FOI 25/26-2132 & FOI 25/26 -2133 Document 2

Impairment categories guide

SGP KP Publishing

Exported on 2026-03-03 05:40:05

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This document was released under the Freedom of Information Act 1982 by the National Disability Insurance Agency.

FOI 25/26-2132 & FOI 25/26 -2133 SGP KP Publishing – Impairment categories guide

Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4

2 Impairments categories guide ……………………………………………………………………………….. 5

3 Conditions…………………………………………………………………………………………………………….. 6 3.1 Autism (ASD) ………………………………………………………………………………………………………. 6 3.2 Acquired brain injury …………………………………………………………………………………………….. 6 3.3 Intellectual disability ……………………………………………………………………………………………… 6 3.4 Cerebral Palsy …………………………………………………………………………………………………….. 8 3.5 Down Syndrome ………………………………………………………………………………………………….. 8 3.6 Hearing Impairment ……………………………………………………………………………………………… 8 3.7 Visual Impairment ………………………………………………………………………………………………… 8 3.8 Other Sensory - Speech ……………………………………………………………………………………….. 8 3.9 Multiple Sclerosis …………………………………………………………………………………………………. 8 3.10 Other Neurological ……………………………………………………………………………………………. 9 3.11 Stroke ……………………………………………………………………………………………………………… 9 3.12 Other Physical ………………………………………………………………………………………………….. 9 3.13 Psychosocial disability …………………………………………………………………………………….. 10 3.14 Spinal Cord Injury …………………………………………………………………………………………… 10 3.15 Other …………………………………………………………………………………………………………….. 11

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This article provides guidance for an access delegate to understand what impairment categories to select for a person that meets the eligibility requirements.

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1 Recent updates

14 October 2024 New guidance to:

• reflect legislation changes from 3 October 2024
• decide what impairment categories to select for a person that meets the eligibility requirements.

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2 Impairments categories guide

Impairments are a loss of or damage to a body’s function. When we assess an impairment to meet access, we look at:

• the body’s function
• the body’s structure
• how they think and learn.

To learn more about impairment categories go to article Descriptions of impairment categories.

The following list provides you with information on:

• the condition
• the ICD 10 Code
• the required impairment category for access assessors to select
• optional impairment categories to select as relevant, based on evidence provided with access request.

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3 Conditions

3.1 Autism (ASD)

1. Autism – includes Rett and Asperger Syndrome ICD 10 Codes: F84.0, F84.2, F84.5 Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, physical, psychosocial

3.2 Acquired brain injury

1. Glioblastoma ICD 10 Code: G71.9 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial

2. Hypoxic brain injury ICD 10 Code: 93.1 Required impairment category: Neurological Optional impairment categories: Physical, psychosocial

3. Traumatic brain injury – also called head injury and acquired brain damage ICD 10 Code: T90 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial

3.3 Intellectual disability

1. Mild intellectual disability ICD 10 Codes: F70 Required impairment category: Intellectual Optional impairment categories: Cognitive

2. Moderate intellectual disability ICD 10 Codes: F71 Required impairment category: Intellectual Optional impairment categories: Cognitive, physical, psychosocial

3. Severe intellectual disability ICD 10 Codes: F72 Required impairment category: Intellectual Optional impairment categories: Cognitive, physical, psychosocial

4. Profound intellectual disability ICD 10 Codes: F73 Required impairment category: Intellectual Optional impairment categories: Cognitive, physical, psychosocial

5. Unspecified intellectual disability ICD 10 Codes: F79 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, physical, psychosocial

6. Pervasive developmental disorder ICD 10 Codes: F84.8 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, psychosocial

7. Microcephaly ICD 10 Codes: Q02 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical

8. Other congenital brain conditions – for example, tuberous sclerosis ICD 10 Codes: Q04 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, physical

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9. Spina bifida ICD 10 Codes: Q05 Required impairment category: Physical Optional impairment categories: Intellectual, cognitive, sensory, neurological

10. Foetal alcohol syndrome ICD 10 Codes: Q86.0 Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, sensory, physical, psychosocial

11. Foetal alcohol spectrum disorder (FASD) ICD 10 Codes: Q86.0D Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, sensory, physical, psychosocial

12. Cornelia de Lange syndrome ICD 10 Codes: Q87.1 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

13. Prader Willi syndrome ICD 10 Codes: Q87.1 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, physical, psychosocial

14. Coffin-Lowry syndrome ICD 10 Codes: Q87.8 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

15. Other congenital conditions (causing intellectual disability) ICD 10 Codes: Q89 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

16. Edwards syndrome ICD 10 Codes: Q91 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

17. Patau syndrome ICD 10 Codes: Q91 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

18. Cri du Chat syndrome ICD 10 Codes: Q93.4 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, physical

19. Angelman syndrome ICD 10 Codes: Q93.5 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, physical

20. Other chromosomal syndromes (including Kabuki & Williams syndromes) ICD 10 Codes: Q99 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

21. Fragile X syndrome ICD 10 Codes: Q99.2 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

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3.4 Cerebral Palsy

1. Cerebral palsy ICD 10 Codes: G80 Required impairment category: Physical Optional impairment categories: Intellectual, cognitive, neurological, sensory

3.5 Down Syndrome

1. Down syndrome ICD 10 Codes: Q90 Required impairment category: Intellectual Optional impairment categories: Cognitive, physical

3.6 Hearing Impairment

1. Hearing loss ICD 10 Codes: H90 Required impairment category: Sensory Optional impairment categories: Cognitive

2. Congenital hearing condition ICD 10 Codes: Q16.9 Required impairment category: Sensory Optional impairment categories: Cognitive

3.7 Visual Impairment

1. Albinism ICD 10 Codes: E70.3 Required impairment category: Sensory Optional impairment categories: Not applicable

2. Visual impairment (including blindness) ICD 10 Codes: H54 Required impairment category: Sensory Optional impairment categories: Not applicable

3. Congenital eye conditions ICD 10 Codes: Q15.9 Required impairment category: Sensory Optional impairment categories: Not applicable

3.8 Other Sensory - Speech

1. Other sensory - speech ICD 10 Codes: R47 Required impairment category: Sensory Optional impairment categories: Physical

3.9 Multiple Sclerosis

1. Multiple Sclerosis ICD 10 Codes: G35 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial

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3.10 Other Neurological

1. Alzheimer’s disease ICD 10 Codes: F00 Required impairment category: Cognitive Optional impairment categories: Neurological, physical, psychosocial

2. Unspecified dementia ICD 10 Codes: F03 Required impairment category: Cognitive Optional impairment categories: Neurological, physical, psychosocial

3. Huntington disease ICD 10 Codes: G10 Required impairment category: Physical Optional impairment categories: Cognitive, neurological, psychosocial

4. Motor neurone disease ICD 10 Codes: G12.2 Required impairment category: Physical Optional impairment categories: Cognitive, neurological, sensory, psychosocial

5. Parkinson’s disease ICD 10 Codes: G20 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial

6. Epilepsy – Mandatory TAPIB ICD 10 Codes: G40 Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, psychosocial

7. Muscular dystrophy ICD 10 Codes: G71.0 Required impairment category: Physical Optional impairment categories: Neurological

