Make Eligibility Reassessment decision

This Standard Operating Procedure (SOP) will help you finalise an Eligibility Reassessment (ER) decision in the Business System.

This involves considering if the participant continues to meet the residence and disability or early intervention (EI) requirements. The outcome of this SOP will be one of the following:

Maintain Access Status: the participant still meets the eligibility requirements they joined the NDIS under; or the participant now meets the early intervention requirements when they joined the NDIS under disability.
Change Access Status: the participant now meets the disability requirements when they joined the NDIS under early intervention.
Revocation decision: the participant does not meet the residence, disability or early intervention requirements and will be supported to leave the NDIS.

Note: Maintain Access Status and Change Access Status are not reviewable decisions under the NDIS Act.

1. Recent updates

Date	What’s changed
December 2022	New step added to 3.11.2 to determine if the plan developer is a local area coordinator/early childhood partner.

             | Added instructions on how to locate the Operations Director.
             | Updated formatting, links, grammar and screenshots.                                                                                       |

| October 2022 | New SOP format to align with Our Guidelines refresh. SOPs include process information only. Use Our Guidelines to help you make decisions and refer to Related procedures or resources. | Guidance updated to align with Our Guideline — Leaving the NDIS. | Improved messaging about the participant’s responsibility to provide information to support their eligibility. |

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Standard Operating Procedure

For Internal Use Only

What’s changed

Updates to provide more information about the reasons for a revocation decision. The letters list the information that indicates they are no longer eligible for the NDIS and the reasons for the decision.

Instructions about when to request technical advice from a Quality Development Officer (QDO) or the Technical Advisory Branch (TAB).

Increased contact attempts to 5 for when participant status is revoked.

Additional step to contact the plan developer by phone after a revocation decision, where there are sensitivities, or the plan developer is not the local area coordinator or early childhood partner.

Additional step to add an alert after a revocation decision for a person that joined the NDIS from a defined program.

Additional checks to make sure the ER process has been procedurally fair before making a revocation decision.

2. Checklist

Topic	Checklist
Pre-requisites	You have read and understood:

Our Guideline — Applying to the NDIS
Our Guideline — Leaving the NDIS You have:
an ER task with an Outcome of Opportunity to Respond
confirmed that all pre-checks are complete from SOP - Consider commencement of Eligibility Reassessment or Access Status Change
checked for any approved extension of time requests
confirmed a minimum of 28 days (plus any approved extension of time request) have passed since the Letter — Eligibility Reassessment — Commencement — 1° opportunity to respond was sent to the participant. |

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Procedure

During the ER process, do not reassign the application in the Business System.

Determine ER Request status

An Access Assessor (AA) may receive an ER Request at different points of the process and may complete one or more of these steps.

Obtain work item

In My Inbox: Select Ready for Work.

Note: This will allocate a work item to your inbox.
Select the work item:
- If it relates to an access decision: refer to SOP – Progress NDIS application in the system.
- If you made the original access decision: inform your Team Leader of the conflict of interest and they will re-assign the work item to another Access Delegate.
- If there is an alert for a Younger People in Residential Aged Care (YPIRAC): Re-assign the work item to s47F- personal privacy (NK0019).
- Check if the person lives in a remote or very remote area: refer to SOP – Check for remote or very remote address. If they live in an area classified as Remote or Very Remote (‘M M 6’ or ‘M M 7’ under the Modified Monash Model): Re-assign the s47F- personal privacy work item to (DJS497).

Check work item Type

If ER Request

Select the work item.
Review Outcome to determine the next steps.

Standard Operating Procedure

For Internal Use Only

If Outcome is:

Opportunity to Respond: Go to Step 3.2: Complete pre-checks.
Commence Eligibility Reassessment: Refer to SOP - Consider Eligibility Reassessment outcome following 1st chance to respond.
Not displayed: Refer to SOP – Consider commencement of Eligibility Reassessment or Access Status Change.

3.1.3 If Eligibility Reassessment Evidence Extension Request

Refer to SOP - Action Evidence Extension Request for an Eligibility Reassessment.

3.1.4 If Eligibility Reassessment Call Back Request

Refer to SOP – Action Call back Request for an Eligibility Reassessment.

3.2 Complete pre-checks

Have all the pre-checks been completed?

Yes: Go to Step 3.3: Consider if residence and disability or EI requirements are met.
No: To complete the missed steps, refer to SOP - Consider commencement of Eligibility Reassessment or Access Status Change.

3.3 Consider if residence and disability or EI requirements are met

Note: It is the participant’s responsibility to provide evidence that they continue to meet eligibility requirements.

Review notes in the ER Request work item Outcome Justification to determine the reason for the potential for adverse decision.

Note: This will determine which eligibility criteria you consider, and the order to consider them.

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Standard Operating Procedure

For Internal Use Only

If the Outcome Justification states that the participant:

may not meet residence requirements (only): consider residence criteria.
may not meet residence and disability and EI requirements: consider residence, disability and EI criteria.

