Outcome of your internal review request

DOCUMENT 16 FOI 25/26-3693

GPO Box 700

CANBERRA ACT 2601

1800 800 110

ndis.gov.au

Outcome of your internal review request

NDIS participant number:

Dear <Participant/Authorised Representative First Name>,

Instruction – Select relevant option for the internal review requested. Delete this instruction and remove any information not required

I am writing in response to your request for us to review our decision to approve the statement of supports in <your/participant’s full name> plan that we made on .

I am writing in response to your request for us to review our decision not to vary <your/participant’s full name> plan. We made this original decision on .

I am writing in response to your request for us to review our decision to vary <your/participant’s full name> plan. We made this original decision on .

I am writing in response to your request for us to review our decision not to reassess <your/participant’s full name> plan. We made this decision on .

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Instruction – List all supports requested for an internal review including any variation request. Delete this instruction and remove any lines not required

The decision(s) you have asked us to review are:

1. <information about change request including support category and volume/frequency>
3. <Plan reassessment decision under Section 48>
4. <Plan variation decision under Section 47A>

Outcome of review

I have now reviewed your request under section 100 of the National Disability Insurance Scheme Act 2013 (NDIS Act). A decision has been made based on the facts and circumstances at the time of my decision.

After careful consideration, I have confirmed the original decision is correct.

You will find detailed reasons for my decision in the “Basis of Decision” section at the end of this letter.

What this means for you

This means there has been no change to the current plan and the plan reassessment date remains the same.

Next Steps

There is no further action required from you in relation to this internal review.

If you have any questions about this decision, please contact us in any of the ways listed under the “We’re here to help” section of this letter.

If you don’t agree with our decision, you have a number of options.

You can:

• Obtain further evidence between now and <your/participant’s first name> next plan reassessment.
• Contact <your/participant’s first name> Choose an item. to talk about other ways of using the supports in <your/their> plan.
• Ask for a change to <your/participant’s first name> plan at any time. For more information refer to the Our Guideline - Changing your Plan by visiting the NDIS

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website (ndis.gov.au) hovering over ‘Understanding the NDIS’, selecting ‘Our Guidelines’ and then selecting ‘Changing your plan’, or go to https://ourguidelines.ndis.gov.au/your-plan-menu/changing-your-plan.

• Apply to the Administrative Review Tribunal (ART) for an external review within 28 days. Information about how to apply is available on the ART website (art.gov.au), or by calling 1800 228 333.

The NDIS website (ndis.gov.au) provides more information about requesting an external review. Search for “Our Guidelines” and click on the link to “Reviewing our Decisions” to read more or go to https://ourguidelines.ndis.gov.au/home/reviewing- decision/reviewing-our-decisions/when-can-you-ask-external-review.

Choose an item. can help you to consider alternative ways of working towards goals including connecting you with mainstream and community services.

Support may be available through the National Disability Advocacy Program. You can find out more at dss.gov.au under ‘Disability and Carers’.

Lists of what NDIS participants can and cannot spend their funding on have been released. The lists include items that are NDIS supports and items that are not NDIS supports. For more information read the NDIS Supports list on the Our Guidelines website.

Yours sincerely,

Delegate of the CEO

National Disability Insurance Agency

My Branch Manager:

Reviews Branch

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Instruction – Select relevant option for the internal review requested. Delete this instruction and remove any information not required

Basis of Decision – Internal review (s100)

I have assessed the request in accordance with section 100 of the NDIS Act and determined the following cannot be provided as they do not satisfy the requirements for funding through the NDIS. I have outlined details for each of the requests below and why they do not meet the criteria. You can find further information about these requirements in the National Disability Insurance Scheme (Supports for Participants) Rules 2013, section 34 of the National Disability Insurance Scheme Act 2013 and Our Guidelines.