8. Other Neurological – List A and List C ICD 10 Codes: G99 Required impairment category: Neurological Optional impairment categories: Cognitive, sensory, physical

3.11 Stroke

1. Stroke ICD 10 Codes: I69 Required impairment category: Physical Optional impairment categories: Cognitive, neurological, sensory, psychosocial

3.12 Other Physical

1. Rheumatoid arthritis ICD 10 Codes: M05 Required impairment category: Physical Optional impairment categories: Not applicable

2. Other arthritis – mandatory TAPIB ICD 10 Codes: M12 Required impairment category: Physical Optional impairment categories: Not applicable

3. Other physical ICD 10 Codes: M95 Required impairment category: Physical Optional impairment categories: Psychosocial

4. Multiple traumatic amputations ICD 10 Codes: T05 Required impairment category: Physical Optional impairment categories: Psychosocial

5. Myopathy ICD 10 Codes: G72.9 Required impairment category: Physical Optional impairment categories: Not applicable

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3.13 Psychosocial disability

1. Schizophrenia ICD 10 Codes: F20 Required impairment category: Psychosocial Optional impairment categories: Cognitive

2. Schizoaffective disorder ICD 10 Codes: F25.9 Required impairment category: Psychosocial Optional impairment categories: Cognitive

3. Bipolar affective disorder ICD 10 Codes: F31 Required impairment category: Psychosocial Optional impairment categories: Cognitive

4. Major depressive illness ICD 10 Codes: F32 Required impairment category: Psychosocial Optional impairment categories: Cognitive

5. Other anxiety disorders ICD 10 Codes: F41 Required impairment category: Psychosocial Optional impairment categories: Cognitive

6. Obsessive-compulsive disorder ICD 10 Codes: F42 Required impairment category: Psychosocial Optional impairment categories: Not applicable

7. Post traumatic stress disorder ICD 10 Codes: F43 Required impairment category: Psychosocial Optional impairment categories: Cognitive

8. Borderline personality disorder ICD 10 Codes: F60.3 Required impairment category: Psychosocial Optional impairment categories: Not applicable

9. Tourette syndrome ICD 10 Codes: F95.2 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial

10. Other psychosocial disorders ICD 10 Codes: F99 Required impairment category: Psychosocial Optional impairment categories: Cognitive

11. Anorexia ICD 10 Codes: R63 Required impairment category: Psychosocial Optional impairment categories: Cognitive, physical

3.14 Spinal Cord Injury

1. Malignant neoplasm of spinal cord complete and incomplete ICD 10 Codes: C72.5, C72.7 Required impairment category: Physical Optional impairment categories: Neurological, sensory

2. Spinal cord injury (complete) ICD 10 Codes: T09.5 Required impairment category: Physical Optional impairment categories: Neurological, sensory, psychosocial

3. Spinal cord injury (incomplete) ICD 10 Codes: T09.7 Required impairment category: Physical Optional impairment categories: Neurological, sensory, psychosocial

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3.15 Other

1. Malignant neoplasm of brain ICD 10 Codes: C71 Required impairment category: Neurological Optional impairment categories: Cognitive, psychosocial

2. Metastatic cancer ICD 10 Codes: C79.9 Required impairment category: Physical Optional impairment categories: Cognitive

3. Malignant neoplasm of blood or immune disease ICD 10 Codes: C96 Required impairment category: Physical Optional impairment categories: Cognitive

4. Autoimmune disorders ICD 10 Codes: D89.9 Required impairment category: Physical Optional impairment categories: Cognitive

5. Obesity – mandatory TAPIB ICD 10 Codes: E66 Required impairment category: Physical Optional impairment categories: Psychosocial

6. Classical phenylketonuria ICD 10 Codes: E70.0 Required impairment category: Cognitive Optional impairment categories: Psychosocial

7. Disorders of pyruvate metabolism and gluconeogenesis ICD 10 Codes: E74.4 Required impairment category: Intellectual Optional impairment categories: Neurological, physical

8. Other metabolic disorders ICD 10 Codes: E88 Required impairment category: Intellectual Optional impairment categories: Neurological, physical

9. Dementia – rapidly progressing ICD 10 Codes: F03.9 Required impairment category: Cognitive Optional impairment categories: Not applicable

10. Functional neurological disorder (FND) – mandatory TAPIB ICD 10 Codes: F44.4 Required impairment category: Neurological Optional impairment categories: Cognitive, sensory, physical

11. Other language disorder ICD 10 Codes: F80 Required impairment category: Cognitive Optional impairment categories: Not applicable

12. Peripheral neuropathy – does NOT require TAPIB ICD 10 Codes: F90.0 Required impairment category: Neurological Optional impairment categories: Sensory, physical

13. Oppositional defiant disorder (ODD) ICD 10 Codes: F91.3 Required impairment category: Cognitive Optional impairment categories: Psychosocial

14. Other hereditary ataxias ICD 10 Codes: G11.8 Required impairment category: Neurological Optional impairment categories: Cognitive, sensory, physical

15. Dementia – early onset ICD 10 Codes: G30.0 Required impairment category: Cognitive Optional impairment categories: Not applicable

16. Plegia ICD 10 Codes: G83.1 Required impairment category: Physical Optional impairment categories: Neurological

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17. Chronic pain – mandatory TAPIB ICD 10 Codes: G89.4 Required impairment category: Physical Optional impairment categories: Sensory, psychosocial

18. Postural Orthostatic Tachycardia Syndrome (POTS) – mandatory TAPIB ICD 10 Codes: I49.8 Required impairment category: Neurological Optional impairment categories: Physical

19. Lymphoedema – mandatory TAPIB ICD 10 Codes: I89.0 Required impairment category: Physical Optional impairment categories: Not applicable

20. Chronic lung disease ICD 10 Codes: J44.9 Required impairment category: Physical Optional impairment categories:

21. Chronic Obstructive Pulmonary Disease (COPD) – mandatory TAPIB ICD 10 Codes: J44.9A Required impairment category: Physical Optional impairment categories: Not applicable

22. Osteoarthritis – mandatory TAPIB ICD 10 Codes: M19.9 Required impairment category: Physical Optional impairment categories: Not applicable

23. Systemic lupus erythematosus ICD 10 Codes: M32 Required impairment category: Physical Optional impairment categories: Not applicable

24. Ankylosing spondylitis ICD 10 Codes: M45 Required impairment category: Physical Optional impairment categories: Not applicable

25. Fibromyalgia ICD 10 Codes: M79.7 Required impairment category: Physical Optional impairment categories: Sensory

26. Renal failure ICD 10 Codes: N18 Required impairment category: Physical Optional impairment categories:

27. Ehlers Danlos – does NOT require TAPIB ICD 10 Codes: Q79.6 Required impairment category: Physical Optional impairment categories: Not applicable

28. Dyslexia ICD 10 Codes: R48 Required impairment category: Cognitive Optional impairment categories: Psychosocial

29. Childhood apraxia of speech ICD 10 Codes: R48.2 Required impairment category: Neurological Optional impairment categories: Cognitive

30. Short stature ICD 10 Codes: R62.5 Required impairment category: Physical Optional impairment categories: Not applicable

31. Amputation – single limb or upper/lower limb ICD 10 Codes: Z89 Required impairment category: Physical Optional impairment categories: Cognitive, sensory, psychosocial

32. Amputation – multiple ICD 10 Codes: Z89.1 Required impairment category: Physical Optional impairment categories: Cognitive, sensory, psychosocial

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Agency. Insurance Disability National the by 1982 Act Information of Freedom the under released was document This

Agency. Insurance Disability National the by 1982 Act Information of Freedom the under released was document This

FOI 25/26-2132 & FOI 25/26 -2133 For Internal Use Only

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5. Access – Residence Requirements

5.1 Does the applicant meet the residence requirements?

Legislation

Section 23 Residence requirements

(1) A person meets the residence requirements if the person:

(a) resides in Australia; and (b) is one of the following:

(i) an Australian citizen;
(ii) the holder of a permanent visa;
(iii) a special category visa holder who is a protected SCV holder.

