FOI 24/25-0956 DOCUMENT 1

Practice Guide

For Internal Use Only

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Access and Eligibility Reassessment (ER) Practice Guide

The content of this document is OFFICIAL.

This guide assists the National Access Team (NAT) to assess new applicants’ eligibility and determine if existing participants remain eligible for the National Disability Insurance Scheme (NDIS).

This guide is designed to be used with the Access and Eligibility Reassessment (ER) Decision Tree to make legislatively correct access decisions.

1. Recent updates

What’s changed

Date	What’s changed
October 2022	This is a new resource

2. Checklist

Topic Checklist

Topic	Checklist
Pre-requisites	You have read:

Section 21, 22, 23, 24 and 25 of the National Disability Insurance Scheme Act 2013
NDIS Becoming a Participant Rules 2016
Operational Guidelines - NDIS

You are working through:

Access and ER Decision Tree | | Actions |
1. Are you making an Access or ER decision
1. Access — Age Requirements
1. Access — Residence Requirements
1. Access — Streamlined Decisions
1. Access — Disability Requirements
1. Access — Early Intervention Requirements
1. ER — Residence Requirements |

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Checklist

1. ER — Streamlined Decisions
1. ER — Disability Requirements
1. ER — Early Intervention Requirements
1. Related procedures or resources
1. Feedback
1. Version control

3. Are you making an Access or ER decision?

For Access decisions, go to Section 4. Access — Age Requirements

For ER decisions, go to Section 9. ER - Residence Requirements

4. Access — Age Requirements

4.1 Does the applicant meet the age requirements?

Legislation

Section 22 Age requirements

A person meets the age requirements if the person was aged under 65 when the access request in relation to the person was made.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

the applicant was aged under 65 when their access request was received as valid (that is, complete); or
the applicant is non-defined and their data was received by the NDIA prior to their 65th birthday.


Applicants that meet the age requirements	Go to Section 5.1 Does the applicant meet the residence requirements?
Applicants that do not meet the age requirements	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in SOP - Finalise Access Not Met Decision |

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5. Access – Residence Requirements

5.1 Does the applicant meet the residence requirements?

Legislation

Section 23 Residence requirements

(1) A person meets the residence requirements if the person: (a) resides in Australia; and (b) is one of the following: (i) an Australian citizen; (ii) the holder of a permanent visa; (iii) a special category visa holder who is a protected SCV holder.

(2) In deciding whether or not a person resides in Australia, regard must be had to: (a) the nature of the accommodation used by the person in Australia; and (b) the nature and extent of the family relationships the person has in Australia; and (c) the nature and extent of the person’s employment, business or financial ties with Australia; and (d) the nature and extent of the person’s assets located in Australia; and (e) the frequency and duration of the person’s travel outside Australia; and (f) any other matter relevant to determining whether the person intends to remain permanently in Australia.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant:

lives in Australia for most of the year; and
is an Australian Citizen; or
is the holder of a permanent visa; or
is the holder of a protected Special Category Visa (SCV)


Applicants that meet the residency requirements	Go to Section 6.1 - List A
Applicants that do not meet the residency requirements	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in SOP - Finalise Access Not Met Decision |

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6. Access – Streamlined Decisions

6.1 List A

Where an applicant has been diagnosed with a condition on List A they will meet the disability requirements without further assessment (unless there are an document integrity issues pending investigation).

Note: A person does not need to have a condition on List A to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you meet the disability requirements?

Applicants under the age of 7


Applicants that have a condition on List A	Meet the disability requirements.

Please follow the process in SOP - Finalise Access Met Decision | | Applicants that do not have a condition on List A | Go to Section 6.3 - List D |

Applicants aged 7 and over


Applicants that have a condition on List A	Meet the disability requirements.

Please follow the process in SOP - Finalise Access Met Decision | | Applicants that do not have a condition on List A | Go to Section 6.2 - List B |

6.2 List B

Where an applicant has been diagnosed with a condition on List B, they will be considered to have a disability attributable to one or more impairments that is, or is likely to be, permanent without further assessment.

For applicants diagnosed with a condition on List B, you will only need to assess whether the applicant:

has substantially reduced functional capacity to perform one or more activities;
is affected in their capacity for social or economic participation; and

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is likely to require support under the NDIS for their lifetime.

Note: A person does not need to have a condition on List B to become a participant in the NDIS.

For further information, refer to Our Guidelines - Is your impairment likely to be permanent?

For applicants under the age of 7


Applicants that have a condition on List B	Go to Section 8.3 - Does the applicant meet Section 25(1)(b)?
Applicants that do not have a condition on List B	Go to Section 8.1 - Does the applicant meet Section 25(1)(a)?

For applicants aged 7 and over


Applicants that have a condition on List B	Go to Section 7.3 - Does the applicant meet Section 24(1)(c)?
Applicants that do not have a condition on List B	Go to Section 7.1 - Does the applicant meet Section 24(1)(a)?

6.3 List D

Where a child under the age of 7 has been diagnosed with a condition on List D, they will meet the early intervention requirements without further assessment.

Note: A child does not need to have a List D condition to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you need early intervention?

For applicants under the age of 7


Applicants that have a condition on List D	Meet the early intervention requirements.

