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
April 2023	Added Content:

Guidance information for further information requests including:
* 5.13 Gathering further evidence
* 5.14 Formal requests through further information request letter
* 5.14.1 Timeframes for return of requested evidence
* 5.14.2 Requests for extensions for provision of evidence for an internal review
* 5.14.3 Examples of exceptional circumstances for supported extensions for further information requests
* 5.14.4 Example of initial call guidance and scripting
* 5.14.5 Call quidance for additional evidence or reports

2. Index

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

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4. What will be considered as part of an internal review
5. 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
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
5.13 Gathering further evidence
5.14 Formal requests through further information request letter
- 5.14.1 Timeframes for return of requested evidence
- 5.14.2 Requests for extensions for provision of evidence for an internal review
- 5.14.3 Examples of exceptional circumstances for supported extensions for further information requests
- 5.14.4 Example of initial call guidance and scripting
- 5.14.5 Call guidance additional evidence or reports
Appendix A - Principles for s100 Decision Making

What can be reviewed as part of the statement of supports

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• 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

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.

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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 applies 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.

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

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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.

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.

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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.

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

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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. 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. 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.

5.13 Gathering further evidence

An IRO may determine further evidence is needed in addition to what is on the System to each the correct and preferable decision. This can be determined by reviewing evidence provided and information gathered during the initial contact process. Make sure relevant steps in Complete a Planning Internal Review Decision Standard Operating Procedure are followed. V9.0 2023-04-12 Principles of s100 Planning Review Page 7 of 24 This document is uncontrolled when printed. OFFICIAL Page 858 of 875

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Where the participant has indicated that they do not intend to provide further information and the IRO finds that further information will not materially change the decision, further information should not be requested. Note: The participant has opportunities to provide additional evidence to support the internal review at the time of lodging the internal review request. Providing additional information is included in the RoRD form and acknowledgement letter which allows for 14 days from the acknowledgement letter date to provide additional evidence. Also, during the initial contact phase of the internal review, the IRO must also confirm whether or not no additional information needs to be provided prior to making an outcome. During the initial contact, information can be gathered to determine next steps, including whether or not seeking additional information is required.

5.14 Formal Requests through Further Information Request Letter

An IRO may request information or evidence from a participant to support consideration of legislative criteria being met. The participant may also wish to provide more information for example providing a report or an assessment which is nearing completion. A formal request will be issued via preferred method of correspondence by emailing or malling a completed Internal Review Request for Information Letter or the Internal Review Unable to Contact Letter (if contact has not been made) to the participant. A request forurther information letter is to be sent irrespective of whether the IRO is requesting the information or the participant wishes to provide more information for the internal review. The Internal Review Request for Information Letter and the Internal Review Unable to Contact Letter (when applicable) will detail the evidence required and will include the timeframe for return of evidence (usually up to 28 days allowed). For further information on what to take into consideration when determining the due date timeframe for further information requests, refer to Section 5.14.1 Timeframes for return of requested evidence.

5.14.1 Timeframes for return of requested evidence

The standard timeframe is usually between 14 and 28 days for the return of further evidence or information. This is not a legislative timeframe but is considered a reasonable timeframe for procedural fairness in administrative review. The timeframe for return of additional evidence may be adjusted if considered reasonable – for example if the person advises the evidence will be emailed within a few business days, it may be reasonable to agree on an earlier timeframe for provision of evidence and follow up (for example, 7 calendar days).

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If the participant will need to see their health professional to obtain copies of documents and send them via mail, 28 calendar days for return of this evidence may be a reasonable timeframe.

When determining the length of time for return of evidence for an internal review, consideration should take into account:

Whether or not the original 14 days from the acknowledgement letter date has lapsed.
The timeframe for return of additional evidence should take into account the 60 day PSG target and have the earliest practicable due date. The timeframe should allow for a Participant to return the evidence and for the IRO to review the additional information and complete the internal review. If an additional evidence request will cause the internal review to go over the 60 day PSG timeframe, please discuss with your Line Manager.
Length of time between original decision and internal review requested.
If the participant has had previous opportunities to provide further information.

An Internal Review outcome decision must not proceed unless either the further information timeframe has passed, the person has provided further information, or the unable to contact timeframe has passed.

