Standard Operating Procedure

For Internal Use Only

The contents of this document are OFFICIAL.

Refer for Eligibility Reassessment (ER) or Access Status Change

Use this Standard Operating Procedure (SOP) to consider whether to refer the participant to the National Access and Reassessment Branch (NARB) for a potential:

• Eligibility Reassessment (ER):
  • if the participant may no longer meet the residence and/or disability and early intervention requirements.
• Access Status Change:
  • if the participant entered the NDIS under early intervention and may now meet the disability requirements.
• Maintain or Change Access Status and update primary disability (developmental delay only):
  • if the participant entered the NDIS under the developmental delay (early intervention) requirements and there is now evidence of a permanent impairment.

1. Recent updates

Date	What’s changed
October 2022	Updates to align with Our Guideline — Leaving the NDIS.

New process: ER Referral Checklist — Disability does not need to be completed at each plan reassessment.

New process: Ask for an ER Request that has already commenced to be withdrawn (in development).

New content: to highlight that an ER referral should not be completed if a participant is identified as over 65 and in permanent residential aged care or receiving an aged care package for the first time.

New link to SOP — Finalise the plan before a participant leaves the NDIS. | | November 2021 | SOP — Refer Participant for Eligibility Reassessment has been separated into 3 SOPs to make the process easier to follow: |

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Standard Operating Procedure

For Internal Use Only

Date	What’s changed
SOP — Refer participant for an Eligibility Reassessment (ER) or Access Status Change
SOP — Refer an Eligibility Reassessment (ER) call back or evidence extension request to NARB
SOP – Support the former participant to leave the NDIS after a revocation decision

There have been improvements to the ER referral checklists to make it easier to find the required checklist. This includes:

• reducing the number of checklists down to 2, from 4
• the only consideration when selecting the checklist is based on the participant’s current access status — either early intervention or disability
• the participant’s age is no longer considered when selecting a checklist.

2. Checklist

Topic	Checklist
Pre-requisites	You have read and understood:

* Our Guideline — Applying to the NDIS
* Our Guideline — Leaving the NDIS

You have: * Confirmed the participant can be contacted * Checked if the participant is over 65 and in permanent residential aged care or receiving an aged care package for the first time

| Actions | * 3.1 Check the access decision reason code * 3.2 Review information and evidence * 3.3 Complete Referral Checklist * 3.4 Attach completed Referral Checklist to Inbound Documents Either: * 3.5 Add interaction — Referral for Eligibility Reassessment not required

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Standard Operating Procedure

For Internal Use Only

Checklist

• 3.6 Create Eligibility Reassessment Request

Then:

• 3.7 Continue with plan reassessment (if required)
• 3.8 Add information to an existing Eligibility Reassessment Request (if required)
• 3.9 Withdraw an Eligibility Reassessment Request (if required)

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Procedure

Note: ER – Referral Checklist – Disability does not need to be completed at each plan reassessment. Only complete this checklist if the participant’s support needs or circumstances change, and it is clear they may no longer meet the eligibility requirements.

You can make an ER referral:

• as part of the plan reassessment process
• at check in
• at any other time.

You can’t make an ER referral if:

• You are unable to contact the participant. Do not refer them for an ER until they re-engage with the NDIA. Follow the process in the SOP – Unable to contact the participant.
• You identify a participant who is over 65 and:
  • in permanent residential aged care, or
  • receiving an aged care package for the first time. In this situation, you must help them to leave the NDIS using the SOP – Finalise the plan before a participant leaves the NDIS.

3.1 Check the access decision reason code

Use this procedure to check the participant’s access status.

1. In the NDIS Account screen: Select Pathway.
2. In the Pathway screen: Select the oldest Approved plan.

Standard Operating Procedure

For Internal Use Only

3. The Participant Lifecycle Management screen will display. Select Access.

4. Select the Determine the Access Decision.

5. The Access Decision screen will display. Scroll down to the Proposed Access Decision.

6. Check the Reason Code for the access decision.

7. This will be either Benefit from Early Intervention or Disability Met.

8. If the Reason Code is:

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Standard Operating Procedure

For Internal Use Only

• Benefit from Early Intervention, complete the Referral Checklist: Eligibility Reassessment or Access Status Change – Early Intervention.
• Disability Met, complete the Referral Checklist: Eligibility Reassessment – Disability.

3.2 Review information and evidence

1. Review any existing information and evidence. You do not need to ask the participant to provide any new or additional information for the purpose of considering their eligibility.

Some sources of existing information include:

• any relevant documents on the participant’s record (including Interactions, Inbound Documents and any available Planning Conversation Tool in the Pathway)
• medical or clinical reports, diagnostic and assessment information
• service provider reports and assessments such as progress reports
• information provided with the access request, such as the Access Request Form (ARF)
• early childhood partner documents
• information from family members and carers.

