Make an access decision – Post-legislation changes

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The contents of this document are OFFICIAL.

Make an access decision – Post-legislation changes

Guidance in this document is not approved for use unless you view it in PACE.

This article provides guidance for an access delegate (assessor) to:

• check legislative timeframes
• complete disability evidence
• request further information
• approve or override the streaming case
• record access decision
• submit decision for quality check
• complete access decision correspondence
• notify early childhood partner of access not met decision (developmental delay only)
• check disabilities tab (access met only)
• assign plan approval case (Motor neurone disease only).

The legislation you need to use automatically populates in the access decision case based on what is selected in the access request case.

Go to article [Complete pre-assessment of access decision](complete_pre-assessment_of_access_decision) to decide which version of the legislation and article you need to use to make an access decision.

Use this article if you need to use the post-legislation changes version of the legislation to make an access decision.

Recent updates

14 October 2024

Added link to new article Descriptions of impairments in section Decision Main Criteria.

3 October 2024

Updated guidance to:

• reflect legislation changes from 3 October 2024

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• Update title from Make access decision to make it clear to use this article when making a decision using the post-legislation changes version of the legislation.
• Remove step to consider if the person is from a defined program as defined programs no longer apply.
• To be eligible under the disability requirements, there must be evidence the person requires NDIS supports for their lifetime. NDIS supports are the services, items and equipment that can be funded by the NDIS.
• To be eligible under the early intervention requirements, there must be evidence that supports that are likely to benefit the person will be NDIS supports.
• If the age and residence requirements are met, you must consider both the disability and early intervention requirements. The person may meet both, rather than only one or the other.
• If eligible, you must select the impairments that met the requirements for disability, early intervention requirements or both. Impairments include intellectual, cognitive, neurological, sensory, physical, or impairments to which a psychological disability is attributable. Or you can select developmental delay, and you do not need to select impairments.
• New step to advise the justice liaison officer (JLO) when requesting more evidence (if relevant)
• New step to notify early childhood partner of access not met decision (developmental delay only)
• New step to assign plan the approval case (Motor neurone disease only).

Before you start

You have:

• completed the pre-assessment and checked you need to use the post-legislation changes version of the legislation to make an access decision using article [Complete pre-assessment for an access decision](complete_pre-assessment_for_an_access_decision)
• checked there is evidence of identity or an internal note to explain why it can’t be provided

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• checked the application is complete with evidence of consent to apply, age, residence and disability
• read article [Check eligibility – age and residence requirements](check_eligibility_%E2%80%93_age_and_residence_requirements)
• read article [Understand disability requirements](understand_disability_requirements)
• read article [Understand early intervention requirements](understand_early_intervention_requirements).

Check legislative timeframes

You have 21 days to make a decision or request further information.

When a request for further information has been made, you have 14 days from the date that the last information or report was received to make a decision.

1. Use article [[Check decision – legislative timeframes](/foi-library/releases/0f965ec93d25-foi-24-25-0883-disclosure-log-documents/document-002__check-decision-legislative-timeframes/)](check_decision_%E2%80%93_legislative_timeframes) to check if your decision or request for further information will be outside legislative timeframes. If:
   • inside legislative timeframes: go to section Complete disability evidence.
   • outside legislative timeframes: use article Check decision – legislative timeframes to record an internal note. Then go to section Complete disability evidence.

Complete disability evidence

Links to evidence documents in the access request case will display here.

1. At Have you verified the Evidence of Disability?, select Yes. This is based on section Check evidence of disability in article [Complete pre-assessment of access decision](complete_pre-assessment_of_access_decision).

2. At Select assessed Impairment, enter text into the field and a list will display. Select relevant option.

3. Make a note of the assessed impairment name and ICD code. You will need this for section Decision Main Criteria.

4. At What evidence was used to confirm the Impairment?, select the appropriate option.

   Note: Defined Program no longer populates the access decision.

5. At Does the applicant’s impairment belong to List A, B or D?, select the appropriate option.

   Note: This no longer populates the access decision.

6. For more information about list conditions, go to articles:

   • [Check eligibility – List A condition](check_eligibility_%E2%80%93_list_a_condition)

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• [Check eligibility – List B condition](check_eligibility_%E2%80%93_list_b_condition)
• [Check eligibility – List D condition](check_eligibility_%E2%80%93_list_d_condition).

7. Select Add next to Impairment Assessment to record additional impairments. If an:

   • access met decision, add all impairments that meet eligibility requirements
   • access not met decision, add all reported impairments.

Request further information

1. Decide if you need more information to make an access decision. Only request more information if:

   • the application is complete
   • you need more evidence after receiving the applicant’s disability evidence.

