Complete a plan reassessment (full)

DOCUMENT 1 FOI 24/25-0830OFFICIAL Standard Operating Procedure

For Internal Use Only The contents of this document are OFFICIAL.

Complete a plan reassessment (full)

This Standard Operating Procedure (SOP) will help you conduct a participant requested or CEO-initiated plan reassessment (full).

Note:

 In this SOP, the term participant may also refer to the participant’s child

representative, plan nominee or authorised representative.  A participant requested or CEO-initiated plan reassessment which is started more

than 100 days from the plan reassessment date is known in the NDIS Business

System (System) as an unscheduled plan review.  A CEO - initiated plan reassessment which is started within 100 days from the plan

reassessment date is known in the System as a scheduled plan review.

1. Recent updates

Date What’s changed

June 2022 Replaced language from plan reviews to plan reassessments to reflect legislation changes from 1st July 2022. Reminder that the justifications field is only able to retain 2000 characters.

May 2022 Guidance updated to remove instruction to escalate plans 10% greater than TSP

January 2022 Guidance updated to include:

 added pre-requisite to review and comply with Participant

Service Guarantee timeframe related to your task

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For Internal Use Only 2. Checklist

Topic Checklist

Pre-requisites For all plan reassessments (full): you have read Our Guideline – Changing your plan a participant requested or CEO-initiated plan review (full) application has been initiated in the System the Appointment reminder letter was sent to the participant the participant has been informed they can provide evidence for their supports at the planning meeting. You have: reviewed the participant’s preferred method of communication checked if the participant has a matter before the Administrative Appeals Tribunal (AAT). Follow the Alert information and contact the legal team at AAT Applications to obtain instructions on how to proceed checked if the participant has an active internal review (s100) request. If they do, you have contacted the Internal Review Officer for how to proceed obtained and reviewed any assessments and outcome reports for the participant read and understood the Participant Experience Delivery (PED) Key Performance Indicators (KPIs) and you are complying with the PED KPI and target relevant to this task reviewed the Participant Service Guarantee and are complying with the response timeframe related to your task

For CEO-initiated plan reassessments (full) which started within 100 days of the plan reassessment date:

the pre-check for the plan reassessment check-in has been completed the plan reassessment check-in is underway using the Standard Operating Procedure – Complete CEO-initiated plan review check-in within 100 days of plan review date.

For participant requested or Agency initiated reassessments (full) which started more than 100 days of the plan reassessment date:

the participant is aware of the plan reassessment process

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Topic Checklist

 the participant was sent the Letter – Plan reassessment confirmation (Agency initiated) for a CEO-initiated reassessment more than 100 days from the plan reassessment date.  a National Reassessment Officer (NRO) delegate has made a decision on a Participant Review Request (PRR) resulting in a participant requested plan reassessment. You have read any notes or interactions in the Plan Review Request.

Actions  3.1 Prepare for the plan reassessment (full)  3.2 Complete Pre-Planning tasks  3.3 Complete Planning tasks  3.4 Next steps

3. Procedure

To complete a plan reassessment (full), you must make sure all Pre-Planning and Planning tasks are completed. You need to tell the participant all aspects of their plan will be reassessed.

If you make the decision to change the plan reassessment type, follow the instructions in Standard Operating Procedure – Cancel a plan reassessment application.

3.1 Prepare for the plan review (full)

1. In Pathway select the Review Application with a status of In Progress.

3.1.1 Review the participant’s budget

1. Navigate to the Budget screen to review the utilisation of funds in the previous plan.

2. Select the Approved Plan. Review the amounts in the following fields:

 Approved Funds

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For Internal Use Only  Allocated Funds (the amount allocated to service bookings)  Spent Funds (the actual use of funded supports)  Available Funds.

3. You must also review plan utilisation information in Panda and Panda Live.

4. Consider if plan utilisation is outside of the expected range. If so, a change may be required to the level of supports.

