NDIA Accountability Project

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Make an access decision - Post legislation changes

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Make an access decision - Post legislation changes

Guidance in this document is not approved for use unless you view it in PACE.

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

  • check legislative timeframes
  • complete disability evidence
  • request further information
  • 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)
  • 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 of access decision to decide which version of the legislation and article you need to use to make an access decision.

Use this article if you need to use the post-legislation changes version of the legislation to make an access decision.

Recent updates

9 December 2024 Updated to help you understand how and when to manually send automatic letters to statutory guardians if the participant has a statutory guardian.

Before you start

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  • completed the pre-assessment and checked you need to use the post-legislation changes version of the legislation to make an access decision using article Complete pre-assessment for an access decision
  • checked there is evidence of identity or an internal note to explain why it can’t be provided
  • checked the application is complete with evidence of consent to apply, age, residence and disability
  • read article Check eligibility – age and residence requirements
  • read article Understand disability requirements
  • read article Understand early intervention requirements.

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.

  1. 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 disability evidence.
    • outside legislative timeframes: use article Check decision – legislative timeframes to record an internal note. Then go to section Complete disability evidence.

Complete disability evidence

Links to evidence documents in the access request case will display here.

  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 of access decision.
  2. At Select assessed Impairment, enter text into the field and a list will display. Select relevant option.
  3. Make a note of the assessed impairment name and ICD code. You will need this for section Decision Main Criteria.

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  1. At What evidence was used to confirm the Impairment?, select the appropriate option. Note: Defined Program no longer populates the access decision.
  2. 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.
  3. For more information about list conditions, go to articles:
  • Check eligibility – List A condition
  • Check eligibility – List B condition
  • Check eligibility – List D condition.
  1. Select Add next to Impairment Assessment to record additional impairments. If an:
  • access met decision, add all impairments that meet eligibility requirements
  • access not met decision, add all reported impairments.

Request further information

  1. Decide if you need more information to make an access decision. Only request more information if:
  • the application is complete
  • you need more evidence after receiving the applicant’s disability evidence.
  1. 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.
  2. At Do you require further information from the applicant?, select Yes or No. If:
  • No, select Next, then go to section Approve or override streaming case.

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  • Yes, continue to next step.

Step-by-step instructions:

  1. At Enter the Required Information below, copy relevant templates from Templates for requesting further information to make a decision – Post-legislation changes.
  2. Select Next.
  3. Select one or more of the criteria for the requested information from the provided tick boxes.
  4. Select Next.
  5. Select Done.
  6. Select Next.
  7. At Do you want to preview the document before sending it?, select Yes.
  8. Complete Select a Recipient for preview to preview the letter.
  9. If correct, select Next. If incorrect, select Previous to update the fields that populate the letter.
  10. Select Submit Correspondence.
  11. Select Next. 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.

Check correspondence

  1. From the Person Account case, select the Documents tab.
  2. Check for Further Information Requested letter. Category will be Outbound Correspondence. If:

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  • Yes, if there is a justice liaison officer, go to section Notify the justice liaison officer (JL) (if relevant). If not, go to section Next steps.
  • No, go to next step.
  1. Submit a Report a defect with PACE, my NDIS Provider or Participant Portal, or my NDIS App ticket
  2. Share the ticket with your team leader and assistant director.
  3. If there is a justice liaison officer, go to section Notify the justice liaison officer (JL) (if relevant). If not, go to section Next steps.

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

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.

Assign the enquiry case

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  1. From the Enquiry case, select the Change Owner icon next to the current Case Owner.
  2. At the Search Users free text field, search for the MyNDIS Contact.
  3. Select the tick box next to Send notification email.
  4. Select Change Owner.
  5. Go to section Next Steps.

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 they need to engage with the NDIS.

Generally, the streaming case is completed by a local area coordinator, early childhood partner or planner and the case routes to an access delegate for approval.

  1. Check for a streaming case. A streaming case must be completed and approved before completing the access decision case. If:
    • Yes, 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.

Record access decision

Age and Residency Sub Criterion

  1. Use article Check eligibility – age and residence requirements to help you decide if the age and residence requirements are met.

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

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

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  • Yes, go to section Residency Criterion 1: (Section 23(1)(a)) to consider the next criteria.
  • No, continue to next step.

Step 2

Select Next.

Step 3

Select N/A for all early intervention and disability requirements. You don’t need to consider the remaining eligibility requirements.

Step 4

Go to section Evidence Used for Decisions.

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

  • 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 consider the next criteria.
    • No, continue to next step.

Step 2

Select Next.

Step 3

Select N/A for all early intervention and disability requirements. You don’t need to consider the remaining eligibility requirements.

Step 4

Go to section Evidence Used for Decisions.

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

  • At Is the applicant an Australian Citizen or a Current Eligible Visa Holder? select Yes or No. If:
    • Yes, select Next and go to section Early Intervention Sub Criteria to consider the next criteria.
    • No, continue to next step.

Step 2

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

Step 3

Select Next.

Step 4

Select N/A for all early intervention and disability requirements. You don’t need to consider the remaining eligibility requirements.

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Early Intervention Sub Criteria

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

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)(i) 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 consider if the child has a developmental delay that meets the early intervention requirements.

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

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?

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  • Select Yes or No.

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?:

    • Select Yes or No.

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.

    • Select Next.

Disability Sub Criterion

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

  2. Consider 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 consider the remaining disability requirements based on the evidence.

  3. If none of the above, consider 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 is not met.

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)?:

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  • Select Yes or No.

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.

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

  1. At Does the impairment(s) result in substantially reduced functional capacity?:• Select Yes or No.

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

  1. At Does the impairment affect the person’s capacity for social and economic participation?:• Select Yes or No.

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.

Evidence Used for Decisions (access not met only)

  1. For any access criteria the person does not 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.
  1. Select Next.

Decision Main Criteria

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  • Does the person meet Age Criteria
  • Does the person meet Residency Criteria
  • Does the person meet Disability Criteria
  • Does the person meet Early Intervention Criteria
  • Overall decision.

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

  1. If Overall decision is:
    • Access Not Met, go to step 9.
    • Access Met, go to next step.
  2. Open article Impairment categories guide to complete the next steps.
  3. Search the ICD 10 Code or Condition name for all impairments that meets the requirements for disability, early intervention, or both.
  4. Note the Required impairment category column.
  5. Consider if any of the Optional impairment categories in the guide apply based on the evidence provided:
    • Intellectual
    • Cognitive
    • Neurological
    • Sensory
    • Physical
    • Psychosocial For more information, go to article Descriptions of impairment categories.
  6. 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
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  • Neurological
  • Sensory
  • Physical
  • One or more impairments to which a psychological disability is attributable
  • Developmental Delay.

  1. 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
    • Cognitive
    • Neurological
    • Sensory
    • Physical
    • One or more impairments to which a psychological disability is attributable. Note: this is important as we only fund NDIS supports for eligible impairments that meet the requirements for disability, early intervention or both.

  2. If the decision isn’t correct: Select Back.

    • Re-check and update previous criteria as per above steps.

  3. If the decision is correct:

    • Select Save for later.

If access met for applicant with chronic health condition You must request technical advice from the Technical Advisory and Practice Improvement branch (TAPIB). First send a technical support request to SEB.QUALITY to request Quality Development Officer (QDO) feedback. If the QDO agrees, request technical advice from TAPIB using the following articles: - Create a technical advice case

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  • Complete the risk matrix for a technical advice case
  • Review and action returned technical advice case.

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

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 technical support request (Review Request: Under 25 Psychosocial) to SEB.QUALITY to request QDO feedback.
  2. If the QDO agrees, they will email your team leader or assistant director to request endorsement.

If access met and the applicant resides in hospital You must ask for QDO feedback.

  1. Send a technical support request to SEB.QUALITY to request QDO feedback. They will decide if TAPIB advice is required.

Submit decision for quality check

Submit proposed decision for potential quality check

  1. Complete the Access Assessor Outcome 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.

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 next step.

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  1. Re-assess and amend access decision in line with the feedback.
  2. From the Decision Main Criteria screen, select Save for later.
  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 to SEB.QUALITY. If you don’t agree with the feedback, contact your team leader about the reconsideration process.

Approve access decision

  1. Return to Decision Main Criteria view.
  2. Select Approve to submit decision.
  3. Go to section Complete access decision correspondence.

