Guide

Access

PACE – Pre-decision Quality Check Guide

Scheme Eligibility Branch

Business Assurance Testing

Version 12.0 – APPROVED – February 2026

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Contents

Background ……………………………………………………………………………………………………………………………………………………………… 3

• SEB Quality Framework …………………………………………………………………………………………………………………………………………. 3
• Access Pre-decision Quality Check Purpose …………………………………………………………………………………………………………….. 3
• Access Pre-decision Quality Check Process Overview ………………………………………………………………………………………………. 4
• Access Pre-decision Quality Check Guidance for QDOs ……………………………………………………………………………………………… 5

Quality Checklist Question Set …………………………………………………………………………………………………………………………………… 8

Question Guidelines, Instructions and Related Resources …………………………………………………………………………………………. 11

Quality Adjustment Required Feedback Templates ……………………………………………………………………………………………………. 53

Quality Outcome Achieved Templates ………………………………………………………………………………………………………………………. 84

Appendices …………………………………………………………………………………………………………………………………………………………….. 85

Feedback ………………………………………………………………………………………………………………………………………………………………… 87

Version control ……………………………………………………………………………………………………………………………………………………….. 87

Background

SEB Quality Framework

The National Disability Insurance Agency’s (NDIA) ‘Three Lines of Defence’ Risk Governance Model provides assurance to the Executive Leadership Team (ELT) and the NDIA Board that controls to address critical risks are effective and are implemented as intended.

Scheme Eligibility Branch’s (SEB) business assurance testing forms part of the NDIA’s Line 1 business assurance activities, which are seen as the Agency’s first line of defence against identified risks.

SEB’s Access business assurance testing consists of pre and post Access decision quality checks that focus on:

• critical legislative decision making actions; and
• key procedural compliance actions.

This document sets out the guidelines for pre-Access decision quality checks to assist SEB Quality Development Officers (QDOs) to complete their tasks.

Access Pre-decision Quality Check Purpose

The purpose of Access pre-decision quality checks is to confirm that:

• the decision is legislatively correct
• the decision is supported by the evidence provided
• the correct process has been followed
• the decision has been correctly recorded in the NDIS Business System
• appropriate communications have been provided to the applicant and/or their authorised representative

Conducting checks before the access decision has been finalised helps to develop quality, consistency and integrity in our practice.

Information from business assurance testing can show where processes and controls may need to be added or adjusted in order to deliver SEB and Agency objectives more effectively.

Access Pre-decision Quality Check Process Overview

This section provides an overview of the Access pre-decision quality check process. For detailed instructions, please refer to the Question Guidelines, Instructions and Supporting Information section of this Guide and PACE - SOP - Conduct Access Pre-decision Quality Check.

1. QDOs are assigned quality check work items in a Microsoft Teams message via Power Automate.
2. QDOs complete a quality check on an Access delegate’s submitted decision in line with the following table:

Quality Skill Level	Percentage of decisions subject to a quality check	Correctness rate required
Level 1	100%	0 – 79%
Level 2	25%	80 – 94.9%
Level 3	2%	95% and above

3. QDOs ensure Access delegates have addressed all access legislative and procedural requirements using the instructions in the Question Guidelines, Instructions and Supporting Information section of this guide.
4. The QDO records errors identified using the QDO Outcomes Form and in the Access Quality Check Form.

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5. The QDO Team Leader provides quality check reports to Assessor Team Leaders and SEB leadership on a weekly and monthly basis.
6. Assessor Team Leaders and SEB leadership uses the data as a basis for continuous improvement.

Access Pre-decision Quality Check Guidance for QDOs

Access Pre-decision Quality Check Instructions Overview

This section provides an overview of Access pre-decision quality check process instructions for QDOs. For detailed instructions, please refer to [PACE - SOP - Conduct Access Pre-decision Quality Check](PACE - SOP - Conduct Access Pre-decision Quality Check).

1. Review the proposed access decision in PACE and use the [Question Guidelines, Instructions and Related Resources](Question Guidelines, Instructions and Related Resources) section of this guide to ensure that the Access delegate has addressed all legislative and procedural requirements with reference to supporting evidence.

2. Use the [Access Quality Check Form](Access Quality Check Form) to enter the corresponding outcome for each quality check question and to provide critical and non-critical feedback using templates provided in the [Quality Adjustment Required Feedback Templates](Quality Adjustment Required Feedback Templates) and [Quality Outcome Achieved Templates](Quality Outcome Achieved Templates) section of this guide.

   Note: An email will be automatically sent to the delegate with the quality check outcome, QC feedback, and next steps.

3. Record the quality check outcome and any critical or non-critical feedback provided using the [QDO Outcomes Form](QDO Outcomes Form).

4. The QDO Team Leader will provide quality check reports to Team Leaders on a weekly and monthly basis, who will in turn provide feedback to Access delegates.

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Access Pre-decision Quality Check Practice Guidance for QDOs

Purpose of giving feedback

Giving feedback constructively benefits everyone. Access delegates gain guidance about their work, Team Leaders and SEB leadership gain information about common themes for improvement and coaching, participants gain better outcomes, and the Agency increases its capacity to be effective, consistent, compliant and productive.

Key elements of providing effective feedback

Constructive feedback is clear, concise and actionable. The focus is on the task, evidence and process, rather than opinion. Use non-judgemental language and keep comments brief. Use these steps to guide your feedback:

1. Before providing feedback, consider why you are providing feedback. Check for legislative correctness and procedural compliance. Ask yourself whether the Access delegate followed the correct procedure and if the outcome is supported by sound reasoning and evidence.
2. Use the relevant QDO feedback comments template provided in the [Quality Adjustment Required Feedback Templates](Quality Adjustment Required Feedback Templates) and [Quality Outcome Achieved Templates](Quality Outcome Achieved Templates) section of this guide to give feedback.
3. Describe the specific error, explaining what was incorrect and why.
4. Indicate how to fix the error.
5. Provide any additional links to guidance material if needed.

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Assuring QDO independence

In line with the Agency’s [Conflicts of Interest policy (DOCX 1.43MB)](Conflicts of Interest policy (DOCX 1.43MB)), SEB ensures the QDO who is completing the pre-decision quality check of an access decision is unbiased and does not have a personal relationship with the applicant or a personal interest in their status. SEB also ensures the QDO completing the pre-decision quality check was not involved in the access decision by monitoring data from the QDO Outcomes Form.

In the event a conflict of interest arises, the QDO will declare their involvement or conflict of interest and re-assign the Quality Check to an independent QDO. For further details refer to [PACE – SOP - Conduct Access Pre-decision Quality Check](PACE – SOP - Conduct Access Pre-decision Quality Check).

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Quality Checklist Question Set

Compliance	Question
Legislative	1. Was the access request valid at the time the access decision was made?
Procedural	2. Did the Assessor ensure that there was not an open Internal Review or Administrative Review Tribunal (ART) request?
Procedural	3. If applicable, has the authorised representative been correctly recorded in the Relationships tab?
Legislative	4. If applicable, did the Assessor confirm the legislative timeframe was not met?
Legislative	5. Did the Assessor correctly confirm the applicant meets/does not meet the Age requirements?
Legislative	6. Did the Assessor correctly confirm the applicant meets/does not meet the Residence requirements?
Legislative	7. Did the Assessor correctly confirm the applicant meets/does not meet the Disability and/or Early Intervention requirements?
Procedural	8. Was the access decision recorded correctly in the Business System?

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Compliance	Question
Procedural	9. Where an access met decision has been submitted for an applicant, did the Assessor complete the streaming case correctly?
Procedural	10. Where an access met decision has been submitted for an applicant with a chronic health condition, did the Assessor receive mandatory TAB advice prior to submitting the decision?
Procedural	11. Where an Access Met decision has been proposed for an applicant residing in hospital, did the Assessor confirm that TAB advice is not required?
Procedural	12. Where an access met decision has been submitted for an applicant who is under 25 years of age with a primary disability that is a psychosocial condition, did the Assessor receive mandatory Team Leader or EL1 approval prior to submitting the decision?
Procedural	13. Where an applicant resides in a remote or very remote location (MMM6 and MMM7), did the Assessor follow the correct process for remote and very remote applications?
Procedural	14. Where an applicant is a young person in residential aged care (YPIRAC), did the Assessor follow the correct process for YPIRAC applications?
Procedural	15. Where an applicant has a developmental delay and are working with an Early Childhood Partner was the correct evidence form used?
Procedural	16. Where the applicant has a terminal Illness, glioblastoma, metastatic cancer or Motor Neuron Disease did the

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Compliance	Question
	Assessor follow the correct process for Priority Health Access cases?

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Question Guidelines, Instructions and Related Resources

1. Valid Access Request Check

Relevant Requirements

After a person’s access request has been received by the Agency, it must be validated before being assessed against the access requirements.

An access request is valid and complete when the applicant (and, if applicable, their child representative or authorised representative):

• has provided legal authority to progress with the access request (by signing the Access Request Form or by providing verbal authority),
• has provided documentary evidence in relation to their identity,
• has provided consent to access the applicant’s Centrelink record to verify their age and residency status (or has provided documentary evidence of their age and residency status),
• has provided supporting evidence in relation to the applicant’s disability (not required if an existing client of a defined program),
• has included all information required as part of the request and certified it to be complete.

(Refer to NDIS Act s19 and [Our Guideline – Applying to the NDIS](Our Guideline – Applying to the NDIS), (see ‘What information do we need in your application?’).

Once the access request is considered complete and valid, submitting the Access Request case in the system will update the Status of the Access Request from In Progress to Pending Outcome and create an Access Decision case. This will trigger the relevant timeframe to make the decision or request further evidence.

Staff are required to correctly enter the person’s information, either from their Access Request Form or verbally, and their supporting documents into the NDIS business system. The Access Officer must check the information to verify the request is complete, and validate it before it is progressed to an Access delegate for a decision.

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Note: The validation date entered into PACE must be the date the valid and complete access request was received by the Agency, not the date it was processed by the Access Officer.