Please follow the process in SOP - Finalise Access Met Decision | | Applicants that do not have a condition on List D | Go to Section 8.1 - Developmental Delay |

6.4 0-25 Hearing Impairments

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An applicant meets the early intervention requirements without further assessment if they:

are aged between birth and 25 years of age; and
have confirmed results from a specialist audiological assessment (including electrophysiological testing when required) consistent with auditory neuropathy or hearing loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent.

What to consider

This streamlined access approach for early intervention acknowledges a rich body of evidence that recognises that early intervention supports up to and including the age of 25 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

This same body of evidence suggests that brain development and language capability have been achieved by the age of 26. Therefore, adults aged 26 years and over are not immediately accepted to be likely to benefit from the same early intervention approach because there is no requirement to support the development of the auditory pathways. Adults aged 26 years and over with hearing impairment will therefore be assessed normally, on a case-by-case basis, having regard to the availability of all relevant evidence.

For further information, refer to Our Guidelines - What about people aged between 0 and 25 with a hearing impairment?

For applicant aged under 7


Applicants that meet the hearing impairment criteria	Meet the early intervention requirements.

Please follow the process in SOP - Finalise Access Met Decision | | Applicants that do not meet the hearing impairment criteria | Go to Section 6.2 - List B impairments |

For applicants aged 7 and over


Applicants that meet the hearing impairment criteria	Meet the early intervention requirements.

Please follow the process in SOP - Finalise Access Met Decision |

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Applicants that do not meet the hearing impairment criteria	Go to Section 8.2 - Does the applicant meet Section 25(1)(a)?

7. Access – Disability Requirements

7.1 Does the applicant meet Section 24(1)(a)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

the applicant has a disability (a reduction or loss in their ability to do things); and
their disability is caused by an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and
the impairment is intellectual, cognitive, neurological, sensory, or physical in nature.

Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

Does the evidence demonstrate both that the applicant has an impairment, and that the impairment is resulting in a disability?
Does the evidence demonstrate that the applicant is reduced in their ability to do things, however this reduction cannot be reasonably attributed to an impairment?
Does the evidence demonstrate that the applicant has a loss or significant change in one of their body’s functions or structure, or in how they think and learn; however, there is no indication that this is causing a reduction or loss in their ability to do things?

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Note: A diagnosis is not required to meet this criterion: if the evidence shows the person has a disability caused by a relevant impairment, then they will meet 24(1)(a) – this is because we assess based on the impairment/functional impact.

For further information, refer to Our Guidelines - Is your disability caused by an impairment?

Applicants under the age of 7


Applicants that meet Section 24(1)(a)	Go to Section 7.2 - Does the applicant meet Section 24(1)(b)?
Applicants that do not meet Section 24(1)(a)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in SOP - Finalise Access Not Met Decision |

Applicants aged 7 or over


Applicants that meet Section 24(1)(a)	Go to Section 7.2 - Does the applicant meet Section 24(1)(b)?
Applicants that do not meet Section 24(1)(a)	Go to Section 6.4 - 0-25 Hearing Impairments

7.2 Does the applicant meet Section 24(1)(b)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(b) The impairment or impairments are, or are likely to be, permanent

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant has a:

permanent impairment; or
likely permanent impairment.

Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

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What to consider

Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment?
Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?
Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success?
Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only?
Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

What treatments have been undertaken and what were the outcomes?
If there are evidence-based treatments not undertaken, why were they considered and deemed unsuitable?
What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Is your impairment likely to be permanent? | NDIS

Applicants under the age of 7


Applicants that meet Section 24(1)(b)	Go to Section 7.3 - Does the applicant meet Section 24(1)(c)?
Applicants that do not meet Section 24(1)(b)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in SOP - Finalise Access Not Met Decision |

Applicants aged 7 and over

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Applicants that meet Section 24(1)(b)	Go to Section 7.3 - Does the applicant meet Section 24(1)(c)?
Applicants that do not meet Section 24(1)(b)	Are not eligible for disability or early intervention support from the NDIS.

If they do not meet this criterion, they automatically do not meet Section 25(1)(a).

Please follow the process in SOP - Finalise Access Not Met Decision |

7.3 Does the applicant meet Section 24(1)(c)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(c) The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities: The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities:

(i) communication;

(ii) social interaction;

(iii) learning

(iv) mobility

(v) self-care

(vi) self-management

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, results in substantially reduced functional capacity in one or more of the following activities:

Communication: how they speak, write or use sign language and gestures.
Social interaction: how they make and keep friends, interact with the community, and cope with feelings and emotions in social situations.

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Learning: how they learn, understand and remember new things, and practise and use new skills.
Mobility: how they move around home and the community and how they get in and out of bed or a chair.
Self-care: how they partake in personal care, hygiene, grooming, eating and drinking, and health.
Self-management (if older than 6): how they organise their life, make decision, solve problems and manage money.

Note: When an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

Does the evidence demonstrate that the applicant is unable to participate effectively or completely (i.e., across the whole or majority of tasks) in one or more activities, without formally prescribed equipment?
Does the evidence demonstrate that the applicant is unable to participant effectively or completely in one or more activities, and usually requires the assistance of another person?
Does the evidence demonstrate that the applicant would be unsafe to complete one or more tasks required to participate in an activity without formally prescribed equipment or assistance from another person?
Does the evidence indicate that the applicant is able to participate in each activity effectively by using commonly used items?
Does the evidence indicate that the applicant is able to participate in each activity effectively, albeit more slowly or in a different way?
Would completing tasks more slowly or in a modified way, or using commonly used items, relieve the applicant’s need for personal assistance?