Complete access decision correspondence

Automated Access Met letter

  1. Check the correspondence preferences of the applicant are correct. 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.
  4. A letter preview will generate.
  5. If correct, select Next. If incorrect, select Previous to update the fields that populate the letter.
  6. 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

Knowledge Article

For Internal Use Only

To send a decision letter to the statutory guardian, go to article Send a letter to a statutory guardian or trustee.

Step-by-step process:

  1. At Correspondence Summary, select Next.
  2. Select Done to close the access decision case.
  3. In the Access Decision case, select the Documents tab.
  4. Check for Outcome of Application – Eligible letter. Category is Outbound Correspondence. If:
    • Yes: go to section Check disabilities tab
    • No: go to next step.
  5. Submit a Report a defect with PACE, my NDIS Provider or Participant Portal, or my NDIS App ticket.
  6. Share the ticket with your team leader and assistant director.
  7. Go to section Next steps.
  8. Select Done to close the access decision case.
  9. Complete the manual access not met letter using these articles:
    • Letter – Access not met decision
    • Template – Access not met decision – post legislation changes. Note: only the letter text is required from this resource. Interactions are not required.
  10. Use article Send a manual letter to complete this process.

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

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Knowledge Article

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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. At Enquiry Type, select Partner Supported Access.
  5. At Category, select General Information.
  6. 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. 7. At Enquiry Outcome select Re-assign this enquiry to another user. 8. At Case Re-assignment Reason select Referral to Partner. 9. At Select User or Queue select User. 10. At Case Owner enter the applicant’s MyNDIS Contact.

Check disabilities tab (access met only)

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The Disabilities tab must include all impairments that meet the requirements for disability, early intervention or both as this affects planning.

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 a person account to:
    • add impairments that meet the eligibility requirements
    • remove any impairments that don’t meet the eligibility requirements by adding an End Date.

Assign plan approval case (Motor neurone disease only)

If you are in the Priority Health Access Team and have made an access met decision for an applicant with Motor neurone disease (also known as Lou Gehrig’s disease or Amyotrophic lateral sclerosis), 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 the Change Owner icon next to the current Case Owner.
  2. Select the Users icon (on the left of the search bar) then select Queues.
  3. At the Search Users free text field, search and select Aged Care Referral Routing Queue.
  4. Select Change Owner.

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.

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

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

Article labels

PACE user role names

No change.

Topics

No change.

Case names

No change.

Ownership

No change.

Version control

Version Amended by Brief Description of Change Status Date
4.0 EMN960 Class 1 update - PACE national expansion hypercare
Guidance update to routing rules when user actions ‘Mark Application as Invalid’.
Feedback form link added to notify AO’s team leaders.
EL2 review and approval to QA and publish		 APPROVED 2024-02-20

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Version Ref Description Status Date
5.0 JC0088 Class 2 approval - Changes to support July system release – to support upcoming access legislation changes APPROVED 2024-08-07
6.0 JC0088 Class 2 approval - Updates made to incorporate legislation changes APPROVED 2024-09-25
7.0 VFK746 Class 1 Approval APPROVED 2024-10-02
8.0 VFK746 Class 1 Approval APPROVED 2024-10-10
8.1 REB563 Class 1 update to tell staff if the participant has a statutory guardian, they need to manually send automatically generated letters to statutory guardians DRAFT 2024-11-11
9.0 ED0024 Class 1 Director approval APPROVED 2024-11-20

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Check decision – legislative timeframes

This article provides guidance for an access delegate to:

  • understand application decision timeframes
  • check if application is outside the legislative timeframe
  • record when application is outside the legislative timeframe.

Recent updates

December 2023

Guidance improvement with knowledge update and PACE alignment, includes:

  • both service level agreements (SLA) for 21 and 14 days
  • how to check if SLA is overdue for the access decision.

Before you start

You have:

Application legislative timeframes

Understand access decision timeframes

When a person applies to become a NDIS participant, you have 21 days to make a decision on the application. You must decide which of the following applies:

  • the application is access met
  • the application is access not met
  • we need more information to make a decision.

For more information, refer to the How do we decide if you’re eligible? section in Our Guideline - Applying to the NDIS.

SGP Knowledge Article Template

For Internal Use Only

If you need more information, the applicant will need to provide additional evidence. When this evidence is submitted, you have 14 more days to decide from the three options above.

For more information, refer to Our Guideline - Applying to the NDIS, in section What if we need more information to decide if you’re eligible?

Check legislative timeframes

* From Details tab in Access Decision case. It must be the access decision case.
* At case dashboard, check the Priority status is Overdue. The status can also be found in Case Information.
* At Case Activity tab, scroll to Case Milestones.
* A ticked Violation check box confirms application is outside the legislative timeframes:

    * If yes – record an internal note, go to Record application is outside the legislative timeframe in this article.
    * If no – go to Next Steps in this article.

Record application is outside the legislative timeframe

If the decision for an application takes longer than the legislative timeframe, you must record this in an internal note as internal communication in PACE.

1. Utilise article Log an activity or internal note.
2. Record with Outside legislative timeframe (template):

   Legislative Timeframe Not Met

 An access decision was not made in the legislative timeframe of  <choose applicable – 14 / 21> days.

 Under s21(3) the applicant is taken to not meet the access requirements, and under s100, an internal review of the decision was commenced.

 As a delegate of the CEO, I <User ID> have reviewed and overturned the decision to avoid further delays for the applicant. The access request will now be re-considered.

Next steps

  • After recording the internal note, resume the application assessment. Continue to follow the guidance in article Make an access decision.

Article topics and case names – internal use only

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SGP Knowledge Article Template

For Internal Use Only

Topics

This article relates to the following topics:

  • t_applying
  • t_createaplan.

Case names

You can use this guidance for the:

  • dc_case_accessrequest
  • dc_case_checkin
  • dc_case_planapproval.

Version control

Version Amended by Brief Description of Change Status Date
1.1 GCP654 Update for Staff Experience micro release DRAFT 2023-02-27
1.2 LCM135 CI-Applying work package DRAFT 2023-10-17
1.3 DFB448 Peer review DRAFT 2023-10-20
1.4 LCM135 Respond to Peer Review feedback DRAFT 2023-10-23
1.5 LCM135 VT Review
Number of long sentences: 6 (7.79%)
Number of Passive Sentences: 3 (3.90%)
Readability: 49
Grade Level: 7.9 DRAFT 2023-10-24
1.6 LCM135 Respond to VT Review feedback DRAFT 2023-10-24
1.7 VFK746 EL1 review — progress to BILs and Domain for review DRAFT 2023-11-03
1.8 LCM135 BILs feedback DRAFT 2023-11-10
1.9 LCM135 Respond to BILs feedback DRAFT 2023-11-10

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SGP Knowledge Article Template

For Internal Use Only

Version Amended by Brief Description of Change Status Date
1.10 TER030 Guidance lead review and update from BILs and Domain consultation: DRAFT 2023-11-17
1.11 VFK746 EL1 review – progress to EL2 for QA and publishing approval DRAFT 2023-11-21
2.0 EMN960 EL2 approval APPROVED 2023-11-21

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SGP Knowledge Article Template

For Internal Use Only

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Complete pre-assessment for an access decision

Guidance in this document is not approved for use unless you view it in PACE.

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

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

Recent updates

4 November 2024

Guidance added for cancelling an access decision case.

14 October 2024

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

Before you start

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Accept an access decision case

  1. At Home page, select Omni-Channel tab at the bottom of the screen.
  2. A Status message will appear. Select Available from the drop-down list.
  3. Select the tick box for the case to make a decision on. The Access Decision case will open.
  4. Set Omni-Channel status to Offline. This will make sure you’re only allocated one case at a time to complete.

Check prioritisation

  1. Select Details tab.
  2. Review and note the Prioritisation. If the access request is complete and there’s a Prioritisation Reason, you have 2-5 business days to make an access decision or request further information. For more information go to article Request priority eligibility decision.
  3. Select Decision tab. The Pre-Assessment screen will display.

