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Complete pre-assessment for an access decision

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DOCUMENT 3

Complete pre-assessment for an access decision SGP KP Publishing

Exported on 2025-02-06 23:41:01

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Disclosure Log - FOI 24/25-0735 SGP KP Publishing – Complete pre-assessment for an access decision

Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4

2 Before you start …………………………………………………………………………………………………….. 5

3 Accept an access decision case ……………………………………………………………………………. 6

4 Check prioritisation ………………………………………………………………………………………………. 7

5 Review key information …………………………………………………………………………………………. 8

6 Complete initial checks …………………………………………………………………………………………. 9 6.1 Complete procedural fairness check ………………………………………………………………………. 9 6.2 Check there is no internal review or ART review in progress …………………………………….. 9 6.3 Check if remote, YPIRAC or terminal illness ……………………………………………………………. 9 6.3.1 Update subject to terminal illness ………………………………………………………………………………….. 10 6.3.2 Complete the specialises cohort – unavailable treatments form …………………………………………. 10 6.3.3 Unable to complete Access Decision – Send back to queue ……………………………………………… 11 6.4 Check for eligibility evidence not linked to the case ………………………………………………… 11 6.5 Check for Access Integrity Management referral (AIM) tasks …………………………………… 11 6.6 Check authorised representatives ………………………………………………………………………… 11

7 Check if access request is complete ……………………………………………………………………. 12 7.1 Verify consent to apply ……………………………………………………………………………………….. 12 7.2 Verify identity ………………………………………………………………………………………………….. 12 7.3 Verify age and residence …………………………………………………………………………………….. 12 7.4 Check evidence of disability ………………………………………………………………………………… 12 7.5 Complete identity evidence …………………………………………………………………………………. 13

8 Mark application as invalid ………………………………………………………………………………….. 14

9 Cancel an Access Decision case …………………………………………………………………………. 15

10 Next steps ……………………………………………………………………………………………………….. 16

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Disclosure Log - FOI 24/25-0735 SGP KP Publishing – Complete pre-assessment for an access decision

This article provides guidance for an access delegate (assessor) to:

  • accept an access decision case
  • check prioritisation
  • review key information
  • complete initial checks
  • check if access request is complete
  • mark application as invalid if required
  • cancel the access decision case if required.

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1 Recent updates

4 November 2024
Guidance added for cancelling an access decision case.

14 October 2024

  • Guidance updated to reflect legislation to start a new body called the Administrative Review Tribunal (ART). The ART replaced the Administrative Appeals Tribunal (AAT) on Monday 14 October 2024.

  • Administrative Appeals Tribunal (AAT) changed to Administrative Review Tribunal (ART) throughout.

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2 Before you start

  • You have read Our Guideline – Applying to the NDIS (external), including section How do you apply for the NDIS?

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3 Accept an access decision case

  1. At Home page, select Omni-Channel tab at the bottom of the screen.

  2. A Status message will appear. Select Available from the drop-down list.

  3. Select the tick box for the case to make a decision on. The Access Decision case will open.

  4. Set Omni-Channel status to Offline. This will make sure you’re only allocated one case at a time to complete.

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4 Check prioritisation

  1. Select Details tab.

  2. Review and note the Prioritisation. If the access request is complete and there’s a Prioritisation Reason, you have 2-5 business days to make an access decision or request further information. For more information go to article Request priority eligibility decision.

  3. Select Decision tab. The Pre-Assessment screen will display.

The following sections are in the order you need to complete them, rather than the order in PACE.

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5 Review key information

  1. Select the Progress Case button to move the status from New to In Progress.

  2. Review Key Information, including:

    • Name
    • Date of Birth
    • Age
    • Home Address
    • Australian Citizenship
    • Permanent Resident
    • Visa Class
    • CRN (customer reference number)
    • CRN consent
    • legislation version that will be used for the access decision. This will help you decide what article to go to in section Next Steps.

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6 Complete initial checks

6.1 Complete procedural fairness check

Procedural fairness makes sure our decisions for applicants are fair, respectful, and unbiased.

  1. If you have a conflict of interest, then you must unassign the work item.

  2. Check you’re an independent delegate to work on an application decision. To be independent means you:

    • don’t have a personal interest in the applicant’s status
    • don’t have a relationship with the applicant outside the NDIA
    • haven’t made a previous access not met or revocation decision for the applicant. Note: For more information, go to the Policy Hub – Conflict of Interest.

  3. Do you have a conflict of interest (COI)? If:

    • No, at Sent back to queue?, Select No and go to section Check for eligibility evidence not linked to the case.
    • Yes, go to section Unable to complete Access Decision – Send back to queue.

6.2 Check there is no internal review or ART review in progress

  1. From the Person Account screen, select the Cases tab.

  2. Under Open Cases, check if there’s an Internal Review case or Administrative Review Tribunal (ART) review. If:

    • No, go to section Check if remote, YPIRAC or terminal illness.
    • Yes, go to next step.