In answering the above questions, does the evidence contain sufficient information addressing:

What specific tasks the applicant cannot complete without support?
Why the applicant requires support?

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How often the applicant requires support, and what that support looks like?

For further information, refer to Our Guidelines - Does your impairment substantially reduce your functional capacity?

Applicants under the age of 7


Applicants that meet Section 24(1)(c)	Go to Section 7.4 - Does the applicant meet Section 24(1)(d)?
Applicants that do not meet Section 24(1)(c)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in SOP - Finalise Access Not Met Decision |

Applicants aged 7 and over


Applicants that meet Section 24(1)(c)	Go to Section 7.4 - Does the applicant meet Section 24(1)(d)?
Applicants that do not meet Section 24(1)(c)	Go to Section 6.4 - 0-25 Hearing Impairments

7.4 Does the applicant meet Section 24(1)(d)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(d) The impairment or impairments affect the person’s capacity for social or economic participation.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, affects the applicant’s social or economic participation.

Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

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Does the evidence demonstrate that the applicant’s social participation (e.g., their capacity to play sport, go to the movies, see friends, etc.) is affected by their permanent impairment/s - in any way?
Does the evidence demonstrate that the applicant’s economic participation (e.g., their capacity to travel, to find or maintain voluntary or paid work, etc.) is affected by their permanent impairment - in any way?
Does the evidence demonstrate that the applicant’s social and economic participation is not impacted in any way, and that they can fully engage without any assistance?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

Applicants under the age of 7


Applicants that meet Section 24(1)(d)	Go to Section 7.5 - Does the applicant meet Section 24(1)(e)?
Applicants that do not meet Section 24(1)(c)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in SOP - Finalise Access Not Met Decision |

Applicants aged 7 and over


Applicants that meet Section 24(1)(d)	Go to Section 7.5 - Does the applicant meet Section 24(1)(e)?
Applicants that do not meet Section 24(1)(d)	Go to Section 6.4 - 0-25 Hearing Impairments

7.5 Does the applicant meet Section 24(1)(e)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(e) The person is likely to require support under the National Disability Insurance Scheme for the person’s lifetime.

When is this criterion considered met?

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This criterion is considered met if evidence on the record shows the applicant:

will require the support of the NDIS for their lifetime; or
is likely to require the support of the NDIS for their lifetime.

Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

Does the evidence demonstrate that the applicant is likely to require disability supports that are not clinical in nature, and that focus on their functional ability, for their lifetime?
Does the evidence demonstrate that the applicant will likely be substantially reduced in their functional capacity (in a relevant activity) for their lifetime, despite any interventions?
Are there any recommendations for interventions that are likely to improve the applicant’s functional capacity, and reduce their future need for disability related supports?
If the applicant is a child or young adult, does the evidence indicate that significant functional improvements can be expected - either as they develop, or through interventions?
Does the applicant’s need for support relate to a health condition, and is that support more appropriately funded by the health system?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

Applicants under the age of 7


Applicants that meet Section 24(1)(e)	Meet the disability requirements.

Please follow the process in SOP - Finalise Access Met Decision | | Applicants that do not meet Section 24(1)(e) | Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in SOP - Finalise Access Not Met Decision |

Applicants aged 7 and over

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Applicants that meet Section 24(1)(e)	Meet the disability requirements.

Please follow the process in SOP - Finalise Access Met Decision | | Applicants that do not meet Section 24(1)(e) | Go to Section 6.4 - 0-25 Hearing Impairments |

8. Access - Early Intervention Requirements

For children under the age of 7 they are first assessed against the early intervention criteria. If they do not meet, then assess them against the disability requirements.

For applicants aged 7 or above, only assess their eligibility for early intervention supports if they have not met the disability requirements.

Before you commence the assessment, you must ensure the applicant meets both the age requirements and residency requirements.

8.1 Developmental Delay

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if: (a) the person: (iii) is a child with who has developmental delay

Section 9 Definitions

Developmental delay means a delay in the development of a child under 6 years of age that:

(a) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and

(b) results in substantial reduction in functional capacity in one or more of the following areas of major life activity:

(i) self-care;

(ii) receptive and expressive language;

(iii) cognitive development;

(iv) motor development; and

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(c) results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the child is younger than 6 on the day we determine they have developmental delay.

For further information, refer to Our Guidelines - What about children younger than 6 with developmental delay?


Applicants that meet the Developmental Delay criteria	Meet the early intervention requirements.

Please follow the process in SOP - Finalise Access Met Decision | | Applicants that do not meet the Developmental Delay criteria and do not have a hearing impairment | Go to Section 6.2 - List B | | Applicants that do not meet the Developmental Delay criteria and have a hearing impairment | Go to Section 6.4 - 0-25 Hearing Impairments |

8.2 Does the applicant meet Section 25(1)(a)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person:

(i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or

(ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

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the applicant has an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and
the impairment is intellectual, cognitive, neurological, sensory, or physical in nature; and
the impairment is, or is likely to be, permanent.

Note: When an applicant is diagnosed with a condition on List B or List D, they meet this criterion without further assessment.

What to consider

Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment?
Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?
Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success?
Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only?
Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

What treatments have been undertaken and what were the outcomes?
If there are evidence-based treatments not undertaken, why were they considered and deemed not suitable?
What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Our Guidelines - Do you need early intervention?