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

Review key information

  1. Select the Progress Case button to move the status from New to In Progress.
  2. Review Key Information, including:
  • Name
  • Date of Birth
  • Age
  • Home Address
  • Australian Citizenship
  • Permanent Resident

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Complete initial checks

Complete procedural fairness check

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

  1. If you have a conflict of interest, then you must unassign the work item.
  2. Check you’re an independent delegate to work on an application decision. To be independent means you:
    • don’t have a personal interest in the applicant’s status
    • don’t have a relationship with the applicant outside the NDIA
    • haven’t made a previous access not met or revocation decision for the applicant. Note: For more information, go to the Policy Hub – Conflict of Interest.
  3. Do you have a conflict of interest (COI)? If:
    • No, at Sent back to queue?, Select No and go to section Check for eligibility evidence not linked to the case.
    • Yes, go to section Unable to complete Access Decision – Send back to queue.

Check there is no internal review or ART review in progress

  1. From the Person Account screen, select the Cases tab.
  2. Under Open Cases, check if there’s an Internal Review case or Administrative Review Tribunal (ART) review. If:
    • No, go to section Check if remote, YPIRAC or terminal illness.
    • Yes, go to next step.
  3. Check if the review is for an access decision or revocation decision. If:

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  • access decision, go to section Mark application as invalid.
  • revocation decision, go to next step.
  1. Check when revocation decision was made. If:
    • on or after 3 October 2024, go to section Mark application as invalid.
    • before 3 October 2024, contact your team leader to decide next steps.

Check if remote, YPIRAC or terminal illness

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

  • lives in a remote or very remote location (MMM6 and MMM7) Note: for more information go to Modified Monash Model (external)
  • is a younger person in residential aged care, also known as, YPIRAC
  • is living with a terminal illness
  • is living with Motor Neurone disease or Kennedy’s disease
  • has unavailable treatment options. If you’re not in these teams, you need to change the case owner of the access decision case.
  1. Check if one of the above situations applies. If the applicant:
    • lives in a remote or very remote location (MMM6 and MMM7), change Case Owner to s47F - personal privacy (DJS497).
    • is a younger person in residence aged care (YPIRAC), change Case Owner to s47F - personal privacy (SCM231).
    • is living with a terminal illness, go section Update subject to terminal illness
    • is living with Motor Neurone disease or Kennedy’s disease, go to section Update prioritisation reason to Motor Neurone Disease.
    • has unavailable treatment options, go to section Complete the specialises cohort – unavailable treatments form.

Update subject to terminal illness

  1. From the Access Decision case, select the Details tab.
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  1. At Subject, select Edit Subject, which looks like a pencil icon.
  2. Enter Terminal Illness.
  3. Select Save.
  4. Repeat steps above for the Access Request case.
  5. Change Case Owner to Access Decision Routing Queue.
  6. Update prioritisation reason to Motor Neurone Disease From the Access Decision case, select the Details tab.
  7. Scroll down to Prioritisation.
  8. Select Edit, which looks like a pencil icon, next to Prioritisation Reason.
  9. At Prioritisation Reason, select Disability.
  10. At Priority Description, select Motor Neurone Disease.
  11. Select Save.
  12. Change Case Owner to Access Decision Routing Queue.

Complete the specialises cohort – unavailable treatments form

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

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

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

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

Unable to complete Access Decision – Send back to queue

  1. At Sent back to queue?, select I am no longer able to complete this Access Decision.
  2. At Reason, select the relevant option.
  3. At Justification, enter details about the conflict of interest.
  4. Select Next.

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

Check for eligibility evidence not linked to the case

  1. Check for eligibility evidence not linked to the access decision case that needs to be considered. This includes evidence in SAP CRM, enquiries inbox and enquiry cases.
  2. Check the Account Timeline for any cases, alerts, tasks or log activities relevant to the case. For further guidance, refer to article View the Person Account Timeline.
  3. If required, add and link any eligibility evidence to the access decision case. Go to article Add and link evidence to a case.

Check for Access Integrity Management referral (AIM) tasks

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

  1. From the Person Account, check the Account Timeline for any AIM referral tasks. For further guidance, refer to article View the Person Account Timeline. If:
    • No, go to section Check authorised representatives.
    • Yes, open the task and review Comments for instructions under Task Information.

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

Check authorised representatives

This will make sure that correspondence is generated correctly.

  1. From the Person Account, select the Relationships tab.
  2. Select the Authorised Reps tab.
  3. Check the authorised representative is listed and their correspondence details are correct, if there’s evidence to compare to.

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

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Check if access request is complete

  1. Check if there’s an internal note that records who provided consent to apply. For how to find internal notes, go to article View the Person Account Timeline.
  2. Use article Applicant consent to apply to look at whether the person has consent to apply on behalf of the applicant. If:
  • The applicant or their authorised representative provided consent, go to section Verify identity.
  • The person doesn’t have consent or there’s no internal note, go to section Mark application as invalid.

Verify identity

  1. Check the correct identity documents have been provided and verified for the applicant, and their authorised representative, if they have one. Go to article Understand how to verify identity documents.
  2. If all of the required identity documents aren’t provided and verified, check if there’s an internal note that explains a genuine reason why. If there’s an internal note, contact your team leader to decide next steps.

Note: Identity documents with a Verification Status of Verified DVS don’t need to be uploaded. All other documents must be uploaded to the person account. 3. If identity is:

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

Verify age and residence

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For Internal Use Only

Step-by-Step Process:

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

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

Step 2: Verification of Information

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

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

Check Evidence of Disability

Step 1: Evidence Verification

Check if the evidence of disability has been provided. If:

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

Step 2: Developmental Delay Check

Check if a child younger than 6 with developmental delay:

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

Step 3: Early Childhood Partner Evidence

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

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

Note

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

Complete Identity Evidence

Step 1: Verification Questions

Select Yes or No for questions:

  • Have you verified the Evidence of Age?

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  • Have you verified the Evidence of Residency?
  • Have you verified the Evidence of Identity?

Note: You can’t complete the access decision case until the evidence has been verified and you select Yes for all questions.

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

Mark application as invalid

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

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

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

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

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

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

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

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

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

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

Cancel an Access Decision case

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

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

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

The Cancel Case button is available when:

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

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

  1. Select the Cancel Case button in the top right hand corner of the Access Decision case.
  2. At Closure Reason select Administration error. Note: This is the only reason an access decision can be cancelled.
  3. At Closure Comments enter details as to why the case is being closed.
  4. Select Confirm. A note will state the case is now closed.
  5. Select Done to finish the process.

Next steps

  1. Check Legislation version that will be used for the access decision. Go to section above Review key information to find this. If using:
  • National Disability Insurance Scheme Amendment (getting the NDIS Back on Track No.1) Bill 2024, go to article Make an access decision – Post-legislation changes.

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Knowledge Article

For Internal Use Only

Note: This is the latest version of the National Disability Insurance Scheme Act 2013 which incorporates amendments as per the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No.1) Bill 2024.

Article labels – internal use only

PACE user role names

No change

Topics

No change

Case names

No change

Ownership

No change

Version control

Version Amended by Brief Description of Change Status Date
1.0 JC0088 Class 2 approval Content split from article Make an access decision APPROVED 2024-08-07
2.0 IIW664 Class 1 Approval Guidance updated to remove instruction to check and move chevron in the access request case. APPROVED 2024-08-21
3.0 JC0088 Class 2 Approval APPROVED 2024-09-25

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| | | | | |-|—————–|————————————|——————|—————– | | | Incorporate legislation changes | | | | | | | | | | 4.0 | VFK746 | Class 1 Approval New step to complete the specialises cohort – unavailable treatments form if there are no available treatment options for the applicant. | APPROVED | 2024-09-30 | | | | | | | | | | | | | 5.0 | IIW664 | Class 1 Approval Guidance updated to reflect legislation to start a new body called the Administrative Review Tribunal (ART). The ART replaced the Administrative Appeals Tribunal (ART) on Monday 14 October 2024. Updates include: Administrative Review Tribunal (ART) changed to Administrative Appeals Tribunal (ART) throughout. | APPROVED | 2024-10-07 | | | | | | | 6.0 | CS0074 | Class 2 Approval | APPROVED | 2024-10-28

Understand early intervention requirements

Guidance in this document is not approved for use unless you view it in PACE.

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

  • understand eligibility under the early intervention requirements.