  3. Check if the review is for an access decision or revocation decision. If:

    • access decision, go to section Mark application as invalid.
    • revocation decision, go to next step.

  4. Check when revocation decision was made. If:

    • on or after 3 October 2024, go to section Mark application as invalid.
    • before 3 October 2024, contact your team leader to decide next steps.

6.3 Check if remote, YPIRAC or terminal illness

The access decision case must be completed by an access delegate in the Priority Health Access Team or Specialised Access Team if the applicant:

  • lives in a remote or very remote location (MMM6 and MMM7)
    Note: for more information go to Modified Monash Model (external)
  • is a younger person in residential aged care, also known as, YPIRAC
  • is living with a terminal illness
  • is living with Motor Neurone disease or Kennedy’s disease

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  • has unavailable treatment options.

If you’re not in these teams, you need to change the case owner of the access decision case.

  1. Check if one of the above situations applies. If the applicant:

    • lives in a remote or very remote location (MMM6 and MMM7), change Case Owner to redacted: s47F - personal privacy (DJS497).
    • is a younger person in residence aged care (YPIRAC), change Case Owner to redacted: s47F - personal privacy (SCM231).
    • is living with a terminal illness, go section Update subject to terminal illness
    • is living with Motor Neurone disease or Kennedy’s disease, go to section Update prioritisation reason to Motor Neurone Disease.
    • has unavailable treatment options, go to section Complete the specialises cohort – unavailable treatments form.

6.3.1 Update subject to terminal illness

  1. From the Access Decision case, select the Details tab.

  2. Scroll down to System information.

  3. At Subject, select Edit Subject, which looks like a pencil icon.

  4. Enter Terminal Illness.

  5. Select Save.

  6. Repeat steps above for the Access Request case.

  7. Change Case Owner to Access Decision Routing Queue.

  8. Update prioritisation reason to Motor Neurone Disease From the Access Decision case, select the Details tab.

  9. Scroll down to Prioritisation.

  10. Select Edit, which looks like a pencil icon, next to Prioritisation Reason.

  11. At Prioritisation Reason, select Disability.

  12. At Priority Description, select Motor Neurone Disease.

  13. Select Save.

  14. Change Case Owner to Access Decision Routing Queue.

6.3.2 Complete the specialises cohort – unavailable treatments form

This is when there are known treatments, however treatment is unavailable to the applicant. This may be because of their location, finances, religion or because their disability prevents them from accessing it. This doesn’t apply where there are no known treatments likely to remedy the impairment.

  1. Complete the Specialised Cohort – Unavailable Treatments form (external).

The access decision case will remain assigned to you. A QDO Team Leader will review the application and either:

  • reassign the access decision case to themselves
  • give feedback if you need to progress with an access decision.

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6.3.3 Unable to complete Access Decision – Send back to queue

  1. At Sent back to queue?, select I am no longer able to complete this Access Decision.

  2. At Reason, select the relevant option.

  3. At Justification, enter details about the conflict of interest.

  4. Select Next.

  5. At Confirmation, select Done. The application will be sent back to the queue and another access delegate will be assigned the access decision case.

6.4 Check for eligibility evidence not linked to the case

  1. Check for eligibility evidence not linked to the access decision case that needs to be considered. This includes evidence in SAP CRM, enquiries inbox and enquiry cases.

  2. Check the Account Timeline for any cases, alerts, tasks or log activities relevant to the case. For further guidance, refer to article View the Person Account Timeline.

  3. If required, add and link any eligibility evidence to the access decision case. Go to article Add and link evidence to a case.

6.5 Check for Access Integrity Management referral (AIM) tasks

If there’s an application or evidence document that may not be genuine or real, this is an integrity issue.

  1. From the Person Account, check the Account Timeline for any AIM referral tasks. For further guidance, refer to article View the Person Account Timeline. If:

    • No, go to section Check authorised representatives.
    • Yes, open the task and review Comments for instructions under Task Information.

Note: There may also be alerts in the person account relating to integrity concerns.

6.6 Check authorised representatives

This will make sure that correspondence is generated correctly.

  1. From the Person Account, select the Relationships tab.

  2. Select the Authorised Reps tab.

  3. Check the authorised representative is listed and their correspondence details are correct, if there’s evidence to compare to.

Note: Authorised representatives, including child representative for applicants younger than 18, except in exceptional circumstances, must be listed.

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7 Check if access request is complete

  1. Check if there’s an internal note that records who provided consent to apply. For how to find internal notes, go to article View the Person Account Timeline.

  2. Use article Applicant consent to apply to look at whether the person has consent to apply on behalf of the applicant. If:

    • the applicant or their authorised representative provided consent, go to section Verify identity.
    • the person doesn’t have consent or there’s no internal note, go to section Mark application as invalid.