2. If the applicant is a child with developmental delay turning 6 within the next 90 days, ask your team leader before requesting more information.

   In this situation, it may be more appropriate to make an access not met decision. For an access request, the child must be younger than 6 on the day the access decision is made. For an internal review, the child must have been younger than 6 at the time of the access not met decision. This reduces the risk of the child turning 6 before an access decision is made.

3. At Do you require further information from the applicant?, select Yes or No. If:

   • No, select Next, then go to section Approve or override streaming case.
   • Yes, continue to next step.

4. At Enter the Required Information below, copy relevant templates from Templates for requesting further information to make a decision – Post-legislation changes.

5. Select Next.

6. Select one or more of the criteria for the requested information from the provided tick boxes.

7. Select Next.

8. Select Done.

9. Select Next.

10. At Do you want to preview the document before sending it?, select Yes.

11. Complete Select a Recipient for preview to preview the letter.

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12. If correct, select Next. If incorrect, select Previous to update the fields that populate the letter.

13. Select Submit Correspondence.

14. Select Next. A letter will automatically be sent to the applicant or their authorised representative to request further information. The access decision case is automatically closed.

Check correspondence

1. From the Person Account case, select the Documents tab.

2. Check for Further Information Requested letter. Category will be Outbound Correspondence. If:

   • Yes, if there is a justice liaison officer, go to section Notify the justice liaison officer (JL) (if relevant). If not, go to section Next steps.
   • No, go to next step.

3. Submit a Report a defect with PACE, my NDIS Provider or Participant Portal, or my NDIS App ticket

4. Share the ticket with your team leader and assistant director.

5. If there is a justice liaison officer, go to section Notify the justice liaison officer (JL) (if relevant). If not, go to section Next steps.

Notify the justice liaison officer (JLO) (if relevant)

Create the enquiry case

1. Create an Enquiry case and reassign to the MyNDIS Contact using article Create an enquiry case.

2. At Requested By, select General Enquiry Only.

3. At Case Origin, select Internal.

4. At Enquiry Type, select Access.

5. At Category, select Access Request.

6. At Sub Category, select Escalation Enquiry.

7. In Enquiry Notes, use the following template:

   Further information requested to support <Applicant’s name> NDIS application.

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More information is needed about <permanency/functional capacity/lifetime supports/future support needs/whether the NDIS is the most appropriate service> of <Impairment/Impairments>. .

Refer to Request for More Evidence letter in the person account for more information.

Support the applicant to provide more evidence by (90 days).

8. At Enquiry Outcome select Keep enquiry open - Do not re-assign. This will allow you to assign the case to the JLO later with an email notification.

Assign the enquiry case

9. From the Enquiry case, select the Change Owner icon next to the current Case Owner.

10. At the Search Users free text field, search for the MyNDIS Contact.

11. Select the tick box next to Send notification email.

12. Select Change Owner.

13. Go to section Next Steps.

Approve or override the streaming case

The streaming case is critical to make sure the Typical Support Package (TSP) is generated for eligible applicants, and they’re assigned to the correct team. This is important to make sure they receive the support level they need to engage with the NDIS.

Generally, the streaming case is completed by a local area coordinator, early childhood partner or planner and the case routes to an access delegate for approval.

1. Check for a streaming case. A streaming case must be completed and approved before completing the access decision case. If:

   • Yes, continue to next step.
   • No, create a streaming case. Go to article Complete a streaming case (Streaming and Restreaming). Then continue to next step.

2. Go to article [Approve or override a streaming case (Streaming and Restreaming)](approve_or_override_a_streaming_case_%28streaming_and_restreaming%29) to approve or override the streaming case.

Record access decision

Age and Residency Sub Criterion

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1. Use article [Check eligibility – age and residence requirements](check_eligibility_%E2%80%93_age_and_residence_requirements) to help you decide if the age and residence requirements are met.

Age Criterion 1: (Section 22(1)(a))

1. At Is the applicant under the age of 65 years old? select Yes or No. If

   • Yes, go to section Residency Criterion 1: (Section 23(1)(a)) to consider the next criteria.
   • No, continue to next step.

2. Select Next.

3. Select N/A for all early intervention and disability requirements. You don’t need to consider the remaining eligibility requirements.

4. Go to section Evidence Used for Decisions.

Residency Criterion 1: (Section 23(1)(a))

1. At Is the applicant currently living in Australia? select Yes or No. If:

   • Yes, go to section Residency Criterion 2: (Section 23(1)(b)) to consider the next criteria.
   • No, continue to next step.

