FOI 25/26-2252 & FOI 25/25-2253 Document 1

Understand highly likely and commonly associated impairment categories

SGP KP Publishing

Exported on 2026-03-18 16:08:11

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SGP KP Publishing – Understand highly likely and commonly associated impairment categories

Table of Contents

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

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

3 Understand impairment categories ………………………………………………………………………… 6 3.1 Impairment categories when the participant meets the disability requirements …………….. 6 3.2 Impairment categories when the participant meets the early intervention requirements … 6

4 Understand highly likely and commonly associated impairment categories ……………. 8 4.1 Highly likely impairment categories ………………………………………………………………………… 8 4.2 Commonly associated impairment categories………………………………………………………….. 8

5 Understand how to assign impairment categories when you make an access decision ………………………………………………………………………………………………………………………. 9 5.1 Example – Multiple sclerosis - neurological and cognitive impairment categories ………… 9 5.2 Example – Multiple sclerosis - neurological and physical impairment categories………….. 9 5.3 Example – assigning impairment categories for multiple impairments that combined meet disability requirements ……………………………………………………………………………………………………. 9 5.4 Example – assigning 2 highly likely impairment categories for multiple impairments that meet the disability requirements…………………………………………………………………………………….. 10 5.5 Example - multiple impairments related to the same impairment category ………………… 10

6 Understand how to add an impairment category after a participant has met access 11 6.1 Example - decision to add an impairment category ………………………………………………… 11 6.2 Example – decision to not add an impairment category ………………………………………….. 11

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This article provides guidance for an access delegate to:

•   understand impairment categories
•   understand highly likely and commonly associated impairment categories
•   understand how to assign impairment categories when you make an access decision
•   understand how to add a new impairment category after a participant has met access

                                                                     Recent updates – 3
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1 Recent updates

15 December 2025 New article to support understanding of how highly likely and commonly associated impairment categories are applied based on the participant’s impairments.

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2 Before you start

Impairment categories information is called a ‘Notice of impairments’ in section 32BA of the NDIS Act (the Act).

A participant can ask to change their impairment categories at any time. This includes to add or remove an impairment category. The Act uses the term ‘vary’, but in correspondence, guidance and when talking to participants, we use the term ‘change’ as it’s plain English.

Only access delegates assign participant’s impairment categories.

You:

•   are determining a participant's impairment categories following an access met decision,
    or an application to change impairment categories information and

You have read:

•  and understood Our Guideline – Applying to the NDIS (external), sections What are the
   categories of impairments?, What happens after we decide? and How do we
  weigh evidence of disability?

•    article Descriptions of impairment categories.

Note: the examples in this article are for information only. They are provided to support understanding and don’t include all potential scenarios.

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3 Understand impairment categories

A participant’s impairment categories information may include one or multiple impairment categories.

Where a participant has multiple impairments which relate to a single impairment category, one impairment category is recorded. However, when a participant has one impairment that impacts multiple impairment categories, all relevant impairment categories are recorded. More categories doesn’t mean more support needs.

Note: we use the terms highly likely and commonly associated impairment categories. This is internal language only. When talking to participants, use either impairment categories, or impairment categories information.

When considering adding any impairment categories, they must be:

•   supported by the participant's disability related evidence
•   relevant to how the participant meet's the disability or early intervention requirements.
   For more information go to sections Impairment categories when the participant
  meets the disability requirements, and Impairment categories when the
    participant meets the early intervention requirements.

3.1 Impairment categories when the participant meets the

disability requirements

If the participant meets the disability requirements, the highly likely or commonly associated impairment category needs to cover an impairment that:

•    is likely to be permanent
•   substantially reduces the participant's functional capacity
•   affects the participant's ability to work, study or take part in social life
•    likely needs NDIS support for the participant's lifetime.

For more information go to Our Guideline – Applying to the NDIS (external), section Do you meet the disability requirements?

3.2 Impairment categories when the participant meets the early

intervention requirements

If the participant meets the early intervention requirements, the highly likely or commonly associated impairment category needs to cover an impairment that:

•    is likely to be permanent
•    will likely benefit from early intervention supports and
•   the early intervention supports needed are NDIS supports.

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Note: if a child is younger than 6 with developmental delay, then the impairment categories don’t apply.

For more information go to Our Guideline – Applying to the NDIS (external), section Do you need early intervention?

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4 Understand highly likely and commonly associated impairment categories

In most cases, apply the highly likely impairment category or categories for the condition or conditions that meet the disability or early intervention requirements. Other impairment categories can also be relevant to the participant’s condition. Consider the commonly associated impairment category or categories.

Article Impairment categories guide includes the highly likely and commonly associated impairment categories associated with a participant’s condition. You can also add an impairment category not listed in this guide, as long as:

• you have evidence of this, and

• it covers an impairment that meets the disability or early intervention requirements.

Where a participant has more than one impairment, you must assess the functional impact of each impairment in the context of all the participant’s impairments cumulative impact. For example, a person might have an intellectual disability and a different permanent impairment which causes difficulty moving. On its own the impairment that causes difficulty moving might not result in substantially reduced functional capacity in any activity area. But because of the person’s intellectual disability, they may not be able to use recommended strategies or equipment without support. This means we would consider the functional impacts of the physical impairment in the context of the functional impacts of the intellectual disability. For more information, go to section Example – assigning impairment categories for multiple impairments that combined meet disability requirements in this article.

Note: if the participant’s condition isn’t listed in the guide, consider the evidence to determine the most appropriate impairment categories that apply.

4.1 Highly likely impairment categories

Highly likely impairment categories are categories that research tells us are most likely to be associated with a condition. These categories apply to the permanent impairment the participant met the disability or early intervention requirements for.

A participant can have multiple impairments which relate to a single impairment category. In this case, record only one impairment category. For more information go to section Example - multiple impairments related to the same impairment category in this article.

4.2 Commonly associated impairment categories

In addition to the highly likely impairment categories, you must consider applying any commonly associated impairment categories. The evidence must indicate it’s relevant to the permanent impairment the participant meets the disability or early intervention requirements for. Two people with the same condition may have different impairment categories applied because of how the condition presents for them.

If the participant applies to change their impairment categories information, go to section Understand how to add an impairment category after a participant has met access in this article.

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5 Understand how to assign impairment categories when you make an access decision

The following examples include assigning highly likely and commonly associated impairment categories to a participant’s impairment categories information when you make an access met decision.

5.1 Example – Multiple sclerosis - neurological and cognitive impairment categories

Hailey meets the disability requirements because she has multiple sclerosis. This means the highly likely impairment category is neurological.

Hailey provides evidence that because of her multiple sclerosis, she has difficulty with her memory and concentration causing substantially reduced functional capacity in communication and learning. The delegate decides Hailey has a permanent neurological impairment caused by multiple sclerosis. The delegate also decides that Hailey’s multiple sclerosis causes a permanent cognitive impairment.

This means the delegate will apply the commonly associated category cognitive. Hailey’s impairment categories information will include the impairment categories neurological and cognitive. These apply equally in their impairment categories information and are not defined as highly likely or commonly associated on their record.

5.2 Example – Multiple sclerosis - neurological and physical impairment categories

Alex meets the disability requirements because they have multiple sclerosis. This means the highly likely impairment category is neurological.

Alex also provides evidence that because of their multiple sclerosis, they have a lack of muscle control and coordination of their movements (ataxia). This results in a substantially reduced functional capacity to move around, and Alex needs to use a gait aid to help with walking.

The delegate decides Alex has a permanent neurological impairment caused by multiple sclerosis, and a physical impairment due to difficulty moving their body.

This means the delegate will apply the commonly associated category physical. Alex’s impairment categories information will include the impairment categories neurological and physical. These apply equally in their impairment categories information and are not defined as highly likely or commonly associated on their record.

5.3 Example – assigning impairment categories for multiple impairments that combined meet disability requirements

Joy applies to access the NDIS and provides evidence of impairments associated with moderate intellectual disability and rheumatoid arthritis.

The access delegate considers the combined impact of all of Joy’s permanent impairments. They are satisfied Joy has substantially reduced functional capacity in activity of self-care due to

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the combined impact of Joy’s intellectual disability and rheumatoid arthritis. On its own, Joy’s rheumatoid arthritis would not cause substantially reduced capacity to self-care. However, due to Joy’s intellectual disability, she is unable to use adaptive strategies to physically complete self-care tasks independently.

The delegate records the highly likely impairment categories intellectual and physical. These categories cover the impairments for which Joy meets the disability requirements.

5.4 Example – assigning 2 highly likely impairment categories for multiple impairments that meet the disability requirements

Ahmed applies to access the NDIS and provides evidence of impairments associated with a moderate intellectual disability and profound hearing loss.

The delegate is satisfied that the impairments caused by Ahmed’s intellectual disability and hearing loss meet the disability requirements.

The delegate records 2 highly likely impairment categories for Ahmed. These categories are Intellectual and Sensory. Ahmed’s impairment category information will state Intellectual and Sensory.

5.5 Example - multiple impairments related to the same impairment category

Mei was diagnosed with fusion of the cervical spine after birth. Later in life, Mei had a below-knee amputation.

Mei provides evidence that they have permanent damage to their body functions. This is due to limited range of motion in the neck and upper spine, and the partial loss of a lower limb.

Although Mei has two separate impairments, Mei’s impairment categories information will include only the physical impairment category This covers the impairments related to Mei’s fusion of the cervical spine and below-knee amputation.

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6 Understand how to add an impairment category after a participant has met access

A participant can apply to change their impairment categories at any time. This includes adding or removing an impairment category.

When a participant applies to add an impairment category, you don’t need to review the permanence and functional impact of existing impairments. You do need to check the impact of the existing impairment on any new impairments.

As an access delegate, you will consider the available evidence to make a decision about whether you change the impairment categories or not.

The following examples demonstrate adding an impairment category when the participant asks to change their impairment categories information.

6.1 Example - decision to add an impairment category

Omar meets the disability requirements for an intellectual disability.

Omar’s impairment categories information states intellectual and cognitive to cover the impairments they experience associated with intellectual disability.

Omar’s nominee contacts the NDIA to advise that Omar has recently been diagnosed with Parkinson’s disease. They’d like to change Omar’s impairment categories information to reflect this.

As part of the request, Omar’s nominee provides diagnostic information from Omar’s neurologist. This evidence demonstrates Omar’s Parkinson’s disease results in a permanent impairment and is having a substantial impact on his functional capacity. Omar’s nominee also provides evidence of the functional impact Omar experiences from his Parkinson’s disease, impacting his neurological functioning.

The access delegate considers the application and evidence. They decide to change the impairment categories information. This is because Omar’s Parkinson’s disease results in a permanent impairment which causes substantial reduction in functional capacity.

The delegate adds the neurological impairment category. Omar is given a new impairment categories information which now also includes the neurological impairment category, along with the intellectual and cognitive impairment categories.

6.2 Example – decision to not add an impairment category

Ali has autism and meets the disability requirements. Ali’s highly likely impairment category is neurological. Ali also has intellectual recorded as a commonly associated category.

Ali’s child representative applies to add the sensory category to Ali’s impairment categories information. They give us evidence that says due to Ali’s autism, they have sensory processing difficulties.

The delegate reviews the evidence and looks at the relevant guidance including Our Guideline –

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Applying to the NDIS (external). The delegate confirms that we usually use the sensory category when a participant has a condition such as vision or hearing loss. Sensory processing difficulties however relate to the neurological category, which involves how the brain processes sensory information like sound, touch, movement, and taste.

The delegate decides not to change Ali’s impairment category information. Even though we haven’t added the sensory impairment category, Ali might still get NDIS supports for her sensory processing difficulties. The supports would need to relate to her permanent impairment.

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FOI 25/26-2252 & FOI 25/25-2253 Document 2

Make an access decision SGP KP Publishing

Exported on 2026-03-18 16:11:29

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Table of Contents

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

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

3 Check legislative timeframes …………………………………………………………………………………. 6

4 Complete pre-assessment and verify evidence ………………………………………………………. 7

5 Request further information if more evidence is required ………………………………………. 8 5.1 Check correspondence …………………………………………………………………………………………. 9 5.2 Notify the justice liaison officer (JLO) (if relevant) …………………………………………………….. 9 5.2.1 Create the enquiry case …………………………………………………………………………………………………. 9 5.2.2 Assign the enquiry case …………………………………………………………………………………………………. 9

6 Approve or override the streaming case ………………………………………………………………. 11

7 Record access decision ………………………………………………………………………………………. 12 7.1 Complete Age and Residency Sub Criterion ………………………………………………………….. 12 7.1.1 Age Criterion 1: (Section 22(1)(a)) …………………………………………………………………………………. 12 7.1.2 Residency Criterion 1: (Section 23(1)(a)) ………………………………………………………………………… 12 7.1.3 Residency Criterion 2: (Section 23(1)(b)) ………………………………………………………………………… 12 7.2 Complete Early Intervention Sub Criteria ………………………………………………………………. 13 7.2.1 Early Intervention Criterion 1: (Section 25(1)(a)) ………………………………………………………………. 13 7.2.2 Early Intervention Criterion 2: (Section 25(1)(b)) ………………………………………………………………. 13 7.2.3 Early Intervention Criterion 3: (Section 25(1)(c)) ………………………………………………………………. 13 7.2.4 Early Intervention Criterion 4: (Section 25 (d)) …………………………………………………………………. 14 7.3 Complete Disability Sub Criterion …………………………………………………………………………. 14 7.3.1 Disability Criterion 1: (Section 24 (1)(a)) …………………………………………………………………………. 14 7.3.2 Disability Criterion 2: (Section 24 (1)(b)) …………………………………………………………………………. 14 7.3.3 Disability Criterion 3: (Section 24 (1)(c)) …………………………………………………………………………. 14 7.3.4 Disability Criterion 4: (Section 24 (1)(d)) …………………………………………………………………………. 14 7.3.5 Disability Criterion 5: (Section 24 (1)(e)) ……………………………………………………………………… 15 7.4 Evidence Used for Decisions (access not met only) ……………………………………………….. 15 7.5 Decision Main Criteria ……………………………………………………………………………………. 15 7.5.1 If access met for applicant with chronic health condition ……………………………………………………. 17 7.5.2 If access met for applicant younger than 25 with primary psychosocial disability ………………….. 17 7.5.3 If access met and the applicant resides in hospital …………………………………………………………… 17

8 Submit decision for quality check ……………………………………………………………………… 19 8.1 Submit proposed decision for potential quality check ……………………………………………… 19 8.2 Review quality check feedback ……………………………………………………………………………. 19 8.3 Approve access decision …………………………………………………………………………………….. 19

9 Complete access decision correspondence ……………………………………………………….. 20 9.1 Send automated Access Met letter ………………………………………………………………………. 20 9.1.1 Confirm correspondence is sent ……………………………………………………………………………………. 20 9.2 Manual Access Not Met letter ………………………………………………………………………………. 20

10 Notify early childhood partner of access not met decision (developmental delay only) 22

11 Check disabilities tab (access met only) ……………………………………………………….. 23

12 Request a birth certificate ……………………………………………………………………… 24 12.1 Use alerts in a Person Account ……………………………………………………………………… 24 12.2 Create a task in a person account …………………………………………………………………….. 24 12.3 Use log activity in a person account ……………………………………………………….. 24

13 Assign plan approval case (Motor neurone disease only) …………………………… 25

14 Next steps ……………………………………………………………………………………………………….. 26

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

• check legislative timeframes
• complete pre-assessment and verify evidence
• request further information if more evidence is required
• approve or override the streaming case
• record access decision
• submit decision for quality check
• complete access decision correspondence
• notify early childhood partner of access not met decision (developmental delay only)
• check disabilities tab (access met only)
• request a birth certificate
• assign plan approval case (Motor neurone disease only).

The legislation you need to use automatically populates in the access decision case based on what is selected in the access request case. Go to article Complete pre-assessment for an access decision to decide which version of the legislation you need to use to make an access decision.

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1 Recent updates

15 December 2025 Guidance updated to include:

• link to new article Understand highly likely and commonly associated impairment categories

• that where a participant has more than one impairment, you must assess the functional impact of each impairment in the context of all the participant’s impairments cumulative impact.

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2 Before you start

You have:

• completed the pre-assessment using article Complete pre-assessment for an access decision in the Decision tab of the Access Decision case. This includes checking there is evidence of identity, or an internal note to sufficiently explain why it can’t be provided. You have also checked the application is complete with evidence of consent to apply, age, residence and disability

• read articles Check eligibility – age and residence requirements, Understand disability requirements and Understand early intervention requirements.

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3 Check legislative timeframes

You have 21 days to make a decision or request further information.

When a request for further information has been made, you have 14 days from the date that the last information or report was received, to make a decision.

Use article Check decision – Legislative timeframes to check if your decision or request for further information will be outside legislative timeframes. If:

• inside legislative timeframes, go to section Complete pre-assessment and verify evidence.

• outside legislative timeframes, use article Check decision – Legislative timeframes to record an internal note. Then go to section Complete pre-assessment and verify evidence.

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4 Complete pre-assessment and verify evidence

In the Access Decision case, select the Decision tab. The Pre-assessment will appear on screen. In the Disability Evidence menu, linked evidence documents will display.

1. At Have you verified the Evidence of Disability?, select Yes. This is based on section Check evidence of disability in article Complete pre-assessment for an access decision.

2. In the Impairment Assessment menu at Select Assessed Impairment, enter text into the field and a list will display. Select the relevant option.

   Note: when a Reported Impairment differs from the Assessed Impairment, you can update the Reported Impairment with any impairment that meets access from the Select Assessed Impairment drop-down list.

   For example, the Reported Impairment was Bipolar affective disorder. However, based on the evidence of disability, the applicant meets access for Autism Spectrum Disorder (ASD). In this example, the Reported Impairment would remain as Bipolar affective disorder and you’d update the Assessed Impairment field to ASD, as this was the impairment that met access.

   If multiple impairments are reported in the Access Decision case, and the primary reported impairment didn’t meet the access criteria, override it by selecting the assessed impairment that met access as the primary disability. Additionally, include any other impairments that also met access.

   You must add all the impairments that meet the s24 and s25 eligibility criteria.

3. Make a note of the assessed impairment name and International Classification of Diseases (ICD) code. You’ll need this for section Decision Main Criteria.

4. At What evidence was used to confirm the Impairment?, select the appropriate option.

   Note: Defined Program no longer populates the access decision.

5. At Does the applicant’s impairment belong to List A, B or D?, select the appropriate option.

   Note: this no longer populates the access decision. For more information about list conditions, go to articles:

   • Check eligibility – List A condition

   • Check eligibility – List B condition

   • Check eligibility – List D condition.

6. Select Add next to Impairment Assessment menu heading to record additional impairments. If an:

   • access met decision, make sure all impairments that meet s24 and s25 eligibility requirements are added. Remove any that don’t meet eligibility requirements

   • access not met decision, add all reported impairments.