Review all the participant’s information (including Interactions, Inbound Documents, the NAT inbox, and any other available information on the participant’s record such as the planning conversation tool, plan value, plan usage and supports in place). Notify your Team Leader if you identify any integrity issues then continue with ER.
Assess the evidence against the residence (s23), disability (s24) and EI (s25) requirements, if required use the ARIS process map eligibility decision steps to consider:

First: List A
Second: Criteria that the participant originally met (regardless of age)
Third: The remaining criteria.

For more information to assist you with your decision making, refer to:

Appendices
Our Guideline – Applying to the NDIS
Our Guideline – Leaving the NDIS
Technical Advisory Team (TAT) Digest – Published Advice

Consider if the NSW Prescribed Program exception applies (relevant to the residence requirements only).
Consider if there is sufficient evidence to decide whether the participant meets the residence and/or disability or EI requirements (if the participant joined the NDIS under one of the NSW prescribed programs, only consider the disability and EI requirements and do not consider the residence requirements).
Consider if you require technical support or if you can make a decision to maintain access status, change access status or revoke participant status.

s47E(d) - certain operations of agencies

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s47E(d) - certain operations of agencies

Refer to SOP – Request technical advice to progress an Eligibility Reassessment.

3.3.2 If ER outcome – Maintain Access Status

The information indicates that the participant:

meets residence and disability or early intervention requirements that they joined the NDIS under; or
joined the NDIS under the disability requirements and now meets early intervention requirements

AND

does not have a primary disability that is a chronic health condition; or

3.3.3 If ER outcome – Change Access Status

The information indicates that the participant:

joined the NDIS under early intervention requirements and now meets disability requirements

AND

does not have a primary disability that is a chronic health condition; or

3.3.4 If ER outcome – Revoke Participant Status

Go to Step 3.12: Submit ER outcome: Maintain Access Status.

Go to Step 3.13: Submit ER outcome: Change Access Status (from EI to disability).

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Standard Operating Procedure

For Internal Use Only

The information indicates that:

the participant does not meet the residence and/or disability and early intervention requirements; or
there is no information or insufficient information to determine if the participant meets the residence and disability or early intervention requirements

AND

the NSW Prescribed Program exception does not apply (relevant to the residence requirements only)

AND

the participant has received 12 months of funded supports.

Go to Step 3.4 Check ER process resulting in revocation is procedurally fair.

3.4 Check ER process resulting in revocation is procedurally fair

Refer to SOP - Check for procedural fairness in an Eligibility Reassessment.

3.5 Submit revocation decision for quality check

3.5.1 Prepare Decision Template

Open Template – Eligibility Reassessment – Revocation decision.
Complete fields in the relevant templates.
Save the completed template as a Word document to your desktop or OneDrive. Note: This will be used to populate the ER letter in a later step.
Copy the completed template to paste into the Outcome Justification.

3.5.2 Update ER Request: Revoke

In Eligibility Reassessment Request: Select Edit.
In Outcome: Select Revoke.
In Outcome Justification:

The information indicates that <Participant> does not meet the eligibility requirements. I have made a decision to revoke their participant status.

<Paste the completed eligibility reassessment decision – revocation template>.

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Standard Operating Procedure

For Internal Use Only

In Supporting Info:

Refer to Outcome Justification.

In Reason for Revoke: Select appropriate reason from drop-down.
In Date of Decision: Select today’s date.
Select Submit.

Note: The ER Request will be drawn down by a QDO for quality checking.

Start working on a new work item while waiting for this to be completed.
Once quality feedback is returned, go to Step 3.6: Review quality check feedback: Revocation decision to finalise the decision.

3.6 Review quality check feedback: Revocation decision

After receiving the feedback, you are still responsible for making, documenting and implementing the decision.

In the Business System Inbox: Select Quality Check Act task.
Review the quality feedback provided:
- If you agree with the feedback:
  
  o Next to Acknowledged
  
  o Select Submit
  
  o Go to Step 3.
- If you need further clarification, do not acknowledge the feedback:
  
  o Discuss feedback with your Team Leader.
  
  o If required, follow the reconsideration process.
  
  o Do not proceed to Step 3 until this is resolved.
Finalise the ER decision, taking into consideration the quality check feedback.

3.7 Update plan nominee or child representative contact end dates

Note: You must do this so the nominee or child representative can still use the participant portal to finalise payments and accounts for the next 90 days.

From the NDIS account screen, select Contacts.

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Standard Operating Procedure

For Internal Use Only

Select the Plan Nominee or Child Representative contact.
At Valid To: Enter the date 90 days after revocation decision.

Note: You can use the Time and Date website to help calculate 90 days.

Select Submit.

Note: There is no requirement to extend other relationships as they do not impact portal access. For example: mother or father.

3.8 Send letter: Revocation decision

Open and edit [Letter – Eligibility Reassessment – Revocation decision](Letter – Eligibility Reassessment – Revocation decision).
Copy the completed decision templates into the letter.