2. Select Next.

3. Select N/A for all early intervention and disability requirements. You don’t need to consider the remaining eligibility requirements.

4. Go to section Evidence Used for Decisions.

Residency Criterion 2: (Section 23(1)(b))

1. At Is the applicant an Australian Citizen or a Current Eligible Visa Holder? select Yes or No. If:

   • Yes, select Next and go to section Early Intervention Sub Criteria to consider the next criteria.
   • No, continue to next step.

2. At Why does the applicant not meet the sub criteria?, select the relevant option.

3. Select Next.

4. Select N/A for all early intervention and disability requirements. You don’t need to consider the remaining eligibility requirements.

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5. Go to section Evidence Used for Decisions.

6. Select Next.

Early Intervention Sub Criteria

1. Use article [Understand early intervention requirements](understand_early_intervention_requirements) to help you decide if the early intervention requirements are met.

2. Consider if the applicant has an impairment on List B or D. This no longer populates in the access decision. You need to select the relevant criteria manually. If:

   • list D and the child is younger than 7, select Yes to all early intervention requirements and select Next.
   • list B, select Yes to Early Intervention Criterion 1: (Section 25(1)(a)) and Early Intervention Criterion 2: (Section 25(1)(b)). Then consider the remaining early intervention requirements based on the evidence.

3. If none of the above, consider each early intervention requirement based on the evidence. All early intervention requirements must be answered.

4. If you select No for any criteria, select the reason the early intervention requirement is not met.

Early Intervention Criterion 1: (Section 25(1)(a))

1. At Is there one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be permanent (section 25(1)(a)(i)) or is there one or more identified impairments that are attributable to a psychiatric condition that are, or are likely to be, permanent (section 25(1)(a)(ii))?:

   • Select Yes or No.
   • If No and the applicant is younger than 6, there will be questions to consider if the child has a developmental delay that meets the early intervention requirements.

Early Intervention Criterion 2: (Section 25(1)(b))

1. At Is the provision of early intervention supports likely to benefit the person by reducing the person’s future needs for supports in relation to disability?:

   • Select Yes or No.

Early Intervention Criterion 3: (Section 25(1)(c))

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1. At Is the provision of early intervention supports likely to improve, or reduce deterioration, of functional capacity or strengthen sustainability of informal supports?:

   • Select Yes or No.

Early Intervention Criterion 4: (Section 25 (d))

1. At Are any early intervention supports that would be likely to benefit the person as mentioned in paragraphs 25(1)(b) and (c) NDIS supports?:

   • Select Yes or No.

2. Select Next.

Disability Sub Criterion

1. Use article [Understand disability requirements](understand_disability_requirements) to help you decide if the disability requirements are met.

2. Consider if the applicant has an impairment on List A or B. This no longer populates in the access decision. You need to select the relevant criteria manually. If:

   • list A, the disability requirements are met. Select Yes to all disability requirements and select Next.
   • list B, select Yes to Disability Criterion 1: (Section 24 (1)(a)) and Disability Criterion 2: (Section 24 (1)(b)). Then consider the remaining disability requirements based on the evidence.

3. If none of the above, consider each disability requirement based on the evidence. All disability requirements must be answered.

4. If you select No for any criteria, select the reason the disability requirement is not met.

Disability Criterion 1: (Section 24 (1)(a))

1. At Are the impairment(s) attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to psychiatric condition(s)?:

• Select Yes or No.

Disability Criterion 2: (Section 24 (1)(b))

1. At Are the impairment(s) permanent, or are they likely to be permanent?:

• Select Yes or No.

Disability Criterion 3: (Section 24 (1)(c))

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1. At Does the impairment(s) result in substantially reduced functional capacity?:

• Select Yes or No.

Disability Criterion 4: (Section 24 (1)(d))

1. At Does the impairment affect the person’s capacity for social and economic participation?:

• Select Yes or No.

Disability Criterion 5: (Section 24 (1)(e))

1. At Is the person likely to require support under the NDIS for their lifetime?:

• Select Yes or No.

2. Select Next.

Evidence Used for Decisions (access not met only)

1. For any access criteria the person does not meet, record:

   • Evidence type
   • Evidence (if required) – start to enter the linked evidence name, then select relevant document.
   • Explanation – record Criteria not met – see linked evidence.

2. Select Next.

Decision Main Criteria

1. These questions will automatically be completed with Access Met, Access Not Met or N/A:

   • Does the person meet Age Criteria
   • Does the person meet Residency Criteria
   • Does the person meet Disability Criteria
   • Does the person meet Early Intervention Criteria
   • Overall decision.

   Note: An applicant may meet both the disability and early intervention requirements.

