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National Access QDO & AA — Technical Meetings Section 24(1)(b)

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Slide 1

OFFICIAL

National Access QDO & AA — Technical Meetings

Section 24(1)(b)

redacted: s22(1)(a)(ii) - irrelevant@NDIS.GOV.AU

OFFICIAL

We will now move on now to Section 24(1)(b)

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DOCUMENT 9

Slide 2

OFFICIAL

Overview

  • Explanation of Section 24(1)(b)
  • Case Study 1 — Autism
  • Case Study 2 — Fibromyalgia and Chronic Fatigue Syndrome
  • Case Study 3 — Borderline Personality Disorder, Generalised Anxiety and Post Traumatic Stress Disorder (PTSD)
  • Test your knowledge — True or False
  • Key Points
  • Questions

For this criteria will be going through:

  • CLICK Explanation of Section 24(1)(b)
  • CLICK Case Study on Autism
  • CLICK Case Study on Fibromyalgia and Chronic Fatigue Syndrome
  • CLICK Case Study on Borderline Personality Disorder, Generalised Anxiety and PTSD
  • CLICK An opportunity to test your knowledge
  • CLICK Key Points
  • CLICK And we will finish with questions

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Slide 3

OFFICIAL

Section 24(1)(b)

As defined in the NDIS Act 2013, Section 24(1)(b) states:

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

Is your impairment likely to be permanent? of Our Guidelines also states:

  • Even when your condition or diagnosis is permanent, we’ll check if your impairment is permanent too. For example, you may not be eligible if your impairment is temporary, still being treated, or if there are remaining treatment options.

Section 24(1)(b) is one of the main criteria that the person needs to meet. This is because some of the remainder of the criteria is assessed on the permanent impairment. To meet this criteria the person must have an impairment, or impairments that are, or are likely to be permanent.

When looking at this criteria, you are looking for the permanency of the impairment, not the disability and not the condition. Someone could have a permanent condition and it may not result in a permanent impairment. Someone could also be undertaking intervention to improve their disability, but not to remedy the impairment.

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Slide 4

OFFICIAL

Section 24(1)(b)

The NDIS (Becoming a Participant) Rules 2016 Sections 5.4-5.7 provide further information on when an impairment is permanent, or likely to be permanent:

  • 5.4 — An impairment 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.
  • 5.5 — An impairment may be permanent notwithstanding that the severity of its impact on the functional capacity of the person may fluctuate or there are prospects that the severity of the impact of the impairment on the person’s functional capacity, including their psychosocial functioning, may improve.
  • 5.6 — An impairment may require medical treatment and review before a determination can be made about whether the impairment is permanent or likely to be permanent. The impairment is, or is likely to be permanent only if the impairment does not require further medical treatment or review in order for its permanency or likely permanency to be demonstrated (even though the impairment may continue to be treated and reviewed after this has been demonstrated).
  • 5.7 — If an impairment is of a degenerative nature, the impairment is, or is likely to be, permanent if medical or other treatment would not, or would be unlikely to, improve the condition.

The NDIS (Becoming a Participant) Rules 2016 should be a resource that you regularly refer to. These rules explain how the legislative criteria is met or when it is not met. So not matter what the impairment is and how much you know about it, if you refer to these Rules and breakdown the evidence and match it up with these Rules you will be able to determine whether the evidence demonstrates the impairment is, or is likely to be permanent. The evidence does not need to demonstrate all of these sections are met, only one or more. The wording in these paragraphs can also assist in making your Access Not Met calls.

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Section 5.4 of the Rules states “an impairment 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”. This means that the delegate needs to be satisfied that if the applicant undertakes this treatment then they will no longer have an impairment.

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Section 5.5 of the Rules states “an impairment may be permanent not withstanding that the severity of its impact on the functional capacity of the person may fluctuate or there are prospects that the severity of the impact of the impairment on the person’s functional capacity, including their psychosocial functioning, may improve”. This means that the impairment may improve or even decline, but treatment will not remedy the impairment. The person’s impairment can still fluctuate, but the underlying impairment will still be there.