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5 Request further information if more evidence is required

1. Decide if you need more information to make an access decision. Only request more information if:

   • the application is complete and

   • you need more evidence after receiving the applicant’s disability evidence.

2. If the applicant is a child with developmental delay turning 6 within the next 90 days, ask your team leader before requesting more information.

   In this situation, it may be more appropriate to make an access not met decision. For an access request, the child must be younger than 6 on the day the access decision is made. For an internal review, the child must have been younger than 6 at the time of the access not met decision. This reduces the risk of the child turning 6 before an access decision is made when the child is no longer eligible to meet access for Early Intervention for Developmental Delay.

3. In Further information at Do you require further information from the applicant?, select Yes or No. If:

   • No, select Next. Then go to section Approve or override the streaming case.

   • Yes, continue to step 4.

4. At Enter the Required Information below, use the headings from article Templates for requesting further information to indicate what further information has been requested.

   • Permanence (s24(1)(b)) and/or Lifetime NDIS supports (s24(1)(e))

   • Functional capacity (s24(1)(c)) and/or Lifetime NDIS supports (s24(1)(e))

   • Developmental delay (s25(1)(a))

   • Future support needs (s25(1)(b)) and/or Early intervention supports will be NDIS supports (s25(1)(d)).

   Note: this is a workaround until the text box in PACE removes the character limit of 255 characters. Full details of the requested information should be in the Request for Further Information correspondence sent to the applicant.

5. Select Next.

6. Select one or more of the criteria for the requested information from the provided tickboxes.

7. Select Next.

8. Select Done.

9. Select Next.

10. At Do you want to preview the document before sending it?, select Yes.

11. Complete Select a Recipient for preview to preview the letter.

12. If correct, select Next. If incorrect, select Previous to update the fields that populate the letter.

13. Select Submit Correspondence.

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14. Select Done. A letter will automatically be sent to the applicant or their authorised representative to request further information. The access decision case is automatically closed.

Note: if the participant has a statutory guardian and the relationship is established with an organisation account, you’ll need to manually send the auto-created Request for more evidence letter to the statutory guardian. To do this, go to article Send a letter to a statutory guardian or trustee.

5.1 Check correspondence

1. From the Person Account case, select the Documents tab.

2. Check for Request for more evidence letter. Category will be Outbound Correspondence. If:

   • Yes a letter is available, go to step 5.

   • No letter, go to step 3.

3. Submit a Report an Issue with PACE, my NDIS Provider or Participant Portal, or my NDIS App ticket.

4. Share the ticket with your team leader and assistant director.

5. If there’s a Justice Liaison Officer (JLO), go to section Notify the justice liaison officer (JLO) (if relevant). If not, go to section Next steps.

5.2 Notify the justice liaison officer (JLO) (if relevant)

5.2.1 Create the enquiry case

1. Create an Enquiry case and reassign to the MyNDIS Contact using article Create an enquiry case.

2. At Requested By, select General Enquiry Only.

3. At Case Origin, select Internal.

4. At Enquiry Type, select Access.

5. At Category, select Access Request.

6. At Sub Category, select Escalation Enquiry.

7. In Enquiry Notes, use the following template:

   Further information requested to support <Applicant’s name> NDIS application. More information is needed about <permanency/functional capacity/lifetime supports/future support needs/whether the NDIS is the most appropriate service> of <Impairment/Impairments>. . Refer to Request for More Evidence letter in the person account for more information. Support the applicant to provide more evidence by (90 days).

8. At Enquiry Outcome, select Keep enquiry open - Do not re-assign. This will allow you to assign the case to the JLO later with an email notification.

5.2.2 Assign the enquiry case

1. From the Enquiry case, select Change Owner next to the current Case Owner.

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2. At the Search Users free text field, search for the MyNDIS Contact.

3. Select the tickbox next to Send notification email.

4. Select Change Owner.

5. Go to section Next steps.

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6 Approve or override the streaming case

The streaming case is critical to make sure the Typical Support Package (TSP) is generated for eligible applicants, and they’re assigned to the correct team. This is important to make sure they receive the support level needed to engage with the NDIS.

Generally, the streaming case is submitted by a local area coordinator, early childhood partner or planner as part of the steps for submitting an access request case. The streaming case routes to an access delegate for approval.

1. Check for a streaming case.

   A streaming case must be completed and approved by an access delegate before completing the access decision case. If:

   • Yes, there’s a streaming case, continue to next step.

   • No, create a streaming case. Go to article Complete a streaming case (streaming and restreaming). Then continue to next step.

2. Go to article Approve or override a streaming case (streaming and restreaming) to approve or override the streaming case.

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7 Record access decision

7.1 Complete Age and Residency Sub Criterion

Once you’ve completed pre-assessment and verified evidence and selected Next, the following criterions will appear in the Decision tab. Use article Check eligibility – age and residence requirements to help you decide if the age and residence requirements are met.

7.1.1 Age Criterion 1: (Section 22(1)(a))

1. At Is the applicant under the age of 65 years old? select Yes or No. If:

   • Yes, go to section Residency Criterion 1: (Section 23(1)(a)) to review the next criteria.

   • No, continue to step 2.

2. Select Next.

   Note: N/A will auto populate on the Age & Residency Sub Criterion page. It will be greyed out and can’t be changed. Then N/A will automatically populate on the next Early Intervention Sub Criteria and Disability Sub Criteria page but isn’t greyed out and technically can be changed. Don’t change the criterion, N/A will automatically display for all remaining criteria.

3. Go to section Evidence Used for Decisions (access not met only).

7.1.2 Residency Criterion 1: (Section 23(1)(a))

1. At Is the applicant currently living in Australia? select Yes or No. If:

   • Yes, go to section Residency Criterion 2: (Section 23(1)(b)) to review the next criteria.

   • No, continue to next step.

2. Select Next.

   Note: if the applicant doesn’t meet the residency requirements then No will be automatically selected at this question. N/A will autopopulate for the rest of the residency questions. It will be greyed out and can’t be changed.

   N/A will automatically populate on the next Early Intervention Sub Criteria and Disability Sub Criteria pages, but isn’t greyed out and technically can be changed. Don’t change the criterion, N/A will automatically display for all remaining criteria.

3. Go to section Evidence Used for Decisions (access not met only).

7.1.3 Residency Criterion 2: (Section 23(1)(b))

1. At Is the applicant an Australian Citizen or a Current Eligible Visa Holder? select Yes or No. If:

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* Yes, select Next and go to section Complete Early Intervention Sub Criteria to review the next criteria.

* No, continue to next step.

2. At Why does the applicant not meet the sub criteria?, select the relevant option.

3. Select Next. N/A will automatically display for all remaining criteria.

4. Select Next.

5. Go to section Evidence Used for Decisions (access not met only).

7.2 Complete Early Intervention Sub Criteria

1. Use article Understand early intervention requirements to help you decide if the early intervention requirements are met.

2. Check if the applicant has an impairment on List B or D. This no longer populates in the access decision. You need to select the relevant criteria manually. If:

   • List D and the child is younger than 7, select Yes to all early intervention requirements and select Next.

   • List B, select Yes to Early Intervention Criterion 1: (Section 25(1)(a). Then review the remaining early intervention requirements based on the evidence.

3. If none of the above, review each early intervention requirement based on the evidence. All early intervention requirements must be answered.

4. If you select No for any criteria, select the reason the early intervention requirement isn’t met.

7.2.1 Early Intervention Criterion 1: (Section 25(1)(a))

1. At Is there one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be permanent (section 25(1)(a)) or is there one or more identified impairments that are attributable to a psychiatric condition that are, or are likely to be, permanent (section 25(1)(a)(ii))?:

   • Select Yes or No.

   • If No and the applicant is younger than 6, there will be questions to review if the child has a developmental delay that meets the early intervention requirements.

7.2.2 Early Intervention Criterion 2: (Section 25(1)(b))

1. At Is the provision of early intervention supports likely to benefit the person by reducing the person’s future needs for supports in relation to disability?:

   • Select Yes or No.

7.2.3 Early Intervention Criterion 3: (Section 25(1)(c))

1. At Is the provision of early intervention supports likely to improve, or reduce deterioration, of functional capacity or strengthen sustainability of informal supports?:

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* Select Yes or No.

7.2.4 Early Intervention Criterion 4: (Section 25 (d))

1. At Are any early intervention supports that would be likely to benefit the person as mentioned in paragraphs 25(1)(b) and (c) NDIS supports?:

   • Select Yes or No.

2. Select Next.

7.3 Complete Disability Sub Criterion

1. Use article Understand disability requirements to help you decide if the disability requirements are met.

2. Check if the applicant has an impairment on List A or B. This no longer populates in the access decision. You need to select the relevant criteria manually. If:

   • List A, the disability requirements are met. Select Yes to all disability requirements and select Next.

   • List B, select Yes to Disability Criterion 1: (Section 24 (1)(a)) and Disability Criterion 2: (Section 24 (1)(b)). Then review the remaining disability requirements based on the evidence.

3. If none of the above, review each disability requirement based on the evidence. All disability requirements must be answered.

4. If you select No for any criteria, select the reason the disability requirement isn’t met.

7.3.1 Disability Criterion 1: (Section 24 (1)(a))

1. At Are the impairment(s) attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to psychiatric condition(s)?:

   • Select Yes or No.

7.3.2 Disability Criterion 2: (Section 24 (1)(b))

1. At Are the impairment(s) permanent, or are they likely to be permanent?:

   • Select Yes or No.

7.3.3 Disability Criterion 3: (Section 24 (1)(c))

1. At Does the impairment(s) result in substantially reduced functional capacity?:

   • Select Yes or No.

7.3.4 Disability Criterion 4: (Section 24 (1)(d))

1. At Does the impairment affect the person’s capacity for social and economic participation?:

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* Select Yes or No.

7.3.5 Disability Criterion 5: (Section 24 (1)(e))

1. At Is the person likely to require support under the NDIS for their lifetime?:

   • Select Yes or No.

2. Select Next.

7.4 Evidence Used for Decisions (access not met only)

1. For any access criteria the person doesn’t meet, record:

   • Evidence type

   • Evidence (if required) – start to enter the linked evidence name, then select relevant document

   • Explanation – record Criteria not met – see linked evidence.

2. Select Next.

7.5 Decision Main Criteria

1. These criteria will automatically be completed with ACCESS MET, ACCESS NOT MET or N/A:

   • Does the person meet Age Criteria

   • Does the person meet Residency Criteria

   • Does the person meet Early Intervention Criteria

   • Does the person meet Disability Criteria Note: the Disability Criteria decision will appear below the list of eligibility criteria list of impairments.

   • Overall decision.

     Note: an applicant may meet both the disability and early intervention requirements.

2. If the decision isn’t correct:

   • Select Back

   • Recheck and update your responses as per above steps.

3. If the Overall decision is:

   • Access Not Met, go to step 10.

   • Access Met, go to step 4.

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4. Open articles Impairment categories guide and Understand highly likely and commonly associated impairment categories to complete the next steps.

5. Search the ICD 10 Code or Condition name for all impairments that meet the requirements for disability, early intervention, or both.

   Note: where a participant has more than one impairment, you must assess the functional impact of each impairment in the context of all the participant’s impairments cumulative impact. For more information, go to article Understand highly likely and commonly associated impairment categories.

6. Note the Highly likely impairment category column.

7. Check if any of the Commonly associated impairment categories in the guide apply based on the evidence provided:

   • Intellectual

   • Cognitive

   • Neurological

   • Sensory

   • Physical

   • Psychosocial.

   For more information, go to section What are the categories of impairments? in Our Guideline – Applying to the NDIS (external) and article Descriptions of impairment categories.

8. If the early intervention requirements are met, at Which of the following meet the eligibility criteria for access?, select options that apply for all eligible impairments that met the early intervention requirements:

   • Intellectual

   • Cognitive

   • Neurological

   • Sensory

   • Physical

   • One or more impairments to which a psychological disability is attributable Note: use the term ‘psychosocial disability’ when speaking with the participant or in any PACE record keeping. PACE uses the term ‘psychological disability’. This is an error in PACE.

   • Developmental Delay.

   The options you select will populate the Notice of impairments attached to the Access Met letter.

9. If the disability requirements are met, at Which of the following meet the eligibility criteria for access?, select options that apply for all eligible impairments that met the disability requirements:

   • Intellectual

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* Cognitive

* Neurological

* Sensory

* Physical

* One or more impairments to which a psychological disability is attributable.

  Note: use the term 'psychosocial disability' when speaking with the participant or in any PACE record keeping. PACE uses the term 'psychological disability'. This is an error in PACE.

  The options you select will populate the Notice of impairments attached to the Access Met letter.

10. If the decision isn’t correct, select Back. Recheck and update previous criteria as per above steps.

11. If the decision is correct, select Save for later.

7.5.1 If access met for applicant with chronic health condition

You must request technical advice from the Technical Advisory and Practice Improvement Branch (TAPIB).

Refer to the Participant journey intranet page for email templates to use when requesting Quality Officer (QO) feedback.

1. First send a technical support request to SEB.QUALITY to request QO feedback.

2. If the QO agrees, request technical advice from TAPIB using the following articles:

   • Create a technical advice case

   • Complete the risk matrix for a technical advice case

   • Review and action returned technical advice case.

     Note: you can review the relevant article in the TAPIB Digest to help you refine your request.

7.5.2 If access met for applicant younger than 25 with primary psychosocial disability

You must receive endorsement from your team leader or assistant director.

1. First send a review request (Review Request: Under 25 Psychosocial) to SEB.QUALITY to ask for QO feedback.

2. If the QO agrees, they’ll email your team leader or assistant director to request endorsement.

7.5.3 If access met and the applicant resides in hospital

You must ask for QO feedback.

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1. Send an advice request to SEB.QUALITY to ask for QO feedback. They’ll decide if TAPIB advice is required.

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8 Submit decision for quality check

8.1 Submit proposed decision for potential quality check

1. Complete the Access Assessor Outcomes Form to submit the proposed access decision for a potential quality check. An email will advise you if the proposed decision is sent for quality check. If:

   • not sent for quality check, go to section Approve access decision

   • sent for quality check, go to section Review quality check feedback.

8.2 Review quality check feedback

1. Review quality check feedback when received by email. If:

   • no adjustment required and you agree with the feedback, go to section Approve access decision

   • adjustment required and you agree with the feedback, continue to step 2

   • if you don’t agree with the feedback, contact your team leader about the reconsideration process.

2. Action the feedback and if the decision needs resubmitting for quality check, select Save for later from the Decision Main Criteria screen.

3. Go to section above Submit proposed decision for potential quality check to re-submit for a potential quality check.

   Note: for technical support to understand the legislative criteria, please send a technical support request via the Technical Support and QO Endorsements form.

8.3 Approve access decision

1. Return to Decision Main Criteria view.

2. Select Approve to submit decision.

3. Go to section Complete access decision correspondence.

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9 Complete access decision correspondence

9.1 Send automated Access Met letter

1. Check the correspondence preferences of the applicant are correct using article Check a person’s preferred contact method and select Next.

2. At Do you want to preview the document before sending it? select Yes or No.

3. If you select Yes, you need to Select a Recipient for preview. Select the applicant you wish to preview the correspondence for and select Next. A letter preview will generate.

   Note: the Access Met letter includes information on impairment categories. For more information, go to section What happens after we decide? in Our Guideline – Applying to the NDIS (external).

4. If correct, select Next. If incorrect, select Previous to update the fields that populate the letter.

5. Select Submit Correspondence. An automatic Access Met decision letter will be sent to the person or authorised representative.

   Note: if the participant has a statutory guardian and the relationship is established with an organisation account, you’ll need to manually send the auto-created Access Met decision letter to the statutory guardian. To do this, go to article Send a letter to a statutory guardian or trustee.

6. At Correspondence Summary, select Done.

7. Select Done to close the access decision case.

9.1.1 Confirm correspondence is sent

1. In the Access Decision case, select the Documents tab.

2. Check if the Outcome of Application letter is in Outbound Correspondence. If:

   • Yes, go to section Check disabilities tab (access met only)

   • No, this means there’s a correspondence error in PACE. Go to step 3.

3. Use guidance in article Correspondence error messages. If you still can’t resolve the correspondence error, submit a Service Delivery Support Suite (PACE and Legislation) - ICT Service Desk - Service project.

4. Go to section Next steps.

9.2 Manual Access Not Met letter

PACE won’t generate an automatic Access Not Met letter. You need to complete and send a manual letter.

1. Select Done to close the access decision case.

2. Complete the manual Access Not Met letter using these templates:

   • Letter – Access not met decision

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* Template – Access not met decision.

  Note: only the letter text is required from this resource. Interactions aren't required.

3. Use article Send a manual letter to complete this process.

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10 Notify early childhood partner of access not met decision (developmental delay only)

If the child is younger than 6 with a developmental delay, you need to notify the early childhood partner of the access not met decision.

1. Create an Enquiry case and reassign to the MyNDIS Contact using article Create an enquiry case.

2. At Requested By, select General Enquiry Only.

3. At Case Origin, select Internal.

4. Select Next.

5. At Type, select Access.

6. At Category, select Partner Supported Access.

7. At Sub Category, select General Information.

8. Select Next.

9. At Has there been any risks identified that may impact the participant, nominee or NDIS associated with this enquiry? select Yes or No. If:

   • Yes, select the relevant risks from the list. Then select Next.

   • No, select Next.

10. In Enquiry Notes, use the following template:

<Access not met decision for developmental delay made on . Evidence provided does not support the developmental delay criteria because <provide a summary of the justification for the decision e.g. the applicant does not have a significantly lower ability to do everyday activities, when compared to children of the same age>. <If the child is turning 6 within 90 days: The child is turning 6 within 90 days. It may be more appropriate to support the applicant with an internal review, rather than a new access request. For an access request, the child must be younger than 6 on the day the access decision is made. For an internal review, the child must have been younger than 6 at the time of the access not met decision. This reduces the risk of the child turning 6 before an access decision is made.> Access request outcome will be communicated to the applicant’s authorised representative – refer to case activity for updates.

Please support applicant with next steps such as early connections.>

11. At Enquiry Outcome, select Re-assign this enquiry to another user.

12. At Case Re-assignment Reason, select Referral to Partner.

13. At Select User or Queue, select User.

14. At Case Owner, enter the applicant’s MyNDIS Contact.

15. Select Next.

16. Review the information. If incorrect, select Previous and make the appropriate changes. If correct, select Submit.

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11 Check disabilities tab (access met only)

The Disabilities tab must include all impairments that meet the requirements for disability, early intervention or both as this affects planning. This tab is used by all NDIA staff and partners to help understand a participant’s impairments and support needs.

Please make sure all information is correct.

There may be impairments that you need to add or remove.

