FOI 24/25-0830

DOCUMENT 9

Complete an eligibility reassessment referral

SGP KP Publishing

Exported on 2025-02-28 01:07:11

Page 83 of 271

FOI 24/25-0830

SGP KP Publishing – Complete an eligibility reassessment referral

Table of Contents

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

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

3 Create the Eligibility Reassessment case ………………………………………………………………. 6

4 Complete the eligibility reassessment referral ……………………………………………………….. 7

5 Contact the participant about the eligibility reassessment referral …………………………. 8

6 Next steps …………………………………………………………………………………………………………… 10

Table of Contents – 2

Page 84 of 271

FOI 24/25-0830

SGP KP Publishing – Complete an eligibility reassessment referral

This article provides guidance for a local area coordinator, early childhood partner and planner delegate to:

• create the Eligibility Reassessment case
• complete the eligibility reassessment referral
• contact the participant about the eligibility reassessment referral.

IMPORTANT: Scheme integrity officers do not need to complete the referral workflow.

Recent updates – 3

Page 85 of 271

FOI 24/25-0830

SGP KP Publishing – Complete an eligibility reassessment referral

1 Recent updates

3 October 2024

Guidance updated:

• to reflect legislation changes effective from 3 October 2024
• to incorporate content from article ‘When to refer the participant for an eligibility reassessment’, relating to completing the referral tab of the ER case.
• content relating to making the decision to refer for an ER has been moved to article ‘When to refer the participant for an eligibility reassessment’.

Recent updates – 4

Page 86 of 271

FOI 24/25-0830

SGP KP Publishing – Complete an eligibility reassessment referral

2 Before you start

You have either:

• followed steps in article [When to refer the participant for an eligibility reassessment](When%20to%20refer%20the%20participant%20for%20an%20eligibility%20reassessment) and have decided to make an eligibility reassessment referral. Start at section Create the Eligibility Reassessment case
• been notified via the Omni-Channel that an automatic Eligibility Reassessment referral has been generated.

You have read and understood:

• eligibility in Our Guideline – Applying to the NDIS (external)
• eligibility reassessment in Our Guideline – Leaving the NDIS (external)
• article [Guide -Conversation style guide appendix B](Guide%20-Conversation%20style%20guide%20appendix%20B) section Sensitive Conversations.

Before you start – 5

Page 87 of 271

FOI 24/25-0830

SGP KP Publishing – Complete an eligibility reassessment referral

3 Create the Eligibility Reassessment case

The fields within the referral workflow are dynamic and will update based on the participant’s age, residency, and disability requirements recorded in their Decisions, Justification and Evidence (DJE) framework. To check the DJE, use article [When to refer the participant for an eligibility reassessment](When%20to%20refer%20the%20participant%20for%20an%20eligibility%20reassessment), section Review the participants current access Decisions, Justifications and Evidence (DJE).

During the eligibility reassessment process you will:

• remain the my NDIS contact for the participant during this time
• continue with the plan reassessment if one is in progress
• let the participant know they can still use the NDIS supports in their plan
• help them use the NDIS supports in their plan if they need you to.

1. Go to the participant’s Person Account.

2. Select Cases tab.

3. Check for an automatically generated Eligibility Reassessment case. Has a case already been generated? If:

   • Yes: continue to section Complete the eligibility reassessment referral.
   • No: continue to step 4.

4. In the top right hand corner, select New.

5. Select Eligibility Reassessment from the case list.

6. Complete the case information.

7. Select Save.

Create the Eligibility Reassessment case – 6

Page 88 of 271

FOI 24/25-0830

SGP KP Publishing – Complete an eligibility reassessment referral

4 Complete the eligibility reassessment referral

You must link supporting evidence to support the case when routed to an access assessor.

1. Check for any information related to the participant’s eligibility in the Enquiry inbox.

2. In the Eligibility Reassessment case, select Evidence tab. Link any relevant evidence to the case using article [Add and link evidence to a case](Add%20and%20link%20evidence%20to%20a%20case).

3. Select Referral tab.

IMPORTANT: If the eligibility reassessment case was created before 19 January 2024, you must select Cancel. This will refresh the data allowing you to progress the eligibility reassessment case.

