NDIA Accountability Project

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Internal Review Explanation of Decision (EOD)

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DOCUMENT 10

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Guidance

For Internal Use Only

The contents of this document are OFFICIAL.

Internal Review Explanation of Decision (EOD) contact guidance

1. What is the resource?

Guidance to assist members of the Internal Review Team when a request for ‘Explanation of a Decision’ (EOD) for an Internal Review decision is received. The Participant Service Guarantee sets out that the NDIA will complete an explanation of a decision within 28 days. The internal KPI is 14 days. Following a request, we need to provide an EOD in the Applicant/Participant’s preferred format to improve the understanding of how and why the NDIA has made the decision. This may require phone call contact to discuss the reasoning as well as a letter with the reasons for the decision written in plain English.

The EOD can be received any time after the Applicant/Participant or their Authorised Representative has completed the internal review outcome. This resource assists you to contact an Applicant/Participant or their authorised representative to explain an s100 outcome.

Note: The request for explanation of a decision (RED) is sometimes referred to as a RED or EOD.

3. How long will it take to complete an explanation of decision for a completed internal review?

We must complete the explanation decision for an Internal Review Decision within 28 days of receiving the request. The internal KPI is 14 days.

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If you are unable to complete an EOD within 14 days from the request date (this may be due to a delay in referral) undertake the explanation as a priority and ensure your line manager is advised.

4. What to consider before initiating contact and during contact?

Here are some things to consider before initiating contact:

  • Preferred communication approach including possible need for an interpreter and or assistive technology.
  • Check if there are any other representatives that should be involved to help the Applicant/Participant understand the process or decision and next steps to support.
  • Review all available information on the relevant record, including System interactions, inbound documents and any other information available in the planning conversation tool and also check the s100 outcome and interactions.
  • Prepare to help them to understand the link between the evidence provided, the Legislation and the decision (Don’t over prepare. You should be prepared – but also be flexible in your approach).
  • Check for any change of circumstances or new evidence to warrant a new access request or a change of circumstances plan reassessment.
  • Check for any complaints lodged or feedback received.
  • Speak with a colleague or team leader for coaching or support if required.

During contact the following strategies may be helpful:

  • Listen to the applicant/participant, carer or representative and tailor your approach to suit the individual, consider active and inclusive language and if others are involved, maintain focus on the participant whilst communicating with the stakeholders.
  • Remember to take your time explaining the decision and be mindful not to rush the explanation.
  • If phone contact is the preferred option, consider non-verbal communication such as tone, pitch, pace, clarity of voice.
  • Use your own words; use plain English.

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  • If you don’t have all the answers, let the applicant/participant or their representative know you will get back to them with a response. Be transparent and let them know when and how you will get back to them.
  • Show empathy and compassion, use the person’s name, check for understanding and paraphrasing.
  • Provide appropriate responses and manage expectations.
  • Summarise the conversation.
  • Explain options and next steps including; encouraging the Applicant/Participant to contact their Local Area Coordinator or Early Childhood (EC) partner for assistance or Support Coordination/Planner where applicable based on the type of internal review completed and circumstances to assist with support needs, providing information on how to contact the agency in the future if there are changes, further information about best practice information to provide for new access pathways or plan reassessment including information accessible via the webpage.
  • Checking if EOD letter required, or requestor is understanding of the EOD and this step is not required.

When completed, ensure you have documented the EOD contact, actions and outcomes.

Remember the Participant Service Charter Engagement Principles of being transparent, responsive, respectful, empowering and connected.

5. Scenarios

5.1 Example one – EOD IRT Access

Jason is 10 years old and lives with family in a rural and remote town in NSW. Jason’s primary disability is Attention Deficit Hyperactivity Disorder (ADHD). He has only recently been diagnosed by a Paediatrician and commenced pharmaceutical treatment with the aim of improving his functional impacts.

His mother Jane (Child Authorised Representative) had requested an internal review (s100) as she disagreed with the access not met decision, noting that he requires additional supports in the education setting while at school and referral for behavioural management to assist with the adjustment to his new diagnosis. Jason currently attends Primary School and does not get any funding for a teacher aid or supports within the school.

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The Access Internal Review Officer had reviewed all the relevant information available within the System and made the decision to confirm the original decision of access not met. The internal review outcome was communicated two weeks ago by the preferred method of contact - email.

Since the outcome Jane has contacted the NCC and requested an explanation of a decision (EOD) on the internal review. Contact was requested to be made via mobile phone.

The Internal Review Officer receives the EOD request and prepares for the contact. The s100 outcome was made based on the level of evidence provided for the original access decision with no other evidence provided for the internal review.

There was no evidence provided to satisfy permanency requirements, or that the agency is best placed to fund the supports required. The Paediatrician had referred to supports within the education setting and referral for counselling through a care plan.

No further information or evidence was provided for the internal review, likely as support services/interventions are best funded under another system (e.g. education).

No further information or evidence was provided during the original access request or the internal review process to support this.