Note: The template was saved to your desktop or OneDrive earlier.

Send letter to the participant or representative via their preferred correspondence method.
Delete the template saved to your desktop or OneDrive after you have completed this step.

3.8.1 Attach the letter to Inbound Documents

In the NDIS Account screen: Select Documents.
Select Add Items and select Inbound Document.
In Description: Letter – ER – Revocation decision.
In Status: Select Completed.
In Category 1: Select NDIA Service.
In Category 2: Select Other Correspondence.

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Standard Operating Procedure

For Internal Use Only

In Employee Responsible: Enter your details.
In Note: Letter <emailed/mailed> to on by .
Select the Upload File button under Attachments.
In the File Explorer window: Select the relevant document.
Select Save.

3.9 Contact former participant or representative: Revocation decision

Note: A representative could be the former participant’s nominee or child representative. If the former participant has a nominee, they will be listed as a contact as a Plan Nominee.

If the person’s preferred correspondence method is email or letter, you must still attempt to call them about the revocation decision. The exception is if the person has requested no phone calls (for example, they are Deaf and have requested written communication only), or if they have not provided a phone number.

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3.9.1 Contact person: Revocation decision

Refer to SOP – Send SMS using Whispir messenger to send ‘Contact attempt SMS template’ to advise you will be calling.

Note: Only send this SMS before your first attempt to call the person.
Do not contact the person by SMS if they have told the Agency that they do not consent to this form of communication.
Prepare for your call:
- Review the relevant evidence on the person’s record, and your reasons for the revocation decision.
- Have the Letter – Eligibility Reassessment – Revocation decision handy for reference during the call.
- Read Sensitive conversations in the Conversation Style Guide.
Make 5 telephone contact attempts (over a 3-day period, at different times of day) to the former participant, nominee or child representative. The first call should be made on the day of the decision. If you reach voicemail and the person identifies themselves, leave a brief message requesting they contact the NDIA on 1800 800 110. You must complete all required contact attempts, even if the number is disconnected.

3.9.1.1 Record an Interaction following each unsuccesful call attempt

In the NDIS Account screen: Select Interactions.
Select Add Items and then select Interaction.
In Category 1: Select Pathway.
In Category 2: Select Review.
In Category 3: Select Eligibility Reassessment.
In Channel: Select Internal Notes.
In Status: Select Completed.
In Notes:

Revocation decision made on .

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Call not answered.

Select Submit.

3.9.2 If all 5 contact attempts are unsuccessful

Refer to SOP – Send SMS using Whispir messenger to send ‘Unsuccessful contact attempt’ SMS to advise you tried to call.

Note: Only send this SMS after you make all required call attempts.
Do not contact the person by SMS if they have told the Agency that they do not consent to this form of communication.
Continue with ER process.
Go to Step 3.9.4: Add Interaction: ER revocation outcome.

3.9.3 If the call is answered

Notify the person that you are calling to let them know about their Eligibility Reassessment outcome.
Explain that we provided opportunity for the participant to provide further information to show they continue to meet the eligibility requirements.
Note that the Eligibility Reassessment Commencement Letter was sent on <date>, the Second Opportunity to Respond Letter was sent on <date>, and call attempts were made on <date/s>.
.
Explain that we have considered their information against the eligibility requirements (including any new information provided).

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Standard Operating Procedure

For Internal Use Only

Advise the person that they do not meet the <residence> and/or their impairment does not meet the <disability and early intervention> requirements, so we will support them to leave the NDIS and connect with community and other government supports.

Using the letter as a guide:

Outline the specific information/evidence we considered to make the decision.
Explain which eligibility requirement/s are not met. Refer to relevant information to explain the decisions reasons.
Encourage them to contact their plan developer or <local area coordinator (LAC) / early childhood partner (ECP)> for information about their plan, and to connect them with community and government services.
If you need further support to explain the decision to the person, seek assistance from your Team Leader.
Advise the person of their review rights.
Advise the person that the decision takes effect from <Date of letter>, and that they will receive a letter shortly which explains the decision and their review rights.
Advise the person that from <Date of letter>, they can no longer use NDIS funds to purchase supports as they are no longer a NDIS participant.
If they had access to the myplace Participant Portal, access will end 90 days after the date of the letter, on <90 days from date of letter>.
Advise the person that providers must complete all payment requests within the 90 days. After this time, providers will not be able to make any further requests. Only claims for supports received prior to <Date of letter> can be claimed.
Ask if they have any questions.

Go to Step 3.9.4: Add Interaction: ER revocation outcome.

3.9.4 Add Interaction: ER revocation outcome

In the NDIS Account screen: Select Interactions.

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Standard Operating Procedure

For Internal Use Only

Select Add Items and then select Interaction.
In Category 1: Select Pathway.
In Category 2: Select Review.
In Category 3: Select Eligibility Reassessment.
In Channel: Select Internal Notes.
In Status: Select Completed.

Revocation decision made on .

Phone call made to to advise that the eligibility requirements have not been met, and that a decision has been made to revoke the person’s status as a participant.