5. Review Interactions in the System for information on plan utilisation.

6. Discuss plan utilisation with the participant, where low or high plan utilisation has been identified. In your conversation discuss:

 plan implementation barriers: For example, the participant may not understand

their plan or how to use the funding allocated. The participant may need an

explanation of the role of support coordination to help in the management of their

budget categories.  plan monitoring barriers: For example, the participant may not know how to use

the myplace portal to view and monitor their plan spending.

Note: Low plan utilisation does not always mean the supports in the current plan are no longer required, or they need to be reduced. You should discuss why the participant has not been able to use their plan funding. Where the plan is over utilised it may indicate a review of the participant’s goals and informal, community and mainstream supports is required.

3.1.2 Review eligibility

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1. To check if you need to refer the participant for an eligibility reassessment, refer to SOP – Refer participant for an eligibility reassessment (ER) or access status change.

2. You should continue with the plan reassessment process while any Eligibility Reassessment takes place. The exception to this may be Early Childhood Services. Refer to the Early Childhood Services Branch page for further guidance.

3.2 Complete Pre-Planning tasks

When the review application is initiated, new Pre-Planning tasks will be automatically created to develop the new plan. Review and update the Pre-Planning tasks so you have a good understanding of the participant’s current supports, needs and progress towards their goals.

1. From the NDIS Account select Disabilities.

2. Review the participant’s primary disability and any secondary disabilities. The primary disability must be the one with the greatest functional impact. For example, the disability which reduces the participant’s capacity the most.

Update the participant’s primary disability if required. If you do not have the required delegation, submit a request to change the disability. Refer to Standard Operating Procedure – Add or change disability.

3. Navigate to the Pre-Planning page.

4. Complete the Pre-Planning tasks with the participant, including updating information about the participant’s current:

 situation and goals  supports from family members, carers, friends and community and mainstream

services  disability compensation status.

For more guidance on completing the Pre-Planning tasks, refer to the Pre-Planning page.

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For Internal Use Only 5. Complete the WHODAS or PEDI-CAT task using the Standard Operating Procedure – Complete the update the severity tools task or Standard Operating Procedure – Complete the WHODAS. Information will pre-populate from the previous plan.

Note: This step does not need to be completed if an impairment specific Severity Indicator Tool has been completed and recorded in the System.

6. From the NDIS Account screen select Streaming to determine whether re-streaming is required. If re-streaming is required, refer to the Standard Operating Procedure – Update participant streaming.

7. Create an Interaction to record the details of the review conversation:

 For participant requested or CEO-initiated reassessments which started more than

100 days from the plan reassessment date use the Interaction Templates –

Changing your plan – Plan reassessment conversation for CEO-initiated plan

reassessments more than 100 days from plan reassessment Interaction.  For CEO-initiated plan reassessments started within 100 days of the plan

reassessment date use the Interaction Templates – Changing your plan - Plan

reassessment conversation – plan reassessment (full) within 100 days of plan

reassessment date Interaction.

3.3 Complete Planning tasks

1. Navigate to Panda and Panda Live and review the National In-kind Listing Report to identify whether the participant is receiving in-kind supports. Consider these supports as part of your reasonable and necessary decision-making.

3.3.1 Complete the Determine the Funded Supports Task

1. In Planning, select Determine the Funded Supports task.

2. Determine the level of funded supports required in the new plan. For more information refer to Our Guideline – Reasonable and necessary supports.

Note: For participants with high intensity supports in the Core budget, refer to Standard Operating Procedure – Add self-care and community access supports.

3. Include reasonable and necessary supports using Standard Operating Procedure – Complete the determine the funded supports task.

 Make your decision in accordance with section 34 of the National Disability Insurance Scheme Act 2013.

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For Internal Use Only  Include your justification when the plan is submitted or finalised

Note: The justifications field has a limit of 2000 characters.

4. Manually adjust the Capital and Capacity Building budgets for plans other than 12 months duration using information in 3.3.2 Plan duration and pro-rata of Capital and Capacity Building funds.

5. Provide evidence and justifications if you adjust the System generated TSP. Where available, attach supporting evidence from a relevant professional as an Inbound Document in the System. Record your justifications in the Review and Submit Plan for Approval task.