2. If Overall decision is:

   • Access Not Met, go to step 9.

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• Access Met, go to next step.

3. Open article [Impairment Categories Guide](impairment_categories_guide) to complete the next steps.

4. Search the ICD 10 Code or Condition name for all impairments that meets the requirements for disability, early intervention, or both.

5. Note the Required impairment category column.

6. Consider if any of the Optional impairment categories in the guide apply based on the evidence provided:

   • Intellectual
   • Cognitive
   • Neurological
   • Sensory
   • Physical
   • Psychosocial

   For more information, go to article [Descriptions of impairment categories](descriptions_of_impairment_categories).

7. If the early intervention requirements are met, at Which of the following meet the eligibility criteria for access?, select options that apply for all eligible impairments that met the early intervention requirements:

   • Intellectual
   • Cognitive
   • Neurological
   • Sensory
   • Physical
   • One or more impairments to which a psychological disability is attributable
   • Developmental Delay.

8. If the disability requirements are met, at Which of the following meet the eligibility criteria for access?, select options that apply for all eligible impairments that met the disability requirements:

   • Intellectual
   • Cognitive
   • Neurological
   • Sensory

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• Physical
• One or more impairments to which a psychological disability is attributable.

Note: This is important as we only fund NDIS supports for eligible impairments that meet the requirements for disability, early intervention or both.

9. If the decision isn’t correct: Select Back.

   • Re-check and update previous criteria as per above steps.

10. If the decision is correct:

• Select Save for later.

If access met for applicant with chronic health condition

You must request technical advice from the Technical Advisory and Practice Improvement branch (TAPIB).

1. First send a technical support request to SEB.QUALITY to request Quality Development Officer (QDO) feedback.

2. If the QDO agrees, request technical advice from TAPIB using the following articles:

   • [Create a technical advice case](create_a_technical_advice_case)
   • [Complete the risk matrix for a technical advice case](complete_the_risk_matrix_for_a_technical_advice_case)
   • [Review and action returned technical advice case](review_and_action_returned_technical_advice_case).

   Note: You can review relevant article in the TAPIB Digest to help you refine your request.

If access met for applicant younger than 25 with primary psychosocial disability

You must receive endorsement from your team leader or assistant director.

1. First send a technical support request (Review Request: Under 25 Psychosocial) to SEB.QUALITY to request QDO feedback.

2. If the QDO agrees, they will email your team leader or assistant director to request endorsement.

If access met and the applicant resides in hospital

You must ask for QDO feedback.

1. Send a technical support request to SEB.QUALITY to request QDO feedback. They will decide if TAPIB advice is required.

Submit decision for quality check

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Submit proposed decision for potential quality check

1. Complete the Access Assessor Outcome Form to submit the proposed access decision for a potential quality check. An email will advise you if the proposed decision is sent for quality check. If:

   • not sent for quality check, go to section Approve access decision
   • sent for quality check, go to section Review quality check feedback.

Review quality check feedback

1. Review quality check feedback when received by email. If:

   • no adjustment required and you agree with the feedback, go to section Approve access decision
   • adjustment required and you agree with the feedback, continue to next step.

2. Re-assess and amend access decision in line with the feedback.

3. From the Decision Main Criteria screen, select Save for later.

4. Go to section above Submit proposed decision for potential quality check to re-submit for a potential quality check.

   Note: For technical support to understand the legislative criteria, please send a technical support request to SEB.QUALITY.

   If you don’t agree with the feedback, contact your team leader about the reconsideration process.

Approve access decision

1. Return to Decision Main Criteria view.

2. Select Approve to submit decision.

3. Go to section Complete access decision correspondence.

Complete access decision correspondence

Automated Access Met letter

1. Check the correspondence preferences of the applicant are correct. Select Next.

2. At Do you want to preview the document before sending it? select Yes or No.

3. If you select Yes, you need to Select a Recipient for preview?. Select the applicant you wish to preview the correspondence for and select Next.

4. A letter preview will generate.

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5. If correct, select Next. If incorrect, select Previous to update the fields that populate the letter.

6. Select Submit Correspondence. An automatic access met decision letter will be sent to the person or authorised representative.

7. At Correspondence Summary select Next.

8. Select Done to close the access decision case.

Check correspondence

1. In the Access Decision case, select the Documents tab.

2. Check for Outcome of Application – Eligible letter. Category is Outbound Correspondence. If:

   • Yes, go to section Check disabilities tab
   • No, go to next step.