(2) In deciding whether or not a person resides in Australia, regard must be had to:

(a) the nature of the accommodation used by the person in Australia; and (b) the nature and extent of the family relationships the person has in Australia; and (c) the nature and extent of the person’s employment, business or financial ties with Australia; and (d) the nature and extent of the person’s assets located in Australia; and (e) the frequency and duration of the person’s travel outside Australia; and (f) any other matter relevant to determining whether the person intends to remain permanently in Australia.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant:

• lives in Australia for most of the year; and
• is an Australian Citizen; or
• is the holder of a permanent visa; or
• is the holder of a protected Special Category Visa (SCV)

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6. Access – Streamlined Decisions

6.1 List A

List A conditions that are likely to meet the disability requirements.

Note: A person does not need to have a condition on List A to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you meet the disability requirements?

Applicants under the age of 7

Applicants aged 7 and over

6.2 List B

Where an applicant has been diagnosed with a condition on List B, they will be considered to have a disability attributable to one or more conditions that are likely to result in a permanent impairment.

For applicants diagnosed with a condition on List B, you will only need to assess whether the applicant:

• has substantially reduced functional capacity to perform one or more activities;
• is affected in their capacity for social or economic participation; and
• is likely to require support under the NDIS for their lifetime.

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Note: A person does not need to have a condition on List B to become a participant in the NDIS.

For further information, refer to Our Guidelines - Is your impairment likely to be permanent?

For applicants under the age of 7

For applicants aged 7 and over

6.3 List D

Where a child under the age of 7 has been diagnosed with a condition on List D, they will meet the early intervention requirements without further assessment.

Note: A child does not need to have a List D condition to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you need early intervention?

For applicants under the age of 7

6.4 0-25 Hearing Impairments

An applicant meets the early intervention requirements without further assessment if they:

• are aged between birth and 25 years of age; and

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• have confirmed results from a specialist audiological assessment (including electrophysiological testing when required) consistent with auditory neuropathy or hearing loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent.

What to consider

This streamlined access approach for early intervention acknowledges a rich body of evidence that recognises that early intervention supports up to and including the age of 25 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

This same body of evidence suggests that brain development and language capability have been achieved by the age of 26. Therefore, adults aged 26 years and over are not immediately accepted to be likely to benefit from the same early intervention approach because there is no requirement to support the development of the auditory pathways. Adults aged 26 years and over with hearing impairment will therefore be assessed normally, on a case-by-case basis, having regard to the availability of all relevant evidence.

For further information, refer to Our Guidelines - What about people aged between 0 and 25 with a hearing impairment?

For applicant aged under 7

For applicants aged 7 and over

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7. Access – Disability Requirements

7.1 Does the applicant meet Section 24(1)(a)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable

–

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant has a disability (a reduction or loss in their ability to do things); and
• their disability is caused by an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and
• the impairment is intellectual, cognitive, neurological, sensory, or physical in nature.

Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate both that the applicant has an impairment, and that the impairment is resulting in a disability?
• Does the evidence demonstrate that the applicant is reduced in their ability to do things, however this reduction cannot be reasonably attributed to an impairment?
• Does the evidence demonstrate that the applicant has a loss or significant change in one of their body’s functions or structure, or in how they think and learn; however, there is no indication that this is causing a reduction or loss in their ability to do things?

Note: A diagnosis is not required to meet this criterion: if the evidence shows the person has a disability caused by a relevant impairment, then they will meet 24(1)(a) – this is because we assess based on the impairment/functional impact.

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For further information, refer to Our Guidelines - Is your disability caused by an impairment?

Applicants under the age of 7

Applicants aged 7 or over

7.2 Does the applicant meet Section 24(1)(b)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(b) The impairment or impairments are, or are likely to be, permanent

–

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant has a:

• permanent impairment; or
• likely permanent impairment.

Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

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• Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment?
• Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?
• Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success?
• Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only?
• Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes?
• If there are evidence-based treatments not undertaken, why were they considered and deemed unsuitable?
• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Is your impairment likely to be permanent? | NDIS

Applicants under the age of 7

Applicants aged 7 and over

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7.3 Does the applicant meet Section 24(1)(c)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(c) The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities: The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities:

(i) communication;

(ii) social interaction;

(iii) learning

(iv) mobility

(v) self-care

(vi) self-management

–

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, results in substantially reduced functional capacity in one or more of the following activities:

• Communication: how they speak, write or use sign language and gestures.
• Social interaction: how they make and keep friends, interact with the community, and cope with feelings and emotions in social situations.
• Learning: how they learn, understand and remember new things, and practise and use new skills.

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• Mobility: how they move around home and the community and how they get in and out of bed or a chair.
• Self-care: how they partake in personal care, hygiene, grooming, eating and drinking, and health.
• Self-management (if older than 6): how they organise their life, make decision, solve problems and manage money.

Note: When an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant is unable to participate effectively or completely (i.e., across the whole or majority of tasks) in one or more activities, without formally prescribed equipment?
• Does the evidence demonstrate that the applicant is unable to participant effectively or completely in one or more activities, and usually requires the assistance of another person?
• Does the evidence demonstrate that the applicant would be unsafe to complete one or more tasks required to participate in an activity without formally prescribed equipment or assistance from another person?
• Does the evidence indicate that the applicant is able to participate in each activity effectively by using commonly used items?
• Does the evidence indicate that the applicant is able to participate in each activity effectively, albeit more slowly or in a different way?
• Would completing tasks more slowly or in a modified way, or using commonly used items, relieve the applicant’s need for personal assistance?

In answering the above questions, does the evidence contain sufficient information addressing:

• What specific tasks the applicant cannot complete without support?
• Why the applicant requires support?
• How often the applicant requires support, and what that support looks like?

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For further information, refer to Our Guidelines - Does your impairment substantially reduce your functional capacity?

Applicants under the age of 7

Applicants aged 7 and over

7.4 Does the applicant meet Section 24(1)(d)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(d) The impairment or impairments affect the person’s capacity for social or economic participation.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, affects the applicant’s social or economic participation.

Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant’s social participation (e.g., their capacity to play sport, go to the movies, see friends, etc.) is affected by their permanent impairment/s - in any way?

