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Finalise eligibility reassessment decision

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Finalise eligibility reassessment decision

SGP KP Publishing

Exported on 2024-10-09 10:40:12

Page 176 of 247

Disclosure Log - FOI 24/25-0368

SGP KP Publishing – Finalise eligibility reassessment decision

Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Complete a check for procedural fairness ……………………………………………………………… 6 4 Finalise the eligibility reassessment decision ………………………………………………………… 7 5 Complete a manual procedural fairness check ………………………………………………………. 8 5.1 Check correspondence …………………………………………………………………………………………. 8 5.2 Check contact attempts ………………………………………………………………………………………… 8 5.3 Check for outstanding enquiries …………………………………………………………………………….. 8 5.4 Check evidence extension requests ……………………………………………………………………….. 8 6 Complete the ER Outcome tab and contact participant to let them know the eligibility reassessment decision ………………………………………………………………………………………………. 10 7 Next steps for access met, disability change outcomes, or once the QDO approves a revoke outcome …………………………………………………………………………………………………………. 12 8 Next steps …………………………………………………………………………………………………………… 13

DISCLOSURE LOG - FOI 24/25-0368

SGP KP Publishing – Finalise eligibility reassessment decision

This article provides guidance for an access delegate to:

  • complete a check for procedural fairness
  • finalise the eligibility reassessment decision
  • complete a manual procedural fairness check
  • complete the eligibility reassessment (ER) outcome tab and contact participant to let them know the eligibility reassessment decision
  • next steps for access met, disability change outcomes, or once the QDO approves a revoke outcome.

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Recent updates

3 October 2024

Guidance updates:

  • to reflect legislation changes effective from 3 October 2024
  • new section added: Complete a manual procedural fairness check when the decision is to revoke
  • additional detail added to Finalise the eligibility reassessment decision
  • removed section: Create a reminder to revoke access on SAP CRM in 28 days, as this is completed by a quality development officer.

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Before you start

You have: * read about eligibility in Our Guideline – Applying to the NDIS (external) and Our Guideline – Leaving the NDIS (external) * checked if there is a request to voluntarily leave the NDIS. If so, close out the Eligibility Reassessment case and create a Leaving the NDIS case. For more information see article Understand the leaving case. Assign this to the My NDIS contact. * accepted an eligibility reassessment case

You have read articles: * [When to refer the participant for an eligibility reassessment](external) * [Understand procedural fairness and eligibility reassessment requirements](external) * [Contact attempts and unable to contact in an eligibility reassessment case](external).

Disclosure Log - FOI 24/25-0368

SGP KP Publishing – Finalise eligibility reassessment decision

Complete a check for procedural fairness

  1. Go to ER Outcome tab.
  2. Complete the Procedural Fairness Checklist.

Note: You can’t commence the eligibility reassessment decision until the Procedural Fairness Checklist has been completed. For more information see article Accept a case from the eligibility reassessment queue and complete the procedural fairness check.

Note: If the eligibility reassessment outcome is to revoke access, the manual procedural fairness check will also need to be completed. See section Complete a manual procedural fairness check.

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Finalise the eligibility reassessment decision

It is the participant’s responsibility to provide evidence that they continue to meet the eligibility requirements.

  1. Review the Eligibility Check tab to understand the background of the eligibility reassessment, including:
    • why the previous access delegate progressed the eligibility reassessment case.
    • the eligibility criteria we were checking the participant continues to meet.
  2. If the Eligibility Check tab indicates the participant may not meet the:
    • residence requirements – assess the residence, disability and early intervention criteria.
    • disability and early intervention requirements – assess the disability and early intervention criteria.

Note: If the participant joined the NDIS under a NSW prescribed program, only consider the disability and early intervention requirements. Do not consider the residence requirements. 3. To finalise the eligibility reassessment decision, review all information and evidence on the participant’s Person Account, relating to eligibility. If there isn’t clear evidence the person continues to meet all eligibility criteria, their eligibility needs to be reassessed. 4. Check for outstanding evidence related to the participant’s eligibility including in the: - Enquiry inbox. Check and action any relevant emails - eligibility reassessment case under Evidence or Documents tabs - Person Account under Document or My Profile then Evidence tabs - related enquiry case (if relevant) - participant’s SAP CRM record Inbound Documents (if relevant). 5. If the evidence isn’t already in the eligibility reassessment case, you must link it to the case. Use article Upload evidence to support an eligibility reassessment (ER) case section Upload evidence to support the eligibility reassessment case.