1. From the Person Account, select My Profile.

2. Select the Disabilities tab.

3. Review Active status to see what impairments are current.

4. If required, use article Update the participant’s disabilities using the update person account case, section Update the participant’s disabilities using the Update Person Account case to:

   • add impairments that meet the eligibility requirements

   • remove any impairments that don’t meet the eligibility requirements by adding an End Date if it was added in error.

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12 Request a birth certificate

If a proof of birth declaration is used as evidence of identity for an applicant in the priority Hearing Stream, a birth certificate must be requested by the my NDIS contact 6 months after access is met. You’ll need to set up both an Alert and a Task to ensure this follow up occurs.

12.1 Use alerts in a Person Account

To create a manual alert from the Person Account, use article Create update or end-date an alert, section Create a manual alert. To request a birth certificate, follow steps 1 to 3 in the article, then:

1. In the New Alert screen, select the Alert Category drop-down list and choose Contact Alert.

2. At Alert Name, select Agency Single Contact.

3. At Alert Reason, add: request a birth certificate.

4. At Additional Information, add: proof of birth used as evidence of identity. Request a birth certificate 6 months after access is met.

5. Follow steps 8 to 11 in article Create update or end-date an alert to complete the alert.

12.2 Create a task in a person account

1. At the Person Account, select the Activity tab.

2. In the Timeline tab, at New on the right hand side of the screen, select New Task from the drop-down list.

3. Select RFI Task from the options.

4. Select Next.

5. At Subject, select Other.

6. Leave Type blank. At Assigned To search for and add the my NDIS contact.

7. In Comments, add: proof of birth used as evidence of identity. Request a birth certificate 6 months after access is met.

8. At Other Information, set a reminder to contact the participant to request a birth certificate 6 months after access is met.

9. Select Save.

12.3 Use log activity in a person account

Use article Log an activity or internal note, section Log an activity or internal note to the person account. Follow steps 1 to 5 in the article, then:

1. At Activity Type, select Virtual.

2. At Subject, select Contact with Participant.

3. At Category, select Reports and Evidence.

4. At Comments, add: proof of birth used as evidence of identity. Request a birth certificate 6 months after access is met.

5. Select Save.

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13 Assign plan approval case (Motor neurone disease only)

If you’re in the Priority Health Access Team and you’ve made an access met decision for an applicant with Motor neurone disease (also known as Lou Gehrig’s disease or Amyotrophic lateral sclerosis) or Kennedy’s disease, assign the Plan Approval case to the Aged Care Referral Routing Queue.

In all other situations, a plan approval case will automatically route to the relevant queue.

1. In the Plan Approval case, select Change Owner.

2. At Please select if the case owner is a user or a queue, select Queue.

3. At the Search Users free text field, search and select Aged Care Referral Routing Queue.

4. Select Change Owner.

5. Select Finish.

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14 Next steps

1. After you complete the access decision case, an automatic contact applicant task will create. Contact the applicant or their authorised representative. If:

   • Access met or access not met, go to article Contact to advise outcome of access decision.

   • Further information requested, go to article Contact to request further information for an access decision.

2. For an access met decision, a plan approval case will automatically route to the relevant queue for a planner to develop the participant’s first NDIS plan.

3. Identify if any open enquiry cases in the person record relate to the Access request, and close the cases if now completed. Refer to article Create an enquiry case for guidance.

4. If there’s no plan approval case on the person record, you’ll need to lodge a Report an Issue with PACE, my NDIS Provider or Participant Portal, or my NDIS App ticket and share it with your team leader and assistant director.

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FOI 25/26-2252 & FOI 25/25-2253 Document 3

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Table of Contents

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

2 Using the Impairments categories guide ……………………………………………………….. 5

3 Conditions …………………………………………………………………………………………………………….. 6 3.1 Autism (ASD) ………………………………………………………………………………………………………. 6 3.2 Acquired brain injury …………………………………………………………………………………………….. 6 3.3 Intellectual disability ……………………………………………………………………………………………… 7 3.4 Other conditions/syndromes with intellectual disability ……………………………………………… 7 3.5 Hearing impairment ……………………………………………………………………………………………… 9 3.6 Vision …………………………………………………………………………………………………………………. 9 3.7 Other sensory ……………………………………………………………………………………………………… 9 3.8 Neurological ………………………………………………………………………………………………………. 10 3.9 Other physical ……………………………………………………………………………………………………. 12 3.10 Psychosocial ………………………………………………………………………………………………….. 13 3.11 Spinal cord injury ……………………………………………………………………………………………. 14 3.12 Other …………………………………………………………………………………………………………….. 14 3.13 Dementia related conditions …………………………………………………………………………….. 17

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This article provides guidance for all NDIA staff and partners to understand which impairment categories to select for a person that meets the disability or early intervention requirements.

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1 Recent updates

23 February 2026 Guidance updated to add global developmental delay to this impairment categories guide.

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2 Using the Impairments categories guide

Impairments are a loss of or damage to a body’s function. When we assess an impairment to meet access, we look at:

• the body’s function
• the body’s structure
• how the person thinks and learns.

Evidence from national and international sources, and peak organisation websites were reviewed to determine the impairments related to disability-related conditions or diagnoses. These sources include the:

• International Classification of Diseases (ICD)
• International Classification of Functioning, Disability and Health (ICF)
• Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
• National Institute of Health (NIH)
• Australian Government: Australian Institute of Health and Welfare (AIHW).

To learn more about:

• impairment categories, go to article Descriptions of impairment categories
• highly likely and commonly associated impairment categories, go to article Understand highly likely and commonly associated impairment categories.

Access delegates will determine a participant’s impairment categories following an access met decision, or an application to change impairment categories information.

Before you consider adding an impairment category, check if you need to request advice from TAPIB. For more information see Mandatory and Non-Mandatory Advice Requests.

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3 Conditions

The following list provides you with information on the:

• condition
• ICD 10 Codes
• highly likely impairment category for access assessors to select
• commonly associated impairment categories for access assessors to select as relevant, based on evidence provided.

Note: if the participant’s condition isn’t listed here, consider the evidence to determine which impairment categories apply to their impairment or impairments.

Impairment categories may also relate to the participant when the condition isn’t listed in this guide, as long as:

• there is evidence of this, and
• they cover impairments for which the participant meets the disability or early intervention eligibility requirements.

You should use the Ctrl+F function on your keyboard to find specific conditions in this guide.

Note: if a child is younger than 6 with developmental delay, then the impairment categories don’t apply. If a child’s condition is global developmental delay, go to section Other conditions/syndromes with intellectual disability for the impairment category information.

3.1 Autism (ASD)

1. Autism – ASD – includes Asperger syndrome ICD 10 Codes: F84.0, F84.5 Highly likely impairment category: Neurological Commonly associated impairment categories: Intellectual, cognitive, physical, psychosocial

3.2 Acquired brain injury

1. Glioblastoma ICD 10 Code: G71.9 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, physical, psychosocial

2. Hypoxic brain injury ICD 10 Code: G93.1 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, physical, psychosocial

3. Traumatic brain injury – also called head injury and acquired brain damage ICD 10 Code: T90

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Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, physical, psychosocial

4. Stroke ICD 10 Code: I69 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, physical, sensory, psychosocial

5. Malignant neoplasm of brain ICD 10 Code: C71 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, psychosocial

3.3 Intellectual disability

1. Mild intellectual disability ICD 10 Code: F70 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, psychosocial

2. Moderate intellectual disability ICD 10 Code: F71 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, physical, psychosocial

3. Severe intellectual disability ICD 10 Code: F72 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, physical, psychosocial

4. Profound intellectual disability ICD 10 Code: F73 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, physical, psychosocial

5. Unspecified intellectual disability ICD 10 Code: F79 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, sensory, physical, psychosocial

3.4 Other conditions/syndromes with intellectual disability

1. Global developmental delay ICD 10 Code: 84.01 Highly likely impairment category: Intellectual Commonly associated impairment categories: Neurological, physical, cognitive

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2. Microcephaly ICD 10 Code: Q02 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, sensory, physical

3. Other congenital brain conditions – for example, tuberous sclerosis ICD 10 Code: Q04 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, physical

4. Cornelia de Lange syndrome ICD 10 Code: Q87.1 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, sensory, physical, psychosocial

5. Prader Willi syndrome ICD 10 Code: Q87.1 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, physical, psychosocial

6. Coffin-Lowry syndrome ICD 10 Code: Q87.8 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, sensory, physical, psychosocial

7. Other congenital conditions causing intellectual disability ICD 10 Code: Q89 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, sensory, physical, psychosocial

8. Edwards syndrome ICD 10 Code: Q91 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, sensory, physical, psychosocial

9. Patau syndrome ICD 10 Code: Q91 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, sensory, physical, psychosocial

10. Cri du Chat syndrome ICD 10 Code: Q93.4 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, sensory, physical

11. Angelman syndrome ICD 10 Code: Q93.5 Highly likely impairment category: Intellectual

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Commonly associated impairment categories: Cognitive, neurological, physical

12. Other chromosomal syndromes – including Kabuki & Williams syndromes ICD 10 Code: Q99 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, neurological, sensory, physical, psychosocial

13. Fragile X syndrome ICD 10 Code: Q99.2 Highly likely impairment category: Intellectual for males, cognitive for females Commonly associated impairment categories: Cognitive, neurological, sensory, physical, psychosocial

14. Down syndrome ICD 10 Code: Q90 Highly likely impairment category: Intellectual Commonly associated impairment categories: Cognitive, physical, sensory

3.5 Hearing impairment

1. Hearing loss ICD 10 Code: H90 Highly likely impairment category: Sensory Commonly associated impairment category: Cognitive

2. Congenital hearing condition ICD 10 Code: Q16.9 Highly likely impairment category: Sensory Commonly associated impairment category: Cognitive

3.6 Vision

1. Albinism ICD 10 Code: E70.3 Highly likely impairment category: Sensory Commonly associated impairment category: Not applicable

2. Visual impairment – including blindness ICD 10 Code: H54 Highly likely impairment category: Sensory Commonly associated impairment category: Not applicable

3. Congenital eye conditions ICD 10 Code: Q15.9 Highly likely impairment category: Sensory Commonly associated impairment category: Not applicable

3.7 Other sensory

1. Deaf Blindness – dual sensory impairment ICD 10 Code: Z73.82

Highly likely impairment category: Sensory Commonly associated impairment categories: Cognitive, psychosocial

2. Other sensory – speech ICD 10 Code: R47 Highly likely impairment category: Sensory Commonly associated impairment category: Physical

3.8 Neurological

1. Multiple sclerosis ICD 10 Code: G35 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, sensory, physical, psychosocial

2. Rett syndrome ICD 10 Code: 84.2 Highly likely impairment category: Neurological Commonly associated impairment categories: Intellectual, cognitive, physical, psychosocial

3. Cerebral palsy ICD 10 Code: G80 Highly likely impairment category: Neurological Commonly associated impairment categories: Intellectual, cognitive, physical, sensory

4. Huntington disease ICD 10 Code: G10 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, physical, psychosocial

5. Motor neurone disease ICD 10 Code: G12.2 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, physical, sensory, psychosocial

6. Parkinson’s disease ICD 10 Code: G20 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, sensory, physical, psychosocial

7. Epilepsy ICD 10 Code: G40 Highly likely impairment category: Neurological Commonly associated impairment categories: Intellectual, cognitive, psychosocial

8. Muscular dystrophy ICD 10 Code: G71.0 Highly likely impairment category: Neurological

Commonly associated impairment category: Physical

9. Other Neurological – List A and List C ICD 10 Code: G99 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, sensory, physical

10. Tourette syndrome ICD 10 Code: F95.2 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, physical, psychosocial

11. Peripheral neuropathy ICD 10 Code: F90.0 Highly likely impairment category: Neurological Commonly associated impairment categories: Sensory, physical

12. Plegia ICD 10 Code: G83.1 Highly likely impairment category: Neurological Commonly associated impairment category: Physical

13. Spina bifida ICD 10 Code: Q05 Highly likely impairment category: Neurological Commonly associated impairment categories: Intellectual, cognitive, sensory, physical

14. Fetal alcohol syndrome ICD 10 Code: Q86.0 Highly likely impairment category: Neurological Commonly associated impairment categories: Intellectual, cognitive, sensory, physical, psychosocial

15. Fetal alcohol spectrum disorder (FASD) ICD 10 Code: Q86.0D Highly likely impairment category: Neurological Commonly associated impairment categories: Intellectual, cognitive, sensory, physical, psychosocial

16. Attention deficit hyperactive disorder (ADHD) ICD 10 Code: F90 Highly likely impairment category: Neurological Commonly associated impairment category: Cognitive

17. Developmental language disorder ICD 10 Code: F80.9 Highly likely impairment category: Neurological Commonly associated impairment category: Not applicable

18. Chronic regional pain syndrome ICD 10 Code: G90.5 Highly likely impairment category: Neurological Commonly associated impairment category: Physical

19. Brachial plexus injury ICD 10 Code: S14.3 Highly likely impairment category: Neurological Commonly associated impairment category: Physical

20. Dysgraphia ICD 10 Code: F81.8 Highly likely impairment category: Neurological Commonly associated impairment category: Physical

21. Functional seizures ICD 10 Code: F44.5 Highly likely impairment category: Neurological Commonly associated impairment category: Psychosocial

3.9 Other physical

1. Rheumatoid arthritis ICD 10 Code: M05 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

2. Other arthritis ICD 10 Code: M12 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

3. Other physical ICD 10 Code: M95 Highly likely impairment category: Physical Commonly associated impairment category: Psychosocial

4. Multiple traumatic amputations ICD 10 Code: T05 Highly likely impairment category: Physical Commonly associated impairment categories: Cognitive, neurological, psychosocial

5. Myopathy ICD 10 Code: G72.9 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

6. Amputation – single limb or upper/lower limb ICD 10 Code: Z89 Highly likely impairment category: Physical Commonly associated impairment categories: Cognitive, neurological, psychosocial

7. Amputation – multiple ICD 10 Code: Z89.1 Highly likely impairment category: Physical Commonly associated impairment categories: Cognitive, neurological, psychosocial

8. Diabetes mellitus ICD 10 Code: E14

Highly likely impairment category: Physical Commonly associated impairment category: Sensory

9. Human immune deficiency virus (HIV) ICD 10 Code: B22 Highly likely impairment category: Physical Commonly associated impairment category: Cognitive

10. Other unspecified infectious diseases ICD 10 Code: B99 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

3.10 Psychosocial

1. Schizophrenia ICD 10 Code: F20 Highly likely impairment category: Psychosocial Commonly associated impairment category: Cognitive

2. Schizoaffective disorder ICD 10 Code: F25.9 Highly likely impairment category: Psychosocial Commonly associated impairment category: Cognitive

3. Bipolar affective disorder ICD 10 Code: F31 Highly likely impairment category: Psychosocial Commonly associated impairment category: Cognitive

4. Major depressive illness ICD 10 Code: F32 Highly likely impairment category: Psychosocial Commonly associated impairment category: Cognitive

5. Other anxiety disorders ICD 10 Code: F41 Highly likely impairment category: Psychosocial Commonly associated impairment category: Cognitive

6. Obsessive-compulsive disorder ICD 10 Code: F42 Highly likely impairment category: Psychosocial Commonly associated impairment category: Not applicable

7. Post traumatic stress disorder (PTSD) ICD 10 Code: F43 Highly likely impairment category: Psychosocial Commonly associated impairment category: Cognitive

8. Borderline personality disorder ICD 10 Code: F60.3 Highly likely impairment category: Psychosocial

Commonly associated impairment category: Not applicable

9. Other psychosocial disorders ICD 10 Code: F99 Highly likely impairment category: Psychosocial Commonly associated impairment category: Cognitive

10. Anorexia ICD 10 Code: R63 Highly likely impairment category: Psychosocial Commonly associated impairment categories: Cognitive, physical

3.11 Spinal cord injury

1. Malignant neoplasm of spinal cord complete and incomplete ICD 10 Codes: C72.5, C72.7 Highly likely impairment category: Neurological Commonly associated impairment categories: Sensory, physical

2. Spinal cord injury (complete) ICD 10 Code: T09.5 Highly likely impairment category: Neurological Commonly associated impairment categories: Sensory, physical, psychosocial

3. Spinal cord injury (incomplete) ICD 10 Code: T09.7 Highly likely impairment category: Neurological Commonly associated impairment categories: Physical, sensory, psychosocial

3.12 Other

1. Metastatic cancer ICD 10 Code: C79.9 Highly likely impairment category: Physical Commonly associated impairment category: Cognitive

2. Malignant neoplasm of blood or immune disease ICD 10 Code: C96 Highly likely impairment category: Physical Commonly associated impairment category: Cognitive

3. Autoimmune disorders ICD 10 Code: D89.9 Highly likely impairment category: Physical Commonly associated impairment category: Cognitive

4. Obesity ICD 10 Code: E66 Highly likely impairment category: Physical Commonly associated impairment category: Psychosocial

5. Classical phenylketonuria ICD 10 Code: E70.0

Highly likely impairment category: Cognitive Commonly associated impairment category: Psychosocial

6. Disorders of pyruvate metabolism and gluconeogenesis ICD 10 Code: E74.4 Highly likely impairment category: Intellectual Commonly associated impairment categories: Neurological, physical

7. Other metabolic disorders ICD 10 Code: E88 Highly likely impairment category: Intellectual Commonly associated impairment categories: Neurological, physical

8. Functional neurological disorder (FND) ICD 10 Code: F44.4 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, sensory, physical

9. Other language disorder ICD 10 Code: F80 Highly likely impairment category: Cognitive Commonly associated impairment category: Not applicable

10. Oppositional defiant disorder (ODD) ICD 10 Code: F91.3 Highly likely impairment category: Psychosocial Commonly associated impairment category: Cognitive

11. Other hereditary ataxias ICD 10 Code: G11.8 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, sensory, physical

12. Chronic pain ICD 10 Code: G89.4 Highly likely impairment category: Physical Commonly associated impairment categories: Neurological, sensory, psychosocial

13. Postural Orthostatic Tachycardia Syndrome (POTS) ICD 10 Code: I49.8 Highly likely impairment category: Neurological Commonly associated impairment category: Physical

14. Lymphoedema ICD 10 Code: I89.0 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

15. Chronic lung disease ICD 10 Code: J44.9 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

16. Chronic Obstructive Pulmonary Disease (COPD) ICD 10 Code: J44.9A Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

17. Osteoarthritis ICD 10 Code: M19.9 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

18. Systemic lupus erythematosus ICD 10 Code: M32 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

19. Ankylosing spondylitis ICD 10 Code: M45 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

20. Fibromyalgia ICD 10 Code: M79.7 Highly likely impairment category: Physical Commonly associated impairment category: Neurological

21. Renal failure ICD 10 Code: N18 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

22. Ehlers Danlos ICD 10 Code: Q79.6 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

23. Dyslexia ICD 10 Code: R48 Highly likely impairment category: Neurological Commonly associated impairment category: Cognitive

24. Childhood apraxia of speech ICD 10 Code: R48.2 Highly likely impairment category: Neurological Commonly associated impairment category: Cognitive

25. Short stature ICD 10 Code: R62.5 Highly likely impairment category: Physical Commonly associated impairment category: Not applicable

26. Conduct Disorder (CD) ICD 10 Code: F91.9 Highly likely impairment category: Psychosocial Commonly associated impairment category: Cognitive

3.13 Dementia related conditions

1. Alzheimer’s disease ICD 10 Code: F00 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, physical, psychosocial

2. Unspecified dementia ICD 10 Code: F03 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, physical, psychosocial

3. Dementia – rapidly progressing ICD 10 Code: F03.9 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, physical, psychosocial

4. Dementia – early onset ICD 10 Code: G30.0 Highly likely impairment category: Neurological Commonly associated impairment categories: Cognitive, physical, psychosocial

FOI 25/26-2252 & FOI 25/25-2253 Document 4

Record an assessment - PEDI-CAT

SGP KP Publishing

Exported on 2026-03-18 16:13:20

Table of Contents

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

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

3 Understand a PEDI-CAT assessment …………………………………………………………………….. 6 3.1 The PEDI-CAT assessment ………………………………………………………………………………….. 6 3.2 The difference between a new assessment and manually entered score ……………………. 6

4 Complete a new PEDI-CAT assessment …………………………………………………………………. 7

5 Record a manual PEDI-CAT assessment ……………………………………………………….. 8

This article provides guidance for all NDIA staff and partners to:

•   understand and record a PEDI-CAT assessment
•   complete a new PEDI-CAT assessment
•   record a manual PEDI-CAT assessment.

