DOCUMENT 8

ndis

Overview of Access decision making

Scheme Eligibility Branch

Page 368 of 459

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.

Facilitator notes:

[Show or hide this slide as needed]

Say

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.

Click [to go to next slide]

Page 370 of 459

DISCLOSURE LOG - FOI 24/25-0764

Session outline:

Overview of Access decision making

Part One: The access eligibility requirements Age requirements (section 22) and; Residence requirements (section 23) and; Disability requirements (section 24); and/or Early intervention requirements (section 25)

Part two: Making your decision Streamlined access, streaming, critical thinking, communicating the decision.

OFFICIAL

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.

Page 371 of 459

Click [to go to next slide]

Page 372 of 459

Disclosure Log - FOI 24/25-0764

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.

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.

Click [to go to next slide]

Page 373 of 459

Part one —

The access eligibility

requirements

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.]

DISCLOSURE LOG - FOI 24/25-0764

Section 24 - Disability requirements

OFFICIAL

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.]

Disclosure Log - FOI 24/25-0764

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 ts 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.

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.

Page 382 of 459

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.

Click [to go to next slide]

Page 383 of 459

Activities — Our Guidelines

OFFICIAL

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’.`

Page 384 of 459 11

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.

Click [to go to next slide]

Disclosure Log - FOI 24/25-0764

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.

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?]

Page 386 of 459 12

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.] Click [to go to next slide]

Disclosure Log - FOI 24/25-0764

Activity One - Answers

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, nervological, 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]

Page 388 of 459

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?

Page 389 of 459

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.

Click [to go to next slide]

Activity Two — Disability requirements

Section 24(1)(b)

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

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]

Page 391 of 459 14

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.]

Click [to go to next slide]

Disclosure Log - FOI 24/25-0764

Activity Two - Answers

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

Page 393 of 459

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 a 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.

Click [to go to next slide]

Disclosure Log - FOI 24/25-0764

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

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`

Page 396 of 459 16

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]

Disclosure Log - FOI 24/25-0764

Activity Three - Answers

OFFICIAL

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

Page 398 of 459 17

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.

Click [to go to next slide]

Disclosure Log - FOI 24/25-0764

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

ndis}

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

Page 401 of 459 18

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]

Disclosure Log - FOI 24/25-0764

Activity Four - Answers

OFFICIAL

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

Page 403 of 459 19

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.

Click [to go to next slide]

DISCLOSURE LOG - FOI 24/25-0764

What evidence should be provided?


Disability Requirements:	Early Intervention Requirements:
Confirm permanent impairment	Confirm permanent impairment

Need for early intervention | | Impact on functional capacity | |

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]

Page 430 of 459

Disclosure Log - FOI 24/25-0764

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.

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.

Page 431 of 459

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]

Page 432 of 459

DISCLOSURE LOG - FOI 24/25-0764

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).

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.

Page 433 of 459

Click [to go to next slide]

Page 434 of 459

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.

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.

Page 435 of 459

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

Click [to go to next slide]

Streamlined access requirements

Page 437 of 459

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

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]

Disclosure Log - FOI 24/25-0764

OFFICIAL

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

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?

Page 439 of 459

Pause

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]

Important steps in PACE

ndis.gov.au | XX Month Year

Page 442 of 459

Disclosure Log - FOI 24/25-0764

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) « 4

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).

Page 443 of 459

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]