Instructions

Determine if there is correct authority to make an Access Request:

1. In the Person Account, go to Relationships > Authorised Reps to check if there is an authorised representative.
   • If there are no authorised representatives – no further investigation required.
2. If there are authorised representatives– check whether there is evidence of who has lodged the application:
   • Third Party Consent Form, email, an activity log of a conversation, or legal documentation for legally appointed guardians, and
   • Access Request Form (ARF), and/or
   • Internal Note from the Partner within the Access Request case.

Determine if the person has had 1 birth or arrival and 2 use in community documents verified (where applicable, identity documents required for child representative, nominee or authorised representative in addition to the person):

1. Go to Person Account: Select the Details tab.
2. In the Person Account, go to My Profile > Evidence to verify 3 relevant identity documents (1 Birth or Arrival and 2 Use in Community documents).
   • The Document Category column will indicate whether it is a Birth or Arrival (BA) or Use in Community (UiC) document.
   • The Verification Status will indicate whether the document has been verified and via which method. If Verification Status is:
     • Verified DVS – no further checks required.

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• Verified Manual – review the PACE record for an AIM Referral and an Internal Note.

  Note: Refer to [Progress an Access Request case](Progress an Access Request case) (section Verify evidence of identity) and [Check a person’s identity using Centrelink payment information](Check a person’s identity using Centrelink payment information) for further information on appropriate scenarios to refer to AIM.

• Fail – review PACE for an Internal Note.

  Note: Fail should be used by a delegate if an:

  • identity document fails DVS, AND
  • additional Centrelink checks provide a level of assurance of the applicant’s identity.

• Unverifiable Document (Eyeball) – check for integrity concerns. (This may appear at Verified NVD)

  Note: Unverifiable Document (Eyeball) should only be used if:

  • document cannot be verified by DVS (e.g. utility bill), AND
  • there are no integrity concerns.

Note: Face to Document verification is not required at this stage for an access request to be valid or to progress with an access decision.

• The Name Match column will indicate whether the name on the document matches the applicant’s.

Note: There are instances where a name will not match (for example, maiden name on birth certificate). In this instance, a verified document of name change is required. Partners are not allowed to upload copies of identity documents. The above indicators are how you will verify them.

3. If the applicant is a child, in their Person Account:
   • Go to Relationships > Authorised Reps to confirm that a child representative has been added (the Status must be Active).

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• Go to the child representative’s Person Account:
  • Go to the Documents tab and follow Steps 1 and 2 as outlined above to verify 3 relevant identity documents

Determine if the person or their authorised representative has provided consent to access their Centrelink record to verify their age and residency status (or has provided documentary evidence of their age and residency status):

1. Determine if applicant or their authorised representative has provided consent to check Centrelink Mainframe:
   • Go to Person Account: Select the Details tab.
   • Under Consents check the Consent To Use CRN checkbox.
2. If Consent To Use CRN checkbox has been ticked:
   • check age and residence details in Centrelink Mainframe.
3. If Consent To Use CRN checkbox has not been ticked:
   • Go to Person Account > Documents to check Access Request Form (if attached to the record) to confirm consent for Centrelink has not been provided.
   • Check Internal Notes and Enquiries for consent.
   • Check Documents to verify age and residence.

Determine if the person has provided supporting evidence in relation to their disability (not required if an existing client of a defined program):

1. Go to Person Account: Select Documents tab to locate evidence of impairment.
2. If unable to locate evidence of impairment in Documents, go to the Cases tab in the Person Account.

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3. Under Open Cases: Select Access Decision.
4. Navigate to the Documents tab for any evidence that may have been uploaded directly to the Access Decision case.

Note: Refer to Document Category and Document SubCategory for ease of navigation (for example, Document Category – Supporting Information and Document SubCategory – Evidence of Disability). However, it is best practice to check all relevant evidence on file regardless of the label.

If a quality adjustment is required, in preparation to provide feedback, complete and copy the [Valid Access Request Quality Adjustment Template](Valid Access Request Quality Adjustment Template).

Related Resources

• [NDIS Act 2013 (C19)](NDIS Act 2013 (C19)) and [NDIS Act 2013](NDIS Act 2013), section 19
• [NDIS Our Guidelines – Applying to the NDIS](NDIS Our Guidelines – Applying to the NDIS) (see ’How do you apply for the NDIS? > ‘What information do we need in your application?’)
• [KA: Prepare to make an access decision](KA: Prepare to make an access decision)
• [KA: Submit an access decision](KA: Submit an access decision)
• [KA: Validate the application or request evidence](KA: Validate the application or request evidence)
• [KA: How to complete the access request form](KA: How to complete the access request form)
• [KA: Applicant consent to apply](KA: Applicant consent to apply)
• [KA: Understand the identity confirmation status](KA: Understand the identity confirmation status)
• [KA: Understand the Document Verification Service](KA: Understand the Document Verification Service)
• [KA: Record consent to share information or for a third party to act](KA: Record consent to share information or for a third party to act)
• [KA: Understand authorised representatives](KA: Understand authorised representatives)
• [KA: What is consent and how do I know it has been provided](KA: What is consent and how do I know it has been provided)
• [KA: Check evidence to act on behalf of another person](KA: Check evidence to act on behalf of another person)
• [KA: Check consent, nominee, child representative or self-representation authorities](KA: Check consent, nominee, child representative or self-representation authorities)

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Guidelines for Q1

Was the access request valid at the time the access decision was made?

Yes: Quality Outcome Achieved

1. All the documents required to validate the access request were received and reviewed:
   • If applicable, authority to make an Access Request.
   • Identity documents (including the child representative, nominee or authorised representative, where applicable).
2. The person’s age and residency was verified through:
   • Centrelink record with consent, and/or
   • documents attached to the record.
3. Evidence of impairment has been uploaded to the record.

No: Quality Adjustment Required

1. All documents required to validate the access request not received or were incomplete (including for the child representative, nominee or authorised representative, where applicable), or
2. The person’s age and/or residence was not verified through their Centrelink record or documents attached to the record, or
3. There is no evidence of impairment uploaded to the record.

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2. Internal Review and Administrative Review Tribunal (ART) Check

Relevant Requirements

Under both the previous (C19) and [current versions](current versions) of the NDIS Act 2013, there are changes in the applicant’s limit on making new access requests.

An applicant cannot make a new access request whilst they have an open Internal Review (s100) or Administrative Review Tribunal (ART) request for:

• an access not met decision
• a revocation decision (unless the [previous version of the NDIS Act 2013 (C19)](previous version of the NDIS Act 2013 (C19)) applies)

Instructions

Check for an open internal review:

1. In Person account, go to Cases > Cases > Open Cases.
2. Check if there is an open internal review (s100) of:
   • an access not met decision, or
   • a revocation decision and the new access request was made on or after 3 October 2024.

If a quality adjustment is required, in preparation to provide feedback, complete and copy the [Internal Review and Administrative Review Tribunal (ART) Quality Adjustment Template](Internal Review and Administrative Review Tribunal (ART) Quality Adjustment Template).

Check for an open Administrative Review Tribunal (ART) review:

1. Review alerts on the account.

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Note: Active Alerts should automatically populate when you enter a record.

2. Check for an alert that there is an Administrative Review Tribunal (ART) case or review in progress for:

   • an access not met decision, or
   • a revocation decision and the new access request was made on or after 3 October 2024.

   Note: The alert may refer to the previous name Administrative Appeals Tribunal (AAT).

If a quality adjustment is required, in preparation to provide feedback, complete and copy the [Internal Review and Administrative Review Tribunal (ART) Quality Adjustment Template](Internal Review and Administrative Review Tribunal (ART) Quality Adjustment Template).

Related Resources

• [NDIS Act 2013 (C19)](NDIS Act 2013 (C19)) and [NDIS Act 2013](NDIS Act 2013), section 19
• [Legislation Decision Tree](Legislation Decision Tree)
• [KA: Progress an access request case](KA: Progress an access request case)
• [Create, update or end-date an alert](Create, update or end-date an alert)

Guidelines for Q2

Did the Access Assessor ensure that there was not an open Internal Review or Administrative Review Tribunal (ART) request?

Yes: Quality Outcome Achieved

1. There is no open internal review or Administrative Appeals Tribunal (AAT) for an access not met or revocation decision.

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No: Quality Adjustment Required

1. There is an open internal review or Administrative Appeals Tribunal (AAT) for an access not met decision.
2. There is an open internal review or Administrative Appeals Tribunal (AAT) for a revocation decision and the new access request was made on or after 3 October 2024.

3. Authorised Representative Listed in Relationships Check

Relevant Requirements

For any applicants under the age of 18, consent to make an access request must be given by a child representative, or in exceptional circumstances, by themselves or another person as determined in writing by the CEO. Access staff must ensure that the child representative is linked to the applicant’s record. This also applies to applicants over the age of 18 who have a legal guardian or have chosen to nominate an authorised representative to act on their behalf. The identity of a new contact must be verified before they are added to a record in PACE.

Instructions

For new and non-defined applicants under the age of 18:

1. In the applicant’s Person Account, go to Relationships > Authorised Reps to confirm that a child representative has been added (the Status must be Active, and their Role is Child Representative).
2. Go to the child representative’s Person Account.
3. Go to Details > Address to confirm the correct address.
4. Determine if the child representative has been correctly linked to the applicant’s record, and that the address in the child representative’s Person Account is correct.

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If a quality adjustment is required, in preparation to provide feedback, complete and copy the [Authorised Representative Listed in Relationships Quality Adjustment Template](Authorised Representative Listed in Relationships Quality Adjustment Template).

For applicants over the age of 18 with an authorised representative:

1. In the applicant’s Person Account, go to Relationships > Authorised Reps to confirm that the authorised representative has been added (the Status must be Active).
2. Go to Person Account > Cases tab.
3. Under Closed Cases: Select Manage Authorised Representative.
4. Navigate to the Authority Details tab.
5. Under Request Details Summary, confirm the Appointee Name.
6. In the Evidence section, review evidence of consent (this could be a Third Party Consent Form, email, an activity log of a conversation, or legal documentation for legally appointed guardians).
7. You can also check the Documents tab in the applicant’s Person Account for a signed consent form or access request form granting consent.

