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DOCUMENT 6

Access Request — Supporting Evidence Form

The National Disability Insurance Agency (NDIA) will use the information in this form to determine if a person meets the requirements to become a participant in the National Disability Insurance Scheme (NDIS). For children under 6 with a developmental delay, please use the Access Request — Supporting Evidence Form for Children Under 6 with Developmental Delay.

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SECTION 1: Details of the person applying to become a participant in the NDIS

This part of the form can be completed by you, a parent, representative or professional

SECTION 2: Details of the person’s impairment/s

This part of the form must be completed by a treating doctor or specialist

1. Details of the health professional completing Section 2

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2. Details of the person’s impairment/s

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3. Are there early intervention supports that are likely to benefit the person by reducing their future needs for supports?

The provision of early supports will:

• Alleviate the impact on functional capacity
• Prevent deterioration of functional capacity
• Improve functional capacity
• Strengthen the sustainability of available or existing supports

Details of recommended early intervention supports:

Would benefit from DBT - has not been able to engage due to financial constraints.

Would benefit from an assistance dog

4. Have any assessments been undertaken of the person’s impairment(s)?

Please record assessment type, the date the assessment was undertaken and the assessment score or rating

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SECTION 3: Details of the functional impact of the impairment/s

This part of the form must be completed by a health or education professional

You can provide an existing report instead of completing this Section, however it is important that the information you provide matches the information required by this Section.

1. Mobility

Moving around the home, getting in and out of bed or a chair, mobilising in the community including using public transport or a motor vehicle.

• Assistance required does not include commonly used items such as glasses, walking sticks, non-slip bath mats, bathroom grab rails and hand rails installed at stairs.

Does the person require assistance to be mobile because of their impairment/s?

[ ] No, does not need assistance

[ ] Yes, needs special equipment [ ] Yes, needs assistive technology [ ] Yes, needs home modifications [X] Yes, needs assistance from other persons (including physical assistance, guidance, supervision or prompting)

If yes, please describe the type of assistance required:

Jamie is unable to access the community due to overwhelming intrusive thoughts and panic. This is from past trauma that she experienced as a child. On most days she is unable to leave her bedroom.

2. Communication

Being understood in spoken, written or sign language and ability to understand language and express needs and wants by gesture, speech or context appropriate for age.

Does the person require assistance to communicate because of their impairment/s?

[ ] No, does not need assistance

[ ] Yes, needs special equipment [ ] Yes, needs assistive technology [ ] Yes, needs home modifications [X] Yes, needs assistance from other persons (including physical assistance, guidance, supervision or prompting)

If yes, please describe the type of assistance required:

Jamie does not communicate with people that she does not know. She took a number of months to engage with health professionals. She is currently undertaking an extended inpatient stay and has now started to communicate with certain health professionals. She does not express her needs appropriately.

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3. Social interaction

Making and keeping friends and relationships, behaving within limits accepted by others, coping with feelings and emotions.

Does the person require assistance to interact socially because of their impairment/s?

[ ] No, does not need assistance

[ ] Yes, needs special equipment [ ] Yes, needs assistive technology [X] Yes, needs assistance from other persons: (including physical assistance, guidance, supervision or prompting)

If yes, please describe the type of social interaction assistance required:

Jasmine has a pattern of instability in personal relationships, intense emotions, poor self-image and impulsivity. She has formed inappropriate relationships to avoid feeling abandoned. She displays inappropriate behaviour (such as intense anger). She has not been able to sustain positive relationships. She has no relationships with her family due to past trauma.

4. Learning

Understanding and remembering information, learning new things, practicing and using new skills

Does the person require assistance to learn effectively because of their impairment/s?

[X] No, does not need assistance

[ ] Yes, needs special equipment [ ] Yes, needs assistive technology [ ] Yes, needs assistance from other persons: (including physical assistance, guidance, supervision or prompting)

If yes, please describe the type of assistance required:

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5. Self-Care

Showering/ bathing, dressing, eating, toileting, caring for own health.

• Assistance required does not include commonly used items such as non-slip bath mats, bathroom grab rails and hand rails installed at stairs.

Does the person require assistance with self-care because of their impairment/s?

[ ] No, does not need assistance

[ ] Yes, need special equipment [ ] Yes, needs assistive technology [ ] Yes, needs home modification [X] Yes, needs assistance from other persons in the areas of:

• showering/bathing
• toileting
• eating/drinking
• dressing
• overnight care (e.g. turning)

If yes, please describe the type of assistance required:

Jamie does not recognise when she needs to take a shower/clean her teeth. She is not motivated to make nutritious meals. She requires assistance with medication as she is often not compliant.

6. Self-Management

Doing daily jobs, making decisions and handling problems and money (not applicable for children under 8 years of age)

Does the person require assistance with self-management because of their disability?

[ ] No, does not need assistance

[ ] Yes, needs special equipment [ ] Yes, needs assistive technology [X] Yes, needs assistance from other persons: (physical assistance, guidance, supervision or prompting)

If yes, please describe the type of assistance required:

Jamie cannot manage her money and requires a formal arrangement in place. She is not capable of making her own decisions. Her treating team are in the process of organising Trustee and Guardianship.

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ndis

Overview of Access decision making

Scheme Eligibility Branch

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Acknowledgement of Country

Before we begin, I would like to acknowledge the Traditional Owners and Custodians of the Country on which we meet today, and their continuing connection to land, sea, and community. I pay my respects to their Elders, past and present.

I would like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander peoples here today.

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Facilitator notes:

[Show or hide this slide as needed.]

Say

Before we begin, I would like to acknowledge the Traditional Owners and Custodians of the Country on which we meet today, and their continuing connection to land, sea, and community. I pay my respects to their Elders, past and present.

I acknowledge that I am facilitating this training from the lands of the [insert name] people.

I would like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander peoples here today.

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Session outline: Overview of Access decision making

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Facilitator notes:

Say

Welcome to this module, where we will guide you through the essential decision-making tasks for Assessors. The module is split into two parts.

In Part One, we focus on understanding the eligibility requirements. Before getting into the decision-making process, it’s crucial to understand the eligibility requirements and the initial steps involved in assessing the request. We cover the key access eligibility criteria which are listed here on the left.

In Part two, we move on to show you how to make your decision based on the evidence and information gathered, through to communicating the decision to the applicant.

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Learning outcomes

This session has been designed to help you:

• develop a broad understanding of the access eligibility requirements for accessing the NDIS
• build confidence in navigating the Intranet and sourcing information in Our Guidelines
• enhance your critical thinking skills while reviewing evidence
• develop an understanding of streamlined access processes
• understand the final tasks involved in making and communicating your decision.

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Facilitator notes:

Say

Let’s look at our learning outcomes for today’s session.

This session has been designed to help you: develop a broad understanding of the access eligibility requirements for accessing the NDIS build confidence in navigating the Intranet and sourcing information in Our Guidelines enhance your critical thinking skills while reviewing evidence develop an understanding of streamlined access processes understand the final tasks involved in making and communicating your decision.

