Guidance

For Internal Use Only At times, a participant or their authorised representative may request a face-to-face meeting.

As the IRT is a virtual team with a limited footprint across the country, the IRT does not include face-to-face meetings as part of its current service offering.

Telephone calls (or emails where preferred) allow for IROs to deliver decisions in real time. The Agency’s position is for consultations and discussions to occur over the phone to support as many participants as possible.

You can refer to Section 4 what to consider before initiating contact and during contact in the Internal Review Explanation of Decision (EOD) Contact Guidance for strategies when discussing a request for a face-to-face meeting.

If a participant uses Assistive Technology to enable them to communicate by phone (e.g. voice generating software), interpreting supports, or the direct assistance from another person (e.g. advocate or authorised representative), an IRO may need to arrange a specific time to call. When arranging these phone calls, review the System to identify the support they require and/or engage with their authorised representative. In relation to interpreting services, follow the advice in the Agency wide Practice Guide — Assisting Communication.

If a participant’s request for a face-to-face meeting escalates and they refuse to engage, seek assistance from your line manager to identify a pathway forward.

6. Feedback

If you have any feedback about this Standard Operating Procedure, please complete our Internal Review Team Quality and Continuous Improvement Form and email it to the Business Improvement Team. In your email, remember to include the title of the product you are referring to and describe your suggestion or issue concisely.

7. Version Control

Version	Amended by	Brief Description of Change	Status	Date
1.0	DII394	Class1 approval	APPROVED	2021-02-03
2.0	CAP525	Class 1 approval	APPROVED	2021-07-23
			DLL320
			SWO065

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Version	Amended by	Brief Description of Change	Status	Date
3.0	KMM575	Removed out of scope change of preference example.
Move to new template. Class 1 approval.	APPROVED	2021-11-23
4.0	LW0022	Review of flow of document.
Feedback provided from SWO0065.
Deleted section about additional information. Updated information about what is part of internal review and added in OG link. Updated conversation to contact and communication. Updated based on feedback SWO0065. Inclusion of appendix information - guidance information for progression of s100 planning decision tasks. Additional guidance information added. Removed withdrawn section and conversation prompts. Minor updates to index and example wording based on feedback provided SWO065.	APPROVED BC0038	2022-08-17
5.0	LW0022	Updated content in section 5.1 Minor update to wording in 5.2 for consistency.	APPROVED RMO411	2022-09-06
6.0	KMM575	Principles for s100 Decision Making table added.	APPROVED	2022-12-02
7.0	KMM575 TWL527	Face-to-face meeting request guidance added.	APPROVED	2023-01-05

Appendices

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Appendix A – Principles for s100 Decision Making

Principles for s100 decision making (Questions Yes or Relevant part of Act or to guide your internal review).

Does the requested support provide the same	Yes	Rule 5.1(c)
benefit as another support already funded in the		S34(c) and (d)
current plan?

Have you provided education on plan flexibility? (Early resolution, duplicated supports).
Have you considered plan utilisation - current and historical?
Have you considered the support within and across the budget categories? That is, the interface between core and capacity building budgets and/or ATHM (previously funded or requested).
Is there alternate funding such as Local Area Coordination/ECEI? (This is alternate funding as per Rule 5.1(c).)

Our Guideline - Reasonable and Necessary Supports.

Each support that is funded in a plan must be a reasonable and necessary support, however we also consider how supports will work together as a package to address disability support needs, or to achieve an outcome. The supports the NDIA fund must be reasonable and necessary individually, but they must also be reasonable and necessary as a package of supports.

Would we fund it? information

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Principles for s100 decision making (Questions Yes or Relevant part of Act or to guide your internal review).

No	Rule
No	Rule 5.1 (b)

Does the requested support relate to the participant’s disability/eligible functional impairments?

Our Guideline - Reasonable and Necessary Supports.

Sometimes, the participant might ask for supports to help with impairments that were not part of your Access eligibility assessment. When this happens, the IRO needs to make sure the support will help address needs that arise from an impairment that meets the same eligibility criteria we consider at

Access to the NDIS - Operational Guideline.

Our Guideline - Disability Health Supports practice guidance if the support is not directly related to the participant’s ongoing functional impairment.

Is the requested support most appropriately funded	No	$34 (f)

Health
Mental Health and Psychosocial Disability
Child Protection and Family Support
Early Childhood Development
School Education
Higher Education, Vocational Education and Training
Employment
Housing and Community Infrastructure
Transport
Justice
Aged Care

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Principles for s100 decision making (Questions Yes or Relevant part of Act or to guide your internal review).

Our Guideline mainstream and community support interfaces.

COAG and would we fund it? information

Mainstream supports are other government services such as employment, education, health and family support services. They are available to everyone including people without disability.

Is the requested support linked to a goal? No $34 (a) Our Guideline - Reasonable and Necessary Supports $34 (c) and (d)

The supports the NDIA fund need to help the participant increase their independence and pursue their goals. This means the supports should help overcome any disability-specific barriers which may be stopping the participant in pursuing their goals. This doesn’t mean the NDIA will fund all support costs associated with pursuing participant goals.

Setting more goals or bigger goals doesn’t mean we’ll provide more funding or fund more supports.
Setting a goal doesn’t mean we have an obligation to fund supports that help you pursue that goal.
Seeking to include a new goal cannot be considered as part of an s100 review (this is $47) that is, a participant can change their goals at any time but cannot have new supports to meet those new goals.

