ndis’ Standard Operating Procedure

For Internal Use Only

The contents of this document are OFFICIAL.

Complete a Planning Internal Review Decision

This Standard Operating Procedure (SOP) will help you to make timely and quality decisions consistently by explaining:

The key actions and pathways to make an s100 decision
When to communicate with participants or their representatives
How to give effect to your decision
How to return the participant into the regular review cycle

Note: All references to “participant” in this document also refers to authorised representatives/nominees/child representatives.

Recent updates

Date	What’s changed
September 2022	Added Content:
Initial contact required when the Acknowledgement letter time frame of 14 days has not passed.
Steps included about plan inflation and when to seek EL endorsement. Change from 40% to 50% or more inflation for endorsement by Assistant Director and 100% or more inflation of plan for endorsement by Director.
Initial contact required for all s100 requests where a participant funding has been reduced by more than 20% in the most recent plan. Call required if decision reduces plan funding by more then 20%
March 2022	Added Content:
Document pre contact SMS was sent.
Check for update to disability.
Pre-requisite added for change to section 100(5) of the Act.
Naming convention for the decision letter.

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Date	What’s changed
	APS5 IROs and those without delegation must seek team leader support before contacting TAB.
Changes to the mid cost AT and linked to the AT SOPs.
Amended Content:
At section 4.5 if the plan is inflated more than 50 percent a discussion is required, this has changed to 40 percent.
Updated workflow rules link to IRT page.
Wording at section 4.12 – complete remaining closure tasks.
Added in wording to reflect IROs without delegation are making a recommendation.
Linked to the new HDD SOP for new approval process.

Checklist

Topic	Checklist
Pre-requisites	You have:

Not been involved in the making of the original decision that is being reviewed. The internal review must be completed by a different delegate.
Role delegation or skill tags to access and modify review items on the Business System (system), for example, the s100 form. Otherwise, access to a Team Leader.
Access to the intranet to view linked SOPs and templates.
Read and considered the available Service Delivery Resources on the intranet, particularly in regards to Pre-planning, Planning and Review before assessing requested supports.
Identified intake has been completed and you are familiar with the Intake of a Planning Internal Review Request Standard Operating Procedure and Managing Miscategorised Internal Review Requests Standard Operating Procedure.
Allocated the work item to yourself following all steps in the Self Allocation on the System Standard Operating Procedure |

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ndis’ Standard Operating Procedure

For Internal Use Only

Topic	Checklist
	Familiarised yourself with Contact Process Standard Operating Procedure
	Familiarised yourself with the Escalation and Prioritisation Matrix

Actions	4.1 Conduct a desktop review
	4.2 Determine if contact is required
	4.3 Make a decision for the internal review request
	4.4 Make a preliminary decision on plan duration
	4.5 Submit a decision outcome
	4.6 Build the new plan
	4.7 Approve the new plan
	4.8 Record the Decision Outcome
	4.9 Prepare the decision letter
	4.10 Send decision letter and relevant documents
	4.11 Inform National Delivery or Partners in the Community of decision made.
	4.12 Complete remaining closure tasks

	Appendix A - Assigning a Review Application or Interaction for action by ND and PiTC

Scope of Review

Background

The intent of an internal review is to reconsider a decision by ‘standing in the shoes of the original decision maker’. This means reviewers will usually consider if the original decision made, was correct under the law based on the participant’s situation and support needs at the time of the original decision. The internal review team will seek to review the request based on the issue/s at hand, and confine the scope of the review to those issue/s that the participant wishes to raise as part of their request. If there are dependencies or related issues, these will also be considered. For further guidance on what is in scope for an internal review refer to the Principles of s100 Planning Review guidance.

Referrals to other teams

The Home and Living Team complete internal reviews that includes at least one of the following review types (noting the Home and Living Team will then conduct the entire s100):

SIL funding in dispute
SDA funding in dispute

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Medium Term Accommodation in dispute
Independent living options in dispute
Complex Home Modifications in dispute
NSW Living alone with significant supports in dispute

The Review of Reviewable Decision (RORD) form or supporting information on the s100 work item should identify the above supports are what is being disputed. Refer to any interactions on the record for any Home and Living applications and read file alerts. If you are unsure, please confirm with your team leader.

If you have been assigned a s100 work item and the request is a dispute as listed above, and you have not yet commenced the review, complete the following steps:

In the IRT Database, identify the case in the review screen using the browse all cases button and close the record by entering in the Outcome as Referral - Housing.
Assign the s100 work item to Melinda Fuller in the system.

