FOI 24/25-1284
AAT Case Management Guide
DOCUMENT 3
Access for Chronic Health Conditions
OFFICIAL For Internal Use Only
Field Content Reference Documents Title Access for Chronic Health Conditions This document is part of a suite of guidance documents for case managers to use in formulating Purpose . ar their approach to managing individual cases before the Administrative Appeals Tribunal (AAT). For the purposes of this guidance document, chronj National Strategic health conditions refer to a broad range of chronic Framework for Chronic and complex health conditions across the sp illnesses. The eight major chronic conditio Scope
identified by the Australian Institute of Welfare are arthritis, asthma, back cardiovascular disease, chronic o
Escalation to Hearing Oversight Committee (HOC)
substantial risk o parameters of th
Agency (NDI
policy on the subject
attd our focus should cticably and quickly as
IA is to assist the AAT and the best possible articipant by agreement.
condition, an applicant’s chronic pndition must satisfy the disability
ents. A chronic health condition satisfies the Pity requirements if:
e it is caused by an intellectual, cognitive, neurological, sensory, psychological, or physical impairment; and it is likely to be permanent; and it substantially reduces an applicant’s functional capacity; and
NDIA Dispute Resolution Policy
Appendix B to the Legal Services Directions 2017
Sections 24 and 25 of the National Disability
Insurance Scheme Act 2013
Rules 5, 6 and 7 of the National Disability
Insurance Scheme
(Becoming a Participant) Rules 2016
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FOI 24/25-1284
AAT Case Management Guide
Access for Chronic Health Conditions
OFFICIAL For Internal Use Only
e it affects an applicant’s ability to work, study or take part in their social life; and
e an applicant will likely need the support of the Scheme for the remainder of their life.
Alternatively, an applicant will be eligible for access to the Scheme if they satisfy the early intervention requirements on the basis of their chronic health condition, meaning:
e the chronic health condition is likely to be permanent;
e early intervention supports are likely t reduce the need for need future su
e the early intervention needed is appropriately funded by the
Operational Guideline — Applying to the NDIS
Eligibility and medical conditions FAQ | NDIS
NDIA Posture in relation to this subject
own merit, based on the a
ul
Support | Productivity Commission
Council of Australian Governments (COAG) — Principles to determine responsibilities of the NDIS and other service
systems
Evidence recommended
Appeals Tribunal (AAT)
recent evidence from a
ich confirms an applicant’s the applicant’s functional reatments, and outcomes, as well t options and expected outcomes.
dence, and that they have treated the applicant for a significant period of time.
Providing evidence of our disability | NDIS
Types of disability evidence | NDIS
Persons Giving Expert and Opinion Evidence
Guideline | Administrative Appeals
Tribunal
Other considerations
To satisfy the access requirements, a participant’s chronic health condition must be evidenced to substantially reduce their functional capacity.
Section 24(1)(c) of the National Disability
Insurance Scheme Act 2013
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FOI 24/25-1284
AAT Case Management Guide
Access for Chronic Health Conditions
OFFICIAL For Internal Use Only
The NDIA will not fund supports for chronic health conditions that are unrelated to a participant’s disability. For example, the NDIA may approve access to the Scheme on the basis of a limb amputation as a result of peripheral arterial disease within the setting of diabetes but will not fund supports related to the treatment or management of peripheral arterial disease or diabetes.
Rule 5.8 of the National Disability Insurance
Scheme (Becoming a Participant) Rules 2016
Eligibility and medical conditions FAQ | NDIS
Previous matters that may advise the
The determination of the AAT regarding whether an applicant’s chronic health condition satisfies the requirements for access to the Scheme will us turn on the question of a substantial reducti applicant’s functional capacity.
The test is not whether or not the c condition is significant, but whet legislative requirements for access
CKJW and National Disability Insurance
NDIA position balance of the available evidence. In each of these cases, the Nika and National d . the . Disability Insurance under review on Agency [2021] AATA 2127 Document admin 4 January 2023 Approved
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