I advised the person that from the date of the letter, they can no longer use NDIS funds to purchase supports as they are no longer an NDIS participant.

I advised the person to contact their plan developer or <local area coordinator (LAC) / early childhood partner (ECP)> for information about their plan and community and government services.

I advised the person of their review rights.

Select Submit.

3.10 Update alerts on record

3.10.1 Update ER alert end date

In the NDIS Account Screen: Select Internal Use.
Select Plan Alerts.
Select the Eligibility Reassessment alert.

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Standard Operating Procedure

For Internal Use Only

In End Date: Edit to today’s date.
Select Submit.
If the person:

was a defined participant, go to Step 3.10.2: Add alert for defined records (if required).
was not a defined participant, go to Step 3.11: Notify plan developer – Revocation.

3.10.2 Add alert for defined records (if required)

Note: This is an important step to make sure that any future applications from the person are considered as new (not defined).

Select Add Items and then select Alert.
Select the Primary checkbox.
In Alert: Select Eligibility Reassessment.
In Additional Information:

redacted They are no longer a defined participant.

Any future applications should be treated as new and evidence of disability must be provided.

Select Submit.

3.11 Notify plan developer – Revocation

3.11.1 Add Interaction: Notify plan developer – Revocation

In the NDIS Account screen: Select Interactions.
Select Add Items and then select Interaction.
In Category 1: Select Pathway.
In Category 2: Select Review.
In Category 3: Select Eligibility Reassessment.
In Channel: Select Internal Notes.
In Status: Select Open.
In Notes:

Interaction to notify plan developer that Eligibility Reassessment is complete.

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Standard Operating Procedure

For Internal Use Only

Refer to Eligibility Re-Assessment Request for information about status of the request.

For Action: Follow instructions in SOP – Finalise the plan before a participant leaves the NDIS, to finalise the plan and support the former participant to leave the NDIS.

<If relevant: Please note there is no <LAC / ECP> in their area, and in this scenario, it has been agreed that national delivery will complete the relevant steps to support the former participant.

Select Submit.
Select Edit.
Select Assign.
Select Employee.
In Employee: Enter the plan developer’s name (Contact with relationship type My NDIS Contact).

Note: Where there is no My NDIS Contact, assign the interaction to the National Delivery Inbox (Return to SDP Inboxes) within the person’s geographical location. 14. Select Assign. 15. Select Submit.

If there are sensitivities/concerns with the revocation or the plan developer is not an local area coordinator/early childhood partner: Go to Step 3.11.2: Contact the local area coordinator or early childhood partner.

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Standard Operating Procedure

For Internal Use Only

If there is no local area coordinator or early childhood partner in their area: Go to Step 3.11.3: Email the relevant Operations Director.
If there are no sensitivities and the plan developer is the local area coordinator or early childhood partner:

End of process.

3.11.2 Contact the local area coordinator or early childhood partner

Note: Only complete this step if the plan developer is not a local area coordinator or early childhood partner, or if there are sensitivities/concerns.

3.11.2.1 Check if the plan developer is a local area coordinator or early childhood partner.

From the NDIS Account screen, select Contacts.
Select the My NDIS Contact to view the Contact details.

Note: Click on the row and not on any hyperlinks within the row to view the details in Contacts.

Name 1	Relationship Type
Advocate	Advocate
	Alternate Contact
	Mother
	My NDIS Contact
	Child Representative

The Update Relationship detail will open. Check the Position field to see if they are a local area coordinator or early childhood partner.

Valid From: 26.09.2022

Valid To: 31.12.9999

Preferred Name:

redacted

Phone:

Email:

Organisation:

Position: Early Childhood Coordinator

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3.11.2.2 Contact the local area coordinator early childhood partner

Make one contact attempt to the local area coordinator or early childhood partner via phone or Microsoft Teams.
Advise them that <Person’s> access has been revoked on .
Advise them of any sensitivities/risks you are aware of.
Advise them to make sure that relevant community and other government service connections are in place.

3.11.2.3 Update Notify plan developer interaction.

Note: You do not need to create a new interaction, as you will update the existing interaction to notify the plan developer. The interaction should still remain Open.

Open the Notify plan developer Interaction you created in Step 3.11.1.
Select Edit.
In Notes: I contacted <LAC / ECP> <LAC / ECP name> via <phone/MS Teams> to advise that has had their participant status revoked.

redacted OR Unable to contact.
Select Submit.

Note: Keep the interaction Open to make sure the plan developer receives it. End of process.

3.11.3 Email the relevant Operations Director

Note: Only complete this step if there is no local area coordinator or early childhood partner available in the former participant’s area.

Refer to the National Delivery intranet page.
Select the state or territory where the former participant lives.
Find the name of the Operations Director in the Our Team table. Note: for Victoria and Tasmania, this is in the Our Workgroups and Team menu.
Open Email Template – Eligibility Reassessment – Decision to revoke and no PITC in local area.
Complete fields in the body of the email.

