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Referral Checklist: Eligibility Reassessment or Access Status Change — Early Intervention

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Referral Checklist: Eligibility Reassessment or Access Status Change — Early Intervention

The contents of this document are OFFICIAL.

This checklist will help you decide if a participant who joined the NDIS under early intervention requirements should be referred for an:

  • Eligibility Reassessment (ER); or
  • Access status change from early intervention to disability.

A participant must leave the NDIS if they don’t meet the following requirements:

  • Residence
  • Disability or Early Intervention.

They must also leave the NDIS if they are over 65 and:

  • in permanent residential aged care for the first time after turning 65, or
  • are receiving an aged care package

This needs to be verified by receiving a copy of the participant’s aged care residential service agreement to view the date of entry. If you identify a participant over 65, in this situation, you must help them to leave the NDIS using the SOP — Finalise the plan before a participant leaves the NDIS. Don’t complete this checklist.

1. Recent updates

Date What’s changed
October 2022 - Guidance updates to align with Our Guideline — Leaving the NDIS
- SOP — Cease participant status has been divided into 3 SOP’s: - SOP - Ask for an Access Request to be withdrawn - SOP - Finalise the plan before a participant leaves the NDIS - SOP - Cease the participant status to leave the NDIS
April 2022 - Guidance updated to align with Our Guideline — Applying to the NDIS.
- Link to Our Guideline — Mainstream and Community supports
- Duplicated technical content removed

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Standard Operating Procedure

For Internal Use Only

What’s changed

  • New action 3.2: Attach completed checklist to participant’s record
  • Existing content updated to highlight the different considerations for global developmental delay and developmental delay.

2. Checklist

Topic Checklist
Pre-requisites You have:
  • read and understood Our Guideline — Applying to the NDIS.
  • read and understood Our Guideline — Leaving the NDIS
  • reviewed all information on the participant’s record (including interactions, inbound documents and planning conversation tools).
  • followed the instructions in SOP — Refer the participant for an Eligibility Reassessment (ER) or Access Status Change.
You have checked the participant:
can be contacted
has an access status of ‘Benefit from Early Intervention’.
is not over 65 and: 
*   in permanent residential aged care for the first time after turning 65, or
*   are receiving an aged care package
Actions
3.1 Complete the checklist
3.2 Attach completed checklist to participant’s record

3. Procedure

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Standard Operating Procedure

For Internal Use Only

2.1

  1. Complete the checklist and follow the instructions in SOP — Refer the participant for an Eligibility Reassessment (ER) or Access Status Change. Unless specified otherwise, complete the checklist by progressing through each question consecutively.
Participant information Details
Participant’s name:
Staff member completing checklist:
Date completed: Click or tap to enter a date.
  1. Is the participant over 65 and:
  • first entered aged care permanently for the first time after turning 65 years, or
  • receiving an aged care package?

This needs to be verified by receiving a copy of the participant’s aged care residential service agreement to view the date of entry.

[_] Yes, do not refer to NARB

If selected, do not complete remainder of checklist. Instead, refer to SOP — Finalise the plan before a participant leaves the NDIS.

[_] No

  1. Is the participant listed as ‘unable to contact’?

[_] Yes, do not refer to NARB

If selected, do not complete remainder of checklist. Instead, refer to SOP — Unable to contact the participant.

[-] No

  1. Is the participant’s primary disability ‘developmental delay’ in the NDIS Business System (System)? Note: This does not include ‘Global Developmental Delay’. Answer No if the participant’s primary disability is ‘Global Development Delay’ to continue with the checklist.

[_] Yes

[_] No, go to question 6

If participant has Global Developmental Delay, answer ‘No’.

  1. Is the participant 6 years or above?

This question is only relevant if the participant has a primary disability of developmental delay. Refer all children 6 and over with a primary disability of developmental delay to NARB. The following are the 3

[_] Yes, refer to NARB for potential ER, access status change or maintain access status decision

[-] No

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Standard Operating Procedure

For Internal Use Only

Participant information

potential outcomes of the referral:

  • Revocation — If there is no evidence of a permanent impairment.
  • Access status change (EI to Disability) — If there is evidence of a permanent impairment and all of the disability requirements are met. (In this scenario, NARB will update the primary disability.)
  • Maintain access status — If there is evidence of a permanent impairment and all the El requirements are met. (In this scenario, NARB will update the primary disability.)

5. Is there evidence of an impairment that is likely to be permanent?

This question is only relevant if the participant has a primary disability of developmental delay.

This question determines if you should make a referral to NARB for a potential update to the child’s primary disability from developmental delay to a permanent impairment.

The following are 2 of the potential outcomes of the referral:

  • Access status change (EI to Disability) — If there is evidence of a permanent impairment and all of the disability requirements are met. (In this scenario, NARB will update the primary disability.)
  • Maintain access status
    • If there is evidence of a permanent impairment and all the El requirements are met. (In this scenario, NARB will update the primary disability.) OR
    • If there is insufficient evidence of a permanent impairment and all of the developmental delay El requirements are met. (In this scenario, the primary disability will not be updated.)