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Section 5.6 of the Rules states “an impairment may require medical treatment and review before a determination can be made about whether the impairment is permanent or likely

to be permanent. The impairment is, or is likely to be permanent only if the impairment does not require further medical treatment or review in order for its permanency or likely permanency to be demonstrated (even though the impairment may continue to be treated and reviewed after this has been demonstrated)”. This is slightly different to Section 5.4 in that if further treatment is recommended, you may not be able to determine the permanency of the impairment, this would therefore mean Section 24(1)(b) is not met. You do not need to know the outcomes for this treatment. The important part of this section though is the last sentence – the impairment can still be treated and reviewed after permanency has been demonstrated. A good example of this are psychosocial disabilities. People will quite often engage in maintenance treatment, not to remedy the impairment but to maintain it and prevent it from declining. If the evidence demonstrates the impairment is permanent but they still require treatment for maintenance then Section 24(1)(b) would be met. If it is not referred to in the evidence, it is important to clarify whether the listed treatment is to remedy the impairment or for maintenance.

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The final section is section 5.7 which states “if an impairment is of a degenerative nature, the impairment is, or is likely to be, permanent if medical or other treatment would not, or would be unlikely to, improve the condition”. This means that if the impairment is degenerative in nature then it is likely permanent. When assessing the evidence you need to determine that the impairment is degenerative and not the condition. Refer back to the points in the technical meeting for Section 24(1)(a) for a refresher on determining what the impairment is.

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Slide 5

OFFICIAL

Section 24(1)(b)

It is important not to associate certain diagnoses with not meeting Section 24(1)(b) as there are no lists with conditions that do not meet Section 24(1)(b). Regardless of the name of the diagnosis, if the evidence demonstrates the person has a disability attributable to an impairment then this criterion will be met.

The only blanket rule when it comes to conditions that meet Section 24(1)(b) is if they are listed on List A or List B.

This is as per Do you meet the disability requirements? and Is your impairment likely to be permanent? of Our Guidelines:

  • 8.6.1 — List A Conditions

    Where an applicant has been diagnosed with a condition/s on List A the NDIA will be satisfied that the person meets the disability requirements without further assessment. A person does not need to have a condition on List A to become a participant in the NDIS.

  • 8.6.2 — List B Conditions

    Where an applicant has been diagnosed with a condition/s on List B the NDIA will be satisfied that the person has a disability attributable to one or more impairments that is, or is likely to be, permanent without further assessment. This therefore means the delegate only needs to assess from Section 24(1)(c) onwards.

As usual it is important that we do not blanket rule conditions for not meeting this criterion. There are definitely conditions that are not likely to meet, however as there is no lists or legislative criteria stating certain conditions do not meet 24(1)(b), we must assess each case individually.

Whilst there isn’t a policy excluding conditions, there is a policy which states that conditions on List A and B will automatically meet Section 24(1)(b).

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As we know, a condition on List A will meet the Section 24 Disability criteria. This is as per Do you meet the Disability Requirements? Of Our Guidelines.

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The other conditions that will automatically meet Section 24(1)(b) are those on List B. This is as per Is your impairment likely to be permanent? Of Our Guidelines. Therefore, if the person has a condition on List B, the confirmation of this condition is enough to meet Section 24(1)(a) and (b) and you only need to assess the remainder of the criteria

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Slide 6

OFFICIAL

Section 24(1)(b)

From the below examples, which section of the NDIS (Becoming a Participant) Rules 2016 or Our Guidelines is applicable?

  • The person is living with a diagnosis of Intellectual Disability
  • The person is living with a degenerative neurological impairment
  • The person is living with Major Depressive Disorder for 20+ years with fluctuating functional capacity, their psychiatrist has optimally treated them and they have regular psychology intervention for maintenance.

Now, to apply those definitions to what we might see in an application for the NDIS. I’ll read out a sentence, and then use the “hand up” function if you are able to identify what section of the Rules or Our Guidelines is applicable

CLICK - will show sentence — the person is living with a diagnosis of Intellectual Disability — we are looking for the applicable section of Our Guidelines.

Give people time to put hands up, call one someone to answer

CLICK - will show “List B — Is your impairment likely to be permanent?”