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• Does the evidence demonstrate that the applicant’s economic participation (e.g., their capacity to travel, to find or maintain voluntary or paid work, etc.) is affected by their permanent impairment - in any way?
• Does the evidence demonstrate that the applicant’s social and economic participation is not impacted in any way, and that they can fully engage without any assistance?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

Applicants under the age of 7

Applicants aged 7 and over

7.5 Does the applicant meet Section 24(1)(e)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(e) The person is likely to require support under the National Disability Insurance Scheme for the person’s lifetime.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant:

• will require the support of the NDIS for their lifetime; or

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• is likely to require the support of the NDIS for their lifetime.

Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant is likely to require disability supports that are not clinical in nature, and that focus on their functional ability, for their lifetime?
• Does the evidence demonstrate that the applicant will likely be substantially reduced in their functional capacity (in a relevant activity) for their lifetime, despite any interventions?
• Are there any recommendations for interventions that are likely to improve the applicant’s functional capacity, and reduce their future need for disability related supports?
• If the applicant is a child or young adult, does the evidence indicate that significant functional improvements can be expected - either as they develop, or through interventions?
• Does the applicant’s need for support relate to a health condition, and is that support more appropriately funded by the health system?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

Applicants under the age of 7

Applicants aged 7 and over

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8. Access - Early Intervention Requirements

For children under the age of 7 they are first assessed against the early intervention criteria. If they do not meet, then assess them against the disability requirements.

For applicants aged 7 or above, only assess their eligibility for early intervention supports if they have not met the disability requirements.

Before you commence the assessment, you must ensure the applicant meets both the age requirements and residency requirements.

8.1 Developmental Delay

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person:

(iii) is a child with who has developmental delay

Section 9 Definitions

Developmental delay means a delay in the development of a child under 6 years of age that:

(a) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and

(b) results in substantial reduction in functional capacity in one or more of the following areas of major life activity:

(i) self-care;

(ii) receptive and expressive language;

(iii) cognitive development;

(iv) motor development; and

(c) results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

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When is this criterion considered met?

This criterion is considered met if evidence on the record shows the child is younger than 6 on the day we determine they have developmental delay.

For further information, refer to Our Guidelines - What about children younger than 6 with developmental delay?

8.2 Does the applicant meet Section 25(1)(a)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person:

(i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or
(ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent

–

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant has an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and
• the impairment is intellectual, cognitive, neurological, sensory, or physical in nature; and

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• the impairment is, or is likely to be, permanent.

Note: When an applicant is diagnosed with a condition on List B or List D, they meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment?
• Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?
• Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success?
• Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only?
• Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes?
• If there are evidence-based treatments not undertaken, why were they considered and deemed not suitable?
• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Our Guidelines - Do you need early intervention?

Applicants aged under 7

Applicants aged 7 and over

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8.3 Does the applicant meet Section 25(1)(b)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

–

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports for the applicant’s permanent impairment/s will reduce their need for disability-related supports in the future.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and indicate that this intervention will mean the applicant needs less disability supports in the future?
• Does the evidence note which specific supports the applicant will no longer require should early intervention be undertaken?

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• Does the evidence indicate that early intervention is likely to result in greater independence for the applicant?
• If the applicant has accessed intervention before, is the outcome noted? Did previous intervention reduce their need for disability related supports?
• Is the recommended support of a functional nature, or capacity building in nature?
• In answering the above questions, does the evidence contain sufficient information addressing:
• How the applicant’s impairment is likely to impact them over time?
• What supports the applicant will require if they don’t receive intervention?
• What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to Our Guidelines - How will early intervention help you?

For applicants aged under 7

For applicants aged 7 and over

8.4 Does the applicant meet Section 25(1)(c)?

Legislation

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Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self‑care or self‑management; or
(ii) preventing the deterioration of such functional capacity; or
(iii) improving such functional capacity; or
(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

–

When is this criterion considered met?

• This criterion is considered met if evidence on the record shows early intervention supports will help the applicant by:
• addressing the impact of their impairment on their ability to move around, communicate, socialise, learning, look after themselves, or organise their life
• preventing their functional capacity from getting worse
• improving their functional capacity
• supporting their informal supports to build their skills to help the applicant.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will mitigate or alleviate the impact of the applicant’s permanent impairment on their functional capacity?
• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will prevent the applicant’s functional capacity from declining?
• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will improve the applicant’s functional capacity?

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• Does the evidence indicate that intervention is likely to strengthen the sustainability of informal supports available to the person, and result in a decreased need for formal disability related supports?

In answering the above questions, does the evidence contain sufficient information addressing:

• How the applicant’s impairment is likely to impact them over time?
• What supports the applicant will require if they don’t receive intervention?
• What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to Our Guidelines - How will early intervention help you?

For applicants aged under 7

For applicants aged 7 and over

8.5 Does the applicant meet Section 25(3)?

Legislation

Section 25 Early intervention requirements

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(3) … the person does not meet the early intervention requirements if the CEO is satisfied that early intervention support for the person is not most appropriately funded or provided through the National Disability Insurance Scheme, and is more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or through systems of service delivery or support services offered:

(a) as part of a universal service obligation; or

(b) in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows early intervention supports are most appropriately funded by the NDIS.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

Whether or not funding is available through other general systems is not the test of whether it is most appropriately funded or provided through the NDIS. For example, the fact that the health system does not adequately fund what is essentially clinical treatment (or some other form of support that is more appropriately funded through the health system) does not make it the responsibility of the NDIS.

For further information, refer to Our Guidelines - Is your early intervention most appropriately funded by the NDIS?

For applicants aged under 7

For applicants aged 7 and over

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9. Related procedures or resources

• National Disability Insurance Scheme Act 2013
• National Disability Insurance Scheme (Becoming a Participant) Rules 2016
• Our Guidelines - Applying to the NDIS
• KA – Make an access decision
• KA – Complete an Eligibility Check
• KA – Finalise an Eligibility Reassessment decision
• Access and ER Decision Tree

10. Feedback

If you would like to provide feedback about this guidance material, please discuss with your team leader who can send a request to redacted: s47E(d) - certain operations of agencies@ndis.gov.au.

11. Version control

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Access and Eligibility Reassessment (ER) Practice Guide – Current NDIS Act 2013

The content of this document is OFFICIAL.

This guide assists the Scheme Eligibility Branch to assess new applicants’ eligibility and determine if existing participants remain eligible for the National Disability Insurance Scheme (NDIS).

This guide is designed to be used with the Access and Eligibility Reassessment (ER) Decision Tree to make legislatively correct decisions for all eligibility reassessments and any initial access requests received on or after 3 October 2024. If you are making an access decision for a request received before 3 October 2024, refer to Access Practice Guide Previous NDIS Act 2013 (C19).

1. Recent updates

2. Checklist

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3. Are you making an Access or ER decision?

For Access decisions, go to Section 4. Access – Age Requirements

For ER decisions, go to Section 9. ER – Residence Requirements

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4. Access – Age Requirements

4.1 Does the applicant meet the age requirements?

Legislation

Section 22 Age requirements

A person meets the age requirements if the person was aged under 65 when the access request in relation to the person was made.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant was aged under 65 when their access request was received as valid (that is, complete)

5. Access – Residence Requirements

5.1 Does the applicant meet the residence requirements?

Legislation

Section 23 Residence requirements

(1) A person meets the residence requirements if the person:

(a) resides in Australia; and (b) is one of the following:

(i) an Australian citizen;
(ii) the holder of a permanent visa;
(iii) a special category visa holder who is a protected Special Category Visa (SCV) holder.