4. Complete the Residence and Early Intervention or Disability questions.

5. Review the Summary information. Select Next.

6. Review the Decision information.

7. If amendments are:

   • required, select Back- Draft decisions list, and make the amendments.
   • not required, select Justification.

8. Review the Justification. Select Next.

9. Select Done. The referral is submitted.

Complete the eligibility reassessment referral – 7

Page 89 of 271

FOI 24/25-0830

SGP KP Publishing – Complete an eligibility reassessment referral

5 Contact the participant about the eligibility reassessment referral

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

1. Check the person’s preferred communication method and authorisations. For more information about contacting the participant, read article [[[Contact attempts and unable to contact in an eligibility reassessment case](/foi-library/releases/d12c3f3ba399-foi-24-25-0830-documents-documents/document-011__contact-attempts-and-unable-to-contact-in-an-eligibility-reassessment-case/)](/foi-library/releases/d12c3f3ba399-foi-24-25-0830-documents-documents/document-011__contact-attempts-and-unable-to-contact-in-an-eligibility-reassessment-case/)](Contact%20attempts%20and%20unable%20to%20contact%20in%20an%20eligibility%20reassessment%20case).

2. 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:

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

   • 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.

   Note: The only exception is if a child is 6 or older with developmental delay. You can make an eligibility reassessment referral if you were unable to contact the family. You still need to make and record your attempts to contact the family.

3. 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.

4. Help the person understand the referral. Select the relevant talking points below:

   • During a plan reassessment, we may check to see if the participant is still eligible for the NDIS.

   • We checked, and it looks like the participant either: no longer meets the eligibility requirements; now meets the early intervention requirements; or now meets the disability requirements.

   • We call this an eligibility reassessment.

   • Eligibility reassessments are separate from plan reassessments.

   • Eligibility reassessments are completed by independent delegates. Independent delegate means a person who hasn’t made decisions about the participant’s plan or eligibility before.

   • Participants who are eligible under the early intervention requirements, have support needs that are more likely to change.

   • We’ll check each time a participant is due for a plan reassessment, whether they still meet early intervention requirements.

   • During check ins we’ll explain what information we need to decide if they are still eligible.

   • If they’ve benefitted from early intervention supports, they might have built their skills and increased their capacity, so they no longer need NDIS supports.

   • If the participant no longer meets early intervention requirements, we’ll check if they meet the disability requirements.

   • We’ll talk to families or carers before a child with developmental delay turns 6 or child with global developmental delay turns 7.

   • We’ll make sure we explain what information we need to decide if the child is still eligible.

   • If the outcome is to revoke their participant status, their plan will end 28 days from the decision date, regardless of the original plan end date.

Contact the participant about the eligibility reassessment referral – 8

Page 90 of 271

FOI 24/25-0830

SGP KP Publishing – Complete an eligibility reassessment referral

• The next steps are that a delegate will check through and consider if an eligibility reassessment is needed. You will be notified if this occurs.

5. Record your conversation in PACE using article [Log an activity or internal note](Log%20an%20activity%20or%20internal%20note), to inform the access delegate that the participant has been notified of the referral. This also means the participant doesn’t have to retell their story when we contact them.

Contact the participant about the eligibility reassessment referral – 9

Page 91 of 271

FOI 24/25-0830

SGP KP Publishing – Complete an eligibility reassessment referral

6 Next steps

Once the referral has been submitted, the case will move to In Progress and route to the eligibility reassessment queue.

An access delegate will start an ER eligibility check.

You can view the details and progress of this case from the Details tab of the participants Account.

1. If the access delegate decides the change of disability status, you’ll be notified in PACE. You’ll support the person to receive the appropriate supports.

2. If an access delegate decides the person is no longer eligible, you’ll be notified in PACE. You’ll support the person to:

   • leave the NDIS and understand our eligibility decision, using Our Guideline – Leaving the NDIS

   • understand their rights when it comes to reviews and complaints, using Our Guideline - Reviewing our decisions (external)

   • start or help maintain connections with community and mainstream supports, using Our Guideline – Community connections (external).

Next steps – 10

Page 92 of 271