7.2 Verify identity

  1. Check the correct identity documents have been provided and verified for the applicant, and their authorised representative, if they have one. Go to article Understand how to verify identity documents.

  2. If all of the required identity documents aren’t provided and verified, check if there’s an internal note that explains a genuine reason why. If there’s an internal note, contact your team leader to decide next steps.
    Note: Identity documents with a Verification Status of Verified DVS don’t need to be uploaded. All other documents must be uploaded to the person account.

  3. If identity is:

    • verified or there’s an internal note to explain why not, go to section Verify age and residence.
    • not verified and there’s no internal note to explain why, the access request isn’t complete. Go to section Mark application as invalid.

7.3 Verify age and residence

  1. Go to article Consent to use Centrelink information to check if the person has given consent to check age and residence in Centrelink. For child applicants, we also need consent to check the child representative’s Centrelink. If:

    • Yes, go to article Verify age and residence with Centrelink information.
    • No, go to article Understand age and residence evidence.

  2. With consent, check if Account Name, Date of Birth, Address and Residence Information matches Centrelink or documents. If age and residence is:

    • Verified, go to section Check evidence of disability.
    • Not verified, go to section Mark application as invalid.

7.4 Check evidence of disability

  1. Check evidence of disability has been provided. If:

    • Yes, go to next step.
    • No, go to section Mark application as invalid.

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  1. Check if child younger than 6 with developmental delay:

    • Yes, go to next step.
    • No, go to section Complete identity evidence.

  2. If an early childhood partner gives any evidence of developmental delay (EODD) form on or after 16 September, check the correct version (version Aug 24) of the form was used. If:

    • Yes, go to section Complete identity evidence.
    • No, go to section Mark application as invalid.

Note: This is a check to make sure the access request is complete. You’ll complete Disability Evidence in a later step using either article Make an access decision - Pre-legislation changes or Make an access decision – Post-legislation changes.

7.5 Complete identity evidence

  1. Select Yes or No for questions:

    • Have you verified the Evidence of Age?
    • Have you verified the Evidence of Residency?
    • Have you verified the Evidence of Identity?
      Note: You can’t complete the access decision case until the evidence has been verified and you select Yes for all questions.

  2. If:

    • Yes to all questions, go to section Next Steps.
    • No to any question, the access request is not complete. Go to section Mark application as invalid.

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8 Mark application as invalid

An access request isn’t complete if there’s no evidence of:

  • consent to apply from the applicant or their authorised representative
  • age, residence and disability
  • identity or an internal note confirming why identity documents haven’t been provided

An access request isn’t complete if there’s evidence of:

  • an internal review or Administrative Review Tribunal (ART) review in progress for an access decision
  • an internal review or Administrative Review Tribunal (ART) review in progress for a revocation decision made on or after 3 October 2024.

  1. At Is the Access Request Invalid or Incomplete?, select Yes or No. If:

    • No, select Next and go to section Next Steps.
    • Yes, go to step 2.

  2. At Provide reason why the application is invalid, enter the details into the free text field.

  3. Select Next. The access decision case is now closed. The access request case will automatically reassign to the Access Request Routing Queue.

  4. Complete the AO Support Webform (external) to notify the access officer’s team leader.

If at any point you need to cancel the Access Decision case go to section Cancel an Access Decision case. Otherwise continue to Next Steps.

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9 Cancel an Access Decision case

Note: Don’t cancel the case once you’ve approved the decision for access met or access not met. If you make an error at this stage, select Previous to correct the error.

For more information go to articles Complete pre-assessment for an access decision or When to withdraw an access application.

The Access Decision case can only be cancelled by an access delegate in the Scheme Eligibility branch.

The Cancel Case button is available when:

  • the Access Decision case is in the status New or In Progress.

Note: When you cancel an Access Decision case, the Access Request case will automatically change to In Progress. You’ll need to cancel or withdraw the Access Request case. Go to article When to withdraw an access application.

  1. Select the Cancel Case button in the top right hand corner of the Access Decision case.

  2. At Closure Reason select Administration error.
    Note: This is the only reason an access decision can be cancelled.

  3. At Closure Comments enter details as to why the case is being closed.

  4. Select Confirm. A note will state the case is now closed.

  5. Select Done to finish the process.

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10 Next steps

  1. Check Legislation version that will be used for the access decision. Go to section above Review key information to find this. If using:

    • National Disability Insurance Scheme Amendment (getting the NDIS Back on Track No.1) Bill 2024, go to article Make an access decision – Post-legislation changes.
      Note: This is the latest version of the National Disability Insurance Scheme Act 2013 which incorporates amendments as per the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No.1) Bill 2024.

    • National Disability Insurance Scheme 2013, go to article Make an access decision – Pre-legislation changes.

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