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Standard Operating Procedure

FOI 23/24-0960 OFFICIAL

For Internal Use Only

Select Send.

3.11.3.1 Update Notify plan developer interaction

Note: You do not need to create a new interaction, as you will update the existing interaction to notify the plan developer. The interaction should remain Open.

Open the Notify plan developer Interaction you created in Step 3.11.1.
Select Edit.
In Notes:

I sent an email sent to Operations Director, <Operations Director’s name> to advise:

there is no <LAC / ECP> available in the former participant’s area to support them to link with community and other government services.
that I have assigned an interaction to the RTS inbox to request support for the former participant to leave the NDIS.

Select Submit.

Note: Keep the interaction Open to make sure the plan developer receives it.

End of process.

3.12 Submit ER outcome: Maintain Access Status

3.12.1 Prepare Decision Template

Open Template – Eligibility Reassessment – Maintain or Change Access Status.
Complete fields in the relevant templates.
Copy the completed template to paste into the Outcome Justification.

3.12.2 Update ER Request: Maintain Access Status

In Eligibility Reassessment Request: Select Edit.
In Outcome: Select Maintain Access Status.
In Outcome Justification:

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Standard Operating Procedure

FOI 23/24-0960OFFICIAL

For Internal Use Only

In Supporting Info, copy and paste the content from Outcome Justification.

Note: The content in Outcome Justification and in Supporting Info must be identical. The Supporting Info content will make up the history log of the Eligibility Reassessment.

In Reason for Maintain Access Status: Select reason from drop-down menu.

Disability and Residence Valid: Sufficient evidence the residence and disability requirements are met.
Early Intervention and Residence Valid: Sufficient evidence residence and early intervention requirements are met.

Note: Do not use Insufficient evidence to Alter Decision, Record Ceased or Invalid Checklist/Checklist not provided.

Select Submit.
If your Maintain Access Status decision:

is not sent for quality checking: o Go to Step 3.15: Send letter: Maintain or Change Access Status.
is sent for quality checking:

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Standard Operating Procedure

For Internal Use Only

o Start working on another work item. Once quality feedback is returned, go to Step 3.14: Review quality check feedback: Maintain/Change Access Status (if sent for quality checking).

3.13 Submit ER outcome: Change Access Status (from EI to disability)

Changing the participant’s access status from early intervention to disability is not a decision under the NDIS Act. This means it is not a reviewable decision.

If the participant joined the NDIS under disability requirements and now meets the early intervention requirements, their access status must be maintained. Do not change their access status.

3.13.1 Prepare Decision Template

Open Template – Eligibility Reassessment – Maintain or Change Access Status.
Complete fields in the relevant templates.
Copy the completed template to paste into the Outcome Justification.

3.13.2 Update ER Request: Change Access Status

In Eligibility Reassessment Request: Select Edit.
In Outcome: Select Change Access Status.

3.13.3 In Outcome Justification:

. .

3.13.4 In Supporting Info:

Refer to Outcome Justification.

3.13.5 In Access Decision Reason:

Select Disability Met

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Standard Operating Procedure

For Internal Use Only

Note: Benefit from Early Intervention, Exceptional Circumstances and Continuity of Supports are not applicable.

In Access Decision Notes: Status Change from EI to Disability.
Select Submit.
If your change access status decision:
- is not sent for quality checking:
  - Go to Step 3.15: Send letter: Maintain or Change Access Status.
- is sent for quality checking:
  - Go to Step 3.14: Review quality check feedback: Maintain/Change Access Status (if sent for quality checking).

3.14 Review quality check feedback: Maintain/Change Access Status (if sent for quality checking)

After receiving the feedback, you are still responsible for making, documenting and implementing the decision.

In the Business System Inbox: Select Quality Check Act task.
Review the quality feedback provided:
- If you agree with the feedback:
  - Next to Acknowledged: Select Yes
  - Select Submit
  - Go to Step 3.
- If you need further clarification of the feedback, do not acknowledge it. Discuss it with your Team Leader, and if applicable, follow the reconsideration process. Do not proceed to Step 3 until this is resolved.
Finalise the ER outcome, taking into consideration the quality check feedback:
- If the outcome continues to be either maintain or change access status, go to Step 3.15: Send letter: Maintain or Change Access Status.

3.15 Send letter: Maintain or Change Access Status

3.15.1 Prepare and send letter to participant

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Standard Operating Procedure

For Internal Use Only

Open and edit Letter – Eligibility Reassessment – Maintain or change access status.
Send the letter to the participant or representative via their preferred correspondence method.

3.15.2 Attach letter to Inbound Documents

Go to the NDIS Account screen: Select Documents.
Select Add Items and then Inbound Documents.
In Description: Letter – End of Eligibility Reassessment Process.
In Status: Select Completed.
In Category 1: Select NDIA Service.
In Category 2: Select Other Correspondence.