Procedure

Conduct a desktop review

Finding and uploading documents

As you review existing documents throughout the process of making a decision make sure those documents are linked to the s100 form. If they are already in inbound documents under a different line, you will need to link the document to the s100 form before reaching an outcome.
The participant has been given an opportunity to provide evidence both at the time they submit the request and since the acknowledgement letter was sent. Check that it has been 10 calendar days since the acknowledgment letter was sent so the participant has had the opportunity to provide any additional evidence before progressing with this review.
When you are reviewing a request and receive further information, this must be added to inbound documents under the line titled “s100 internal review request dd/mm/yyyy”.

Note: When uploading a document please follow this naming convention style:

Participant Surname First Name NDIS number Topic/Document Name. For example Smith James 4312345678 Occupational Therapist Report July 2021, or Smith James 4312345678 Unable to Contact Letter.

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Review the category and requested outcomes

Review the s100 Form or the Review of Reviewable Decision Form in Inbound Documents and the intake interaction and determine:

The category of s100 review being requested (for example, a s100 on a statement of supports, or on a decision not to review a plan).
Why the participant has made the request and the outcomes they are seeking. For a review regarding statement of supports, identify the specific details of the request, including the requested frequency/nature/funding value of requested supports.

Review the evidence available

Review the participant’s record for available evidence or information to support the review request. For example, assessments, reports, quotes and any interactions with the participant such as phone conversations.
Given the participant has had an opportunity to provide additional evidence at the time of the review request and following acknowledgement of the s100 it is not expected that the delegate will need to request additional available information. Additional available evidence should only be requested by delegates if it is likely to materially change the decision or there is an identified risk to the participant if we don’t fund it and we need the evidence to justify the decision. If you think additional evidence is required, follow the steps in section 4.2.
Review the participant’s record including all pre-planning and planning tasks in the current plan, justifications in the plan, the utilisation of these supports, and any other relevant interactions to develop an understanding of what was funded and why. Note: Panda Live V2 is a helpful tool to identify budget utilisation and plan value compared with TSP.
Consider whether there are opportunities for early resolution – for example, the participant’s request may be achieved simply through flexible use of the plan. Unless supports are fixed (stated) in the plan the core support budget is fully flexible. The Capacity Budget is flexible within each category across all non-stated support items. If early resolution seems likely to resolve the participant’s request, they will need to understand a withdrawal is required and what the consequences are when withdrawing their internal review. If so, withdrawal can be discussed, for contact with the participant go to section 4.2. For further information on the early resolution, criteria see Withdrawal of an Internal Review Request Standard Operating Procedure.

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Review open activities to identify if there is an open Change of Circumstances interaction – Request Disability Update. If the task is open do not continue until this has been completed. This process is estimated to take 48 business hours. Seek team leader advice if this has not been actioned within this timeframe.
Consider whether the requested supports are related to the disability/disabilities recorded. If these have been updated recently the National Operations Team will have added to the s100 alert that is open. <Disability update approved/declined, NOT Delegate , dd/mm/yyyy>. If there is no change in functional capacity proceed with the s100 or if there has been a change to functional capacity since the original decision consider discussing the option of a PRR with the participant. If a PRR is required, refer to the steps in the Standard Operating Procedure – Create a plan reassessment (or variation) request (PRR).
Consider whether the approval and funding of the requested supports will have an impact on any other supports in the plan. For example, the funding of vehicle modifications may lead to the removal of transport funds. If so, this will need to be discussed with the participant go to section 4.2.

Review other details on participant’s record.

Review the participant’s record including alerts to make sure you are aware of any concerns. For example, it may be indicated the participant has complex needs or accessibility requirements and you may require the procedures from Standard Operating Procedure – Assist the Participant with their preferred method of communication.

If you identify the participant is in the Complex Support Needs (CSN) pathway, contact the relevant staff member regarding the s100 review before proceeding. Their details can be found on an active alert on the file or interactions. If the staff member details are missing, email CSN. The purpose of this contact is to advise CSN the participant has a s100 internal review requested and clarify if there is any information IRT need to be advised to best support the participant with their request for internal review. Record your conversation with the CSN team on the participant’s s100 form.
If you identify the participant is in receipt of compensation and has had a Compensation Reduction Amount (CRA) applied to their plan, or special circumstances considered, please reassign the s100 work item request to the IRT Escalations Team and email redacted: s22(1)(a)(ii) - irrelevant material.

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If you identify the participant has also been waiting for Assistive Technology or Home Modifications (ATHM), take note of this as there are additional closure tasks that are required.
If you identify the participant is a YPIRAC participant or the request is in relation to any of the Home and Living categories refer to Intake of a Planning Internal Review Request Standard Operating Procedure for details on identifying those that need to be completed by another team and reallocate to that team following steps for reallocation in the Intake SOP.