Advise if correct/incorrect — an Intellectual Disability is considered to be a permanent impairment as it is on List B — as per Is your impairment likely to be permanent? of Our Guidelines. If the person has a condition on List B, then Section 24(1)(b) is met.

CLICK - will show sentence — the person is living with a degenerative neurological impairment — we are looking for the relevant section of the Rules.

Give people time to put hands up, call one someone to answer

CLICK - will show “Section 5.7 of the Rules”

Advise if correct/incorrect — this aligns with Section 5.7 of the Rules due to the impairment being degenerative in nature.

CLICK - will show sentence — the person is living with Major Depressive Disorder for 20+ years with fluctuating functional capacity, their psychiatrist has optimally treated them and they have regular psychology intervention for maintenance — we are looking for the 2 applicable sections of the Rules for this one.

Give people time to put hands up, call one someone to answer

CLICK - will show “Section 5.5 of the Rules” and “Section 5.6 of the Rules”

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Advise if correct/incorrect – this has 2 applicable sections of the Rules – 5.5 due to the fluctuating nature of the impairment, and section 5.6 as the impairment continues to be treated after permanency has been established.

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Slide 7

OFFICIAL

Section 24(1)(b) — Case Studies

Navigate to:

  • Access Assessor OneNote
  • Technical Meetings and Training
  • Section 24(1)(b)
  • Read through the case studies

We’ll now give you some time to read through the case studies for Section 24(1)(b). These are found in the Access Assessor OneNote.

Provide approximately 30 minutes to read through the slide — can move on earlier if everyone is ready.

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Slide 8

Case Study 1

  • Name: Josephine* (For training purposes only)
  • Age: 10 years old
  • Diagnosis: Autism Spectrum Disorder
  • Evidence:
    • Access Request Form
    • Supporting Evidence Form

Note: This is a de-identified case. For the purposes of the case study, the dates of the EOD are recent.

The following 3 case studies are de-identified case studies of real cases that delegates have made a decision on. For the purposes of this training, all the evidence of disability (EOD) is recent. It is acknowledged that for some of these cases you will not see regularly when assessing applications. The idea of a case study is to help further explain the criteria, but not to create a blanket rule. If you have the underlying understanding of the criteria, then you are able to apply it to more complex cases when you break down the evidence.

Everyone should have read the case studies prior to the training. For a brief summary of this case study:

  • Josephine is 10 years old living with Autism
  • The GP has ticked yes to “is there any other treatment that is likely to remedy the impairment” and stated psychologist, OT and Speech Pathology is required.
  • The psychologist has completed the SEF and states that treatment has not been undertaken due to financial constraints

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Slide 9

OFFICIAL

Case Study 1 — Q&A

Q: Does Josephine meet Section 24(1)(b)?

A: Yes, although both the Access Request Form (ARF) and Supporting Evidence Form (SEF) state that the impairment is not permanent, Autism is a List B impairment (it falls under the category of “Pervasive Developmental Disorders not meeting severity criteria in List A or List C”). Therefore, in line with Is your impairment likely to be permanent? of Our Guidelines, Section 24(1)(a) and (b) are met.

Q: If Autism wasn’t a List B condition, based on the ARF and SEF, would you request further information to determine the permanency of the impairment?

A: No, even though both the ARF and SEF state the impairment is not permanent, research indicates that there is no treatment for Autism and it is a lifelong condition (Reference: American Psychiatric Association). It would be considered to be a likely permanent neurological impairment. The recommended intervention would be to improve the functional impact (i.e. the disability), but not to remedy the neurological impairment.

We will now go through a few questions, please use the hand up function if you would like to answer.

CLICK TO SHOW QUESTION Does Josephine meet Section 24(1)(b)?

CLICK TO SHOW ANSWER

Correct/Incorrect - Yes, although both the ARF and SEF state that the impairment is not permanent, Autism is a List B impairment (it falls under the category of “Pervasive Developmental Disorders not meeting severity criteria in List A or List C”). Therefore, in line with Is your impairment likely to be permanent? of Our Guidelines, Section 24(1)(a) and (b) are met.

