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

Principles of s100 Planning Review

This guidance is to support an understanding of what is considered for an internal review of a decision for Internal Review Officers (IROs) and Business Support Officers (BSOs).

The NDIA has more than one way to change a plan. Sometimes it is hard to understand which pathway is the right one to address a participant’s request for a review/reassessment or variation. This document can be used in conjunction with the Choose the Right Request Tool.

Note: All references to “participant” in this document also refers to authorised representatives/nominees/child representatives.

1. Recent updates

Date	What’s changed
February 2023	Added Content: Continuous improvement updates for face-to-face meeting requests

2. Index

1. What can be reviewed as part of the statement of supports
1. What will be considered as part of an internal review
1. Additional Guidance for s100 planning review
- 5.1 Update to Participant statement of goals and aspirations (section 47)
- 5.2 Update the Severity Indicator and WHODAS
- 5.3 Update Participant Streaming
- 5.4 Updating Listed Primary Disability
- 5.5 Referral for Complex Support Needs (CSN)
- 5.6 Refer Participant for Eligibility Reassessment (ER)
- 5.7 Referral of Participant that may have received a Compensation amount
- 5.8 Appointing a Plan Nominee

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• 5.9 Collecting and updating bank details • 5.10 Make a request for service Support Coordination and Recovery Coach as part of the s100 • 5.11 Participant Critical Incident (PCI) as part of the s100 • 5.12 Internal Review face to face meeting requests • 8.1 Appendix A - Principles for s100 Decision Making

3. What can be reviewed as part of the statement of supports

The statement of supports includes:

• What NDIS funded supports are included in a participant’s plan. • How those supports are described. • How long the plan goes for. • How the funding in the plan is managed.

4. What will be considered as part of an internal review

When reviewing a decision about a participant’s plan, Our Guidelines state we will make our decision based on the facts and circumstances at the time of our internal review decision.

The internal review will consider:

• Any evidence from the original decision • Reasons for the original decision • Additional information that has been provided for the internal review • The facts and circumstances of the participant at the time of making the internal review decision (this means we can consider any changes since the original decision was made, which may impact their statement of supports, such as, a change to the participant’s capacity to do things for themselves or an ongoing change to their living situation, which may mean they need more or less supports) • The NDIS Act, Our Guidelines and internal guidance material

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Guidance

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Guidance

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The internal review team will seek to review the request based on the support/s in dispute, and to those disputes(s) the participant wishes to raise or is dissatisfied with as part of their internal review request as well as any dependencies or related supports.

The participant may request a review of all the funded supports in the plan. They may also identify a specific support they are seeking funding for. While it is preferable for the participant to have raised any specific requests with the original decision maker, it is not compulsory. Therefore there does not have to be an explicit request for a support made, plan management type or length of plan during the planning process for it to be considered as part of the internal review.

During a planning meeting the participant does not have to specifically identify the supports they wish to be included in their plan. It is the planner’s and internal review officer’s responsibility to gather and review all information before making a decision about what funded supports are included in the participant’s plan. In some situations, a participant may prefer to have a plan reassessment or plan variation undertaken first before proceeding with their internal review. In these cases, the Internal Review Officer should seek to understand the circumstances and ensure all options are well understood before enabling the participant’s preferred pathway.

Similarly if new quotes, reports or assessments requested by the original delegate are submitted as part of the internal review process these can be considered if that is the preferred pathway for the participant. This could include functional capacity assessment, assistive technology or home modifications quote or reports that has been provided between the original decision and the internal review request. It is important the participant understands the impact of their decision to their review rights.

5. Additional Guidance for s100 planning review

The following information applies to s100 regarding a participant statement of support and only apples only if there are supports in dispute.

5.1 Update to Participant statement of goals and aspirations (section 47)

The statement of goals and aspirations is not a reviewable decision. Where a participant wants to add or change a goal but no changes are required to the supports funded, they do not need to have a plan reassessment. Changes to the participant statement can be made at any time and can be sent to enquiries@ndis.gov.au. If the requested change also requires a reassessment of their support needs, then a plan reassessment (section 48) is the correct pathway.

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When an update to the Participant statement of goals and aspirations is requested or provided information as part of the s100 process, the IRO can update this for the Participant in CRM. Refer to Administrative Change Task Standard Operating Procedure.

5.2 Update the Severity Indicator and WHODAS

Updates to the Severity Indicator and WHODAS may require updating by the IRO and is dependent on the decision outcome.

Confirmed Decision The IRO cannot complete an update to the severity indicator or the WHODAS as a review application will not be generated. The IRO can provide information regarding future SI/WHODAS updates within the plan implementation interaction.

Vary/Set-aside Decision

As part of the pre-planning tasks the IRO should confirm the relevant tool has been applied correctly using the participant’s primary disability. Updates to the SI/WHODAS may be required. Refer to Complete the Update Severity Tools task Standard Operating Procedure.

5.3 Update Participant Streaming

If the IRO identifies streaming factors from information provided during the internal review then the IRO should review and update the participants streaming. Refer to the Update participant streaming Standard Operating Procedure.

5.4 Updating listed Primary Disability

If the IRO identifies evidence or information provided during the internal review or the participant has advised their disability is recorded incorrectly. Then the IRO should review and change the listed disability information on the record.