Type	Value
Description	Letter – End of Eligibility Reassessment Process
Document Type	`dropdown`
Site Location	`dropdown`
Priority	Low
Status	Completed
Reason	`dropdown`

In Employee Responsible: Enter your details.
In Note: Letter <emailed/mailed> to on by .

Standard Operating Procedure

For Internal Use Only

Select Upload File button under Attachments.
In File Explorer window: Select the relevant document.
Select Save.
Go to Step 3.16: Contact participant or representative: Explain Maintain/Change Access Status outcome.

3.16 Contact participant or representative: Explain Maintain/Change Access Status outcome

Note: A representative could be the participant’s nominee or child representative. If the participant has a nominee, they will be listed as a contact as a Plan Nominee.

3.16.1 Contact the participant or their representative

Refer to SOP – Send SMS using Whispir messenger to send ‘Contact attempt SMS template’ to advise you will be calling.

Note: Do not contact the person by SMS if they have told the Agency that they do not consent to this form of communication.

Make one telephone contact attempt to the participant, nominee or child representative. If you reach voicemail and the person identifies themselves, leave a brief message requesting they contact the NDIA on 1800 800 110.

3.16.2 If unsuccessful contact attempt

Refer to SOP – Send SMS using Whispir messenger to send ‘Unsuccessful contact attempt’ SMS to advise you tried to call.

Note: Do not contact the person by SMS if they have told the Agency that they do not consent to this form of communication.

Go to Step 3.15.4: Update the Alert’s End Date.

3.16.3 If the call is answered

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Standard Operating Procedure

For Internal Use Only

Using the letter as a guide, notify the person that you are calling to update them on the outcome of their Eligibility Reassessment.
Advise the person that we have completed a review of their eligibility, and that they continue to meet the eligibility requirements.
If Change Access Status: Advise the person that they originally met the requirements for early intervention and based on the available information, they now meet the disability requirements.
If Maintain Access Status: Advise the person that based on the available information, they continue to meet the residence and <disability> or <early intervention> requirements.
This means that they will continue to be a participant of the NDIS and there will be no change to their current supports.
If the person has any questions about their plan or funding, refer them to their <local area coordinator/early childhood partner/NDIA planner>.

Go to Step 3.16.4: Update the Alert’s End Date.

3.16.4 Update the Alert’s End Date

In the NDIS Account screen: Select Internal Use.
Select Plan Alerts.
Select the Eligibility Reassessment alert.
In End Date: Edit to today’s date.
Select Submit.

3.16.5 Add Interaction: Maintain or Change Status

In the NDIS Account screen: Select Interactions.
Select Add Items and then select Interaction.
In Category 1: Select Pathway.
In Category 2: Select Review.
In Category 3: Select Eligibility Reassessment.
In Channel: Select Internal Notes.

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In Status: Select Completed.
In Notes:

Phone call made to <Person> to advise them that the Eligibility Reassessment is now complete.

<Person’s> access status has been <maintained/changed from early intervention to disability>.

OR .

Select Submit.
Go to Step 3.17: Check/update primary and secondary disabilities.

3.17 Check/update primary and secondary disabilities

The Disabilities tab needs to reflect only the disabilities where the participant meets disability or early intervention requirements, as this is important for the planning stage.

You need to confirm that their eligible impairments are reflected correctly in the business system. This includes listing any other eligible impairments in both the Primary Disability and Secondary Disabilities tab.

3.17.1 View Disabilities Screen

In the NDIS Account screen: Select Disabilities.
In Disabilities: Select the > next to Secondary.
In Disabilities: Select the > next to Primary.

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Note: To view both the primary and secondary disabilities at the same time, open the Secondary tab first, followed by the Primary.

Note: This screen will list all current and previous primary and secondary disabilities. Take note of the Effective Start and Effective End dates to determine what disabilities are current.

3.17.2 Consider if the listed primary disability still meets the eligibility requirements

Consider if there is sufficient evidence the primary disability meets the eligibility requirements:
- If primary disability no longer meets the disability or early intervention requirements: Go to Step 3.17.3: Update primary disability.
- If primary disability continues to meet the disability or early intervention requirements: Go to Step 3.17.4: Consider if any secondary disabilities no longer meet the eligibility requirements.

Note: If the existing primary disability continues to meet the eligibility requirements, and there are additional disabilities that also meet eligibility, do not change the primary disability.

3.17.3 Update primary disability

Do not delete the previous primary disability. When the primary disability is changed, this will automatically apply an end date to the previous primary disability.

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3.17.3.1 If primary disability is listed as a secondary disability

In Secondary: Select the Convert to Primary Disability icon.
Complete additional fields (if known).
Select Submit.

3.17.3.2 If the primary disability is not listed as a secondary disability

In the NDIS Account screen.
Select Add Items and then select Disability.
In Reported Impairment: Start typing the disability and select when displayed. Note: Alternatively, select from the list of disabilities.
Next to Primary: Select the checkbox.
Complete additional fields (if known).

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Select Submit.

