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The contents of this document are OFFICIAL.

Eligibility Reassessment

Participant Workbook

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Background

The National Disability Insurance Agency (NDIA) is enhancing its eligibility reassessment processes to a centralised and nationally consistent approach.

What is Eligibility Reassessment?

A participant must continue to meet the eligibility requirements to remain in the National Disability Insurance Scheme (NDIS).
Ensuring a participant still meets these requirements is a normal part of the NDIS journey and is called Eligibility Reassessment (ER).
This can occur at any time, as part of the plan review process, or when a participant’s circumstances change.
A small number of participants will transition from the NDIS each year as they reach their goals and no longer require support from the NDIS.
These measures contribute to NDIS sustainability by ensuring that only people for whom the Scheme was intended are accessing supports.

The Eligibility Reassessment process change

The NDIA is implementing an enhanced ER process nationally, working closely with Partners in the Community to support the identification of participants who may require a reassessment of their Scheme eligibility.

The process change will deliver a completed Eligibility checklist for all Scheme Participants as part of their Planning discussions.
Any participant identified as requiring an Eligibility review will be referred to the National Access & Workload Management Branch (NAWMB).
An Access Assessor from NAWMB will conduct a further review of the participant circumstances and make contact with the participant if a review will progress. The Assessor will continue discussions with the participant throughout the review process to ensure they are supported in gathering information required to support their review.
Centralising the Eligibility Reassessment process will ensure the participant receives a fair, transparent and collaborative review of their Scheme Eligibility.

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Eligibility Reassessment Process Diagram

1. Identify participant for Eligibility Reassessment	2. Commence Eligibility Reassessment	3. Identify Potential for Adverse Decision	4. Decide Outcome	5. Assist to Leave/Continue Planning
Participant identified for ER ↓ Make sure Plan continues during ER.	Review Info and decide if ER should commence ↓ Notify participant, give opportunity to provide further info. Notify PITC/Planner	Participant provides info at their discretion. ↓ Review info against legislative requirements ↓ Notify participant that an adverse decision is likely. Give opportunity to respond. Notify PITC/Planner.	Participant provides evidence at their discretion. ↓ Review information and consider revocation decision ↓ Decision checked by a Quality Delegate in all circumstances ↓ If decision passes quality check notify participant of outcome. Notify PITC/Planner.	Participant leaves scheme or continues to receive funding ↓ If participant exits, LAC or EC Partner supports referral to mainstream services.

[Legend: PITC/Planners, Participant, NAWM Delegate, Quality Delegate]

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Checklist - Observation and Practice

redacted: s22(1)(a)(ii) - irrelevant material

ER checklists will also be provided for you to complete.

Any information you require to research on a SOP, Operational Guideline or within the NDIS Act will require access to a laptop.

You will also find space to take notes as the facilitator debriefs the groups response to each activity.

Our First Scenario

Let’s meet Otis

Otis is 14 years old and has been a participant for 2 years, entering the Scheme under the Disability requirements. You have been working with him since he received his first plan.
Over the past 3 years, Otis has had psychiatric and psychological supports from clinical health services for his eating disorder, depression and anxiety
He has been home schooled and his cognitive and academic achievements are within average range. He transferred to a mainstream school prior to his first plan.
Otis received a diagnosis of Autism in May 2016. Results of clinical testing under the DSM –V gave him a diagnosis of Level 1, this diagnosis is listed as his primary disability.
He also received a diagnosis of ADHD in September 2018.
You have received the following recommendations in a report from his clinical psychologist:

Collaborative Relationships: A team approach between parents and appropriate school staff and teachers will be important to ensure that recommendations are effectively introduced. An Individual Learning Plan will enable those involved in Otis’s school life to collaborative on effective strategies (and also communicate what is not working for Otis.) This will need to include strategies for when his anxiety is elevated and he becomes unwell, feels sick in his stomach or needs some time out from class.

One-on-One Support: If practical within the classroom, brief periods of intensive support would be beneficial to help Otis to ensure he is feeling confident in class and following the required work tasks. Positive reinforcement from his teachers such as giving specific praise will help to build self-esteem and help Otis to become aware of his strengths. Otis also requires support for any group work or social expectations. Otis has been very clear in his descriptions of group work that he is unable to approach his peers and waits for someone to approach his to join their group, and he is unable to speak in social groups.

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Otis requires a structured and consistent classroom: Structure and consistency will provide Otis with a classroom environment that will mean he can predict what will be happening and therefore his anxiety for change will decrease. This will in turn allow him to focus more on tasks rather than the experience of anxiety due to change and unpredictable tasks.

Limit Sensory Stimuli: Otis experiences sensitivity to noise as well as being sensitive to movement at times. It is important that he can access smaller classrooms when possible if he feels overwhelmed, with few students, distractions and noise. Otis may not cope with physical education or movement at times, due to the connection between movement and his stomach difficulties. This will need to be monitored and have a flexible plan for when he may feel unwell.

Otis must be prepared for any major changes or transitions: This includes any school changes, new school or even a change in teachers or relief teachers. This preparation or forewarning will decrease his anxiety for change and limit the impact change will have on his health and ability to function.

Social Support: Otis has difficulty approaching and engaging with his peers. He would rather be by himself than approach others to join in group activities and finds group work distressing. Otis should not be forced into social groups or gatherings; however, he would benefit from support when it is required for him to participate in groups and social events so he can learn how to initiate social interaction, discussions and participation with his peer group. Otis would benefit from having access to his school counsellor or House Coordinator if he is feeling distressed or unwell.

School Excursion/Camp Support: Otis will require specific support for school overnight excursions/ camps that will need to include a full schedule of what he will be doing and what is required of his, who he will be rooming with and which teacher will be able to support his if he is feeling unwell or distressed. Otis will also require access to contact his parents during overnight school excursions.

Home Environment

Psychiatric Support: Otis will require ongoing psychiatric support from his Psychiatrist Dr Bruce Lean to ensure he has the highest level of care for his ongoing Depression, Anxiety and eating difficulties.

Psychological Support: Otis would benefit from continuing to receive emotional regulation support and social skill support from his psychologist. This will allow his to continue to receive support for his eating difficulties as well as his developmental of social and communication skills. Although Otis does not need to build a large social network (as he does not want this) he will need to learn appropriate social behaviours and responses to ensure he can function to his full potential within social environments to achieve his plans and goals.

NDIS Funding: Due to the diagnosis of Autism, Depression, Anxiety and Otis’s high needs, he and his family will continue to highly benefit from the support of the NDIS service to fund the level of intervention needed for Otis’s development.

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This includes funding for psychological support, as well as occupational therapy needed for his in-home care such as sensory resources. I highly recommend he continue in the NDIS for these therapies and supports to be funded.

Government Parenting Support: Otis’s family can use this assessment for an application with Centrelink to receive family carers’ payments due to the diagnosis of Autistic Disorder.

Today you are completing a review for Otis.

Complete an ER Checklist for Otis

My Notes:

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