1 Recent updates

15 December 2025 Guidance updated to:

•  remove content about an issue with the PEDI-CAT
•  add system steps
•  add link to article Record information from the DSM5 – Autism.

2 Before you start

You have:

•   read Our Guidelines – Applying to the NDIS (external)
•   read the article Understand functional capacity assessments
•   created a functional capacity assessment using the article Create a new functional
    capacity assessment case.

3 Understand a PEDI-CAT assessment

3.1 The PEDI-CAT assessment

A Paediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) assessment helps us understand a child’s ability to complete tasks in their daily life.

We use the PEDI-CAT assessment with children younger than 9. Sometimes, we use PEDI- CAT for children aged 9-16 if there isn’t another tool available.

You will need to re do a PEDI-CAT that has been completed by a medical professional if the full report isn’t provided, or the incorrect scores are given.

For children younger than 9 with an autism diagnosis, a PEDI-CAT along with a DSM5- Autism assessment will need to be completed. These assessments are completed to understand their functional capacity needs. To complete a PEDI-CAT use this article. Once you have completed the PEDI-CAT go to article Record information from the DSM5- Autism to complete the DSM5 – Autism assessment.

3.2 The difference between a new assessment and manually

entered score

For a new PEDI-CAT, PACE will direct you to an external Pearson site. Pearson will automatically populate a score based on answers to the questions.

A manual PEDI-CAT assessment is one completed outside of Pearson. You’ll enter the score in PACE. For example, a parent might give you a PEDI-CAT assessment from their child’s doctor.

If you receive a PEDI-CAT assessment score from within the last 3 months you can manually enter the score in PACE. If the PEDI-CAT assessment score is from more than 3 months ago, use Pearson to get a new assessment score.

For a PEDI-CAT that’s:

•   new, go to section Complete a new PEDI-CAT assessment in this article
•   manual, go to section Record a manual PEDI-CAT assessment in this article.

4 Complete a new PEDI-CAT assessment

From the Functional Capacity Assessment case, in the Select Tools step complete the following steps:

1.  At Would you like to carry out a new assessment now? either select:

     o  Yes, for a new PEDI-CAT and go to step 2

     o  No, to record a manual PEDI-CAT and go to Record a manual PEDI-CAT
         assessment section in this article.

2.  Select PEDICAT or PEDICAT-ASD.
   Note:

     o     if the child has a diagnosis of autism then the PEDICAT ASD should be
            selected

     o   don't open a new assessment if you're not completing it that day.

3.  Select No to Manually enter scores

4.  Select Next.

5.  Confirm details are correct.

6.  Select Launch PEDI-CAT to open in Pearson.

7.  Complete online PEDI-CAT assessment.

8.  Once completed, return to PACE and select Check status to refresh.

9.  Select Next. Do not select Save for later as it returns you to the start of the process
    without saving your input.

10. Check confirmation details.

11. Select Done.

12.  If the participant:

     o   is younger than 9 with an autism diagnosis, you will also need to complete the
        DSM5- Autism assessment. Go to article Record information from the DSM5-
          Autism

     o   is younger than 9 with any other diagnosis other than autism. You don't need to
          complete the DSM5- Autism assessment.

5 Record a manual PEDI-CAT assessment

From the Functional Capacity Assessment case, in the Select Tools step complete the following steps:

1.  At Would you like to carry out a new assessment now? select No.

2.  Select Yes to Manually enter scores.

3.  Select PEDICAT or PEDICAT ASD.
   Note: if the child has a diagnosis of autism then the PEDICAT ASD should be selected.

4.  Select Next.

5.  Enter Assessment completion date.

6.  Enter all Domain Scaled Scores.

     o  add the numerical scores into the domain fields.

          Note: for children younger than 3 years, record the PEDI-CAT Responsibility
        Domain as 0. This is because domain scaled scores aren't completed for
            children younger than 3 years old.

7.  Enter all Domain T Scores.

     o  when the T score generates and displays as less than 10, record the score as
         1 in PACE.

     o  when the T score generates greater than or equal to 10, record the exact
           score in PACE.

          Note: for children younger than 3 years, record the PEDI-CAT Responsibility
        Domain as 0. This is because domain T scores aren't completed for children
          younger than 3 years old.

8.  Enter all Domain Age Percentiles.

   Note: this score will show as either an exact number or a percentile band.

     o     if exact score, enter as displayed

     o  when the age percentile generates and displays as less than the 5th
            percentile, record the score as 1 in PACE

     o   for age percentile 5 to 25, record the lower percentile (5) or the number
           displayed

     o   for age percentile 25 to 50, record the lower percentile (25)

     o   for age percentile 50 to 75, record the lower percentile (50)

     o   for age percentile 75 or above, record 75.

          Note: for children younger than 3, record the PEDI-CAT Responsibility Domain
          as 0. The Responsibility domain questions are not completed for children
          younger than 3 because the tasks assessed in this section are typically not
           developmentally appropriate for children in this age group.

9.  Select Next.

10. Check the Confirmation details. Select Done.

    Note: if you have received results of a PEDI-CAT from the family or a medical professional that’s not on system, go to article Add documents to a case.

11. If the participant:

    o is younger than 9 with an autism diagnosis, you will also need to complete the DSM5- Autism assessment. Go to article Record information from the DSM5- Autism

    o is younger than 9 with any other diagnosis other than autism. You don’t need to complete the DSM5- Autism assessment.

FOI 25/26-2252 & FOI 25/25-2253 Document 5

Understand disability requirements

SGP KP Publishing

Exported on 2026-03-18 16:14:09

Table of Contents

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

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

3 Overview ………………………………………………………………………………………………………………. 6

4 Disability requirements ……………………………………………………………………………………. 7 4.1 Check eligibility for disability requirements ………………………………………………………………. 7 4.2 Additional considerations…………………………………………………………………………………… 7

5 How to weigh evidence of disability ……………………………………………………….. 8

6 Next steps …………………………………………………………………………………………………………….. 9

This article provides guidance for all NDIA staff and partners to understand:

•    eligibility under the disability requirements
•  how to weigh evidence of disability.

1 Recent updates

7 July 2025 Article Make an access decision - pre-legislation changes is archived. Article Make an access decision - post legislation changes has been renamed to Make an access decision. Use article Make an access decision in next steps.

2 Before you start

You have:

•   read and understood Our Guideline – Applying to the NDIS (external), including section
 Do you meet the disability requirements?

•   read article What evidence of disability is required?
•   read article Check eligibility – age and residence requirements.

3 Overview

To be eligible for NDIS, the person must meet the requirements for:

•  age
•   residence
•    disability, early intervention, or both.

4 Disability requirements

To meet the disability requirements, we must have evidence of all of the following:

•   their disability is related to an impairment
•   their impairment is likely to be permanent
•   their permanent impairment significantly reduces their functional capacity to undertake
   one or more of the following activities: moving around, communicating, socialising,
    learning, or undertaking self-care or self-management tasks

•   their permanent impairment affects their ability to work, study or take part in social life
•    they'll likely need NDIS support for their lifetime.

4.1 Check eligibility for disability requirements

Use these articles to check evidence for a decision:

•  Check eligibility – DIS – disability caused by an impairment
•  Check eligibility – DIS – likely permanence
•  Check eligibility – DIS – significant functional impact
•  Check eligibility – DIS – social and economic impact
•  Check eligibility – DIS – NDIS supports for life.

4.2 Additional considerations

Use these articles before you check evidence for a decision.

•  Check if there is evidence of a condition on List A. Go to Check eligibility – List A
    condition.

   Note: A person is likely to meet the disability requirements if they provide evidence of
     their diagnosis.
•  Check if there is evidence of a condition on List B. Go to Check eligibility – List B
    condition.

   Note: A person is likely to meet some of the disability requirements if they provide
   evidence of their diagnosis.

5 How to weigh evidence of disability

When you weigh the relevance and importance of the provided disability evidence, consider:

•  who is providing the evidence of disability?
•  how old is the evidence of disability (particularly relevant for functional capacity
   evidence)?

For further information, refer to Our Guideline – Applying to the NDIS (external), including sections:

•  What information do we need in your application?
•  Who can give us evidence of your impairments?
•  How do we weigh evidence of disability?

6 Next steps

To consider the early intervention requirements go to article Understand early intervention requirements.

If you are an access delegate:

•   to make an access decision continue to article Make an access decision
•   to make an eligibility reassessment decision continue to article Finalise eligibility
   reassessment decision.

FOI 25/26-2252 & FOI 25/25-2253 Document 6

Understand early intervention requirements

SGP KP Publishing

Exported on 2026-03-18 16:14:40

Table of Contents

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

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

3 Overview ………………………………………………………………………………………………………………. 6

4 Early intervention requirements ……………………………………………………………………… 7 4.1 Check eligibility for early intervention requirements …………………………… 7 4.2 Additional considerations…………………………………………………………………………………… 7

5 Next steps …………………………………………………………………………………………………………….. 8

This article provides guidance for all NDIA staff and partners to understand eligibility under the early intervention requirements.

1 Recent updates

7 July 2025 Article Make an access decision - pre-legislation changes is archived. Article Make an access decision - post legislation changes has been renamed to Make an access decision. Use article Make an access decision in next steps.

2 Before you start

You have:

•   read Our Guideline – Applying to the NDIS (external) including section, Do you need
    early intervention?

•   read article What evidence of disability is required?
•   read article Check eligibility – age and residence requirements.

3 Overview

To be eligible for NDIS, the person must meet the requirements for:

•  age
•   residence
•    disability, early intervention, or both.

The purpose of early intervention is to lessen the impact of a person’s impairment by providing support at the earliest possible stage.

Early intervention support is intended to benefit a person by reducing their future need for supports and by strengthening informal supports. For example, building the capacity of their carer.

Early intervention is for both children and adults and may be required only for a short time.

A person may not need supports for life, so their treating professional or early childhood partner will advise us how early intervention could benefit the person or child.

4 Early intervention requirements

To meet the early intervention requirements, we must have evidence of all of the following:

•   they have an impairment that's likely to be permanent, or they're a child younger than 6
    with developmental delay

•   early intervention supports are likely to reduce their future support needs
•   early intervention supports are likely to benefit them
•   the early intervention supports they need are NDIS supports.

4.1 Check eligibility for early intervention requirements

Use these articles to check evidence for a decision:

•  Check eligibility – EI – impairment is likely permanent
•  Check eligibility – EI – likely to reduce future support needs
•  Check eligibility – EI – likely to improve or reduce deterioration of functional capacity or
    strengthen informal supports

•  Check eligibility – EI – supports will be NDIS supports.

4.2 Additional considerations

Use these articles before you check evidence for a decision:

•     if the child is younger than 7, check if there is evidence of a condition on List D. Go to
     article Check eligibility – List D condition.

   Note: a child is likely to meet the early intervention requirements if they provide
   evidence of their diagnosis.

•   check if the person is diagnosed with a condition on List B, Go to article Check eligibility
   – List B condition.

   Note: a person is likely to meet one of the early intervention requirements if they
    provide evidence of their diagnosis.

•     if the child is younger than 6, check if they have a developmental delay. Go to article
  Check eligibility – EI – developmental delay

•     if the person if aged between 0 and 25 with a hearing impairment, go to article Check
       eligibility – EI – hearing loss 0-25 years of age.

5 Next steps

To consider the disability requirements go to article Understand disability requirements.

If you are an access delegate:

•   to make an access decision continue to article Make an access decision
•   to make an eligibility reassessment decision continue to article Finalise eligibility
   reassessment decision.

FOI 25/26-2252 & FOI 25/25-2253 Document 7

Applicant - record disability conditions and impairments

SGP KP Publishing

Exported on 2026-03-18 16:16:15

Table of Contents

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

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

3 Reported condition ……………………………………………………………………………………. 6

4 Impairment evidence ……………………………………………………………………………………. 7 4.1 Gather evidence ………………………………………………………………………………………………….. 7

5 Record a disability in an access request case …………………………………………. 8

6 Next steps …………………………………………………………………………………………………………….. 9

This article provides guidance for a local area coordinator, early childhood partner, business support officer, liaison officer (HLO/JLO), participant support officer or access delegate to:

•   learn about a reported condition
•   understand and gather impairment evidence
•   record conditions and impairments in an access request case.

1 Recent updates

15 December 2025 Update language about primary disability to align with language in new article Understand the disabilities tab in the person account.

2 Before you start

You have:

•   read and understood Our Guideline - Applying to the NDIS (external) including sections
 Do you meet the disability requirements? and Is your disability related to an
   impairment?

•   read the articles What evidence of disability is required? and Understand disability
    requirements.

FOI 25/26-2252 & FOI 25/25-2253 SGP KP Publishing – Applicant - record disability conditions and impairments

3 Reported condition

When a person with a disability applies to the NDIS, they will provide their impairment evidence. This is a reported condition. The person may have more than one impairment when they apply.

Reported condition – 6

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4 Impairment evidence

You need a person’s impairment evidence to decide if they’re eligible to become an NDIS participant. This could include evidence of:

• treatment history
• any recommended supports or early interventions
• how an impairment affects their day-to-day life.

A treating health professional, who is most relevant to an applicant’s disability should provide the impairment evidence. It should also include the applicant’s functional capacity evidence.

For early intervention, an early childhood partner can provide developmental delay evidence. For more information, go to article [What evidence of disability is required?]

4.1 Gather evidence

When you gather evidence, make sure you get their name, contact details and relationship to the applicant. This will allow for easy follow up.

1. Record details of who has provided evidence on the applicant’s behalf. Use article [Log an activity or internal note].
2. Include references for any information or specific documents you have sourced.

To add evidence or documents to a case, use article [Add and link evidence to a case].

Impairment evidence – 7

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5 Record a disability in an access request case

To enter disabilities, you need to be in the Disabilities step of the Access Request case form.

1. To add a disability, select New.

2. At Select reported condition, start to enter the condition name. The system will suggest possible disabilities based on what you enter. Select the appropriate disability. This will auto-fill the ICD Disability and ICD Disability Code fields.

3. Select one Primary Disability using the checkbox. This is used to describe the disability that usually has or may have the greatest impact on the participant’s daily life.

   Note: you can only select one primary disability.

4. You must specify a Start Date for the disability. This may be either from birth or when onset of the disability occurred. Do not enter an end date.

5. At Evidence, select the type of disability evidence from the options shown.

6. Select Save.

7. Repeat the steps above to add additional disabilities. Remember you may only select the Primary Disability checkbox once.

8. At Was your primary disability caused by an accident or event?, select Yes or No based on the information provided.

9. If you select Yes, you’ll need to provide the date, and details of any compensation. For more information on providing compensation details, go to article [Check for compensation when recording disabilities].

10. Select Next.

Record a disability in an access request case – 8

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6 Next steps

1. To complete the access request form, use article [Complete form in the access request case].
2. Use the Evidence tab to upload any documentary evidence of the person’s disability. Use articles [Record treating professional details] and [Upload requested evidence for a new applicant].

Next steps – 9

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FOI 25/26-2252 & FOI 25/25-2253

Document 8

Record information from the DSM5 -

Autism

SGP KP Publishing

Exported on 2026-03-18 16:16:51

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FOI 25/26-2252 & FOI 25/25-2253 SGP KP Publishing – Record information from the DSM5 - Autism

Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. Understand and record a DSM-5 assessment ………………………………………………………… 6

Table of Contents – 2

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FOI 25/26-2252 & FOI 25/25-2253 SGP KP Publishing – Record information from the DSM5 - Autism

This article provides guidance for a local area coordinator, early childhood coordinator and all NDIA staff (planner, payment officer, internal review officer, complaints officer, participant service officer, access officer, quality officer, technical advisor, SDA officer, NCC officer, provider support) to:

• understand the DSM-5 assessment
• understand the DSM-5 – autism levels
• record the DSM-5 results.

Recent updates – 3

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FOI 25/26-2252 & FOI 25/25-2253 SGP KP Publishing – Record information from the DSM5 - Autism

1 Recent updates

July 2023 Update to system steps and language to align with PACE and knowledge consistency.

Recent updates – 4

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FOI 25/26-2252 & FOI 25/25-2253 SGP KP Publishing – Record information from the DSM5 - Autism

2 Before you start

You have:

• read [Our Guidelines – applying to the NDIS]
• read the article [Understand functional capacity assessments]
• read the article [Create a new functional capacity assessment case].

Before you start – 5

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FOI 25/26-2252 & FOI 25/25-2253 SGP KP Publishing – Record information from the DSM5 - Autism

3 Understand and record a DSM-5 assessment

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a diagnostic manual. Mental health professionals use it to diagnose and understand a range of diseases. This includes autism.

A medical professional must complete the DSM-5 autism spectrum disorder assessment.

To learn more about recording the DSM-5 for intellectual disability, go to [record information from the DSM5 – intellectual disability].

The DSM5 – autism levels

A health professional determines the severity of autism using measures of social communication and of restrictive, repetitive behaviours.

The DSM-5 Autism assessment allocates a person’s support needs into one of three levels:

• Level 1 - Requiring support
• Level 2 - Requiring substantial support
• Level 3 - Requiring very substantial support.