If a quality adjustment is required, in preparation to provide feedback, complete and copy the [Authorised Representative Listed in Relationships Quality Adjustment Template](Authorised Representative Listed in Relationships Quality Adjustment Template).

Related Resources

• Previous version of the [NDIS Act 2013 (C19)](NDIS Act 2013 (C19))
• Current version of the [NDIS Act 2013](NDIS Act 2013)

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• [NDIS (Becoming a Participant) Rules 2016](NDIS (Becoming a Participant) Rules 2016)
• [NDIS Our Guidelines – Applying to the NDIS](NDIS Our Guidelines – Applying to the NDIS)
• [KA: Prepare to make an access decision](KA: Prepare to make an access decision)
• [KA: Submit an access decision](KA: Submit an access decision)
• [KA: Check consent, nominee, child representative or self-representation authorities](KA: Check consent, nominee, child representative or self-representation authorities)
• [KA: Add or cancel a relationship](KA: Add or cancel a relationship)
• [KA: Understand authorised representatives](KA: Understand authorised representatives)
• [KA: Record consent to share or for a third party to act](KA: Record consent to share or for a third party to act)
• [KA: What is consent and how do I know it has been provided](KA: What is consent and how do I know it has been provided)
• [KA: Check evidence to act on behalf of another person](KA: Check evidence to act on behalf of another person)

Guidelines for Q3

If applicable, has the authorised representative been correctly recorded in the Relationships tab?

Yes: Quality Outcome Achieved

1. If applicable, the authorised representative is listed as an Authorised Rep in the Relationships tab, and
2. Sufficient evidence that authority has been given has been verified, and
3. If they are a correspondence nominee or a child representative, the authorised representative’s address is correct.

No: Quality Adjustment Required

1. If applicable, the authorised representative is not listed as an Authorised Rep in the Relationships tab, and/or
2. Insufficient evidence that authority has been given, and/or

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No: Quality Adjustment Required

3. If they are a correspondence nominee or a child representative, the authorised representative’s address is incorrect.

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4. Legislative Timeframe Check

Relevant Requirements

An access decision or a further information request must be made within 21 days of receiving a valid access request (s20). Following a further information request, an access decision or a further information request must be made within 14 days of receiving the last information or report (s26). If an application is outside the legislative timeframe, Access delegates are required to record an internal note advising this.

Instructions

1. Check the application against legislative timeframes. For further instructions on checking legislative timeframes, refer to article [Check decision - legislative timeframes](Check decision - legislative timeframes) under section Timeframes for making an access decision.
2. If the decision was submitted outside the legislative timeframe:
   • Go to the Activity Panel on the right of the screen to locate Internal Note advising the application is outside the legislative timeframe.

If a quality adjustment is required, in preparation to provide feedback, complete and copy the [Legislative Timeframe Quality Adjustment Template](Legislative Timeframe Quality Adjustment Template).

Related Resources

• Previous version of the [NDIS Act 2013 (C19)](NDIS Act 2013 (C19)) and current version of the [NDIS Act 2013](NDIS Act 2013), section 20
• [NDIS (Becoming a Participant) Rules 2016](NDIS (Becoming a Participant) Rules 2016)
• [NDIS Our Guidelines – Applying to the NDIS](NDIS Our Guidelines – Applying to the NDIS)
• [KA: Submit an access decision](KA: Submit an access decision)
• [KA: Check decision – Legislative timeframes](KA: Check decision – Legislative timeframes)
• [KA: Log an activity or internal note](KA: Log an activity or internal note)

Guidelines for Q3

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Did the Assessor correctly confirm the legislative timeframe was not met?

Yes: Quality Outcome Achieved

1. The decision was made within the legislative timeframe, or
2. An internal note has been recorded advising that the application is outside the legislative timeframe.

No: Quality Adjustment Required

1. The decision was not made within the legislative timeframe, and there is no internal note advising of this.

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5. Age Requirements Check

Relevant Requirements

The access requirements for age are that the person must be under 65 years of age at the time of the access request (s22).

Instructions

1. Go to Person Account > Cases tab.

2. Under Open Cases: Select Access Decision.

   Note: The Status of this case will be In Progress.

3. Navigate to the Decision tab to review the proposed decision summarised in the Decision Main Criteria.

4. Select Back and then use the Previous buttons to review and confirm the proposed decision matches Age & Residency Sub Criterion outcome.

5. To determine if consent to check Centrelink Mainframe to verify age and residence has been given, go to:

   • Person Account: Select Details tab.
   • Under Consents check the Consent to Use CRN checkbox.
   • If Consent To Use CRN checkbox has been ticked, check age details in Centrelink Mainframe.

6. If Consent To Use CRN checkbox has not been ticked:

   • go to Person Account > Documents to check Access Request Form (if attached to the record) to confirm consent for Centrelink has not been provided.

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• Check Internal Notes and Enquiries for consent.
• Check Documents for evidence the applicants meets/does not meet age.

7. Determine if the applicant did or did not meet the age requirements based on the evidence provided, and that the Assessor applied the legislation correctly.

Note: Where evidence is insufficient but the applicant resides in a Rural/Remote area, different evidence standards are accepted.

If a quality adjustment is required, in preparation to provide feedback, complete and copy the [Age Requirements Quality Adjustment Template](Age Requirements Quality Adjustment Template).

Related Resources

• Previous version of the [NDIS Act 2013 (C19)](NDIS Act 2013 (C19)) and current version of the [NDIS Act 2013](NDIS Act 2013), section 22
• [NDIS (Becoming a Participant) Rules 2016](NDIS (Becoming a Participant) Rules 2016)
• [NDIS Our Guidelines – Applying to the NDIS](NDIS Our Guidelines – Applying to the NDIS)
• [KA: Submit an access decision](KA: Submit an access decision)
• [KA: Check evidence for a decision – Age and residence requirements](KA: Check evidence for a decision – Age and residence requirements)
• [KA: Consent to use Centrelink information](KA: Consent to use Centrelink information)
• [KA: Providing evidence of age and residency](KA: Providing evidence of age and residency)

Guidelines for Q5

Did the Assessor correctly confirm the applicant meets/does not meet the Age requirements?

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Yes: Quality Outcome Achieved

1. Verification obtained through:
   • Centrelink record, with consent, and/or
   • Documents attached to record.
2. Verification shows that legislative requirements for age were correctly assessed as met/not met.

No: Quality Adjustment Required

1. Evidence of age does not reflect the decision that has been made, or
2. No evidence of age is available to verify the decision.

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6. Australian Residence Requirements Check - s23(1)(a) and s23(1)(b)

Relevant Requirements

Under section s23(1)(a) of the Australian residence requirements, an applicant must:

• live in Australia.

Under section 23(1)(b) of the Australian residence requirements, an applicant must:

• be an Australian citizen, OR
• hold a Permanent Visa, OR
• hold a Protected Special Category Visa.

Instructions

1. Go to Person Account > Cases tab.

2. Under Open Cases: Select Access Decision.

   Note: The Status of this case will be In Progress.

3. Navigate to the Decision tab to review the proposed decision summarised in the Decision Main Criteria.

4. Select Back and then use the Previous buttons to review and confirm the proposed decision matches Age & Residency Sub Criterion outcome.

5. To determine if consent to check Centrelink Mainframe to verify age and residence has been given, go to:

   • Person Account: Select Details tab.

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• Under Consents check the Consent to Use CRN checkbox.

6. If Consent To Use CRN checkbox has been ticked:

   • Check residence details in Centrelink Mainframe.

7. If Consent To Use CRN checkbox has not been ticked:

   • Go to Person Account > Documents to check Access Request Form (if attached to the record) to confirm consent for Centrelink has not been provided.
   • Check Internal Notes and Enquiries for any indication of consent.
   • Check Documents for evidence the applicants meets/does not meet residence.

8. Go to Person Account > Details > Address to check relevant answers recorded next to:

   • Home Address

9. Go to Person Account > Details > Residence Information to check relevant answers recorded next to:

   • Australian Citizen
   • Country Of Birth
   • Visa Type
   • Residency Status

10. Determine if the applicant did or did not meet the Australian residence requirements and whether they do or do not reside permanently in Australia based on the evidence provided, and that the Assessor applied the legislation correctly.

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Note: Where evidence is insufficient but the applicant resides in a Rural/Remote area, different evidence standards are accepted.

If a quality adjustment is required, in preparation to provide feedback, complete and copy the [Australian Residence Requirements Quality Adjustment Template](Australian Residence Requirements Quality Adjustment Template).

Related Resources

• Previous version of the [NDIS Act 2013 (C19)](NDIS Act 2013 (C19)) and current version of the [NDIS Act 2013](NDIS Act 2013), section 23
• [NDIS (Becoming a Participant) Rules 2016](NDIS (Becoming a Participant) Rules 2016)
• [NDIS Our Guidelines – Applying to the NDIS](NDIS Our Guidelines – Applying to the NDIS)
• [KA: Submit an access decision](KA: Submit an access decision)
• [KA: Check evidence for a decision – Age and residence requirements](KA: Check evidence for a decision – Age and residence requirements)
• [KA: Consent to use Centrelink information](KA: Consent to use Centrelink information)
• [KA: Providing evidence of age and residency](KA: Providing evidence of age and residency)

Guidelines for Q6

Did the Assessor correctly confirm the applicant meets/does not meet the Australian Residence requirements?

Yes: Quality Outcome Achieved

1. Verification obtained through:
   • Centrelink record, with consent, and/or
   • Documents attached to record.
2. Verification shows that legislative requirements for s23(1)(a) and s23(1)(b) of the Australian residence were correctly assessed as met/not met.

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No: Quality Adjustment Required

1. Evidence of residence does not reflect the decision that has been made, or
2. No evidence of residence is available to verify the decision.

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7. Confirmation of Disability or Early Intervention Requirements Check

Relevant Requirements

A person meets the access criteria if the NDIA is satisfied the person meets the age and residence requirements, and either the disability or the early intervention requirements (section 21).