If information is provided prior to the timeframe expiring, IROs would need to make contact to confirm all documents have been received (unless it is clear that all information requested has been supplied) and that there is no further documents to be provided. If there are no further documents to provide, the IRO can then progress with the review. Otherwise, if there are documents still to be received, the IRO would need to wait the full timeframe.

5.14.2 Requests for extensions for provision of evidence for an Internal Review

When a participant asks for extra time to provide further evidence there must be a clear reason for the IRO to agree. Some examples are included in section 5.14.3.

A fair extension would be an additional 7-14 days (a total of 36-43 days since the evidence was requested). This is not a legislative requirement but allows a reasonable timeframe for evidence to be returned and a decision to be made.

If an extended timeframe for further information will lead the internal review to becoming older than 60 days, consult with your Line Manager for endorsement of the timeframe extension.

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If a Line Manager approves an extension, it must be recorded as an interaction on the System. Follow relevant steps in the Complete a Planning Internal Review Decision Standard Operating Procedure to update the systems required for the agreed extension timeframe including documentation of reasons for extension.

5.14.3 Example of exceptional circumstances for supported extensions for further information requests

There are a range of exceptional circumstances listed below which may result in an extension of time to provide evidence. Consideration is given for other matters that may require an extension.

Specialist appointment or Allied Health Professional appointment has been booked but has not yet occurred.
Local or State Emergencies or severe weather events impacting on gathering of evidence.
Rural or Remote geographical impacts (visiting specialists).
Changes to caring arrangements, including informal supports, due to death, serious illness or injury of informal supports, or significant and unexpected deterioration of disability-related functional capacity.
Risk to self, others, community or agency reputation.
A participant is living in an emergency declared region which has been affected by a recent emergency.
A participant requires a specialist appointment and there is a long wait for appointments; a participant is hospitalised and has no advocate/support coordinator, which can assist with gathering additional evidence.
Unstable or fragile arrangements can also be considered (for example risk of relinquishment of a child).
Participants who do not have any disability specific supports in place and are re-entering the community after a long term residential stay (for example prison release, mental health treatment release, newly acquired significant disability, spinal cord injury).
Recent or upcoming hospital admission or discharge.

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• Impacts of COVID related self-isolation or other health related impacts preventing the gathering and/or provision of additional information.

5.14.4 Example initial call guidance and scripting

Good morning/afternoon

My name is , I am from the NDIA and I am calling you in regard to <participant’s name/your> s100 internal review request.

Before we begin can I please complete proof of identity with you to ensure your privacy?

Complete POI steps refer to Record and Verify Identity for an Individual and Complete a Planning Internal Review Decision Standard Operating Procedure.

My role as an internal review officer is to consider the current plan you have and the parts that you are not happy with and why you are requesting a review. We can also check if what you are wanting to achieve can be met with your current plan budget.

I am a decision maker that is separate to your original . Once I have confirmed with you today the requests relating to your review and any other information I will be able to make a timely decision for you based on the information that we have.

I can confirm that we have the following evidence available including <state briefly list of evidence provided for the internal review for example Functional Capacity Assessment report, Physiotherapy report, quote>, I will use this to assist with coming to a decision about your request.

Would you be able to provide me with details of the supports that you are requesting that differs from your current plan, and the reasons why you require this support?

Take information on the supports being requested and why, and document as part of your confirmation interaction on CRM along with key discussion points. Finalise this in detail after the call.

Other points to cover during phone call contact:

• Confirm the preferred plan management type. • Confirm preference for plan duration and any relevant issues. • If applicable, confirm any assistive technology supports that may have been claimed already and advise if decision is set-aside funding will be removed from the new plan.

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Ensure any supports specifically withdrawn by the participant is included in the interaction note.
Allow time to explain or discuss keeping it to the point or relevant peripheral issues.
Prompt with information from the current plan – e.g., number of supports already provided and number they require, AT, etc. “I can see here you have 2 hours per day for core self-care, how many hours did you require?”
Acknowledge any challenges or difficulties they have experienced (for example, I’m sorry you experienced that, or I’m sorry that occurred)
Where you need to gain an understanding from lived experience you should ask questions that help you to create a picture of the person/need. For example:

So that I can get a clear understanding of the requested supports, what will they will help you to do differently than what your current plan can support you with? What does a typical day/evening/morning routine look like for you? Choose which is most relevant. You are looking for information that describes if a support need is a verbal or physical prompt, task set up, full physical assistance and if needs fluctuate then when and why?