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Part one —- The access eligibility

requirements

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Facilitator notes:

[The purpose of this section is for new starters to gain an introduction to the Disability and Early Intervention requirements, and to build their confidence navigating the Intranet and sourcing information in Our Guidelines. Section 24 and Section 25 will be explored in more depth in later weeks.]

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Decision making steps

1. Verify age and residency
2. Review evidence and determine the outcome
3. Complete streaming
4. Process and submit the access decision case
5. Communicate the decision

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Facilitator notes:

Say

First, let’s take a look at this flow diagram which gives you an overview of the steps involved in making an access decision.

The first step is verifying age and residency. We then review the evidence to determine the outcome, complete streaming and process and submit the access decision case.

Finally, we must communicate our decision to the applicant or their authorised representative.

We cover each of these steps as we move along today’s training.

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Eligibility requirements

An applicant will meet the access requirements if, at the time of considering the access request, they meet the:

• Age requirements (section 22) and;
• Residence requirements (section 23) and:
• Disability requirements (section 24); and/or
• Early intervention requirements (section 25)

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Facilitator notes:

Say

For us to begin to assess a request, we need to have a solid understanding of the eligibility requirements. Let’s recap what they are.

An applicant will meet the access requirements if, at the time of considering the access request they meet the following requirements as outlined in the NDIS Act:

Age requirements (section 22) and; Residence requirements (section 23) and: Disability requirements (section 24); and/or Early intervention requirements (section 25)

You will get more familiar with these requirements as we move through today’s training. Let’s start with age and residency requirements on the next slide.

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Age (s22) and residency (s23)

• Under 65 years old when access request made
• Reside in Australia, and
• Are an Australian citizen, or hold a permanent visa or a protected Special Category Visa (SCV).

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Facilitator notes:

Say

The first step in assessing a request is verifying age and residency.

Let’s recap the age and residency requirements.

[Ask learners the following questions and pause for answers before providing the answers.]

Does anyone remember what the age requirements are?

Pause [for answers]

Click to reveal answer

A person will meet the age requirements if they are under 65 years of age when the access request is made.

What are the residency requirements?

Pause [for answers]

Click to reveal answer

A person will meet the residency requirements if they:

Reside in Australia, and Are an Australian citizen, or hold a permanent visa or a protected Special Category Visa (SCV).

When you review an access request, you must first verify the information provided about the person’s age and residency.

Age and residency can be checked using Centrelink with consent or supporting information that has been provided.

You will be provided with further training on this in a subsequent module when everyone has full access to our systems.

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Section 24 - Disability requirements

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Facilitator notes:

[The purpose of this section is for new starters to gain an introduction to the Disability requirements, and to build their confidence navigating the Intranet and sourcing information in Our Guidelines. Section 24 and Section 25 will be explored in more depth in later weeks.]

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Disability requirements (s24)

(1) A person meets the disability requirements if:

(a) The person has a disability due to intellectual, cognitive, neurological, sensory, physical, or psychosocial impairments; and

(b) The impairment is, or is likely to be, permanent; and

(c) The impairment results in substantially reduced functional capacity

(d) The impairment affects the person’s capacity for social or economic participation; and

(e) The person is likely to require NDIS supports for their lifetime.

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Facilitator notes:

Say

In this part, we’ll explore the disability requirements for accessing the NDIS, as outlined in Section 24 of the NDIS Act.

You can see the relevant subsections on the slide.

In summary, Section 24 of the NDIS Act specifies that to access the NDIS, a person must have a permanent impairment that significantly reduces their ability to perform daily activities such as communication, social interaction, learning, mobility, self-care, or self-management. Additionally, they must require lifelong support under the NDIS.

We’ll do a range of activities aimed at building your knowledge on these requirements and your confidence in navigating the Intranet and sourcing information in Our Guidelines.

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Activities — Our Guidelines

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Facilitator notes: [Facilitator to demonstrate navigating to the correct area of the OGs noting that the website may have undergone changes.]

Say

Now we’re going to do some activities. In these activities, you will need to navigate to Our Guidelines. I will show you how to do this now.

[Share your screen and follow the steps below whilst explaining the steps to the learners.]

• Go to the Access page on the intranet by opening a new tab on your browser, hovering over ‘Service Delivery’ and selecting ‘Access’.
• Scroll down slightly and select ‘NDIS Operational Guidelines (external)’.
• Scroll down and select ‘Applying to the NDIS’.
• Scroll down. You’ll see that there are 2 versions of our ‘Applying to the NDIS’ guidelines. They are ‘Applying to the NDIS’ and ‘Applying to the NDIS – Pre-legislation changes’. For these activities, we will select the first one, ‘Applying to the NDIS’.

In each activity, you will navigate to a different section within Our Guidelines.

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Activity one - Disability requirements

Section 24(1)(a)

The person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to one or more impairments attributable to a psychiatric condition.

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Facilitator notes:

[This slide introduces new starters to the Disability and Early Intervention requirements. There is also an activity where you will paste questions into the chat. When pasting the questions, right click and select ‘Paste as plain text’.]

Activity: [Learners navigate the intranet and source information in Our Guidelines.]

Say Let’s begin with the Disability Requirements. For this activity, navigate to the sub-heading ‘Do you meet the disability requirements?’

Paste in chat [Question 1: How would you explain ‘impairment’ in plain English? Question 2: What does the Agency think about when considering an applicant’s disability? Question 3: Define the following impairments: intellectual, cognitive, neurological, sensory, physical. Question 4: True or False? Diagnostic evidence will generally be required to determine whether a person has a disability caused by an impairment. Question 5: How important is the cause of an applicant’s impairment?]

[Give learners 10 mins to complete activity. Answers on next slide.]

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Activity One - Answers

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Facilitator notes:

[Bring the group back and go through their responses using the answers and additional debrief points below.]

Say Section 24(1)(a) : The person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to one or more impairments attributable to a psychiatric condition.

Question 1: How would you explain ‘impairment’ in plain English?

Pause [for answers]

Loss of, or damage to, a physical, sensory or mental function.

Question 2: What does the Agency think about when considering an applicant’s disability?

Pause [for answers]

When considering an applicant’s disability, we think about whether any reduction or loss of ability to do things, across all life domains, is because of an impairment.

Pause [for answers]

Question 3: Define the following impairments: intellectual, cognitive, neurological, sensory, physical.

Answer:

• intellectual – how a person speaks and listens, reads and writes, solves problems, and processes and remembers information
• cognitive – how a person thinks, learns new things, uses judgment to make decisions, and pays attention
• neurological – how the body functions
• sensory – how a person sees or hears
• physical – the ability to move parts of the body

Question 4

True or False?

Diagnostic information will generally be required to determine whether a person has a disability attributable to an impairment.

Answer: True. Whilst the NDIA is not diagnostically driven, an Access Delegate requires evidence from a relevant Treating Health Professional to make the access decision. It is important to note that we cannot request that an applicant undergoes an assessment to determine a diagnosis.

Question 5

How important is the cause of an applicant’s impairment?

Answer:

It doesn’t matter what caused the applicant’s impairment, for example if they’ve had it from birth, or acquired it from an injury, an accident or a health condition.

