Contact the participant to explain the outcome of their eligibility reassessment | FOI document library

FOI 24/25-0830 DOCUMENT 8

Contact the participant to explain the outcome of their eligibility reassessment SGP KP Publishing

                Exported on 2025-02-28 01:06:20

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SGP KP Publishing – Contact the participant to explain the outcome of their eligibility reassessment

Table of Contents

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

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

3 Review the details of the ER eligibility decision ……………………………………………………… 6

4 Create the Call task ……………………………………………………………………………………………….. 7

5 Contact the participant about the outcome of their eligibility reassessment …………… 8 5.1 Scenario 1: Revoke outcome ………………………………………………………………………………… 8 5.2 Scenario 2: Eligibility criteria change outcome ……………………………………………………….. 10 5.2.1 Log the contact attempt ………………………………………………………………………………………………… 10 5.3 Scenario 3: Maintain access outcome …………………………………………………………………… 11 5.3.1 Log the contact attempt ………………………………………………………………………………………………… 11 5.4 Complete the Call task ……………………………………………………………………………………….. 11 5.5 Send a letter to the participant …………………………………………………………………………….. 12

6 Next Steps ………………………………………………………………………………………………….. 13

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SGP KP Publishing – Contact the participant to explain the outcome of their eligibility reassessment

This article provides guidance for an access delegate to: • review the details of the Eligibility Reassessment (ER) decision • create the call task • contact the participant about the outcome of their eligibility reassessment • send a letter to the participant.

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1 Recent updates

3 October 2024 Updates to guidance: • to reflect legislation changes from 3 October 2024. • to include new section Complete the Call task • template included for emailing a manual outcome letter in PACE • Letter – Eligibility reassessment evidence request is now named Letter - Eligibility reassessment opportunity to respond.

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2 Before you start

An eligibility reassessment decision has been made using articles: • Finalise eligibility reassessment decision • Review quality feedback (QDO) if the decision is no longer eligible.

You’ve read and understood Our Guideline – Applying to the NDIS (external).

You’ve read and understood articles: • When to refer the participant for an eligibility reassessment • Understand procedural fairness and eligibility reassessment requirements • Review the referral information and complete the eligibility reassessment check • Contact attempts and unable to contact in an eligibility reassessment case • Guide - Conversation style guide.

If you are contacting the participant to inform them of an update to their NDIS eligibility during the ER eligibility check stage, use article: Contact the participant if eligibility changes at the Eligibility Check stage of an eligibility reassessment.

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3 Review the details of the ER eligibility decision

From the Person Account, select the Decisions tab.
Select the Eligibility Reassessment case in the Case Type column.
At Decision Outcome, review the outcome of the eligibility reassessment. If the decision outcome is:

o Criteria Met: go to section Create the Call task. Note: a Call task will not automatically generate in PACE for this scenario.

o Criteria Not Met: go to section Contact the participant about the outcome of their eligibility reassessment.
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SGP KP Publishing – Contact the participant to explain the outcome of their eligibility reassessment

4 Create the Call task

If the decision was to maintain the participant’s status or change their eligibility, a Call task won’t automatically generate. You must create a Call task before you contact the participant.

In the Person Account, select Cases.
Select All Cases.
Select the Eligibility Reassessment case from the list of cases.
Select the New Task tab in the Activity panel.
At Subject select Call.
At Due Date select Today.
Select Save.

Note: You must contact the participant using their preferred contact method, which can include calling.

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5 Contact the participant about the outcome of their eligibility reassessment

When contacting the participant, their nominee or child representative, make sure you follow the guidelines in article Guide - Conversation style guide.

Check the person’s preferred communication method and authorisations.
Contact the participant, their nominee or child representative using article Contact attempts and unable to contact in an eligibility reassessment case. Your actions will be different depending upon if the person answers. If:

o Successful: introduce yourself and confirm if this is a suitable time for the call. Go to step 3.

o Unsuccessful: follow guidance in article Contact attempts and unable to contact in an eligibility reassessment case. You must also record the contact attempt, go to section Log the contact attempt in the relevant Scenario below.
Complete a security check to verify you’re speaking to the correct person. Read article Consider a request for personal information, section How to complete a security check.
If the outcome you’re contacting the participant, their nominee or child representative about is to:

o revoke: the participant is no longer eligible for the NDIS. Go to section Scenario 1: Revoke outcome

o eligibility criteria change: the participant entered the NDIS under the early intervention requirements and now meets the requirements for disability. Go to section Scenario 2: eligibility criteria change outcome

o maintain access: the participant continues to meet the residence requirements and the requirements for disability or early intervention. Go to section Scenario 3: Maintain access outcome.

