Policy Statement - Attribution

Purpose

The purpose of this policy is to provide an interim position about how the National Disability Insurance Agency (NDIA) assesses supports in relation to impairments:

for which the participant was granted access for, when they applied to the National Disability Insurance Scheme (NDIS)
which have been acquired after the NDIS access decision
have never been assessed by the NDIA
which were assessed as part of an NDIS access request but the participant was advised by the NDIA the impairment(s) did not meet the NDIS access criteria.

Scope

The NDIA is committed to supporting participants through the planning process and accessing NDIS supports once they have met the NDIS access requirements. The National Disability Insurance Scheme Act 2013 (NDIS Act) does not specify:

whether funded supports should be based on the impairments to which a disability is attributable and which satisfied the criteria for accessing the Scheme, or
for any impairment the participant experiences either at the time of the access decision or at any time at or following the access decision.

NDIA Policy Position

The NDIA’s interim position is to adopt a ‘whole of person’ approach to funding supports in accordance with the reasonable and necessary criteria in section 34(1)(a-f) of the NDIS Act, irrespective of the impairments assessed at the time of access.

Where participants seek funding for supports/s that do not relate to an impairment/s for which they were purportedly granted access, delegates must not:

require participants to make a new access request; or
consider whether the impairment for which the support is related meets or would meet the access criteria in sections 24 and 25 of the NDIS Act; or
refuse to fund the support for the reason that it is not related to an impairment/s for which the participant has met, or would meet access for; or
refuse to fund the support for the reason it is not related to the primary disability recorded in the NDIS Business System (the system).

This policy must be read in conjunction with the National Disability Insurance Scheme Act 2013 (NDIS Act) and NDIS Rules.

Access Requests

When making an access request and determining whether a person meets the disability requirements (section 24 of the NDIS Act), prospective participants will specify the primary impairment which has the greatest functional impact on their daily life and any secondary impairments. These impairments are recorded in the system as the primary disability and any secondary disabilities.

When the NDIA has determined the prospective participant meets the age, residence and disability or early intervention criteria, they are granted access and become an NDIS participant.

Once a person becomes a participant, there is no requirement to make a new or subsequent access request to the NDIA to obtain funding for supports related to existing and any newly acquired impairments.

Planning

This policy places the participant at the centre of all planning decisions and acknowledges that a participant’s support needs may change over time.

At each planning meeting, the NDIA considers all of the participant’s impairments when determining reasonable and necessary supports.

Where a participant has two or more impairments or acquires a new impairment, supports will be provided or funded on the basis of whether the support meets each of the criteria under section 34(1) of the NDIS Act:

The support will assist the participant to pursue the goals, objectives and aspirations included in the participant’s statement of goals and aspirations;
The support will assist the participant to undertake activities, so as to facilitate the participant’s social and economic participation;
The support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;
The support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;
The funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide;
The support is most appropriately funded or provided through the National Disability Insurance Scheme, and is not more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or systems of service delivery or support services offered:
- As part of a universal service obligation; or
- In accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability;

Whether or not an impairment would meet the access criteria is not a relevant consideration when assessing general or reasonable and necessary supports for a participant.

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Primary Disability

The decision to fund reasonable and necessary supports based on a primary disability or any secondary disabilities recorded in the NDIS business system (the system) is not a relevant consideration when determining reasonable and necessary supports.

Although, the concept of primary disability is one factor used to inform the Typical Support Package (TSP), the NDIS Act does not contemplate the identification and allocation of a primary disability. Rather section 24 refers to the identification and assessment of an impairment.

Further work will be undertaken to consider how the whole of person approach interacts with the concept of a primary disability for each participant.

Evidence

Participants must provide probative evidence about the proposed supports to assist the NDIA to assess whether general or reasonable and necessary supports are to be included in a participant’s plan. To confirm whether a support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice, such evidence may include:

literature;
lived experience of the participant;
anything the NDIA has learnt through the delivery of the NDIS; and
may include expert opinion.

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Knowledge Management Relationship

Legislative Framework	NDIS Act 2013
NDIS Rules 2013

Supporting Documents	Nil

Relevant Policies	Applied Principles and Table of Supports
NDIS Scheme Policy

Staff Guidance	Standard Operating Procedure — Change Disability Post Access
Practice Guide — Determine Reasonable and Necessary Supports

Governance Details

Functional Impairment: the loss of, or damage to, a physical, sensory or mental function, which results in the ability to perform an activity.
Permanent impairment: an impairment where there are no known, available and appropriate evidence-based clinical, medical or other treatments that would be likely to remedy the impairment.
Probative Evidence - evidence which is sufficiently useful to prove the proposed support will meet the requirements of s34 of the NDIS Act.
Prospective participant — a person who has submitted an access request, but the decision regarding access has not been made. |

Version Control

Version	Date	Author	Description of Changes
1.0	29/10/19	Planning Policy and Improvement	Final

Autism

AA OneNote>Access Decision Support>Autism

LIST A requirements	The List A requirements for Autism Spectrum Disorder (ASD) are:
Confirmation of Level 2 or 3 Autism	• Confirmation of Level 2 or 3 Autism
Confirmed by a specialist multi-disciplinary team, paediatrician, psychiatrist or clinical psychologist, neuropsychologist, educational psychologist, or developmental psychologist	• Confirmed by a specialist multi-disciplinary team, paediatrician, psychiatrist or clinical psychologist, neuropsychologist, educational psychologist, or developmental psychologist
Report/EOD completed from 2013 onwards	• Report/EOD completed from 2013 onwards

See relevant sections below for further explanation.