(2) In deciding whether or not a person resides in Australia, regard must be had to:

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(a) the nature of the accommodation used by the person in Australia; and (b) the nature and extent of the family relationships the person has in Australia; and (c) the nature and extent of the person’s employment, business or financial ties with Australia; and (d) the nature and extent of the person’s assets located in Australia; and (e) the frequency and duration of the person’s travel outside Australia; and (f) any other matter relevant to determining whether the person intends to remain permanently in Australia.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant:

• lives in Australia for most of the year; and
• is an Australian Citizen; or
• is the holder of a permanent visa; or
• is the holder of a protected Special Category Visa (SCV)

6. Access – Streamlined Decisions

6.1 List A

List A conditions that are likely to meet the disability requirements.

Note: A person does not need to have a condition on List A to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you meet the disability requirements?

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6.2 0-25 Hearing Impairments

An applicant meets the early intervention requirements without further assessment if they:

• are aged between birth and 25 years of age; and
• have confirmed results from a specialist audiological assessment (including electrophysiological testing when required) consistent with auditory neuropathy or hearing loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent.

What to consider

This streamlined access approach for early intervention acknowledges a rich body of evidence that recognises that early intervention supports up to and including the age of 25 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

This same body of evidence suggests that brain development and language capability have been achieved by the age of 26. Therefore, adults aged 26 years and over are not immediately accepted to be likely to benefit from the same early intervention approach because there is no requirement to support the development of the auditory pathways. Adults aged 26 years and over with hearing impairment will therefore be assessed normally, on a case-by-case basis, having regard to the availability of all relevant evidence.

For further information, refer to Our Guidelines - What about people aged between 0 and 25 with a hearing impairment?

Applicants that have a List A condition who are under 7

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Applicants that have a List A condition who are over 7

Applicants that DON’T have a List A condition who are over 7

Applicants that DON’T have a List A condition who are under 7

6.3 List D

Where a child under the age of 7 has been diagnosed with a condition on List D, they will meet the early intervention requirements without further assessment.

Note: A child does not need to have a List D condition to become a participant of the NDIS.

For further information, refer to [Our Guidelines - Do you need early intervention?]

Applicants that have a List A condition who are under 7

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Applicants under the age of 7 who DON’T have a List A condition who are under 7

6.4 Developmental Delay

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person is a child who has developmental delay; and

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability; and

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, selfcare or self-management; or

(ii) preventing the deterioration of such functional capacity; or

(iii) improving such functional capacity; or

(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer; and

(d) the CEO is satisfied any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

Section 9 Definitions

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Developmental delay means a delay in the development of a child under 6 years of age that:

(a) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and

(b) results in substantial reduction in functional capacity in one or more of the following areas of major life activity:

(i) self-care;

(ii) receptive and expressive language;

(iii) cognitive development;

(iv) motor development; and

(c) results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the child is younger than 6 on the day we determine they have developmental delay.

For further information, refer to [Our Guidelines - What about children younger than 6 with developmental delay?]

Applicants that have a List A condition who are under 7

Applicants that DON’T have a condition on List A who are under 7

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6.5 List B

Where an applicant has been diagnosed with a condition on List B, they will be considered to have a disability attributable to one or more conditions that are likely to result in a permanent impairment.

For applicants diagnosed with a condition on List B, you will only need to assess whether the applicant:

• has substantially reduced functional capacity to perform one or more activities; • is affected in their capacity for social or economic participation; and • is likely to require support under the NDIS for their lifetime.

Note: A person does not need to have a condition on List B to become a participant in the NDIS.

For further information, refer to [Our Guidelines - Is your impairment likely to be permanent?]

For applicants who meet any of the following and DON’T have a condition on List A:

• 0-25 Hearing Loss • List D • Developmental Delay criteria

For applicants who DON’T meet the criteria for any of the following:

• 0-25 Hearing Loss • List D • Developmental Delay

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7 Access - Early Intervention Requirements

For children under the age of 7 they are first assessed against the [early intervention criteria]. If they do not meet, then assess them against the [disability requirements].

Before you commence the assessment, you must ensure the applicant meets both the [age requirements] and [residency requirements].

7.1 Does the applicant meet Section 25(1)(a)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person:

(i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or

(ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant has an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and • the impairment is intellectual, cognitive, neurological, sensory, physical or psychosocial in nature; and • the impairment is, or is likely to be, permanent.

Note: When an applicant is diagnosed with a condition on List B or List D, they meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment? • Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?

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• Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success? • Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only? • Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes? • If there are evidence-based treatments not undertaken, why were they considered and deemed not suitable? • What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to [Our Guidelines - Do you need early intervention?]

7.2 Does the applicant meet Section 25(1)(b)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

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(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports for the applicant’s permanent impairment/s will reduce their need for disability-related supports in the future.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and indicate that this intervention will mean the applicant needs less disability supports in the future? • Does the evidence note which specific supports the applicant will no longer require should early intervention be undertaken? • Does the evidence indicate that early intervention is likely to result in greater independence for the applicant? • If the applicant has accessed intervention before, is the outcome noted? Did previous intervention reduce their need for disability related supports? • Is the recommended support of a functional nature, or capacity building in nature? • In answering the above questions, does the evidence contain sufficient information addressing: • How the applicant’s impairment is likely to impact them over time? • What supports the applicant will require if they don’t receive intervention? • What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to [Our Guidelines - How will early intervention help you?]

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7.3 Does the applicant meet Section 25(1)(c)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self-care or self-management; or

(ii) preventing the deterioration of such functional capacity; or

(iii) improving such functional capacity; or

(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

When is this criterion considered met?

• This criterion is considered met if evidence on the record shows early intervention supports will help the applicant by:

• addressing the impact of their impairment on their ability to move around, communicate, socialise, learning, look after themselves, or organise their life • preventing their functional capacity from getting worse • improving their functional capacity • supporting their informal supports to build their skills to help the applicant.

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Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will mitigate or alleviate the impact of the applicant’s permanent impairment on their functional capacity? • Does the evidence contain specific recommendations for early intervention, and detail how this intervention will prevent the applicant’s functional capacity from declining? • Does the evidence contain specific recommendations for early intervention, and detail how this intervention will improve the applicant’s functional capacity? • Does the evidence indicate that intervention is likely to strengthen the sustainability of informal supports available to the person, and result in a decreased need for formal disability related supports? • In answering the above questions, does the evidence contain sufficient information addressing: • How the applicant’s impairment is likely to impact them over time? • What supports the applicant will require if they don’t receive intervention? • What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to [Our Guidelines - How will early intervention help you?]

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7.4 Does the applicant meet section 25(1)(d)?

Legislation

Section 25 Early intervention requirements

(d) … any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports required are NDIS supports.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Can any of the supports which have been recommended be considered ‘NDIS Supports’? For the list of NDIS Supports see [[Supports that are NDIS Supports](/foi-library/releases/f0fa8902b736-foi-24-25-0509-document-disclosure-log/document-001__supports-that-are-ndis-supports/)].