Record the DSM-5 results

Where a participant presents with a DSM-5 Autism assessment, complete the following PACE steps:

At the Select Tools step in the Functional Capacity Assessment:

1. Select No to Carry out a new assessment.
2. Select Yes to Manually enter scores.
3. Select Diagnostic and statistical manual of mental disorders (DSM-5) Autism.
4. Select Next.
5. Enter Assessment completion date.
6. Select Score or Rating.
7. Select Next.
8. Check the Confirmation details.
9. Select Done.

Next steps

There are no further steps.

Understand and record a DSM-5 assessment – 6

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FOI 25/26-2252 & FOI 25/25-2253

Document 9

Check eligibility - EI - Developmental

delay

SGP KP Publishing

Exported on 2026-03-18 16:17:40

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FOI 25/26-2252 & FOI 25/25-2253 SGP KP Publishing – Check eligibility - EI - Developmental delay

Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. How to find developmental delay evidence…………………………………………………………….. 6 3.1 How to find developmental delay evidence ……………………………………………………………… 6 3.2 What to consider when checking eligibility ……………………………………………………….. 6
4. Next steps …………………………………………………………………………………………………………….. 7

Table of Contents – 2

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This article provides guidance for all NDIA staff and partners to understand how to find developmental delay evidence.

Recent updates – 3

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1 Recent updates

7 July 2025 Article Make an access decision - pre-legislation changes is archived. Article Make an access decision - post legislation changes has been renamed to Make an access decision. Use article Make an access decision in next steps.

Recent updates – 4

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2 Before you start

You have read and understood:

• [Our Guideline - Applying to the NDIS (external)], what about children younger than 6 with developmental delay?
• [Our Guideline - Early childhood approach (external)]
• article [Understand early intervention requirements]
• article [Check eligibility – age and residence].

Before you start – 5

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3 How to find developmental delay evidence

3.1 How to find developmental delay evidence

You need to review all available information about the child’s impairment and developmental delay before you make an access decision. To do this, check their application and linked evidence in PACE.

To find linked evidence in PACE select the Documents tab. This will provide a list of the documents that have been linked as evidence. For example, the completed Form – Evidence of development delay.

3.2 What to consider when checking eligibility

When you review evidence to check if the child is eligible under this early intervention requirement, consider:

• the child is younger than 6
• the child’s impairment
• the child’s developmental delay
• the recommended early intervention supports
• if the early intervention supports recommended are NDIS support
• recommendation have been made by the right early childhood professional
• our legislation and guidance
• if we have enough evidence to decide or need more.

How to find developmental delay evidence – 6

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FOI 25/26-2252 & FOI 25/25-2253 SGP KP Publishing – Check eligibility - EI - Developmental delay

4 Next steps

To consider the other early intervention requirements, go to article [Understand early intervention requirements].

If you are an access delegate:

• to make an access decision continue to either article [Make an access decision].
• to make an eligibility reassessment decision continue to article [Finalise eligibility reassessment decision].

Next steps – 7

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Document 10

Check eligibility - List A condition

SGP KP Publishing

Exported on 2026-03-18 16:18:13

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FOI 25/26-2252 & FOI 25/25-2253 SGP KP Publishing – Check eligibility - List A condition

Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. Overview ………………………………………………………………………………………………………………. 6
4. Check for a List A condition ………………………………………………………………………………….. 7 4.1 How to find evidence of a List A Condition ………………………………………………………………. 7 4.2 If the person has a List A condition ………………………………………………………………………… 7 4.3 If the person doesn’t have a List A condition ……………………………………………………………. 7
5. Next steps …………………………………………………………………………………………………………….. 8

Table of Contents – 2

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This article provides guidance for all NDIA staff and partners to check for a List A condition.

Recent updates – 3

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1 Recent updates

7 July 2025 Article Make an access decision - pre-legislation changes is archived. Article Make an access decision - post legislation changes has been renamed to Make an access decision. Use article Make an access decision in next steps.

Recent updates – 4

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2 Before you start

You have:

• read [Our Guideline – Applying to the NDIS (external)]
• considered the age and residence requirements using article [Check eligibility – Age and residence requirements].

Before you start – 5

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3 Overview

To be eligible for the NDIS, the person must meet the requirements for:

• age
• residence
• disability, early intervention, or both.

When a person gives us evidence that they’ve been diagnosed with one or more conditions on [List A: Conditions that are likely to meet the disability requirements (external)] they’ll likely meet the disability requirements.

Overview – 6

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4 Check for a List A condition

4.1 How to find evidence of a List A Condition

A person may inform us that they have a List A condition, or we might identify it when reviewing their disability evidence.

Before making an eligibility decision, make sure you review the application and any provided disability evidence for any diagnosed [List A: Conditions that are likely to meet the disability requirements (external)].

4.2 If the person has a List A condition

If there’s evidence of a List A condition, the disability requirements are met.

You also need to think about the early intervention requirements. Go to article [Understand early intervention requirements].

4.3 If the person doesn’t have a List A condition

If the person doesn’t have a List A condition, think about all the disability and early intervention requirements using articles:

• [Understand disability requirements]
• [Understand early intervention requirements].

Check for a List A condition – 7

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5 Next steps

If you’re an access delegate:

• to make an access decision continue to article [Make an access decision].
• to make an eligibility reassessment decision continue to article [Finalise eligibility reassessment decision].

Next steps – 8

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Document 11

Check eligibility - List B condition

SGP KP Publishing

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Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. Overview ………………………………………………………………………………………………………………. 6
4. Check for a List B condition ………………………………………………………………………………….. 7 4.1 How to find evidence that a person has a List B condition …………………………………………. 7 4.2 If the person has a List B condition ……………………………………………………………………… 7 4.3 If the person doesn’t have a List B condition ……………………………………………………………. 7
5. Next steps …………………………………………………………………………………………………………….. 8

Table of Contents – 2

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This article provides guidance for all NDIA staff and partners to check for a List B condition.

Recent updates – 3

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1 Recent updates

7 July 2025

Article Make an access decision - pre-legislation changes is archived. Article Make an access decision - post legislation changes has been renamed to Make an access decision. Use article Make an access decision in next steps.

Recent updates – 4

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2 Before you start

You have:

• read [Our Guideline – Applying to the NDIS (external)]
• considered the age and residence requirements using article [Check eligibility – age and residence requirements].

Before you start – 5

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3 Overview

To be eligible for the NDIS, the person must meet the requirements for:

• age
• residence
• disability, early intervention, or both.

When a person gives us evidence that they’ve been diagnosed with one or more conditions on [List B: Conditions that are likely to result in a permanent impairment (external)], they’ll meet some of the disability requirements and early intervention requirements.

Overview – 6

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4 Check for a List B condition

4.1 How to find evidence that a person has a List B condition

A person may inform us that they have a List B condition, or we might identify it when reviewing their disability evidence.

Before making an eligibility decision, make sure you review the application and any disability evidence for any diagnosed [List B: Conditions that are likely to result in a permanent impairment (external)].

4.2 If the person has a List B condition

If the person has evidence of a List B condition, only some of the disability and early intervention requirements are met.

The following disability requirements are met:

• The person has a disability that us caused by one or more impairments (s24(1)(a)).
• The person’s impairment or impairments are likely to be permanent (s24(1)(b)).

The following early intervention requirement is met:

• The person has one or more impairments that are likely to be permanent (s25(1)(a)).

You’ll need to then think about the remaining disability and early intervention requirements using articles:

• [Understand disability requirements]
• [Understand early intervention requirements].

4.3 If the person doesn’t have a List B condition

If the person doesn’t have a List B condition, think about all of the disability and early intervention requirements using articles:

• [Understand disability requirements]
• [Understand early intervention requirements].

Check for a List B condition – 7

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5 Next steps

If you’re an access delegate:

• to make an access decision continue to article [Make an access decision].
• to make an eligibility reassessment decision continue to article [Finalise eligibility reassessment decision].

Next steps – 8

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Document 12

Descriptions of impairment

categories

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Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Impairment categories …………………………………………………………………………………………… 5
3. References ……………………………………………………………………………………………………………. 6

Table of Contents – 2

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This article provides guidance for an access delegate to understand the impairment categories when deciding what categories to select for a person that meets the eligibility requirements.

Recent updates – 3

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1 Recent updates

14 October 2024 New guidance to:

• reflect legislation changes from 3 October 2024
• understand the impairment categories when deciding what categories to select for a person that meets the eligibility requirements.

Recent updates – 4

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2 Impairment categories

1. Intellectual Such as how you speak and listen, read and write, solve problems, and process and remember information.

   An intellectual impairment may be considered a developmental disorder as it becomes apparent at an early age¹. Without these skills, a person needs additional supports to succeed at school, work, or independent life. Conditions such as down’s syndrome and cerebral palsy may be associated with intellectual impairments.

2. Cognitive Such as how you think, learn new things, use judgment to make decisions, and pay attention.

   Cognitive impairment involves various aspects of high-level mental functions and processes such as attention, memory, knowledge, decision-making, planning, reasoning, judgment, perception, comprehension, language, and visuospatial function . There are some similarities with intellectual impairments however, cognitive impairments generally become apparent at a later stage in life and are associated with brain injury or pathology¹. Conditions such as dementia and traumatic brain injury may cause cognitive impairments.

3. Neurological Such as how your body functions.

   Neurological impairments happen when there’s a change in function of the nervous system, which includes the brain and spinal cord². Damage to either or both areas can affect the way the nervous system processes information. Parkinsons disease, epilepsy and multiple sclerosis³ are conditions which have a neurological basis.

4. Sensory Such as how you see or hear.

   Sensory impairment most commonly relates to hearing or visual loss but can include all senses².

5. Physical Such as the ability to move parts of your body.

   Physical impairment may cause limitations in posture control, moving and coordinating parts of the body or in stamina². There are many conditions which can cause a physical impairment including amputation of a limb, arthritis, multiple sclerosis, heart disease.

6. Psychosocial This means you have reduced capacity to do daily life activities and tasks due to your mental health.

   Participants with a psychosocial impairment may find it hard to engage in education, training and employment or engage with the community. Mental health conditions such as bipolar affective disorder and schizophrenia are commonly associated with psychosocial impairments¹ but other conditions such as autism could also have associated psychosocial impairments.

To learn more about impairment categories, go to article [Impairment categories guide].

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3 References

¹ The Diagnostic and Statistical Manual of Mental Disorders (5th edition. DSM-5, American Psychiatric Association, 2013). ² International Classification of Functioning, Disability, and Health: ICF. Geneva. World Health Organisation, 2001. ³ World Health Organisation (WHO), (1983). The ICD-10 classification of mental and behavioural disorders. World Health Organisation.

References – 6

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Document 13

Create a new functional capacity

assessment case

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Table of Contents

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

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

3 Create a new functional capacity assessment case ……………………………………………….. 6

4 Next steps …………………………………………………………………………………………………………….. 7

                                                                       Table of Contents – 2
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This article provides guidance for a local area coordinator, early childhood partner and all NDIA staff (planner delegate, payments officer, internal review delegate, complaints officer, participant support officer, access delegate, technical advisors, National Contact Centre, liaison officers (HLO/JLO), complex support needs (CSN) planner, national reassessment delegate) to:

•   create a new functional capacity assessment case.

                                                                     Recent updates – 3
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1 Recent updates

December 2023

•   Current guidance with updated PACE steps that include process steps to create a new
    functional capacity assessment case
•   Article split from existing article Understand functional capacity assessments with
    information consolidated and removal of redundant and common capability content.

                                                                     Recent updates – 4
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2 Before you start

You have:

•   read article Understand functional capacity assessments
•   read Our Guidelines – Applying to the NDIS, including section Does your impairment
    substantially reduce your functional capacity?

•   read article How to apply for the NDIS in PACE to understand when during the
    application process you need to create a new functional capacity assessment case

•   discussed with the applicant the daily impact their disability has on them, to decide the
    type of assessment that will best suit their support needs.

                                                                          Before you start – 5
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3 Create a new functional capacity assessment case

1.  From the Person Account, in account view, select Cases tab.

2.  Select New in the top-right corner of the cases panel.

3.  Select Functional Capacity Assessment.

4.  Select Next.

5.  In Categorisation section, select Origin.

6.  Select Save.

7.  From the functional capacity assessment view, select Assessment tab.

8.  Review the details before proceeding.

9.  Select Next.

10. Select Yes or No for an authorised representative.

11. Select Next.

The next steps will depend on the type of functional capacity assessment you need to complete or record.

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4 Next steps

1.  Determine from your discussion with the applicant, if a new or manual assessment is
    required. For more information on assessment types, refer to article Understand
    functional capacity assessments.

2.  Then select the article for the relevant assessment you will complete:

     o  New assessment

                ▪   Record assessment – WHODAS

                ▪   Record assessment – PEDI-CAT

     o  Manual assessment

                ▪   Record information - life skills profile (LSP - 16)

                ▪   Record information – functional impact of hearing loss

                ▪   Record information – functional impact of vision loss

                ▪   Record information - level of lesion

                ▪   Record information - the care and needs scale

                ▪   Record information – Vineland Adaptive Behaviour scales

                ▪   Record information from the DSM5 – Autism

                ▪   Record information from the DSM5 – intellectual disability

                ▪   Record gross motor functional classification scale

                ▪   Record information - Manual Ability Classification system

                ▪   Record a communication function classification score

                ▪   Record information - disease steps assessment

                ▪   Record information - expanded disability status scale

                ▪   Record information - Modified Rankin scale

                                                                           Next steps – 7
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Understand functional capacity

    assessments
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Table of Contents

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

2 Understand and record a functional capacity assessment ……………………………………… 5 2.1 Understand functional capacity assessments ………………………………………………………….. 5 2.2 The purpose of a functional capacity assessment ……………………………………………………. 5 2.3 New assessment and manual assessment ……………………………………………………………… 5 2.4 Before completing the assessment ………………………………………………………………………… 5 2.5 Complete a new assessment ………………………………………………………………………………… 6 2.6 Types of functional capacity assessments ………………………………………………………………. 6 2.6.1 General ……………………………………………………………………………………………………………………….. 6 2.6.2 Hearing loss …………………………………………………………………………………………………………………. 7 2.6.3 Vision loss ……………………………………………………………………………………………………………………. 7 2.6.4 Spinal Injury …………………………………………………………………………………………………………………. 7 2.6.5 Traumatic brain injury ………………………………………………………………………………………………….. 7 2.6.6 Intellectual and development disability ……………………………………………………………………… 7 2.6.7 Cerebral palsy ………………………………………………………………………………………………………………. 7 2.6.8 Multiple Sclerosis ………………………………………………………………………………………………………….. 7 2.6.9 Stroke / Neurological disability ……………………………………………………………………………………. 7

3 Next steps …………………………………………………………………………………………………………….. 8

                                                                       Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to understand:

•  a functional capacity assessment
•   the purpose of a functional capacity assessment
•   the difference between a new and manual assessment
•   what to do before completing a new assessment
•   completing a new assessment

                                                                     Recent updates – 3
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1 Recent updates

28 July 2025

Updated knowledge article links.

                                                                     Recent updates – 4
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2 Understand and record a functional capacity

assessment

2.1 Understand functional capacity assessments

A functional capacity assessment is how we assess the impact a person’s disability or a child’s developmental delay has on their daily activities. Depending on their developmental delay or disability, the type of functional capacity assessment that we complete may vary.

2.2 The purpose of a functional capacity assessment

Functional capacity assessments are a form of evidence. We use them to understand the needs of a person. We complete this assessment to:

•   help us identify the level of support and funding they will need in their plan
•   understand how they manage everyday activities
•   assist us in making decisions.

Partners can also use this information to understand the person’s situation. This helps them to support the person to connect with the right supports.

2.3 New assessment and manual assessment

A new assessment refers to you completing a new PEDI-CAT or WHODAS assessment in PACE. To learn more, go to articles:

•   Record an assessment – PEDI-CAT
•   Record assessment – WHODAS

A manual assessment refers to any previously completed functional capacity assessments. For example, a person might give you a report from their doctor. You will enter the scores from the report in PACE.

The participant, their nominee or child representative, or their treating health professional can provide the score of an external assessment.

2.4 Before completing the assessment

Before completing the assessment, check for any exceptions, including:

•     if the person does not want to complete assessment
•     if the person has a priority situation
•     if there are any identified risks

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•     if they have reapplied within the last 6 months.
•   check their preferred communication method and authorisations. For help go to article
  Check a person's preferred contact method.

When you contact an applicant, participant, their provider, or authorised representative, you must:

•   check their preferred communication method and authorisations. For help go to article
  Check a person’s preferred contact method

•   log an activity. For help go to article Log an activity or internal note.

2.5 Complete a new assessment

You need to make the person feel comfortable when communicating. When you are talking to them face to face or over the phone, make sure you:

•   prepare for the conversation
•   understand the person-centred approach
•   understand the question you are asking
•    tailor wording from assessment questions
•   build rapport
•   actively listen
•  manage expectations with the individual that this does not mean they will get a funded
  NDIS plan.

For more information, go to Guide - Conversation style guide.

To begin a functional capacity assessment create a new Functional Capacity Assessment case. To do this use article Create a new functional capacity assessment case.

2.6 Types of functional capacity assessments

There are many types of functional capacity assessments. We use them to help assess the level of impact a person’s developmental delay or disability has on their lives.

For more information, go to articles:

2.6.1 General

•   Record information – life skills profile (LSP - 16)
•   Record assessment – WHODAS
•   Record assessment – PEDI-CAT.

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2.6.2 Hearing loss

•   Record information – Functional impact of hearing Loss

2.6.3 Vision loss

•   Record Information – Functional impact of vision loss

2.6.4 Spinal Injury

•   Record information - level of lesion assessment

2.6.5 Traumatic brain injury

•   Record information – the Care and Needs Scale

2.6.6 Intellectual and development disability

•   Record information - Vineland Adaptive Behaviour Scales
•   Record information from the DSM5 – Autism
•   Record information from the DSM5 – intellectual disability.

2.6.7 Cerebral palsy

•   Record information – Gross Motor Functional Classification Scale
•   Record information – Manual ability classification system
•   Record a communication function classification score

2.6.8 Multiple Sclerosis

•   Record information – Disease steps assessment
•   Record information – Expanded Disability Status Scale.

2.6.9 Stroke / Neurological disability

•   Record information – Modified Rankin Scale.

                                   Understand and record a functional capacity assessment – 7
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3 Next steps

Read article Create a new functional capacity assessment case.

                                                                           Next steps – 8
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Check eligibility – DIS – significant

     functional impact
          SGP KP Publishing

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Table of Contents

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

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

3 Evidence of significant functional impact ………………………………………………………………. 6 3.1 Review evidence of the impairment that substantially reduces functional capacity ……….. 6

4 Next steps …………………………………………………………………………………………………………….. 8

                                                                       Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to review evidence of the impairment that substantially reduces functional capacity.