Recent updates

3 October 2024

Updates to reflect legislation changes from 3 October 2024:

  • Applicants may now meet both disability and early intervention requirements, instead of just one.
  • The requirements for early intervention have changed from ‘early intervention you need is most appropriately funded by the NDIS’ to ‘Early intervention supports that are likely to benefit you will be NDIS supports.’

Before you start

You have:

Overview

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

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

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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.

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.

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.

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.

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  • 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.

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 – pre-legislation changes or Make an access decision – post legislation changes. • To make an eligibility reassessment decision, continue to article Finalise eligibility reassessment decision.

Article labels – internal use only

PACE user role names

No change.

Topics

No change.

Case names

No change.

Ownership

No change.

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Version control

Version Amended by Brief Description of Change Status Date
1.0 EMN960 Class 1 approval New article adapted from multiple access El-decision child “check evidence for a decision…” articles. APPROVED 2023-07-07
2.0 JC0088 Class 2 SG BM approval. Updates to reflect legislation changes from 3 October 2024: APPROVED 2024-08-29

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SGB Knowledge Article Template

For Internal Use Only

The contents of this document are OFFICIAL.

Understand disability requirements

Guidance in this document is not approved for use unless you view it in PACE. This article provides guidance for all NDIA staff and partners to understand:

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

Recent updates

3 October 2024 Updates to reflect legislation changes from 3 October 2024: Applicants may now meet both disability and early intervention requirements, instead of just one. The disability requirement has changed from lifetime supports under the NDIS to NDIS supports for their lifetime.

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.

Overview

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

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

Disability requirements

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SGB Knowledge Article Template

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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.

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.

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.

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?

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For Internal Use Only

  • 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?

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 – pre- legislation changes or Make an access decision – post legislation changes.
  • To make an eligibility reassessment decision, continue to article Finalise eligibility reassessment decision.

Article labels

PACE user role names

No change.

Topics

No change.

Case names

No change.

Ownership

No change.

Version Control

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SGB Knowledge Article Template

For Internal Use Only

Version Amended by Brief Description of Change Status Date
1.0 EMN960 Class 1 approval New article split from ‘Check evidence for a decision – impairment caused disability’ APPROVED 2023-07-07
2.0 JC0088 Class 2 SG BM approval Updates to reflect legislation changes from 3 October 2024 APPROVED 2024-08-29

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New item

Which system was this item completed in?

  • PACE
  • CRM

Was this item completed in Overtime?

  • Yes
  • No

What are you submitting? *

  • Proposed decision for a potential quality check (Reminder: Click “Save for Later” on the decision)
  • Work item or outcome

When was this outcome completed?

  • Today
  • Not Today

NDIS number * Enter a number

Applicant name Enter value here

Was this a Priority or Specialised cohort?

  • Yes
  • No

Did you complete any end to end (E2E) processing?

Did you progress an Access decision?

  • Yes
  • No

Did you progress an Eligibility Reassessment decision?

  • Yes
  • No

Did you seek advice from any stakeholders?

  • Yes
  • No

Were there any quality checking processes involved in the decision?

  • Yes
  • No

What is the applicant’s primary disability?

Enter value here

Does the access request indicate compensation?

  • Yes (Ensure “KA — Check for compensation when recording disabilities” is followed)
  • No

Did you complete any phone calls or respond to email enquiries?

  • Yes
  • No

NDIS Access Decision

Applicant NDIS number:

<If you’re sending to the applicant, delete the below section. If the recipient isn’t the applicant, add the recipient’s NDIS number. Delete this instruction.>

Your NDIS number:

Dear <Applicant/Representative Given Name>,

I am writing to let you know the outcome of <your/applicant’s full name’s> application for the National Disability Insurance Scheme (NDIS).

Decision outcome

I have considered <your/applicant’s name’s> application. Based on the evidence provided <your/their> circumstances do not meet the <age/residence/disability or early intervention> requirements described in the Click or tap to enter an option.

This means, based on current information,<you/applicant’s name> <are/is> not eligible for the NDIS. I am sending you this letter to provide you with <your/their> access decision in writing. Delete the following sentence or include it, if it is relevant

<I attempted to contact you to discuss this decision, but I was unable to reach you.>

How did we make the decision?

The NDIS Act requires that a person meets the following requirements to be eligible for the NDIS:

  • Age (s22); and
  • Residence (s23); and

Instructions for adding the right eligibility criteria

If you made the decision using National Disability Insurance Scheme Act 2013 (6 July 2024 version):

  • Insert option 1. Delete all red text and option 2.

If you made your access decision using National Disability Insurance Scheme Act 2013 (3 October 2024 version):

  • Insert option 2. Delete all red text and option 1.

Option 1:

  • <Disability (s24) or early Intervention requirements (s25)>

Option 2:

  • <Disability (s24) or early Intervention requirements (s25), or both>

I considered <your/applicant’s name’s> NDIS application and the evidence you provided against these requirements. The evidence I considered was:

Instructions for using the access not met decision templates to enter supporting evidence

Open either Template – Access not met decision – Pre-legislation changes or Template – Access not met decision – Post-legislation changes. Fill out the relevant templates, before inserting them into the letter. This will make sure the template formatting stays the same.

Insert the:

  • supporting evidence template

Delete these instructions.

Reason for the decision

Instructions for using the access not met decision templates to enter your reason for the decision

Open either Template – Access not met decision – Pre-legislation changes or Template – Access not met decision – Post-legislation changes.

Next steps

Instructions for applicants not in the remote or very remote area (MMM6 & MMM7)

All letters for applicants that are not in the remote or very remote cohort must include the details of the local area coordinator or early childhood partner in their Local Government Area (LGA) (Note: the early childhood partner option should only be selected if the person is younger than 9).

Use template 1 if the applicant is not in a remote or very remote area (MMM6 & MMM7).

Delete all red text and template 2.

Template 1:

<You/applicant’s name> can still contact <a local area coordinator/an early childhood partner> even if <you/they> are not an NDIS participant. <A local area coordinator/An early childhood partner> can provide <you/applicant’s name> with information and may be able to help connect <you/them> with community and government services that might be able to support <you/them>.

Your <local area coordinator/early childhood partner> service is:

Name:

Address:

Phone:

Email:

Instructions for applicants in the remote or very remote area (MMM6 & MMM7)

All letters for applicants that are in the remote or very remote cohort who don’t have an local area coordinator or early childhood partner in their LGA must include details of their closest NDIS office.

Use template 2 if the applicant is in a remote or very remote area (MMM6 & MMM7) and doesn’t have a local area coordinator or early childhood partner in their LGA.

Delete all red text and template 1.

Template 2:

<You/applicant’s name> can contact your closest NDIS office, which is:

  • Address:
  • Phone:
  • Email:

You can also contact the NDIS on 1800 800 110.

Applying again

<You/applicant’s first name> can apply to the NDIS again.

If <you/applicant’s first name> doesn’t request a review of this decision, <you/they> can apply again at any time.

If <you/they> request a review of this decision, <you’ll/they’ll> need to wait until the outcome of <you/their> review before <you/they> apply to the NDIS again.

Requesting a review

If <you/applicant’s first name> disagree with this decision or have new information, <you/they> can ask for the decision to be reviewed. <You/they> can do this within 3 months from the date of this letter. Details about how to do this are included at the end of this letter. If <you/applicant’s first name> want to learn more about how we make decisions, visit our website (ndis.gov.au). Search for ‘Our Guidelines’ and click on the link to ‘Applying’.

If <you/applicant’s first name> has any questions or would like to discuss the information in this letter, please contact us. <You/applicant’s first name> can contact us in any of the ways listed under the ‘We’re here to help’ section of this letter.

Instructions for completing the right signature block

If you are a non-SES Delegate, please complete signature block 1, including your first SES line Manager’s name and position.

Delete all red text and signature block 2.

Signature block 1:

Delegate of the CEO

National Disability Insurance Agency

My Branch Manager:

If you are an SES Delegate, please complete signature block 2.

Delete all red text and the first signature block 1.