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Activity Two — Disability requirements

Section 24(1)(b)

The impairment or impairments are, or are likely to be, permanent

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Facilitator notes:

[This slide contains an activity where learners will navigate to Our Guidelines. You will need to paste questions into the chat.]

Say To complete this next activity, you need to refer to the sub-heading ‘Is your impairment likely to be permanent?’

Section 24(1)(b): the impairment or impairments are, or are likely to be, permanent.

Paste in chat [Question 1: True or False? A disability is, or is likely to be, permanent only if there are no known, available and appropriate evidence-based clinical, medical or other treatments that would be likely to remedy the impairment. Question 2: If a disability varies in intensity, could it still meet permanence criteria despite the variation? For example – impairments that are of a chronic episodic nature. Question 3: What evidence would you need to sight to be satisfied that the disability is permanent, or likely to be permanent?]

[Allow learners 10 minutes to complete the activity. Answers on next slide.]

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Activity Two - Answers

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Facilitator notes:

[Bring the group back and go through their responses using the answers and additional debrief points below.]

Say Section 24(1)(b): the impairment or impairments are, or are likely to be, permanent.

Question 1: True or False?

An impairment is, or is likely to be, permanent only after all available and appropriate treatment options have been pursued.

Pause [for answers]

True. If there is a potential treatment which may reduce, or eliminate, disability related functional impacts this must be explored before the impacts are considered permanent.

However, if treatment has been explored or is in progress, and a relevant Treating Health Professional verifies the impairment will remain irrespective of the treatment outcome, permanence would be met.

This is particularly relevant for a person with a psychosocial disability who may still be receiving clinical treatment.

Question 2: If a disability varies in intensity, could it still meet permanence criteria despite the variation? For example – impairments that are of a chronic episodic nature.

Pause [for answers]

Yes. An impairment may also be permanent even if the severity of its impact on the functional capacity of the person, may fluctuate or improve.

An impairment might still be considered permanent due to the overall impact on a person’s life, and the likelihood of lifetime impact.

Impairments of a degenerative nature are also permanent, or likely to be, if medical / other treatments haven’t, or are unlikely to improve it.

Question 3: What evidence would you need to sight to be satisfied that the disability is permanent, or likely to be permanent?

Pause [for answers]

That:

• There are no known, available, appropriate and evidence-based treatments likely to remedy the impairment
• An impairment that varies in intensity is permanent despite the variation
• The impairment is permanent despite the fact that its functional impacts may fluctuate or improve
• Further treating or medical review is not required to demonstrate that the impairment is permanent
• No further medical or other treatment would be likely to improve an impairment that is degenerative in nature

This is matter of judgment but what the Becoming a Participant Rules are trying to do is rule out cases where the permanency or likely permanency has not been established because the person requires further medical treatment or review before the permanency or likely permanency can be demonstrated.

This does not mean that an impairment will not be permanent or likely to be permanent if it requires further medical treatment or review.

In some cases, an impairment may continue to be treated and reviewed after it has been demonstrated that is permanent or likely to be permanent.

If a relevant Treating Health Professional verifies disability related functional impacts will remain irrespective of the treatment outcome, permanence would be met.

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Activity Three — Disability requirements

Section 24(1)(c)

The impairment or impairments result in substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities:

(i) communication;

(ii) social interaction;

(iii) learning;

(iv) mobility;

(v) self-care;

(vi) self-management

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Facilitator notes:

[This slide contains an activity where learners will navigate to Our Guidelines. You will need to paste questions into the chat.]

Say To answer these questions, you need to refer to the sub-heading ‘Does your impairment substantially reduce your functional capacity?’

Section 24(1)(c): the impairment or impairments, result in substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities:

• Communication
• Social interaction
• Learning
• Mobility
• Self-care and
• Self-management

Paste in chat [Question 1: A person’s impairment is considered to result in substantially reduced functional capacity if they usually need disability specific supports to undertake activities in the areas of communication, social interaction, learning, mobility, self-care and self-management (if older than 6). What are some examples of disability specific supports? Question 2: Which factors does the Agency consider when deciding if an applicant’s impairment substantially reduces their functional capacity? Question 3: How would an Access Delegate determine if an applicant’s hearing impairment leads to a substantially reduced functional capacity?]

[Allow 5 minutes for learners to answer the questions. Answers on next slide.]

Click [to go to next slide]

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Activity Three - Answers

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Facilitator notes:

[Bring the group back and go through their responses using the answers and additional debrief points below.]

Say Section 24(1)(c): the impairment or impairments, result in substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities:

• Communication
• Social interaction
• Learning
• Mobility
• Self-care and
• Self-management

Question 1: A person’s impairment is considered to result in substantially reduced functional capacity if they usually need disability specific supports to undertake activities in the areas of communication, social interaction, learning, mobility, self-care and self-management (if older than 6). What are some examples of disability specific supports? Pause [for answers]

• a high level of support from other people, such as physical assistance, guidance, supervision or prompting
• assistive technology, equipment or home modifications that are prescribed by your doctor, allied health professional or other medical professional.

Question 2: Which factors does the Agency consider when deciding if an applicant’s impairment substantially reduces their functional capacity?

Pause [for answers]

The Agency considers how the applicant might be involved in different areas of life, like home, school, work and the community, and how tasks and actions are carried out in those contexts.

Question 3: How would an Access Delegate determine if an applicant’s hearing impairment leads to substantially reduced functional capacity?

Pause [for answers]

Generally, hearing loss would be considered substantial if the loss is at least 65 decibels in the better ear based on a pure tone average of 500Hz, 1000Hz, 2000Hz and 4000Hz.

Pause

It is important to note that the guideline requires us to consider substantially reduced functional capacity in relation to impairments that are permanent.

This means we need to consider whether any substantial reduction is attributable to an impairment that meets the permanency criteria.

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Activity Four — Disability requirements

Section 24(1)(d)

The impairment or impairments affect the person’s capacity for social or economic participation

Section 24(1)(e)

The person is likely to require NDIS supports under the National Disability Insurance Scheme for the person’s lifetime

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Facilitator notes: [This slide contains an activity where learners will navigate to Our Guidelines. You will need to paste questions into the chat.]

Say To answer these questions, you need to refer to the sub-headings: ‘Does your impairment affect your social, work or study life?’ and ‘Will you likely need support under the NDIS for your whole life?’

We will now look at:

• Section 24(1)(d): the impairment or impairments affect the person’s capacity for social or economic participation and;
• Section 24(1)(e): the person is likely to require NDIS support under the National Disability Insurance Scheme for the person’s lifetime

Paste in chat [Question 1: Give an example of how a person’s capacity for social and economic participation may be affected? Question 2: True or False? If an impairment varies in intensity (for example, because the impairment is of a chronic episodic nature) the person is unlikely to meet Section 24(1)(e).]

[Allow 5 minutes for learners to answer the questions. Answers on next slide.]

Click [to go to next slide]

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Activity Four - Answers

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Facilitator notes:

[Bring the group back and go through their responses using the answers and additional debrief points below.]

Say Question 1: Give an example of how a person’s capacity for social and economic participation might be affected?