Applicants aged under 7


Applicants that meet Section 25(1)(a)	Go to Section 8.3 - Does the applicant meet Section 25(1)(b)?

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Applicants that do not meet Section 25(1)(a)	Are not eligible for early intervention.

You will now assess them against the disability requirements.

Go to Section 7.1 - Does the applicant meet Section 24(1)(a)? |

Applicants aged 7 and over


Applicants that meet Section 25(1)(a)	Go to Section 8.3 - Does the applicant meet Section 25(1)(b)?
Applicants that do not meet Section 25(1)(a)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in SOP - Finalise Access Not Met Decision |

8.3 Does the applicant meet Section 25(1)(b)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports for the applicant’s permanent impairment/s will reduce their need for disability-related supports in the future.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

Does the evidence contain specific recommendations for early intervention, and indicate that this intervention will mean the applicant needs less disability supports in the future?

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Does the evidence note which specific supports the applicant will no longer require should early intervention be undertaken?
Does the evidence indicate that early intervention is likely to result in greater independence for the applicant?
If the applicant has accessed intervention before, is the outcome noted? Did previous intervention reduce their need for disability related supports?
Is the recommended support of a functional nature, or capacity building in nature?
In answering the above questions, does the evidence contain sufficient information addressing:
How the applicant’s impairment is likely to impact them over time?
What supports the applicant will require if they don’t receive intervention?
What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to Our Guidelines - How will early intervention help you?

For applicants aged under 7


Applicants that meet Section 25(1)(b)	Go to Section 8.4 - Does the applicant meet Section 25(1)(c)?
Applicants that do not meet Section 25(1)(b)	Are not eligible for early intervention.

You will now assess them against the disability requirements.

Go to Section 7.1 - Does the applicant meet Section 24(1)(a)? |

For applicants aged 7 and over


Applicants that meet Section 25 (1)(b)	Go to Section 8.4 - Does the applicant meet Section 25(1)(c)?
Applicants that do not meet Section 24(1)(c)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in SOP - Finalise Access Not Met Decision |

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8.4 Does the applicant meet Section 25(1)(c)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self‑care or self‑management; or

(ii) preventing the deterioration of such functional capacity; or

(iii) improving such functional capacity; or

(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows early intervention supports will help the applicant by:
addressing the impact of their impairment on their ability to move around, communicate, socialise, learning, look after themselves, or organise their life
preventing their functional capacity from getting worse
improving their functional capacity
supporting their informal supports to build their skills to help the applicant.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

Does the evidence contain specific recommendations for early intervention, and detail how this intervention will mitigate or alleviate the impact of the applicant’s permanent impairment on their functional capacity?
Does the evidence contain specific recommendations for early intervention, and detail how this intervention will prevent the applicant’s functional capacity from declining?

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Does the evidence contain specific recommendations for early intervention, and detail how this intervention will improve the applicant’s functional capacity?
Does the evidence indicate that intervention is likely to strengthen the sustainability of informal supports available to the person, and result in a decreased need for formal disability related supports?

In answering the above questions, does the evidence contain sufficient information addressing:

How the applicant’s impairment is likely to impact them over time?
What supports the applicant will require if they don’t receive intervention?
What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to Our Guidelines - How will early intervention help you?

For applicants aged under 7


Applicants that meet Section 25(1)(c)	Go to Section 8.5 - Does the applicant meet Section 25(3)?
Applicants that do not meet Section 25(1)(c)	Are not eligible for early intervention.

You will now assess them against the disability requirements.

Go to Section 7.1 - Does the applicant meet Section 24(1)(a)? |

For applicants aged 7 and over


Applicants that meet Section 25(1)(c)	Go to Section 8.5 - Does the applicant meet Section 25(3)?
Applicants that do not meet Section 25(1)(c)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in SOP - Finalise Access Not Met Decision |

8.5 Does the applicant meet Section 25(3)?

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Legislation

Section 25 Early intervention requirements

(3) … the person does not meet the early intervention requirements if the CEO is satisfied that early intervention support for the person is not most appropriately funded or provided through the National Disability Insurance Scheme, and is more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or through systems of service delivery or support services offered:

(a) as part of a universal service obligation; or

(b) in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows early intervention supports are most appropriately funded by the NDIS.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

Whether or not funding is available through other general systems is not the test of whether it is most appropriately funded or provided through the NDIS. For example, the fact that the health system does not adequately fund what is essentially clinical treatment (or some other form of support that is more appropriately funded through the health system) does not make it the responsibility of the NDIS.

For further information, refer to Our Guidelines - Is your early intervention most appropriately funded by the NDIS?

For applicants aged under 7


Applicants that meet Section 25(3)	Meet the early intervention requirements.

Please follow the process in SOP - Finalise Access Met Decision | | Applicants that do not meet Section 25(3) | Are not eligible for early intervention.

You will now assess them against the disability requirements. |

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	Go to Section 7.1 - Does the applicant meet Section 24(1)(a)?

For applicants aged 7 and over


Applicants that meet Section 25(3)	Meet the early intervention requirements.