Signature block 2:

Delegate of the CEO

National Disability Insurance Agency

We’re here to help:

Online

Phone

  • NDIS National Contact Centre 1800 800 110
  • TTY Users 1800 555 677
  • Speak and Listen Users 1800 555 727
  • If you need help with English 131 450

In Person

  • You can also visit a local area coordinator, early childhood partner or NDIS Office in your area

How to request a review of this decision

If you disagree with this decision, you can request an internal review of a decision. You can do this within 3 months from the date of this letter. If you request a review of this decision, you’ll need to wait until the outcome of your review before you apply to the NDIS again. When asking for an internal review, you should explain why you think the decision made is incorrect. The staff member who works on the internal review won’t have been involved in the earlier decision. They may want to talk to you as part of this process. If you would like to request an internal review of a decision, you can do this by:

  • Sending a letter to: National Disability Insurance Agency GPO Box 700 Canberra ACT 2601

  • Visiting a NDIS office

  • Calling 1800 800 110

  • Sending an email to enquiries@ndis.gov.au If you request an internal review and are not happy with our decision, you can apply for an external review. The Administrative Review Tribunal (ART) will be the external reviewer. Visit the ART website (art.gov.au). Click on ‘ART forms’ and select ‘NDIS review forms’. You can also call the ART on 1800 228 333.

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Version control

Version Amended by Brief description of change Status Date
6.0 EMN960 LJ0007 Class 1 approved.
Updated to align with the early childhood age range change. APPROVED 2023-06-21
7.0 EMN960 Class 1 approved.
Updated email address from NAT to NDIS enquiries APPROVED 2023-11-27
8.0 JC0088 Class 2 approved.
Updates to reflect legislation changes from 3 October 2024.
Instructions and options to choose legislation the decision was made with.
Instructions and options to choose the right eligibility criteria.
Information on when a person can apply for the NDIS again. APPROVED 2024-09-25
9.0 JC0088 Class 2 approval.
Guidance updated to reflect legislation to start a new body called the Administrative Review Tribunal (ART). The ART APPROVED 2024-10-07

FOI 24/25-0883

replaced the Administrative Appeals Tribunal (ART) on Monday 14 October 2024. Updates include: • Administrative Review Tribunal (ART) changed to Administrative Appeals Tribunal (ART) throughout. • Hyperlink to new ART website added.

Section ID Description Status Date
10.0 IIW664 Class 1 approval Continuous improvement updates [SSI-3252] to improve accessibility and user experience. Updates include • NDIS number field updates so staff can add applicant or representative NDIS number. • Red (255) font replaced with Red (192) improve accessibility for visually impaired users. APPROVED 2024-10-25

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- Instruction formatting updated to improve clarity.
- All developer fields changed to rich text fields so staff can Tab through fields.

Contact to advise outcome of access decision

Guidance in this document is not approved for use unless you view it in PACE.

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

  • open the contact applicant task
  • review access decision details
  • contact applicant
  • record contact attempts
  • complete the contact applicant task.

Recent updates

3 October 2024

  • Updated guidance to reflect legislation changes from 3 October 2024
  • Change title from Contact to advise outcome
  • If eligible, update to notify the person if they met the requirements for disability, early intervention, or both
  • Additional steps for how to complete the contact applicant task.

Before you start

You have read and understood:

  • Our Guideline – Applying to the NDIS (external), including sections: What happens after we decide? What happens if you’re eligible? What happens if you’re not eligible?
  • guide Conversation style guide.

Open the contact applicant task

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Knowledge Article

For Internal Use Only

After we make the access decision, a task is automatically created to notify the applicant or their authorised representative.

If you made the access decision, you’ll usually complete this task too.

If you didn’t make the decision and you are responsible for completing the task, you’ll need to reassign the task to yourself.

Open the task

  1. From the Person Account, select the Cases tab.
  2. Select the Cases sub-tab and select the down-arrow next to All Cases.
  3. Select the relevant Access Decision case.
  4. Select the Case Activity tab.
  5. Under Open Activities, select the Contact Applicant or Nominee regarding Access Decision task.
  6. Select the Details tab.
  7. Under Task Information, at Activity Type, select Internal Note from the drop down options.
  8. Under Additional Information, at Assigned to, enter your name/login ID (if not already assigned to you).
  9. Select Save.
  10. Go to section Review access decision details.

Review access decision details

  1. From Person Account, select Decisions tab.
  2. Select the latest Access Decision on the list.
  3. At Decision Point, check the application outcome: Access Met or Access Not Met.
  4. At Sub-Decisions section, check the reasons for the decision.

Contact applicant

Before contacting an applicant or their authorised representative, you must use their preferred communication method and authorisations.

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Knowledge Article

Before making the call

  • Check the person’s preferred contact method. Go to article Check a person’s preferred contact method.
  • Send an SMS to let the person know you’re going to call them from a private number. Use template We are going to call you in article Send an SMS in PACE.
  • When making the call, follow the guidelines in the NDIS Conversation style guide.

Required contact attempts

You must attempt to contact the applicant or their authorised representative to advise them of the decision. The number of attempts needed depends on the decision we made:

  • If access met, you must make at least 1 attempt to contact them.
  • If access not met, you must make at least 3 attempts (over 2 days and at different times of day).

Make the call

Application outcome – access met

  • Introduce yourself and confirm if this is a suitable time for the call.
  • Perform a security check to verify you’re speaking to the correct person. For more information, refer to section How to complete a security check in article Consider a request for personal information.
  • Inform the person their NDIS application was successful, and they are now a participant of the scheme. Advise the person if they met the requirements for disability, early intervention, or both.
  • Inform them that a member of the NDIS team will call them soon to take them through the next steps. This will include developing their plan and arranging their supports.
  • Let them know they’ll also receive a letter or email explaining this information, and describing what happens next.
  • Respond to any questions or concerns they might have.

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Knowledge Article

OFFICIAL

Application outcome – access not met

  1. Introduce yourself and confirm if this is a suitable time for the call.
  2. Perform a security check, to verify you’re speaking to the correct person. For more information, refer to section How to complete a security check in article Consider a request for personal information.
  3. Inform the person their NDIS application was not successful.
  4. Explain the reasons their application was not approved.
  5. If you need further support to explain the decision to the person, ask your Team Leader.
  6. Give information about their review rights.
  7. Make sure the person knows how to contact their local area coordinator or early childhood partner.
  8. Explain that their local area coordinator or early childhood partner can offer more information. They can also help with accessing mainstream and community supports.
  9. Let them know they’ll also receive a letter explaining this information, including contact details for their local area coordinator or early childhood partner.
  10. Remind them that they can reapply at any time if their situation changes.
  11. Respond to any questions or concerns they might have.
  12. For more information, refer to section What happens if you’re not eligible? in Our Guideline – Applying to the NDIS (external). You can also refer them to this information.

Record contact attempts

After attempting to contact the person (successfully or not), you must log an activity to record this. Go to article Log an activity or internal note. Record the note in the Activity Log using the relevant template:

Access met

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Knowledge Article

For Internal Use Only

Unsuccessful contact attempt

Phone call made to <Applicant/Authorised Representative> on all available numbers to advise the outcome of their NDIS application. Call not answered.

Successful contact attempt

Phone call made to <Applicant/Authorised Representative> on all available numbers to advise the outcome of their NDIS application. I confirmed they are eligible for the NDIS and that they meet requirements for <disability / early intervention / both disability and early intervention> I explained the next steps.

Access not met

Unsuccessful contact attempt

<First/second/third> phone call attempt made to <Applicant/Authorised Representative> on all available numbers to explain the reasons for the access not met decision. Call not answered.

Successful contact attempt

Phone call made to <Applicant/Authorised Representative> to explain the reasons for the access not met decision. I explained the requirement they did not meet with reference to their relevant supporting information. I provided information about their review rights. I provided the <Applicant/Authorised Representative> the details of their <local area coordinator/early childhood partner>. I explained their <local area coordinator/early childhood partner> can help with accessing information and talking about access to mainstream and community supports.

.

Complete the contact applicant task

  1. From the Person Account, select the Cases tab.
  2. Select the Cases sub-tab and select the down-arrow next to All Cases.

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Knowledge Article

For Internal Use Only

  1. Select the relevant Access Decision case.
  2. Select the Case Activity tab.
  3. Under Open Activities, select the Contact Applicant or Nominee regarding Access Decision task.
  4. Select the Details tab.
  5. Under Task Information, at Activity Type, select Internal Note from the drop down options.
  6. Under Task Information, at Comments, select the edit icon.