5.1 Scenario 1: Revoke outcome

Help the person understand what happened before you made the decision. Explain:

o you’ve decided the participant is no longer eligible for the NDIS o we offered a reasonable opportunity to give further information showing the participant continues to meet the eligibility requirements

o the date we sent Letter - Eligibility reassessment opportunity to respond. Note: This was previously called Letter – Eligibility reassessment evidence request.

o if relevant, when we granted the participant more time to give evidence.
Help the person understand how you made your decision. Explain:

o each piece of evidence and information you used to make your decision o what the eligibility requirements are, using Our Guideline – Applying to the NDIS (external)

o why the participant no longer meets the eligibility requirements and how the evidence and information you used shows this.
Help the person understand what happens next. Explain:

o if they disagree with your decision, they can ask for an internal review within 3 months from the letter date. This will be completed by someone who wasn’t involved with making the original decision
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SGP KP Publishing – Contact the participant to explain the outcome of their eligibility reassessment

  o   they'll receive a letter which explains your decision and more information about
        the participant's review rights

  o  you can help them understand how to request a review using Our Guideline –
       Reviewing our decisions (external)

  o     if the participant chooses to review the decision, they will not be able to reapply
          for the NDIS until the review is complete

  o  your decision takes effect 28 days from the date the decision is made
  o   after 28 days, the participant can no longer use NDIS funds to purchase NDIS
        supports. This is because the participant is no longer an NDIS participant

  o  access to the my place Participant Portal will end 180 days after they are no
        longer a participant. If the participant's NDIS plan had self-managed funding,
       they will need to contact their providers and pay these accounts within 90 days.
       Providers can only claim for supports received before the date the participant
       leaves the NDIS

  o   the participant's my NDIS contact or provider can support them with their
       connections to community and government support, as they prepare to leave
        the NDIS.

4. Use article Log an activity or internal note to log the contact attempt in the Eligibility Reassessment case. In the Comments section, use the relevant template. If the contact attempt was:

  o  successful: use the template below, then go to section Send a letter to the
        participant.

Revocation – successful contact attempt comment template

Revocation decision made on .

Phone call made to <Person/Authorised Representative> to advise that the eligibility requirements have not been met, and that a decision has been made to revoke <Participant’s> status as a participant.

     I explained the requirements the participant didn't meet with reference to their
    relevant supporting information.

     I advised the person that the decision takes effect 28 days from the date of the
    decision. After 28 days, the participant can no longer use NDIS funds to
  purchase NDIS supports. This is because they are no longer an NDIS
     participant.

     I advised the person that access to the myplace Participant Portal will end 180 days
     after the date of the letter. Providers must complete all payment requests within
    the 180 days. After this time, providers will not be able to make any further
    requests. Providers can only claim for supports received prior to the date the
     participant leaves the NDIS.

     I advised the person that the participant's my NDIS contact can support them, as
   they prepare to leave the NDIS.

     I advised the person of their review rights.

  o  unsuccessful: use the template below, then follow guidance in article Contact
       attempts and unable to contact in an eligibility reassessment case.

Revocation - unsuccessful contact attempt comment template

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SGP KP Publishing – Contact the participant to explain the outcome of their eligibility reassessment

<First/Second/Third> phone call attempt made to <Participant/Authorised Representative>, on all available numbers, to advise that the eligibility requirements have not been met and a decision has been made to revoke <Participant’s> status as a participant.

 Call not answered.

5.2 Scenario 2: Eligibility criteria change outcome

Help the person understand the outcome. Explain:

o the participant joined the NDIS under the early intervention requirements o you’ve decided the participant now meets the disability requirements o each piece of evidence and information you used to make your decision o what the disability requirements are, using Our Guideline – Applying to the NDIS (external)

o why the participant now meets the disability requirements o the participant’s my NDIS contact will let them know if any changes are needed to their current NDIS supports

o how to connect with the participant’s my NDIS contact if they have questions about their plan or funding.