6. Go to 3.3.3 Complete the remaining Planning tasks.

3.3.2 Plan duration and pro-rata of Capital and Capacity Building funds

1. Consider the participant’s individual circumstances and adjust Capital and Capacity Building supports to meet their needs. Some Capital and Capacity Building funding cannot be decreased.

Note: If you select Per Week in the Support Calculator the Frequency will calculate to the whole number without rounding up. For example, a 365 day plan is 52.14 weeks. This means the Frequency default calculation will be 52 instead of adjusting to 53. This change will happen automatically when you use the Generate Support Plan button.

If you have not used the Generate Support Plan button, you must check the value in the Frequency field. You must re-enter the support items where the value has not calculated correctly.

2. Select Capital and review the supports. You will not need to adjust a support which is only provided once. The main adjustment for consideration would be equipment rental, maintenance and repairs. Consider the participant’s circumstances and if reasonable and necessary, increase or decrease the funding according to the plan duration.

3. Select Capacity Building and review the supports. If reasonable and necessary, increase or decrease the supports as required. For example, if Capacity Building funding is required for an assessment from an occupational therapist, it is likely a time limited support. This means the participant will need the same amount of funding for the assessment regardless of the plan duration.

4. For more information on pro-rata calculations for Capital and Capacity Building supports, refer to 4.1 Plan duration and pro-rata scenarios.

3.3.3 Complete the remaining Planning tasks

1. Select Determine Plan Management task. Review the participant’s plan management choice and record the rationale for the proposed plan management option.

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For Internal Use Only 2. Complete the Pre-Select Provider(s) for Quotable Item(s), if required.

Completing this task must not delay developing and approving the participant’s plan. This task will appear when there are quotable items in the participant’s funded supports. It will be locked in the System until Determine the Funded Supports and Determine Plan Management tasks are completed.

3. Do not select or submit service bookings in the Restart Service Bookings task.

4. Select the Review and Submit Draft Plan task.

5. Complete this task using the Standard Operating Procedure – Review and submit plan for approval.

Note: For the plan reassessment (full), the delegate may not agree with the reasonable and necessary supports and a Plan Alignment Meeting (PAM) may be required. To decide whether a PAM is needed, you should follow the process outlined in Standard Operating Procedure – Prepare for the plan alignment meeting.

6. Plan delegates complete the Finalise Plan and Approve task using the Standard Operating Procedure – Finalise and approve a plan. This includes whether the plan and System generated letter is sent to the participant or you Generate Plan Only.

 Make sure the Partner in the Community (PiTC) or support coordinator is notified the

plan reassessment (full) has been completed. They will support the participant to

contact their service providers.

 If the participant does not have a PiTC, advise the participant their current service

bookings will end when their new plan is approved. They will need to contact their

service providers to:

• let them know a new plan is in place

• negotiate a new service agreement

• create service bookings for the new plan.

3.4 Next steps

When the participant’s plan reassessment (full) is approved:

1. Complete the plan implementation steps using Standard Operating Procedure – Complete the implement the plan task.

2. Complete the provider quotations task if:

 the Pre-select Providers for Quotable Items task was not completed during the

planning process, or

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For Internal Use Only  there are funded support items within the new plan which require a quote (the quote

required box is ticked).

3. Advise the participant:

 of the supports approved in their plan  how the decision was made in accordance with section 34 of the NDIS Act  we will send their new plan by their preferred method of communication  of their right to submit an internal review of the decision within 3 months of receiving

the plan  service bookings need to be re-established with providers. Payment requests for the

previous plan dates can be submitted in the myplace portal by the participant or the

provider for 90 days after the service booking end date.

4. Appendices

4.1 Plan duration and pro-rata scenarios

4.1.1 Capital supports

 Example 1

If the participant uses a wheelchair, consider the age of the equipment and any

maintenance schedules. This will help you determine the need for repair and

maintenance during the plan duration or replacement costs. Adjust the funding as

required. Refer to Our Guidelines – Assistive technology on the NDIS website and

Assistive Technology guidance on the Planning resources page.

4.1.2 Capacity Building

 Example 1

Support coordination is usually ongoing (weekly or monthly) so will require adjusting.

