DOCUMENT 4
ndis
Overview of ER decision making
Scheme Eligibility Branch
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Acknowledgement of Country
Before we begin, I would like to acknowledge the Traditional Owners and Custodians of the Country on which we meet today, and their continuing connection to land, sea, and community. I pay my respects to their Elders, past and present.
I would like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander peoples here today.
Facilitator notes:
Say
Before we begin, I would like to acknowledge the Traditional Owners and Custodians of the Country on which we meet today, and their continuing connection to land, sea, and community. I pay my respects to their Elders, past and present.
I acknowledge that I am facilitating this training from the lands of the [insert name] people.
I would like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander peoples here today.
Click [to go to next slide].
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DISCLOSURE LOG - FOI 24/25-0764
| OFFICIAL |
|---|
Session outline:
Overview of Eligibility Reassessment decision making
Part One: ER eligibility requirements Residence requirements (section 23) and: Disability requirements (section 24); or Early intervention requirements (section 25)
Part two: Making your decision Streamlined access, critical thinking, and communicating the decision.
Facilitator notes: Say
Welcome to this module, where we will guide you through the essential decision-making tasks for Eligibility Reassessment assessors. The module is split into two parts.
In Part One, we focus on understanding the eligibility requirements. Before getting into the decision-making process, it’s crucial to understand the requirements and the initial steps involved in assessing a participant’s eligibility. We cover the key eligibility criteria, which are listed here on the left.
In Part two, we move on to show you how to make your decision based on the evidence and information gathered, through to communicating the decision to the applicant.
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Click [to go to next slide]
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Disclosure Log - FOI 24/25-0764
Learning outcomes
This session has been designed to help you:
- develop a broad understanding of the eligibility requirements for receiving NDIS support
- build confidence in navigating the Intranet and sourcing information in Our Guidelines
- enhance your critical thinking skills while reviewing evidence
- develop an understanding of streamlined eligibility processes
- recognise the stages and outcomes of the Eligibility Reassessment process
- understand the final tasks involved in making and communicating your decision.
Facilitator notes:
Say Let’s look at our learning outcomes for today’s session. This session has been designed to help you:
- develop an understanding of access decision-making tasks
- understand the disability and early intervention requirements for accessing the NDIS.
- enhance your critical thinking skills while reviewing evidence.
- develop an understanding of streamlined eligibility processes
- recognise the stages and outcomes of the Eligibility Reassessment process
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- understand the final tasks involved in making and communicating your decision.
Click [to go to next slide]
Disclosure Log - FOI 24/25-0764
Eligibility requirements
A participant will remain eligible for the NDIS if they meet the following eligibility requirements:
- Residence requirements (section 23) and;
- Disability requirements (section 24); or
- Early intervention requirements (section 25)
Facilitator notes: Say For us to complete an eligibility reassessment, we need to have a solid understanding of these eligibility requirements. Let’s recap what they are. A participant will remain eligible for the NDIS if they meet the following eligibility requirements, as outlined in the NDIS Act:
- Residence requirements (section 23) and;
- Disability requirements (section 24); or
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- Early intervention requirements (section 25)
You will get more familiar with these requirements as we move through today’s training. Let’s start with residency requirements on the next slide.
Click [to go to next slide]
Section 24 - Disability requirements
Click [to go to next slide]
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Disclosure Log - FOI 24/25-0764
Disability requirements (s24)
(1) A person meets the disability requirements if: (a) The person has a disability due to intellectual, cognitive, neurological, sensory, physical, or psychosocial impairments; and (b) The impairment is, or is likely to be, permanent; and (c) The impairment results in substantially reduced functional capacity; and (d) The impairment affects the person’s capacity for social or economic participation; and (e) The person is likely to require NDIS supports for their lifetime.
Facilitator notes: Say
In this part, we’ll explore the disability requirements for accessing the NDIS, as outlined in Section 24 of the NDIS Act. You can see the relevant subsections on the slide.
In summary, Section 24 of the NDIS Act specifies that to access the NDIS, a person must have a permanent impairment that significantly reduces their ability to perform daily activities such as communication, social interaction, learning, mobility, self-care, or self-management. Additionally, they must require lifelong support under the NDIS.
We’ll do a range of activities aimed at building your knowledge on these requirements and your confidence in navigating the Intranet and sourcing information in Our Guidelines.
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Click [to go to next slide]
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Activities — Our Guidelines
Facilitator notes:
[Facilitator to demonstrate navigating to the correct area of the OGs noting that the website may have undergone changes. Facilitator to emphasise that OG Applying for the NDIS assists in understanding the legislation, while Leaving the NDIS explains ER.]}
Say
Now we’re going to do some activities. In these activities, you will need to navigate to Our Guidelines. | will show you how to do this now.
