Understand procedural fairness and eligibility reassessment requirements

SGP KP Publishing

Exported on 2024-10-09 10:53:30

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SGP KP Publishing – Understand procedural fairness and eligibility reassessment requirements

1 Before you start …………………………………………………………………………………………………….. 4 2 Understand procedural fairness …………………………………………………………………………….. 5 3 What is procedural fairness? …………………………………………………………………………………. 6 4 What is the purpose of the procedural fairness checklist? ……………………………………… 7 5 What about manual procedural fairness checks? …………………………………………………… 8 6 Has the My NDIS contact been able to contact the participant? ………………………………. 9 7 Review information and evidence ………………………………………………………………………… 10 8 Consider the eligibility requirements ……………………………………………………………………. 11 9 Consider residence requirements ………………………………………………………………………… 12 10 Consider early Intervention requirements …………………………………………………………. 13 11 Consider disability requirements ……………………………………………………………………… 14 12 Consider the participant’s impairment ………………………………………………………………. 15 13 Consider the assessment summary ………………………………………………………………….. 16 14 Next steps ……………………………………………………………………………………………………….. 17

Table of Contents – 2

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SGP KP Publishing – Understand procedural fairness and eligibility reassessment requirements

This article provides guidance for an access assessor to:

understand procedural fairness
consider the eligibility requirements
consider the participant’s impairment
consider the assessment summary.

To complete the Eligibility Check in PACE, you need to understand these requirements.

When we talk about contacting a participant, we mean the participant or their authorised representative.

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SGP KP Publishing – Understand procedural fairness and eligibility reassessment requirements

Before you start

You have read:

Are you eligible for the NDIS? in Our Guideline – Applying to the NDIS
What happens if we check your eligibility? in Our Guideline – Leaving the NDIS.

You have been asked to:

draw down an eligibility reassessment referral
complete an eligibility check
decide if an eligibility reassessment should commence
decide if the participant needs an access status change.

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SGP KP Publishing – Understand procedural fairness and eligibility reassessment requirements

Understand procedural fairness

You will complete an Eligibility Check in PACE. The Eligibility Check will help you decide if an eligibility reassessment should commence. The Procedural Fairness Checklist is the first part of the check.

The procedural fairness check will automatically check who has progressed the case and created the referral. If you approved the participants access, you must select Yes when prompted and the case will be routed back to the eligibility reassessment queue.

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SGP KP Publishing – Understand procedural fairness and eligibility reassessment requirements

What is procedural fairness?

Procedural fairness is about making sure we give participants a reasonable opportunity to have their say and provide us with evidence about their situation. It is also about making sure our decisions are fair and unbiased. When we say fair and unbiased, we mean our decisions are made by someone who wouldn’t benefit from the decision or be impacted by it.

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SGP KP Publishing – Understand procedural fairness and eligibility reassessment requirements

What is the purpose of the procedural fairness checklist?

The checklist has questions to make sure you are an independent delegate. This is how we make sure our decisions are fair and unbiased.

You aren’t an independent delegate if you have:

a personal interest in the participant’s status, or
a personal relationship with the participant (outside the NDIA), or
been involved in making the original eligibility decision or any planning decisions.

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SGP KP Publishing – Understand procedural fairness and eligibility reassessment requirements

What about manual procedural fairness checks?

Procedural fairness is also about:

being transparent with the participant
giving them reasonable opportunity to provide information, and to present a case to support their continued eligibility.

There are steps you will take to make sure we follow procedural fairness. That is what we mean when we say manual procedural fairness checks.

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Has the My NDIS contact been able to contact the participant?

This is an important manual procedural fairness check. The My NDIS contact will record their contact with the participant in PACE. You will check PACE. If the My NDIS contact is unable to contact the participant, do not make an eligibility reassessment referral.

If the My NDIS contact made an eligibility reassessment referral without contacting the participant:

do not commence an eligibility reassessment
close the eligibility reassessment case – read article Action if ER not required to learn more.

If the My NDIS contact was able to contact the participant, continue with the eligibility reassessment. Do this even if you are unable to contact them.

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SGP KP Publishing – Understand procedural fairness and eligibility reassessment requirements

Review information and evidence

You will make sure we follow procedural fairness by thoroughly reviewing existing information and evidence.

Some sources of existing information include:

conversations about the participant’s situation recorded in PACE
any relevant documents on the participant’s record
medical or clinical reports, diagnostic and assessment information
service provider reports and assessments such as progress reports
information provided with the participant’s access to the NDIS
early childhood partner documents
information from family members and carers.

Consider the eligibility requirements

After you complete the procedural fairness checklist, you will consider the eligibility requirements to complete the impairment assessment. PACE will pre-populate responses for each eligibility requirement based on the:

Referral checklist
Impairment assessment.

This means some responses will already be pre-populated in PACE.

Consider residence requirements

Read Do you meet the residence requirements in Our Guidelines – Applying to the NDIS. This will help you consider the residence requirements if you need to.

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10 Consider early Intervention requirements

Read Do you need early intervention in Our Guidelines – Applying to the NDIS to learn more. This will help you consider the early intervention requirements if you need to.

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SGP KP Publishing – Understand procedural fairness and eligibility reassessment requirements

Consider disability requirements

Read Do you meet the disability requirements in Our Guidelines – Applying to the NDIS.. This will help you consider the disability requirements if you need to.

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12 Consider the participant’s impairment

An impairment assessment is another part of the eligibility check. The impairment assessment asks you to consider if the reassessment impairment belongs to List A, B or D. You will use the Appendices in Our Guidelines – Applying to the NDIS to consider if the impairment belongs to List A, B or D.

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13 Consider the assessment summary

The last part of the eligibility check is the assessment summary. This part of the eligibility check asks you to consider:

Has the participant’s primary impairment changed?
Have changes been made to the secondary impairments listed in the Participant’s record?

You will answer Yes or No and select the reassessed impairment, if needed. Your responses will be based on your thorough review of the participant’s information and evidence.

PACE will pre-populate Yes or No for primary disability change or access status change. The pre-populated response is based on the answers you entered about the participant’s impairment and eligibility.

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SGP KP Publishing – Understand procedural fairness and eligibility reassessment requirements

Next steps

You will:

make a decision about the participant’s eligibility
use the eligibility check tab in PACE to record your decision making.

To learn more about using the eligibility check tab in PACE read articles:

Draw down a referral and check procedural fairness for an ER case
Review and link participant evidence to the eligibility reassessment case.

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