CLICK TO SHOW QUESTION If Autism wasn’t a List B condition, based on the ARF and SEF, would you request further information to determine the permanency of the impairment?

CLICK TO SHOW ANSWER

Correct/Incorrect - No, even though both the ARF and SEF state the impairment is not permanent, research indicates that there is no treatment for Autism and it is a lifelong condition (Reference: American Psychiatric Association). It would be considered to be a likely permanent neurological impairment. The recommended intervention would be to improve the functional impact (i.e. the disability), but not to remedy the neurological impairment.

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Slide 10

Case Study 2

  • Name: Annabel* (For training purposes only)
  • Age: 52 years old
  • Diagnosis: Fibromyalgia and Chronic Fatigue Syndrome
  • Evidence:
    • Supporting Evidence Form

Note: This is a de-identified case. For the purposes of the case study, the date of the EOD is recent.

This next case study is for a 52 year old living with Fibromyalgia and Chronic Fatigue Syndrome. The local GP has completed the SEF and indicated that Annabel has been living with these conditions for over 10 years and has utilised pain medication. The GP states that Annie would benefit from an Occupational Therapy (OT) home assessment and physiotherapy and her functional capacity is reduced.

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Slide 11

OFFICIAL

Case Study 2 — Q&A

Q: Does Annabel have a permanent, or likely permanent, impairment?

A: No — although the GP has stated the impairments are permanent, they have not provided information on the treatment that Annabel has undertaken.

Q: What section/s of the NDIS (Becoming a Participant) Rules 2016 are applicable?

A: Section 5.4 and 5.6 — There are a number of appropriate evidence-based treatments that are available that Annabel could engage in. This could be — pain management clinic, multi-disciplinary team intervention, specialist intervention, graded exercise and pacing program. These could potentially remedy the impairment (5.4), or as we do not know the outcome of these treatments, the permanency of the impairment cannot be determined (5.6).

Q: Should further information be sought?

A: No — As Annabel would not meet Section 24(1)(c) further information is not required as even if permanency could be established, she does not have a substantial reduction. If the EOD was indicating she does have a substantial reduction then it would be recommended to seek further information on permanency.

First question for this case study

CLICK TO SHOW QUESTION Does Annabel have a permanent, or likely permanent, impairment?

CLICK TO SHOW ANSWER Correct/Incorrect - No — although the GP has stated the impairments are permanent, they have not provided information on the treatment that Annabel has undertaken.

CLICK TO SHOW QUESTION What section/s of the NDIS (Becoming a Participant) Rules 2016 are applicable?

CLICK TO SHOW ANSWER

Correct/Incorrect - Section 5.4 and 5.6 — There are a number of appropriate evidence-based treatments that are available that Annabel could engage in. This could be — pain management clinic, multi-disciplinary team intervention, specialist intervention, graded exercise and pacing program. These could potentially remedy the impairment (5.4), or as we do not know the outcome of these treatments, the permanency of the impairment cannot be determined (5.6).

CLICK TO SHOW QUESTION Should further information be sought?

CLICK TO SHOW ANSWER

Correct/Incorrect - No — As Annabel would not meet Section 24(1)(c) further information is not required as even if permanency could be established, she does not have a substantial

reduction. If the EOD was indicating she does have a substantial reduction then it would be recommended to seek further information on permanency.

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Slide 12

Case Study 3

  • Age: 23 years old
  • Diagnosis: Borderline Personality Disorder, Generalised Anxiety Disorder and Post Traumatic Stress Disorder (PTSD)
  • Evidence:
    • Supporting Evidence Form

Note: This is a de-identified case. For the purposes of the case study, the date of the EOD is recent.

The final case study is for Jamie, a 23 year old living with Borderline Personality Disorder, Generalised Anxiety Disorder and Post Traumatic Stress Disorder (PTSD). The Supporting Evidence Form has been completed by the multi-disciplinary team at the inpatient unit and states that Jamie was diagnosed at 19 years old, but has been showing signs for 8 years. There is a recommendation for Dialectal Behavioural Therapy, however Jamie cannot afford this. He has undertaken Cognitive Behaviour Therapy (CBT), engaged with Child and Adolescent Mental Health Services, has medication, undertaken Eye Movement Desensitisation and Reprocessing (EMDR) therapy and had hospital admissions. They have stated the impairment is permanent but will fluctuate and that the Generalised Anxiety Disorder and PTSD are as a result of childhood trauma.

