FOIOFFICIAL24/25-0999 DOCUMENT 52 SGP Knowledge Article Template For Internal Use Only
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Understand procedural fairness and eligibility reassessment requirements
This article provides guidance for an access assessor to understand the requirements for completing an eligibility reassessment. The requirements include:
- understand procedural fairness
- consider the eligibility requirements
- consider the participant’s impairment
- consider the assessment summary.
To complete the Eligibility Check in PACE, you need to understand these requirements.
When we talk about contacting a participant, we mean the participant or their authorised representative.
Recent updates
| Date | What’s changed |
|---|---|
| April 2023 | New knowledge article |
| - |
Before you start
You have read:
- Are you eligible for the NDIS? in Our Guideline – Applying to the NDIS
- What happens if we check your eligibility? in Our Guideline – Leaving the NDIS.
You have been asked to:
- draw down an eligibility reassessment referral
- complete an eligibility check
- decide if an eligibility reassessment should commence
- decide if the participant needs an access status change.
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Understand procedural fairness
You will complete an Eligibility Check in PACE. The Eligibility Check will help you decide if an eligibility reassessment should commence. The Procedural Fairness Checklist is the first part of the check.
The procedural fairness check will automatically check who has progressed the case and created the referral. If you approved the participants access, you must select Yes when prompted and the case will be routed back to the eligibility reassessment queue.
What is procedural fairness?
Procedural fairness is about making sure we give participants a reasonable opportunity to have their say and provide us with evidence about their situation. It is also about making sure our decisions are fair and unbiased. When we say fair and unbiased, we mean our decisions are made by someone who wouldn’t benefit from the decision or be impacted by it.
What is the purpose of the procedural fairness checklist?
The checklist has questions to make sure you are an independent delegate. This is how we make sure we our decisions are fair and unbiased.
You aren’t an independent delegate if you have:
- a personal interest in the participant’s status, or
- a personal relationship with the participant (outside the NDIA), or
- been involved in making the original eligibility decision or any planning decisions.
What about manual procedural fairness checks?
Procedural fairness is also about:
- being transparent with the participant
- giving them reasonable opportunity to provide information, and to present a case to support their continued eligibility.
There are steps you will take to make sure we follow procedural fairness. That is what we mean when we say manual procedural fairness checks.
Has the My NDIS contact been able to contact the participant?
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This is an important manual procedural fairness check. The My NDIS contact will record their contact with the participant in PACE. You will check PACE. If the My NDIS contact is unable to contact the participant, do not make an eligibility reassessment referral.
If the My NDIS contact made an eligibility reassessment referral without contacting the participant:
- do not commence an eligibility reassessment
- close the eligibility reassessment case – read article Action if ER not required to learn more.
If the My NDIS contact was able to contact the participant, continue with the eligibility reassessment. Do this even if you are unable to contact them.
Review information and evidence
You will make sure we follow procedural fairness by thoroughly reviewing existing information and evidence.
Some sources of existing information include:
- conversations about the participant’s situation recorded in PACE
- any relevant documents on the participant’s record
- medical or clinical reports, diagnostic and assessment information
- service provider reports and assessments such as progress reports
- information provided with the participant’s access to the NDIS
- early childhood partner documents
- information from family members and carers.
Consider the eligibility requirements
After you complete the procedural fairness checklist, you will consider the eligibility requirements to complete the impairment assessment. PACE will pre-populate responses for each eligibility requirement based on the:
- Referral checklist
- Impairment assessment.
This means some responses will already be in PACE.
Consider residence requirements
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Read Do you meet the residence requirements in Our Guidelines – Applying to the NDIS. This will help you consider the residence requirements if you need to.
Consider early Intervention requirements
Read Do you need early intervention in Our Guidelines – Applying to the NDIS to learn more. This will help you consider the early intervention requirements if you need to.
Consider disability requirements
Read Do you meet the disability requirements in Our Guidelines – Applying to the NDIS. This will help you consider the disability requirements if you need to.
Consider the participant’s impairment
An impairment assessment is another part of the eligibility check. The impairment assessment asks you to consider if the reassessment impairment belongs to List A, B or D. You will use the Appendices in Our Guidelines – Applying to the NDIS to consider if the impairment belongs to List A, B or D.
Consider the assessment summary
The last part of the eligibility check is the assessment summary. This part of the eligibility check asks you to consider:
- Has the participant’s primary impairment changed?
- Have changes been made to the secondary impairments listed in the Participant’s record?
You will answer Yes or No and select the reassessed impairment, if needed. Your responses will be based on your thorough review of the participant’s information and evidence.
PACE will pre-populate Yes or No for primary disability change or access status change. The pre-populated response is based on the answers you entered about the participant’s impairment and eligibility.
Next steps
You will:
- make a decision about the participant’s eligibility
- use the eligibility check tab in PACE to record your decision making.
To learn more about using the eligibility check tab in PACE read articles:
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- Draw down a referral and check procedural fairness for an ER case
- Review and link participant evidence to the eligibility reassessment case.
Version control
| Version | Amended by | Brief Description of Change | Status | Date |
|---|---|---|---|---|
| 1.0 | CW0032 | Class 2 approved | APPROVED | 2023-03-31 |
| 1.1 | AGK382 | Minor amendments and re-approved for publication | APPROVED | 2023-04-07 |
| 2.0 | AGK382 | - Amended header to reflect content - Added PACE summary to section ‘understand procedural fairness’ |
APPROVED | 2023-04-07 |
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