If all call attempts are unsuccessful: Copy and paste template below into Comments:

<1/3> phone call attempts made to <Applicant/Authorised Representative> on all available numbers to explain the reasons for the access not met decision. Calls not answered.

If you successfully contacted the person: Copy and paste the Successful contact attempt template from the Activity Log. 9. Under Additional Information, at Assigned to, enter your name/login ID (if not already assigned to you). 10. Under Additional Information, at Status, select Completed. 11. Select Save. This task is now closed.

Next steps

  1. For an access met decision, a plan approval case will automatically route to the relevant queue for a planner to develop their first participant NDIS plan.
  2. Once you contacted the person of their outcome, no further action is needed.

Article labels – internal use only

PACE user role names

No change.

Topics

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Version control

Version Amended by Brief Description of Change Status Date
1.0 EMN960 Draft approved by Class 3 Director with edits APPROVED 2022-11-14
2.0 EMN960 EL2 Approval APPROVED 2023-11-21
3.0 EMN960 EL2 Approval Updates made to reflect information about 1.17 SMS feature release APPROVED 2024-02-20
4.0 JC0088 Class 2 Approval Update to align with legislation changes APPROVED 2024-09-25

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Contact to request further information for access decision

Guidance in this document is not approved for use unless you view it in PACE.

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

  • contact an applicant to request further information
  • record the contact attempts.

Recent updates

12 August 2024

Guidance for an access delegate on how to:

  • contact an applicant for further information
  • document the attempts made to establish contact.

Before you start

You have:

  • used article Make an access decision and you need to contact an applicant to request further information
  • read and understood Our Guideline - Applying to the NDIS (external) including section What if we need more information to decide if you’re eligible?

Review details of the Access Decision

Open and assign a Contact Applicant task

After further information is requested, a task is created to contact the person or representative. If you submitted the request for further information, you’ll normally also complete this task. If you didn’t complete the request for further information, but you are responsible for completing the task, you can open the task through PACE. You’ll also need to reassign the task to yourself.

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SGB Knowledge Article Template

For Internal Use Only

Search for the person in the global search field at the top of the screen. At the Person Account, select the Cases tab. Select the Cases sub-tab and select the down-arrow next to All Cases. Select the relevant Access Decision case. Select the Case Activity tab. Under Open Activities, select the Contact Applicant or Nominee regarding s26 Request for Information (RFI) task. Select the Details tab. Under Task Information, at Activity Type, select Internal Note from the drop down options. Under Additional Information, At Assigned to, enter your name/login ID. Select Save.

Request further information details

If you didn’t complete the request for further information, review the person’s record to help you make the phone call. The following information in the Access Decision case will help:

  • From the Access Decision case, select Documents
  • Review the Request for more evidence letter
  • Select the Details tab
  • Review Closure Information.

Contact applicant

Before contacting an applicant or authorised representative, you must first check their preferred communication method and authorisations.

Before making the call

  • Go to article Check a participant’s preferred contact method for more information.
  • Go to article Send an SMS in PACE to send an SMS alert before calling the applicant or authorised representative, informing them of an upcoming call from a private number. Use the We are going to call you template found in the article Send an SMS in PACE.

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SGB Knowledge Article Template

For Internal Use Only

  1. When making the call, make sure you follow the guidelines in the Guide - Conversation style guide.

Required contact attempts

You must attempt to contact the participant at least 3 times to advise the applicant or authorised representative of the further information request.

Make the call

If the call is answered

  1. Introduce yourself and confirm if this is a suitable time for the call.
  2. Perform a security check to verify you’re speaking to the correct person. For more information, refer to section How to complete a security check in article Consider a request for personal information.
  3. Thank the person for the information they have already provided.
  4. Explain that you need more information to decide if the applicant is eligible for the NDIS.
  5. Explain what information the person needs to provide.
  6. Explain that information should come from the treating professional most relevant to the applicant’s disability. Give examples based on the applicant’s disability.
  7. Explain that information may be returned via email, mail or to a local NDIA office.
  8. Advise that information needs to be provided in 90 days or the application will be withdrawn.
  9. If the applicant has a myNDIS contact, advise them that they can reach out for help during the process of their NDIS application.

Note: If the applicant advises they require more than 90 days to provide the requested information, consider an extension.

Record contact attempts

After attempting to contact the person (successfully or not), you must log an activity to record this. Follow guidance in article Log an activity or internal note. Record the note using the relevant template: No answer

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SGB Knowledge Article Template

For Internal Use Only

<First/Second/Third> phone call attempt to <Applicant/Authorised Representative> on all available numbers, to ask for more information to decide if applicant is eligible for the NDIS.

Call not answered.

Successful contact

Phone call made to <Applicant/Authorised Representative> on all available numbers, to ask for more information.

I explained the information needed to decide if the applicant is eligible for the NDIS.

I explained how this information can be returned to the NDIA.

I explained this information must be provided within 90 days or the application will be withdrawn.

Complete the Contact Applicant task

Once you have completed all required contact attempts:

  1. At Access Decision case, select the Case Activity tab.
  2. Under Open Activities, select the Contact Applicant or Nominee regarding s26 Request for Information (RFI) task.
  3. Select the Details tab.
  4. Under Task Information, at Comments, select the edit icon.
  5. If all call attempts are unsuccessful, copy and paste the template below into the Comments field:

Three phone call attempts made to <Applicant/Authorised Representative> on all available numbers to request further information to decide if applicant is eligible for the NDIS. Calls not answered. 6. If you successfully contacted the person, copy and paste the Successful contact attempt template from the Activity Log. 7. Under Additional Information, at Status, select Completed. 8. Select Save, this task is now closed.

Next steps

  1. If there is no request for extension, no further steps are required.

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ndis: SGB Knowledge Article Template

For Internal Use Only

  1. If an extension to provide further information has been requested, consider an extension.

Article labels — internal use only

PACE user role names

Add: dc_users_accessdelegate Delete:

Topics

Add: t_applying Delete:

Case names

Add: dc_case_accessrequest Delete:

Ownership

Add: own_sgapplyingandengaging Delete:

Version control

Version Amended by Brief Description of Change Status Date
1.0 JC0088 Class 2 approval Instructions for an access delegate (assessor) to contact an applicant to request further information and record the contact attempts. APPROVED 2024-07-08

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Send a manual letter

Guidance in this document is not approved for use unless you view it in PACE.

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

  • understand when to use a manual PACE letter
  • send a manual letter via an email in PACE
  • send a manual letter via post
  • upload a manual letter to a case.

Recent updates

14 October 2024

Link to new Nominee and Child representative letter added: Letter - Notification of child representative role ending on participant’s 18th birthday.

3 October 2024

Guidance updates to reflect legislation changes from 3 October 2024:

  • we’ve added links to access templates for pre and post legislation changes.
  • we’ve added links to new letters for NDIS budget breakdown and replacement support decisions.
  • note added to remind staff once a letter has been sent by email, they must delete the saved copy of the letter from their computer.

Before you start

You have checked:

  • the participant’s communication preferences using article Check a person’s preferred contact method
  • consent and authority using article Check consent, nominee, child-representative or self-representation authorities.

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When to use a manual PACE letter

If a letter is generated and sent as part of a case in PACE, use the generated letter and not this manual letter process. You’ll only be able to edit specific fields in manual letters where information is needed.

The manual process applies to the following letters:

Access

  • Letter – Access Not Met Decision
  • Template – Access not met decision – Pre-legislation changes
  • Template – Access not met decision – Post-legislation changes

Nominees and child representatives

  • Letter – Nominee request to participant
  • Letter – Notification of nominee request – consent for nominee
  • Letter – Nominee request declined
  • Letter – Nominee cancellation – to cancelled nominee
  • Letter – Nominee cancellation – to participant
  • Letter – Nominee suspension – to suspended nominee
  • Letter – Nominee suspension – to participant
  • Letter – Child representative unsuccessful request
  • Letter – Child representative revocation to continuing representative
  • Letter – Child representative revocation to revoked representative
  • Letter – Child self-represent – approved to participant
  • Letter – Child self-represent – approved to revoked child representative
  • Letter – Child self-represent – declined to participant
  • Letter – Child self-represent – declined to child representative
  • Letter – Appointed representative to contact us
  • Letter – Notification of child representative role ending on participant’s 18th birthday

To learn more about nominee and child representative letters, go to article Complete manual letters for child representatives, child self-representation and nominees.