Consider the following before answering this question:

  • Refer to Do you have an impairment that’s likely to be permanent? in Our Guideline — Applying to the NDIS.
  • Generally, conditions such as developmental delay and ADHD are likely to have treatment options available,

☐ Yes, refer to NARB for potential access status change or maintain access status decision ☐ No

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Standard Operating Procedure

For Internal Use Only

Participant Information

and therefore unlikely to be considered permanent.

Answer Yes if the participant has a disability on [List A](List A), [List B](List B) or [List D](List D), or the information indicates the participant has pursued all treatment options (as per information in the OG).

Note: A participant does not need to have a disability on List A, B or D to meet the eligibility requirements of a permanent impairment.

  1. Has the participant received at least 12 months of funding?
  • Yes, go to question 8
  • No
  1. Did an administrative error record an ‘Access Met’ decision incorrectly?

For example, the interaction indicates the decision was ‘Access Not Met’, but the application status is ‘Access Met.’

Note: Only consider this question if the participant has had less than 12 months of funded supports. A referral is not required if the participant has received less than 12 months and the decision was recorded correctly.

  • Yes, refer to NARB for potential correction. If selected, do not complete remainder of checklist.
  • No, do not refer to NARB. If selected, do not complete remainder of checklist.
  1. Is the primary disability in the system correct?

This should be the permanent impairment or developmental delay that has the biggest impact on the participant’s daily life.

Note: If there is no evidence to confirm the primary disability is correct and there is no evidence of an updated disability, answer ‘yes’ to this question.

  • Yes
  • No, follow SOP — Add or change disability (Post Access) to update the primary disability, then go to next question.

Residence Requirements — Section 23

  1. Is there evidence the participant doesn’t live in Australia?
  • Yes (they may not meet the residence requirements), refer to NARB for potential ER. If selected, do not complete remainder of checklist.
  • No

Refer to Do you live in Australia? in [Our Guideline — Applying to the NDIS](Our Guideline — Applying to the NDIS).

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Standard Operating Procedure

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Residence Requirements — Section 23

10. Is there evidence the other residence requirements are not met?

  • A person must live in Australia and be one of the following:

    • an Australian citizen
    • holder of a permanent visa
    • holder of a protected special category visa (SCV).

  • The exception to this is a person who met the criteria outlined in the NSW Prescribed Program Rules.

  • Refer to Are you an Australian citizen or permanent resident? in Our Guideline — Applying to the NDIS

    [ ] Yes (they may not meet the residence requirements), refer to NARB for potential ER If selected, do not complete remainder of checklist. [ ] No

Early Intervention Requirements — Developmental Delay,

Section 25(1)(a)(iii)

11. Is the participant a child younger than 6 years with developmental delay?

[ ] Yes
[ ] No, go to question 14

12. Does the child have a substantial delay in one or more of the following areas of major life activities:

  • self-care

  • receptive and expressive language

  • cognitive development

  • motor development?

  • Consider the following before answering this question:

    [ ] Yes (they have a substantial developmental delay) [ ] No (they may not meet the El requirements), refer to NARB for potential ER If selected, do not complete remainder of checklist.

13. Does the child require more than one professional working together to support them across multiple activities and settings for an extended period of time (more than 12 months)?

  • Examples of multiple settings may include home,

    [ ] Yes (they meet the El requirements), do not refer to NARB If selected, do not complete remainder of checklist.

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Standard Operating Procedure

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Early Intervention Requirements — Developmental Delay,

Section 25(1)(a)(iii)

  • community and early childhood centres.
  • Examples of multiple professionals working as a team may include speech therapists, psychologists, occupation therapists, physiotherapists and special educators.
  • Consider the following before answering this question:
    • Refer to Does the child need specialist services from more than one type of professional and for longer than 12 months? in Our Guideline — Applying to the NDIS.

L_] No (they may not meet the El requirements), refer to NARB for potential ER If selected, do not complete remainder of checklist.

List A met?

Details

14. Is there evidence the participant has a disability on List A?

  • Disabilities on List A are likely to meet the disability requirements without further information.
  • Consider the following before answering this question:
    • A disability must meet the specific requirements as stated on List A.

For example, if the participant has Autism Spectrum Disorder and evidence does not indicate a level of 2 or 3 and does not have a diagnosis of a List A condition from a treating professional, answer No and continue with the checklist.

  • Answer Yes if the participant has a disability on List A.

Note: A participant does not need to have a disability on List A, B or D to meet the eligibility requirements.

[] Yes (they may meet the disability requirements), refer to NARB for potential access status change (EI to Disability) If selected, do not complete remainder of checklist. [-] No

List D met?

Details

15. Is the participant a child younger than 7 years with evidence of a disability on List D?

[_] Yes (they meet the El requirements), do not refer

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Standard Operating Procedure

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List D met?

