FOIOFFICIAL24/25-0999 DOCUMENT 44 Knowledge Article
For Internal Use Only The contents of this document are OFFICIAL.
Check eligibility – Terminal illness
Guidance in this document is not approved for use unless you view it in PACE.
This article provides guidance for an access delegate and review officer to:
understand the priority access pathway for people with terminal illness identify if the applicant may have a terminal illness check for evidence the applicant needs palliative care supports make an eligibility decision for an applicant with a terminal illness.
Recent updates
September 2024
Article title changed from ‘Check evidence for a decision – terminal illness’ to ‘Check
eligibility – Terminal illness’
Before you start
You have read and understood:
Our Guideline – Applying to the NDIS (external) including section Will you likely need
NDIS supports for your lifetime? Our Guideline – Mainstream and community support (external) article Understand palliative care article Understand disability requirements article Make an access decision - pre-legislation changes or article Make an access
decision – post-legislation changes article Guide – Conversation style guide and appendix B in sections Sensitive
conversations and Explaining your access or planning decisions.
You have reviewed:
any evidence of informal, mainstream or community palliative care supports.
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For Internal Use Only Priority access pathway for people with terminal illness
NDIS applications from people with terminal illness are submitted through the priority access pathway. For more information, read article Request priority eligibility decision.
The Priority Health Access Team will make the eligibility decision within 5 days.
If an access met decision is made, the new participant will be streamed to the Aged Care and Hospital Interface branch if they have palliative support care needs. The Aged Care and Hospital Interface branch will develop the participant’s plan within 30 days.
Identify if the applicant may have a terminal illness
In a person’s NDIS application, their primary disability may indicate there is an underlying health condition which may reduce their quality or expected length of life. For example, if their disability is described as an acquired brain injury.
The person may also specify that they have a terminal illness. Terminal illnesses may include many different types of cancers, chronic obstructive pulmonary disease (COPD), or end-stage kidney or liver diseases.
Other illnesses may also be terminal but have a relatively long life expectancy. Conditions including Huntington’s Disease, Parkinson’s Disease and dementias may be terminal, but applicants with these conditions may not require palliative care supports at the time of their access application.
Note: These conditions do not automatically mean the applicant is suitable for the priority planning pathway.
Information in an NDIS application may indicate the person has a terminal illness and may need palliative care supports funded by the health system. This information might include:
a prognosis category, such as ‘guarded’ or ‘poor’ time-framed prognosis, for example 3 to 18 months to live terminal or end-stage illness staged health condition, for example stage 3, 4 or 5 no longer suitable for active treatment – treatment is for symptom management reference to pain management related to comfort references to past treatments, for example chemotherapy, immunotherapy, radiotherapy organ failure, for example lung, heart, liver, or kidney high levels of nursing support
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For Internal Use Only specialist or community palliative care team involvement.
Check for evidence the applicant needs palliative care supports
Before making an eligibility decision for a disability caused by a terminal illness, you must make sure the applicant meets the age and residence requirements. Learn more in article Make an access decision - pre-legislation changes or article Make an access decision – post- legislation changes.
You then need to understand any evidence of palliative care support needs. Information about current treatments, goals of care, and stage of illness can help you understand the applicant’s support needs. A suitably qualified treating health professional must provide this evidence.
Evidence may include information about:
current and future treatments designed to make people comfortable or slow disease
progression rather than make them better anticipated outcomes of the treatments evidence of the stage of disease progression level of care and clinical supports required current and future goals of care.
You may need to request further information from a treating health professional. Talking about dying and terminal illness can be hard. But it’s important to talk about it so people can be prepared.
To help you prepare to talk with an applicant with a terminal illness, go to article Navigate conversations about life-limiting conditions.
Make an eligibility decision for an applicant with a terminal illness
A specialised access team, called the Priority Health Access Team, makes decisions about access eligibility for people with terminal illness and disability.
If you identify an applicant may have a terminal illness, you must request advice from the Technical Advice and Practice Improvement Branch (TAPIB). This is regardless of the
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For Internal Use Only proposed eligibility decision. To learn more, go to Requesting Advice or article Create a technical advice case.
Before an eligibility decision is made, we’ll need to understand the applicant’s disability and its impact on their life.
Information in the technical advice case helps TAPIB understand the applicant’s situation. This could include information about if the applicant:
is applying to the NDIS because of an identified terminal illness is applying to the NDIS because of another reported impairment that’s a direct result of a
terminal illness or treatment has declining function because of the progression of a terminal illness has palliative support needs, for example supports intended for quality-of-life purposes
rather than improving social and economic participation requires a high level of skilled clinical support, for example palliative pain management or
specialist nursing care.
Note: The free-text field in the technical advice case has a limit of 255 characters. You can use these as examples to provide a brief summary of the participant’s situation. Follow the guidance in article [Create a technical advice case](/foi-library/releases/bc455e3f7247-foi-24-25-0515-documents/document-001__create-a-technical-advice-case/) to complete the case and provide supporting information.
Next steps
- To determine eligibility after you have received advice from TAPIB, continue to follow
guidance in article Make an access decision - pre-legislation changes or article Make an
access decision – post-legislation changes.
- If the participant is eligible for the priority pathway and an access met decision is made,
the participant will be streamed to the Aged Care and Hospital Interface branch. The
Aged Care and Hospital Interface branch will develop the participant’s plan within 30
days.
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Version control
Version Amended by Brief Description of Change Status Date
Class 3 Approval CW0032 New article to help users identify if an 1.0 APPROVED 2024-03-25 HB0014 applicant has a life-limiting condition, and progress for an eligibility decision.
Class 2 Approval Clarified the priority pathway is for applicants with terminal illness and 2.0 CW0032 APPROVED 2024-04-04 disability. Added links to relevant articles on the applying process in next steps section
Class 2 Approval
Updated title from ‘Check
evidence for a decision – life- 3.0 JC0088 APPROVED 2024-04-29 limiting condition’ to ‘Check
evidence for a decision – terminal
illness’.
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For Internal Use Only Updated language from ‘life-
limiting condition’ to ‘terminal
illness’ throughout. Updated team name from
‘Specialist Access Team’ to
‘Priority Health Access Team’ New section with overview
of the priority pathway Updated next steps
Class 1 Approval Article title changed from ‘Check 4.0 IIW664 evidence for a decision – terminal APPROVED 2024-09-23 illness’ to ‘Check eligibility – Terminal illness’
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