                                                                     Recent updates – 3
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1 Recent updates

7 July 2025 Article Make an access decision - pre-legislation changes is archived. Article Make an access decision - post legislation changes has been renamed to Make an access decision. Use article Make an access decision Before you start and in Next steps.

                                                                     Recent updates – 4
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2 Before you start

You have:

•   read Our Guideline – Applying to the NDIS (external) including the section Does your
   impairment substantially reduce your functional capacity?

•   read articles Understand disability requirements, What evidence of disability is required
   and Make an access decision.

                                                                          Before you start – 5
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3 Evidence of significant functional impact

3.1 Review evidence of the impairment that substantially

reduces functional capacity

We need to learn about the person’s impairment before we can make a decision about their eligibility.

To do this you need to check their application and evidence in PACE.

You need evidence the person’s impairment substantially reduces their functional capacity in one or more of the following areas:

•   communication
•   social interaction
•   learning
•   mobility
•   self-care
•   self-management (if older than 6).

A person’s needs might vary from time to time. This means they may go up and down each day or each month. A good example of this can be progressive multiple sclerosis. We consider a person’s ability over time and take into account how their ability fluctuates.

When a person’s impairment substantially reduces their functional capacity, they usually need disability-specific supports to join in or do these tasks and activities.

These disability-specific supports include:

•   support from other people, such as physical assistance, guidance, supervision or
    prompting.

•   assistive technology, equipment or home modifications prescribed by the person's
    doctor, allied health professional or other medical professional.

To decide if a person is eligible, you need to determine their capacity and where they need more help. To decide if a support is reasonable and necessary, you need to consider what information you have available to identify if the person meets the NDIS funding criteria (external).

If a person has more than one permanent impairment, you will need to consider them together to see if their functional capacity is reduced substantially.

You need to consider:

•   the person's involvement in different areas of life, like at home, school, work and in the
   community

•  how they carry out tasks and activities

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•   any other factors impacting their everyday life.

The disability requirements are just one of the eligibility requirements. To be eligible for the NDIS, the applicant must also meet the age and residence requirements. Go to article Check eligibility – Age and residence requirements.

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4 Next steps

If you are an access delegate:

•   to determine eligibility continue to follow guidance in article Make an access decision.
•   to check the timeframes to make a decision follow guidance in article Check decision –
    Legislative timeframes.

                                                                           Next steps – 8
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FOI 25/26-2252 & FOI 25/25-2253 Document 16

Check eligibility – DIS – NDIS

  supports for life
       SGP KP Publishing

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Table of Contents

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

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

3 Review evidence …………………………………………………………………………………………………… 6

4 Next steps …………………………………………………………………………………………………………….. 7

                                                                       Table of Contents – 2
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This article provides guidance for an access delegate to review evidence to check if a person is likely to need NDIS supports for their lifetime.

                                                                     Recent updates – 3
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1 Recent updates

7 July 2025 Article Make an access decision - pre-legislation changes is archived. Article Make an access decision - post legislation changes has been renamed to Make an access decision. Use article Make an access decision in next steps.

                                                                     Recent updates – 4
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2 Before you start

You have read and understood:

•    article Understand disability requirements
•    article Understand early intervention requirements
•  Our Guideline - Applying to the NDIS (external) section Will you likely need NDIS
   support for your lifetime?

                                                                          Before you start – 5
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3 Review evidence

To be eligible for the NDIS, a person must likely need NDIS supports for their lifetime. To approve their application, you need to see evidence showing this.

NDIS supports are the services, items and equipment that can be funded by the NDIS. NDIS supports are investments that help a participant build or maintain their functional capacity and independence, and help them work, study or take part in social life.

When we decide if an applicant will likely need NDIS supports for their lifetime, we consider:

•   their life circumstances
•   the nature of their long-term support needs

•   whether their needs could be best met by the NDIS, or by other government and
   community services.

When you’re deciding if a person is eligible, you need to review:

•  how old the evidence is
•  who provided the evidence.

If a person provides more than one piece of evidence, you may need to consider one as more relevant than others. We call this weighing evidence.

For further information:

•   read Our Guideline - Applying to the NDIS (external) section, How we weigh evidence
    of disability?
•   refer to article What evidence of disability is required?.

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4 Next steps

To consider the other disability requirements go to article Understand disability requirements.

If you are an access delegate:

•   to make an access decision continue to article Make an access decision.
•   to make an eligibility reassessment decision, continue to article Finalise eligibility
   reassessment decision.

                                                                           Next steps – 7
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What evidence of disability is

      required
       SGP KP Publishing

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Table of Contents

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

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

3 Who can provide evidence of disability? ……………………………………………………………….. 6

4 What evidence does the NDIA require? ………………………………………………………………….. 7

5 How to check evidence ………………………………………………………………………………………….. 8

6 What if the person lives in a remote region? ………………………………………………………….. 9

7 Next steps …………………………………………………………………………………………………………… 10

                                                                       Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to understand:

•  who can provide evidence of disability
•   what evidence the NDIA requires
•  how to check evidence
•   what to do if the person lives in a remote region.

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1 Recent updates

7 July 2025 Updates to guidance include:

•   case name Update Impairment case is now Vary Impairment Categories case.
•    article Make an access decision - pre-legislation changes is archived.
•    article Make an access decision - post legislation renamed Make an access decision.
•    article Submit an application to change the participant's Notice of impairments changed
     to Submit an application to change the participant's impairment categories information.

•    article Decide whether to change the participant's Notice of Impairments updated to
   Decide whether to change the participant's impairment categories information.

                                                                     Recent updates – 4
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2 Before you start

You have read and understood Our Guideline – Applying to the NDIS (external) including sections Do you meet the disability requirements? and Do you need early intervention?

                                                                          Before you start – 5
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3 Who can provide evidence of disability?

A person’s treating professional must provide disability evidence.

Evidence provided by treating professionals – such as medical reports – needs to consist of genuine, original documents. The information must also be specific to the person applying or the participant updating their categories of impairments.

Before accepting evidence from a treating professional, you should read the article Check treating professional details.

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4 What evidence does the NDIA require?

Anyone applying for the NDIS needs to have evidence of disability, regardless of what NDIS support they are asking for. A person’s evidence needs to show they meet all of the disability requirements.

We ask for this evidence from the person:

•  when they first apply to the NDIS
•  when making an access decision
•     if they apply to vary their impairment categories in their impairment category information
•   during an eligibility reassessment.

You can’t submit the access request case until you have evidence of disability from the person.

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5 How to check evidence

Before you make a decision about the person’s NDIS eligibility, you need to check the person’s disability evidence:

•    is from a treating professional registered with AHPRA (the Australian Health Practitioner
    Regulation Agency). Use article Check treating professional details.

•   provides enough information to show if the person is eligible for priority application
    decision. Use article Request priority eligibility decision.
•   demonstrates that the person has a condition from List A (external), List B (external) or
     List D (external).

•  shows if the person meets the requirements for disability, early intervention or both. Use
     article Understand disability requirements and Understand early intervention
    requirements.

If the evidence does not show each of the above, the person may need to provide additional evidence.

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6 What if the person lives in a remote region?

The NDIA makes some exceptions to the evidence requirements for people living in remote regions of Australia. People living in these regions may find it difficult to provide or obtain evidence.

When you support people who live in very remote communities, you must record information about their:

•   local health service
•   consent for the NDIA to talk to the local health service
•   local community connection contact
•   Council and/or Department of Social Services contact in the area.

The person lives in a remote region if they live in a MM6 or MM7 region, under the Modified Monash Model (external).

If this is the case, you should talk with your team leader. They can help you consider options and alternatives for the person’s circumstances.

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7 Next steps

1.    If you are completing an:

     o  Access Request case: continue with article Complete form in the access
           request case.

     o  Access Decision case: continue with article Make an access decision.

     o  Vary Impairment Categories case: continue with articles Submit an
             application to change the participant's impairment categories information or
          Decide whether to change the participant's impairment categories information.

     o   Eligibility Reassessment case: continue with articles Complete an eligibility
          reassessment referral, Review the referral information and complete the
                 eligibility reassessment check or Finalise eligibility reassessment decision.

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Check eligibility - DIS – disability

caused by an impairment SGP KP Publishing

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Table of Contents

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

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

3 Evidence an impairment is caused by a disability ………………………………………………….. 6 3.1 How to find evidence a disability is related to an impairment ……………………………………… 6 3.2 What to consider when making an eligibility decision ……………………………………………….. 6

4 Next steps …………………………………………………………………………………………………………….. 7

                                                                       Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to understand:

•  how to find evidence showing disability is related to an impairment
•   what to consider when making an eligibility decision for this requirement.

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1 Recent updates

7 July 2025 Article Make an access decision - pre-legislation changes is archived. Article Make an access decision - post legislation changes has been renamed to Make an access decision. Use article Make an access decision in next steps.

                                                                     Recent updates – 4
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2 Before you start

You have read:

•  and understood Our Guideline – Applying to the NDIS (external) section Do you meet
   the disability requirements?

•    article Understand disability requirements
•    article What evidence of disability is required?

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3 Evidence an impairment is caused by a disability

3.1 How to find evidence a disability is related to an

impairment

You need to review all available information about the person’s impairment and disability before making a decision. To do this, check their application and evidence in PACE.

3.2 What to consider when making an eligibility decision

To make an eligibility decision about this disability requirement, consider:

•   the person's impairment
•   their disability
•   our legislation and guidance
•     if we have enough evidence to decide or need more.

The disability requirements are just one of the eligibility requirements. To be eligible for the NDIS, the applicant must also meet the age and residence requirements. Go to article Check eligibility – Age and residence requirements.

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4 Next steps

If you are an access delegate:

•   to determine eligibility continue to follow guidance in article Make an access decision.
•   to check the timeframes to make a decision follow guidance in article Check decision –
    Legislative timeframes.

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Check eligibility – DIS – likely

   permanence
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Table of Contents

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

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

3 Evidence of likely permanence ……………………………………………………………………… 6 3.1 Review evidence of likely permanence …………………………………………………………………… 6

4 Next steps ………………………………………………………………………………………………….. 7

                                                                       Table of Contents – 2
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This article provides guidance for all NDIA staff and partners to review evidence of likely permanence.

                                                                     Recent updates – 3
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1 Recent updates

7 July 2025 Article Make an access decision - pre-legislation changes is archived. Article Make an access decision - post legislation changes has been renamed to Make an access decision. Use article Make an access decision in next steps.

                                                                     Recent updates – 4
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2 Before you start

You have read:

•  and understood Our Guideline – Applying to the NDIS (external) section Do you meet
   the disability requirements?

•    article Understand disability requirements
•    article What evidence of disability is required?

                                                                          Before you start – 5
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3 Evidence of likely permanence

3.1 Review evidence of likely permanence

You need evidence an applicant will have the impairment for their lifetime to be eligible for the NDIS. To confirm their permanent impairment, we need evidence from their doctor or specialist.

The impairment may be episodic or vary in intensity. This means it will still be permanent due to the overall impact on their life and likelihood they’ll be impacted across their lifetime.

Even when their condition or diagnosis is permanent, we’ll also check if the impairment is permanent as well.

For example, they may not be eligible if the impairment is temporary, still being treated or if there are known, available and appropriate evidence-based clinical, medical or other remaining treatments options that are likely to remedy the impairment.

We’ll generally consider if their impairment is likely to be permanent, after all available and appropriate treatment options have been pursued.

If an applicant gives us evidence they’re diagnosed with a List B (external) condition, we’ll usually decide if their disability from an impairment is likely to be permanent.

For more information, go to section Is your impairment likely to be permanent? In Our Guideline – Applying to the NDIS (external).

The disability requirements are just one of the eligibility requirements. To be eligible for the NDIS, the applicant must also meet age and residence requirements. Go to article Check eligibility – Age and residence requirements.

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4 Next steps

If you are an access delegate:

•   to determine eligibility continue to follow guidance in article Make an access decision.
•   to check the timeframes to make a decision follow guidance in article Check decision –
    Legislative timeframes.

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   eligibility reassessment
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Table of Contents

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

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

3 Consider an eligibility reassessment ……………………………………………………………………… 6 3.1 Automatic eligibility reassessment referrals ……………………………………………………….. 6 3.2 Manual eligibility reassessment referrals ……………………………………………………….. 6

4 Complete an eligibility pre-check by reviewing available information …………….. 2 8 4.1 Check the participant has met access for 14 months and received funding for 12 months 8 4.2 Check for any open ER or Leaving cases ……………………………………………………………….. 8 4.3 Review evidence on the participant record ……………………………………………………………… 8 4.4 Review the participants original access decision and information …………………………… 9

5 When to refer the participant for an eligibility reassessment …………………………… 10 5.1 Commence an eligibility reassessment referral………………………………………………………. 10

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This article provides guidance for a local area coordinator, early childhood partner, planner delegate or planner (non-partnered area) to:

•   consider an eligibility reassessment
•   complete an eligibility pre-check by reviewing available information
•   understand when to refer the participant for an eligibility reassessment.

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1 Recent updates

20 January 2025 Guidance updated to help staff understand an eligibility reassessment is only continued when the participant has:

•  been an NDIS participant for at least 14 months, and
•   received NDIS funding for at least 12 months.

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2 Before you start

You have read and understood:

•  Our Guideline – Applying to the NDIS (external)
•  Our Guideline – Leaving the NDIS (external) section Are you still eligible for the
  NDIS?

If you are an early childhood partner, you have also read and understood articles:

•  EC: Guide – Check-in eligibility conversations for children younger than 6 with
   developmental delay
•  EC: Guide – Evidence sources to demonstrate if an impairment is likely to be
   permanent for children who previously met access for developmental delay.

To learn more about leaving the NDIS read:

•  Our Guideline – Reviewing our decisions (external)
•    article Understand the leaving case.

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3 Consider an eligibility reassessment

We may need to check a participant’s eligibility if information shows they may no longer be eligible, or their disability support needs, or situation has changed. We call this an eligibility reassessment. For more information see Our Guideline – Leaving the NDIS (external).

If the participant met the disability requirements, we don’t need to check their eligibility at every plan reassessment. We only need to check if we get evidence they may no longer be eligible.

If the participant met the early intervention requirements, an automatic referral may be created.

3.1 Automatic eligibility reassessment referrals

An eligibility reassessment case will be generated automatically when the participant:

•   with developmental delay turns 6
•   with global development delay turns 7
•  who is eligible under the early intervention requirement has a primary impairment of
    hearing loss and turns 26.

If an automatic case has been generated, the participant’s my NDIS contact will be notified via the Omni-Channel to start an eligibility reassessment checklist. They’ll consider all information to determine if an eligibility reassessment is needed.

When completing an automatic referral, check for more information about the participant before completing the referral. To check for more information:

1.  Complete steps in section Review evidence on the participant record.

2.  Complete steps in section Review the participants original access decision and
   information.

3.  Then continue to article Complete an eligibility reassessment referral.

3.2 Manual eligibility reassessment referrals

Sometimes you’ll need to manually create an eligibility reassessment referral. For example, if you receive a report from the participant’s treating professional that says their disability support needs have changed.

If the participant’s situation has changed and you think they need an eligibility reassessment, you can manually make an eligibility reassessment referral. This can take place:

•   as part of the plan reassessment process
•   at check-in
•   at any other time.

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First you need to complete an eligibility pre-check to confirm whether you need to create an eligibility reassessment referral. Continue to section Complete an eligibility pre-check by reviewing available information.

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4 Complete an eligibility pre-check by reviewing

available information

4.1 Check the participant has met access for 14 months and

received funding for 12 months

1. Go to the participant's Person Account.

2. Go to the Account Timeline in the navigation pane.

3.  Find the first Plan Approval case in the Timeline.

   Note: This will usually be at the bottom of the list.

4.  Check the date of the Access Decision. Is this more than 14 months ago?

   Note: If there is no date in PACE, check SAP CRM for this information.

         If:

     o  Yes: continue to section Check for any open ER or Leaving cases.

     o  No: the eligibility reassessment won't continue to be considered until after the
             participant has received NDIS funding for 12 months and met access for 14
          months. It will remain in the Eligibility Reassessment Hold Queue until the 14
         months are up. If you choose to continue with the referral, go to section Check
            for any open ER or Leaving cases.

4.2 Check for any open ER or Leaving cases

1. Go to the participant's Person Account, Cases tab.

2.  Check Open Cases for an existing:

     o   Eligibility Reassessment case

     o  Leaving the NDIS case

3.   Is there an existing case in progress? If:

     o  Yes: they can't be referred for an eligibility reassessment. End of process.

     o  No: continue to section Review evidence on the participant record.

4.3 Review evidence on the participant record

1.  Check all available information to make sure you give an accurate referral based on the
     participant's current situation. Check:

     o  any relevant documents on the participant's record

     o   medical, clinical, diagnostic or assessment reports

     o   provider reports and assessments such as progress reports

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     o   early childhood partner documents

     o   information from family members and carers, such as a carer impact statement.

          Note: You don't need to ask the participant to give any new or additional
            information to pre-check eligibility.

4.4 Review the participants original access decision and

information

The Decisions, Justifications and Evidence (DJE) framework of the Access Decision case records evidence used. It helps record decisions to meet the requirements of the participant service guarantee and the NDIS Act (2013).

1. Go to the participant's Person Account, Decisions tab.

2.  In the Decision Name column, select Access Decision.

3.  Review all information within the Details tab to understand how the participant met the
   access criteria for the NDIS.

4. Go to the Decisions tab, and review all Justifications and sub-criterion decisions
  made for the access decision.

5.  Review all Evidence/explanation, read the type of evidence and documents recorded
     to support the access decision.

6.  In Sub-decisions, read the Decision Name and how the participant met the access
      criteria for the NDIS.

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5 When to refer the participant for an eligibility

reassessment

1.  Has the participant's support needs or circumstances changed? If:

     o  Yes, continue to step 2.

     o  No, they can't be referred for an eligibility reassessment. End of process.

2.  Check whether the participant that met access under the disability requirements, now
   appears to no longer meet residence requirements, or no longer meet the disability and
    early intervention requirements. If:

     o  Yes: continue to section Commence an eligibility reassessment referral.

     o  No: they can't be referred for an eligibility reassessment. End of process.

3.  Check whether the participant that met access under the early intervention
    requirements, and now they're likely to no longer meet residence requirements, or no
    longer meet the early intervention requirements, and now meet disability requirements.
         If:

     o  Yes, go to section Commence an eligibility reassessment referral.

     o  No, they can't be referred for an eligibility reassessment. End of process.

Note: A participant can meet both the disability and early intervention requirements.