Please follow the process in SOP - Finalise Access Met Decision | | Applicants that do not meet Section 25(3) | Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in SOP - Finalise Access Not Met Decision |

9. ER – Residence Requirements

9.1 Does the participant continue to meet the residence requirements?

Legislation

Section 23 Residence requirements

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant:

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lives in Australia for most of the year; and
is an Australian Citizen; or
is the holder of a permanent visa; or
is the holder of a protected Special Category Visa (SCV)


Participants that continue to meet the residence requirements	Go to Section 10.1 - List A
Participants that no longer meet the residence requirements	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision |

10. ER - Streamlined Decisions

10.1 List A

Where a participant has been diagnosed with a condition on List A they will continue to meet the disability requirements without further assessment (unless there are an document integrity issues pending investigation).

Note: A person does not need to have a condition on List A to continue to be eligible for the NDIS.

For further information, refer to Our Guidelines - Do you meet the disability requirements?

For participants under the age of 7


Participants that have a condition on List A	Meet the disability requirements.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or |

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	* SOP - Consider ER outcome following 1st chance to respond, or

SOP - Make an eligibility reassessment decision | | Participants that do not have a condition on List A | Go to Section 10.3 - List D |

For participants aged 7 and over


Participants that have a condition on List A	Meet the disability requirements.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision | | Participants that do not have a condition on List A impairment | Go to Section 10.2 - List B |

10.2 List B

Where a participant has been diagnosed with a condition on List B, they will be considered to have a disability attributable to one or more impairments that is, or is likely to be, permanent without further assessment.

For participants diagnosed with a condition on List B, you will only need to assess whether the participant:

has an impairment that results in substantially reduced functional capacity to perform one or more activities;
has an impairment which affect their capacity for social or economic participation; and
is likely to require support under the NDIS for their lifetime.

Note: A person does not need to have a condition on List B to continue to be eligible for the NDIS.

For further information, refer to Our Guidelines – Is your impairment likely to be permanent?

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For participants under the age of 7


Participants that have a condition on List B	Go to Section 12.3 – Does the participant meet Section 25(1)(b)?
Participants that do not have a condition on List B	Go to Section 12.2 – Does the participant meet Section 25(1)(a)?

For participants aged 7 and over


Participants that have a condition on List B	Go to Section 11.3 – Does the participant meet Section 24(1)(c)?.
Participants that do not have a condition on List B	Go to Section 11.1 – Does the participant meet Section 24(1)(a)?

10.3 List D

Where a child under the age of 7 has been diagnosed with a condition on List D, they will continue to meet the early intervention requirements without further assessment.

Note: A child does not need to have a condition on List D to continue to be eligible for the NDIS.

For further information, refer to Our Guidelines – Do you need early intervention?

For participants under the age of 7


Participants that have a condition on List D	Meet the early intervention requirements.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision | | Participants that do not have a condition on List D | Go to Section 12.1 – Developmental Delay |

10.4 0-25 Hearing Impairments

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A participant continues to meet the early intervention requirements without further assessment if they:

are aged between birth and 25 years of age; and
have confirmed results from a specialist audiological assessment (including electrophysiological testing when required) consistent with auditory neuropathy or hearing loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent.

What to consider

For further information, refer to Our Guidelines - What about people aged between 0 and 25 with a hearing impairment?

For participants under the age of 7


Participants that meet the hearing impairment criteria	Meet the early intervention requirements.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision | | Participants that do not meet the hearing impairment criteria | Go to Section 10.2 - List B |

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For applicants aged 7 and over


Participants that meet the hearing impairment criteria	Meet the early intervention requirements.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision | | Participants that do not meet the hearing impairment criteria | Go to Section 12.2 – Does the participant meet Section 25(1)(a)? |

11. ER - Disability Requirements

11.1 Does the participant meet Section 24(1)(a)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

the participant has a disability (a reduction or loss in their ability to do things); and
their disability is caused by an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and
the impairment is intellectual, cognitive, neurological, sensory, or physical in nature.

Note: Where a participant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

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What to consider

Does the evidence demonstrate both that the participant has an impairment, and that the impairment is resulting in a disability?
Does the evidence demonstrate that the participant is reduced in their ability to do things, however this reduction cannot be reasonably attributed to an impairment?
Does the evidence demonstrate that the participant has a loss or significant change in one of their body’s functions or structure, or in how they think and learn; however, there is no indication that this is causing a reduction or loss in their ability to do things?

For further information, refer to Our Guidelines - Is your disability caused by an impairment?

For participants under the age of 7


Participants that meet Section 24(1)(a)	Go to Section 11.2 - Does the participant meet Section 24(1)(b)?
Participants that do not meet Section 24(1)(a)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision |

For participants aged 7 and over


Participants that meet Section 24(1)(a)	Go to Section 11.2 - Does the participant meet Section 24(1)(b)?
Participants that do not meet Section 24(1)(a)	Go to Section 10.4 – 0-25 Hearing Impairments

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11.2 Does the participant meet Section 24(1)(b)?

Legislation

Section 24 Disability requirements

(2) A person meets the disability requirements if:

(b) The impairment or impairments are, or are likely to be, permanent

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant has a:

permanent impairment; or
likely permanent impairment.

Note: Where a participant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

Does the evidence demonstrate that the participant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment?
Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?
Does the evidence indicate that the participant requires further treatment, and that this treatment has some prospect of success?
Does the evidence demonstrate that the participant requires ongoing treatment, but that it is for maintenance purposes only?
Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

What treatments have been undertaken and what were the outcomes?
If there are evidence-based treatments not undertaken, why were they considered and deemed unsuitable?