After the completion of the above review of circumstances, you should have developed a preliminary view for the request(s).

Determine if contact is required

After the desktop review is completed, you need to contact the participant/authorised representative to discuss the review if the following exceptions apply:

If there is high or extreme risk identified for the participant in accordance with the escalation and prioritisation matrix
When the Acknowledgement letter time frame of 14 days has not passed. If contact is successful confirm that all information relating to the request has been received. If contact is unsuccessful, wait till day 15 to progress to making a decision.
If the participant has had their plan funding reduced by more than 20% in the most recent plan for the whole plan. Contact is required on all these s100 requests to ensure IRO has full understanding of the facts and circumstances at the time of the internal review decision.
Information provided by participant is still unclear after you have reviewed PCT, justification and interactions, and further clarity is required to progress the request.
The IRO is unable to locate or view evidence used by the Planner with the original decision and required to undertake the s100 decision.
If it appears that an early resolution is possible through a clarification phone call. Refer to Withdrawal of an Internal Review Requests Standard Operating Procedure.
The request appears to be miscategorised (refer to the Managing miscategorised internal review requests SOP to identify when a call is required).

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If the above criteria is met refer to Contact Process Standard Operating Procedure. If you are not sure if contact is required prior to progression of the s100 please refer to your line manager.

4.2.1 You can then proceed with one of the options below:

a) Determine if further information needs to be received before a decision can be made. This option is for reviews where further information is required to make a decision. Refer to the Internal Review Gathering Evidence Guide. When asking for additional evidence you need to be clear on the following:
What you are asking for and why it is needed to make a decision
Limit the request for additional evidence to what is within the scope of the review.
Confirm a time frame to return the information – a maximum of 28 days and advise the participant that if the evidence is not provided in the timeframe a decision will be made based on information available and the circumstances as they exist at the time the reviewer makes the decision. Be clear with the participant why and what you are requesting the additional evidence or information for and limit this to what is required within the scope of the review. Additional time may be allowed in exceptional circumstances if the participant cannot reasonably acquire the evidence within this time. Assistant Directors are required to approve any extension of the timeframe. This will not extend the pause process below.
Send the Internal Review Request for Information Letter to the participant and upload this document onto the system.
Inform the participant to return the evidence by emailing the documents to Internal Reviews planning and:
Inform the participant to note their full name and NDIS number in the email subject.
If required, obtain consent to speak to third parties (for example occupational therapists, physiotherapists) and document consent on the participant record.
Create an Alert on the participant’s record as per below with an end date calculated at 28 days from the day of request for information:

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Image caption: Screenshot showing a system Alert on the participant’s record. The primary box is unticked, the Alert title is ‘s100 in progress’, additional information states ‘RFI pending for s100’, the start date is 4.03.2021 and end date is 2.04.2021.

Update the Database putting the record on hold as per IRT Planning Database Manual.
If the review is for a statement of supports, enquire about their preferred plan management options for the requested supports. If you preliminary assess this preferred self-management is unable to be provided (prohibited by agency guidance, and the participant only prefers the self-management option), inform them you may record this as a declined request on the s100 review.
Confirm with the participant that as a result of the internal review decision a new plan may be created and confirm with the participant any preferences they may have regarding plan duration. Refer to section 4.4 for further information.
Inform the participant that they may be contacted again or will receive a letter with the outcome of a review request.
Proceed to section 4.3.

b) Review request can be withdrawn

This option is for participant requested withdrawals or for early resolution of requested supports achieved. Discuss the option for withdrawal with the participant and inform them of the consequences of withdrawing the internal review. Once the request to withdraw is confirmed, follow the key talking points in the Withdrawal of an Internal Review Request Standard Operating Procedure.

Record the conversation in both the s100 supporting information field and the s100 Request Received interaction using the s100 - Request Withdrawn early

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resolution interaction from the Internal Review of a Planning Request Interaction Templates.
- Once you have completed the withdrawal conversation, complete this review by following the Withdrawal of an Internal Review Request Standard Operating Procedure.

C) Review request is miscategorised

This option is for miscategorised reviews which have been confirmed after clarification with the participant. This only applies when the entire request is miscategorised. - Complete the conversation and review by following the appropriate steps in the Managing Miscategorised Internal Review Requests Standard Operating Procedure.

