DOCUMENT 3

Review the referral information and complete the eligibility reassessment check

SGP KP Publishing

Exported on 2025-03-03 22:07:17

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SGP KP Publishing – Review the referral information and complete the eligibility reassessment check

1 Recent updates …………………………………………………………………………………………………….. 4

2 Before you start …………………………………………………………………………………………………….. 5

3 Complete a review of the referral information and available evidence …………………….. 6 3.1 Review the referral information. …………………………………………………………………………….. 6 3.2 Check and link all available evidence relating to eligibility …………………………………………. 6

4 Complete the ER eligibility check ………………………………………………………………………….. 7

Table of Contents – 2

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SGP KP Publishing – Review the referral information and complete the eligibility reassessment check

This article provides guidance for an access delegate to:

complete a review of the referral information and available evidence
complete the eligibility reassessment (ER) eligibility check.

Recent updates – 3

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SGP KP Publishing – Review the referral information and complete the eligibility reassessment check

1 Recent updates

3 October 2024

Guidance updated:

to reflect legislation changes from 3 October 2024.
to ensure the Procedural Fairness Checklist occurs prior to following guidance in this article.
new section added: ‘Check and link all available evidence relating to eligibility’
new Note for those who joined the NDIS under an NSW prescribed program.

Recent updates – 4

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2 Before you start

You have read and understood:

Our Guideline - Leaving the NDIS (external) section Are you still eligible for the NDIS
Our Guideline – Applying to the NDIS (external)
the eligibility reassessment requirements by reading article When to refer the participant for an eligibility reassessment.

Using article Accept a case from the eligibility reassessment queue and complete procedural fairness check, you have:

accepted a case from the eligibility reassessment queue
answered No to all Procedural Fairness Checklist questions in the Eligibility Check tab.
Check there are no active Administrative Appeal Tribunal (AAT) orders for Eligibility Reassessment. If there’s an active AAT Eligibility Reassessment order DO NOT proceed, speak to your Team Leader.

Before you start – 5

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3 Complete a review of the referral information and available evidence

3.1 Review the referral information.

Select the Referral tab in the Eligibility Reassessment case.
Check why the case was referred.
Check if the participant:
- may not meet the residence requirements: assess the residence.
  
  Note: If the participant joined the NDIS under one of the NSW prescribed programs, only consider the disability and early intervention requirements. Do not consider the residence requirements.
- may not meet the requirements for disability, early intervention or both: assess the early intervention and disability requirements.
- may continue to meet the eligibility criteria and have a change in eligibility status: assess the disability and early intervention requirements.
Select Evidence tab and review the linked evidence to check the justification for referral. See article Review supporting evidence for an eligibility reassessment referral.

3.2 Check and link all available evidence relating to eligibility

To make an accurate decision, you must review all available evidence relating to eligibility.

Check for outstanding evidence related to the participant’s eligibility including:
- Checking for relevant emails in the Enquiry inbox.
- Internal notes (Administrative Appeal Tribunal (AAT) and SAP CRM evidence)
- Eligibility Reassessment case under Documents tab
- Person Account under Document and under My Profile then Evidence tabs
- related Enquiry case (if relevant)
- participant’s SAP CRM record Inbound Documents (if relevant).
If the evidence isn’t already in the eligibility reassessment case, you must link it to the case Evidence tab. Use article Upload evidence to support an eligibility reassessment (ER) case, section Upload evidence to support the eligibility reassessment case.

Note: You don’t need to upload documents in SAP CRM to PACE.

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4 Complete the ER eligibility check

When you’re confident that you understand the case history:

Select Eligibility Check tab and complete the steps.

Note: Do not select Back at any point, as this may prevent the case from progressing. If you need to make changes during the ER Eligibility Check tab, contact your team leader for support. They will check whether Back can be selected, and if not, raise an ICT ticket to resolve this.
At Impairment Assessment select the primary and secondary impairments.
At Does the Reassessment Impairment belong to list A, B or D? Select the response using information from:
- Our Guideline – Applying to the NDIS (external) Appendices
- Review supporting evidence for an eligibility reassessment referral.
Select Next.
At Residence Section 23 Sub Criterion answer all questions. If the referral checklist didn’t indicate the participant may not meet the residence requirements, select N/A.

Note: At questions Is the participant currently living in Australia? and Is the participant an Australian citizen or a current Eligible visa holder?, select N/A if the referral indicated the participant may not meet the residence requirements and the participant joined the NDIS under a NSW prescribed program.
If the participant is 7 years or older complete Disability Section 24 Sub Criterion. Select Yes or No for all criteria.

Note: Due to NDIS Amendment (Getting the NDIS Back on Track No. 1) Bill 2024, section 25(3) and section 24(1)(e) will not be correctly reflected in PACE. You will still need to select whether this requirement is met or not by selecting Yes or No in the System. You will be advised later in this article to record an Internal Note explaining that you have applied the correct version of the legislation.
If the participant is younger than 7 complete Early Intervention Section 25 Sub Criterion. Select Yes or No for all criteria. If you respond No, select the justification.

Note: You will be advised later in this article to record an Internal Note explaining that you have applied the correct legislation.
Review the recorded Sub Criterion and Overall Criteria Summary and select Next.
At Access Disability Change, are you updating the primary impairment? If:
- No, select Next.
- Yes, complete the options. Updating the Primary Impairment will update the person account automatically. The existing primary impairment will become a secondary impairment in the person account. If you need to update the secondary impairment, update this in the person account. See article Update a person account. Select Next.
Complete the Summary, Decision and Justification screens. If the result is not correct at any of these screens, please do not select Back, contact your team leader for support.
At Evidence, Select Justification, select the first section of the legislative criteria that is being checked.
For the following mandatory questions, add the evidence used to decide whether or not an eligibility reassessment is required:

At Evidence name enter the name of the evidence.

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At Evidence Link select the relevant evidence linked to the case. If the evidence is not appearing in the drop down list, upload and link the evidence using section Check and link all available evidence relating to eligibility.
At Explanation use the following template for each piece of evidence:

<from/with> <Title and person’s name> dated .

Select Next.
For an access not met ER eligibility check outcome, check for any internal notes in the Access Decision case to see whether access was granted through the Administrative Appeals Tribunal (AAT). Use article View the Person Account Timeline to find relevant internal notes. If:

access was granted through the AAT, speak to your Team Leader about how to proceed.
there are no related internal notes, continue to step 15.

If the ER Eligibility Check outcome is:

access not met: An eligibility reassessment is required. The case will go to the Eligibility Reassessment Hold Queue. Contact the participant to notify them of the eligibility reassessment using article Notify the participant about an eligibility reassessment.
access met: the case will close.

Note: Maintain access decision do not require a contact attempt. End of process.
access disability change: the case will close. If the eligibility criteria was updated from early intervention to disability, contact the participant to notify them. Use article Contact the participant if eligibility changes at the Eligibility Check stage of an eligibility reassessment.

Note: Delegates are advised to contact your Team leader for support if they need to make changes to the decision after they have entered it into the Eligibility Reassessment (ER) Outcome tab.

Record an internal note using article Log an activity or internal note. Use the below template:

Eligibility Reassessment legislative decision The Eligibility Reassessment was valid for a decision on <DD/MM/YYY>. The <Eligibility Check/ER Outcome> decision has been made under NDIS Amendment (Getting the NDIS Back on Track No. 1) Bill 2024. Section 24(1)(e) and section 25(3) of the sub criterion questions incorrectly reflect the NDIS Act 2013 legislation. All external communication including letters and phone calls reflect the correct 2024 legislation.

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