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What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Is your impairment likely to be permanent? | NDIS

For participants under the age of 7


Participants that meet Section 24(1)(b)	Go to Section 11.3 - Does the participant meet Section 24(1)(c)?
Participants that do not meet Section 24(1)(b)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision |

For participants aged 7 and over


Participants that meet Section 24(1)(b)	Go to Section 11.3 - Does the participant meet Section 24(1)(c)?
Participants that do not meet Section 24(1)(b)	Are not eligible for disability or early intervention support from the NDIS.

If they do not meet this criterion, they automatically do not meet Section 25(1)(a).

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change or
SOP - Consider ER outcome following 1st chance to respond
SOP - Make an eligibility reassessment decision |

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11.3 Does the participant meet Section 24(1)(c)?

Legislation

Section 24 Disability requirements

(2) A person meets the disability requirements if:

(i) communication;

(ii) social interaction;

(iii) learning

(iv) mobility

(v) self-care

(vi) self-management

…

When is this criterion considered met?

Communication: how they speak, write or use sign language and gestures.
Social interaction: how they make and keep friends, interact with the community, and cope with feelings and emotions in social situations.
Learning: how they learn, understand and remember new things, and practise and use new skills.
Mobility: how they move around home and the community and how they get in and out of bed or a chair.
Self-care: how they partake in personal care, hygiene, grooming, eating and drinking, and health.
Self-management (if older than 6): how they organise their life, make decision, solve problems and manage money.

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Note: When a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

Does the evidence demonstrate that the participant is unable to participate effectively or completely (i.e., across the whole or majority of tasks) in one or more activities, without formally prescribed equipment?
Does the evidence demonstrate that the participant is unable to participant effectively or completely in one or more activities, and usually requires the assistance of another person?
Does the evidence demonstrate that the participant would be unsafe to complete one or more tasks required to participate in an activity without formally prescribed equipment or assistance from another person?
Does the evidence indicate that the participant is able to participate in each activity effectively by using commonly used items?
Does the evidence indicate that the participant is able to participate in each activity effectively, albeit more slowly or in a different way?
Would completing tasks more slowly or in a modified way, or using commonly used items, relieve the participant’s need for personal assistance?

In answering the above questions, does the evidence contain sufficient information addressing:

What specific tasks the participant cannot complete without support?
Why the participant requires support?
How often the participant requires support, and what that support looks like?

For further information, refer to Our Guidelines - Does your impairment substantially reduce your functional capacity?

For participants under the age of 7


Participants that meet Section 24(1)(c)	Go to Section 11.4 - Does the participant meet Section 24(1)(d)?

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Participants that do not meet Section 24(1)(c)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision |

For participants aged 7 and over


Participants that meet Section 24(1)(c)	Go to Section 11.4 - Does the participant meet Section 24(1)(d)?
Participants that do not meet Section 24(1)(c)	Go to Section 10.4 – 0-25 Hearing Impairments

11.4 Does the participant meet Section 24(1)(d)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(d) The impairment or impairments affect the person’s capacity for social or economic participation.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, affects the participant’s social or economic participation.

Note: Where a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

Does the evidence demonstrate that the participant’s social participation (e.g., their capacity to play sport, go to the movies, see friends, etc.) is affected by their permanent impairment/s - in any way?

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Does the evidence demonstrate that the participant’s economic participation (e.g., their capacity to travel, to find or maintain voluntary or paid work, etc.) is affected by their permanent impairment - in any way?
Does the evidence demonstrate that the participant’s social and economic participation is not impacted in any way, and that they can fully engage without any assistance?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

For participants under the age of 7


Participants that meet Section 24(1)(d)	Go to Section 11.5 - Does the participant meet Section 24(1)(e)?
Participants that do not meet Section 24(1)(d)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision |

For participants aged 7 and over


Participants that meet Section 24(1)(d)	Go to Section 11.5 - Does the participant meet Section 24(1)(e)?
Participants that do not meet Section 24(1)(d)	Go to Section 10.4 – 0-25 Hearing Impairments

11.5 Does the participant meet Section 24(1)(e)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

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(e) The person is likely to require support under the National Disability Insurance Scheme for the person’s lifetime.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant:

will require the support of the NDIS for their lifetime; or
is likely to require the support of the NDIS for their lifetime.

Note: Where a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

Does the evidence demonstrate that the participant is likely to require disability supports that are not clinical in nature, and that focus on their functional ability, for their lifetime?
Does the evidence demonstrate that the participant will likely be substantially reduced in their functional capacity (in a relevant activity) for their lifetime, despite any interventions?
Are there any recommendations for interventions that are likely to improve the participant’s functional capacity, and reduce their future need for disability related supports?
If the participant is a child or young adult, does the evidence indicate that significant functional improvements can be expected - either as they develop, or through interventions?
Does the participant’s need for support relate to a health condition, and is that support more appropriately funded by the health system?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

For participants under the age of 7


Participants that meet Section 24(1)(e)	Continue to be eligible for the NDIS under the disability requirements.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or |

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	* SOP - Consider ER outcome following 1st chance to respond, or

SOP - Make an eligibility reassessment decision | | Participants that do not meet Section 24(1)(e) | Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision |

For participants aged 7 and over


Participants that meet Section 24(1)(e)	Continue to be eligible for the NDIS under the disability requirements.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision | | Participants that do not meet Section 24(1)(e) | Go to Section 10.4 – 0-25 Hearing Impairments |

12. ER – Early Intervention Requirements

12.1 Developmental Delay

Legislation

Section 25 Early intervention requirements

(2) A person meets the early intervention requirements if:

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(a) the person: (iii) is a child with who has developmental delay

Section 9 Definitions

Developmental delay means a delay in the development of a child under 6 years of age that:

(a) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and

(b) results in substantial reduction in functional capacity in one or more of the following areas of major life activity:

(i) self-care;

(ii) receptive and expressive language;

(iii) cognitive development;

(iv) motor development; and

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the child is younger than 6 on the day we determine they have developmental delay.