5.1 Commence an eligibility reassessment referral

1.  Create a new eligibility reassessment case using article Complete an eligibility
   reassessment referral.

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            referral
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Table of Contents

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

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

3 Create the Eligibility Reassessment case ……………………………………………………….. 6

4 Complete the eligibility reassessment referral ……………………………………………………….. 7

5 Contact the participant about the eligibility reassessment referral …………….. 9

6 Next steps ………………………………………………………………………………………………….. 11

                                                                       Table of Contents – 2
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This article provides guidance for an access delegate, local area coordinator, early childhood partner, planner delegate and planner (non-partnered area) to:

•   create the eligibility reassessment case
•   complete the eligibility reassessment referral
•   contact the participant about the eligibility reassessment referral.

Note: scheme integrity officers do not need to complete the referral workflow.

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1 Recent updates

14 July 2025 Guidance updated to:

•  remove references that participants who are no longer eligible for the NDIS will no
    longer be a participant, from 28 days after the decision is made, or from their plan
   reassessment date, whichever is earlier

•  add note in section Contact the participant about the eligibility reassessment referral to
   read EC Guide – Check-in eligibility conversations for children younger than 6 with
   developmental delays where the participant is a child with developmental delay.

7 July 2025 Guidance updated to:

•   reflect legislation change that participants need to meet the residence requirements,
   and either disability requirements, early intervention requirements, or both

•   include information that PACE will automatically create an eligibility reassessment
     referral for participants who turn 26 and met access under early intervention for hearing
     loss.

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2 Before you start

You have either:

•   followed steps in article When to refer the participant for an eligibility reassessment and
   have decided to make an eligibility reassessment referral.

•  been notified via the Omni-Channel that an automatic Eligibility Reassessment referral
   has been generated.

You have read and understood:

•    eligibility in Our Guideline – Applying to the NDIS (external)
•    eligibility reassessment in Our Guideline – Leaving the NDIS (external)
•    article Guide – Conversation style guide appendix B section Sensitive Conversations.

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3 Create the Eligibility Reassessment case

During the eligibility reassessment process you will:

•   continue to be the my NDIS contact for the participant during this time
•   continue with the plan reassessment if one is in progress
•    let the participant know they can still use the NDIS supports in their plan
•   help them use the NDIS supports in their plan if they need you to.

1. Go to the participant's Person Account.

2.  Select Cases tab.

3.  Check for an automatically generated Eligibility Reassessment case. Has a case
    already been generated? If:

     o  Yes: continue to section Complete the eligibility reassessment referral.

     o  No: continue to next step.

4.  In the top right hand corner, select New.

5.  Select Eligibility Reassessment from the case list.

6.  Select Next.

7.  Select Save.

Note: if an Eligibility Reassessment case is created in error or system generated and not required, you won’t have the PACE permissions to withdraw the case, unless you are a team leader in the Scheme Eligibility Branch. Instead, complete the questions in the referral tab. Add an Internal Note stating the eligibility reassessment referral is not required. If a referral is not required, the case will close.

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4 Complete the eligibility reassessment referral

You must link supporting evidence to support the access delegate who will complete the eligibility reassessment case.

The fields within the referral workflow are dynamic and will update based on the participant’s age, residency, early intervention requirements, and disability requirements recorded in their Decisions, Justification and Evidence (DJE) framework. To check the DJE, use article When to refer the participant for an eligibility reassessment, section Review the participants original access decision and information.

Note: if the participant met access for the NDIS under the early intervention requirements with a primary impairment of developmental delay, global developmental delay, or hearing loss, the system will automatically create an eligibility reassessment referral. Go to step 5 for more information.

1.  Gather all evidence related to the participant's eligibility in the Enquiry inbox in PACE.

2.  In the Eligibility Reassessment case, select Evidence tab. Link any relevant evidence
     to the case using article Add and link evidence to a case.

3.  Select Referral tab.

   Note: if the eligibility reassessment case was created before 19 January 2024, you
  must select Cancel. This will refresh the data allowing you to progress the eligibility
   reassessment case.

4.  Complete the Residence, Early Intervention and Disability questions.

5. PACE will automatically create an eligibility reassessment referral for participants who:

     o   turn 6 and met access for NDIS under early intervention for developmental
          delay

     o   turn 7 and met access for NDIS under early intervention for global
         developmental delay

     o   turn 26 and met access for NDIS under early intervention for hearing loss.

                      If the participant has a new disability that may meet the disability or early
             intervention requirements that needs to be added, and there isn't an existing
                 eligibility reassessment referral, then you must complete an eligibility
          reassessment referral. As a temporary work around for PACE and for the
              referral to continue, you must select Yes to Has a disability on List A?,
           regardless if the disability is on List A.

          Note: where the participant you're referring doesn't have a disability on List A,
        make an Internal Note to explain the participant doesn't have a disability on
               List A and you have selected Yes to Has a disability on List A? as a
          temporary work around for PACE.

6.  Review the Summary information. Select Next.

7.  Review the Decision information.

8.    If amendments are:

     o   required, select Back - Draft decisions list, and make the amendments.

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  o  not required, select Next - Justification.

9. Review the Justification. Select Next.

10. Select Done. The referral is submitted.

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5 Contact the participant about the eligibility

reassessment referral

When contacting the participant, their nominee or child representative, make sure you follow the guidance in article Guide - Conversation style guide.

Note: for children with developmental delay, read article EC Guide – Check-in eligibility conversations for children younger than 6 with developmental delay before making contact attempts.

1.  Use articles Check a person's preferred contact method and Check consent, nominee,
     child representative or self-representation authorities to contact the participant, their
   nominee or child representative using their preferred contact method.

2.  Contact the participant, their nominee or child representative using article Contact
    attempts and unable to contact in an eligibility reassessment case. Your actions will be
     different depending upon if the person answers. If:

     o  Successful: introduce yourself and confirm if this is a suitable time for the call.
       Go to step 3.

     o  Unsuccessful: follow guidance in article Contact attempts and unable to
            contact in an eligibility reassessment case.

          Note: you must continue with the eligibility reassessment referral even if you
           are unable to contact the participant, nominee or child representative.

3.  Complete a security check to verify you're speaking to the correct person. Read article
   Consider a request for personal information, section How to complete a security
   check.

4.  Help the person understand the referral.

    Select the relevant talking points below:

     o   At times, we may check to see if the participant is still eligible for the NDIS.

     o  We call this an eligibility reassessment check, to see if an eligibility
          reassessment is required.

     o  We checked, and the participant may no longer meet eligibility requirements. Or
           they now meet early intervention, disability, or both eligibility requirements.

     o   Eligibility reassessments are separate from plan reassessments.

     o   Eligibility reassessments are completed by independent delegates.
          Independent delegate means one of our staff who hasn't made decisions about
            the participant's plan or eligibility before.

     o   Participants who are eligible under the early intervention requirements, have
           support needs that are more likely to change.

     o   We'll check each time a participant is due for a plan reassessment, whether
           they still meet early intervention requirements.

     o    If they've benefitted from early intervention supports, they might have built their
                skills and increased their capacity, so they no longer need NDIS supports.

     o  During check ins we'll explain what information we need to decide if they're still
               eligible.

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  o    If the participant no longer meets early intervention requirements, we'll check if
       they meet the disability requirements.

  o   We'll talk to families or carers before a child with developmental delay turns 6 or
         child with global developmental delay turns 7. We'll make sure we explain what
        information we need to decide if the child is still eligible.

  o    If the participant no longer meets the residence or disability and early
         intervention requirements, they'll leave the NDIS. They will no longer be a
         participant, and they'll be told when they'll leave the NDIS.

  o  For more information, refer to Our Guideline – Leaving the NDIS (external). You
      can also refer them to this information.

  o  The next steps are that a delegate will check through and consider if an
            eligibility reassessment is needed. You will be notified if this occurs.

5. Record your conversation in PACE using article Log an activity or internal note, to inform the access delegate that the participant has been notified of the referral. This also means the participant doesn’t have to retell their story when we contact them about their eligibility reassessment.

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6 Next steps

Once the referral has been submitted, the case will move to In Progress and route to the Eligibility Reassessment Routing Queue.

An access delegate will start an eligibility check in an Eligibility Reassessment case.

You can view the details and progress of this case from the Details tab of the Person Account.

1.    If the access delegate decides to change the eligibility status, you'll be notified in PACE.
    You'll support the person to receive the appropriate supports.

2.    If an access delegate decides the person is no longer eligible, you'll be notified in
  PACE. You'll support the person to:

     o   leave the NDIS and understand our eligibility decision, using Our Guideline –
          Leaving the NDIS (external)

     o  understand their rights when it comes to reviews and complaints, using Our
           Guideline – Reviewing our decisions (external)

     o   start or help maintain connections with community and mainstream supports,
           using Our Guideline – Community connections (external).

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Document 22

Access and Eligibility Reassessment (ER)

Practice Guide — Current NDIS Act 2013

The content of this document is OFFICIAL.

This guide assists the Scheme Eligibility Branch to assess new applicants’ eligibility and determine if existing participants remain eligible for the National Disability Insurance Scheme (NDIS).

This guide is designed to be used with the Access and Eligibility Reassessment (ER) Decision

Tree to make legislatively correct decisions for all eligibility reassessments and any initial access requests received on or after 3 October 2024. If you are making an access decision for a request received before 3 October 2024, refer to Access Practice Guide Previous NDIS

Act 2013 (C19).

1. Recent updates

2. Checklist

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3. Are you making an Access or ER decision?

For Access decisions, go to Section 4. Access — Age Requirements

For ER decisions, go to Section 9. ER— Residence Requirements

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  ## 4. Access – Age Requirements

4.1 Does the applicant meet the age requirements?

Legislation

Section 22 Age requirements

A person meets the age requirements if the person was aged under 65 when the access request in relation to the person was made.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant was aged under 65 when their access request was received as valid (that is, complete)

  ## 5. Access – Residence Requirements

5.1 Does the applicant meet the residence requirements?

Legislation

Section 23 Residence requirements

(1) A person meets the residence requirements if the person: (a) resides in Australia; and (b) is one of the following: (i) an Australian citizen; (ii) the holder of a permanent visa; (iii) a special category visa holder who is a protected Special Category Visa (SCV) holder.

(2) In deciding whether or not a person resides in Australia, regard must be had to:

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  (a) the nature of the accommodation used by the person in Australia; and
  (b) the nature and extent of the family relationships the person has in Australia; and
   (c) the nature and extent of the person’s employment, business or financial ties with
      Australia; and
  (d) the nature and extent of the person’s assets located in Australia; and
  (e) the frequency and duration of the person’s travel outside Australia; and
    (f) any other matter relevant to determining whether the person intends to remain
    permanently in Australia.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant:

• lives in Australia for most of the year; and

• is an Australian Citizen; or

• is the holder of a permanent visa; or

• is the holder of a protected Special Category Visa (SCV)

 ## 6. Access – Streamlined Decisions

6.1 List A

List A conditions that are likely to meet the disability requirements.

Note: A person does not need to have a condition on List A to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you meet the disability requirements?

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6.2 0-25 Hearing Impairments

An applicant meets the early intervention requirements without further assessment if they:

• are aged between birth and 25 years of age; and • have confirmed results from a specialist audiological assessment (including

electrophysiological testing when required) consistent with auditory neuropathy or hearing

loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be

permanent.

What to consider

This streamlined access approach for early intervention acknowledges a rich body of evidence that recognises that early intervention supports up to and including the age of 25 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

This same body of evidence suggests that brain development and language capability have been achieved by the age of 26. Therefore, adults aged 26 years and over are not immediately accepted to be likely to benefit from the same early intervention approach because there is no requirement to support the development of the auditory pathways. Adults aged 26 years and over with hearing impairment will therefore be assessed normally, on a case-by-case basis, having regard to the availability of all relevant evidence.

For further information, refer to Our Guidelines - What about people aged between 0 and 25 with a hearing impairment?

Applicants that have a List A condition who are under 7

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Applicants that have a List A condition who are over 7

Applicants that DON’T have a List A condition who are over 7

Applicants that DON’T have a List A condition who are under 7

6.3 List D

Where a child under the age of 7 has been diagnosed with a condition on List D, they will meet the early intervention requirements without further assessment.

Note: A child does not need to have a List D condition to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you need early intervention?

Applicants that have a List A condition who are under 7

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Applicants under the age of 7 who DON’T have a List A condition who are under 7

6.4 Developmental Delay

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person is a child who has developmental delay; and

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability; and

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

      (i)     mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, selfcare or self-management; or

       (ii)    preventing the deterioration of such functional capacity; or

       (iii)   improving such functional capacity; or

     (iv)   strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer; and

(d) the CEO is satisfied any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

Section 9 Definitions

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Developmental delay means a delay in the development of a child under 6 years of age that:

(a) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and

(b) results in substantial reduction in functional capacity in one or more of the following areas of major life activity:

     (i)  self-care;

     (ii) receptive and expressive language;

      (iii) cognitive development;

    (iv) motor development; and

(c) results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the child is younger than 6 on the day we determine they have developmental delay.

For further information, refer to [Our Guidelines - What about children younger than 6 with developmental delay?]

Applicants that have a List A condition who are under 7

Applicants that DON’T have a condition on List A who are under 7

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6.5 List B

Where an applicant has been diagnosed with a condition on List B, they will be considered to have a disability attributable to one or more conditions that are likely to result in a permanent impairment.

For applicants diagnosed with a condition on List B, you will only need to assess whether the applicant:

• has substantially reduced functional capacity to perform one or more activities; • is affected in their capacity for social or economic participation; and • is likely to require support under the NDIS for their lifetime.

Note: A person does not need to have a condition on List B to become a participant in the NDIS.

For further information, refer to [Our Guidelines - Is your impairment likely to be permanent?]

For applicants who meet any of the following and DON’T have a condition on List A:

• 0-25 Hearing Loss

• List D

• Developmental Delay criteria

For applicants who DON’T meet the criteria for any of the following:

• 0-25 Hearing Loss

• List D

• Developmental Delay

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7 Access - Early Intervention Requirements

For children under the age of 7 they are first assessed against the early intervention criteria. If they do not meet, then assess them against the disability requirements.

Before you commence the assessment, you must ensure the applicant meets both the age requirements and residency requirements.

7.1 Does the applicant meet Section 25(1)(a)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

  (a) the person:

          (i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or

           (ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant has an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and • the impairment is intellectual, cognitive, neurological, sensory, physical or psychosocial in nature; and • the impairment is, or is likely to be, permanent.

Note: When an applicant is diagnosed with a condition on List B or List D, they meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment? • Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?

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• Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success? • Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only? • Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes? • If there are evidence-based treatments not undertaken, why were they considered and deemed not suitable? • What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to [Our Guidelines - Do you need early intervention?]

7.2 Does the applicant meet Section 25(1)(b)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

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  (b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports for the applicant’s permanent impairment/s will reduce their need for disability-related supports in the future.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and indicate that this intervention will mean the applicant needs less disability supports in the future? • Does the evidence note which specific supports the applicant will no longer require should early intervention be undertaken? • Does the evidence indicate that early intervention is likely to result in greater independence for the applicant? • If the applicant has accessed intervention before, is the outcome noted? Did previous intervention reduce their need for disability related supports? • Is the recommended support of a functional nature, or capacity building in nature? • In answering the above questions, does the evidence contain sufficient information addressing: • How the applicant’s impairment is likely to impact them over time? • What supports the applicant will require if they don’t receive intervention? • What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to [Our Guidelines - How will early intervention help you?]

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7.3 Does the applicant meet Section 25(1)(c)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

   (c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

          (i)  mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self‑care or self‑management; or

           (ii) preventing the deterioration of such functional capacity; or

            (iii) improving such functional capacity; or

        (iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

When is this criterion considered met?

• This criterion is considered met if evidence on the record shows early intervention supports will help the applicant by:

• addressing the impact of their impairment on their ability to move around, communicate, socialise, learning, look after themselves, or organise their life • preventing their functional capacity from getting worse • improving their functional capacity • supporting their informal supports to build their skills to help the applicant.

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Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will mitigate or alleviate the impact of the applicant’s permanent impairment on their functional capacity? • Does the evidence contain specific recommendations for early intervention, and detail how this intervention will prevent the applicant’s functional capacity from declining? • Does the evidence contain specific recommendations for early intervention, and detail how this intervention will improve the applicant’s functional capacity? • Does the evidence indicate that intervention is likely to strengthen the sustainability of informal supports available to the person, and result in a decreased need for formal disability related supports? • In answering the above questions, does the evidence contain sufficient information addressing: • How the applicant’s impairment is likely to impact them over time? • What supports the applicant will require if they don’t receive intervention? • What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to [Our Guidelines - How will early intervention help you?]

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| | proceed to knowledge articles Prepare to make an access decision and Submit an access decision |

7.4 Does the applicant meet section 25(1)(d)?

Legislation

Section 25 Early intervention requirements

   (d) … any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports required are NDIS supports.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Can any of the supports which have been recommended be considered ‘NDIS Supports’? For the list of NDIS Supports see Supports that are NDIS Supports.

If none of the recommended supports are on the NDIS Supports list, or they are all supports the NDIS will not fund, then the applicant will not meet this criterion. For the list of supports the NDIS will not fund see Supports that are not NDIS Supports. Remember that you only need to have at least one support on the Supports that are NDIS Supports list to meet this criterion.

For further information, refer to [What does the NDIS fund?]

For applicants who do not have a List A impairment

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| | Go to Section 8.1 - Does the applicant meet Section 24(1)(a)? |

For applicants who have a List A impairment

8 Access – Disability Requirements

8.1 Does the applicant meet Section 24(1)(a)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

  (a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant has a disability (a reduction or loss in their ability to do things); and • their disability is caused by an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and • the impairment is intellectual, cognitive, neurological, sensory or physical in nature, or • they have a psychosocial disability (a reduced capacity to do daily life activities and tasks due to their mental health).

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Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate both that the applicant has an impairment, and that the impairment is resulting in a disability? • Does the evidence demonstrate that the applicant is reduced in their ability to do things, however this reduction cannot be reasonably attributed to an impairment? • Does the evidence demonstrate that the applicant has a loss or significant change in one of their body’s functions or structure. however, there is no indication that this is causing a reduction or loss in their ability to do things?

Note: A diagnosis is not required to meet this criterion: if the evidence shows the person has a disability caused by a relevant impairment, then they will meet 24(1)(a) – this is because we assess based on the impairment/functional impact.

For further information, refer to [Our Guidelines - Is your disability caused by an impairment?]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

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8.2 Does the applicant meet Section 24(1)(b)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

  (b) The impairment or impairments are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant has a:

• permanent impairment; or • likely permanent impairment.

Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment? • Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored? • Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success? • Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only? • Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes? • If there are evidence-based treatments not undertaken, why were they considered and deemed unsuitable?

