DISCLOSURE LOG - FOI 24/25-0753
AAT Case Management Guide
DOCUMENT 1
Access for Chronic Health Conditions
OFFICIAL For internal Use Only
| Field | Content | Reference Documents |
|---|---|---|
| Title | Access for Chronic Health Conditions | |
| Purpose | This document is part of a suite of guidance documents for case managers to use in formulating their approach to managing individual cases before the Administrative Appeals Tribunal (AAT). | |
| Scope | For the purposes of this guidance document, chronic health conditions refer to a broad range of chronic and complex health conditions across the spectrum of illnesses. The eight major chronic conditions identified by the Australian Institute of Health Welfare are arthritis, asthma, back pain, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, and mental health conditions. | National Strategic Framework for Chronic Conditions |
| Escalation to Hearing Oversight Committee (HOC) | If a matter is within the parameters of this document, the AAT Case Management Branch may approve proceeding to hearing. Where there is substantial doubt as to whether a matter falls outside the parameters of this document, it should be referred to HOC. | |
| Current National Disability Insurance Agency (NDIA) policy on the subject | The AAT proposes to assist and our focus should be on resolving issues practically and quickly as possible. The role of the IA is to assist the AAT and the participant in reaching the best possible resolution by agreement. To be eligible for access to the Scheme on the basis of a chronic health condition, an applicant’s chronic condition must satisfy the disability requirements. A chronic health condition satisfies the disability requirements if: |
- it is caused by an intellectual, cognitive, neurological, sensory, psychological, or physical impairment; and
- it is likely to be permanent; and
- it substantially reduces an applicant’s functional capacity; and | NDIA Dispute Resolution Policy Appendix B to the Legal Services Directions 2017 Sections 24 and 25 of the National Disability Insurance Scheme Act 2013 Rules 5, 6 and 7 of the National Disability Insurance Scheme (Becoming a Participant) Rules 2016 |
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FOI 24/25-0753
AAT Case Management Guide
Access for Chronic Health Conditions
OFFICIAL For internal Use Only
e it affects an applicant’s ability to work, study or take part in their social life; and
e an applicant will likely need the support of the Scheme for the remainder of their life.
Alternatively, an applicant will be eligible for access to the Scheme if they satisfy the early intervention requirements on the basis of their chronic health condition, meaning:
- the chronic health condition is likely to be permanent;
- early intervention supports are likely to reduce the need for need future supports;
- the early intervention needed is appropriately funded by the NDIA.
It is important that each matter is determined on its own merit, based on the available evidence. There is no blanket ‘yes’ or ‘no’ response to the question of whether individuals with chronic health conditions should be permitted access to the Scheme. The response will primarily rely on individual’s disability support needs.
NDIA Posture
in relation to this subject
Evidence recommended to inform a specific matter before the Administrative Appeals Tribunal (AAT)
To consider an applicant’s eligibility to access the Scheme, the NDIA requires recent evidence from a health professional which confirms an applicant’s disability, its impacts on the applicant’s functional capacity, previous treatments, and outcomes, as well as any ongoing treatment options and expected outcomes. It is important that the health care professional giving evidence is the most appropriate person to provide evidence, and that they have treated the applicant for a significant period of time.
Operational Guideline — Applying to the NDIS Elaibility and medical conditions FAQ | NDIS
Council of Australian Governments (COAG) — Principles to determine responsibilities of the NDIS and other service systems
Providing evidence of your disability | NDIS Types of disability evidence | NDIS Persons Giving Expert and Opinion Evidence Guideline | Administrative Appeals Tribunal Section 24(1)(c) of the National Disability Insurance Scheme Act 2013
To satisfy the access requirements, a participant’s chronic health condition must be evidenced to substantially reduce their functional capacity.
Other considerations
redacted
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AAT Case Management Guide
Access for Chronic Health Conditions
OFFICIAL For internal Use Only
The NDIA will not fund supports for chronic health conditions that are unrelated to a participant’s disability. For example, the NDIA may approve access to the Scheme on the basis of a limb amputation as a result of peripheral arterial disease within the setting of diabetes but will not fund supports related to the treatment or management of peripheral arterial disease or diabetes.
Rule 5.8 of the National Disability Insurance Scheme (Becoming a Participant) Rules 2016
Eligibility and medical conditions FAQ | NDIS
The determination of the AAT regarding whether an applicant’s chronic health condition satisfies the requirements for access to the Scheme will usually turn on the question of a substantial reduction in an applicant’s functional capacity.
The test is not whether or not the chronic health condition is significant, but whether the legislative requirements for access are met on the balance of the available evidence.
In each of these cases, the AAT affirmed the decision under review on the basis that the AAT was not satisfied that the applicant’s chronic health condition substantially reduced their functional capacity.
Document admin
Approved
redacted
4 January 2023
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