3.17.4 Consider if any secondary disabilities no longer meet the eligibility requirements

Consider if there is sufficient evidence that any secondary disabilities continue to meet the eligibility requirements:

If a secondary disability no longer meets the disability or early intervention requirements: Go to Step 3.17.5: Update Effective End Date for secondary disability.
If the secondary disabilities continue to meet the disability or early intervention requirements: Go to Step 3.17.6: Consider if additional secondary disabilities meet the disability or early intervention requirements.
If there are no secondary disabilities listed: Go to Step 3.17.6: Consider if additional secondary disabilities meet the disability or early intervention requirements.

3.17.5 Update Effective End date for secondary disability

Select relevant disability.
In the Effective End date: Update to current date.

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Select Submit.

Note: The disability will show within Secondary Disabilities with an end date.

3.17.6 Consider if additional secondary disabilities meet the disability or early intervention requirements

Consider if there is sufficient evidence that an additional secondary disability meets the disability or early intervention requirements:
- If an additional secondary disability meets the disability or early intervention requirements: Go to Step 3.17.7: Add secondary disability.
- If there is insufficient evidence that any additional disabilities meet the disability or early intervention requirements: Go to Step 3.18: Add Interaction: Notify plan developer – ER outcome.

3.17.7 Add secondary disability

In the NDIS Account screen.
Select Add Items: Select Disability.
In Reported Impairment: Start typing the disability and select when displayed.

Note: Alternatively, select from the list of disabilities.
Next to Primary: Do not select the checkbox.
Complete additional fields (if known).

Note: Do not adjust the Effective End date as it will auto-populate with 31.12.9999.

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Select Submit.
Go to Step 3.18: Add Interaction: Notify plan developer – ER outcome.

3.18 Add Interaction: Notify plan developer – ER outcome

In the NDIS Account screen: Select Interactions.
Select Add Items and then select Interaction.
In Category 1: Select Pathway.
In Category 2: Select Review.
In Category 3: Select Eligibility Reassessment.
In Channel: Select Internal Notes.
In Status: Select Open.
In Notes:

Interaction to notify plan developer of Eligibility Reassessment update.
Refer to Eligibility Re-Assessment Request for information about the status of the request.
Refer to SOP – Refer Participant for an Eligibility Reassessment (ER) or Access Status Change for information about the process.

No action required. Plan developer to note and close interaction.

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Select Submit.
Select Edit.
Select Assign.
Select Employee.
In Employee: Enter the plan developer’s name (Contact with relationship type My NDIS Contact).

Note: Where there is no My NDIS Contact, assign the interaction to the National Delivery Inbox (Return to SDP Inboxes) within the person’s geographical location.

Select Assign.
Select Submit.

End of process.

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Appendices

4.1 The Legislation

While the NDIS provides lifetime disability support for many participants, others build capacity and achieve their goals to the extent that they no longer meet the eligibility requirements and leave the NDIS.

This SOP provides instructions for when an Access Assessor (AA) receives an ER referral from a plan developer indicating that the participant:

may not meet the residence requirements (section 23);

may not meet the disability requirements (section 24) and early intervention requirements (section 25);

was granted access to the NDIS under the early intervention requirements (section 25) may now meet the disability requirements (section 24).

All participants must continue to meet the residence requirements and the disability requirements or early intervention requirements.

There are some exceptions to when an ER should be undertaken:

If the participant joined the NDIS under the NSW Prescribed Program Rules, their NDIS access should not be revoked based on residence requirements. This also includes participants who joined the NDIS under these rules, but now reside in another state or territory. For these participants, ER can only be based on the disability and early intervention requirements.
If the AAT has previously made a determination relating to the participant’s access to the NDIS, seek advice from a QDO Team Leader before commencing an ER. The QDO Team Leader will seek advice from TAB/Legal as required. QDO Team Leader advice is not required if you are maintaining or changing access status.

4.2 Independent Delegate

The AA who decides whether to commence or undertakes an ER must be independent. That is, they will not have:

a personal interest in the participant’s status; or

Standard Operating Procedure

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a personal relationship with the participant (outside the NDIA);
must not have been involved in making the original access decision or any planning decisions.

An AA can be involved in any or all stages of the ER process.

4.3 ER Outcomes

There are 2 ER outcomes under (s 30(1), NDIS Act). They are:

To exercise the power to revoke a person’s access, which includes:
- revoking participant status.
To not exercise the power to revoke a person’s access, which includes:
- maintaining access status; or
- changing access status.

Note: To not exercise the power to revoke a person’s access is not a reviewable decision.

4.3.1 Maintain Access Status

A person maintains their participant status when they continue to meet the access requirements they joined the NDIS under. Or, if they joined the NDIS under disability requirements and now meet the early intervention requirements.

4.3.2 Change Access Status

A person’s status is changed from early intervention to disability when the participant who joined the NDIS under early intervention requirements now meets the disability requirements.

Note: Changing access status is not a decision under the NDIS Act. It is also considered maintaining access status.

4.3.3 Decision to Revoke

If an AA is satisfied a person no longer meets the residence and/or disability and early intervention requirements, their status as a participant will be revoked (section 30).