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• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to [Is your impairment likely to be permanent? | NDIS]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

8.3 Does the applicant meet Section 24(1)(c)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

   (c) The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities: The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities:

          (i)  communication;

           (ii) social interaction;

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            (iii) learning

        (iv) mobility

       (v) self-care

        (vi) self-management

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, results in substantially reduced functional capacity in one or more of the following activities:

• Communication: how they speak, write or use sign language and gestures. • Social interaction: how they make and keep friends, interact with the community, and cope with feelings and emotions in social situations. • Learning: how they learn, understand and remember new things, and practise and use new skills. • Mobility: how they move around home and the community and how they get in and out of bed or a chair. • Self-care: how they partake in personal care, hygiene, grooming, eating and drinking, and health. • Self-management (if older than 6): how they organise their life, make decision, solve problems and manage money.

Note: When an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant is unable to participate effectively or completely (i.e. across the whole or majority of tasks) in one or more activities, without formally prescribed equipment? • Does the evidence demonstrate that the applicant is unable to participate effectively or completely in one or more activities, and usually requires the assistance of another person?

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• Does the evidence demonstrate that the applicant would be unsafe to complete one or more tasks required to participate in an activity without formally prescribed equipment or assistance from another person? • Does the evidence indicate that the applicant is able to participate in each activity effectively by using commonly used items? • Does the evidence indicate that the applicant is able to participate in each activity effectively, albeit more slowly or in a different way? • Would completing tasks more slowly or in a modified way, or using commonly used items, relieve the applicant’s need for personal assistance?

In answering the above questions, does the evidence contain sufficient information addressing:

• What specific tasks the applicant cannot complete without support? • Why the applicant requires support? • How often the applicant requires support, and what that support looks like?

For further information, refer to [Our Guidelines - Does your impairment substantially reduce your functional capacity?]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

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| | Please follow the process in knowledge articles Prepare to make an access decision and Submit an access decision |

8.4 Does the applicant meet Section 24(1)(d)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

  (d) The impairment or impairments affect the person’s capacity for social or economic participation.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, affects the applicant’s social or economic participation.

Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant’s social participation (e.g. their capacity to play sport, go to the movies, see friends, etc.) is affected by their permanent impairment/s - in any way? • Does the evidence demonstrate that the applicant’s economic participation (e.g., their capacity to travel, to find or maintain voluntary or paid work, etc.) is affected by their permanent impairment - in any way? • Does the evidence demonstrate that the applicant’s social and economic participation is not impacted in any way, and that they can fully engage without any assistance?

Note: There is no threshold that the person’s permanent impairment affects their social or economic participation. It just needs to be affected.

For further information, refer to [Our Guidelines - Does your impairment affect your social, work or study life?]

If the person does NOT meet the Early Intervention criteria

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If the person does meet the Early Intervention criteria

8.5 Does the applicant meet Section 24(1)(e)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

  (e) The person is likely to require NDIS supports under the National Disability Insurance Scheme for the person’s lifetime.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant:

• will likely require NDIS supports under the National Disability Insurance Scheme for their lifetime.

Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant is likely to require NDIS Supports, for their lifetime?

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• Does the evidence demonstrate that the applicant will likely be substantially reduced in their functional capacity (in a relevant activity) for their lifetime, despite any interventions?

• Are there any recommendations for interventions that are likely to improve the applicant’s functional capacity, and reduce their future need for disability related supports?

• If the applicant is a child or young adult, does the evidence indicate that significant functional improvements can be expected - either as they develop, or through interventions?

• Does the applicant’s need for support only relate to supports which the NDIS does not fund?

If none of the recommended supports are on the NDIS Supports list, or they are all supports the NDIS will not fund, then the applicant will not meet this criterion. For the list of supports the NDIS will not fund see Supports that are not NDIS Supports. Remember that you only need to have at least one support on the Supports that are NDIS Supports list to meet this criterion.

For further information, refer to [What does NDIS fund] and [Our Guidelines - Does your impairment affect your social, work or study life?]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

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| | Please follow the process in knowledge articles Prepare to make an access decision and Submit an access decision |

9 ER – Residence Requirements

9.1 Does the participant continue to meet the residence requirements?

Legislation

Section 23 Residence requirements

(1) A person meets the residence requirements if the person: (a) resides in Australia; and (b) is one of the following: (i) an Australian citizen; (ii) the holder of a permanent visa; (iii) a special category visa holder who is a protected SCV holder.

(2) In deciding whether or not a person resides in Australia, regard must be had to: (a) the nature of the accommodation used by the person in Australia; and (b) the nature and extent of the family relationships the person has in Australia; and (c) the nature and extent of the person’s employment, business or financial ties with Australia; and (d) the nature and extent of the person’s assets located in Australia; and (e) the frequency and duration of the person’s travel outside Australia; and (f) any other matter relevant to determining whether the person intends to remain permanently in Australia.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant:

• lives in Australia for most of the year; and

• is an Australian Citizen; or

• is the holder of a permanent visa; or

• is the holder of a protected Special Category Visa (SCV)

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10 ER – Streamlined Decisions

10.1 List A

[List A] conditions that are likely to meet the disability requirements.

Note: A person does not need to have a condition on List A to become a participant of the NDIS.

For further information, refer to [Our Guidelines - Do you meet the disability requirements?]

10.2 0-25 Hearing Impairments

An applicant meets the early intervention requirements without further assessment if they:

• are aged between birth and 25 years of age; and

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• have confirmed results from a specialist audiological assessment (including electrophysiological testing when required) consistent with auditory neuropathy or hearing loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent.

What to consider

This streamlined access approach for early intervention acknowledges a rich body of evidence that recognises that early intervention supports up to and including the age of 25 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

This same body of evidence suggests that brain development and language capability have been achieved by the age of 26. Therefore, adults aged 26 years and over are not immediately accepted to be likely to benefit from the same early intervention approach because there is no requirement to support the development of the auditory pathways. Adults aged 26 years and over with hearing impairment will therefore be assessed normally, on a case-by-case basis, having regard to the availability of all relevant evidence.

For further information, refer to [Our Guidelines - What about people aged between 0 and 25 with a hearing impairment?]

Participants that have a List A condition who are under 7

Participants that have a List A condition who are over 7

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Participants that DON’T have a List A condition who are over 7

Participants that DON’T have a List A condition who are under 7

10.3 List D

Where a child under the age of 7 has been diagnosed with a condition on List D, they will meet the early intervention requirements without further assessment.

Note: A child does not need to have a List D condition to become a participant of the NDIS.

For further information, refer to [Our Guidelines - Do you need early intervention?]

Participants that have a List A condition who are under 7

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Participants under the age of 7 who DON’T have a List A condition who are under 7

10.4 Developmental Delay

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person is a child who has developmental delay; and

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability; and

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

      (i)     mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, selfcare or self-management; or

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       (ii)    preventing the deterioration of such functional capacity; or

       (iii)   improving such functional capacity; or

     (iv)   strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer; and

(d) the CEO is satisfied any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

Section 9 Definitions

Developmental delay means a delay in the development of a child under 6 years of age that:

(d) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and

(e) results in substantial reduction in functional capacity in one or more of the following areas of major life activity:

     (i)  self-care;

     (ii) receptive and expressive language;

      (iii) cognitive development;

    (iv) motor development; and

(f) results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the child is younger than 6 on the day we determine they have developmental delay.

For further information, refer to [Our Guidelines - What about children younger than 6 with developmental delay?]

Participants that have a List A condition who are under 7

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| | • knowledge article KA – Finalise an Eligibility Reassessment decision | | Participants that don’t meet the Developmental Delay criteria | Go to Section 10.5 – List B |

Participants that DON’T have a condition on List A who are under 7

10.5 List B

Where an applicant has been diagnosed with a condition on List B, they will be considered to have a disability attributable to one or more conditions that are likely to result in a permanent impairment.

For applicants diagnosed with a condition on List B, you will only need to assess whether the applicant:

• has substantially reduced functional capacity to perform one or more activities; • is affected in their capacity for social or economic participation; and • is likely to require support under the NDIS for their lifetime.

Note: A person does not need to have a condition on List B to become a participant in the NDIS.

For further information, refer to [Our Guidelines - Is your impairment likely to be permanent?]

For participants who MEET any of the following and DON’T have a condition on List A:

• 0-25 Hearing Loss

• List D

• Developmental Delay criteria

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For participants who DON’T meet the criteria for any of the following:

• 0-25 Hearing Loss

• List D

• Developmental Delay

11 ER – Early Intervention Requirements

11.1 Does the participant meet Section 25(1)(a)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

  (a) the person:

          (i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or

           (ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the participant has an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and • the impairment is intellectual, cognitive, neurological, sensory, or physical in nature; and

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• the impairment is, or is likely to be, permanent.

Note: Where a participant is diagnosed with a condition on List B or List D, they meet this criterion without further assessment.

• What to consider

• Does the evidence demonstrate that the participant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment? • Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored? • Does the evidence indicate that the participant requires further treatment, and that this treatment has some prospect of success? • Does the evidence demonstrate that the participant requires ongoing treatment, but that it is for maintenance purposes only? • Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes? • If there are evidence-based treatments not undertaken, why were they considered and deemed not suitable? • What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to [Our Guidelines - Do you need early intervention?]

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| | Note: If the participant has a List A condition, they are eligible under the disability requirements and you can proceed to:

• knowledge article KA – Complete an Eligibility Check; or
• knowledge article KA – Finalise an Eligibility Reassessment decision |

11.2 Does the participant meet Section 25(1)(b)?

Legislation

Section 25 Early intervention requirements

(2) A person meets the early intervention requirements if:

  (b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports for the participant’s permanent impairment/s will reduce their need for disability-related supports in the future.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and indicate that this intervention will mean the participant needs less disability supports in the future? • Does the evidence note which specific supports the participant will no longer require should early intervention be undertaken? • Does the evidence indicate that early intervention is likely to result in greater independence for the participant? • If the participant has accessed intervention before, is the outcome noted? Did previous intervention reduce their need for disability related supports? • Is the recommended support of a functional nature, or capacity building in nature?

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In answering the above questions, does the evidence contain sufficient information addressing:

• How the participant’s impairment is likely to impact them over time? • What supports the participant will require if they don’t receive intervention? • What supports the participant currently requires, and what supports (if any) the participant is likely to require after intervention?

For further information, refer to [Our Guidelines - How will early intervention help you?]

11.3 Does the participant meet Section 25(1)(c)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

   (c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

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          (i)  mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self‑care or self‑management; or

           (ii) preventing the deterioration of such functional capacity; or

            (iii) improving such functional capacity; or

        (iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

When is this criterion considered met?

• This criterion is considered met if evidence on the record shows early intervention supports will help the participant by:

• addressing the impact of their impairment on their ability to move around, communicate, socialise, learning, look after themselves, or organise their life • preventing their functional capacity from getting worse • improving their functional capacity • supporting their informal supports to build their skills to help the participant.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will mitigate or alleviate the impact of the participant’s permanent impairment on their functional capacity? • Does the evidence contain specific recommendations for early intervention, and detail how this intervention will prevent the participant’s functional capacity from declining? • Does the evidence contain specific recommendations for early intervention, and detail how this intervention will improve the participant’s functional capacity? • Does the evidence indicate that intervention is likely to strengthen the sustainability of informal supports available to the person, and result in a decreased need for formal disability related supports? • In answering the above questions, does the evidence contain sufficient information addressing: • How the participant’s impairment is likely to impact them over time?

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• What supports the participant will require if they don’t receive intervention? • What supports the participant currently requires, and what supports (if any) the participant is likely to require after intervention?

For further information, refer to [Our Guidelines - How will early intervention help you?]

11.4 Does the participant meet Section 25(1)(d)?

Legislation

Section 25 Early intervention requirements

  (d) … any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows early intervention supports required are NDIS supports.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

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• Can at least some of the supports which have been recommended be considered ‘NDIS Supports’? For the list of NDIS Supports see Supports that are NDIS Supports.

If none of the recommended supports are on the NDIS Supports list, or they are all supports the NDIS will not fund, then the participant will not meet this criterion. For the list of supports the NDIS will not fund see Supports that are not NDIS Supports. Remember that you only need to have at least one support on the Supports that are NDIS Supports list to meet this criterion.

For further information, refer to [What does the NDIS fund?]

For participants who do not have a List A impairment

For participants who have a List A impairment

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| | • knowledge article KA – Complete an Eligibility Check; or
• knowledge article KA – Finalise an Eligibility Reassessment decision |

12 ER - Disability Requirements

12.1 Does the participant meet Section 24(1)(a)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

  (a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the participant has a disability (a reduction or loss in their ability to do things); and • their disability is caused by an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and • the impairment is intellectual, cognitive, neurological, sensory, or physical in nature, or • they have a psychosocial disability (a reduced capacity to do daily life activities and tasks due to their mental health).

Note: Where a participant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate both that the participant has an impairment, and that the impairment is resulting in a disability? • Does the evidence demonstrate that the participant is reduced in their ability to do things, however this reduction cannot be reasonably attributed to an impairment?

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• Does the evidence demonstrate that the participant has a loss or significant change in one of their body’s functions or structure, however, there is no indication that this is causing a reduction or loss in their ability to do things?

Note: A diagnosis is not required to meet this criterion: if the evidence shows the person has a disability caused by a relevant impairment, then they will meet 24(1)(a) – this is because we assess based on the impairment/functional impact.

For further information, refer to [Our Guidelines - Is your disability caused by an impairment?]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

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12.2 Does the participant meet Section 24(1)(b)?

Legislation

Section 24 Disability requirements

(2) A person meets the disability requirements if:

  (b) The impairment or impairments are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant has a:

• permanent impairment; or • likely permanent impairment.

Note: Where a participant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment? • Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored? • Does the evidence indicate that the participant requires further treatment, and that this treatment has some prospect of success? • Does the evidence demonstrate that the participant requires ongoing treatment, but that it is for maintenance purposes only? • Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes? • If there are evidence-based treatments not undertaken, why were they considered and deemed unsuitable?

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• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to [Is your impairment likely to be permanent? | NDIS]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

12.3 Does the participant meet Section 24(1)(c)?

Legislation

Section 24 Disability requirements

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(2) A person meets the disability requirements if:

   (c) The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities:

          (i)  communication;

           (ii) social interaction;

            (iii) learning

        (iv) mobility

       (v) self-care

        (vi) self-management

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, results in substantially reduced functional capacity in one or more of the following activities:

• Communication: how they speak, write or use sign language and gestures. • Social interaction: how they make and keep friends, interact with the community, and cope with feelings and emotions in social situations. • Learning: how they learn, understand and remember new things, and practise and use new skills. • Mobility: how they move around home and the community and how they get in and out of bed or a chair. • Self-care: how they partake in personal care, hygiene, grooming, eating and drinking, and health. • Self-management (if older than 6): how they organise their life, make decision, solve problems and manage money.

Note: When a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant is unable to participate effectively or completely (i.e., across the whole or majority of tasks) in one or more activities, without formally prescribed equipment?

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• Does the evidence demonstrate that the participant is unable to participant effectively or completely in one or more activities, and usually requires the assistance of another person? • Does the evidence demonstrate that the participant would be unsafe to complete one or more tasks required to participate in an activity without formally prescribed equipment or assistance from another person? • Does the evidence indicate that the participant is able to participate in each activity effectively by using commonly used items? • Does the evidence indicate that the participant is able to participate in each activity effectively, albeit more slowly or in a different way? • Would completing tasks more slowly or in a modified way, or using commonly used items, relieve the participant’s need for personal assistance?

In answering the above questions, does the evidence contain sufficient information addressing:

• What specific tasks the participant cannot complete without support? • Why the participant requires support? • How often the participant requires support, and what that support looks like?

For further information, refer to [Our Guidelines - Does your impairment substantially reduce your functional capacity?]

If the person does NOT meet the Early Intervention criteria

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If the person does meet the Early Intervention criteria

12.4 Does the participant meet Section 24(1)(d)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

  (d) The impairment or impairments affect the person’s capacity for social or economic participation.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, affects the participant’s social or economic participation.

Note: Where a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant’s social participation (e.g., their capacity to play sport, go to the movies, see friends, etc.) is affected by their permanent impairment/s - in any way? • Does the evidence demonstrate that the participant’s economic participation (e.g., their capacity to travel, to find or maintain voluntary or paid work, etc.) is affected by their permanent impairment - in any way?

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• Does the evidence demonstrate that the participant’s social and economic participation is not impacted in any way, and that they can fully engage without any assistance?

Note: There is no threshold that the person’s permanent impairment affects their social or economic participation. It just needs to be affected.

For further information, refer to [Our Guidelines - Does your impairment affect your social, work or study life?]

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

12.5 Does the participant meet Section 24(1)(e)?

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Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

  (e) The person is likely to require NDIS supports under the National Disability Insurance
   Scheme for the person’s lifetime.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant:

• will require or is likely to require NDIS supports for their lifetime.

Note: Where a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant is likely to require NDIS Supports, for

their lifetime?

• Does the evidence demonstrate that the participant will likely be substantially reduced in

their functional capacity (in a relevant activity) for their lifetime, despite any interventions?

• Are there any recommendations for interventions that are likely to improve the participant’s

functional capacity, and reduce their future need for disability related supports?

• If the participant is a child or young adult, does the evidence indicate that significant

functional improvements can be expected - either as they develop, or through

interventions? • Does the participant’s need for support only relate to supports which the NDIS does not

fund?

If none of the recommended supports are on the NDIS Supports list, or they are all supports the NDIS will not fund, then the participant will not meet this criterion. For the list of supports the NDIS will not fund see Supports that are not NDIS Supports. Remember that you only need to have at least one support on the Supports that are NDIS Supports list to meet this criterion.

For further information, refer to What does NDIS fund and Our Guidelines - Does your impairment affect your social, work or study life?

If the person does NOT meet the Early Intervention criteria

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If the person does meet the Early Intervention criteria

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13 Related procedures or resources

• National Disability Insurance Scheme (Becoming a Participant) Rules 2016 • Current NDIS Act 2013 • Our Guidelines - Applying to the NDIS • KA – Prepare to make an access decision • KA – Submit an access decision • KA – Complete an Eligibility Check • KA – Finalise an Eligibility Reassessment decision • Access and ER Decision Tree

14 Feedback

If you would like to provide feedback about this guidance material, please discuss with your team leader who can send a request to SEB.BUSINESSIMPROVEMENT @ndis.gov.au.

15 Version control

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Functional Phone Calls

The content of this document is OFFICIAL

A further information call can assist in determining many different criteria. This guide assumes Section 24(1)(b) has been met and focusses on a functional call to assist in determining Section 24(1)(c). Information in this call should expand on the primary information provided by a treating health professional. If new information is received and you are using this to form your decision it must be confirmed in writing from the treating health professional. Each person has their own individual needs, preferences and experiences, therefore the same impairment can impact people in different ways. It is important to take this into consideration when completing a functional call.

redacted: s47E(d) - certain operations of agencies

a

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