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Slide 13

OFFICIAL

Case Study 3 — Q&A

Q: Does Jamie have a permanent, or likely permanent, impairment?

A: Cannot be determined — Whilst the treating team have recommended Dialectal Behaviour Therapy (DBT) (which is a known treatment option for Borderline Personality Disorder), there has been no further treatment recommended for her diagnoses of PTSD and Generalised Anxiety Disorder. As we are determining the permanency of the impairments, not the conditions, further information is needed from the treating team to understand what the expected outcomes for DBT are and it’s overall impact for the psychiatric impairment.

Q: Should further information be sought?

A: Yes — further information is required to make a sound decision. Jamie has a substantial reduction in functional capacity however the treating team have indicated that DBT would improve functional capacity. Clarification is required to meet Section 24(1)(b) and (e).

First question for this case study:

CLICK TO SHOW QUESTION Does Jamie have a permanent, or likely permanent, impairment?

CLICK TO SHOW ANSWER

Correct/Incorrect - Cannot be determined — Whilst the treating team have recommended Dialectal Behaviour Therapy (DBT) (which is a known treatment option for Borderline Personality Disorder), there has been no further treatment recommended for her diagnoses of PTSD and Generalised Anxiety Disorder. As we are determining the permanency of the impairments, not the conditions, further information is needed from the treating team to understand what the expected outcomes for DBT are and it’s overall impact for the psychiatric impairment.

CLICK TO SHOW QUESTION Should further information be sought?

CLICK TO SHOW ANSWER

Correct/Incorrect - Yes — further information is required to make a sound decision. Jamie has a substantial reduction in functional capacity however the treating team have indicated that DBT would improve functional capacity. Clarification is required to meet Section 24(1)(b) and (e).

A beneficial resource to refer to is the “Mental Health and NDIS” page on the external NDIS website. This has a number of different resources and includes information on people living with a psychosocial disability who are aged under 25 years old.

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Slide 14

OFFICIAL

Test your Knowledge — True or False

The delegate needs confirmation that the impairment is fully treated and stabilised to meet Section 24(1)(b)

False — the phrase ‘fully treated and stabilised” is not NDIA legislation or policy, therefore delegates should not be asking for this information. Delegates need to be satisfied that the impairment is permanent in line with Sections 5.4-5.7 of the NDIS (Becoming a Participant) Rules 2016.

A person can meet the permanency criteria but still continue treatment?

True — clarification will be required to determine what the outcome of the treatment will be, however as per Section 5.6 of the NDIS (Becoming a Participant) Rules 2016, the impairment can continue to be treated after permanency has been demonstrated. If the treatment is likely to remedy the impairment then Section 24(1)(b) would not be met in line with Section 5.4 of the NDIS (Becoming a Participant) Rules 2016.

That’s all of our case studies, so we will now go onto a couple of True or False questions. For this one I will ask the question and then everyone that thinks the answer is true, put your hand up.

CLICK TO SHOW QUESTION The delegate needs confirmation that the impairment is fully treated and stabilised to meet Section 24(1)(b)

If you think the answer is true, raise your hand now wait for people to raise their hands

CLICK TO SHOW ANSWER

The answer is false - the phrase “fully treated and stabilised” is not NDIA legislation or policy, therefore delegates should not be asking for this information. Delegates need to be satisfied that the impairment is permanent in line with Sections 5.4-5.7 of the NDIS (Becoming a Participant) Rules 2016.

Okay, next question

CLICK TO SHOW QUESTION A person can meet the permanency criteria but still continue treatment?

If you think the answer is true, raise your hand now wait for people to raise their hands

CLICK TO SHOW ANSWER

The answer is true — clarification will be required to determine what the outcome of the treatment will be, however as per Section 5.6 of the NDIS (Becoming a Participant) Rules 2016, the impairment can continue to be treated after permanency has been demonstrated.