Pause [for answers]

• Barriers to joining sporting activities or accessing movie theatres
• Difficulties in finding and keeping a job
• Challenges with spending and saving money

Question 2: True or False? If an impairment varies in intensity (for example, because the impairment is of a chronic episodic nature) the person is unlikely to meet Section 24(1)(e).

Pause [for answers]

False. Even if a person’s needs go up and down over time, or happen episodically, we may still consider it’s likely they’ll need lifetime support under the NDIS.

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Section 25 — Early Intervention Requirements

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Facilitator note:

[The purpose of this module is for new starters to gain an introduction to the Early Intervention requirements, and to build their confidence navigating the Intranet and sourcing information in Our Guidelines. Section 25 will be explored in more depth in later weeks.]

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FOI 24/25-1472

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Early intervention (El) requirements (s25)

Section 25(1): A person meets the early intervention requirements if:

(a) The person has one or more identified impairments that are permanent.

(b) Early intervention supports are likely to reduce future need for supports

(c) Early intervention supports are likely to benefit the person

(d) Early intervention supports are NDIS supports as defined in the legislation.

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FOI 24/25-1472

Summary of Comments on Make an Access Decision - Part 1

Page: 21

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:31 AM

Facilitator notes:

Say

As you will now know, to determine if an applicant is eligible to become an NDIS participant, you will assess the legislative requirements outlined in Section 24 and 25 of the NDIS Act.

In the last section, we covered Section 24 Disability requirements. We are now going to focus on the criteria for Early Intervention (Section 25). We sometimes refer to this as EI for short. You can see a summary of section 25(1) on the slide.

In short, this section of the NDIS Act states that a person may qualify for early intervention supports if they have a permanent impairment or they are a child with developmental delay. These supports should likely reduce future disability needs, likely to benefit the person and must be appropriately funded through the NDIS.

We’ll explore EI in general here and will take an indepth look into developmental delay in a later module.

Click [to go to next slide]

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Legislation change transitional period

Prior to October 3rd

• Apply section 25(3)

From October 3rd

• Apply section 25(1)d — early intervention supports must be an NDIS support

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Page: 22

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:32 AM

Facilitator notes:

Say

Legislation change transitional period.

Recent changes to the NDIS Act have impacted our work in Access. During this transitional period, the legislation we apply depends on when the application was made.

The previous legislation included section 25(3), which has been replaced by section 25(1)(d) in the current legislation. Both subsections determine if early intervention supports are likely to benefit the person according to legislative requirements.

The change clarifies that early intervention supports must be NDIS supports as defined in the legislation and specifies when a mainstream system is responsible for providing early intervention support.

We assess either section 25(3) or section 25(1)(d), depending on when the request was made.

Requests made before October 3rd are assessed under the old legislation, while requests made from October 3rd onwards area assessed against the current legislation.

You will learn how to consider these sections as you progress through your training.

Click [to go to next slide]

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Activity One: Early Intervention requirements

We need to decide that getting early intervention supports means you’ll likely need fewer disability supports in the future.

Question 1

What do you notice about the early intervention requirements that is similar to the disability requirements?

Question 2

What age must a child be to be assessed against the developmental delay criteria?

Question 3

What are some factors we will consider to determine if a person is likely to benefit from early intervention supports?

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Page: 23

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:32 AM

Facilitator notes:

[This slide contains an activity where learners will navigate to Our Guidelines. You will need to paste questions into the chat.]

Say

So as we know, Section 25 of the NDIS Act outlines the early intervention requirements for meeting access.

This section is broken down further to include sub-sections such as 25(1)(a), 25(1)(b) and so on.

Let’s explore the Early Intervention requirements by doing this next activity.

Go to the sub-heading of our Applying to the NDIS guidelines, ‘Do you need early intervention?’

Paste in chat [Question 1: What do you notice about the early intervention requirements that is similar to the disability requirements? Question 2: What age must a child be to be assessed against the developmental delay criteria? Question 3: What are some factors we will consider to determine if a person is likely to benefit from early intervention supports?]

[Give learners 10 minutes to complete the activity. Answers on next slide.]

Click [to go to next slide]

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Early Intervention activity - Answers

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24

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Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:32 AM

Facilitator notes:

[Bring the group back and go through their responses using the answers and additional debrief points below.]

Say

Question 1: What do you notice about the early intervention requirements that is similar to the disability requirements?

Pause [for answers]

A person must have an intellectual, cognitive, neurological, sensory, or physical impairment, or an impairment attributable to a psychiatric condition, that is likely to be permanent.

Early intervention must be most appropriately funded by the NDIS.

You will notice that the early interventions only consider the impairment, compared to the disability requirements which consider both the impairment and the disability in Section 24(1)(a).

Question 2: What age must a child be to be assessed against the developmental delay criteria?

Pause [for answers]

Under 6 years of age.

We will consider the developmental delay requirements in more depth in a later module.

Question 3: What are some factors we will consider to determine if a person is likely to benefit from early intervention supports?

Pause [for answers]

• how your impairment might change over time
• how long you’ve had your impairment
• if there’s been a significant change to your impairment
• if your needs are likely to change soon, such as if you’re finishing school.

Click [to go to next slide]

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Final note: Applications made before October 3rd

Prior to October 3rd

• We decide if a person meets either the disability or early intervention requirements.

From October 3rd

• Separately consider, decide, and communicate if a person meets the disability requirements, the early intervention requirements, or both.

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Page: 25

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:33 AM

Facilitator notes:

Say

As we learnt earlier, we are currently in a transition period where we’ll need to choose which version of the legislation to apply based on the date the access request was made.

When considering the disability and early intervention requirements, for requests made before 3rd October, when making an access decision, we decide whether a person meets either the disability or early intervention requirements.

This means that there is no need to separately decide whether a person meets the disability requirements or early intervention requirements.

Pause

For requests made after 3rd October, we’ll need to separately consider and communicate whether a person meets the disability requirements, the early intervention requirements, or both.

Click [to go to next slide]

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Let’s take a break

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o Po

26

Page: 26

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:33 AM

Facilitator notes:

Say

Let’s take a 15-minute break.

[Tell learners what time to be back in front of their computers.]

[Leave this slide showing during the break.]

Click [to go to next slide]

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Part two —

Making your decision

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Decision making steps

• Verify age and residency
• Review evidence and make a decision
• Complete streaming
• Process and submit the access decision case
• Communicate the decision

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Page: 28

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:33 AM

Facilitator notes:

Say

Now that we understand our access eligibility requirements, we are well on our way to making our first decision.

In this section, we’ll focus on the steps involved in decision-making, from weighing the evidence to critical thinking skills, actioning your decision in PACE and finally to communicating the decision to the applicant.

Click [to go to next slide]

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Making decisions within the NDIS

• Apply legislative criteria to ensure consistent decisions.
• Judge the weight of each piece of evidence.
• Each applicant is unique, with different disabilities and complexities.

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Page: 29

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:34 AM

Facilitator notes:

Say

Making decisions within the NDIS involves applying legislative criteria to individual cases to ensure consistency across all decisions.

The NDIS Becoming a Participant Rules allow you, as a delegate, to consider evidence from various sources, including the applicant, family members, carers, and health professionals.