For further information, refer to Our Guidelines - What about children younger than 6 with developmental delay?


Participants that are under 6 with Developmental delay	Meet the early intervention requirements.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision | | Participants that do not meet the Developmental Delay criteria and do not have a hearing impairment | Go to Section 10.2 – List B |

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Participants that do not meet the Developmental Delay criteria and have a hearing impairment	Go to Section 10.4 – 0-25 Hearing Impairment

12.2 Does the participant meet Section 25(1)(a)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person:

(i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or

(ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

the participant has an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and
the impairment is intellectual, cognitive, neurological, sensory, or physical in nature; and
the impairment is, or is likely to be, permanent.

Note: Where a participant is diagnosed with a condition on List B or List D, they meet this criterion without further assessment.

What to consider
Does the evidence demonstrate that the participant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment?
Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?
Does the evidence indicate that the participant requires further treatment, and that this treatment has some prospect of success?

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Does the evidence demonstrate that the participant requires ongoing treatment, but that it is for maintenance purposes only?
Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

What treatments have been undertaken and what were the outcomes?
If there are evidence-based treatments not undertaken, why were they considered and deemed not suitable?
What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Our Guidelines - Do you need early intervention?

For participants under the age of 7


Participants that meet Section 25(1)(a)	Go to Section 12.2 - Does the participant meet Section 25(1)(b)?
Participants that do not meet Section 25(1)(a)	Go to Section 11.1 - Does the participant meet Section 24(1)(a)?

For participants aged 7 and over


Participants that meet Section 25(1)(a)	Go to Section 12.2 - Does the participant meet Section 25(1)(b)?
Participants that do not meet Section 25(1)(a)	Are not eligible for disability or early intervention support from the NDIS.

Please follow the process in:

SOP - Consider commencement of eligibility reassessment or access status change, or
SOP - Consider ER outcome following 1st chance to respond, or
SOP - Make an eligibility reassessment decision |

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12.3 Does the participant meet Section 25(1)(b)?

Legislation

Section 25 Early intervention requirements

(2) A person meets the early intervention requirements if:

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports for the participant’s permanent impairment/s will reduce their need for disability-related supports in the future.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

Does the evidence contain specific recommendations for early intervention, and indicate that this intervention will mean the participant needs less disability supports in the future?
Does the evidence note which specific supports the participant will no longer require should early intervention be undertaken?
Does the evidence indicate that early intervention is likely to result in greater independence for the participant?
If the participant has accessed intervention before, is the outcome noted? Did previous intervention reduce their need for disability related supports?
Is the recommended support of a functional nature, or capacity building in nature?
In answering the above questions, does the evidence contain sufficient information addressing:
- How the participant’s impairment is likely to impact them over time?
- What supports the participant will require if they don’t receive intervention?
- What supports the participant currently requires, and what supports (if any) the participant is likely to require after intervention?

For further information, refer to [Our Guidelines - How will early intervention help you?]

For participants under the age of 7

Participants that meet Section 25(1)(b)	Go to Section 12.4 - Does the participant meet Section 25(c)?
Participants that do not meet Section 25(1)(b)	Go to Section 11.1 - Does the participant meet Section 24(1)(a)?

For participants aged 7 and over

Participants that meet Section 25(1)(b)	Go to Section 12.4 - Does the participant meet Section 25(c)?
Participants that do not meet Section 25(1)(b)	Are not eligible for disability or early intervention support from the NDIS. Please follow the process in: * SOP - Consider commencement of eligibility reassessment or access status change, or * SOP - Consider ER outcome following 1st chance to respond, or * SOP - Make an eligibility reassessment decision

12.4 Does the participant meet Section 25(1)(c)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self‑care or self‑management; or

(ii) preventing the deterioration of such functional capacity; or

(iii) improving such functional capacity; or

(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows early intervention supports will help the participant by:
- addressing the impact of their impairment on their ability to move around, communicate, socialise, learning, look after themselves, or organise their life
- preventing their functional capacity from getting worse
- improving their functional capacity
- supporting their informal supports to build their skills to help the participant.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

Does the evidence contain specific recommendations for early intervention, and detail how this intervention will mitigate or alleviate the impact of the participant’s permanent impairment on their functional capacity?
Does the evidence contain specific recommendations for early intervention, and detail how this intervention will prevent the participant’s functional capacity from declining?
Does the evidence contain specific recommendations for early intervention, and detail how this intervention will improve the participant’s functional capacity?
Does the evidence indicate that intervention is likely to strengthen the sustainability of informal supports available to the person, and result in a decreased need for formal disability related supports?