Note: You don’t need to upload documents in SAP CRM to PACE. 6. There will be three possible outcomes for the eligibility reassessment. Use Our Guideline – Applying to the NDIS (external) section Appendices, to either: - maintain the participant’s status as eligible for the NDIS. Continue to section Complete the ER Outcome tab and contact participant to let them know the eligibility reassessment decision. - change the eligibility criteria. Continue to section Complete the ER Outcome tab and contact participant to let them know the eligibility reassessment decision. - revoke the participant status. Continue to section Complete a manual procedural fairness check. Note: you cannot revoke a participant due to a lack of information or evidence if they have not been given reasonable opportunity to respond.

Note: Decisions for participants who are living with terminal illness must only be completed by delegates in the Priority Health Access team.

Note: If TAPIB advice is required, go to article Create a technical advice case.

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Complete a manual procedural fairness check

If the outcome is to revoke the participant status, you must complete a manual procedural fairness check. Start at section Check correspondence. If you are not revoking the participant’s status, go to section Complete the ER Outcome tab and contact participant to let them know the eligibility reassessment decision.

5.1 Check correspondence

Check the participant, their nominee or child representative was sent correspondence to notify them about the eligibility reassessment.

  • Check whether the participant has a correspondence nominee or child representative. Go to the participant’s Person Account. Select Relationships, then Authorised Reps. Any child representative or nominee roles will appear here. For more information go to article Check consent, nominee, child representative or self-representation authorities.
  • If the participant has a child representative or correspondence nominee, navigate to the representatives Person Account. Otherwise stay in the participant’s Person Account.
  • Select Documents tab.
  • Review the eligibility reassessment correspondence sent to the participant. Check either the Letter - Eligibility Reassessment Evidence Request or Letter – Eligibility Reassessment opportunity to respond were sent. If a letter was not sent, notify your team leader.
  • Open the correspondence and review whether the participant had at least 28 days from the date of the letter to provide information.

5.2 Check contact attempts

  1. Go to the Eligibility Reassessment case.
  2. Select Case Activity tab. Select Activity History.
  3. Check the correct number of contact attempts were made to notify the participant of the eligibility reassessment. See article [Contact attempts and unable to contact in an eligibility reassessment case](#).
  4. If one or more phone call attempts have not been completed, discuss this with your team leader.

5.3 Check for outstanding enquiries

Check if the participant has any outstanding eligibility reassessment enquiries.

  1. Go to Person Account, Cases tab.
  2. Select Cases, then All Cases.
  3. In the Case Record Type column, check for any open Enquiry cases created after the eligibility reassessment commenced.
  4. Action any eligibility reassessment enquiries before proceeding.

5.4 Check evidence extension requests

Check if the participant has any outstanding evidence extension requests.

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SGP KP Publishing – Finalise eligibility reassessment decision

  1. Go to Person Account, Cases tab.
  2. Select Cases, then All Cases.
  3. In the Case Record Type column, check for extension of time requests by reviewing Enquiry and Evidence Extension cases created after the eligibility reassessment commenced.

Note: NCC may create enquiry cases for extension requests. 4. If there is an outstanding evidence extension request, continue to article Action evidence extension request for eligibility reassessment case.

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Complete the ER Outcome tab and contact participant to let them know the eligibility reassessment decision

Make sure you’re confident in your final decision and enter it accurately into the ER Outcome tab.

Do not select Back at any point, as this may prevent the case from progressing. If you need to make changes to the decision after you have entered it into the ER Outcome tab, contact your team leader for support. They will check whether Back can be selected, and if not, raise an ICT ticket to resolve this.

  1. Check the participant has a my NDIS contact assigned in PACE using article Update the My NDIS Contact. A PACE task won’t begin if there isn’t a my NDIS contact assigned, which means any updates won’t be picked up until their next check-in.
  2. Select ER outcome tab and complete the steps.
  3. At Impairment assessment, select the primary and secondary impairments.
  4. At Residence Section 23 Sub Criterion, answer all questions.

Note: At Is the applicant currently living in Australia? and Is the applicant an Australian citizen or a current eligible visa holder? Select N/A when the participant may not meet the residence requirements and they joined under a NSW prescribed program. 5. If the participant is 7 years or older complete Disability Section 24 Sub Criterion. If not, go to step 7. The questions will automatically generate from the answer to the earlier question Does the reassessment impairment belong to List A, B or D? 6. All eligibility criteria sections must be answered. If you select No for any criteria, select the correct justification from the dropdown options. If section 24(1)(b) is not met, then the remaining criteria will not be met.