Instruction: In this section you must insert reasons for your decision against each request. This could be: rules not satisfied, reasonable and necessary criteria not met, supports not changed or plan management requirements not met. Insert the relevant information for each request as outlined in the letter using the templates for Internal Review Team Planning Decision Letters. Delete this instruction and any additional lines not required

Basis of Decision – Internal review (s100)

In <your/participant’s name> request, <you/participant’s name> <have/has> asked for <more supports to be included in <your/their> plan due to a change in circumstances>/<your/participant’s name> plan to be changed>. However, <select relevant sentence. Delete this instruction and any information not required

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<you have not provided information that tells us how <your/participant’s name> circumstances have changed, or another reason to make a change to <your/their> supports.>

<I was not satisfied that these changes are enough to justify a change to <your/participant’s name> plan.>

<I believe your request could be met by existing informal, community and government supports.>

<I believe <your/participant’s name> needs can be met within <your/their> current plan.>

<Provide information for declining the review. For example, explain why the circumstance/new information do not justify a change to the participant’s plan, what further information is needed, or how they can make use of their current plan or community/mainstream supports.

[Instruction: When using Our Guidelines to support your decision, include a link to the specific section of the Operational Guideline (For example. https://ourguidelines.ndis.gov.au/home/reviewing-decision/reviewing-our-decisions), or refer to the specific section of the Our Guideline and quote the text of that section (for example, ‘The NDIS Our Guideline for Changing Your Plan – When would we decide not to change your plan? says “There may be several reasons why we might decide not to change your plan by doing a plan reassessment or variation when you ask us to” where…)>]

Option 3 – Decision not to reassess the plan (s48)(3)(a) specific

Basis of Decision – Internal review (s100)

In <your/participant’s name> request, <you/participant’s name> <have/has> asked for the plan to be reassessed due to . However, the original decision maker made a decision to vary <your/participant’s name> plan under Section 48(3)(a) instead as <insert reason for original decision maker to vary

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the plan instead of reassess>. I agree with the original decision maker not to reassess <your/participant’s name> plan as <you have not provided information that tells us how <your/participant’s name> circumstances have changed, or another reason to make a change to <your/their> supports.>/<I was not satisfied that these changes are enough to justify a reassessment to <your/participant’s name> plan.>//<I believe your request could be met by existing informal, community and government supports.>/<I believe <your/participant’s name> needs can be met within <your/their> current plan.><The request is in response to a minor error in the plan which constitutes a plan variation (under Section 47A).>

<Provide information for declining the reassessment. For example, explain why the circumstance/new information do not justify a reassessment to the participant’s plan, what further information is needed, or how they can make use of their current plan or community/mainstream supports.

[Instruction: When using Our Guidelines to support your decision, include a link to the specific section of the Our Guideline (for example https://ourguidelines.ndis.gov.au/home/reviewing-decision/reviewing-our-decisions), or refer to the specific section of the Our Guideline and quote the text of that section (e.g., ‘The NDIS Our Guideline for Changing Your Plan – When would we decide not to change your plan? says “There may be several reasons why we might decide not to change your plan by doing a plan reassessment or variation when you ask us to” where…)>]

Basis of Decision – Internal review (s100)

In <your/participant’s name> request, <you/participant’s name> <have/has> asked for the <plan/support(s)> to be varied due to . However, <I believe <your/participant’s name> needs can be met within <your/their current plan.>/<I believe your request could be met by existing informal, community and government supports.>/<there is insufficient new supporting information/evidence to support a change to <your/participant’s name> plan.>/

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<Provide information for declining the review. For example, explain why the variation power is not intended to duplicate the existing internal review, appeal or reassessment avenues available, or be a negotiation of the level of funding in the plan.

[Instruction: When using Our Guidelines to support your decision, include a link to the specific section of the Our Guideline (for example https://ourguidelines.ndis.gov.au/home/reviewing-decision/reviewing-our-decisions), or refer to the specific section of the Our Guideline and quote the text of that section (for example, ‘The NDIS Our Guideline for Changing Your Plan – When would we decide not to change your plan? says “There may be several reasons why we might decide not to change your plan by doing a plan reassessment or variation when you ask us to” where…)>]

Materials reviewed

While I have reviewed all of the documents provided, the main documents I have considered are listed below:

1. National Disability Insurance Scheme Act 2013
2. National Disability Insurance Scheme (Supports for Participants) Rules 2013
3. Our Guidelines
4. National Disability Insurance Scheme (NDIS Supports) Transitional Rules 2024
5. Participant Statement of Supports (NDIS Plan)
6. [Describe Document 1 in the format ‘Title, Author, Date’]
7. [Describe Document 2 in the format ‘Title, Author, Date’]

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