You must judge the weight or value of each piece of evidence. For example, you would give considerable weight to a doctor’s evidence on a specific medical matter, just as you would to family members’ evidence on the impact of a support on the informal support they provide.

There is no one-size-fits-all approach or blanket rules for making access decisions because we are dealing with individuals. Applicants have different disability types, experiences, and varying degrees of complexity.

When you complete this training and start your job, use the guides to decision-making and QDO technical support to make your decisions. Over time, you will build your knowledge and skills in this area.

For now, this training aims to provide you with the fundamental information you need and an approach for considering and assessing evidence against the criteria.

Click [to go to next slide]

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Delegate responsibilities

Instrument of delegation

• Go to the ‘Intranet’.
• Click ‘Corporate Services’.
• On the left-hand side click ‘Legal Services’.
• Select Delegations and Authorisations.
• Expand the heading ‘NDIS Operations Delegations’.
• Scroll down and open ‘National Disability Insurance Scheme Act 2013 Instrument of Delegation 5 of 2024 (signed)’.

[Delegations and authorisations (ndia.gov.au)](Delegations and authorisations (ndia.gov.au))

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Page: 30

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:34 AM

Facilitator notes:

Say

We are now going to look at our responsibilities as delegates to make decisions.

What do you think it means to be a legislated decision maker?

[Allow learners a few minutes to answer and then read the following answer aloud.]

As a legislation decision maker;

• You are empowered under the CEO of the NDIA instrument of delegation; and
• As an Australian Public Servant, you are guided by the APS Code of Conduct and relevant legislation; and
• Your decision making needs to withstand the scrutiny of review if need be; and
• Justification of your decision making must be evidence based.

[Refer learners to open the Instrument of Delegation by following the pathway outlined on the slide. Refer learners to Schedule 1 on Page 2.]

As NDIA staff, we can only exercise or perform legislative functions and powers, such as making decisions, if we hold the right delegation.

This Instrument of Delegation outlines functions and powers of the CEO under the NDIS Act 2013 that the CEO has delegated to us to allow us to complete our work.

As you can see on page 2, there are specific powers and functions that relate to access and revocation of participant status.

For example, you can see in row 3 of the table that APS4 access delegates have the power to decide an access request for non-defined applicants and those on List A or List D under section 20 of the NDIS Act.

In addition, as you can see in row 5, APS4 Access Assessors also have the power to revoke a person’s status as a participant in the NDIS under Subsection 30(1).

APS4 Delegates use this power to complete eligibility reassessments.

As you can see, it is our responsibility as delegates to understand the specific functions and powers that are delegated to our roles.

Click [to go to next slide]

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Considering Risk

All NDIA staff and partners are responsible for identifying, assessing, managing and reporting risks.

• Risk factors or critical incidents may be identified during conversations, or have previously been documented in PACE.
• A reported critical event involving a participant is called a participant critical incident (PCI). PCIs and risks are assessed using the Risk matrix.
• Before we assess eligibility, we must identify any risk factors and raise these with your TL.

PACE Knowledge Articles:

• [Identify risks and vulnerabilities (external)](Identify risks and vulnerabilities (external))
• [Understanding participant critical incidents (external)](Understanding participant critical incidents (external))
• [Assess the participant critical incident risk level (external)](Assess the participant critical incident risk level (external))

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Page: 31

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:34 AM

Facilitator notes:

Say

All NDIA staff and partners are responsible for identifying, assessing, managing and reporting risks.

As delegates, when we assess an applicant or participant, we need to consider all the information we have for that person on record.

It is important to remember we support people with diverse, lived experiences. We must also recognise that people with disability can be vulnerable to harm.

As part of our role, we need to be able to understand when a person may be at risk and proceed accordingly.

Risk factors, vulnerabilities, or critical incidents may be identified during our conversations with a person or already be documented in cases and interactions in PACE.

Examples of risk factors we may observe include a risk of harm to themselves or others, abuse or neglect, evidence of rapidly progressing conditions and impairments, or a risk to informal supports. An event involving a participant is called a participant critical incident (PCI) and is reported in PACE. All PCIs and risk factors are assessed using the agency’s Risk matrix.

It is our responsibility to identify any risk factors relating to an applicant or participant before we assess their eligibility. If a risk is identified, this must be raised with your team leader to discuss the best course of action.

Likewise, any risk identified during interactions with an applicant or participant must be reported and appropriately escalated, with support from your TL.

For further guidance on considering and managing risk, refer to the PACE knowledge articles linked on the slide.

Click [to go to next slide]

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Critical thinking

• We begin with the right approach
• We look deeper and farther
• We ask complex questions
• We answer questions using a variety of thinking processes
• We reflect on how we are answering the questions

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Page: 32

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:35 AM

Facilitator notes:

[Source: The University of Toronto (Scarborough)]

Say

As an access delegate, your responsibilities include judging pieces of evidence and interpreting and applying legislation to make decisions.

Applying critical thinking is crucial for success in this role. Critical thinking involves self-guided, self-disciplined reasoning with a high standard of fairness and accuracy.

The slide here outlines steps in critical thinking, such as starting with the right approach, looking deeper, and reflecting on how we answer questions.

As Assessors, be open-minded, ask vital questions, and weigh evidence from various sources to make well-reasoned decisions.

Click [to go to next slide]

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Critical thinking

Critical Thinking OFFICIAL

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Page: 33

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:35 AM

Facilitator notes:

[The purpose of this slide is to introduce learners to the fundamentals of critical thinking via YouTube video.]

Say

We’re now going to watch a short video around critical thinking. See if you can answer the brain teasers.

[Play the video for learners. Alternatively, ask learners to watch the video individually and raise their hand once they have finished. Video URL: https://youtu.be/m2eINI4WXkc]

Critical thinking is the art of analysing, processing and understanding information. Critical thinkers can draw reasonable conclusions from a set of information to distinguish useful (and useless) details for decision-making.

Think about how you would rate your existing critical thinking skills? Have you used these types of skills in previous or current work roles?

Click [to go to next slide]

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Evaluating evidence

• Consider the age of the evidence
• Identify the source of the evidence
• Prioritize high-quality evidence

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Page: 34

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:35 AM

Facilitator notes:

Say

We recognize that a person may have evidence of their disability from various health professionals at different times. When determining NDIS eligibility, we consider:

• The age of the evidence
• The source of the evidence

We weigh evidence based on what we consider ‘best practice’, or highest quality. This evidence carries the most weight in our decision-making process.

Click [to go to next slide]

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What evidence should be provided?

Disability Requirements:

• Confirm permanent impairment
• Impact on functional capacity

Early Intervention Requirements:

• Confirm permanent impairment
• Need for early intervention

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Page: 35

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:35 AM

Facilitator notes:

Say

What type of evidence do you need to see as an assessor to determine eligibility?

For the disability requirements, we need evidence to confirm a person’s permanent impairment and evidence about how this impacts their functional capacity.

For the early intervention requirements, we need evidence to confirm a person’s permanent impairment and evidence that confirms their need for early intervention.

Click [to go to next slide]

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How old should evidence be?

Permanent impairment confirmation:

Evidence from any age is acceptable.

Functional capacity impact:

Evidence should be from the last 12 months.