If none of the recommended supports are on the NDIS Supports list, or they are all supports the NDIS will not fund, then the applicant will not meet this criterion. For the list of supports the NDIS will not fund see [Supports that are not NDIS Supports]. Remember that you only need to have at least one support on the [Supports that are NDIS Supports] list to meet this criterion.

For further information, refer to [What does the NDIS fund?]

For applicants who do not have a List A impairment

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For applicants who have a List A impairment

8 Access – Disability Requirements

8.1 Does the applicant meet Section 24(1)(a)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant has a disability (a reduction or loss in their ability to do things); and • their disability is caused by an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and • the impairment is intellectual, cognitive, neurological, sensory or physical in nature, or • they have a psychosocial disability (a reduced capacity to do daily life activities and tasks due to their mental health).

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Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate both that the applicant has an impairment, and that the impairment is resulting in a disability? • Does the evidence demonstrate that the applicant is reduced in their ability to do things, however this reduction cannot be reasonably attributed to an impairment? • Does the evidence demonstrate that the applicant has a loss or significant change in one of their body’s functions or structure. however, there is no indication that this is causing a reduction or loss in their ability to do things?

Note: A diagnosis is not required to meet this criterion: if the evidence shows the person has a disability caused by a relevant impairment, then they will meet 24(1)(a) – this is because we assess based on the impairment/functional impact.

For further information, refer to [Our Guidelines - Is your disability caused by an impairment?]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

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8.2 Does the applicant meet Section 24(1)(b)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(b) The impairment or impairments are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant has a:

• permanent impairment; or • likely permanent impairment.

Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment? • Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored? • Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success? • Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only? • Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes? • If there are evidence-based treatments not undertaken, why were they considered and deemed unsuitable?

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• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to [Is your impairment likely to be permanent? | NDIS]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

8.3 Does the applicant meet Section 24(1)(c)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(c) The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities: The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities:

(i) communication;

(ii) social interaction;

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(iii) learning

(iv) mobility

(v) self-care

(vi) self-management

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, results in substantially reduced functional capacity in one or more of the following activities:

• Communication: how they speak, write or use sign language and gestures. • Social interaction: how they make and keep friends, interact with the community, and cope with feelings and emotions in social situations. • Learning: how they learn, understand and remember new things, and practise and use new skills. • Mobility: how they move around home and the community and how they get in and out of bed or a chair. • Self-care: how they partake in personal care, hygiene, grooming, eating and drinking, and health. • Self-management (if older than 6): how they organise their life, make decision, solve problems and manage money.

Note: When an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant is unable to participate effectively or completely (i.e. across the whole or majority of tasks) in one or more activities, without formally prescribed equipment? • Does the evidence demonstrate that the applicant is unable to participate effectively or completely in one or more activities, and usually requires the assistance of another person?

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• Does the evidence demonstrate that the applicant would be unsafe to complete one or more tasks required to participate in an activity without formally prescribed equipment or assistance from another person? • Does the evidence indicate that the applicant is able to participate in each activity effectively by using commonly used items? • Does the evidence indicate that the applicant is able to participate in each activity effectively, albeit more slowly or in a different way? • Would completing tasks more slowly or in a modified way, or using commonly used items, relieve the applicant’s need for personal assistance?

In answering the above questions, does the evidence contain sufficient information addressing:

• What specific tasks the applicant cannot complete without support? • Why the applicant requires support? • How often the applicant requires support, and what that support looks like?

For further information, refer to [Our Guidelines - Does your impairment substantially reduce your functional capacity?]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

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8.4 Does the applicant meet Section 24(1)(d)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(d) The impairment or impairments affect the person’s capacity for social or economic participation.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, affects the applicant’s social or economic participation.

Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant’s social participation (e.g. their capacity to play sport, go to the movies, see friends, etc.) is affected by their permanent impairment/s - in any way? • Does the evidence demonstrate that the applicant’s economic participation (e.g., their capacity to travel, to find or maintain voluntary or paid work, etc.) is affected by their permanent impairment - in any way? • Does the evidence demonstrate that the applicant’s social and economic participation is not impacted in any way, and that they can fully engage without any assistance?

Note: There is no threshold that the person’s permanent impairment affects their social or economic participation. It just needs to be affected.

For further information, refer to [Our Guidelines - Does your impairment affect your social, work or study life?]

If the person does NOT meet the Early Intervention criteria

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If the person does meet the Early Intervention criteria

8.5 Does the applicant meet Section 24(1)(e)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(e) The person is likely to require NDIS supports under the National Disability Insurance Scheme for the person’s lifetime.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant:

• will likely require NDIS supports under the National Disability Insurance Scheme for their lifetime.

Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant is likely to require NDIS Supports, for their lifetime?

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• Does the evidence demonstrate that the applicant will likely be substantially reduced in their functional capacity (in a relevant activity) for their lifetime, despite any interventions? • Are there any recommendations for interventions that are likely to improve the applicant’s functional capacity, and reduce their future need for disability related supports? • If the applicant is a child or young adult, does the evidence indicate that significant functional improvements can be expected - either as they develop, or through interventions? • Does the applicant’s need for support only relate to supports which the NDIS does not fund?

If none of the recommended supports are on the NDIS Supports list, or they are all supports the NDIS will not fund, then the applicant will not meet this criterion. For the list of supports the NDIS will not fund see [Supports that are not NDIS Supports]. Remember that you only need to have at least one support on the [Supports that are NDIS Supports] list to meet this criterion.

For further information, refer to [What does NDIS fund] and [Our Guidelines - Does your impairment affect your social, work or study life?]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

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9 ER – Residence Requirements

9.1 Does the participant continue to meet the residence requirements?

Legislation

Section 23 Residence requirements

(1) A person meets the residence requirements if the person:

(a) resides in Australia; and

(b) is one of the following:

(i) an Australian citizen;

(ii) the holder of a permanent visa;

(iii) a special category visa holder who is a protected SCV holder.

(2) In deciding whether or not a person resides in Australia, regard must be had to:

(a) the nature of the accommodation used by the person in Australia; and

(b) the nature and extent of the family relationships the person has in Australia; and

(c) the nature and extent of the person’s employment, business or financial ties with Australia; and

(d) the nature and extent of the person’s assets located in Australia; and

(e) the frequency and duration of the person’s travel outside Australia; and

(f) any other matter relevant to determining whether the person intends to remain permanently in Australia.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant:

• lives in Australia for most of the year; and

• is an Australian Citizen; or

• is the holder of a permanent visa; or

• is the holder of a protected Special Category Visa (SCV)

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10 ER – Streamlined Decisions

10.1 List A

[List A] conditions that are likely to meet the disability requirements.

Note: A person does not need to have a condition on List A to become a participant of the NDIS.

For further information, refer to [Our Guidelines - Do you meet the disability requirements?]

10.2 0-25 Hearing Impairments

An applicant meets the early intervention requirements without further assessment if they:

• are aged between birth and 25 years of age; and

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• have confirmed results from a specialist audiological assessment (including electrophysiological testing when required) consistent with auditory neuropathy or hearing loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent.