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If the treatment is likely to remedy the impairment then Section 24(1)(b) would not be met in line with Section 5.4 of the NDIS (Becoming a Participant) Rules 2016.

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Slide 15

OFFICIAL

Test your Knowledge — True or False

I assessed a previous case where surgery was recommended for someone living COPD. On this next case I am assessing there is no mention of surgery, so I should say Section 24(1)(b) is not met.

False — it is important to remember that we need to assess each case on the information provided. We, as delegates cannot recommend a treatment option, but we can ask if it is an appropriate treatment option for this person. We must be careful not to bring previously learnt knowledge from cases or research to new cases. Instead, use this knowledge and research to assist in applying the legislation to the evidence, but not to determine it.

The psychologist has stated that the impairments are permanent for someone aged 18 living with Schizophrenia. I don’t have any other treatment information so will determine that Section 24(1)(b) is met.

False — It is important to remember that permanency must be demonstrated and not just stated. There is no other information on treatment options and therefore permanency cannot be determined. If this was someone older who has an established diagnosis of Schizophrenia, as the delegate you could determine that Section 24(1)(b) is met as the impairment could be considered likely to be permanent. However for a young person, more information is required than a sentence stating the impairment is permanent.

CLICK TO SHOW QUESTION

I assessed a previous case where surgery was recommended for someone living Chronic Obstructive Pulmonary Disease (COPD). On this next case I am assessing there is no mention of surgery, so I should say Section 24(1)(b) is not met.

If you think the answer is true, raise your hand now wait for people to raise their hands

CLICK TO SHOW ANSWER

The answer is false - it is important to remember that we need to assess each case on the information provided. We, as delegates cannot recommend a treatment option, but we can ask if it is an appropriate treatment option for this person. We must be careful not to bring previously learnt knowledge from cases or research to new cases. Instead, use this knowledge and research to assist in applying the legislation to the evidence, but not to determine it.

Okay, next question

CLICK TO SHOW QUESTION

The psychologist has stated that the impairments are permanent for someone aged 18 living with Schizophrenia. I don’t have any other treatment information so will determine that Section 24(1)(b) is met.

If you think the answer is true, raise your hand now wait for people to raise their hands

CLICK TO SHOW ANSWER

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The answer is false – It is important to remember that permanency must be demonstrated and not just stated. There is no other information on treatment options and therefore permanency cannot be determined. If this was someone older who has an established diagnosis of Schizophrenia, as the delegate you could determine that Section 24(1)(b) is met as the impairment could be considered likely to be permanent. However for a young person, more information is required than a sentence stating the impairment is permanent.

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Slide 16

OFFICIAL

Key Points

  • The only blanket rule when it comes to Section 24(1)(b) is when a person has a condition on List B of Our Guidelines, they will automatically meet Section 24(1)(a) and Section 24(1)(b).
    • This is in line with Is your impairment likely to be permanent? Of Our Guidelines which states: If you give us evidence you have been diagnosed with a condition on List B, we’ll likely decide your disability is from an impairment that’s likely to be permanent.
  • It is good to look at the NDIS (Becoming a Participant) Rules 2016 when determining if someone meets Section 24(1)(b), this can also be helpful when making your Access Not Met phone calls to further explain the criteria. A summary of the Rules are below:
    • Section 5.4: The impairment is not permanent, or likely permanent if there are known, available and appropriate evidence-based clinical, medical or other treatments that would likely remedy the impairment.
    • Section 5.5: An impairment can be permanent, or likely permanent if the person’s functional capacity fluctuates, however at their baseline functioning, despite optimal treatment, they still experience an impairment.
    • Section 5.6: The permanency of the impairment cannot be determined if there are further medical treatments or interventions available that could improve the person’s functional capacity. NB: Treatment can still continue once after permanency has been determined if the baseline functioning still shows an impairment.
    • Section 5.7: If the impairment is degenerative in nature it is likely permanent unless medical treatment is likely to improve the condition.