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Knowledge Article

Request for information

  • Letter – Request for information

To complete the request for information letter, go to article Complete a manual request for information letter during plan approval.

Eligibility reassessment

  • Letter – Update to NDIS eligibility
  • Letter - Eligibility reassessment opportunity to respond
  • Letter - Eligibility reassessment more time outcome - granted
  • Letter - Eligibility reassessment more time outcome - not granted
  • Letter – Outcome of eligibility reassessment - stay
  • Letter - Outcome after eligibility reassessment - leave

Explanation of a decision

  • Letter - Explanation of a decision – Participant supports
  • Letter - Explanation of a decision - Other decisions
  • Letter – Replacement support requested – Approved
  • Letter – Replacement support requested – Not approved

Plan change decision made outside of 21 days

  • Letter – s47A and s48 decision outside 21 days manual decline
  • Letter – s47A and s48 decision outside 21 days manual vary
  • Letter – s47A and s48 decision outside 21 days manual reassess.

To learn when to use these letters, go to article Progress a plan change (s47a and s48) request over 21 days.

Home and living supports

Only home and living delegates can use this letter. Save the Letter – Home and living supports in the participant’s documents. During plan approval, the planner delegate will review this letter and add funding to the participant’s plan. Send a copy of this letter after the plan approval meeting.

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Budget breakdown summary

  • Letter – NDIS budget breakdown for participants
  • Letter – NDIS budget breakdown for nominees

Send a manual letter via an email in PACE

Where possible, you should send a PDF version of the manual letter to a participant by email in PACE. For more information, read article Send and receive an email in PACE.

Note: You:

  • can’t send an email from an eligibility reassessment or manage authorised representative case.
  • will need to contact the participant using their preferred method of communication.

To send email correspondence:

  1. From the case view, within the Activity panel on the far-right, select Send Email.
  2. Within the From field, select NDIS enquiries from the dropdown list.
  3. At the To field search for the relevant contact. This will prepopulate with the email address recorded on the person account.

Note: To send an email to someone not recorded on the person account add their email address in the To field. 4. Select a Sensitivity Label Category from the dropdown list.

Note: If you select OFFICIAL Sensitive (OS) IMM, you must select a Sensitivity Label Subcategory. 5. Include in the Subject field the topic of the letter – for example, Child Representative Outcome. For any decision letters, include the topic and the word ‘outcome’. 6. Enter the message body. Use your business area’s correspondence templates as needed.

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Knowledge Article

For Internal Use Only

Save the letter as a PDF.

In Word select File, then Save a Copy. Select PDF from the file type dropdown list. Follow the standard process to save a copy of the letter.

Attach the letter as a PDF.

To do this select Attach file, the paperclip icon, select the letter and select Open.

Select Send.

Once it is sent,

you can access a copy of the email in the person account. Select the Activity tab. At Timeline drop down the relevant case from where the email was sent. The email will appear in Activity History.

You can also access a copy at the Case Activity tab in the case.

IMPORTANT: Once you have confirmed the email has been sent, you must delete the saved copy of the letter from your local system.

Send a manual letter via post

If the participant doesn’t have email to receive communications, you can send the letter via post. When posting the physical letter, please refer to the current postage process for your location.

Upload a manual letter to a case

To save the PDF letter in a case:

From the case view,

select the Documents tab.

Select Add Documents.

Select Participant Communication from the Document Category dropdown list.

Select NDIA Decision, or General Communication from the Document SubCategory dropdown list.

Select Yes,

in response to Does the document contain any Personal identifiable information (PII)?

Copy the below template,

update as required and enter it into the Description field:

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ndis Knowledge Article

For Internal Use Only A physical letter regarding [enter letter name] was sent via post to [enter contact name(s)], on the [DD/MM/YYYY] to the address of [enter address]. This letter was posted from [enter location and address] by [enter contact name]. 7. Select Next. 8. Select the Upload Files button to upload the PDF letter. 9. Select Save. 10. Once uploaded, select Close.

IMPORTANT: Once you’ve confirmed it’s uploaded to PACE, you must delete the saved copy of the letter from your computer.

Next steps

If you’re sending a manual request for information letter, complete all steps in article Complete a manual request for information letter during plan approval.

Article labels – internal use only

PACE user role names

No change

Topics

No change

Case names

No change

Ownership

No change

Version control

Version Amended by Brief Description of Change Status Date
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Knowledge Article

For Internal Use Only

Number Code Description Status Date
12.0 JC0088 Class 2 approval. Updates to reflect legislation changes from 3 October 2024. We’ve added links to access templates for pre and post legislation changes. We’ve added links to new letters for NDIS budget breakdown and replacement support decisions. Note added to remind staff once a letter has been sent by email, they must delete the saved copy of the letter from their computer. APPROVED 2024-09-25
13.0 JS0082 Class 1 Approval New heading and links updated for Letter – NDIS budget breakdown for participants and Letter – NDIS budget breakdown for nominees APPROVED 2024-10-02
13.1 TCM150 Update to add link for new Nominee and Child representative letter DRAFT 2024-10-03
13.2 CFO548 Peer review DRAFT 2024-10-03
13.3 TCM150 Action from Peer review DRAFT 2024-10-03
14.0 IIW664 EL2 Approval APPROVED 2024-09-26

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Template — Access not met decision — Post-legislation changes

This template will help Access Assessors update the Letter — Access not met decision to explain the reasons they decided an applicant is not eligible for the NDIS.

This includes the following decision reasons:

  • age requirements not met
  • residence requirements not met
  • disability requirements not met
  • early intervention requirements not met.

Note: Use this template to update letters for post-legislation change decisions. For pre-legislation change decisions, go to Template — Access not met decision — Pre-legislation changes.

Recent updates

Date What’s changed
4 November 2024 Scenarios in the Early intervention not met section updated to note that secondary impairments were also considered (if relevant).
3 October 2024 New template to reflect legislation changes from 3 October 2024. Includes note to help staff understand we have published two access not met decision templates.
There is a template for pre-legislation changes.
There is a template for post-legislation changes.

Checklist

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Template

For Internal Use Only

Topic Checklist
Pre-requisites You have:
  • read and understood Our Guideline – Applying to the NDIS (external)
  • read and understood Our Guideline – Mainstream and community supports (external)
  • assessed the application against the NDIS eligibility requirements and decided a person is not eligible. | | Actions | - 3.1 Supporting evidence
  • 3.2 Age not met
  • 3.3 Residence not met
  • 3.4 Disability not met (use first disability not met criteria only)
  • 3.5 Early intervention not met (use first early intervention not met criteria only) |

Templates

Template content has been ‘hidden’ to make it easier to find the correct template. When you find the template you need, reveal the content by:

  1. Selecting the arrow next to the heading, or
  2. Right-click the heading then:
  • select Expand/Collapse
  • select Expand Heading.

Copy template into a blank Microsoft Word document. 4. Customise the template using content control fields including: text fields, drop-down menus (labelled as ‘Choose an item.’) and date fields.

  • To avoid missing any fields, you can use the Tab button on your keyboard to move from one field to the next.
  • Check any title in the field for instructions about what to write. For example, it might prompt you to choose between ‘you’ or ‘they,’ depending on who will receive the letter:

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Template

For Internal Use Only

Delete highlighted headings, instructions or text. Use MS Word>Review>Spelling & Grammar to check your work. Copy and paste content into the relevant access task and letter.

Supporting evidence

Evidence provided for the application (delete this heading)

Age not met

Instruction: When a person is not eligible based on age requirements, update the text fields in the relevant templates then copy and paste into the decision interaction and letter:

  • 3.1: Supporting evidence; and
  • 3.2: Age not met
You are not younger than 65: Section 22(1)(a) (delete this heading)

Residence not met

Instruction: When a person is not eligible based on residence requirements, update the text fields in the relevant templates then copy and paste into the decision interaction and letter template:

  • 3.1: Supporting evidence; and
  • 3.3: Residence not met
You are not an Australian Citizen, permanent residence and living in Australia: Section (23)(1)(b) (delete this heading)

Disability not met

Instruction: When a person is not eligible based on disability requirements, update the text fields in the relevant templates then copy and paste into the decision interaction and letter template:

  • 3.1: Supporting evidence
  • 3.4: Disability not met (Use first disability not met criteria only)
  • 3.5: Early intervention not met (Use first early intervention not met criteria only).