Note: Under the new version of the [NDIS Act 2013](NDIS Act 2013), the applicant can meet both disability requirements (s24) and early intervention requirements (s25).

The access decision is based on a correct application of the NDIS legislation (previous (C19) or [current version](current version)) of the NDIS Act 2013, Rules and [Our Guidelines – Applying to the NDIS](Our Guidelines – Applying to the NDIS), against the evidence provided in the person’s record.

Refer to the applicable legislation (current version of the [NDIS Act 2013](NDIS Act 2013) and previous version of the [NDIS Act 2013 (C19)](NDIS Act 2013 (C19)),) to understand the disability requirements (s24) and early intervention requirements (s25).

If a person does not meet one or more of the disability requirements, the NDIA will consider whether the person can become a participant in the NDIS under the early intervention requirements instead.

For all children under 7 years of age (except children diagnosed with a condition on [List A](List A)), the NDIA will first consider whether the child meets the early intervention requirements, before considering the disability requirements.

The NDIA has developed a list of conditions which are designed to streamline the access process in certain cases.

Where an applicant has a condition included in [List A](List A) or List B, the NDIA will be satisfied that the person meets one or more of the disability requirements. Where a child under the age of 7 has been diagnosed with a condition/s on [List D](List D) the NDIA will be satisfied that the child meets the early intervention requirements without further assessment.

Instructions

Relevant Requirements

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Check which legislation applies:

1. In the Access Request case, check when the Access Request was complete.

   Note: An Access Request is considered complete when the following information was received:

   • consent to apply from the applicant or authorised representative,
   • verifiable evidence of age and residence,
   • evidence of disability, and
   • verifiable evidence of identity.

2. In Access Decision case > Pre-Assessment page, review the greyed out selection under Legislation version that will be used for the access decision. If the Access Request was complete:

   • before 3 October 2024, this will show NDIS Act 2013.
   • on or after 3 October 2024, this will show NDIS Amendment (Getting the NDIS Back on Track No.) Act 2024.

   Note: This will reflect what was selected in the Access Request case.

Check the access decision:

1. Go to Person Account > Cases tab.

2. Under Open Cases: Select Access Decision.

   Note: The Status of this case will be In Progress.

3. Navigate to the Decision tab to review the proposed decision summarised in the Decision Main Criteria.

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4. Navigate through the proposed decision using the Back and Previous button to review the Disability and Early Intervention criteria selections.
5. Navigate to the Documents tab to check evidence of impairment provided against the decision/s recorded.
6. Check Person Account > Documents for any evidence of impairment provided that has not been linked to the Access Decision case. Ensure you also check SAP CRM and Enquiries inbox for any evidence that has not been transferred over to PACE.
7. Determine if the applicant did or did not meet the Disability and/or Early Intervention requirements based on the evidence provided, and whether the correct legislative sub-criteria was assessed.

Note: If the new version of the [NDIS Act 2013](NDIS Act 2013) applies, an applicant can meet both the Early Intervention and Disability requirements.

If a quality adjustment is required, in preparation to provide feedback, complete and copy the [Confirmation of Disability or Early Intervention Requirements Quality Adjustment Template](Confirmation of Disability or Early Intervention Requirements Quality Adjustment Template).

Related Resources

• Previous version of the [NDIS Act 2013 (C19)](NDIS Act 2013 (C19)) and current version of the [NDIS Act 2013](NDIS Act 2013), section 24
• [NDIS (Becoming a Participant) Rules 2016](NDIS (Becoming a Participant) Rules 2016)
• [NDIS Our Guidelines – Applying to the NDIS](NDIS Our Guidelines – Applying to the NDIS)
• [KA: Submit an access decision](KA: Submit an access decision)
• [KA: Understand disability requirements](KA: Understand disability requirements)
• [KA: Check evidence for a decision – impairment caused disability](KA: Check evidence for a decision – impairment caused disability)
• [KA: Check evidence for a decision – disability requirements – likely permanence](KA: Check evidence for a decision – disability requirements – likely permanence)
• [KA: Check evidence for a decision – significant functional impact](KA: Check evidence for a decision – significant functional impact)
• [KA: Check evidence for a decision – disability requirements – social and economic impact](KA: Check evidence for a decision – disability requirements – social and economic impact)
• [KA: Determine lifetime support eligibility](KA: Determine lifetime support eligibility)
• [KA: Understand early intervention requirements](KA: Understand early intervention requirements)
• [KA: (EI) Check evidence for a decision – Impairment is likely to be permanent](KA: (EI) Check evidence for a decision – Impairment is likely to be permanent)
• [KA: (EI) Check evidence for a decision – Likely to reduce future support needs](KA: (EI) Check evidence for a decision – Likely to reduce future support needs)

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• [KA: (EI) Check evidence for a decision – Likely to improve or reduce deterioration of functional capacity or strengthen informal supports](KA: (EI) Check evidence for a decision – Likely to improve or reduce deterioration of functional capacity or strengthen informal supports)
• [KA: (EI) Check evidence for a decision – Support most appropriately funded by NDIS](KA: (EI) Check evidence for a decision – Support most appropriately funded by NDIS)
• [KA: Check evidence for a decision – developmental delay](KA: Check evidence for a decision – developmental delay)
• [KA: Evidence Guide – List A conditions](KA: Evidence Guide – List A conditions)
• [KA: Evidence Guide – List B conditions](KA: Evidence Guide – List B conditions)
• [KA: Evidence Guide – List D conditions](KA: Evidence Guide – List D conditions)

Guidelines for Q7

Did the Assessor correctly confirm the applicant meets/does not meet the Disability and/or Early Intervention requirements?

Yes: Quality Outcome Achieved

1. Evidence supports that the legislation the decision has been made under is correct
2. Evidence attached supports decision that the disability and/or early intervention legislative requirements are met/not met
3. Evidence attached supports Sub Criterion selections (including List A/List B/List D under Impairment Assessment where applicable)

No: Quality Adjustment Required

1. Evidence supports that the decision has been made under in correct legislation, or
2. Supporting evidence insufficient to support decision – further evidence required, or

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3. Sub Criterion selections and Impairment Assessment indicate incorrect section of the legislation applied (e.g. disability requirements instead of EI), or incorrect application of [Our Guidelines – Applying to the NDIS](Our Guidelines – Applying to the NDIS) (e.g. incorrect application of List A, regardless if the overall decision is correct), or
4. Decision Main Criteria and Sub Criterion selections indicate disability or early intervention requirements incorrectly assessed.

8. Recording the Access Decision in the Business System Check

Relevant Requirements

The access decision must be recorded accurately in the business system by:

• entering the correct impairment/impairments into the Impairment Assessment
• (if the current version of the NDIS Act 2013 applies and Access Met decision proposed) selecting the correct impairment/s that meet the eligibility criteria in the Decision Main Criteria
• selecting the correct justifications in line with legislative and policy requirements
• adding and/or linking all relevant evidence relating to the access decision:
  • from SAP CRM and Enquiries Inbox to PACE (if applicable)
  • in the Person Account > My Profile > Evidence
  • in the Person Account under Documents
  • in the Access Decision case under Documents

Instructions

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Determine if the correct impairment/impairments were entered into the Impairment Assessment:

1. Go to Person Account > Cases.

2. Under Open Cases: Select Access Decision.

   Note: The Status of this case will be In Progress.

3. From the Decision Main Criteria view, navigate through the proposed decision using the Back and Previous buttons to go to the first screen.

4. Review primary and any secondary impairments that have been entered under Select assessed Impairment under Impairment Assessment.

   • For an Access Met decision, take note that all impairments that meet the legislative requirements have been added.
   • For an Access Not Met decision, all reported impairments have been added.

Determine if the correct impairment/s that meet the eligibility criteria were selected:

Note: This only applies if the decision was made under the current version of the [NDIS Act 2013](NDIS Act 2013) and the proposed decision is Access Met. If the delegate is proposing an Access met decision under the current version of the [NDIS Act 2013](NDIS Act 2013), additional question/s of Which of the following meet the eligibility criteria for access? will have populated under the eligibility requirements that are being met (Early Intervention or Disability requirements).

1. Open the [Impairment Categories Guide](Impairment Categories Guide).
2. Search the ICD 10 Code or Condition name for any impairment that has met the eligibility criteria.
3. Note the category from the Highly likely impairment category.

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4. Use the guidance in [Understand highly likely and commonly associated impairment categories](Understand highly likely and commonly associated impairment categories) to determine if the correct Commonly associated impairment categories have been selected.
5. If the eligible impairment does not appear in the [Impairment Categories Guide](Impairment Categories Guide) determine if the correct categories were selected based on the functional impacts which relate to the condition that meets the Early Intervention and/or Disability requirements.
6. In the Access Decision case, go to the Decision Main Criteria view.
7. Under Which of the following meet the eligibility criteria for access? review the impairment/s that have been selected.

Determine if the correct justification was selected for any Sub Criterion that does not meet legislative requirements:

1. From the Decision Main Criteria view, navigate through the proposed decision using the Back and Previous buttons.
2. Review the dropdown selections ‘Why does the applicant not meet the sub criteria’ to establish if the correct option was selected (where multiple options are available).

Determine if all supporting evidence and correspondence relating to the access decision has been added to PACE:

1. In the Person Account, go to the Documents tab to review the supporting evidence relating to the access decision.
2. Check for any outstanding evidence relating to the access decision in SAP CRM under Inbound Documents.
3. Check for any outstanding evidence relating to the access decision in the Enquiries inbox.

Determine if supporting evidence relating to the access decision is linked to the Access Decision case:

1. In Person Account > My Profile > Evidence, check that all supporting evidence and correspondence relating to the access decision has been added/linked correctly.
   • Documents must have the correct Evidence Type, Document Type, and Date Received.

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Note: Multiple documents can only be added together if they share the same Evidence Type, Document Type, and Date Received. If documents with different details are added together, correspondence will not generate correctly.

2. In Access Decision case under the Documents tab, check that all supporting evidence relating to the access decision has been added/linked.

