NDIA Accountability Project

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Complete a desktop review before a check-in

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Complete a desktop review before a check-in

SGP KP Publishing

Exported on 2025-01-20 23:38:52

Page 197 of 208

Table of Contents

Recent updates

Before you start

Complete a desktop review

Life stage

Participant profile

Disabilities

Plan duration

Plan budget and utilisation

Complaints

Internal reviews

Administrative Review Tribunal (ART) decisions

Plan Change Requests

Review the person account

Complete a desktop review for a discretionary overutilisation check-in

Next steps

SGP KP Publishing – Complete a desktop review before a check-in

This article provides guidance for a planner delegate, planner (non-partnered area), review officer, participant support officer, local area coordinator, or early childhood partner to:

  • complete a desktop review
  • review the person account
  • complete a desktop review for a discretionary overutilisation check-in.

Recent updates – 3 Page 199 of 208

SGP KP Publishing – Complete a desktop review before a check-in

Recent updates

4 November 2024

Added guidance on how to complete a desktop review for a discretionary overutilisation check- in.

Recent updates – 4 Page 200 of 208

2 Before you start

You have read and understood:

  • the Guide - Conversation style guide
  • Our Guideline – Your plan (external)
  • article Understand types of check-ins.

Page 201 of 208 Before you start – 5

Complete a desktop review

Before a check-in, it’s important to review the participant’s information and conduct a desktop review to understand:

  • the reason for the check-in
  • the participant’s current situation
  • any challenges the participant has with using their plan
  • how the plan is currently managed
  • the current level of plan spending
  • if there have been any challenges with accepting claims before
  • if there are any in-progress or recently closed cases, and the decision outcomes
  • any potential changes or updates to the participant’s plan
  • if the participant is likely to need their eligibility reassessed
  • any identified risks or vulnerabilities
  • the participant’s preferred communication method and their personal details, including pronouns
  • if the participant needs any additional communication support
  • evidence from any recent provider reports, including progress reports from support coordinators or recovery coaches.

It’s important to consider if this check-in:

  • is a regular scheduled check-in, for example a 3 or 6 month check-in
  • has come from an enquiry
  • is because a participant’s situation meets the risk criteria
  • is a discretionary overutilisation check-in
  • is for a participant transitioning from SAP CRM to PACE
  • is the last check-in before the participant’s plan reassessment
  • will be longer because a Short Form Outcomes Framework (SFOF) questionnaire is due
  • will be longer if Personal and Environmental Circumstances (PEC) questions and functional capacity assessments are due for children younger than 7.

Once you understand the participant’s situation, review the participant’s details, open Cases, and recent interactions in the Activity tab on the Person Account.

Life stage

Check the participant’s date of birth to see if there are any life transitions. A life transition could be if they:

  • are a child with developmental delay turning 6, or a child with global developmental delay turning 7
  • are turning 18 or 65
  • are starting or leaving school
  • want to start or find a job

SGP KP Publishing – Complete a desktop review before a check-in

  • want to begin tertiary study, like university or TAFE.

For participants who have a work and study goal in their plan, there are a number of work and study NDIS supports available. For example, there are capacity building employment supports for young people moving from school to work.

To learn more about work and study supports, go to article Understand work and study supports. To learn more about eligibility conversations for children with developmental delay, go to article EC: Guide - Check-in eligibility conversations for children younger than 6 with developmental delay.

  1. From the Person Account, select Details.
  2. Check Date of birth.

Participant profile

Determine if the participant’s current plan supports them to pursue their goals or if they need new supports.

  1. From the Person Account, select My Profile.
  2. Select Goals to see the participant’s current goals.
  3. Select About Me and ICM Supports (Informal, Community and Mainstream Supports) to learn about the participant’s current supports and involvement with other services.

Disabilities

Review the participant’s disability information and check if their functional capacity is changing. Assess new reports or evidence for updated information which show the participant may need a change in supports. For example, support coordination progress reports, therapy reports or an eligibility conversation for children younger than 6 with developmental delay.

To review a disability from the Person Account:

  1. Select My Profile.
  2. Select Disabilities.
  3. Select a Disability record to view Details, including the primary disability.

To review any new reports or assessments from the Person Account:

  1. Select Documents and review documents.
  2. Select Files and review any further information.

Plan duration

For participants transitioning from SAP CRM to PACE, their plan duration will remain the same. New participants whose first plan is developed in PACE will have a plan duration of 12 months. The planner delegate will add an internal note if they have assessed that plan and recommend a plan longer than the initial 12 months.

  1. From the Person Account, select Activity.
  2. Select Timeline.
  3. Select Event Type (funnel) on the right-hand side.