4.2.2 Record the conversation with participant

Record the conversation with participant, including that the pre contact SMS was sent as an interaction on the system using the s100 contact interaction template from Internal Review of a Planning Request Interaction Templates. Note: Please add your progress interactions to the s100 Request Received interaction already created during intake. This will make sure all conversations, actions, progress on the s100 are captured in the one interaction trail. Only differ from this when an open interaction is created and needs to be assigned to another team/region for action.
Make sure any specific supports withdrawn from the review (if any) by the participant have been noted on the interaction.
Record the date of contact and progress of review in the IRT Database. Make sure the participant contacted date field is completed.
If you are waiting for further information, make sure you have added an alert on the participant record and set the review in the IRT Database to on hold. Refer to section 4.2. Once the requested evidence or further information is received, proceed to the next step.

4.3 Make a decision for the internal review request

Note: For internal review officers without delegation you are making a recommendation.

The available evidence will need to be assessed to determine whether the original decision should be appropriately set aside or confirmed according to the legislation.

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Refer to the [Principles of s100 Decision Making] to support your decision making.
Consider the available evidence to build a view on the participant’s current functional capacity or circumstances. If there is conflicting information, consider which source is most credible.
Make sure any evidence or information considered in your decision is uploaded to Inbound Documents and linked to the s100 form. If evidence considered was gathered during a call, the interaction should be recorded in the “Supporting Information” field using the relevant interaction template. Follow the steps below for linking all evidence to the s100 form:

Update Supporting Information, if required.

Image caption: Screenshot of the Request Details screen on the participant record showing the supporting information field where the interaction should be recorded. 5. Select Add to add Attachments, if required (Documents already in Inbound Documents).

Image caption: Screenshot of the Attachments screen highlighted by a red box showing the plus button on the right side to attach documents. 6. Select Save.

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Image caption: Screenshot of the system Attachments screen showing a test document attached and a save button at the bottom right.

A success message displays. Select OK. Consider each request alongside the available evidence and whether it meets the legislation under the NDIS Act and relevant Rules under the Act. For example, a request on statement of supports will require consideration under section 34 (reasonable and necessary) and Part 5 of the NDIS (Supports for Participants) Rules.
An internal review request on decision not to review a plan (s.48) will require consideration of the criteria under NDIA’s Operational guidelines for s48. You do not need to assess the requested supports as your decision is whether or not the decision made not to review a plan is correct. The next step in the process for these requests is at section 4.5.
Review the Operational Guidelines – Reasonable and Necessary Supports and Would we fund it for additional guidance on making decisions on statement of supports if required.
Seek advice from your Team Leader or Assistant Director if required.
Seek specialist input from the Technical Advisory Branch (TAB) if required.

Note: APS5 Internal review officers and those without delegation must seek team leader support before contacting TAB. Check the Requesting Advice intranet page for mandatory TAB referrals. Before making a decision, it is mandatory to obtain and follow TAB advice in relation to requests for the listed mandatory items. If you disagree with the advice received from TAB, discuss first with your team leader (or equivalent) and then contact TAT enquiries who will contact the TAB Advisor or TAB Assistant Director for further discussion and resolution. Refer to the Requesting Advice intranet page for more guidance.

Consider seeking advice from the Early Childhood Services Branch if it relates to a participant who is under 7 years.
Apply any agency guidance and policy if applicable from the NDIS operational guidelines.

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Weigh the above factors to determine a set aside or confirmed decision.

Make a preliminary decision on plan duration

Note: For internal review officers without delegation you are making a preliminary recommendation on plan duration. Delegates should be guided by the Panda Live V2 recommendation of plan duration in most instances. Typically, this would be for requests that meet the following criteria. Criteria:

There are no expected life stages changes to occur for the duration of the plan
Funded supports are within TSP or the plan is not inflated by more than 10 percent of the previous plan value.

If criteria is not met, you should retain the same end date (as close as possible) and record your justification for altering the recommended plan duration when completing the Risk Assessment in Pre Planning. You will need to pro-rata funding when you build the plan. Delegates should also consider other factors when determining plan duration such as:

Keeping family groups review schedules together
Supported Independent Living (SIL) Participant groups together
Utilisation variance in previous plans
Support meets R&N for the duration of the plan and there are no time limited supports included.

If more than two of these considerations apply, speak to your Team Leader or Assistant Director regarding a shorter plan duration.

Submit a decision outcome

Once a decision has been determined, it needs to be submitted on the system. Note: If the decision being reviewed is the decision not to review a plan you will not need to follow step 2 below.