Now for the Key Points:

CLICK FOR PARAGRAPH

The only blanket rule when it comes to Section 24(1)(b) is when a person has a condition on List B of Our Guidelines, they will automatically meet Section 24(1)(a) and Section 24(1)(b).

  • This is in line with Is your impairment likely to be permanent? Of Our Guidelines which states: If you give us evidence you have been diagnosed with a condition on List B, we’ll likely decide your disability is from an impairment that’s likely to be permanent.

CLICK FOR PARAGRAPH

It is good to look at the NDIS (Becoming a Participant) Rules 2016 when determining if someone meets Section 24(1)(b), this can also be helpful when making your Access Not Met phone calls to further explain the criteria. A summary of the Rules are below:

  • Section 5.4: The impairment is not permanent, or likely permanent if there are known, available and appropriate evidence-based clinical, medical or other treatments that would likely remedy the impairment.
  • Section 5.5: An impairment can be permanent, or likely permanent if the person’s functional capacity fluctuates, however at their baseline functioning, despite optimal treatment, they still experience an impairment.
  • Section 5.6: The permanency of the impairment cannot be determined if there are further medical treatments or interventions available that could improve the person’s functional capacity. NB: Treatment can still continue once after permanency has been determined if the baseline functioning still shows an impairment.

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  • Section 5.7: If the impairment is degenerative in nature it is likely permanent unless medical treatment is likely to improve the condition.

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Slide 17

OFFICIAL

Key Points

  • If you determine that someone does not meet the access criteria:
    • If you say they do not meet Section 24(1)(b) then they will not meet Section 25(1)(a) of the Early Intervention criteria and no further assessment is required.
    • If you say they do meet Section 24(1)(b) but do not meet further Section 24 criteria, then they will meet Section 25(1)(a) and you then assess the rest of the Early Intervention criteria.
  • It is important to remember that the delegate needs to determine the permanency (or likely permanency) of the impairment and not the condition or the disability. Therefore, someone may be diagnosed with a lifelong condition, however the impairment resulting from this may not be permanent, or likely permanent. The impairment may also be permanent, and the treatment may be aimed at improving the disability.
  • For psychosocial disabilities, “recovery” can mean clinical recovery or the health professional may be using a “recovery oriented approach”
    • Clinical Recovery — Clinical treatment is being undertaken in an aim to remedy the psychiatric impairment. This may mean the applicant does not meet Section 24(1)(b) in line with Section 5.4 and 5.6 of the NDIS (Becoming a Participant) Rules 2016
    • Recovery Oriented Approach — Enabling a person living with a mental health condition to create and live a meaningful and contributing life in their community (Ref: Mental Health Coordinating Council — Recovery Oriented Language Guide — Second Edition) This can mean the impairment is likely permanent, and the intervention the applicant requires is for maintenance of their psychosocial disability, and not for clinical treatment. This would therefore meet Section 24(1)(b) based on Section 5.5 of the NDIS (Becoming a Participant) Rules 2016

CLICK FOR FIRST PARAHRAPH

  • If you determine that someone does not meet the access criteria:
    • If you say they do not meet Section 24(1)(b) then they will not meet Section 25(1)(a) of the Early Intervention criteria and no further assessment is required.
    • If you say they do meet Section 24(1)(b) but do not meet further Section 24 criteria, then they will meet Section 25(1)(a) and you then assess the rest of the Early Intervention criteria.

CLICK FOR PARAGRAPH

It is important to remember that the delegate needs to determine the permanency (or likely permanency) of the impairment and not the condition or the disability. Therefore, someone may be diagnosed with a lifelong condition, however the impairment resulting from this may not be permanent, or likely permanent. The impairment may also be permanent, and the treatment may be aimed at improving the disability.