SGP KP Publishing – Complete a desktop review before a check-in

  1. Select the checkbox next to Task.
  2. Select Apply.
  3. Review the list of tasks for Internal Communication.
  4. Select the internal communication and check Comments for a plan duration internal note.

Plan budget and utilisation

Review information about the participant’s plan to understand how they are managing their current budget and NDIS funded supports, including fund management options. This is particularly important for a discretionary overutilisation check-in.

Identify if there is overuse or underuse of funded supports. Check frequent budget updates which could indicate the participant’s plan isn’t meeting their support needs.

  1. From the Person Account, select My Budget.
  2. Budget Overview, Budget Updates, Transactions, Recurring Claims, Bank Accounts and Claim Verification will display.
  3. From My Profile, select Plan.
  4. Select the participant’s current plan.
  5. The Plan screen will open.
  6. In Details, check the Plan Management Options.
  7. Select Claims if you want to view recent claims.
  8. Select Related for Plan History and Claim Coverage information.

Confirm the participant has given consent to share information about their plan to providers and approved contacts. You can contact providers and approved contacts if you need more information about the participant’s supports, if consent has been provided. You’ll need consent to share information if you refer the participant to new support services. Learn more in article Applicant consent to share information.

Check Cases for open cases that may require action. This may include plan change requests, complaints, pending Administrative Review Tribunal (ART) decisions or internal reviews.

Check any relevant closed cases from the past 18 months, for example previous check-ins or any rejected plan change cases.

Complaints

If there are any existing complaints that need actioning:

  1. Check the Person Account for any recent Activity. Review Activity History and Alerts History for any active alerts or open complaints.

SGP KP Publishing – Complete a desktop review before a check-in

  • Follow up with the complaints officer assigned to an open complaint to see if you can resolve the matter.
  • Email the complaints team at redacted if you can’t make contact with the complaints officer.

Internal reviews

If there are any outstanding internal reviews which require action:

  1. Check the Person Account for any recent Activity. Review Activity History and Alerts History for any active alerts or open internal review cases.
  2. Follow-up with the internal review delegate to understand how to proceed with the check-in conversation.

Note: If there’s no internal review delegate assigned, email the internal review team at redacted

Administrative Review Tribunal (ART) decisions

For pending Administrative Review Tribunal (ART) decisions, email redacted to learn how to proceed with the check in.

Plan Change Requests

For plan change requests requiring action, contact the my NDIS contact responsible for the case for how to proceed with the check-in case. Consider if there are any risks to the participant that would mean the plan change request needs internal priority. To review a plan change request, go to article Assign and review a plan change case.

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SGP KP Publishing – Complete a desktop review before a check-in

Review the person account

Review the Person Account for information which indicates the participant’s situation may have changed. To review any recent Activity:

  • From the Person Account, select Activity.
  • Review recent Account Updates for changes in the participant’s details.
  • Check Alerts History for any active alerts. Note: Consider if it’s appropriate to also check SAP CRM for any information that hasn’t transferred to PACE.
  • Review Activity History. To review any recent Decisions:
  • From the Person Account, select Decisions.
  • Review recent decisions to determine changes to the participant’s plan.
  • Select Decision Name to open for full details. To review any recent Cases:
  • From the Person Account, select Cases.
  • Review any Cases, Feedback & Complaints, Request for Services and Critical Incidents information.

Complete a desktop review for a discretionary

overutilisation check-in

Completing a desktop review for a discretionary overutilisation check-in will help you:

  • understand how the participant is managing their plan
  • understand the reason and level of overutilisation
  • determine what education and support strategies are needed. This will help you determine if a check-in is needed.

As well as the guidance in the previous sections of this article, you should consider:

  • if the participant has been using their funding only on NDIS supports (external) related to their disability
  • if the participant has had any supports declined, and if there are claims for that support
  • if there’s any evidence that identifies the reason for overutilisation. This could be in Documents or Activities. For example, the participant is funded for weekday rates and an email from the Support Coordinator outlines that they’re accessing supports on weekends continuously
  • if there are any unusual requests or patterns in the participant’s payment requests. For example very large or small amounts, or whole numbers like $1000
  • the risk indicators and support strategies for overutilisation in article Understand overutilisation risk indicators and support strategies. If another business area is working with the participant, talk to your team leader about how you should proceed.

Next steps

  • If a check-in case is automatically created and assigned to you, continue with the check-in case. Go to article Book change or cancel a check-in.
  • If it’s a discretionary check-in from an enquiry, you’ll need to create a check-in case. Go to article Create a check-in case.