Determine if the Status of the Access Request case is Pending Outcome:

1. In the Person Record, under the Cases tab, select the open Access Request case.
2. Check the chevrons on the top of the screen to determine the Access Request case status.

If a quality adjustment is required, in preparation to provide feedback, complete and copy the [Recording Access Decision in the Business System Quality Adjustment Template](Recording Access Decision in the Business System Quality Adjustment Template).

Related Resources

• Previous version of the [NDIS Act 2013 (C19)](NDIS Act 2013 (C19))
• Current version of the [NDIS Act 2013](NDIS Act 2013)
• [NDIS (Becoming a Participant) Rules 2016](NDIS (Becoming a Participant) Rules 2016)
• [NDIS Our Guidelines – Applying to the NDIS](NDIS Our Guidelines – Applying to the NDIS)
• [KA: Submit an access decision](KA: Submit an access decision)
• [KA: Adding and linking evidence to an access decision or ER case](KA: Adding and linking evidence to an access decision or ER case)
• [KA: Impairment Categories Guide](KA: Impairment Categories Guide)
• [KA: Descriptions of impairment categories](KA: Descriptions of impairment categories)
• [KA: Understand highly likely and commonly associated impairment categories](KA: Understand highly likely and commonly associated impairment categories)

Guidelines for Q8

Was the access decision recorded correctly in the Business System?

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Yes: Quality Outcome Achieved

1. Impairment/impairments entered into the Impairment Assessment are accurate, and
2. (if the current version of the NDIS Act 2013 applies) Impairment/s that meet the eligibility criteria selected in the Decision Main Criteria have the correct Impairment Categories selected, and
3. All justifications describe the delegate’s decision-making clearly and accurately, in line with legislative and policy requirements, and
4. All relevant evidence relating to the access decision is correctly added/linked under Person Account > My Profile > Evidence, and
5. All relevant evidence relating to the access decision is added/linked to Person Account > Documents, and
6. All relevant evidence relating to the access decision is added/linked to Access Decision case > Documents, and
7. All evidence in SAP CRM relating to the access decision has been added to the PACE record (if applicable), and
8. All evidence in the Enquiries inbox relating to the access decision has been linked to the PACE record (if applicable), and
9. The Status of the Access Request case is Pending Outcome.

No: Quality Adjustment Required

1. Impairment/impairments entered into the Impairment Assessment are not accurate, or
2. (if the current version of the NDIS Act 2013 applies) Impairment/s that meet the eligibility criteria selected in the Decision Main Criteria do not have the correct Impairment Categories selected, and

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3. Justifications do not describe the delegate’s decision-making clearly and accurately, in line with legislative and policy requirements, or
4. All relevant evidence relating to the access decision has not been correctly added/linked under Person Account > My Profile > Evidence, or
5. All relevant evidence relating to the access decision has not been added/linked to Person Account > Documents, or
6. All relevant evidence relating to the access decision has not been added/linked to the Access Decision case > Documents, or
7. All relevant evidence from SAP CRM relating to the access decision case has not been added to PACE (if applicable), or
8. All evidence in the Enquiries inbox relating to the access decision has not been linked to the PACE record (if applicable), or
9. The Status of the Access Request case is not Pending Outcome.

9. Streaming for Access Met Decision

Relevant Requirements

Streaming decisions ensure participants receive the support they need to connect with the NDIS. Some participants need more support than others. This is internally called the service stream response, or streaming. Streaming helps predict the level of support each participant will likely need when dealing with the NDIS pathway.

To make sure that a TSP budget with no dollars is not generated, streaming must be completed before an access approval decision.

Instructions

1. Go to Person Account > Cases tab.

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2. Under Open Cases: Select Access Decision.

   Note: The Status of this case will be In Progress.

3. Navigate to the Decision tab to review the proposed decision summarised in the Decision Main Criteria view. If this screen shows an Access Not Met decision, proceed to Q11. If this screen shows an Access Met decision, continue to Steps 4-8.

4. Go to Person Account > Cases tab.

5. Under Closed Cases: Select Streaming.

6. In Streaming > Details, check the Closure Reason which should reflect Request Approved.

7. Go to Streaming > Streaming.

8. Click Continue in the Form Updated message.

Review the streaming value, including the answers to the streaming questions. If a quality adjustment is required, in preparation to provide feedback, complete and copy the [Streaming for Access Met Decisions Quality Adjustment Template](Streaming for Access Met Decisions Quality Adjustment Template).

Related Resources

• [KA: Complete a streaming case (Streaming and Restreaming)](KA: Complete a streaming case (Streaming and Restreaming))
• [KA: Approve or override a streaming case](KA: Approve or override a streaming case)

Guidelines for Q9

Where an access met decision has been submitted for an applicant, did the Assessor complete the streaming case correctly?

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Yes: Quality Outcome Achieved

1. Streaming was completed correctly.

No: Quality Adjustment Required

1. Streaming was not completed or completed incorrectly.

10. Mandatory TAB Advice for Access Met Decision – Chronic Health Condition Process Check

Relevant Requirements

It is mandatory that an Access delegate seek TAB advice before making an access met decision for applicants with a chronic health condition, or if the applicant is receiving or requires palliative or end-of life care.

Instructions

1. Go to Person Account > Cases tab.
2. Under Closed Cases: Select Technical Advice.
3. Navigate to the Advice tab to review TAB advice.

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4. Go to Outlook > SEB.Quality inbox and review emails that may indicate QDO endorsement of TAB advice request was sought.

5. Go to SharePoint Workspace > TAB Tracker and review data that may indicate QDO endorsement of TAB advice request was sought.

6. Determine whether mandatory TAB advice was sought for an access met decision where are chronic health condition is present.

If a quality adjustment is required, in preparation to provide feedback, complete and copy the Mandatory TAB Advice for Access Met Decision – Chronic Health Condition Quality Adjustment Template.

Related Resources

• KA: Create a technical advice case
• KA: Complete the risk matrix for a technical advice case
• KA: Review and action returned technical advice case
• Technical Advisory Branch Intranet Site – Requesting Advice
• Email Template – QDO endorsement for TAB Advice Request
• Access Assessor OneNote – Access Decision Support – TAB Advice Request
• QDO OneNote – Rostered Tasks – TAB Requests

Guidelines for Q10

Where an access met decision has been submitted for an applicant with a chronic health condition, did the Assessor receive mandatory TAB advice prior to submitting the decision?

Yes: Quality Outcome Achieved
1. Technical Advice case confirms mandatory TAB advice had been sought before making an access met decision for an applicant with a chronic health condition, and

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2. Proposed decision aligns with the TAB advice, or
3. Proposed decision does not align with the TAB advice, but EL2 approval has been received.

No: Quality Adjustment Required
1. No evidence to confirm mandatory TAB advice had been sought before making an access met decision for an applicant with a chronic health condition, and/or
2. Proposed decision does not align with the TAB advice and EL2 approval has not been provided.

11. Confirmation that TAB Advice is not Required Check

Relevant Requirements

It is mandatory that an Access delegate refers all applicants currently residing in hospital (including those who are ready for discharge) who meet the eligibility requirements to a QDO using the TAB Advice Request Process before making the Access Met Decision. A QDO will review the application to ensure TAB advice is not required.

Instructions

1. Go to Outlook > SEB.Quality inbox and review emails that may indicate QDO endorsement was sought.
2. Determine whether mandatory QDO endorsement was sought and returned as TAB Advice Not Required for an access met decision where the applicant currently resides in hospital.

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If feedback is required, in preparation to provide feedback, complete and copy the Confirmation that TAB Advice is not Required Non-Critical Feedback Template.

Related Resources

• Email Template – QDO endorsement for TAB Advice Request
• Access Assessor OneNote – Access Decision Support – TAB Advice Request

Guidelines for Q11

Where an access met decision has been submitted for an applicant currently residing in hospital, did the Assessor receive mandatory QDO advice prior to submitting the decision?

Yes: Quality Outcome Achieved
1. SEB.Quality inbox confirms mandatory QDO advice had been sought before making an access met decision for an applicant currently residing in hospital.

Overall Pass with Feedback
1. No evidence in SEB.Quality to confirm mandatory QDO advice had been sought before making an access met decision for an applicant currently residing in hospital.

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12. Team Leader or EL1 Approval for Access Met Decision - <25 Psychosocial Process Check

Relevant Requirements

It is mandatory that an Access delegate seek Team Leader or EL1 approval before making an access met decision for applicants who are aged under 25 years with a primary psychosocial disability.

Instructions

1. Go to Outlook > SEB.Quality inbox and review emails that may indicate Team Leader or EL1 approval was sought.

2. Determine whether mandatory Team Leader or EL1 approval was sought for an access met decision where the applicant was aged under 25 years with a primary disability that is a psychosocial impairment.

If a quality adjustment is required, in preparation to provide feedback, complete and copy the Team Leader or EL1 Approval of Access Met Decision <25 Psychosocial Quality Adjustment Template.

Related Resources

• Email Template - Review Request: Under 25 Psychosocial - Disability
• Email Template - Review Request: Under 25 Psychosocial – Early Intervention
• Access Assessor OneNote – Access Decision Support – <25 Years Psychosocial – Access Met

Guidelines for Q12

Where an access met decision has been submitted for an applicant who is under 25 years of age with a primary disability that is a psychosocial condition, did the Assessor receive mandatory Team Leader or EL1 approval prior to submitting the decision?

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Yes: Quality Outcome Achieved
1. SEB.Quality inbox confirms mandatory Team Leader or EL1 approval had been sought before making an access met decision for an applicant who is aged under 25 years with a primary disability.

No: Quality Adjustment Required
1. No evidence in SEB.Quality to confirm mandatory Team Leader or EL1 approval had been sought before making an access met decision for an applicant who is aged under 25 years with a primary psychosocial disability.

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13. Remote and Very Remote (MMM6 and MMM7) Applications Process Check

Relevant Requirements

All applications from people who reside in remote and very remote locations (MMM6 and MMM7) must be assessed by the Remote and Very Remote (RVR) Access Assessor Team.