5.2.1 Log the contact attempt

Log this interaction, in the Eligibility Reassessment case, using article Log an activity or internal note.
In the Comments section, use the relevant template. If the contact attempt was:

o successful: use the template below, then go to section Send a letter to the participant.

Eligibility criteria change - successful contact attempt comment template Phone call made to <Participant/Authorised Representative> to advise them that a decision has been made to update the participant’s eligibility criteria based on the available evidence.
```
   <Participant's> eligibility criteria has been changed from early intervention to
       disability.

   <Details of conversation>.
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o unsuccessful: use the template below, then follow guidance in article Contact attempts and unable to contact in an eligibility reassessment case.

Eligibility criteria change - unsuccessful contact attempt comment template <First/Second/Third/> phone call attempt made to <Participant/Authorised Representative> on all available numbers, to advise them that the participant’s eligibility criteria has been changed from early intervention to disability.
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     Call not answered.

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SGP KP Publishing – Contact the participant to explain the outcome of their eligibility reassessment

5.3 Scenario 3: Maintain access outcome

Help the person understand the outcome. Explain:

o based on the available information, you’ve decided the participant is still eligible for the NDIS

o the information and evidence we used to decide the participant is still eligible o the participant’s my NDIS contact will let them know if any changes are needed to their current NDIS supports

o how to connect with the participant’s my NDIS contact if they have questions about their plan or funding.

5.3.1 Log the contact attempt

Log this interaction, in the Eligibility Reassessment case, using article Log an activity or internal note.

In the Comments section, use the relevant template. If the contact attempt was:

o successful: use the template below, then go to section Send a letter to the participant

Access met - successful contact attempt comment template
Phone call made to <Applicant/Authorised Representative> on all available
  numbers, to advise them that the eligibility reassessment is now complete
              .
   <Participant's> eligibility criteria has been maintained

   <Details of conversation>.

o unsuccessful: use the template below. Then follow guidance in article Contact attempts and unable to contact in an eligibility reassessment case.

Access met - unsuccessful contact attempt comment template
   <First/Second/Third/> phone call attempt made to <Participant/Authorised
  Representative>, on all available numbers, to advise them that the eligibility
  reassessment is now complete.

     Call not answered.

5.4 Complete the Call task

Once you have completed all required contact attempts, or you have made contact:

Navigate to the Eligibility Reassessment case. Select Case Activity.
Under Open Activities: Select either

o Call the participant to explain the outcome of their eligibility reassessment task

o Call task.
Select Edit.
At Activity Type select Internal Note.
Copy and past the relevant scenario Log contact attempt template into Comments.

In Status, at Additional Information, select Completed from the drop-down options.

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Select Save. The task is now closed.

5.5 Send a letter to the participant

You must send a letter to the participant with the outcome of the eligibility reassessment. There are different letters depending on the outcome.

If the eligibility reassessment outcome is no longer eligible:

o Send Letter - Outcome after eligibility reassessment – leave. Go to article [[Send a manual letter](/foi-library/releases/0f965ec93d25-foi-24-25-0883-disclosure-log-documents/document-010__send-a-manual-letter/)](/foi-library/releases/0f965ec93d25-foi-24-25-0883-disclosure-log-documents/document-010__send-a-manual-letter/).
If the eligibility reassessment outcome is access met or eligibility criteria change:

o Send Letter – Outcome of eligibility reassessment – stay. Go to article Send a manual letter.

When following steps in article Send a manual letter section Send a manual letter via an email in PACE:

o In the Subject text field, enter the following template:

 NDIS Eligibility – Correspondence from the National Disability Insurance
  Agency (NDIA) | <Participant Name> - <NDIS Number>

o In the message body text field, enter:

  Dear <Participant/Representative first name>,

   Please find attached a letter from the National Disability Insurance Agency.

   Kind regards,

     <First Name, Last Initial>
   Delegate of the CEO
   ELIGIBILITY REASSESSMENT
    National Disability Insurance Agency

My Branch Manager: Cassie Hammond

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6 Next Steps

If the eligibility reassessment outcome was:

o revoke: the QDO will manually assign the Leaving the NDIS case to the my NDIS contact.

o eligibility criteria change: A task will automatically generate for the my NDIS contact to contact the person and check if a plan reassessment is required.

o maintain access: no further action is required.
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