Who can provide a LIST A diagnosis for Autism?

• Operational Guidelines: - specialist multi-disciplinary team, - paediatrician, - psychiatrist, or - clinical psychologist.

Additional health professionals:

neuropsychologist,
educational psychologist, or
developmental psychologist.

Note: The List A requirements do not need to be met for someone to be a participant. A diagnosis from other health professionals can still be accepted, however it would be assessed under List B.

DSM-V

Our Guidelines state that a List A diagnosis for Autism Spectrum Disorder must be assessed using the current Diagnostic and Statistical Manual of Mental Disorders (DSM-V). If the report is dated after 2013 (i.e. when the DSM-V was released), we do not need confirmation that it was completed against the DSM-V.

Registrars and Fellows

If you have evidence from a Registrar or a Fellow (such as a Paediatric Registrar or a Psychiatry Registrar or paediatric fellow) then this is not sufficient to meet List A unless it has also been signed off by one of the treating health professionals for List A. This is because when someone is a registrar/fellow they are still in training for their

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speciality. We can still accept the diagnosis as they already hold a medical qualification, however are just not finished their speciality training. You will also notice that they will not be registered in AHPRA as the specialist. Therefore, the easiest way to determine if they are suitably qualified is to check their qualifications and specialities on AHPRA.

Provisional Allied Health Professionals

If the only evidence on file is provided from a provisional allied health professional and the evidence is not signed off by their supervising practitioner, more information will be required and this can also be supported by an AHPRA check https://www.ahpra.gov.au/.

List A - Letter Head/Signature of Health Professionals

We have seen an increasing amount of EOD from Psychologists that are not registered on AHPRA as a Clinical Psychologist but have mentioned “Clin” in their qualifications. This is not sufficient for List A Autism as they are not endorsed as a Clinical Psychologist. I have provided an example below of what we might see. This example shows that the person completed a Masters in Clinical Psychology, but we can also see that they have only signed off as a “Psychologist”. In this instance, it would be best practice to check AHPRA to see what their endorsements are. If AHPRA states Clinical Psychologist then we would accept this for List A Autism purposes. If it does not state Clinical Psychologist then we would not accept it for List A Autism purposes (we of course can still accept the diagnosis, but would be assessing under List B).

First name Surname B.Sc (Psych), M.Psych (Clin), MAPS Psychologist

List A - Multidisciplinary Team

We have received some very valuable information from TAB around applying the “specialist multidisciplinary team” aspect of Our Guidelines for diagnoses of Autism Level 2 and 3. In summary reports can either be separate or combined but all professionals must sign and they must be from different disciplines. If not signed, they are invalid.

Note: If Multidisciplinary Team professionals working separately but collaboratively in separate reports, there has to be an indication in their reports they agree with the correlating professional. Please note, this advice only relates to the Specialist Multidisciplinary Team aspect of the OGs, meaning that if the diagnosis of Level 2 or 3 Autism is provided by a Paediatrician, Psychiatrist, Clinical Psychologist, Neuropsychologist, Educational

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Psychologist, or Developmental Psychologist this is acceptable without further sign off. Another reminder that someone does not need to meet the List A requirements to be a participant, so if someone other than these health professionals provide the diagnosis then we can still accept it, it is just assessed under List B. The advice guidance has been attached to this email and will be uploaded in the One Note as well.

<<ADV 2019 7577 POL SPOC Multidisciplinary Team for purpose of ASD diagnosis 20200828 KT00171.pdf>>

Requesting Further Information - DSM-V Levels

Assessors should not be sending out Further Information Requests solely to ask for a DSM-V Level for Autism. A level is not required to meet Access so we should not be delaying a decision if there is sufficient information to make a decision. Functional phone calls and further information letters should still be actioned if we need further information to make a decision. Please speak to a QDO if you would like assistance to make a functional phone call prior to sending a formal S26 letter.

Handwritten Levels of Autism on Typed Forms

The Program Support Team have advised that we would not accept the below example of a handwritten level, unless it has come through via email directly from a health professional. A hand written level on the SEF is acceptable. The reason is because this could’ve been added by someone other than the health professional. If you come across a case like this, please call the health professional to confirm. The diagnosis can still be accepted.

This is to confirm that I have diagnosed HE with Autism and as such is eligible for the ASPECT Package under DMS-V. f enel &

However, we do have cases where the health professionals have a pre-populated form and then tick the level. This is still acceptable. The difference between these two situations is that the example above has added in the level post writing the letter, and this example below is part of a template.

This is to confirm that | have diagnosed with Autism:

Level 1
Level 2
Level 3

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Levels of Autism - Description of the Level

There are some health professionals that will write the description of the level, instead of the number of the level. This is accepted if the wording of the description matches the level. Please see below examples:

Level 1 or Requiring Support
Level 2 or Requiring Substantial Support
Level 3 or Requiring Very Substantial Support

Reminder: A level is not required to progress an access decision.