Current circumstances:

Recent evidence ensures understanding of current support needs.

Weighing evidence:

• Newer evidence is generally given more weight.
• Lack of updated evidence may affect eligibility.

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Page: 36

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:35 AM

Facilitator notes:

Say

How old should evidence be?

When assessing evidence for NDIS eligibility, it’s important to understand a few key points.

First, evidence from a person’s doctor or specialist to confirm their permanent impairment can be from any age. However, when it comes to how their impairment impacts their functional capacity, the evidence should be from the last 12 months. This is because a person’s functional capacity can change over time, even if their impairment does not. Having up-to-date evidence helps us understand their current support needs accurately.

If an applicant provides multiple pieces of evidence, we generally give more weight to the newer evidence. Older evidence might require additional information to support it. If updated evidence is not provided, it could affect the applicant’s eligibility for the NDIS.

By following these guidelines, we ensure that our decisions are fair and based on the most current information available.

Click [to go to next slide]

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Who should provide evidence?

We generally prefer evidence from a treating professional who:

• Is the most appropriately qualified to provide evidence of the primary disability.
• Has treated the person for at least six months.
• Is registered to practice in Australia or New Zealand.
• Provides original, genuine, and specific disability evidence (e.g. a medical report).

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Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:36 AM

Facilitator notes:

Say

Who should provide evidence?

We generally prefer evidence that comes from a treating professional who:

• is the most appropriately qualified person to provide evidence of your primary disability
• has treated the person for a significant period of time (at least six months)
• is registered to practise in Australia or New Zealand
• provides disability evidence (such as a medical report) that is original, genuine and specific to the individual.

Click [to go to next slide]

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Confidence in decision making

• Leverage your professional background and life experience.
• Set aside personal biases.
• Avoid procrastination due to fear of mistakes.
• Confidence in decision-making will grow with experience.

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Page: 38

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:36 AM

Facilitator notes:

Say

Confidence in your decision-making ability is crucial. Sometimes, you may lack complete information or face different interpretations.

Your professional background and life experience will influence your decisions. Recognizing this influence is key to becoming an insightful delegate.

It’s essential to set aside personal biases and base your decisions on the available evidence.

Don’t procrastinate out of fear of making mistakes. Learning to apply our legislation and make legally sound decisions is a process. Your skills and confidence will grow with experience.

Remember, you will receive further training and support to build your decision-making confidence.

Click [to go to next slide]

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Streamlined access requirements

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39

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Streamlined requirements

Lists designed to streamline the access process:

• List A — conditions which are likely to meet the disability requirements of s24
• List B — permanent conditions for which functional capacity is variable
• List D — permanent impairment/early intervention, under 7

Other streamlined processes:

• Hearing 0-25

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Page: 40

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:36 AM

Facilitator notes:

Say

The NDIA has developed lists of conditions which are designed to streamline the access process in certain cases.

There is also a streamlined process for people aged 0-25 with hearing impairments.

We won’t go into detail about the streamlined hearing requirements now, but it is important to be aware of this approach. You can find more information about these requirements in Our Guidelines – Applying to the NDIS, under the heading ‘How will early intervention help you?’

Click [to go to next slide]

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List A, B, and D

Lists designed to streamline the access process:

• List A — conditions which are likely to meet the disability requirements of s24
• List B — permanent conditions for which functional capacity is variable
• List D — permanent impairment/early intervention, under 7

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Page: 41

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:36 AM

Facilitator notes:

Say

We are now going to look at the other streamlined lists; List A, B and D.

[Refer learners to locate List A on the NDIS website.]

List A describes conditions which are likely to meet the disability requirements in section 24 of the NDIS act.

This means that conditions on this list will generally meet the disability requirements without any further assessment.

What are some examples of conditions on List A?

Pause [for answers]

[Any conditions listed on List A are acceptable.]

[Refer learners to locate List B.]

List B describes permanent conditions for which functional capacity is variable.

This means conditions on this List likely meet the requirements of Section 24 (1)(a) and (b) but further assessment of the remaining disability requirements is required.

What are some examples of conditions on List B?

Pause [for answers]

[Any conditions listed on List B are acceptable.]

List D describes permanent impairments that likely meet the early intervention requirements without any further assessment. List D only applies to children under the age of 7.

[Refer learners to locate List D.]

What are some examples of condition on List D?

Pause [for answers]

[Any conditions on List D are acceptable.]

For List A and List D, no further evidence is required to satisfy the DIS and EI criteria respectively for conditions on these lists.

For List B, impairment and permanency are satisfied but further evidence of functional capacity is required to determine if the disability or early intervention requirements are met.

After verifying age and residency, you will then consider whether the applicant has an impairment on one of these Lists before proceeding to assessing the remaining access requirements.

Click [to go to next slide]

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Important steps in PACE

ndis.gov.au | XX Month Year

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First step: Check for active review

• Check for an active review before progressing an access decision case.
• Don’t progress an access decision case if an applicant has an active review
• If an applicant has an active review, refer to guidance

[Access Assessor OneNote (sharepoint.com)](Access Assessor OneNote (sharepoint.com))

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Page: 43

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:37 AM

Facilitator notes:

Say

Certain decisions made by the NDIA carry formal rights of review under the NDIS Act.

This means if an applicant does not agree with certain decisions, they can request that the decision outcome be reviewed.

Internal reviews of access decisions are called s100s and are completed by the Access Internal Review Team.

If the applicant disagrees with the internal review decision, they may request an external review. External reviews are completed by the Administrative Review Tribunal (ART).

Pause

When working on an access decision, we need to check if there’s an active review of a Revocation or Access Not Met decision. This could be an internal review (s100) or an external review (ART).

If there is a review of an access decision in progress, we cannot proceed with the access decision case. You will need to refer to guidance to notify the appropriate team that a new access request cannot be submitted when there is an active review of access in place.

Click [to go to next slide]

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Legislation change: Cutover period

Request made before 3 October 2024 – Apply previous legislation

[Knowledge Article – Update legislation selection in an access request case (external)](Knowledge Article – Update legislation selection in an access request case (external))

Request made on or after 3 October 2024 – Apply current legislation

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Page: 44

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:37 AM

Facilitator notes:

Say

Next, we need to check that the correct version of the legislation has been selected for an access request.

We assess access requests against the previous legislation if made before 3 October 2024 and against the current legislation if made on or after 3 October 2024.

If the incorrect legislation has been selected, please refer to guidance.

Click [to go to next slide]

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Complete Streaming

Streaming is the predicted level of support the participant is likely to require to navigate the NDIS Pathway

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Page: 45

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:37 AM

Facilitator notes:

Say

We are now going to look at Streaming.

Participants entering the National Disability Insurance Scheme (NDIS) have unique circumstances and differing levels of knowledge about how the NDIS works.

A service stream response otherwise referred to as streaming, is the predicted level of support the participant is likely to require to navigate the NDIS Pathway.

It does not refer to the complexity of the person’s disability, as some people with complex disabilities will require minimal agency assistance.

The term streaming is for internal use only.