If you are an Internal Review Officer without delegation, email your Team Leader to seek approval. Wait for their approval before proceeding to section 4.6.
If the plan is inflated by more than 50 percent the decision needs to be endorsed by an Assistant Director before proceeding. If the plan is inflated by more than 100% the decision needs to be endorsed by a Director. Seeking specialist advice from TAB or ECS should be considered in these cases to support significant deviation from the V15.0 2022-09-09 Complete a Planning Internal Review Decision Page 13 of 29 This document is uncontrolled when printed. OFFICIAL Page 203 of 875

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original decision especially where no new evidence has been provided. If the advice received has been the reason for the 50% inflation or greater you are not required to seek EL endorsement. 3. Otherwise, if you have delegation to submit a decision outcome, proceed to open the s100 form for this review under open activities and select Edit.

Image caption: Screenshot of the system s100 form showing the Edit button highlighted at the bottom of the screen. 4. Update the Supporting Information stating all evidence/information supporting the decision has been uploaded to the system and linked to the s100 form. Select Save to confirm your updates.

Image caption: Screenshot of system s100 form showing the supporting information field highlighted where all evidence/information supporting the decision should be recorded. At the bottom of the form the Save button is highlighted.

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Record the outcome decision by selecting Ready to Submit outcome. Select the appropriate decision outcome as Confirm Decision or Set-Aside Decision. Do not select the Vary decision option as the system currently does not allow us to ‘vary’ plans. A plan review will be initiated for a set-aside decision.

Image caption: Screenshot of the s100 ready to submit system screen, with the Outcome Justification drop down options Confirm Decision and Set-Aside Decision each highlighted in a red box. 6. For Confirmed decisions, record a justification explaining the outcome in the Outcome Justification box. Below are examples for a review on statement of supports or a decision to not review a plan.

Review on statement of supports • s100 confirm: s100 decision made to confirm the original decision, the supports requested were not found to meet NDIS funding criteria or could not be considered as they were out of scope. See outcome letter for details.

Review on decision not to review a plan (s48) • s100 confirm: s100 decision made to confirm the original decision as it was unable to be demonstrated that; circumstances have changed, or there is new information that would change/affect our assessment of the participant’s needs, or, their needs can’t be met by existing supports. See outcome letter for details. 7. For Set-aside decisions, record a justification explaining the outcome in the Outcome Justification box. Below are examples for a review on statement of supports or a decision to not review a plan.

Note: You must include in the justification the TSP has been considered when determining reasonable and necessary supports.

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Review on statement of supports

s100 Set aside: A s100 review request was submitted on [insert date], consideration was given to s34 reasonable and necessary criteria in the NDIS Act and the NDIS Rules. TSP has been considered when determining reasonable and necessary criteria. As a result of this, a plan review was initiated to give effect to the decision to vary the current level of funding – the original budget has been set aside.

Review on decision not to review a plan

s100 decision to set aside the decision not to approve a request to review the plan under s48. A plan review is approved and has been initiated to give effect to the s100 decision.
The plan review has been initiated and now needs to be assigned for action. Follow the steps in Appendix A to assign the plan review and interaction.
Go to section 4.8

Build the new plan (if required)

If the outcome of an internal review was a ‘Confirmed decision’, ‘for an internal plan review decision’ skip to section 4.8.
A set-aside decision for a statement of supports will have a new and automatically generated Review Application under Pathway in the participant record with a status of in-progress.

Complete pre-planning tasks

Complete the pre planning tasks below as per the Standard Operating Procedure - Complete a Plan Review (light touch).

The Outcomes Questionnaire in Pre Planning must be reviewed and submitted so quotes can be implemented after the review. Occasionally this may be blanked out as the participant has moved into another age group and a different outcomes questionnaire is required. If this occurs we can still submit the outcomes questionnaire and make a note in the implementation interaction that this was not completed for the purpose of giving effect to a s100 internal review decision.
Risk Assessment/Plan Duration: Refer to section 4.5 and the Standard Operating Procedure – Complete the Risk Assessment task. Adopt the approach to make the plan the duration the same as what it was originally approved for, for example 12 months or the participant preference as indicated previously. This will mean pro-rata will not need

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To be completed. However, based on your investigations of the original plan, Panda recommendations, conversation/s with the participant, risk and/or participant’s current circumstances, you identify a shorter term plan duration approach is required, pro-rata will need to be completed to reflect the plan duration.

Note: If there is a discrepancy in plan duration calculated in the Pre Planning Risk Assessment compared to the original approved plan duration or a plan duration you have determined based on the participants circumstances and risk. You will need to adjust it accordingly for the remaining month/days while ticking the ‘Plan reviewed early or amended’ box and note it is an outcome of an internal review.

Select Review and Submit for Funded Supports and select Yes.

Complete planning tasks

Complete the Determine Funded Supports Task as per Standard Operating Procedure - Complete a plan review (light touch) noting this will be pre populated with approved funded supports from the current active plan.