Divide the allocated funding by the number of months by 12 (and multiply by the

number of months in the new plan). If the funding generated for support coordination

is $2400.00 and the new plan duration is 24 months:

$2400.00 divided by 12 months (CB funding generates at 12 months) = $200.00

$200.00 x 24 months (length of new plan) = $4,800.00.

Replace the amount in Support Category with the new pro-rata amount.

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For Internal Use Only  Example 2

Support connection is a time limited support, usually funded for around 12 hours for

a 12-month plan. A shorter plan may not need this many hours. Consider how many

supports the person needs to connect to in the timeframe when making your

reasonable and necessary decision. Adjust the funding as required.  Example 3

You chose a 6 month plan duration. There is funding in Capacity Building for 12

hours of occupational therapy aimed at building independence in living skills, and

funding in Capital for a manual wheelchair. The participant will need the same

amount of funding for these supports in order to meet their goals regardless of the

plan duration, so you would not adjust the funding.  Example 4

You chose a 24-month plan duration. There is $7,000 funding generated in Capacity

Building for support coordination. You will need to adjust the funding to reflect 24

months of support coordination. Funding must be in line with the appropriate support

coordination level as guided in the Standard Operating Procedure – Include support

coordination in a plan.

5. Related procedures or resources

 National Disability Insurance Scheme Act 2013 – Section 48 (external)  Our Guideline – Changing your plan  Standard Operating Procedure – Support tool to determine CEO-initiated plan

reassessment type within 100 days of plan reassessment date  Standard Operating Procedure – View or edit an open request for internal review  Standard Operating Procedure – View, edit or withdraw a plan review reassessment  SOP – Refer participant for an eligibility reassessment (ER) or access status change  Interaction Templates – Changing your plan  Standard Operating Procedure – Add self-care and community access supports  Standard Operating Procedure – Add or change disability  Standard Operating Procedure – Include support coordination in a plan  Standard Operating Procedure – Complete the risk assessment task

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For Internal Use Only  Practice Guide – Early Childhood plan reviews  Standard Operating Procedure – Add, check or change a my NDIS contact  Standard Operating Procedure – Complete the participant statement  Standard Operating Procedure – Update participant streaming  Standard Operating Procedure – Monitor the plan budget  Panda and Panda Live  Standard Operating Procedure – Complete the determine the funded supports task  Standard Operating Procedure – Review and submit plan for approval  Standard Operating Procedure – Initiate and record quotes  Standard Operating Procedure – Prepare for the plan alignment meeting  Standard Operating Procedure – Finalise and approve a plan  Standard Operating Procedure – Complete the implement the plan task  Conversation Style Guide  Standard Operating Procedure – Cancel a plan reassessment application

6. Feedback

If you have any feedback about this Standard Operating Procedure, please complete our Feedback Form.

7. Version control

Version Amended Brief Description of Change Status Date by

1.0 CW0032 Class 2 approved. APPROVED 2021-03-15

LS0042 Endorsed by State Manager NSW/ACT, National Delivery on 29 March 2021.

Updated guidance for:

 completing the WHODAS or PEDI- CAT in the System

 when to Generate Plan Only.

Includes updated language to support Our Guideline – Plan Reviews.

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Version Amended Brief Description of Change Status Date by

Class 2 – Approval

Included guidance for:

 the mandatory checking of ongoing 2.0 BM0056 APPROVED 2021-07-27 eligibility to the NDIS

 referral for an eligibility reassessment where required.

Class 1 approval

Guidance updated to add pre-requisite to 3.0 JS0082 review and comply with Participant APPROVED 2021-12-20 Service Guarantee timeframe related to your task.

Class 1 approval 4.0 JS0082 Guidance updated to remove instruction APPROVED 2022-04-27 to escalate plans 10% greater than TSP.

Class 2 approval

Guidance updates to include legislation changes being introduced from 1st July 2022. 5.0 CW0032 APPROVED 2022-06-30 Updates also include reminder that plans are unable to be approved when justifications are greater than 2000 characters.

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