  • Disabilities on List D meet the early intervention requirements. Note: A participant does not need to have a disability on List A, B or D to meet the eligibility requirements.

Early Intervention Requirements — Permanence, Section 25(1)(a)(ii)

16. Is there evidence of an impairment that is likely to be permanent?

  • Yes (the impairment is permanent)
  • No (they may not meet the El requirements), refer to NARB for potential ER. If selected, do not complete remainder of checklist.

A person must have a permanent impairment or be younger than 6 with developmental delay to be eligible for the NDIS.

Consider the following before answering this question:

  • Refer to Do you have an impairment that’s likely to be permanent? in Our Guideline — Applying to the NDIS.
  • Generally, conditions such as developmental delay and ADHD are likely to have treatment options available, and therefore unlikely to be considered permanent.

Answer Yes if the participant has a disability on List B OR the information indicates the participant has pursued all treatment options (as per information in the OG).

If the child was granted access for developmental delay:

  • At the plan review after the child turns 6 years of age, they need to demonstrate that they have a permanent impairment to continue to be eligible.

Note: A participant does not need to have a disability on List A, B or D to meet the eligibility requirements.

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Standard Operating Procedure

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Early Intervention Requirements — Reduces future support needs and functional capacity, Section 25(1)(b) & 25(1)(c)

17. Is the primary disability in the System ‘Hearing loss’?

  • Yes
  • No, go to question 20

18. Is the participant 26 years old or above?

This question is only relevant if the participant has a primary disability of hearing loss.

  • Yes, refer to NARB for potential ER or access status change If selected, do not complete remainder of checklist.
  • No

19. Is there evidence of:

  • hearing loss or auditory neuropathy ≥ 25 decibels in either ear at 2 or more adjacent frequencies?

    This question is only relevant if the participant has a primary disability of hearing loss.

    • Yes, (they meet the EI requirements and access status change is not required), do not refer to NARB
    • No
      • Refer to What about people aged between 0 and 25 with a hearing impairment? in Our Guideline — Applying to the NDIS.
      • Refer to How will early intervention help you? in Our Guideline — Applying to the NDIS.

20. Is there evidence that further intervention is likely to reduce their need for future supports?

  • Yes
  • No (they may not meet the EI requirements), refer to NARB for potential ER If selected, do not complete remainder of checklist.

Early Intervention Requirements — Most appropriate service system, Section 25(3)

21. Are the supports relating to the participant’s permanent impairment most appropriately funded by the NDIS?

e Consider the following before answering this question:

  • Yes
  • No, refer to NARB for potential ER

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Standard Operating Procedure

For Internal Use Only

Early Intervention Requirements — Most appropriate service Details

  • Refer to Is your early intervention most appropriately funded by the NDIS? in [Our Guideline – Applying to the NDIS](Guideline – Applying to the NDIS).

If selected, do not complete remainder of checklist.

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OFFICIAL

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ndis Standard Operating Procedure For Internal Use Only

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Standard Operating Procedure

For Internal Use Only

2.2 Attach completed checklist to participant’s record

  1. Attach the completed checklist to the participant’s record.

  2. If required, send the referral using SOP — Refer the participant for an redacted Reassessment (ER) or Access Status Change.

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Standard Operating Procedure

For Internal Use Only

  • Our Guideline — Applying to the NDIS
  • Our Guideline — Mainstream and Community supports
  • SOP - Ask for an Access Request to be withdrawn
  • SOP - Finalise the plan before a participant leaves the NDIS
  • SOP — Cease the participant status to leave the NDIS
  • SOP — Refer the participant for an Eligibility Reassessment (ER) or Access Status Change

4. Feedback

If you have any feedback about this guidance material, please complete our Feedback Form.

5. Version control

Version Amended by Brief Description of Change Status Date
1.0 TS0036 Class 2: NAR BM review and approval APPROVED 2021-11-10
CW0032 Class 2: SGP BM review and approval
LS0042 Class 2: ND review and approval
AGV957 Class 2: PP BM review and approval
CMO0032 Class 2: ECS BM review and approval

Simplified from 4 checklists into 2 checklists

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Referral Checklist - ER or Access Status Change — El

This document is uncontrolled when printed.

Standard Operating Procedure

For Internal Use Only

Version Amended by Brief Description of Change Status Date
2.0 CH0026 Class 2: NAR BM approval APPROVED 2022-04-07
CW0032 Class 2: SGP BM approval
LS0042 Class 2: ND approval
SGV957 Class 2: PP BM approval
LKMO022 Class 2: ECS BM approval
Align with Our Guideline — Applying to the NDIS
Updates based on SGPB EL2 feedback: include new question (2) to identify participants who are over 65 years and in residential aged care or receiving an aged care package.
3.0 EMNS960 Class 1 approval. APPROVED 2022-07-21
Updates to align with Our Guideline — Leaving the NDIS.

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