Note: If the plan duration is not what the original approved plan was for, make sure the calculated supports are correct for the time period in each category, you may need to apply pro-rata to the supports. Where you do need to pro rata follow the methodology found in Standard Operating Procedure - Complete a plan review (light touch), Standard Operating Procedure – Complete the Risk Assessment, or Standard Operating Procedure – Complete a plan review (full) which provides guidance for pro rata Capacity Building and Capital Supports. All supports in the plan will need to be pro-rated even if you have not changed the level of funding in the previous plan with the exception of stated capital supports.

Special Consideration is required for some specialist plan builds, for example ECEI participants. Refer to the relevant SOPs and ECEI Practice Guide on the intranet when building their plans.
Changes to NDIA’s approach to funding supports may also have occurred since the approval of the original plan. For example, changes arising from Price Guide updates, employment support changes, SIL changes, hearing service changes and others. Make sure you are aware of any recent changes to supports by reviewing the intranet resources guidance page, and you have applied any recent updates to new and existing supports in the new plan.
Check and maintain in-kind information in the plan for relevant supports to make sure there is not duplication of funding since the generation of the TSP and phasing

Standard Operating Procedure

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out of in-kind programs. Make sure you are accessing information available in Panda Live v1 for the latest in-kind data and information.

Notes regarding SIL: If you have a plan which includes SIL, make sure you follow Standard Operating Procedure – Supported Independent Living (SIL) advice and use IRT SIL interaction templates for referencing SIL in s100 decisions. Refer to Internal Review of a Planning Request Interaction Templates.

If you intend to make changes to the SIL funding, you will need to discuss this with the SIL Assessment Team before approving a plan, as you will need the SIL assessors updated SIL recommendation to know the amount of SIL supports to include in the plan.

To make sure you receive the SIL assessor’s recommendation in time, send the interaction to the appropriate state-based SIL team CRM inbox, and if required, escalate through to the SIL Team Leader via email, and if further escalation is necessary, directly contact the National SIL Director,

The SIL Team Inbox are NSW ACT SIL, VIC TAS SIL, SA NT SIL, QLD SIL and WA SIL for assigning the open interaction to the appropriate state SIL team.

For more information refer to:

Standard Operating Procedure – Supported Independent Living (SIL) Section 4.4 for state and territory SIL CRM Inboxes. Section 6.2 - Include SIL in the participant’s plan.
SIL Intranet page for state and territory SIL teams MS Outlook contact details.
Operational Guideline – Supported Independent Living (SIL).

Note: If there are In-Kind supports as part of the plan, refer to the In-Kind intranet page for guidance, check the transition dates for the state/territory of the participant and speak to your Team Leader. Do not contact or notify the SIL Team for plans with In-Kind supports.

Any Capital Supports funding claimed in the original plan should be removed. Claimed capital supports can be determined from checking the plan utilisation (ensuring you have considered costs of repair and maintenance) or any accepted assistive technology quotes.

Note: The definition of ‘mid cost AT’ has changed from $5000 to $15000. Participants no longer need a quote for AT that cost less than $15000. The Factsheet – Understand assistive technology evidence, advice, assessments and quotes provides a general overview of the update.

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Refer to the following Standard Operating Procedures for further guidance on adding low, mid and high cost supports and repairs and maintenance for new and existing items:

Standard Operating Procedure – Add low cost assistive technology supports in a plan
Standard Operating Procedure - Add mid cost assistive technology in a plan
Standard Operating Procedure – Add high cost assistive technology in a plan and include replacement AT
Standard Operating Procedure – Add funding for repairs, maintenance, rental and trial of assistive technology

Check if the system has made an error in adding any funding for Capital Supports were not approved in the last plan, which will need to be removed. 3. Plan comments may need to be updated to reflect the supports in the new plan as a result of the decision outcome. This may also include reviewing and updating any existing comments that relate to the supports determined in scope for the internal review and removing those that no longer apply to explain to the participant what the funding is for. Comments should be written in each of the Support Categories where funded supports have been placed. A Support Category are the areas in the plan where funding/line items have been placed, for example, Consumables, Daily Activities, Social Community and Civic Participation, Transport, CB Choice and Control, CB Daily Activity, CB Relationships, Assistive Technology, Home Modifications to name a few.

Note: Plan comments will be printed in the participants plan. Refer to Standard Operating Procedure – What print’s on a plan.

Image caption: Screenshot showing comments for each support type in the Finalise Plan and Approve tab. Comments column highlighted. Example showing from top to

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bottom. First line: Support category: CB Choice and control, price: 2627.17, comment: plan management and financial capacity building - set up costs. Second line: CB daily activity, price: 5676.00, comments: support to build my skills so I can achieve all my plan goals. Third line: CB Employment, price: 7733.23, comments supports to help me find and keep a job.

