Fact Sheet - Free Text ‘reason for our decision’

Introduction

We need to make sure we are making good, evidence-based decisions. The most important part of this is to communicate these decisions clearly – if we do this in a way that is clear and meaningful, this improves the participant experience. Being clear about the reasons for our decisions:

• Reflects the principles outlined in the NDIS Participant Service Charter, particularly the principle of transparency.
• Delivers the ‘communicating with us’ promises in the NDIS Participant Service Improvement Plan 2020-21.
• Is a requirement of the legislation.

Guidelines

Follow these guidelines when drafting free text in ‘Justification for the plan approval letter’:

• Ensure you are entering your reason for decision in the correct free text box Note: information entered in this box will print on the plan.
• Ensure comments are objective, include facts based on evidence, and avoid personal opinions or feelings.
• Reference all information the participant has provided in your decision. This includes any documents or material relied on such as medical reports, comments, conversations, emails and participant submissions.
• Keep the text short, simple and in plain conversational English.
• Avoid jargon.
• Introduce all acronyms before using them. For example, ‘Assistive Technology (AT)’.
• Cross-check your decision against the statutory criteria to ensure you meet all necessary sections. Do not include considerations that are not required by the criteria in the

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Fact Sheet - Free Text ‘reason for our decision’

legislation. For example, do not include considerations around whether the participant can or cannot afford a support.

• Provide the basis for how you reached your decision against each criteria in the legislation. For example, if a support does not meet two of the reasonable and necessary criteria, explain your decision about both criteria.
• Provide the reasoning you used to reach your outcome on the overall matter. For example, explain what supports you have not included in the participant’s plan.

Examples

Example 1 - Section 34(1)(a) Support will not assist the participant to pursue

the goals in their plan

Example

You asked us for help to be able to cook breakfast in the morning. We haven’t received any information which indicates you need help in preparing your meals and this request wouldn’t help you to pursue your goals. You can if you would like to, fund cooking lessons yourself.

I have included 2 hours of support each month for you to go to your local community house. This will help you to pursue the goal in your plan to ‘be able to attend your local community house’.

Example 2 - Section 34(1)(b) Support will not assist the participant to

undertake activities to facilitate their social and/or economic participation

Example

In your request you asked us to include funding for a new microwave so you would be able to heat up food when your friends visit you. The information we received from your occupational therapist doesn’t provide us with any evidence you need a microwave because of your disability. A microwave is considered to be a household item that most people have in their homes so I have not included funding for this in your plan. You can buy this yourself though if you would like.

Or

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Fact Sheet - Free Text ‘reason for our decision’

You asked to have funding for a personal trainer included in your plan. We did not receive enough information from your allied health professional telling us you need a personal trainer to safely participate in exercise classes. I have included funding for 8 sessions of group exercise therapy classes in your plan. This will help you pursue your goal of meeting new people and improving your general fitness and mobility. If you would like a personal trainer you could pay for this yourself.

Example 3 - Section 34(1)(c) Does not represent value for money

Example

I have included funding in your plan for a new wheelchair which was recommended in the report you gave us from your Occupational Therapist. However, there were some additional features for the wheelchair you asked for that your OT did not recommend. I have not included funding in your plan for these additional features. If you would like to buy the wheelchair you requested which has the additional features, you can pay the difference in cost between the 2.

Or

Following your recent plan check-in I have included weekly hydrotherapy sessions to help you improve your mobility. You did ask for funding in your plan for a swimming pool to be put into your backyard. Unfortunately, I cannot fund a swimming pool as this does not represent value for money as your occupational therapist has recommended you attend weekly hydrotherapy sessions.

Example 4 - Section 34(1)(d) Support is not likely to be effective or beneficial to the participant

Example

You requested we fund fortnightly massage sessions in your plan as you think this might help you better manage your mobility.

I have looked at the evidence you provided alongside best practice and cannot find any supportive evidence that including funding for massage therapy will assist you in improving your mobility.