The Internal Review Officer in making the EOD contact should consider:

  • Reviewing all applicant information and details in the System including interactions and inbound documents.
  • Reviewing the decision and evidence i.e. on what grounds was this decision based.
  • Reviewing relevant resources like Standard Operating Procedures, Operational Guidelines and practice guidance where necessary.
  • Check authority and contact details for Mother.
  • Make call to his mother Jane, introducing self as the internal review officer.
  • Confirm that Jane has time to discuss outcome. If not arrange another suitable time for a call back.
  • Confirm confirmation of the outcome of the internal review email received include the sent.
  • Explain related level of evidence relating to the criteria not satisfied.
  • Refer to best practice level of evidence, operational guidelines and resources from the internet (Types of disability evidence).

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  • Explanation around why permanency criteria and why the agency is not best to fund the supports as recommended by the Paediatrician.
  • Provide information about Local Area Coordinator details in the area.
  • Ensure that there is no change to the circumstances or additional evidence to provide for access. If so, provide information about contacting agency for a new access request.
  • If there is high or extreme risk factors identified, please seek support via team leader.
  • If an EOD is requested in writing check preferred method of receipt of letter by email or mail.
  • Confirm with Jane that she understands the information by summarising the key points (e.g. why the decision was made) and in closing, provide next steps including further review rights if applicable information and support to help her son Jason find services he needs including referring him to his Local Area Coordinator Partner.

5.2 Example two – EOD IRT Planning

Kate is 11 years old, attends primary school and her primary disability is Autism Level 1. Kate’s father, Jacob had requested an internal review (s100) as he disagreed with the level of 30 hours of therapy funding for the year. Kate’s Occupational Therapist (OT) had recommended 1 hour per week for occupational therapy and 1 hour per week for speech.

The Internal Review Officer has reviewed all the records and has an internal review decision with an outcome that 30 hours per year is reasonable and necessary based on the evidence provided for the original decision and the internal review. Jacob has received a letter from the NDIA Internal Review Officer confirming the original decision.

After the outcome of the internal review was received. Jacob has requested to speak with the Internal Review Officer to discuss the reasons for the decision. He has stated that he would like the Occupational Therapist (an allied health professional) to be involved in the request of the explanation of the decision phone call. All consent is on the record for contact authority. There will be the parent and OT present on the phone conversation with the Internal Review Officer for the EOD.

The Internal Review Officer in making the EOD contact should consider:

  • Reviewing all Participant information and details in the System including interactions and inbound documents.

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  • Reviewing the decision and evidence i.e. on what grounds was this decision based.
  • Reviewing relevant resources like Standard Operating Procedures, Operational Guidelines and practice guidance where necessary. Check authority and contact details for parent and provider.
  • Ensure time suits for the contact. Send reminder SMS for call at least one hour before making call.
  • Make a call to his father Jacob and OT as arranged voice conference, introducing self as the internal review officer who made the internal review decision.
  • Confirm that Jacob/OT has time to discuss outcome. If not arrange another suitable time for a call back.
  • Confirm confirmation of the outcome of the internal review email received include the sent.
  • Explain related level of evidence relating to the criteria not satisfied.
  • Refer to best practice level of evidence, operational guidelines and resources from the internet (Plan reassessment reports, Types of disability evidence and [Reasonable and necessary supports](https://www.ndis.gov.au)).
  • Explanation about reasonable and necessary support and best practice evidence against the information/evidence provided as considered in the internal review.
  • Provide information about Local Area Coordinator details in the area.
  • Ensure that there is no change to the circumstances or additional evidence to provide. If so provide information about request for plan variation or reassessment. Refer to the [Create a plan reassessment (or variation) request (PRR) Standard Operating Procedure](https://www.ndis.gov.au).
  • If there is exceptional risk factors identified for planning internal review officers seek support via team leader.
  • If an EOD is requested in writing check preferred method of receipt of letter by email or mail.
  • Confirm with Jacob that he understands the information by summarising the key points (e.g. why the decision was made) and in closing and provide next steps, including further review rights if applicable.

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6. Other support information

  • Some of these conversation may be difficult.
  • Developing and using our communication skills, self-awareness and awareness of others will help us to influence positive outcomes and experiences for applicants and participants. It also enables us to provide important information and next steps to support them.
  • We may find that some people become dissatisfied and emotional when something happens or a decision is made that is different from what they expected.
  • You may also be met with unreasonable behaviour or information about an individual that may have an impact on your health, safety and well-being. It is important to look after your well-being to ensure you can be at your best.

Remember to reach if you need support:

  • Peers and team leaders.
  • Peer Support Officer.
  • Employee Assistance Program (EAP).
  • External supports.

You can also refer to the Managing Unreasonable Behaviour Guideline and Understanding Suicide and Self-Harm Fact Sheet.

7. Feedback

If you have any feedback about this Standard Operating Procedure, please complete our IRT Planning Quality and Continuous Improvement Form and email it to the Business Improvement Team. In your email, remember to include the title of the product you are referring to and describe your suggestion or issue concisely.

8. Version control

Version Amended by Brief Description of Change Status Date
1.0 LW0022 Initial Version - Class 2 Approval - BC0038 APPROVED 2022-07-28

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Version Amended by Brief Description of Change Status Date
2.0 KMM575

LW0022		 IRO EOD letters pending approval.

Minor updates based on SW0065, RMO411 feedback.		 APPROVED 2022-11-18

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