CLICK FOR PARAGRAPH

  • For psychosocial disabilities, “recovery” can mean clinical recovery or the health professional may be using a “recovery oriented approach”
  • Clinical Recovery — Clinical treatment is being undertaken in an aim to remedy the psychiatric impairment. This may mean the applicant does not meet Section 24(1)(b) in line with Section 5.4 and 5.6 of the NDIS (Becoming a Participant) Rules 2016

CLICK FOR PARAGRAPH

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  • Recovery Oriented Approach – Enabling a person living with a mental health condition to create and live a meaningful and contributing life in their community (Ref: Mental Health Coordinating Council – Recovery Oriented Language Guide – Second Edition)
    • This can mean the impairment is likely permanent, and the intervention the applicant requires is for maintenance of their psychosocial disability, and not for clinical treatment. This would therefore meet Section 24(1)(b) based on Section 5.5 of the NDIS (Becoming a Participant) Rules 2016

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Slide 18

OFFICIAL

Key Points

  • Someone living with a psychosocial disability may no longer be engaged with a psychiatrist because they are optimally treated (meaning their medication is effective in managing symptoms, but they may still experience functional impact). We do not necessarily need information from a psychiatrist or for someone to be readily engaged with a psychiatrist to determine the permanency of a psychosocial disability/psychiatric impairment.
    • NB: In some circumstances we will require information from the treating psychiatrist — for example someone aged under 25 years of age living with a high prevalent psychosocial disability. However, if they are not likely to meet Section 24(1)(c) then you would not need to seek further information as the remainder of the Disability criteria will not be met.
  • For physical and neurological impairments, when determining the permanency, you may be able to use the analogy of a full body scan — for example, someone diagnosed with:
    • Arthritis — if you were to take a full body scan, you could see the arthritis causing the physical impacts. If for instance, the arthritis was in their knee and they are waiting for a knee replacement, the impairment would not be considered permanent in line with Section 5.4 of the NDIS (Becoming a Participant) Rules 2016 as a knee replacement can remedy the impairment. If you took another full body scan after the knee replacement, the arthritis would no longer be causing a physical impairment.
    • Multiple Sclerosis — if you were to take a brain scan you would see lesions on the brain, therefore a neurological impairment. Multiple Sclerosis is a List B impairment and therefore meets the permanency criteria. However, we do sometimes see evidence that states the person would benefit from allied health intervention. This intervention is to improve the disability, and not to remedy the impairment.
    • Stroke — when someone has a stroke, their brain cells die due to lack of oxygen. If you were to take a brain scan you would see the dead brain cells, therefore a neurological impairment that is likely permanent as the brain cells are dead. Rehabilitation and intervention focuses on improving the disability and not the impairment.

Someone living with a psychosocial disability may no longer be engaged with a psychiatrist because they are optimally treated (meaning their medication is effective in managing symptoms, but they may still experience functional impact). We do not necessarily need information from a psychiatrist or for someone to be readily engaged with a psychiatrist to determine the permanency of a psychosocial disability/psychiatric impairment.

  • NB: In some circumstances we will require information from the treating psychiatrist — for example someone aged under 25 years of age living with a high prevalent psychosocial disability. However, if they are not likely to meet Section 24(1)(c) then you would not need to seek further information as the remainder of the Disability criteria will not be met.

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For physical and neurological impairments, when determining the permanency, you may be able to use the analogy of a full body scan — for example, someone diagnosed with:

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Arthritis — if you were to take a full body scan, you could see the arthritis causing the physical impacts. If for instance, the arthritis was in their knee and they are waiting for a knee replacement, the impairment would not be considered permanent in line with Section 5.4 of the NDIS (Becoming a Participant) Rules 2016 as a knee replacement can remedy the impairment. If you took another full body scan after the knee replacement, the arthritis would no longer be causing a physical impairment.

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Multiple Sclerosis — if you were to take a brain scan you would see lesions on the brain, therefore a neurological impairment. Multiple Sclerosis is a List B impairment and therefore meets the permanency criteria. However, we do sometimes see evidence that states the person would benefit from allied health intervention. This intervention is to improve the disability, and not to remedy the impairment.

Page 322 of 362

CLICK FOR PARAGRAPH

Stroke – when someone has a stroke, their brain cells die due to lack of oxygen. If you were to take a brain scan you would see the dead brain cells, therefore a neurological impairment that is likely permanent as the brain cells are dead. Rehabilitation and intervention focuses on improving the disability and not the impairment.

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Page 323 of 362