[Share your screen and follow the steps below whilst explaining the steps to the learners.]
- Go to the Access page on the intranet by opening a new tab on your browser, hovering over ‘Service Delivery’ and
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Selecting ‘Access’.
-
Scroll down slightly and select ‘NDIS Operational Guidelines (external)’.
-
Scroll down and select ‘Applying to the NDIS’.
-
Scroll down. You’ll see that there are 2 versions of our ‘Applying to the NDIS’ guidelines. They are ‘Applying to the NDIS’ and ‘Applying to the NDIS – Pre-legislation changes’. For these activities, we will select the first one, ‘Applying to the NDIS’.
In each activity, you will navigate to a different section within Our Guidelines, and answer several questions.
Click [to go to next slide]
Activity one - Disability requirements
Section 24(1)(a)
The person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to one or more impairments attributable to a psychiatric condition.
Facilitator notes:
Activity: Learners navigate the intranet and source information in Our Guidelines – Applying to the NDIS.
Say
Let’s begin with the Disability Requirements. For this activity, navigate to the sub-heading ‘Do you meet the disability requirements?’.
Paste in chat
- How would you explain ‘impairment’ in plain English?
- What does the Agency think about when considering a person’s disability?
- Define the following impairments: intellectual, cognitive, neurological, sensory, physical.
- True or False? Diagnostic evidence will generally be required to determine whether a person has a disability
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caused by an impairment.
How important is the cause of a person’s impairment?
[Give learners 15 mins to complete activity. Answers on next slide.] Click [to go to next slide]
Activity One - Answers
Facilitator notes:
[Bring the group back and go through their responses using the answers and additional debrief points below.] Say
Section 24(1)(a) : The person has a disability that is attributable to one or more intellectual, cognitive, neprological sensory or physical impairments or to one or more impairments attributable to a psychiatric condition.
So, let’s go through the questions!
Question 1: How would you explain ‘impairment’ in plain English?
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Question 2
What does the Agency think about when considering a person’s disability?
Question 3: Define the following impairments: intellectual, cognitive, neurological, sensory, physical.
Pause [for answers]
Answer:
- intellectual – how a person speaks and listens, reads and writes, solves problems, and processes and remembers information
- cognitive – how a person thinks, learns new things, uses judgment to make decisions, and pays attention
- neurological – how the body functions
- sensory – how a person sees or hears
- physical – the ability to move parts of the body
Question 4: True or False? Diagnostic information will generally be required to determine whether a person has a disability attributable to an impairment.
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Question 5: How important is the cause of a person’s impairment?
Pause [for answers]
A: It doesn’t matter what caused the person’s impairment, for example if they’ve had it from birth, or acquired it from an injury, an accident or a health condition.
Click [to go to next slide]
Activity Two — Disability requirements
Section 24{1}(b)
The impairment or impairments are, or are likely to be, permanent
Facilitator notes:
Say Let’s look at the next section, 24(1)(b): the impairment or impairments are, or are likely to be, permanent.
To complete this next activity, you need to refer to the sub-heading ‘Is your impairment likely to be permanent?’
Paste in chat
- True or False? A disability is, or is likely to be, permanent only if there are no known, available and appropriate evidence-based clinical, medical or other treatments that would be likely to remedy the
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impairment.
- If a disability varies in intensity, could it still meet permanence criteria despite the variation? For example –
- What evidence would you need to sight to be satisfied that the disability is permanent, or likely to be permanent?
- [Allow learners 15 minutes to complete the activity. Answers on next slide.] Click [to go to next slide]
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Activity Two - Answers
Facilitator notes: [Bring the group back and go through their responses using the answers and additional debrief points below.] Say
Section 24(1)(b): the impairment or impairments are, or are likely to be, permanent.
Question 1: True or False? An impairment is, or is likely to be, permanent only after all available and appropriate treatment options have been pursued.
Pause [for answers]
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True.
If there is a potential treatment which may reduce, or eliminate, disability related functional impacts this must be explored before the impacts are considered permanent.
However, if treatment has been explored or is in progress, and a relevant Treating Health Professional verifies the impairment will remain irrespective of the treatment outcome, permanence would be met.
This is particularly relevant for a person with a psychosocial disability who may still be receiving clinical treatment.
Question 2: If a disability varies in intensity, could it still meet permanence criteria despite the variation? For example – impairments that are of a chronic episodic nature.
Pause [for answers]
A: Yes. An impairment may also be permanent even if the severity of its impact on the functional capacity of the person, may fluctuate or improve.
An impairment might still be considered permanent due to the overall impact on a person’s life, and the likelihood of lifetime impact.