Instructions

1. Go to Person Account > Details > Address to check whether the applicant resides in a remote or very remote location.

2. Go to the Australian Government Department of Health’s Health Workforce Locator: select Monash Modified Model filter.

3. Enter the applicant’s residential address to determine if the applicant resides in an MMM6 or MMM7 location.

4. Check the email listed in the quality check work item sent in Microsoft Teams message to identify the Access delegate who made the decision.

5. Refer to the QDO OneNote > Rostered Tasks > Streamlined Decision Cohorts to check whether the Access delegate is a member of the RVR Access Assessor Team.

If a quality adjustment is required, in preparation to provide feedback, complete and copy the Remote and Very Remote Applications Process Quality Adjustment Template.

Related Resources

• Australian Government Department of Health – Modified Monash Model (MMM)
• Access Assessor OneNote - Other Resources - Reassigning Work Items
• QDO OneNote – Rostered Tasks – Streamlined Decision Cohorts

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Guidelines for Q13

Where an applicant resides in a remote or very remote location (MMM6 and MMM7), did the Assessor follow the correct process for remote and very remote applications?

Yes: Quality Outcome Achieved
1. The Remote/Very Remote access decision was made by a member of the Remote and Very Remote Access Assessor Team.

No: Quality Adjustment Required
1. The Remote/Very Remote access decision was not made by a member of the Remote and Very Remote Access Assessor Team.

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14. YPIRAC Applications Process Check

Relevant Requirements

All applications from people aged under 65 who reside in a residential aged care facility (YPIRAC) must be assessed by the YP IRAC Access Assessor Team.

Instructions

1. Go to Person Account> Details> Account Information to check the applicant’s date of birth.

2. To check whether to person in a residential aged care facility, go to:

   • Person Account > Alerts to check if there is an alert for YPIRAC.
   • Person Account > Details > Address to check whether the address is a residential aged care facility, and/or
   • Person Account> Documents to check ARF and/or supporting documents for any indication that it is a YPIRAC application, and/or
   • My Aged Care website> find a provider> search for a provider to cross-reference address and/or evidence documents with residential aged care homes database.
   • Person Account > Recent Activity, check for any indication that it is a YPIRAC application.

3. Check the email listed in the quality check work item sent in Microsoft Teams message to identify the Access delegate who made the decision.

4. Refer to the QDO OneNote > Rostered Tasks > Streamlined Decision Cohorts to check whether the Access delegate is a member of the YPIRAC Access Assessor Team.

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If a quality adjustment is required, in preparation to provide feedback, complete and copy the YPIRAC Applications Process Quality Adjustment Template.

Related Resources

• Access Assessor OneNote – Other Resources – Reassigning Work Items
• Complex Support Needs Intranet Page – YPIRAC
• QDO OneNote – Rostered Tasks – Streamlined Decision Cohorts

Guidelines for Q14

Where an applicant is a young person in residential aged care (YPIRAC), did the Assessor follow the correct process for YPIRAC applications?

Yes: Quality Outcome Achieved
1. The YPIRAC access decision was made by a member of the YPIRAC Access Assessor Team.

No: Quality Adjustment Required
1. The YPIRAC access decision was not made by a member of the YPIRAC Access Assessor Team.

15. Evidence of Developmental Delay Form Check

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Relevant Requirements

Applicants applying through an Early Childhood Partner under Developmental Delay are required to use the Form - Evidence of developmental delay (EODD) for children younger than 6 years in early childhood partner areas.

Instructions

1. Check the current form was completed, signed and uploaded.

   a. For information about the current EODD Form refer to KA: EC Complete the Form – Evidence of developmental delay (EODD).

Related Resources

• KA: Prepare to make an access decision
• KA: EC Complete the Form – Evidence of developmental delay (EODD).

Guidelines for Q15

Yes: Quality Outcome Achieved
1. The current Evidence of developmental delay (EODD) form was provided.

Overall Pass with Feedback
1. An outdated Evidence of developmental delay (EODD) form was provided.

16. Priority Health Case Check

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Decisions for applicants applying with disability of a terminal illness, glioblastoma, metastatic cancer, or with a diagnosis of Motor Neuron Disease (also referred to as Lou Gehrig’s Disease, Kennedy’s Disease or Amyotrophic lateral sclerosis) can only be assessed by the Priority Health Access Team (PHAT).

Instructions

1. Check all available evidence of disability for any reference to MND, terminal illness, glioblastoma or metastatic cancer.

2. If there is no evidence that the applicant has a terminal illness, glioblastoma, metastatic cancer or MND – any Access Assessor can process the application

3. If there is evidence the applicant has a terminal illness, glioblastoma, metastatic cancer or MND:

   • Check the email listed in the quality check work item sent in Microsoft Teams message to identify the Access delegate who made the decision.
   • Refer to the QDO OneNote > Rostered Tasks > Streamlined Decision Cohorts to check whether the Access delegate is a member of the SEB Priority Health Access Team (PHAT).

If an applicant’s evidence suggests terminal illness, glioblastoma, metastatic cancer or MND you will need to submit an adjustment using the Priority Health Access case Quality Adjustment Template.

Related Resources

• Prepare to make an access decision

Guidelines for Q15

Yes: Quality Outcome Achieved
1. The applicant with MND or a terminal illness or glioblastoma or metastatic cancer was assessed by the Priority Health Access Team

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No: Quality Adjustment Required
1. The applicant with MND or a terminal illness or glioblastoma or metastatic cancer was not assessed by the Priority Health Access Team

Quality Adjustment Required Feedback Templates

Valid Access Request Quality Adjustment Template

Q1 Valid Access Request Check
The <access met/access not met> decision is not supported. The Access Request that was made is not valid because . As per s19 of the NDIS Act and Our Guidelines – Applying to the NDIS, a valid access request is required prior to progressing to a decision.

<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback:
  • Navigate to the first page of the Access Decision case. |

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- Under Mark Application as Invalid, select Yes to the question Is the Access Request Invalid or Incomplete? and provide an explanation in the free text field.

Note: If you are unable to Mark Application as Invalid, request support from your Team Leader.

• Provide feedback to the AO Team (via your Team Leader) to advise that an access request was incorrectly validated.

• if you do not agree with the feedback:

  • talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check. |

References used for quality check outcome: (select appropriate)

• NDIS Act 2013 (C19) and NDIS Act 2013, section 19
• NDIS Our Guidelines – Applying to the NDIS (see How do you apply for the NDIS? > ‘What information do we need in your application?’)
• KA: Prepare to make an access decision
• KA: Submit an access decision
• KA: Validate the application or request evidence
• KA: How to complete the access request form
• KA: Applicant consent to apply
• KA: Understand the identity confirmation status
• KA: Understand the Document Verification Service
• KA: Record consent to share information or for a third party to act
• KA: Understand authorised representatives
• KA: What is consent and how do I know it has been provided
• KA: Check evidence to act on behalf of another person

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- KA: Check consent, nominee, child representative or self-representation authorities

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Internal Review and Administrative Review Tribunal (ART) Quality Adjustment Template

Q2 Internal Review and Administrative Review Tribunal (ART) Check
The <access met/access not met> decision is not supported. As per s19 of the NDIS 2013 Act (both previous and current version) and Our Guidelines – Applying to the NDIS, a new Access Request cannot be created when there is an open <Internal Review (s100)/Administrative Review Tribunal (ART)> review for <access not met decision/revocation decision>.

<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback:

  • Refer to article Prepare to make an access decision, section Check for open reviews and action accordingly.

• if you do not agree with the feedback:

  • Talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome: (select appropriate)

• NDIS Act 2013 (C19) and NDIS Act 2013, section 19
• Legislation Decision Tree
• Progress an access request case
• Create, update or end-date an alert |

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Authorised Representative Listed in Relationships Quality Adjustment Template

Q3 Authorised Representative Listed in Relationships Check
The <access met/access not met> decision made is not supported because:

• No child representative is listed as an Authorised Rep in the Relationships tab, and/or
• If applicable, incorrect address for authorised representative in PACE, and/or
• Insufficient evidence that authority has been given.

<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback, please:

  • add the child representative as an Authorised Rep, and/or
  • update the address for the authorised representative, and/or
  • create a Manage Authorised Representative case to remove the existing role of Correspondence Nominee and create an enquiry case to reassign to the Partner advising of insufficient evidence that authority has been given, and
  • resubmit your decision for potential quality checking. If you need technical support to understand the legislative criteria, please send a technical support request to SEB.QUALITY.

• if you do not agree with the feedback: |

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o talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check

References used for quality check outcome: (select appropriate)

• Previous version of the NDIS Act 2013 (C19) and current version of the NDIS Act 2013,
• NDIS (Becoming a Participant) Rules 2016
• NDIS Our Guidelines – Applying to the NDIS
• KA: Prepare to make an access decision
• KA: Submit an access decision
• KA: Check consent, nominee, child representative or self-representation authorities
• KA: Add or cancel a relationship
• KA: Understand authorised representatives
• KA: Record consent to share information or for a third party to act
• KA: What is consent and how do I know it has been provided
• KA: Check evidence to act on behalf of another person
• KA: Update a person account
• KA: Create an enquiry case

Legislative Timeframe Quality Adjustment Template

Q4 Legislative Timeframe Check
The <access met/access not met> decision is not supported because the decision is outside the legislative timeframe and no internal note has been recorded. If an application is outside the legislative timeframe, Access delegates are required to create an internal note advising this.

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<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback, please:

• log an activity to create an Internal Note advising the application is outside the legislative timeframe

• resubmit your decision for potential quality checking. If you require technical support to understand the legislative criteria, please send a technical support request to SEB.QUALITY.

• if you do not agree with the feedback:

• talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome: (select appropriate)

• Previous version of the NDIS Act 2013 (C19) and current version of the NDIS Act 2013, section 23
• NDIS (Becoming a Participant) Rules 2016
• NDIS Our Guidelines – Applying to the NDIS
• KA: Submit an access decision
• KA: Check decision – Legislative timeframes
• KA: Log an activity or internal note |

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Age Requirements Quality Adjustment Template

Q5 Age Requirements Check
The decision that the applicant <meets/does not meet> the age requirements is not supported because:

• the applicant was <under 65/over 65> years of age when the access request was made; or
• no evidence of age is included.