What to consider

This streamlined access approach for early intervention acknowledges a rich body of evidence that recognises that early intervention supports up to and including the age of 25 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

This same body of evidence suggests that brain development and language capability have been achieved by the age of 26. Therefore, adults aged 26 years and over are not immediately accepted to be likely to benefit from the same early intervention approach because there is no requirement to support the development of the auditory pathways. Adults aged 26 years and over with hearing impairment will therefore be assessed normally, on a case-by-case basis, having regard to the availability of all relevant evidence.

For further information, refer to [Our Guidelines - What about people aged between 0 and 25 with a hearing impairment?]

Participants that have a List A condition who are under 7

Participants that have a List A condition who are over 7

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Participants that DON’T have a List A condition who are over 7

Participants that DON’T have a List A condition who are under 7

10.3 List D

Where a child under the age of 7 has been diagnosed with a condition on List D, they will meet the early intervention requirements without further assessment.

Note: A child does not need to have a List D condition to become a participant of the NDIS.

For further information, refer to [Our Guidelines - Do you need early intervention?]

Participants that have a List A condition who are under 7

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Participants under the age of 7 who DON’T have a List A condition who are under 7

10.4 Developmental Delay

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person is a child who has developmental delay; and

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability; and

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, selfcare or self-management; or

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(ii) preventing the deterioration of such functional capacity; or

(iii) improving such functional capacity; or

(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer; and

(d) the CEO is satisfied any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

Section 9 Definitions

Developmental delay means a delay in the development of a child under 6 years of age that:

(d) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and

(e) results in substantial reduction in functional capacity in one or more of the following areas of major life activity:

(i) self-care;

(ii) receptive and expressive language;

(iii) cognitive development;

(iv) motor development; and

(f) results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the child is younger than 6 on the day we determine they have developmental delay.

For further information, refer to [Our Guidelines - What about children younger than 6 with developmental delay?]

Participants that have a List A condition who are under 7

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Participants that DON’T have a condition on List A who are under 7

10.5 List B

Where an applicant has been diagnosed with a condition on List B, they will be considered to have a disability attributable to one or more conditions that are likely to result in a permanent impairment.

For applicants diagnosed with a condition on List B, you will only need to assess whether the applicant:

• has substantially reduced functional capacity to perform one or more activities; • is affected in their capacity for social or economic participation; and • is likely to require support under the NDIS for their lifetime.

Note: A person does not need to have a condition on List B to become a participant in the NDIS.

For further information, refer to [Our Guidelines - Is your impairment likely to be permanent?]

For participants who MEET any of the following and DON’T have a condition on List A:

• 0-25 Hearing Loss • List D • Developmental Delay criteria

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For participants who DON’T meet the criteria for any of the following:

• 0-25 Hearing Loss • List D • Developmental Delay

11 ER – Early Intervention Requirements

11.1 Does the participant meet Section 25(1)(a)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person:

(i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or

(ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the participant has an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and • the impairment is intellectual, cognitive, neurological, sensory, or physical in nature; and

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• the impairment is, or is likely to be, permanent.

Note: Where a participant is diagnosed with a condition on List B or List D, they meet this criterion without further assessment.

• What to consider

• Does the evidence demonstrate that the participant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment? • Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored? • Does the evidence indicate that the participant requires further treatment, and that this treatment has some prospect of success? • Does the evidence demonstrate that the participant requires ongoing treatment, but that it is for maintenance purposes only? • Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes? • If there are evidence-based treatments not undertaken, why were they considered and deemed not suitable? • What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to [Our Guidelines - Do you need early intervention?]

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11.2 Does the participant meet Section 25(1)(b)?

Legislation

Section 25 Early intervention requirements

(2) A person meets the early intervention requirements if:

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports for the participant’s permanent impairment/s will reduce their need for disability-related supports in the future.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and indicate that this intervention will mean the participant needs less disability supports in the future? • Does the evidence note which specific supports the participant will no longer require should early intervention be undertaken? • Does the evidence indicate that early intervention is likely to result in greater independence for the participant? • If the participant has accessed intervention before, is the outcome noted? Did previous intervention reduce their need for disability related supports? • Is the recommended support of a functional nature, or capacity building in nature?

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In answering the above questions, does the evidence contain sufficient information addressing:

• How the participant’s impairment is likely to impact them over time? • What supports the participant will require if they don’t receive intervention? • What supports the participant currently requires, and what supports (if any) the participant is likely to require after intervention?

For further information, refer to [Our Guidelines - How will early intervention help you?]

11.3 Does the participant meet Section 25(1)(c)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

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(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self‑care or self‑management; or

(ii) preventing the deterioration of such functional capacity; or

(iii) improving such functional capacity; or

(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

When is this criterion considered met?

• This criterion is considered met if evidence on the record shows early intervention supports will help the participant by:

• addressing the impact of their impairment on their ability to move around, communicate, socialise, learning, look after themselves, or organise their life • preventing their functional capacity from getting worse • improving their functional capacity • supporting their informal supports to build their skills to help the participant.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will mitigate or alleviate the impact of the participant’s permanent impairment on their functional capacity? • Does the evidence contain specific recommendations for early intervention, and detail how this intervention will prevent the participant’s functional capacity from declining? • Does the evidence contain specific recommendations for early intervention, and detail how this intervention will improve the participant’s functional capacity? • Does the evidence indicate that intervention is likely to strengthen the sustainability of informal supports available to the person, and result in a decreased need for formal disability related supports? • In answering the above questions, does the evidence contain sufficient information addressing: • How the participant’s impairment is likely to impact them over time?

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• What supports the participant will require if they don’t receive intervention? • What supports the participant currently requires, and what supports (if any) the participant is likely to require after intervention?

For further information, refer to [Our Guidelines - How will early intervention help you?]

11.4 Does the participant meet Section 25(1)(d)?

Legislation

Section 25 Early intervention requirements

(d) … any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows early intervention supports required are NDIS supports.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

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• Can at least some of the supports which have been recommended be considered ‘NDIS Supports’? For the list of NDIS Supports see [[Supports that are NDIS Supports](/foi-library/releases/f0fa8902b736-foi-24-25-0509-document-disclosure-log/document-001__supports-that-are-ndis-supports/)].

If none of the recommended supports are on the NDIS Supports list, or they are all supports the NDIS will not fund, then the participant will not meet this criterion. For the list of supports the NDIS will not fund see [Supports that are not NDIS Supports]. Remember that you only need to have at least one support on the [Supports that are NDIS Supports] list to meet this criterion.

For further information, refer to [What does the NDIS fund?]

For participants who do not have a List A impairment

For participants who have a List A impairment

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12 ER - Disability Requirements

12.1 Does the participant meet Section 24(1)(a)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the participant has a disability (a reduction or loss in their ability to do things); and • their disability is caused by an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and • the impairment is intellectual, cognitive, neurological, sensory, or physical in nature, or • they have a psychosocial disability (a reduced capacity to do daily life activities and tasks due to their mental health).

Note: Where a participant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate both that the participant has an impairment, and that the impairment is resulting in a disability? • Does the evidence demonstrate that the participant is reduced in their ability to do things, however this reduction cannot be reasonably attributed to an impairment?