2. When reviewing the information and evidence, look for:

• evidence of a change in residence status
• evidence of permanence of impairment
• evidence of recent functional impacts.

3.3 Complete Referral Checklist

1. While reviewing information and evidence on the participant’s record, refer to the Referral Checklist: Eligibility Reassessment or Access Status Change – Early Intervention or Referral Checklist: Eligibility Reassessment – Disability from Step 3.1: Check the access decision reason code.

2. Refer to Our Guideline – Applying to the NDIS for information about the eligibility requirements. This will support you to complete the checklist.

3. Complete the ER checklist using the information and evidence you identified in Step 3.2: Review information and evidence.

4. Use the ER checklist to determine if you need to make a referral. If you are unsure if the participant meets the ER checklist criteria, seek assistance from your supervisor.

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Standard Operating Procedure

For Internal Use Only

Note: If you make a referral for a potential access status change from EI to disability, a NARB delegate may:

• decide to commence an ER for potential revocation instead
• decide not to start an ER if they determine the participant’s status should remain the same.

3.4 Attach completed Referral Checklist to Inbound Documents

Note: NARB can only consider your referral if the checklist is attached to the participant’s record. If you do not attach the checklist, NARB will not progress the ER, and they will return the task for you to attach the checklist.

1. In the NDIS Account screen: Select Add Items and then select Inbound Document.

2. Complete the following fields:

3. Description: Enter ‘Review Checklist’. Do not enter any other information in this field as it will be visible on the participant’s portal.

4. Status: Select Completed.

5. Category 1: Select NDIA Service.

6. Category 2: Select Other Form.

7. Employee Responsible: Search for your details and select your name.

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Add interaction – Referral for Eligibility Reassessment not required

Only use this interaction if you have used the ER checklist and decided not to refer the participant for an ER at this time.

1. In the NDIS Account screen: Select Add Items and then select Interaction.

Standard Operating Procedure

For Internal Use Only

2. The Create Interaction screen will display. Complete the interaction using the following:

3. Category 1: Select Pathway.

4. Category 2: Select Review.

5. Category 3: Select Eligibility Reassessment.

6. Channel: Select Internal Notes.

7. Status: Select Completed.

8. Notes:

Referral for Eligibility Reassessment not required at this time.

Eligibility Reassessment Checklist completed and attached to record. Checklist indicates the participant continues to meet the Residence and <Disability> OR <Early Intervention> requirements.

9. Select Submit.

End of process – no further steps to be completed.

3.6 Create Eligibility Reassessment Request

Note: Do not complete this step if an ER is not required.

Create an ER Request if you have used the ER checklist and determined that the participant may:

• not meet the eligibility requirements, or
• need their access status changed from early intervention to disability.

Note: You do not need to refer the participant for an ER if you identify their access status may change from disability to early intervention.

1. In the NDIS Account screen: Select Add Items and then select Eligibility Re-Assessment.

Standard Operating Procedure

For Internal Use Only

2. In Supporting Info, include the following information:

referred to NARB to consider an <ER – Revocation / ER – Access Status Change from EI to Disability / ER – Maintain or Change Access Status with update to primary disability (developmental delay only)>.

Eligibility Reassessment Checklist completed and attached to record.

has a primary disability of <Disability based on evidence – not just what is selected in the system>.

Evidence/information indicates .

<If ER – Revocation:

Question indicates that may not meet the <residence / disability / early intervention> requirements>.

<If ER – Access Status change from EI to Disability:

entered the NDIS under the early intervention requirements, and question indicates that they may now meet the disability requirements.>

<If ER – Maintain or Change Access Status with update to primary disability (developmental delay only):

entered the NDIS under the developmental delay (early intervention) requirements, and question indicates that there may be evidence of a permanent impairment.>

3. In Channel: Select your role from the drop down menu:

• Plan Delegate
• LAC Partner
• ECEI Partner (early childhood partner)
• Other.

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Standard Operating Procedure

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4. In the Attachments section: Select Add (plus sign).

5. Select Review Checklist.

6. Select OK.

7. Select Submit.

8. Select Back.

9. Create a closed Interaction using the Interaction Templates – Reassessments and variations – Eligibility Reassessment.

3.7 Continue with plan reassessment

Plan decisions are independent of the ER decision.

The ER referral should not disrupt the participant’s NDIS funding for supports.

A plan reassessment is called a Plan Review Application in the system. Do not reassign it. An ER Request will generate a separate task for a NARB delegate to action. The Plan Review Application should remain assigned to the plan developer, so that planning activities can continue.