3. Submit a Report a defect with PACE, my NDIS Provider or Participant Portal, or my NDIS App ticket,

4. Share the ticket with your team leader and assistant director.

5. Go to section Next steps.

Manual Access Not Met letter

PACE won’t generate an automatic Access Not Met letter. You need to complete and send a manual letter.

1. Select Done to close the access decision case.

2. Complete the manual access not met letter using these articles:

   • Letter – Access not met decision
   • [Template – Access not met decision – post legislation changes](template_%E2%80%93_access_not_met_decision_%E2%80%93_post_legislation_changes).

   Note: Only the letter text is required from this resource. Interactions are not required.

3. Use article [Send a manual letter](send_a_manual_letter) to complete this process.

Notify early childhood partner of access not met decision (developmental delay only)

If the child is younger than 6 with a developmental delay, you need to notify the early childhood partner of the access not met decision.

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1. Create an Enquiry case and reassign to the MyNDIS Contact using article Create an enquiry case.

2. At Requested By, select General Enquiry Only.

3. At Case Origin, select Internal.

4. At Enquiry Type, select Partner Supported Access.

5. At Category, select General Information.

6. In Enquiry Notes, use the following template:

7. Access not met decision for developmental delay made on .

   Evidence provided does not support the developmental delay criteria because <provide a summary of the justification for the decision e.g. the applicant does not have a significantly lower ability to do everyday activities, when compared to children of the same age>.

   <If the child is turning 6 within 90 days: The child is turning 6 within 90 days. It may be more appropriate to support the applicant with an internal review, rather than a new access request. For an access request, the child must be younger than 6 on the day the access decision is made. For an internal review, the child must have been younger than 6 at the time of the access not met decision. This reduces the risk of the child turning 6 before an access decision is made.>

   Access request outcome will be communicated to the applicant’s authorised representative – refer to case activity for updates.

   Please support applicant with next steps such as early connections.

8. At Enquiry Outcome select Re-assign this enquiry to another user.

9. At Case Re-assignment Reason select Referral to Partner.

10. At Select User or Queue select User.

11. At Case Owner enter the applicant’s MyNDIS Contact.

Check disabilities tab (access met only)

The Disabilities tab must include all impairments that meet the requirements for disability, early intervention or both as this affects planning.

There may be impairments that you need to add or remove.

1. From the Person Account, select My Profile.

2. Select the Disabilities tab.

3. Review Active status to see what impairments are current.

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4. If required, use article [Update a person account](update_a_person_account) to:

   • add impairments that meet the eligibility requirements
   • remove any impairments that don’t meet the eligibility requirements by adding an End Date.

Assign plan approval case (Motor neurone disease only)

If you are in the Priority Health Access Team and have made an access met decision for an applicant with Motor neurone disease (also known as Lou Gehrig’s disease or Amyotrophic lateral sclerosis), assign the Plan Approval case to the Aged Care Referral Routing Queue.

In all other situations, a plan approval case will automatically route to the relevant queue.

1. In the Plan Approval case, select the Change Owner icon next to the current Case Owner.

2. Select the Users icon (on the left of the search bar) then select Queues.

3. At the Search Users free text field, search and select Aged Care Referral Routing Queue.

4. Select Change Owner.

Next steps

1. After you complete the access decision case, an automatic contact applicant task will create. Contact the applicant or their authorised representative. If:

   • Access met or access not met, go to article [Contact to advise outcome of access decision](contact_to_advise_outcome_of_access_decision).
   • Further information requested, go to article Contact to request further information for access decision.

2. For an access met decision, a plan approval case will automatically route to the relevant queue for a planner to develop their first participant NDIS plan.

Article labels – internal use only

PACE user role names

Add:

Delete:

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Topics

Add:

Delete:

Case names

Add:

Delete:

Ownership

Add:

Delete:

Version control

Version	Amended by	Brief Description of Change	Status	Date
4.0	EMN960	Class 1 update – PACE national expansion hypercare Guidance update to routing rules when user actions ‘Mark Application as Invalid’. Feeback form link added to notify AO’s team leaders. EL2 review and approval to QA and publish	APPROVED	2024-02-20
5.0	JC0088	Class 2 approval Changes to support July system release – to support upcoming access legislation changes	APPROVED	2024-08-07
6.0	JC0088	Class 2 approval Updates made to incorporate legislation changes	APPROVED	2024-09-25

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Version	Amended by	Brief Description of Change	Status	Date
6.1	JM0122	Class 1 approval Remove definitions of impairment categories.	DRAFT	2024-10-02
7.0	VFK746	Class 1 Approval	APPROVED	2024-10-02
7.1	JM0122	Add link to new article ‘Descriptions of impairments’	DRAFT	2024-10-07

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