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• Does the evidence demonstrate that the participant has a loss or significant change in one of their body’s functions or structure, however, there is no indication that this is causing a reduction or loss in their ability to do things?

Note: A diagnosis is not required to meet this criterion: if the evidence shows the person has a disability caused by a relevant impairment, then they will meet 24(1)(a) – this is because we assess based on the impairment/functional impact.

For further information, refer to [Our Guidelines - Is your disability caused by an impairment?]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

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12.2 Does the participant meet Section 24(1)(b)?

Legislation

Section 24 Disability requirements

(2) A person meets the disability requirements if:

(b) The impairment or impairments are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant has a:

• permanent impairment; or • likely permanent impairment.

Note: Where a participant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment? • Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored? • Does the evidence indicate that the participant requires further treatment, and that this treatment has some prospect of success? • Does the evidence demonstrate that the participant requires ongoing treatment, but that it is for maintenance purposes only? • Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes? • If there are evidence-based treatments not undertaken, why were they considered and deemed unsuitable?

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• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to [Is your impairment likely to be permanent? | NDIS]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

12.3 Does the participant meet Section 24(1)(c)?

Legislation

Section 24 Disability requirements

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(2) A person meets the disability requirements if:

(c) The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities:

(i) communication;

(ii) social interaction;

(iii) learning

(iv) mobility

(v) self-care

(vi) self-management

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, results in substantially reduced functional capacity in one or more of the following activities:

• Communication: how they speak, write or use sign language and gestures. • Social interaction: how they make and keep friends, interact with the community, and cope with feelings and emotions in social situations. • Learning: how they learn, understand and remember new things, and practise and use new skills. • Mobility: how they move around home and the community and how they get in and out of bed or a chair. • Self-care: how they partake in personal care, hygiene, grooming, eating and drinking, and health. • Self-management (if older than 6): how they organise their life, make decision, solve problems and manage money.

Note: When a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant is unable to participate effectively or completely (i.e., across the whole or majority of tasks) in one or more activities, without formally prescribed equipment?

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• Does the evidence demonstrate that the participant is unable to participant effectively or completely in one or more activities, and usually requires the assistance of another person? • Does the evidence demonstrate that the participant would be unsafe to complete one or more tasks required to participate in an activity without formally prescribed equipment or assistance from another person? • Does the evidence indicate that the participant is able to participate in each activity effectively by using commonly used items? • Does the evidence indicate that the participant is able to participate in each activity effectively, albeit more slowly or in a different way? • Would completing tasks more slowly or in a modified way, or using commonly used items, relieve the participant’s need for personal assistance?

In answering the above questions, does the evidence contain sufficient information addressing:

• What specific tasks the participant cannot complete without support? • Why the participant requires support? • How often the participant requires support, and what that support looks like?

For further information, refer to [Our Guidelines - Does your impairment substantially reduce your functional capacity?]

If the person does NOT meet the Early Intervention criteria

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If the person does meet the Early Intervention criteria

12.4 Does the participant meet Section 24(1)(d)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(d) The impairment or impairments affect the person’s capacity for social or economic participation.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, affects the participant’s social or economic participation.

Note: Where a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant’s social participation (e.g., their capacity to play sport, go to the movies, see friends, etc.) is affected by their permanent impairment/s - in any way? • Does the evidence demonstrate that the participant’s economic participation (e.g., their capacity to travel, to find or maintain voluntary or paid work, etc.) is affected by their permanent impairment - in any way?

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• Does the evidence demonstrate that the participant’s social and economic participation is not impacted in any way, and that they can fully engage without any assistance?

Note: There is no threshold that the person’s permanent impairment affects their social or economic participation. It just needs to be affected.

For further information, refer to [Our Guidelines - Does your impairment affect your social, work or study life?]

If the person does NOT meet the Early Intervention criteria

Please follow the process in either:

• knowledge article [KA – Complete an Eligibility Check]; or
• knowledge article [KA – Finalise an Eligibility Reassessment decision] |

If the person does meet the Early Intervention criteria

Please follow the process in either:

• knowledge article [KA – Complete an Eligibility Check]; or
• knowledge article [KA – Finalise an Eligibility Reassessment decision] |

12.5 Does the participant meet Section 24(1)(e)?

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FOI 25/26-2132 & FOI 25/26-2133

For Internal Use Only

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Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(e) The person is likely to require NDIS supports under the National Disability Insurance Scheme for the person’s lifetime.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant:

• will require or is likely to require NDIS supports for their lifetime.

Note: Where a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant is likely to require NDIS Supports, for their lifetime?
• Does the evidence demonstrate that the participant will likely be substantially reduced in their functional capacity (in a relevant activity) for their lifetime, despite any interventions?
• Are there any recommendations for interventions that are likely to improve the participant’s functional capacity, and reduce their future need for disability related supports?
• If the participant is a child or young adult, does the evidence indicate that significant functional improvements can be expected - either as they develop, or through interventions?
• Does the participant’s need for support only relate to supports which the NDIS does not fund?

If none of the recommended supports are on the NDIS Supports list, or they are all supports the NDIS will not fund, then the participant will not meet this criterion. For the list of supports the NDIS will not fund see [Supports that are not NDIS Supports]. Remember that you only need to have at least one support on the [Supports that are NDIS Supports] list to meet this criterion.

For further information, refer to [What does NDIS fund] and [Our Guidelines - Does your impairment affect your social, work or study life?]

If the person does NOT meet the Early Intervention criteria

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For Internal Use Only

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Please follow the process in either:

• knowledge article [KA – Complete an Eligibility Check]; or
• knowledge article [KA – Finalise an Eligibility Reassessment decision] | | Participants that do not meet Section 24(1)(e) | Are not eligible for disability support from the NDIS.

Please follow the process in either:

• knowledge article [KA – Complete an Eligibility Check]; or
• knowledge article [KA – Finalise an Eligibility Reassessment decision] |

If the person does meet the Early Intervention criteria

Please follow the process in either:

• knowledge article [KA – Complete an Eligibility Check]; or
• knowledge article [KA – Finalise an Eligibility Reassessment decision] | | Participants that do not meet Section 24(1)(e) | Are not eligible for disability, however do satisfy the early intervention requirements.

Please follow the process in either:

• knowledge article [KA – Complete an Eligibility Check]; or
• knowledge article [KA – Finalise an Eligibility Reassessment decision] |

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13 Related procedures or resources

• [National Disability Insurance Scheme (Becoming a Participant) Rules 2016]
• [Current NDIS Act 2013]
• [Our Guidelines - Applying to the NDIS]
• [KA – Prepare to make an access decision]
• [KA – Submit an access decision]
• [KA – Complete an Eligibility Check]
• [KA – Finalise an Eligibility Reassessment decision]
• [Access and ER Decision Tree]

14 Feedback

If you would like to provide feedback about this guidance material, please discuss with your team leader who can send a request to redacted: s47E(d) - certain operations of agencies@ndis.gov.au.

15 Version control

Minor formatting error corrected in ER streamlined cohorts regarding numbering | APROVED | 2024-10-10 | | 3.0 | CH0026 | Class 2 Approval | APPROVED | 2024-11-28 | | 4.0 | LXO144 | Class 2 approval | APPROVED | 2025-07-04 |

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