Click [to go to next slide]

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Streaming

Details Case Activity

• Child

Yes

ari is living in / or will need accommodation outside the family home

• Participant is in hospital awaiting discharge

Yes No

“Is partici; currently involved with the Child Protection

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46

Page: 46

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:37 AM

Facilitator notes:

Say

Participants can be streamed as:

• General
• Supported
• Intensive or
• Super Intensive

The Streaming case must be completed before submitting an Access Met decision. It is only completed for Access Met decisions, not for Access Not Met decisions.

To complete streaming you will consider a number of questions in line with the evidence that has already been provided about the participant. On the slide you can see a screenshot of what this looks like in PACE.

The answers to these questions will then help the system to calculate a recommended streaming option.

The Partner will have created a Streaming case. When you are completing a Streaming case, you may need to change the recommended level of streaming or simply leave it as it already is.

This process is explained in greater detail in the relevant Knowledge Article.

It is important to complete this task correctly, as it is used to determine what support a participant requires to engage with the NDIS.

If you are unsure about how to answer any particular question based on information that you have, you can check with your Team Leader.

It is important that you complete the Streaming case prior to making an Access Met decision. This will ensure that it progresses correctly through to the Planning stage, once you have made your decision.

Click [to go to next slide]

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Finalising your decision

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47

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Process and submit the decision

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Page 265 of 362

Verify age and residency

Review evidence and make a decision

Complete streaming

Process and submit the access decision case

Communicate the decision

48

Page: 48

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:38 AM

Facilitator notes:

Say

Finalising an access decision involves submitting the decision into PACE and communicating the outcome to the applicant.

You will be given a live/video recorded demonstration of how to finalise access decisions throughout the training.

Click [to go to next slide]

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Recording the decision

System changes now allow us to manually record which specific requirements a participant has met.

49

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Page: 49

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:38 AM

Facilitator notes:

Say

Once we’ve made our decision, we need to accurately record it in the access decision case in PACE.

This includes manually recording whether the disability and/or early intervention requirements are met.

Click [to go to next slide]

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Communicate decision outcome

• Communicating our decision outcomes is one of our service commitments.

• We take the time to talk to applicants and thoroughly explain the reasons for our decisions and next steps.

Knowledge Article: Contact to advise access request outcome (external)

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Page: 50

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:38 AM

Facilitator notes:

Say

Communicating our decision outcomes is one of our service commitments.

We take the time to talk to applicants or their representatives and thoroughly explain the reasons for our decisions and next steps.

We send applicants an outcome letter explaining our decision. We also provide advice about next steps the applicant can take.

This includes explaining referring the applicant back to their Local Area Coordinators or Early Childhood Partners who may be able to support the person to find mainstream and other community supports.

It also involves explaining the person’s review rights.

Different process steps apply to some scenarios and it’s important that you refer to the appropriate guidance before communicating a decision outcome to align with the most up to date requirement. The knowledge article ‘Contact to advise access request outcome’ is useful to refer to before communicating a decision outcome.

We will look more closely at review rights in a moment.

Click [to go to next slide]

Page 270 of 362

OFFICIAL

Reviewable decisions

Internal reviews

• Must be requested within 3 months of access decision outcome
• Are completed by the Internal Review Branch

External reviews

• Can only be requested after an internal review has been completed
• Must be requested within 28 days of internal review decision outcome
• Are completed by the Administrative Review Tribunal (ART)

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Page 271 of 362

Page: 51

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:39 AM

Facilitator notes:

Say

We learnt earlier that certain decisions made by the NDIA carry formal rights of review under the NDIS Act.

For example, access not met decisions are reviewable decisions.

If an applicant disagrees with this decision, they can request a review within 3 months of receiving the decision notice.

If the request for review is not made within the 3-month timeframe, the person has the option to make a new access request.

The Access Internal Review Team of the Internal Review Branch handles internal reviews of access decisions.

If the applicant still disagrees after the internal review, they can request an external review by the Administrative Review Tribunal (ART).

However, they must first complete the internal review process. Applicants have 28 days to request an external review after receiving the internal review decision notice.

Pause

When you make the “access not met” phone call, it’s your responsibility to explain these review rights to the applicant.

Note that if a person meets access for one impairment but not for another, this decision is not reviewable.

We make one overall access decision, and declining another impairment does not qualify for review.

This is because an overall “access met” decision is not reviewable.

Click [to go to next slide]

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Useful resources

• Knowledge Article — Prepare to make an access decision (external)
• Knowledge Article - Make an access decision - pre-legislation changes (external)
• Knowledge Article - Make an access decision - post legislation changes (external)
• Access and ER decision tree (external)
• Knowledge Article - Make an access decision - pre-legislation changes (external)
• Knowledge Article - Make an access decision - post legislation changes (external)
• Developmental Delay — Access Assessor OneNote (external)
• Hearing Impairments — Access Assessor OneNote (external)
• Streaming — Access Assessor OneNote (external)
• Knowledge Article — Submit an access decision (external)
• Knowledge Article: Contact to advise access request outcome (external)

52

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Page 273 of 362

Page: 52

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:39 AM

Facilitator notes:

Say

Here are some links that may be useful. I will give you a minute or two to open these links.

Note: It is important to read additional links within articles to ensure you have all required information.

[Allow learners time to open links.]

Click [to go to next slide]

Page 274 of 362

Questions

Page: 53

Number: 1 | Author: Presenter Notes | Subject: Presentation Notes | Date: 24/04/2025 9:48:39 AM

Facilitator notes:

Say

To wrap up today’s training, let’s check on your well-being e.g. How are you feeling so far, can everyone please post a GIF or emoji in the chat, that indicates how you are feeling.

[Allow learners to post their GIF or emoji. Respond and discuss as necessary.]

[Open the floor to questions.]

End of presentation

Page 276 of 362

DOCUMENT &:

ndis

Recap of Legislative Criteria

OFFICIAL

Acknowledgement of Country

I would like to acknowledge the Traditional Owners and Custodians of the Country on which we meet today, and their continuing connection to land, sea and community.

I pay my respects to their Elders, past, present and emerging.

I would like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander peoples here today.

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Overview

• Relevant Sections of the National Disability Insurance Scheme (NDIS) Act 2013 for Access Decisions
• Disability Criteria — Section 24
• Early Intervention Criteria — Section 25
• Questions

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NDIS Act 2013

The National Disability Insurance Scheme Act 2013 (NDIS Act) is the legislation which establishes The National Disability Insurance Scheme.

The NDIS Act sets out:

• The objects and principles under which the NDIS operates
• How a person can become a participant in the NDIS
• A process for internal and external review of certain decisions made under the NDIS Act

To access the NDIS, a person must meet specific access requirements outlined in the relevant legislation.

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NDIS Act 2013 — Relevant Sections

The NDIS Act is the primary consideration when determining access for persons applying to become a Participant of the Scheme.

The most relevant sections for Access are:

• s 21: When a person meets the access criteria
• s 22: Age requirements
• s 23: Residence requirements
• s 24: Disability requirements
• s 25: Early Intervention Requirements
• s 26: Requests that the CEO may make

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Disability Criteria - Activity

• Section 24(1)(a): Disability attributable to an impairment
• Section 24(1)(b): Permanent, or likely to be permanent, impairment
• Section 24(1)(c): Substantial Reduction in Functional Capacity
• Section 24(1)(d): Impairment affects social and/or economic participation
• Section 24(1)(e): Requiring lifetime support under the NDIS

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Section 24(1)(a)

The person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to one or more impairments attributable to a psychiatric condition

What does this mean?