1. You should talk to the participant about what an Eligibility Reassessment is. Some talking points to consider include:

   • During a plan reassessment, we may check to see if the participant is still eligible for the NDIS. This is called an Eligibility Check.
   • If we check and it looks like the participant no longer meets the eligibility requirements, we may reassess their eligibility. We call this an Eligibility Reassessment.

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Standard Operating Procedure

For Internal Use Only

• Eligibility Reassessments are a normal part of an early intervention plan reassessment.
• If the participant met access for NDIS under the early intervention criteria, we will check at each plan reassessment if the participant is still eligible.
• The participant can check whether they met the disability criteria or the early intervention criteria by checking their letter confirming their eligibility for the NDIS or by calling the NDIA.
• Refer to Our Guideline – Leaving the NDIS for information.

2. Continue with the plan reassessment and implementation. This includes considering the appropriate plan duration using the SOP – Complete the Risk Assessment task.

The NARB delegate will:

• review the checklist and available information to consider whether to commence an ER
• notify the participant and plan developer if an ER commences, and at key points throughout the ER process
• notify the plan developer if an ER is not commenced.

Plan developers will:

• remain a key contact for the participant during this time
• support the person to leave the NDIS and link with community and other government services if their participant status is revoked.

3.8 Add information to an existing Eligibility Reassessment Request

The NARB delegate will consider all information and evidence when undertaking an ER. If you receive additional information after an ER referral has been made, follow the instructions below:

1. In the NDIS Account screen: Select Internal Use and Open Activities.
2. In the Transaction Id column: Select the hyperlinked Transaction Id of the Eligibility Re-Assessment Request Activity Type.

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Standard Operating Procedure

For Internal Use Only

3. In the Display Eligibility Re-Assessment Request screen: Select Edit.

4. In Supporting Info: Update with the relevant information.

5. In Attachments: Select Add (plus sign) icon to add documents.

6. Select Submit.

3.9 Withdraw an Eligibility Reassessment Request

If an ER Request is made in error, or is no longer required, you may be able to withdraw the request before the ER is commenced.

1. Has the ER Request commenced?

   • If No: Go to Step 3.9.1: Withdraw an Eligibility Reassessment Request
   • If Yes: No further action required. An Access delegate will maintain the participant’s status if the Eligibility Reassessment is not required.

3.9.1 Withdraw an Eligibility Reassessment Request

1. In the NDIS Account screen: Select Internal Use and Open Activities.

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Standard Operating Procedure

For Internal Use Only

2. In the Transaction Id column: Select the hyperlinked Transaction Id of the Eligibility Re-Assessment Request Activity Type.

3. In the Display Eligibility Re-Assessment Request screen: Select the Withdraw button.

4. In Requested By: Select yourself from the list.

5. In Withdrawal Reason: Select one of the following:

   • Request Recorded in Error
   • Additional Information Submitted.

6. In Supporting Info: Enter relevant details and select Withdraw.

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Related procedures or resources

• NDIS Act 2013
• Our Guideline – Applying to the NDIS
• Our Guideline – Leaving the NDIS
• Referral Checklist: Eligibility Reassessment or Access Status Change – Early Intervention
• Referral Checklist: Eligibility Reassessment – Disability
• SOP – Refer an Eligibility Reassessment (ER) call back or evidence extension request to NARB
• SOP – Support the former participant to leave the NDIS after a revocation decision
• SOP – Unable to contact the participant
• SOP – Finalise the plan when a participant leaves the NDIS
• Practice Guide – Early childhood plan reviews
• Interaction Templates – Reassessments and variations – Eligibility Reassessment

Feedback

If you have any feedback about this Standard Operating Procedure, please complete our Feedback Form.

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Version control

Version	Amended by	Brief Description of Change	Status	Date
2.0	JCO0075	Class 2 Approval	APPROVED	2021-06-18
		Updated highlighting styles and added new instructions for highlighting and version control numbering
3.0	JS0082	Class 1 approval.	APPROVED	2021-12-15
		Security markings updated.
4.0	LNL387	Class 3 PCC approval	APPROVED	2022-09-20
	SMO0075	Class 3 ND approval
	GO0002	Class 3 PXD approval

• Updates to align with Our Guideline — Leaving the NDIS.
• New process: ER Referral Checklist — Disability does not need to be completed at each plan reassessment.
• New process: Ask for an ER Request that has already commenced to be withdrawn (in development).
• New content: to highlight that an ER referral should not be completed if a participant is identified as over 65 and in permanent residential aged care or receiving an aged care package for the first time.
• New link to SOP — Finalise the plan before a participant leaves the NDIS.

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