Once you are satisfied you have included all reasonable and necessary supports in the plan, select Submit.
Complete the Determine Plan Management Task. This task will be pre-populated with the recommended plan management based on the responses in the Complete Risk Assessment Task. Review and confirm it reflects the plan management determined previously. Previous plan management allocations can be viewed in Panda Live v2. When making changes to the Determine Plan Management task make sure the unit of entry is percentage (not currency).

Note: If you have rejected the participant’s request for self-management of their supports, this will be considered a declined request and will need to be reflected when preparing the decision letter and communicating the decision in section 4.9 and section 4.10.

Select Submit.

Approve the new plan

Under the Planning Tab, Internal Review Officers without delegation will need to either select the Review and Submit Draft Plan or Review and Submit Plan for Approval task. Only one will be available based on your role. If you are an internal review officer with delegation, select the Finalise Plan and Approve task.

Review all sections of the Plan as per the Review Sections of the Standard Operating Procedure – Finalise and approve a plan with careful consideration to adjust the justifications (Part 5: Funded supports in the Finalise Plan and Approve task, and Part 4: Funded Supports in the Review and Submit Draft Plan task) to explain the internal review decision for those supports determined in scope for the internal review.

Note: When writing justifications we must consider: supporting information, evidence provided, lived experience, participants goals, participant circumstances and disability support needs, section 34 of the NDIS Act 2013, Part 5 of the NDIS Rules, previous budget utilisation, TSP, inflation and agency wide guidance materials.

a) If no changes are required to the support category:

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Copy the justifications from the previous plan and add “This support category was not changed as part of the s100 Internal Review Request. Justification remains the same”.

b) If changes were made to the support category: Please start each support category justification with the sentence, “As part of the s100 review, I have found these supports meet s34 reasonable and necessary criteria in the NDIS Act and NDIS Rules. I have made a decision to vary the current level of funding.”

If there are existing justifications within this support category, you will need to update the entire justification if you changed the funding making sure the following are included:

describe the support and how it relates to the participant’s disability support needs
describe how the support will help the participant work towards their goals
describe how the support meets reasonable and necessary criteria
refer to any relevant supporting evidence.

Examples to guide your written justifications are included in Appendix Write a best practice justification within the Standard Operating Procedure - Review and Submit plan for approval.

For Internal Review Officers without delegation, click on Save at the bottom of the Review and Submit Draft Plan section. Do not select Submit as this submits the plan to WLM for National Delivery staff and is not a process IRT follow. Email your Team Leader once you have prepared the draft decision letter, and note the plan and letter are ready for approval. You can now refer to section 4.8.
Otherwise, if you are a delegate, proceed to select Yes on the Generate plan only button at Part 9: Delegate after completing the Finalise plan and approve section. This option is selected to suppress the default cover letter which is sent with plan approvals, as it will be replaced by our decision letter.

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Image caption: Screenshot of Part 9: Delegate screen from the Planning; Finalise Plan and Approve system tab. Select yes on the Generate plan only. Note: Prior to selecting Approve, you can select the Print Preview button. This will display a draft copy of the plan and will allow you to proof read and view what will be provided to the participant.

Image caption: Screenshot of the buttons at the bottom of the Finalise Plan and Approve screen with Print Preview highlighted. 3. Select Delegate Approval and then select the Submit button. 4. If an Alert appears stating level 4 delegation approval is required for this plan, follow the steps outlined in section 4.7.1. 5. Once the plan has been approved, if applicable, implement any ‘Quote required line items’ required as a result of this decision outcome (except SDA). The Standard Operating Procedure – Initiate and Record Quotes and Standard Operating Procedure – Consider and action quotes provides guidance on how to implement quotations. For plans that include Supported Independent Living (SIL) funding, create SIL service booking following Standard Operating Procedure – Supported Independent Living (SIL). 6. If the result of your decision reduces the total funded supports by 20% or more the IRO is required to make contact regarding the outcome of the review to explain the decision.

Higher Delegation Approvals Process

Confirm the s100 alert is active on the participant’s record.
Refer to the Higher Decision Delegate Standard Operating Procedure for assigning plans for approval. Note: You will need to seek preliminary endorsement from your Team Leader. APS6 delegates can endorse their own plans and do not require a second level quality check.

Record the Decision Outcome

4.8.1 For Statement of Supports Decision

Record the final outcome decision in the s100 request received interaction using the s100 – Outcome Decision Statement of Supports interaction template outlined in the Internal Review of a Planning Request Interaction Templates.