<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback, please:

  • re-assess the access decision and resubmit your decision for potential quality checking. If you require technical support to understand the legislative criteria, please send a technical support request to SEB.QUALITY.

• if you do not agree with the feedback:

  • talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome: (select appropriate)

• Previous version of the NDIS Act 2013 (C19) and current version of the NDIS Act 2013, section 22
• NDIS (Becoming a Participant) Rules 2016
• NDIS Our Guidelines – Applying to the NDIS |

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- KA: Submit an access decision

• KA: Check evidence for a decision – Age and residence requirements
• KA: Consent to use Centrelink information
• KA: Providing evidence of age and residency |

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Australian Residence Requirements Quality Adjustment Template

Q6 Australian Residence Requirements Check
The decision that the applicant <meets/does not meet> s23(1)(a) and/or s23(1)(b) of the Australian residence requirements is not supported because:

• the applicant <is/is not> an Australian citizen; or the holder of a permanent visa or a Protected SCV; and/or
• the applicant <does/does not> reside in Australia, and/or
• there is no evidence of residence provided.

<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback, please:

  • re-assess the access decision and resubmit your decision for potential quality checking. If you require technical support to understand the legislative criteria, please send a technical support request to SEB.QUALITY.

• if you do not agree with the feedback:

  • talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome: (select appropriate) |

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- Previous version of the NDIS Act 2013 (C19) and current version of the NDIS Act 2013, section 23

• NDIS (Becoming a Participant) Rules 2016
• NDIS Our Guidelines – Applying to the NDIS
• KA: Submit an access decision
• KA: Check evidence for a decision – Age and residence requirements
• KA: Consent to use Centrelink information
• KA: Providing evidence of age and residency |

Confirmation of Disability or Early Intervention Requirements Quality Adjustment Template

Q7.1 Disability Requirements

The <access met/access not met> decision made is not supported because the evidence provided demonstrates that:

• Evidence demonstrates that the legislation applied is <correct/incorrect>; or
• Criteria in Section 24(1)(a) has been <met/not met> because the impairment <does/does not> result in a loss of or damage to physical, sensory or mental function that results in a disability as defined by the NDIS Act (2013) or guidance provided with in Our Guidelines – Applying to the NDIS; or
• Criteria in Section 24(1)(b) has been <met/not met> because <there is sufficient/insufficient> evidence to demonstrate that the applicant has a disability as a result of a permanent impairment or <there is sufficient/insufficient> evidence to demonstrate all available treatment options have been explored to demonstrate the permanency or likely permanency of the impairment; or |

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- Criteria in Section 24(1)(c) has been <met/not met> because the applicant’s permanent impairment <does/does not> result in a substantial reduction in functional capacity because <they are still able to/unable> to complete the activity without assistive technology and/or personal assistance; or ; or

• Criteria in Section 24(1)(d) has been <met/not met> because the applicant’s permanent impairment <does/does not> affect their social and/or economic participation because ; or
• (If previous version of the NDIS Act 2013 (C19) applies) Criteria in Section 24(1)(e) has been <met/not met> because on considering the applicant’s overall circumstances <do/do not> require the support of the NDIS for their lifetime or by assessing the support requirements of the applicant’s in conjunction with the NDIS COAG agreement the types of support required are best met by the <health/education etc. system>.
• (If current version of the NDIS Act 2013 applies) Criteria in Section 24(1)(e) has been <met/not met> because on considering the applicant’s overall circumstances they <do/do not> require NDIS Supports (as per the NDIS In and Out List) for their lifetime.

<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback, please:

  • re-assess the access decision and resubmit your decision for potential quality checking. If you require technical support to understand the legislative criteria, please send a technical support request to SEB.QUALITY
  • (If the legislation is incorrect) Refer to article Prepare to make an access decision, section Key Information to:
    • complete and submit the AO Support Webform to notify the Access Officer’s Team Leader that the legislation has been applied incorrectly, and.
    • assign the Access Decision case to the AO’s Team Leader to be actioned accordingly. |

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- if you do not agree with the feedback:

• talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote> Quality Check. |

References used for quality check outcome: (select appropriate)

• Previous version of the NDIS Act 2013 (C19) and current version of the NDIS Act 2013, section 24
• NDIS (Becoming a Participant) Rules 2016
• NDIS Our Guidelines – Applying to the NDIS
• KA: Submit an access decision
• KA: Understand disability requirements
• KA: Check evidence for a decision – impairment caused disability
• KA: Check evidence for a decision – disability requirements – likely permanence
• KA: Check evidence for a decision – significant functional impact
• KA: Check evidence for a decision – disability requirements – social and economic impact
• KA: Determine lifetime support eligibility

Q7.2 Early Intervention Requirements Check

The <access met/access not met> decision made is not supported because the evidence provided demonstrates that:

• Evidence demonstrates that the legislation applied is <correct/incorrect>; or
• Criteria in Section 25(1)(a) has been <met/not met> because the applicant <does/does not> have an identified impairment that is or is likely to be permanent; or |

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- Criteria in Section 25(1)(b) has been <met/not met> because the provision of early intervention supports stipulated are <not likely/likely> to benefit the person by reducing their future need for disability related supports; or

• Criteria in Section 25(1)(c) has been <met/not met> because the provision of early intervention supports for the person are <not likely/likely> to benefit the person by or or or <strengthening the sustainability of informal supports available to the person, including capacity building of their carer>; or
• (If previous version of the NDIS Act 2013 (C19) applies) Criteria in Section 25(1)(3) has been <met/not met> because the early intervention support required <is/is not> most appropriately funded or provided by other mainstream services.
• (If current version of the NDIS Act 2013 applies) Criteria in Section 25(1)(d) has been <met/not met> because the early intervention support required <is/is not> an NDIS Support (as per the NDIS In and Out List).

<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback, please:

  • re-assess the access decision and resubmit your decision for potential quality checking. If you require technical support to understand the legislative criteria, please send a technical support request to SEB.QUALITY.

• if you do not agree with the feedback:

  • talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome: (select appropriate) |

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- Previous version of the NDIS Act 2013 (C19) and current version of the NDIS Act 2013, section 25

• NDIS (Becoming a Participant) Rules 2016
• NDIS Our Guidelines – Applying to the NDIS
• KA: Submit an access decision
• KA: Understand early intervention requirements
• KA: (EI) Check evidence for a decision – Impairment is likely to be permanent
• KA: (EI) Check evidence for a decision – Likely to reduce future support needs
• KA: (EI) Check evidence for a decision – Likely to improve or reduce deterioration of functional capacity or strengthen informal supports
• KA: (EI) Check evidence for a decision – Support most appropriately funded by NDIS |

Q7.3 Developmental Delay Check

The <access met/access not met> decision made is not supported because the evidence demonstrates that criteria in Section 25(1)(a)(iii) has been <met/not met> because:

• the applicant was <under 6/6 or over> years of age when the decision was made; or
• the applicant <does/does not> have a developmental delay that results in a substantial reduction in functional capacity in one or more of the following life activities: self-care, receptive and expressive language, cognitive development and motor development; or
• the applicant’s developmental delay <does/does not> result 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. |

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<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback, please:

  • re-assess the access decision and resubmit your decision for potential quality checking. If you require technical support to understand the legislative criteria, please send a technical support request to SEB.QUALITY.

• if you do not agree with the feedback:

  • talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome: (select appropriate)

• Previous version of the NDIS Act 2013 (C19) and current version of the NDIS Act 2013, section 25
• NDIS (Becoming a Participant) Rules 2016
• NDIS Our Guidelines – Applying to the NDIS
• KA: Submit an access decision
• KA: Check evidence for a decision – developmental delay |

Q7.4 Incorrect Criteria Assessed (List A/List B/List D)

The <access met/access not met> decision made is not supported because:

• Evidence demonstrates that the legislation applied is <correct/incorrect> |

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- The participant <does/does not> not have an impairment that is on <List A/List B/List D>

• The participant is an existing client of a disability program included in List C

<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback, please:

  • re-assess the access decision and resubmit your decision for potential quality checking. If you require technical support to understand the legislative criteria, please send a technical support request to SEB.QUALITY.

• if you do not agree with the feedback:

  • talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome: (select appropriate)

• Previous version of the NDIS Act 2013 (C19) and current version of the NDIS Act 2013
• NDIS (Becoming a Participant) Rules 2016
• NDIS Our Guidelines – Applying to the NDIS
• KA: Submit an access decision
• KA: Evidence Guide – List A Conditions
• KA: Evidence Guide – List B conditions
• KA: Evidence Guide – List D conditions |

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Recording Access Decision in Business System Quality Adjustment Template

Q8 Recording the Access Decision in the Business System Check

The access decision is not supported because the access decision is not recorded correctly in the business system:

(Select appropriate)

• The Impairment Assessment is incorrect, and/or
• The correct Highly likely impairment category/categories has not been selected, and/or
• The correct Commonly associated impairment category/categories have not been selected, and/or
• The correct impairment categories have not been selected for an impairment that is not listed in the Impairment Categories Guide, and/or
• Justifications recorded do not provide clear, accurate and consistent documentation of assessor’s decision-making in line with legislative and policy requirements, and/or
• All relevant evidence relating to the access decision is not added/linked to the Access Decision case, and/or
• All evidence from SAP CRM relating to the access decision has not been added/linked to the PACE record, and/or
• All evidence from the Enquiries relating to the access decision is not added/linked to the Access Decision case, and/or
• The Access Request case is not in Pending Outcome status.
• |

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<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback, amend the Access Decision case and resubmit your decision for potential quality checking.
• if you do not agree with the feedback, talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome: (select appropriate)

• Previous version of the NDIS Act 2013 (C19) and current version of the NDIS Act 2013
• NDIS (Becoming a Participant) Rules 2016
• NDIS Our Guidelines – Applying to the NDIS
• KA: Submit an access decision
• KA: Adding and linking evidence to an access decision or ER case |

Streaming for Access Met Decisions Quality Adjustment Template

Q9 Streaming for Access Met Decisions Check

The access decision is not supported because Streaming was not <completed/accurate>. Streaming must be completed before an access met decision to make sure that a TSP budget with no dollars is not generated.