In answering the above questions, does the evidence contain sufficient information addressing:

How the participant’s impairment is likely to impact them over time?
What supports the participant will require if they don’t receive intervention?
What supports the participant currently requires, and what supports (if any) the participant is likely to require after intervention?

For further information, refer to [Our Guidelines - How will early intervention help you?]

For participants under the age of 7

Participants that meet Section 25(1)(c)	Go to Section 12.5 - Does the participant meet Section 25(3)?
Participants that do not meet Section 25(1)(c)	Go to Section 11.1 - Does the participant meet Section 24(1)(a)?

For participants aged 7 and over

Participants that meet Section 25(1)(c)	Go to Section 12.5 - Does the participant meet Section 25(3)?
Participants that do not meet Section 25(1)(c)	Are not eligible for disability or early intervention support from the NDIS. Please follow the process in: * SOP - Consider commencement of eligibility reassessment or access status change, or * SOP - Consider ER outcome following 1st chance to respond, or * SOP - Make an eligibility reassessment decision

12.5 Does the participant meet Section 25(3)?

Legislation

Section 25 Early intervention requirements

(3) … the person does not meet the early intervention requirements if the CEO is satisfied that early intervention support for the person is not most appropriately funded or provided through the National Disability Insurance Scheme, and is more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or through systems of service delivery or support services offered:

(a) as part of a universal service obligation; or

(b) in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows early intervention supports are most appropriately funded by the NDIS.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

For further information, refer to [Our Guidelines - Is your early intervention most appropriately funded by the NDIS?]

For participants under the age of 7

Participants that meet Section 25(3)	Continue to be eligible for the NDIS under the early intervention requirements. Please follow the process in: * SOP - Consider commencement of eligibility reassessment or access status change, or * SOP - Consider ER outcome following 1st chance to respond, or * SOP - Make an eligibility reassessment decision
Participants that do not meet Section 25(3)	Go to Section 11.1 - Does the participant meet Section 24(1)(a)?

For participants aged 7 and over

| Participants that meet Section 25(3) | Continue to be eligible for the NDIS under the early intervention requirements.

Please follow the process in:
* SOP - Consider commencement of eligibility reassessment or access status change, or

	* SOP - Consider ER outcome following 1st chance to respond, or * SOP - Make an eligibility reassessment decision
Participants that do not meet Section 25(1)	Are not eligible for disability or early intervention support from the NDIS. Please follow the process in: * SOP - Consider commencement of eligibility reassessment or access status change, or * SOP - Consider ER outcome following 1st chance to respond, or * SOP - Make an eligibility reassessment decision

National Disability Insurance Scheme Act 2013
National Disability Insurance Scheme (Becoming a Participant) Rules 2016
Our Guidelines - Applying to the NDIS
SOP – Progress NDIS Application in the System
SOP - Finalise Access Met Decision
SOP - Finalise Access Not Met Decision
Access and ER Decision Tree

14. Feedback

If you would like to provide feedback about this guidance material, please discuss with your team leader who can send a request to NARB.BUSINESSIMPROVEMENT@ndis.gov.au.

15. Version control

Version	Amended by	Brief Description of Change	Status	Date
1.0	CHO0026	New resource	APPROVED	2022-10-31
2.0	GMQ132	Updated hyperlink	APPROVED	2023-02-16

Access and Eligibility Reassessment (ER) Practice Guide

Access and Eligibility Reassessment (ER) Practice Guide

1. Recent updates

What’s changed

2. Checklist

Topic Checklist

Checklist

3. Are you making an Access or ER decision?

4. Access — Age Requirements

4.1 Does the applicant meet the age requirements?

5. Access – Residence Requirements

5.1 Does the applicant meet the residence requirements?

6. Access – Streamlined Decisions

6.1 List A

6.2 List B

6.3 List D

6.4 0-25 Hearing Impairments

7. Access – Disability Requirements

7.1 Does the applicant meet Section 24(1)(a)?

7.2 Does the applicant meet Section 24(1)(b)?

7.3 Does the applicant meet Section 24(1)(c)?

7.4 Does the applicant meet Section 24(1)(d)?

7.5 Does the applicant meet Section 24(1)(e)?

8. Access - Early Intervention Requirements

8.1 Developmental Delay

8.2 Does the applicant meet Section 25(1)(a)?

8.3 Does the applicant meet Section 25(1)(b)?

8.4 Does the applicant meet Section 25(1)(c)?

8.5 Does the applicant meet Section 25(3)?

9. ER – Residence Requirements

9.1 Does the participant continue to meet the residence requirements?

10. ER - Streamlined Decisions

10.1 List A

10.2 List B

10.3 List D

10.4 0-25 Hearing Impairments

11. ER - Disability Requirements

11.1 Does the participant meet Section 24(1)(a)?

11.2 Does the participant meet Section 24(1)(b)?

11.3 Does the participant meet Section 24(1)(c)?

11.4 Does the participant meet Section 24(1)(d)?

11.5 Does the participant meet Section 24(1)(e)?

12. ER – Early Intervention Requirements

12.1 Developmental Delay

12.2 Does the participant meet Section 25(1)(a)?

12.3 Does the participant meet Section 25(1)(b)?

12.4 Does the participant meet Section 25(1)(c)?

12.5 Does the participant meet Section 25(3)?

13. Related procedures or resources

14. Feedback

15. Version control