Make a plan change decision

FOI 24/25-1912 DOCUMENT 10

Make a plan change decision SGP KP Publishing

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FOI 24/25-1912 SGP KP Publishing – Make a plan change decision

Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4

2 Before you start …………………………………………………………………………………………………….. 5

3 Make a decision on a plan change request …………………………………………………………….. 6

4 Add free text sub-justifications ……………………………………………………………………………… 8 4.1 Plan variation sub-justifications ……………………………………………………………………………… 8 4.1.1 Not to vary – due to a significant change to your support needs …………………………………………… 8 4.1.2 Not to vary – make minor changes to funding in the plan ……………………………………………………. 8 4.1.3 Not to vary – make minor change to supports in the plan (new justification) …………………………… 9 4.1.4 Not to vary – change the plan reassessment date ……………………………………………………………… 9 4.1.5 Not to vary – change the plan management type ……………………………………………………………….. 9 4.1.6 Vary – add crisis or emergency funding ………………………………………………………………………….. 10 4.1.7 Vary – make minor change to the funding in the plan ……………………………………………………….. 10 4.1.8 Vary – make minor change to the supports in the plan (new justification)…………………………….. 10 4.2 Plan reassessment justifications ………………………………………………………………………….. 10 4.2.1 Not to reassess – change in situation …………………………………………………………………………….. 10 4.2.2 Not to reassess – change to the supports in the plan ……………………………………………………….. 10

5 Record an overall plan change decision ………………………………………………………………. 11 5.1 s47A variation decisions ……………………………………………………………………………………… 11 5.2 s48 reassessment decisions ……………………………………………………………………………….. 12

6 Communicate your decision ………………………………………………………………………………… 13

7 Next steps …………………………………………………………………………………………………………… 14

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This article provides guidance for a planner delegate or review officer to:

 make a decision on a plan change request  add free text sub-justifications  record an overall plan change decision  communicate your decision.

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1 Recent updates

3 March 2025

Update to include free text justifications for new plan variation and plan reassessment rules.

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2 Before you start

Note: If you have a plan change request over 21 days do not use this article. Go to Progress a plan change (s47A and s48) request over 21 days.

You have:

 been allocated or assigned yourself a plan change case (received less than 21 days ago)  reviewed the plan change request. Go to article Assign and review a plan change case  read and understood Our Guideline – Changing your plan (external).

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3 Make a decision on a plan change request

When making a plan change decision, you’ll need to consider the following:

 the participant’s situation, including any information or evidence provided  the criteria that must be met to decide to vary a plan or complete a plan reassessment  the type of plan change request. For example, if the plan change case is for a s47A, then you’ll need to decide either to vary or not vary. If you think the participant needs a reassessment, then you’ll need to make a decision not to vary for the s47A and make a decision to do a ‘CEO-initiated plan reassessment’  if a variation to change the plan reassessment date will result in the plan not being reassessed for more than 5 years.

To learn more about changing a plan, go to Our Guidelines – Changing your plan (external).

Note: When a participant is eligible for specialist disability accommodation (SDA) but hasn’t located an enrolled dwelling or isn’t ready to move in, a $1 amount is included in the SDA support category as a placeholder. The plan comment is used to let the participant or their authorised representative know of the SDA decision. Once the participant finds an enrolled SDA dwelling and confirms they can move in, we can consider a s47A to include the SDA funding. In this situation this s47A can only be considered when the request is only for SDA funding.

You’ll need to record your decision for each plan change request in the Plan Change Case.

Depending on the legislative type selected, some plan change requests may be marked as Not Required. If the status of the plan change request is Not Required, you don’t need to do anything.

1. In the Plan Change case, select the Decision tab.

2. Select the correct hyperlink within the Plan Change Requests table.

3. On the Plan Change Request screen, locate the Decision tab.

4. Select a decision from the What decision do you want to make? drop-down list.

Note: If any of the plan change requests are CEO-initiated, you won’t be able to decline the request.

5. Select a Justification from the drop-down list.

6. Select a Sub-justification from the drop-down list.

Note: Sub-justifications related to the new rules are not available on the system until March 2025. Until then, select the most suitable sub-justification from the existing options. You must then add free text sub-justifications to record extra detail.

If you decide to decline a plan change request or partially vary the plan, the Sub- justification you select will be printed on the plan change decision letter.