$47 (2) If a participant gives a changed version of the participant’s statement of goals and aspirations

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Principles for s100 decision making (Questions Yes or Relevant part of Act or to guide your internal review).

to the CEO, the plan is taken to be replaced by a new plan comprising.

a) The changed version of the participant’s statement of goals and aspirations; and

b) The statement of participant supports in the existing plan.

| Does the requested support replace other supports | Yes §34 (e) | available to the participant?

Our Guideline - Reasonable and Necessary Supports

The extent of risks and suitability of family, friends and others to provide support as per Rule 3.4. Community services offer a wide range of supports that may help with your disability support needs. Community supports are things open to everyone in the community, like sporting clubs, community colleges, activity groups, libraries or community gardens. They are often a great way to get involved in your local community, meet new people and learn new skills.

For children under 18, the IRO will consider: if their needs are ‘substantially greater because of their disability, compared to other children the same age.

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For Internal Use Only

Principles for s100 decision making (Questions Yes or Relevant part of Act or to guide your internal review).

Is the request more than standard or typical support required for the context (age, disability) of the participant?
Have you understood what the participant’s routine looks like across the day/week (does the evidence specify length of time and what tasks are required to be completed with partial or complete assistance)
Have you understood how the participant is currently utilising their budget?

Operational Guideline - Specific Types of Supports in Plans

Operational Guideline - Personal care supports

Is the request an increase to the core social, community and civic participation budget where the outcome can be met within the overall plan budget? Yes $34 (c) and (d)

Is the request more than standard or typical support required for the context (age, disability) of the participant?
Consider if the support will complement (not replace) other supports available and that will maximise the participant’s inclusion and independence and to help you fulfil an ordinary life.

Our Guideline - Social and Recreation Support

The participant may need short term support to help them get started with a social and/or recreation

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Principles for s100 decision making (Questions to guide your internal review)	Yes or No	Relevant part of Act or Rule
activity. This short-term support may build their skills so the participant can participate independently. Or it could connect them with someone else who can regularly assist or help them to participate.
Is the request for an increase to the capacity building budget for therapy supports, where progress toward the goals/outcome was evident and can continue to be met within the overall plan budget?	Yes	$34 (c) and (d)

If the request is for more than one type of allied health practitioner consider which is the most appropriate to deliver the support in order to make progress toward a goal/outcome (for example, not duplicating the support).
If request is for alternate therapy (art, music) or intensive therapy (such as, Applied Behaviour Analysis - ABA) consider if there is evidence for specific likely outcomes that will meet the criteria of effective and beneficial as per Rule 3.2 and Our Guideline Reasonable and Necessary support?
Does the participant or their other supports (informal, mainstream, funded - core) have the capacity to implement the allied health strategies or programs?
Does the evidence provide the expected level of detail to support a decision? See

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Principles for s100 decision making (Questions Yes or Relevant part of Act or to guide your internal review).

Plan reassessment reports for information.

Our Guideline - Reasonable and Necessary Supports

The primary source of evidence the IRO will rely on, and give the greatest weight to, is evidence from sources that are reliable and widely recognised. This includes published and refereed literature, and any consensus of expert opinions.

How do we weigh evidence of disability?

Evidence - based best practice

Practice Guide - Understanding Therapy Supports

This means that the therapist can train family or staff to provide support to the participant to implement strategies on a more regular basis.

| Is the request for the cost of activities that everyone would be expected to pay? Or the support is typically something a parent would do for their child? | Yes | Rule 5.1 (b) and (d) |

The participant will need to pay for the costs of the activity that everyone would pay for such as membership or entrance costs. The NDIA may then be able to fund the support the participant needs to take part in the activity because of their disability.

| Is the requested support related to an acute health condition (short term illness/injury) and/or rehabilitation requiring clinical care? | Yes | $34 (f) |

Mental Health and the NDIS

The NDIS is designed to work alongside existing government service

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Principles for s100 decision making (Questions Yes or Relevant part of Act or to guide your internal review).

systems, including health, education, housing and mental health specific treatment services. People with mental health and psychosocial disability issues often require support from a range of sources such as community, family, friends, local or private mental health services and other mainstream systems. The NDIS works closely and in partnership with these other support systems and does not replace them. Our Guideline - mainstream and community supports for where it is a time limited intervention to improve functioning following an acute event, medical treatment or accident (for example, to improve functioning immediately following a stroke or acquired brain injury).

Is the request for coordination of supports for a Yes Rule 5.1 (c) participant streamed general or supported?

Is the participant linked to service providers (mainstream, community and funded)
Consider referring the participant to the Booklets 1-3 for developing and using your plan.

Role of the Local Area Coordinator - The Local Area Coordinator role is to help you to understand the NDIS, and link you with service provides, and mainstream or community supports, that will assist you to work toward your goals.

Unless risk factors exist view Standard Operating Procedure - Support Coordination and seek TL/AD advice.

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Principles for s100 decision making (Questions Yes or Relevant part of Act or to guide your internal review).

Is the request to change the plan duration where Yes $34 (d) there are no major life transitions expected prior to plan end date?

Consider if there are any risks identified in the risk assessment?

Consider the factors relating to length of the plan.

Our Guidelines - How long will your plan go for?

The decision determining plan duration reasonably considered the participant’s individual circumstances, support needs and choice. The term ‘Plan Duration’ refers to the period before which a scheduled reassessment will occur.

Is the request to change plan management where Yes s44 there are unreasonable risks to self-manage?

Are there safeguards in place such as financial management capacity building supports?
Is there evidence to support that there is an unreasonable risk to self- management?
Consider if the participant, plan nominee or child representative is bankrupt or insolvent under administration and/or there are unreasonable risks to self- management.
Complete relevant risk assessment related to plan management type.

Our Guidelines - Creating your plan

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