However, I have included 6 physiotherapy sessions in your plan. Your physiotherapist is going to develop an exercise programme with you to improve your balance and has suggested you join a local walking group.

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Fact Sheet - Free Text ‘reason for our decision’

Example 5 - Section 34(1)(e) Support can reasonably be expected to be provided by families, carers, informal networks OR the community

Example

In Sam’s recent plan check-in you asked us to include funding for a carer to look after him while you attend a family wedding. Providing care and safe supervision to children is the role of parents and other family members or informal supports.

As Sam is only 6 years old, I haven’t included funding in his plan for someone else to care for him while you attend a wedding. Parents would usually arrange supervision for their child if they were unable to provide care for their child because of work or other commitments.

I have included 8 speech therapy sessions in Sam’s plan to help him improve his social skills.

Example 6 - Section 34(1)(f) Support is most appropriately funded or provided through mainstream or other general service systems, not the NDIS

Example

At Nishka’s recent plan check-in you asked for funding to be included in her plan to help her to improve her reading ability. As we discussed, you will need to talk to Nishka’s school as they can provide this support for her. Support for Nishka in the classroom is the responsibility of the Education department. You can ask Niska’s paediatrician to provide evidence and recommendations to the school to assist her to improve her reading level.

I have included 8 occupational therapy sessions in Niska’s plan to help improve her fine motor skills so she can learn to tie her shoelaces by herself.

Example 7 - Rule 5.1(a) Support is likely to cause harm to the participant or pose a risk to other people

Example

You asked me to include funding in your plan for a walking stick as you are sometimes feeling a bit unstable when you are accessing the community. The report I have from your occupational therapist suggests you might be at risk of falls using a walking stick in the community.

Instead, I have included funding in your plan for you to purchase a mobility walking device which has been recommended by your occupational therapist so you can safely access the community.

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Fact Sheet - Free Text ‘reason for our decision’

Example 8 - Rule 5.1(b) Support does not relate to participant’s disability

Example

You requested we include funding for house cleaning and garden maintenance in Elanora’s plan. A 7 year child would not usually be expected to clean the house and look after the garden and lawns but they might help with some of these jobs. I have not included funding for domestic assistance in Elanora’s plan. This request isn’t related to her disability and would not be expected by someone of her age.

I have included funding in Elanora’s plan for 10 hours of occupational therapy sessions to improve her gross motor skills to help her pursue her goal of learning to ride her bike.

Example 9 - Rule 5.1(c) Support duplicates other supports delivered under alternative funding through the NDIS

Example

You asked for transport funding to be included in your plan to help you get to work. In your most recent plan, we paid for your car to be modified so you could drive to work. You confirmed you are still able to drive your car which was been modified and was paid for from your plan. I have not included any funding for transport in this plan as this is a duplication of NDIS funding.

Example 10 - Rule 5.1(d) Support is related to day-to-day living costs

Example

At your recent check in you asked us to include funding to pay for your water bill in your plan. The cost of water is a day-to-day living cost which everyone has to pay for and is not specific to your disability. The NDIS can fund reasonable and necessary supports to help you with things you might not be able to do because of your disability. I have not included funding for your water bill in your plan, as this is not something the NDIS is able to fund.

Example 11 - Rule 5.3 (a) Support is contrary to Commonwealth, Territory or State laws in which the support would be provided

Example

I have including funding in your plan for an electric wheelchair as recommended by your occupational therapist. This model meets the standards and requirements of the state of Victoria. The model of wheelchair you requested does not comply with these regulations in Victoria due to the terrain of the roads in the area you live. Our rules prevent the NDIS from funding a request for supports if it is against the law of the Commonwealth, State or Territory.

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Fact Sheet - Free Text ‘reason for our decision’

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Version Control

Version	Amended by	Brief Description of Change	Status	Date
1.0	GO0002 SM0075	Class 3 Approval Created in response to legislation changes	APPROVED	2022-08-18
2.0	JS0082	Class 1 Approval Updates made to remove reference to content appearing in CRM.	APPROVED	2022-09-08

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