A person ceases to be a participant in the NDIS when their status is revoked under section 30. A revocation decision will take effect from the date of the decision notice.

A person must not use NDIS funds to purchase reasonable and necessary supports for the participant after they cease to be an NDIS participant (section 29(2)).

The decision to revoke a person’s status as a participant is a reviewable decision (section 99, Item 3). This means that the decision may be internally reviewed by a delegate of the CEO

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(section 100) and subsequently externally reviewed by the Administrative Appeals Tribunal (AAT) (section 103).

It is very important, from an administrative law perspective, that the process leading to a revocation decision is procedurally fair. Procedural fairness includes a variety of actions and may change dependent on the participant’s individual situation. Some of these actions relating to ER may include:

ensuring a clear explanation outlining the reasons for a potential revocation decision;
providing the participant a reasonable opportunity to provide information to present their case;
providing guidance to the participant around the types of information/evidence which may assist their case;
properly considering any Extension of Time Request and granting this request where reasonable.

4.4 The Process

4.4.1 Plan developer refers the participant for ER or Access Status Change

A person’s NDIS participant status may be reassessed:

as part of the plan reassessment process; or
at any other time.

Plan developers must consider whether the participant should be referred for ER, or an Access Status Change is required, as part of the plan reassessment process. This involves completion of the Eligibility Reassessment Checklist, with reference to relevant information on the participant’s record. The checklist is attached to the participant’s record before the plan developer completes an ER referral.

Note: An AA must not commence the ER process if there is no checklist attached.

4.4.2 Access Assessor determines if ER is required

Upon receipt of an ER referral, the AA will consider whether the participant is likely to continue to meet the residence and disability or early intervention requirements. They do this by assessing all available information against the legislative requirements.

4.4.3 Access Assessor completes ER

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An ER is commenced when the information indicates that the participant may not meet the eligibility criteria. The AA will contact the participant (or their representative) by phone and in writing to outline the reasons why the person may not meet eligibility criteria. It is important that the participant understands the specific reasons why they may not meet these criteria, and what information they can provide to support their case.

The AA must explain to the participant that it is their responsibility to prove they meet the eligibility criteria. If we do not have clear information that the person continues to meet the eligibility criteria, their access will be revoked.

The plan developer will also be notified of the progress of the ER request and any required actions via an Interaction. The AA also has the option to contact the plan developer by phone if there are any sensitivities or risks.

During the ER process, the participant will have 28 days to provide further information to support their continued eligibility. In exceptional circumstances, they can request an extension of time to provide this information.

Access Assessor determines outcome

The AA will assess all available information against the legislative requirements and decide if the participant’s access status should be:

maintained, (including disability to early intervention); or
changed from early intervention to disability; or
revoked.

All revocation decisions, and some maintain or change status outcomes, will be referred to a QDO for quality checking before being finalised.

The AA will explain the reasons for the outcome to the participant (or their representative) by having a conversation (where required contact attempts are successful) and sending them a letter. The plan developer will also be notified of the ER outcome. If the participant’s status is revoked, the plan developer must support them to leave the NDIS and find other community and government supports.

Throughout the ER process, it is important there is no disruption to the participant’s supports and services during this time.

Our Guideline – Applying to the NDIS
Our Guideline – Leaving the NDIS

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SOP – Request technical advice to progress an Eligibility Reassessment
SOP – Consider commencement of Eligibility Reassessment or Access Status Change
SOP - Consider Eligibility Reassessment outcome following 1st chance to respond
SOP - Action Evidence Extension Request for an Eligibility Reassessment
SOP – Action Call back Request for an Eligibility Reassessment
SOP – Refer request to cease participant status during Eligibility Reassessment
SOP – Request technical advice to progress an Eligibility Reassessment
SOP- Check for remote or very remote address
SOP – Check for procedural fairness in an Eligibility Reassessment
SOP – Complete Eligibility Reassessment missed steps

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6. Feedback

If you would like to provide feedback about this guidance material, please complete our

Feedback form.

7. Version control

Version	Amended by	Brief Description of Change	Status	Date
V1.0	LNL387	Class 3 approval.	APPROVED	2022-09-23
	SMO0075	Updates to align with Leaving Package, and new OG — Leaving the NDIS.
	Go0002
		Updates about the participant’s responsibility to provide information to support their eligibility, and to provide more information about the reasons for a revocation decision. New instructions about requesting technical advice, increased contact attempts, to contact the plan developer by phone after a revocation decision, to add an alert after a revocation decision, and additional checks to make sure the ER process has been procedurally fair before making a revocation decision
V2.0	EMN960	Class 1 approval Updated linked SOP	APPROVED	2022-09-23
V3.0	EMN960	Class 1 approval New instructions included for determining the Operations Director in each state/territory, and whether the plan developer is an LAC/ECP.	APPROVED	2022-11-29

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Version	Amended by	Brief Description of Change	Status
		Updates to some screenshots, formatting, and links.

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