Impairments of a degenerative nature are also permanent, or likely to be, if medical / other treatments haven’t, or are unlikely to improve it.
Question 3: What evidence would you need to sight to be satisfied that the disability is permanent, or likely to be permanent?
Pause [for answers]
That:
- There are no known, available, appropriate and evidence-based treatments likely to remedy the impairment
- An impairment that varies in intensity is permanent despite the variation
- The impairment is permanent despite the fact that its functional impacts may fluctuate or improve
- Further treating or medical review is not required to demonstrate that the impairment is permanent
- No further medical or other treatment would be likely to improve an impairment that is degenerative in nature
To summarise:
- The purpose of the legislation is to rule out cases where permanency or likely permanency has not been established because the person requires further medical treatment or review before this can be demonstrated.
This does not mean that an impairment will not be permanent or likely to be permanent if it requires further medical treatment or review.
In some cases, an impairment may continue to be treated and reviewed after it has been demonstrated that is permanent or likely to be permanent.
If a relevant Treating Health Professional verifies disability-related functional impacts will remain irrespective of the treatment outcome, permanence would be met.
Click [to go to next slide]
Disclosure Log - FOI 24/25-0764
Activity Three — Disability requirements
Section 24(1)(c)
The impairment or impairments result in substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities: (i) communication; (ii) social interaction; (iii) learning; (iv) mobility; (v) self-care; (vi) self-management
Facilitator notes:
Say To answer these next questions, you need to refer to the sub-heading ‘Does your impairment substantially reduce your functional capacity?’ Section 24(1)(c): the impairment or impairments, result in substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities:
- Communication
- Social interaction
- Learning
- Mobility
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A person’s impairment is considered to result in substantially reduced functional capacity if they usually need disability specific supports to undertake activities in the areas of communication, social interaction, learning, mobility, self-care and self-management (if older than 6). What are some examples of disability specific supports?
-
Which factors does the Agency consider when deciding if a participant’s impairment substantially reduces their functional capacity?
-
How would an ERA determine if a participant’s hearing impairment leads to a substantially reduced functional capacity?
[Allow 5 minutes for learners to answer the questions. Answers on next slide.] Click [to go to next slide]
Activity Three - Answers
Facilitator notes: [Bring the group back and go through their responses using the answers and additional debrief points below.] Say
Section 24(1)(c): the impairment or impairments, result in substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities:
- Communication
- Social interaction
- Learning
- Mobility
- Self-care and
- Self-management
Question 1: A person’s impairment is considered to result in substantially reduced functional capacity if they usually need disability specific supports to undertake activities in the areas of communication, social interaction, learning, mobility, self-care and self-management (if older than 6).
What are some examples of disability specific supports?
Pause [for answers]
- a high level of support from other people, such as physical assistance, guidance, supervision or prompting
- assistive technology, equipment or home modifications that are prescribed by your doctor, allied health professional or other medical professional.
Question 2: Which factors does the Agency consider when deciding if a participant’s impairment substantially reduces their functional capacity?
Pause [for answers]
A: The Agency considers how the participant might be involved in different areas of life, like home, school, work and the community, and how tasks and actions are carried out in those contexts.
Question 3: How would an ERA determine if a participant’s hearing impairment leads to substantially reduced functional capacity?
Pause [for answers]
A: Generally, hearing loss would be considered substantial if the loss is at least 65 decibels in the better ear based on a pure tone average of 500Hz, 1000Hz, 2000Hz and 4000Hz.
It is important to note that the guideline requires us to consider substantially reduced functional capacity in relation to impairments that are permanent.
This means we need to consider whether any substantial reduction is attributable to an impairment that meets the permanency criteria.
Click [to go to next slide]
Activity Four — Disability requirements
Section 24(1)(d)
The impairment or impairments affect the person’s capacity for social or economic participation
Section 24(1)(e)
The person is likely to require NDIS supports under the National Disability Insurance Scheme for the person’s lifetime
ndis
Facilitator notes: Say
Finally, let’s refer to the sub-headings: ‘Does your impairment affect your social, work or study life?’ and ‘Will you likely need support under the NDIS for your whole life?’
We will now look at:
- Section 24(1)(d): the impairment or impairments affect the person’s capacity for social or economic participation and;
- Section 24(1)(e): the person is likely to require NDIS support under the National Disability Insurance Scheme for the person’s lifetime
Paste in chat
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Give an example of how a person’s capacity for social and economic participation may be affected?
- True or False? If an impairment varies in intensity (for example, because the impairment is of a chronic episodic nature) the person is unlikely to meet Section 24(1)(e).
[Allow 5 minutes for learners to answer the questions. Answers on next slide.] Click [to go to next slide]