Note: Due to NDIS Amendment (Getting the NDIS Back on Track No. 1) Bill 2024, section 25(3) and section 24(1)(e) will not be correctly reflected in PACE. You will still need to select whether this requirement is met or not by selecting Yes or No in the System. You will be advised later in this article to record an Internal Note explaining that you have applied the correct legislation. 7. At The participant is likely to require lifetime supports under the NDIS select Yes or No.

Note: Due to NDIS Amendment (Getting the NDIS Back on Track No. 1) Bill 2024, section 24(1)(e) will not be correctly reflected in the System. You will still need to select whether this requirement is met or not by selecting Yes or No in PACE. You will be advised later in this article to record an Internal Note explaining that you have applied the correct legislation. 8. If the participant is younger than 7 complete Early Intervention Section 25 Sub Criterion. All eligibility criteria sections must be answered. If you select No for any criteria, select the correct justification from the dropdown options. If section 25(1)(a) is not met, then the remaining criteria will not be met.

Note: Due to NDIS Amendment (Getting the NDIS Back on Track No. 1) Bill 2024, section 25(3) will not be correctly reflected in PACE. You will still need to select whether this requirement is met or not by selecting Yes or No in the System. You will be advised later in this article to record an Internal Note explaining that you have applied the correct legislation.

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  1. At The participant has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be permanent; or one or more identified impairments that are attributable to a psychiatric condition that are, or are likely to be, permanent select Yes or No.

Note: If you answer Yes, sub criteria 2, 3, sub criteria 4 will not appear. 10. Review the recorded Sub Criterion and Overall Criteria Summary. Depending on whether the outcome is maintain, change or revoke, additional pages will populate.

Note: If the decision is not correct, contact your team leader for support. 11. If you are updating the primary impairment, complete Access Disability Change. Updating the Primary Impairment will update the person account automatically. The existing primary impairment will become a secondary impairment in the person account. If you need to update the secondary impairment, update this in the person account. See article Update a person account. Select Next. 12. If the outcome is to:

  • revoke, continue to step 13.
  • access met or disability criteria change, continue to step 14.
  1. Record the evidence used to make the revoke decision using article Log an activity or internal note. Use the below template.

Template for evidence considered for revoke outcome I have reviewed the following documents as part of the eligibility reassessment. The following documents are available in the person’s PACE record: <from/with> <Title and person’s name> dated . Evidence located in <SAP CRM/SAP CRM and PACE>. 14. Review the Summary information. Select Next.

Note: If the decision is to revoke, then the ER Outcome cannot be completed by the delegate. When you select Next at the Summary screen, the case will route to the ER Revocation Queue for a quality development officer (QDO). The QDO will review the case and either approve to revoke access or request an adjustment. The QDO will send the case back to you to finalise the revocation process or adjust the decision.

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Next steps for access met, disability change outcomes, or once the QDO approves a revoke outcome

  1. For a revoke outcome, if the QDO send an adjustment request, continue with article Review the quality feedback (QDO). Otherwise continue to step 2.

  2. In the ER Outcome tab, review the Decision. Select Next.

  3. Review the Justification. If the justification is:

  • not correct, contact your team leader for support.
  • correct, select Next, then Evidence.

  1. Review the Evidence. Select Next and complete the ER Outcome.

  2. Record an internal note using article Log an activity or internal note. Use the below template:

Eligibility Reassessment legislative decision

The Eligibility Reassessment was valid for a decision on <DD/MM/YYYY>. The <Eligibility Check/ER Outcome> decision has been made under NDIS Amendment (Getting the NDIS Back on Track No. 1) Bill 2024. Section 24(1)(e) and section 25(3) of the sub criterion questions incorrectly reflect the NDIS Act 2013 legislation. All external communication including letters and phone calls reflect the correct 2024 legislation.

  1. Contact the participant to let them know the Eligibility Reassessment Decision, and send them a letter with the decision. Use article Contact the participant to explain the outcome of their eligibility reassessment.

  2. If the participant’s status is:

  • maintained or changed, they will continue to be a NDIS participant. No further action is required. End of process.
  • revoked, they are no longer eligible for the NDIS. A Leaving the NDIS case will automatically be created and routed to the my NDIS contact to complete the final checklist. The letter will inform the participant that this will take effect in 28 days. Continue to step 8.
  1. Where the participant has an active record you must check for a person record in SAP CRM and revoke access in SAP CRM if there is. You can only complete this 28 days after the decision is made as revoking access in SAP CRM will immediately cease access to funded supports.

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SGP KP Publishing – Finalise eligibility reassessment decision

Next steps

  1. If the participant has been revoked, revoke access on SAP CRM after 28 days.

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