If you:

o need to include additional sub-justifications go to step 7

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o don’t need to include additional sub-justifications go to step 8.

7. Select Edit Detail to add free text justifications using section Add free text sub- justifications in this article.

8. Select Save.

9. If needed, add any supporting evidence for the decision by selecting New.

10. Select Submit.

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4 Add free text sub-justifications

Use the relevant free text sub-justifications by copying and pasting them in the Details field. Information in the details field will not print on the plan change decision letter.

You can select multiple free text sub-justifications listed below.

Note: The free text sub-justifications listed below relate to new plan management and plan variation and reassessment rules. The list does not include sub-justifications available in the sub-justification drop-down list in PACE.

4.1 Plan variation sub-justifications

4.1.1 Not to vary – due to a significant change to your support needs  The evidence provided doesn’t show a significant change in the participant’s support needs that needs urgent crisis or emergency funding.  The funding requested doesn’t meet the conditions in the rules for the NDIS.  The information provided doesn’t show the participant’s NDIS support needs have significantly changed.  The funding requested doesn’t meet the conditions in the NDIS rules. The information provided doesn’t show a significant change in the participant’s support needs due to the change in situation.  The funding requested doesn’t meet the conditions in the NDIS rules. The information provided doesn’t show a significant change in the participant’s support needs due to the change in functional capacity.  The funding requested doesn’t meet the conditions in the NDIS rules. The information provided doesn’t show a significant change in the participant’s support needs due to the change in informal supports.  The funding requested doesn’t meet the conditions in the NDIS rules. The information provided doesn’t show a significant change in the participant’s support needs due to the change in living arrangements.  The funding requested doesn’t meet the conditions in the NDIS rules. It’s funding the NDIS can’t provide as it should be funded or provided by another Commonwealth, State, or Territory program.

4.1.2 Not to vary – make minor changes to funding in the plan  The increase in funding requested doesn’t meet the conditions set out in the rules for the NDIS.  The increase in funding requested doesn’t meet the conditions set out in the rules for the NDIS as it isn’t for a home modification, vehicle modification or assistive technology support.  The increase in funding requested doesn’t meet the conditions set out in the rules for the NDIS. Additional funding isn’t required as there’s available funding in the plan to pay for the support.  The increase in funding requested doesn’t meet the conditions set out in the rules for the NDIS. The support can still be provided in the same way as expected in the plan.

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 The increase in funding requested doesn’t meet the conditions set out in the rules for the NDIS. The support in the plan can be provided without additional information, services, or materials.

4.1.3 Not to vary – make minor change to supports in the plan (new justification)

Note: You’ll need to add this free text justification and sub-justification into the Details field for ‘Make minor changes to funding in the plan’.

 The request is for a support that is not in line with what the NDIS rules say we can fund.  The information provided shows the support requested is the same as a support already in the plan.  The request is for a support that is not in line with what the NDIS rules say we can fund. The support isn’t for a set period of time or a one-off support.  The request is for a support that is not in line with what the NDIS rules say we can fund. The support requested isn’t to replace, repair, or maintain assistive technology funded in the current or previous plan.  The request is for a support that is not in line with what the NDIS rules say we can fund. The support requested isn’t urgently needed to support economic participation for a set period of time.  The request is for a support that is not in line with what the NDIS rules say we can fund. The support requested isn’t urgently needed to help build skills or support a life change over a set period of time.  The request is for a support that is not in line with what the NDIS rules say we can fund. The support requested is the same as or has the same outcome as a support already provided in the plan.  The information provided shows the support requested can be met by informal, community and mainstream supports.

4.1.4 Not to vary – change the plan reassessment date  A plan can’t go for more than 5 years without a reassessment. This means we’ll work with you to create a new plan before your plan’s current reassessment date.

4.1.5 Not to vary – change the plan management type  The type of plan management requested poses an unreasonable risk, even with supports, safeguards and strategies in place.  The rules for the NDIS say these supports cannot be self-managed.  There is evidence of non-compliance with requests to provide required information or documents.  There is evidence of conduct involving fraud or mismanagement or misuse of funds or other assets.  There is evidence of the participant or the person managing the funding being subjected to legal or financial exploitation or coercion.  There is evidence the participant or the person managing the funding doesn’t have capacity to make decisions or appropriately manage finances.  The funding is unlikely to be spent on NDIS supports.

