard Operating Procedure

For Internal Use Only

1. Person from a defined program on List C?

e Refer to List C of Our Guideline — Applying to the NDIS for a list of defined programs.

e A person from a defined program in Western Australia do not need to provide evidence of disability or developmental delay because the disability requirements for defined programs are considered to be the same as those of the NDIS.

e Meets disability requirement: no further evidence required.

2. Evidence of impairment on List A?

e Refer to List A of Our Guideline — Applying to the NDIS for a list of conditions likely to meet the disability requirements in s24.

e People with impairments on List A are likely to meet the disability requirements following evidence of their impairment.

e Evidence must be from an appropriate treating professional related to the person’s priary disability.

e Meets disability requirement: no further evidence of permanence or functional impairment required.

3. Child under 7 years with evidence of impairment on List D?

e Refer to List D of Our Guideline — Applying to the NDIS for a list of conditions likely to meet the Permanent Impairment/Early Intervention requirements.

e Children under 7 with an impairment directly matching the condition and assessment type listed on List D are likely to meet the Early Intervention requirements.

e Meets early intervention requirement: no further evidence of permanency or functional impairment required.

4. Child under 6 years with evidence of Developmental Delay?

e Use the Our Guideline — Applying to the NDIS to consider if you have sufficient evidence to meet the early intervention criteria.

5. Child under 7 not on List A, D or Developmental Delay?

e Assess against the Early Intervention criteria first using Do you need early intervention? in Our Guideline — Applying to the NDIS.

e If they do not meet these requirements, assess against the disability criteria using Do you meet the disability requirements? in Our Guideline — Applying to the NDIS.

Standard Operating Procedure

For Internal Use Only

6. Aged 25 or under, with evidence of hearing impairment

e If the evidence confirms auditory neuropathy via specialist audiologist, or hearing loss greater than or equal to 25 decibels in either ear at 2 or more adjacent frequencies likely to be permanent or long term.

e Meets early intervention requirement: no further evidence of permanency or functional impairment required.

e More information is available in What about people aged between 0 and 25 with a hearing impairment? in Our Guideline — Applying to the NDIS.

7. Evidence of impairment on List B?

e Refer to List B of the Our Guideline — Applying to the NDIS for a list of conditions considered to be permanent without further evidence.

e People with impairments on List B will not need to provide evidence that their disability is caused by an impairment. You will still need evidence to determine that as a result of a permanent impairment/s, the person:

  • has substantially reduced functional capacity or psychosocial functioning;
  • their capacity for social or economic participation is affected; and
  • is likely to require support under the NDIS for the person’s lifetime in order to meet the disability requirements.

e Use Do you meet the disability requirements? in Our Guideline — Applying to the NDIS to make a decision.

8. All other impairments:

e Assess evidence provided by a treating professional of impairment and its impact on daily function against the disability requirements. Supportive evidence can be provided by the participant and/or their representative. Use the Our Guideline — Applying to the NDIS.

e Where the person meets permanency criteria Sect 24(1)(b), but does not meet the criteria under Sect 24 (1)a, c, d or e, consider the evidence against the early intervention requirements using Do you need early intervention? in Our Guideline — Applying to the NDIS.

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Standard Operating Procedure

For Internal Use Only

  • NDIS Act 2013
  • NDIS (Becoming a Participant) Rules 2016
  • Our Guideline — Applying to the NDIS
  • Our Guideline — Your privacy and information
  • NAWMB Quality Control Audit Guide
  • Australian Health Practitioner Regulation Agency (AHPRA) website
  • Conversation Style Guide
  • Standard Operating Procedure — Finalise access met decision
  • Standard Operating Procedure — Finalise access not met decision
  • Standard Operating Procedure — Request further information (s26) for decision
  • Standard Operating Procedure — Send SMS using Whispir messenger
  • Standard Operating Procedures — Undertake eligibility reassessment
  • Standard Operating Procedure — Verify age and residence using documentary evidence
  • Standard Operating Procedure — Verify age and residence details using Centrelink mainframe
  • Email Template — Escalate potential access integrity issue
  • Email Template — Request QDO endorsement for mandatory TAB Advice
  • Email Template — Mandatory EL1/TL review: Under 25 Psychosocial — Disability.
  • Email Template — Mandatory EL1/TL review: Under 25 Psychosocial — El

6. Feedback

If you would like to provide feedback about this guidance material, please complete our Feedback form.

7. Version control

Version Amended by Brief Description of Change Status Date
1.0 TSO0036 Class 2: NARB BM approval APPROVED 2021-01-29
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Standard Operating Procedure

For Internal Use Only

Version Amended by Brief Description of Change Status Date
CW0032 Class 2: SGP BM approval Separated from SOP — Make Access Decision and transferred into the new SOP template
2.0 AJK223 Class 1: SGB approval; Changed to refer to SOP — Verify Age and Residence Details in Centrelink Mainframe. APPROVED 2021-03-15
3.0 TS0036 CW0032 Class 2: NARB BM approval; Class 2: SGP BM approval APPROVED 2021-05-12
4.0 TS0036 CW0032 Class 2: NARB BM approval; Class 2: SGP BM approval APPROVED 2021-05-26
5.0 TS0036 JC0075 Class 2: NARB BM approval; Class 2: SGP BM approval; Updated TAB process; Updated remote and very remote applications to be reassigned to Danika Sharpe.; Updated to align with SOP — Verify age and residence using documentary evidence; Update to conversation scripting when clarifying information. APPROVED 2021-07-06
6.0 CHO0026 CW0032 Class 2: NARB BM approval; Class 2: SGPB BM approval; SMS instructions updated to use Whispir Messenger APPROVED 2022-02-09
7.0 SMO0075 Class 3: ND GM approval APPROVED 2022-03-21

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Standard Operating Procedure

For Internal Use Only

Version Amended by Brief Description of Change Status Date
GO0002 Class 3: PXD GM approval Updates to align with new Applying OG
New steps to check for integrity issues
8.0 CHO0026 Class 2: NARB BM approval APPROVED 2022-05-09
CW0032 Class 2: SGPB BM approval
Access decision diagram added from the staff manual that will be retired
9.0 EMN960 Class 1: approval APPROVED 2022-09-06
Updated timeframe so the applicant has more time, from 28 to 90 days, to provide evidence.
10.0 EMN960 Class 1 approval APPROVED 2023-02-17
Updates to support a respectful experience for people whose preferred name is different to their legal name:
section 3.4 — added notes to remind you to search using a legal name
section 3.5 — step 1 updated to make sure we are checking title

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