4.8.2 For not to review a plan Decision

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Record the final outcome decision in the s100 request received interaction using the s100 – Outcome Decision Not to review a plan interaction template outlined in the Internal Review of a Planning Request Interaction Templates.

Prepare the decision letter

Based on the decision outcome, complete the relevant letter found on the IRT intranet page.
Follow the instructions on the respective letter template to complete the decision letter and make sure:

The date of the decision letter should be the same date the s100 review decision outcome was in effect (date you approved the plan on the system).
Approved supports should be referred in terms of support hours/quantities, rather than dollar values.
Any requests withdrawn throughout the process need to be recorded, including those where we have spoken to the participant regarding requests that do not meet the scope of an internal review.
Please do not write any more than 2 additional sentences per criteria in the Basis for Decision section. If you wish to provide detailed information on possible next steps including referrals to mainstream and/or community supports or other referrals, you can include this in the implementation interaction completed at section 4.11.
Save a copy of the completed letter as a PDF using the naming convention: Participant Surname First Name NDIS Number Decision letter. For example, Smith James 4300044567 Decision Letter.
For Internal Review Officers without delegation, email the decision letter to your Team Leader for approval. Once approved, proceed to section 4.10.
For delegates, proceed to section 4.10.

Send decision letter and relevant documents

NDIA must give written notice to the participant and/or representative of the internal review decision. If a new plan has been created as a result of the decision you will need to save or print the approved plan locally and send the plan with the decision letter. Complete the following steps:

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From Outbound Documents, save or print the approved plan locally. If you need help to do this, refer to Standard Operating Procedure – View, Print or Suppress an Outbound Document.
Send the plan and letter to the participant or their authorised representative, using their preferred method of communication.
If the participant preferred method contact is via email, use the Internal Review planning email address to send the decision letter as an attachment and use the subject line and email template below and new plan (if applicable).

Email Template for Decision Letter: Subject Line – Outcome of your Internal Review Request Participant Number Body – Please find attached to this email the outcome of your request for an internal review of a decision. Regards,

If there are accessibility requirements required for printing the written notice or any other relevant documents follow the process in the Printing plans in braille and other accessible formats guidance. Please note the financial delegate mentioned will be the EL1 of your respective team.
If there are language requirements required for printing the written notice or any relevant documents, follow the process in Practice Guide – Assisting communication.
If the documents are being posted, mail all the relevant documents above in the one envelope. Check with your local site or team leader about mailing arrangements.
Upload all the mailed documents onto the system as a PDF document in the participant’s Inbound documents line titled ‘s100 internal review request dd/mm/yyyy’. Refer to the Standard Operating Procedure – Inbound Documents for how to upload a document and naming conventions. Refer to section 4.1.1 for naming conventions.

Inform National Delivery or Partners in the Community of Decision made.

After completing an internal review for statement of supports requests National Delivery and Partners in the Community will need to be informed of the decision to implement the new plan or follow-up activities where required.

Complete the appropriate Implementation interaction from the Internal Review of a Planning Request Interaction Templates on the participant’s record on the system.

Standard Operating Procedure

For Internal Use Only

will be either the s100 Completed Change to statement of supports or s100 Completed No change to supports interaction.

Note: If you have identified alternative mainstream or community supports that should be explored you can include this in the interaction template for the local office to follow up with the participant.

Re-assign your completed interaction to the appropriate local NDIS office by following the Workflow Rules.

4.12 Complete remaining closure tasks

Record the outcome of the review in the IRT Planning Database.
You will also need to record the Original Decision Maker (ODM) feedback on the IRT Planning Database to make sure the reason for your decision is recorded in IRT’s database. This is important information that allows us to provide feedback to original decision makers. Refer to the IRT Database Manual.
End date the s100 alert created in section 4.2 by setting the end date as the day of the decision. Refer to Standard Operating Procedure – View or edit an alert for how to edit an alert.
Assign any Assistive Technology and Home Modifications (ATHM) items placed on hold by National Delivery due to an active s100, back to WLM or the Participant’s region (RTS CRM inbox). To do this:

Check interactions using the table format for any ATHM items that are open, and also search redacted: s22(1)(a)(ii) - irrelevant material (KM0054) CRM inbox for the Participant’s name and open ATHM item/s
If an open ATHM item is found, and the interaction ID starts “700” you will need to un-assign the ATHM work item back to WLM by using “User Unavailable” as a reason.
Then apply an extreme workflow identifier to the participant’s record, with an end date of 14 calendar days later. Refer to the Standard Operating Procedure – Add or remove workflow identifiers
If the open item does not start with and interaction ID of “700” you will need to reassign the ATHM interaction to the RTS inbox of the participants jurisdiction using