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 The funding is unlikely to be spent in line with the plan.  The funding is unlikely to be spent on NDIS supports and in line with the plan.

4.1.6 Vary – add crisis or emergency funding  Urgent crisis or emergency funding is needed for a period of time or one off due to the significant change in support needs.

4.1.7 Vary – make minor change to the funding in the plan  The information provided shows a minor change to the funding in the plan will meet the participant’s needs and the conditions in the NDIS rules.

4.1.8 Vary – make minor change to the supports in the plan (new justification)

Note: You’ll need to add this free text justification and sub justification into the Details field for Make minor changes to funding in the plan.

 The information provided shows a minor change to the supports in the plan will meet the participant’s needs and the NDIS funding criteria.

4.2 Plan reassessment justifications

4.2.1 Not to reassess – change in situation  The information provided does not show a significant change in the participant’s need for NDIS supports due to a change in situation.  There is no new information which shows the participant’s need for NDIS supports has significantly changed.

4.2.2 Not to reassess – change to the supports in the plan  The changes requested can be considered when the plan is due for reassessment.  There has been no change to the participant’s entitlement to compensation.  There has been no change to the participant’s right to personal injury supports under a scheme of insurance or Commonwealth, State or Territory law.

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5 Record an overall plan change decision

5.1 s47A variation decisions

For s47A requests, you’ll need to record an overall plan change decision. You’ll need to do this after you’ve recorded your decision on each plan change request in the case.

Note: Your overall plan change decision needs to match the decision of each individual plan change request.

1. In the Plan Change case, select the Decision tab.

2. Select Overall Decision.

3. Select Decision from the drop-down list.

4. Select Justification from the drop-down list.

5. Enter Justification Details into the text field.

6. If you need to add evidence to the decision, select New and go to step 7. Otherwise, go to step 11.

7. To add evidence, select the Evidence Type from the drop-down list:

o If you select Document, go to step 8. o If you select Other, go to step 9.

8. Enter the Evidence Link name. You can view linked evidence on the Evidence tab of the Plan Approval case. To learn more about linking evidence, go to article Add and link evidence to a case.

9. Enter the Evidence Explanation into the free text field.

10. Select Save.

11. Select Submit.

Note: Once the overall decision is made, this can’t be changed.

12. In the Plan Change case, select the Decision tab.

13. Select Generate Decision Letter.

14. Select Yes under Are you sure you want to generate the Decision Letter?

15. Select Submit.

If you want to view the decision letter, go to article Understand and view plan change decision letters.

Note: if the participant has a statutory guardian and the relationship is established with an organisation account, you’ll need to manually send the auto-created Decision letter to the statutory guardian. To do this, go to article Send a letter to a statutory guardian or trustee.

If the overall decision is not to vary because a plan reassessment (s48) is needed, you’ll need to create a CEO-initiated plan reassessment (s48) request. Go to article Create a plan reassessment (s48) request.

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5.2 s48 reassessment decisions

The overall decision on a s48 plan change case is determined when making the decision on the individual plan change request.

1. In the Plan Change case, select the Decision tab.

2. Select Generate Decision Letter.

3. Select Yes under Are you sure you want to generate the Decision Letter?

4. Select Submit.

If you want to view the decision letter, go to article Understand and view plan change decision letters.

Note: if the participant has a statutory guardian and the relationship is established with an organisation account, you’ll need to manually send the auto-created Decision letter to the statutory guardian. To do this, go to article Send a letter to a statutory guardian or trustee.

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6 Communicate your decision

You’ll need to let the participant know once you’ve made your decision.

You must use the relevant scripting in section Discuss a plan change decision of article Discuss a participant plan change request when contacting the participant or their authorised representative.

To record your contact attempts, go to article Contact attempts and unable to contact in a plan change case.

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7 Next steps

You or another delegate may complete the next steps. This will depend on the routing of the case.

1. For a variation, from the Plan Change case, select the Budget Update tab. To complete the plan variation, go to article Action a budget update.

2. For a reassessment, from the Plan Change case, select the Reassessment tab. Select the Case hyperlink to open the Plan Approval case to complete the reassessment. Go to article Change the draft budget.

3. For decisions not to vary or reassess, no further steps are needed. Correspondence has been generated and the plan change case will move to the Completed stage. The plan change case is now closed.

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