Thank you for confirming the supports you require. I can now proceed to review the available information and come to a decision about your supports. There may also be occasions where you can discuss the likelihood of the supports being funded or not. I cannot give you a specific timeframe but will aim to complete internal reviews within a 60 day timeframe from the request date. Once I have completed the decision you will receive an outcome and decision letter in line with the NDIS Act and Rules. If the original decision does not change there will be no change to the plan and you will receive a decision letter which explains the decision. If I approve any supports requested, I will make this change to your plan, and you will receive a copy with the decision letter. Confirm the contact details and preferred method of contact method are correct to receive the decision letter for the internal review. Further information regarding NDIS supports can also be found on the NDIS webpage. V9.0 2023-04-12 Principles of s100 Planning Review Page 12 of 24 This document is uncontrolled when printed. OFFICIAL Page 863 of 875

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5.14.5 Call guidance for additional evidence or reports

In the event the participant wishes to provide additional reports or information and you can see that it would most likely materially change the decision.

Avoid asking open ended questions such as, when can you get me the information? Instead ask something like:

Where further information will not change the decision, advise this to the participant.

In your conversation use your skills to set a time frame that is as soon as possible and takes into consideration the 60 PSG. Negotiate in the first instance how soon the participant or nominee can return documents and confirm this reasonable timeframe taking into account the points of consideration outlined in section 5.14.1.

If they can’t get you the info in a timeframe to be able to make a decision within 60 days, I think we are at the stage we can be open and say something like,

“As I have a requirement to make my decision within a certain time frame, if I don’t have the info by (date) it will be best that I continue to make my decision on the information that I have. If in the future, you obtain further information you may be able to ask for a plan change such as a reassessment or variation depending on the type of info and your circumstances. You will be able to discuss this with your NDIS contact at any time.” (We will always consider individual circumstances so please discuss with your line manager).

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
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Version	Amended by	Brief Description of Change	Status	Date
2.0	CAP525	Class 1 approval	APPROVED	2021-07-23
	DLL320
	SWO065
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 SWO065. 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 SW0065.	APPROVED	2022-08-17
	BCO0038
5.0	LW0022	Updated content in section 5.1 Minor update to wording in 5.2 for consistency.	APPROVED	2022-09-06
	RMO411
6.0	KMM575	Principles for s100 Decision Making table added.	APPROVED	2022-12-02

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Version	Amended by	Brief Description of Change	Status	Date
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
9.0	LW0022	New sections added 5.13 and 5.14. Includes guidance information about further information requests, points to consider when making due date for return of evidence/reports and scripting guidance for initial calls.	APPROVED	2023-04-12

Appendices

8.1 Appendix A -— Principles for s100 Decision Making

Principles for s100 decision making (Questions Yes or No Relevant part of Act or to guide your internal review).

Question	Relevant Part of Act or Rule
Does the requested support provide the same benefit as another support already funded in the current plan?	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

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

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

| 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.

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

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
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.

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.

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

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 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)
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

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

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 Yes $34 (c) and (d) budget where the outcome can be met within the overall plan budget?

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

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

Principles for s100 decision making (Questions to guide your internal review).	Yes or No	Relevant part of Act or Rule
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	s34 (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.

The participant may need short term support to help them get started with a social and/or recreation 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 | s34 (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). |

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Guidance

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

If request is for alternate therapy (art, music) or intensive therapy (such as, Applied Behaviour Analysis - ABA) consider if there is evidence for specific l 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

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.

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Principles for s100 decision making (Questions Yes or No) Relevant part of Act or Rule

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)

Our Guideline - Social and Recreation Support

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 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 participant streamed general or supported? Yes | Rule 5.1 (c)

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

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.

Is the request to change the plan duration where 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 there are unreasonable risks to self-manage?

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

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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