• Disability: Reduction or loss of an ability to do things, across all life domains, because of an impairment.
• Impairment: Loss of, or significant change in, your body’s functions, structure or how you think and learn.

The evidence needs to show that the person has a reduction or loss in ability to do things, across all life domains, because of an impairment.

Body Scan Analogy: If you take a full body scan of someone with Multiple Sclerosis you will see brain lesions (impairment — significant change to a mental function) that is causing (for example) the person to use a 4 Wheel Walker (disability — reduction in their ability to walk)

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Section 24(1)(b)

The impairment or impairments are, or are likely to be, permanent

What does this mean?

• If the person has a condition on List B then it is considered the impairment is likely to be permanent and 24(1)(b) is met
• You are assessing the permanency of the impairment — not the condition and not the disability
• The evidence needs to demonstrate at least one of the below:
  • There are no known, available and appropriate evidence-based clinical, medical or other treatments that would be likely to remedy the impairment
  • The impairment fluctuates, but there is always an underlying impairment
  • No further medical treatment or review is required for the impairment. However, the person can still receive management intervention (i.e. the treatment is so they don’t deteriorate, but they will still have an impairment)
  • The impairment is degenerative in nature and no medical intervention will stop the deterioration

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Section 24(1)(c)

The impairment or impairments result in substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities: communication, social interaction, learning, mobility, self-care, self-management

What does this mean?

• You only assess the substantial reduction in functional capacity for permanent impairments
• The person must usually require the assistance of another person or specially prescribed equipment to complete tasks and activities
• Completing a task at a slower rate, over an extended duration and/or by using commonly used items does not result in a substantial reduction in functional capacity

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Section 24(1)(c) — Yes or No

You are assessing a case where the applicant is living with Fibromyalgia and unilateral Sensorineural Hearing Loss. You have determined that the impairment resulting from Fibromyalgia is not permanent. Sensorineural Hearing Loss is a List B condition. The evidence demonstrates that the Fibromyalgia is resulting in a substantial reduction in functional capacity in mobility. The hearing loss does not result in substantial reduction.

Is section 24(1)(c) met?

No — as it has been determined that the impairment resulting from Fibromyalgia is not permanent you do not assess 24(1)(c). However as Sensorineural Hearing Loss is permanent you assess the functional impacts from this which are not substantial and therefore 24(1)(c) is not met.

You are assessing a case where the applicant is living with a right above knee amputation and is fitted with a prosthetic. The General Practitioner (GP) has completed the Access Request Form (ARF) and ticked “no assistance required” for all domains.

Is section 24(1)(c) not met?

No — 24(1)(c) is likely met as the person is fitted with a prosthetic. As the GP has advised no assistance is required a Clarification call is needed purely to confirm that the applicant requires the prosthetic to mobilise.

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Section 24(1)(d)

The impairment or impairments affect the person’s capacity for social or economic participation

What does this mean?

• Similar to 24(1)(c) you only assess whether the permanent impairments affect the person’s capacity for social or economic participation
• The person’s capacity for social or economic participation only needs to be affected — there is no threshold
• Therefore if 24(1)(c) is met then 24(1)(d) will generally always be met

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Section 24(1)(e)

The person is likely to require support under the National Disability Insurance Scheme for the person’s lifetime

What does this mean?

• The support that the person requires is the responsibility of the NDIS
• Use the COAG to assist in determining this
• Take into consideration if it is a new diagnosis, the person’s age and if capacity building supports are recommended (and are likely to make an improvement to the point there is no longer a substantial reduction in functional capacity)

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EI Criteria - Activity

• Section 25(1)(a): Permanent or likely to be permanent impairment; or Developmental Delay
• Section 25(1)(b): Reduce future need for disability related supports
• Section 25(1)(c): Mitigate or Improve function; and/or Prevent Deterioration; and/or Strengthen Informal Supports
• Section 25(3): Most appropriately funded by NDIS

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Section 25(1)(a)(i) and (ii)

The person: (i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or (ii) has one or more identified impairments that are attributable to a psychiatric condition and are, or are likely to be, permanent; or

What does this mean?

Similar to Section 24(1)(a) and (b):

• The person does not need to have a disability (reduction or loss of an ability to do things).
• The impairment has to be permanent, or likely to be permanent

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Section 25(1)(a)(iii) - Developmental Delay

Developmental delay means a delay in the development of a child under 6 years of age that:

(a) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and (b) results in substantial reduction in functional capacity in one or more of the following areas of major life activity: (i) self-care; (ii) receptive and expressive language; (iii) cognitive development; (iv) motor development; and (c) results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

What does this mean?

• When a child under 6 does not have a permanent or likely to be permanent impairment we assess them under the Developmental Delay criteria.
• To meet the criteria for Developmental Delay, all of the above criteria must be met. If it is not, this is referred to as “developmental concerns”.
• A substantial reduction means what a child does or can do in everyday activities is at a significantly lower competency level when compared to children of the same age.
• An extended duration means the support is needed for longer than 12 months.

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Section 25(1)(b)

The provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

What does this mean?

• Recommended intervention should be capacity building in nature and not something the person will always require
  • For example: An adult living with hearing loss has been recommended a hearing aid. This will not reduce their future need for disability related supports as they will always require this aid.
  • For example: A child with a new diagnosis of Autism and their health professional has recommended occupational therapy, psychology and speech therapy for social skill development, emotional regulation, and improved communication to build their capacity.
• Take into consideration the likely trajectory and impact of the person’s impairment, the potential benefits of early intervention on the impact of the impairment on the person’s functional capacity and in reducing future needs for support and also having evidence from a range of sources (this can include the person themselves)
• For degenerative impairments also take into consideration if the early intervention will prolong their support need. This is reducing their future support needs by delaying them

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Section 25(1)(c)

The provision of early intervention supports for the person is likely to benefit the person by:

(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self-care or self-management; or (ii) preventing the deterioration of such functional capacity; or (iii) improving such functional capacity; or (iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

What does this mean?

• Early Intervention supports only need to benefit the person in at least one of the above ways
• If 25(1)(b) is met then it is likely that 25(1)(c) is met because if you are reducing the need for disability related supports then you are likely also achieving (i), (ii) or (iii)
• Take the same points into consideration for that of determining 25(1)(b)

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Section 25(3)

The early intervention supports are most appropriately funded or provided through the National Disability Insurance Scheme and not another service system

What does this mean?

• You need to know what the early intervention supports are to know if they are the responsibility of the NDIS
• You need to refer to the COAG to determine if the supports are the responsibility of the NDIS or another service system (e.g. health, mental health, education)
  • For example: Clinical early intervention for a psychosocial disability is the responsibility of the mental health service system, not the NDIS
• Someone can receive supports from both the NDIS and other service systems
• A gap in another system does not make it the responsibility of the NDIS (i.e. waiting lists)