Please review the quality adjustment feedback and: |

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Q9 Streaming for Access Met Decisions Check

- if you agree with the feedback:

• complete or amend the Streaming and resubmit your decision for potential quality checking.

• if you do not agree with the feedback:

  • talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome: (select appropriate)

• KA: Make an access decision in PACE
• KA: Complete a streaming case (Streaming and Restreaming) |

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Mandatory TAB Advice for Access Met Decision – Chronic Health Condition Quality Adjustment Template

Q10 Mandatory TAB Advice for Access Met Decision – Chronic Health Condition Process Check

The access met decision is not supported because:

• mandatory TAB advice has not been sought – mandatory TAB advice is required prior to progressing to an Access Met decision for a chronic health condition, or
• the proposed decision does not align with the TAB advice and EL2 approval has not been provided.

<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback:

  • refer to the Access Assessor OneNote > Access Decision Support > TAB Advice Request for the process on how to request TAB advice.
  • Once TAB advice has been received, <re-assess/re-complete> your access decision and resubmit your decision for quality checking.

• if you do not agree with the feedback:

  • talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome: (select appropriate) |

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- KA: Submit an access decision

• KA: Create a technical advice case
• KA: Complete the risk matrix for a technical advice case
• KA: Review and action returned technical advice case
• Technical Advisory Branch Intranet Site – Requesting Advice
• Email Template - QDO endorsement for TAB Advice Request
• Access Assessor OneNote – Access Decision Support – TAB Advice Request |

Confirmation that TAB Advice is not Required for Access Met Decision Non-Critical Feedback Template

Q11 Confirmation that TAB Advice is Not Required for Access Met Decision Check

Pass with feedback: For future decisions, please refer all applicants currently residing in hospital (including those who are ready for discharge) who meet the eligibility requirements to a QDO using the TAB Advice Request process before making an Access Met decision.

References used for quality check outcome: (select appropriate)

• Email Template – QDO endorsement for TAB Advice Request
• Access Assessor OneNote – Access Decision Support – TAB Advice Request |

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Team Leader or EL1 Approval of Access Met Decision <25 Psychosocial Quality Adjustment Template

Q12 Team Leader or EL1 Approval of Access Met Decision - <25 Psychosocial Process Check

The access met decision is not supported because Team Leader or EL1 endorsement has not been sought. Mandatory Team Leader or EL1 endorsement is required prior to progressing to an Access Met decision for someone aged under 25 years where the primary condition is a psychosocial disability.

<Provide specific details about why a quality adjustment is required and which pieces of evidence were used when considering the quality adjustment. Refer to appendix one for an example of good, actionable feedback>

Please review the quality adjustment feedback and:

• if you agree with the feedback:

  • refer to the Access Assessor OneNote > Access Decision Support > <25 Years Psychosocial – Access Met for the process on how to request Team Leader or EL1 approval.
  • Once Team Leader or EL1 advice has been received, <re-assess/re-complete> your access decision and resubmit your decision for quality checking.

• if you do not agree with the feedback:

  • talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome: (select appropriate)

• KA: Submit an access decision
• Email Template - Review Request: Under 25 Psychosocial - Disability |

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- Email Template - Review Request: Under 25 Psychosocial – Early Intervention

• Access Assessor OneNote – Access Decision Support – <25 Years Psychosocial – Access Met |

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Remote and Very Remote Applications Process Quality Adjustment Template

Q13 Remote and Very Remote Applications Process Check

Remote and Very Remote (MMM6 and MMM7) applications must be completed by the R&R Team. Please assign the case to redacted: s47F - personal privacy and email Danika with a copy of the QC feedback so it can be passed onto the new delegate.

References used for quality check outcome: (select appropriate)

• KA: Submit an access decision
• Australian Government Department of Health – Modified Monash Model (MMM)
• redacted: s47E(d) - certain operations of agencies |

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YPIRAC Applications Process Quality Adjustment Template

Q14 YPIRAC Applications Process Check

YPIRAC applications must be completed by the YPIRAC Team. Please assign the case to redacted: s47F - personal privacy and email Sam with a copy of your QC feedback so it can be passed onto the new delegate.

References used for quality check outcome: (select appropriate)

• KA: Submit an access decision
• Access Assessor OneNote - Other Resources - Reassigning Work Items
• Complex Support Needs Intranet Page - YPIRAC |

Evidence of Developmental Delay Form Non-Critical Feedback Template

Q15 Evidence of Developmental Delay (EODD) Form Check

Pass with feedback: Any applicant applying under a Developmental Delay through an Early Childhood Partner is required to use the current form Evidence of developmental delay (EODD) for children younger than 6 years in early childhood partner areas. For future decisions, the Access Decision case will need to be returned for remediation.

References used for quality check outcome: (select appropriate)

• KA: Prepare to make an Access Decision
• KA: EC Complete the Form – Evidence of developmental delay (EODD). |

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Q16 Priority Health Access Team (PHAT) Applications Process Check

Applicants with <Motor Neurone Disease (otherwise known as Lou Gehrig’s Disease, Amyotrophic Lateral Sclerosis, Kennedy’s Disease), a Terminal Illness, Glioblastoma or Metastatic Cancer> need to be assessed by a member of the Priority Health Access Team. Please amend the case details and reassign back to the Access Decision Routing Queue.

References used for quality check outcome: (select appropriate)

• KA: Prepare to make an access decision |

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Quality Outcome Achieved Templates

Quality Outcome Achieved – Access Met

Access Met Decision
Following QDO review, your decision is supported. Continue to proceed with next steps.

References used for quality check outcome: (select appropriate)

• KA: Submit an access decision
• KA: Contact to advise access request outcome
• KA: Record disability conditions and impairments |

Quality Outcome Achieved – Access Not Met

Access Not Met Decision
Following QDO review, your decision is supported. Continue to proceed with next steps.

References used for quality check outcome: (select appropriate)

• KA: Submit an access decision
• KA: Contact to advise access request outcome |

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Appendices

Appendix 1 – Example of Good Feedback

Feedback in response to: Did the Assessor correctly confirm the applicant meets/does not meet either:

• Disability requirements based on evidence of impairment, OR
• Early Intervention requirements based on evidence of impairment if the person did not meet disability? (Includes developmental delay where applicable)

The access met decision made is not supported because the evidence provided demonstrates that: Criteria in Section 24(1)(c) has been not met because the applicant’s permanent impairment does not result in a substantial reduction in functional capacity because they are still able to complete the activity without assistive technology and/or personal assistance.

redacted: s47E(d) - certain operations of agencies

Please review the quality adjustment feedback and:

• if you agree with the feedback:

  • please re-assess the access decision. If you require technical support to understand the legislative criteria, please send a technical support request to SEB.QUALITY

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• if you do not agree with the feedback:
  • talk to your Team Leader about the reconsideration process as outlined in the Access Assessor OneNote > Quality Check.

References used for quality check outcome:

• Previous version of the NDIS Act 2013 (C19) and current version of the NDIS Act 2013, section 24
• NDIS (Becoming a Participant) Rules 2016
• NDIS Our Guidelines – Applying to the NDIS
• KA – Submit an access decision
• KA - Check evidence for a decision – significant functional impact

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Feedback

If you have any feedback about this resource, please speak with your Team Leader. They will forward your feedback to redacted: s47E(d) - certain operations of agencies and include Quality Resource Feedback in the subject line.

Version control

Version No	Approved By	Brief Description of Change:	Status	Date
1.0	LA0011	New resource developed to support WLM, BAF & CRM changes	APPROVED	2018-05-07
1.01	TS0036	Changes made in line with QDO feedback and inclusion of quality audit questions to align with CRM	APPROVED	2018-08-10
1.02	TS0036	Updated in line with feedback and removal of reference to additional age requirements as they no longer apply	APPROVED	2018-10-10
1.03	BL0012	Minor formatting changes	APPROVED	2019-09-13
2,0	TS0036	Resource updated in line with audit recommendations to align with post-decision audit resources, including addition of methodology framework, process overview sections, and change to new template. Additional quality check questions	APPROVED	2021-09-08

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		have been added to align with current process. New template.
2.1	CH0026	Changes made in line with QDO feedback	APPROVED	2021-12-02
3.0	CH0026	Changes made to align with new OG – Applying to the NDIS in line with QDO feedback. Updated headings to meet accessibility requirements. Minor formatting and wording changes	APPROVED	2022-04-29
3.1	CH0026	Edited document for NARB name change from Reviews to Reassessment	APPROVED	2022-06-30
4.0	CH026	Updated resource for PACE transition approved.	APPROVED	2023-10-27
5.0	GMQ132	Updated to reflect process for uploading and linking evidence.	APPROVED	2023-11-15
6.0	GMQ132	Instructions for checking legislative timeframes under Section 3 Legislative Timeframe Check has been removed and replaced with link to article Check decision – legislative timeframes.	APPROVED	2023-11-27
7.0	CH0026	* Changes made based on feedback from QDO Team. Added a new critical criteria for access delegates to check the NAT and Enquiry inboxes.	APPROVED	2024-05-15

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		* Changes made to instructions around checking the status of the Access Request case at the time of decision * Changes made to instructions around checking correct verification status has been used * Updated instructions on adding and linking evidence to access decision case. * Removed instructions for updating standard correspondence.
8.0	CH0026	* Added instruction to check for most current Evidence of developmental delay form * Added Q14 for priority health team cases	APPROVED	2024-09-04
9.0	CH0026	* Added legislation 2024 changes * Removed instructions to check NAT inbox * Amended NA.Quality to SEB.Quality	APPROVED	2024-10-02
10.0	CH0026	Class 2 approval.	APPROVED	2024-11-29
11.0	BLO091	Class 1 approval.	APPROVED	2026-01-27
12.0	CH0026	Class 2 approval.	APPROVED	2026-02-20

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