Where the funding included within the Participant’s Statement of Supports is being disputed the supports being requested are reviewable under s100 of the NDIS Act (2013). The review should consider the information available regarding the disability the participant has met access to the NDIS for and resulting impairments. Any other additional impairments can also be considered and a decision made under s34 of the NDIS Act (2013). A request to change or update the list of disabilities with supports in dispute can be part of the internal review.

Note: If you require assistance determining if a participant secondary impairment/s would meet the access requirements please speak to your Line Manager and/or seek ECS/TAB advice where required.

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Guidance

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For more information on updating or changing disability types refer to the Add or Change Disability Standard Operating Procedure.

5.5 Referral for Complex Support Needs (CSN)

If you determine the participant’s circumstances meet the requirement for referral to the CSN pathway you need to complete a CSN Referral Form which will assist the CSN Operations Triage Team to quickly determine suitability. Refer to the Referral for Complex Support Needs Pathway Standard Operating Procedure.

5.6 Refer Participant for Eligibility Reassessment (ER)

If the IRO identifies the participant may not meet the access requirements for the NDIS, the IRO can provide a brief summary of this information within the plan implementation interaction.

5.7 Referral of Participant that may have received a Compensation amount

No plan with compensation identified should be rolled over, reviewed, or approved without first contacting the Compensation Recoveries Branch for advice.

The Compensation Recoveries (CR) team is in the process of removing old CRM alerts that provide instruction to proceed with plan development without regard to compensation.

All s100 internal review requests relating to Compensation will be allocated to and completed by the Internal Review Team (IRT) Escalations Team.

5.8 Appointing a Plan Nominee

If the IRO identifies the participant has requested or may benefit from the appointment of a nominee, the IRO can provide a brief summary of this information within the plan implementation interaction.

If the IRO identifies consent has lapsed during the internal review, then the IRO should obtain necessary consent for the purposes of conducting the internal review. Any further follow up of the plan nominee requirements for review is to be added as part of the plan implementation interaction.

5.9 Collecting and updating bank details

Participants are encouraged to update this information via the My Place Portal.

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If this option is not suitable for the participant, the IRO can update the details as per the participant request. Refer to the Collect and update bank account details Standard Operating Procedure.

5.10 Make a request for service for Support Coordination and/or Recovery Coach as part of the s100

Any requests for service for Support Coordination and/or Recovery Coach can be included as outstanding tasks in the plan implementation interaction. Information for the interaction should include:

Purpose of referral (Support Coordination or Recovery Coach)
Participant context
Referrals for assessments required for example, Functional Capacity Assessment, Exploring Housing Options
Other additional comments such as, expected outcomes for SC funding and how to best support the participant

5.11 Participant Critical Incident (PCI) as part of the s100

If a PCI occurs during the s100 or the IRO has information that meets the criteria for completing a PCI, this should be completed as soon as IRO has this information. It is our duty of care to report any allegations about incidents which may cause harm to a participant. All staff must ensure the participant and others are safe when first notified of a potential PCI. If the participant or another person is in immediate danger or requires urgent assistance, please call Triple Zero (000) immediately.

You will need to:

Fill in the PCI notification form (DOCX 74KB)
Email the form to s47E(d) - certain operations of agencies @ndis.gov.au within 24 hours
Include detailed and factual information, without drawing conclusions.

Please do not record details on the participant’s CRM record. Once the PCI team receive the completed form, they will investigate incidents quickly, appropriately and in line with legislative requirements. The Agency acknowledges these issues can be triggering. Please seek support when you need to.

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Guidance

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You can find out more about supports for Agency staff and leaders on our Well+ Hub.

Find out more on the Participant critical incidents intranet page.

5.12 Internal Review face-to-face meeting requests

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, the IRT does not include face-to-face meetings as part of the standard service offering. IROs can use telephone calls, email, and SMS to discuss the review with those who request them.

6. Face-to-Face Meeting Requests

If a face-to-face meeting is requested, and after discussing and exploring other options, such as engaging with Advocates/Authorised Representatives, Interpreting Supports, and organising specific times to call, it is determined that a face-to-face meeting may be necessary, seek assistance from your Line Manager to identify a pathway forward.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 SWoO065

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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 SW0O065.
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 SW0065. 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 SWO0065.	APPROVED
BCO0038	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
8.0	KMM575	Continuous improvement updates for face-to-face meeting requests.	APPROVED	2023-02-10

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Appendix A — Principles for s100 Decision Making

Principles for s100 decision making (Questions to guide your internal review).

Principles	Yes or No	Relevant part of Act or Rule
Does the requested support provide the same benefit as another support already funded in the current plan?	Yes	Rule 5.1(c) S34(c) and (d)
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.

Guidance

For Internal Use Only

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

Would we fund it? information

| Does the requested support relate to the participant’s disability/eligible functional impairments? | No | Rule 5.1 (b) |

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 by the NDIS? | 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

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

Aged Care

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.

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.

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

§47 (2) If a participant gives a changed version of the participant’s statement of goals and aspirations 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 available to the participant?	Yes	§34 (e)

Has the participant explored family, friends or the community to provide the extra help needed to pursue the goal?

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.

Is the request an increase to the core daily activity budget where the outcome can be met within the overall plan budget?	Yes	§34 (c) and (d)

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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 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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