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NDIS

Template

For Internal Use Only

3.4.1 Your disability is not related to an impairment: Section 24(1)(a) (delete this heading)

3.4.2 Your impairment is not permanent: Section 24(1)(b) (delete this heading)

3.4.3 Your permanent impairment does not substantially reduce your functional capacity: Section 24(1)(c) (delete this heading)

3.4.4 Your permanent impairment does not affect your social, work or study life: Section 24(1)(d) (delete this heading)

3.4.5 You are not likely to need NDIS supports under the NDIS for your lifetime: Section 24(1)(e) (delete this heading)

Early intervention not met

Instruction: When a person is not eligible based on early intervention requirements, update the text fields in the relevant templates then copy and paste into the decision interaction and letter:

  • 3.1: Supporting evidence
  • 3.4: Disability not met (Use first disability not met criteria only); and
  • 3.5: Early intervention not met (Use first early intervention not met criteria only)

3.5.1 You do not have an impairment that is likely to be permanent or

You are not a child younger than 6 with developmental delay: Section 25(1)(a): (delete this heading)

3.5.2 Early intervention will not help you need less disability support in the future:

Section 25(1)(b): (delete this heading)

3.5.3 Early intervention support will not improve your functional capacity or help your

informal supports: Section 25(1)(c) (delete this heading)

3.5.4 Early intervention supports will likely benefit you and would be NDIS supports

Section 25(1)(d) (delete this heading)

  • NDIS Act 2013
  • NDIS (Becoming a Participant) Rules 2016
  • Applied Principles and Tables of Support
  • Our Guideline — Applying to the NDIS (external)
  • Our Guideline — Mainstream and community supports (external)

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Feedback

If you would like to provide feedback about this guidance material, please complete our Feedback form.

Version control

Version Amended by Brief Description of Change Status Date
1.0 JC0088 New resource created using content from Access - Template - Interaction and Letter - Access Not Met Decision V9.0 - APPROVED- 2022-09-09.docx
New template created to support legislation changes from 3 October 2024.
Includes note to help staff understand we have published two access not met decision templates.
There is a template for pre-legislation changes.
There is a template for post-legislation changes. APPROVED 2024-09-25
2.0 IIW664 Class 1 approval
Previously approved content added back in to note that secondary impairments were also considered (if relevant). APPROVED 2024-10-29

We need more information to approve

<your/Participant’s/Applicant first Name’s> plan

NDIS number: Click or tap here to enter text.

Dear <Participant/Applicant/Parent/Nominee First Name>,

To help us approve <your/Participant’s/Applicant First Name’s> plan as quickly as possible, we need more information.

Information we need

Please send us the following information:

<Instructions: Add all items you are requesting information for from the appropriate template and delete the other options and this instruction when complete.>

  • Insert RFI – Evidence of <your/their> age Template
  • Insert RFI – Evidence <you/they> are an Australian citizen or permanent resident and live in Australia Template
  • Insert RFI – Evidence <your/their> impairment is likely to be permanent Template
  • Insert RFI – Evidence of how <your/their> impairment impacts on functional capacity or ability to undertake activities Template >
  • Insert RFI – Evidence of how early intervention supports will help reduce the need for future supports Template>

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What you need to do

Please send this information to us, including <your/Participant’s/Applicant First Name’s> NDIS number (listed at the start of this letter), within 14 days from the date of this letter.

You can send this to us in any of the ways listed under the We’re here to help section of this letter.

If you have any questions, please contact us in any of the ways listed under the We’re here to help section of this letter.

Yours sincerely,

Online

Phone

  • NDIS National Contact Centre 1800 800 110
  • TTY Users 1800 555 677
  • Speak and Listen Users 1800 555 727
  • If you need help with English 131 450

In Person

  • You can find your closest local area coordinator, early childhood partner or NDIS office on our website. Go to ndis.gov.au, select Contact, then under Offices and contacts in your area you can search your area.

Has your situation changed?

If so, this may affect your NDIS plan or supports. It is important that you contact us about any change in your circumstances. This change could include:

  • compensation you are applying for or have received
  • significant changes to your disability support needs
  • starting school
  • changes to your home and living situation
  • looking for work
  • no longer wanting to be a part of the NDIS.

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Version Amended by Brief Description of Change Status Date
0.1 RPK268 Interim Manual letter created till RFI letter is deployed in PACE. Initial draft created from Letter - Request for information - General v1.0 APPROVED 2022-08-03.docx DRAFT 2023-08-29
0.2 MSM312 Reviewing contents of DRAFT v0.1 against APPROVED version 1.0 for consistency. DRAFT 2023-09-04
0.3 RPK268 Response to reviewers comments DRAFT 2023-09-04
0.4 JJP788 JS0082 Director endorsement Title updated DRAFT 2023-09-05
0.5 RPK268 Editable fields updated based on SME feedback DRAFT 2023-10-06
0.6 JS0082 Class 1 review to progress to Class 2 approval DRAFT 2023-10-10
0.7 CW0032 BM Review DRAFT 2023-10-10
0.8 RPK268 Draft changes following BM review DRAFT 2023-10-17
1.0 CW0032 Class 2 approved Interim Manual letter created till RFI letter is deployed in PACE. Initial draft created from Letter - Request for information - General v1.0 APPROVED 2022-08-03.docx APPROVED 2023-10-18

Update a person account

Guidance in this document is not approved for use unless you view it in PACE.

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

  • update a person account by creating a new update person account case
  • update a person account using the update details button
  • help the participant update their own contact details.

Recent updates

22 July 2024 Guidance updated with a note to remind users about correctly spelling names in PACE.

Before you start

You have:

  • checked consent and authority if the request is from a representative using article Consent to act on applicant behalf or Check consent, nominee, child representative or self-representation authorities
  • completed a security check and identity confirmation, if needed, using article Consider a request for personal information
  • confirmed the person’s identity with evidence such as a linking document if you’re updating a person’s legal first, middle or last name using article Understand how to verify identity documents. Read Fact sheet – Evidence of identity (external) for information about evidence.

Update a person account by creating a new Update Person Account case

You can update a person’s details by completing an update person account case. This includes:

  • person details (name, gender identity, indicators)
  • addresses
  • communication preferences (phone number and email)
  • correspondence preferences (format and delivery method of correspondence)
  • non-compliant behaviour (for use by Compliance/Fraud team only)
  • housing and accommodation
  • relationship information
  • residency and visa information
  • consents
  • my NDIS contact
  • disabilities.

To create a new Update Person Account case, complete the following steps:

  1. Open the Person Account.
  2. Select the Cases tab, then select New.
  3. Select Update Person Account, then select Next.
  4. Complete all mandatory fields, then select Save. This will open the new Update Person Account case.
  5. Select the Update Person Account tab.
  6. Select Requested By?, then select Next.

What would you like to update? From the What would you like to update? screen, select all the details you want to change. Refer to the information below for guidance on how to complete the different updates, or articles that will help you do this. Person details (name, gender identity, indicators)

  1. Add or change information on the Person Details screen, as required.

Note: The first, middle, and last names that you enter should always be the person’s legal name. When entering the person’s name, make sure you spell and use

Knowledge Article

For Internal Use Only

If you’re updating a person’s legal first, middle or last name, make sure you’ve confirmed the person’s identity with the correct evidence, such as a linking document.

Use article Understand how to verify identity documents. To learn more about evidence, read Fact sheet – Evidence of identity (external).

  1. If you select Yes at Have you ever been known by another name?, complete the Previous name and Type of name fields. This helps us confirm the identity of the person.
  2. Enter the person’s Preferred Name and Preferred pronoun, if required. Always use the person’s preferred name and pronouns when you talk to them.
  3. Select Next.

Addresses

  1. Select from the Reason for change of address drop-down list.
  2. In the Home Address section, select the box if the person has No Fixed Address. You should also log an activity to record this information. For more information, go to articles Log an activity or internal note and Record an address – temporary accommodation and homelessness.

Note: If you need to select No Fixed Address, you will still need to enter some information in the Home Address and Postal Address fields. If the person has no fixed address, talk to them about recording a postal address, for example a support agency. This means that the person can receive letters from us. 3. Start to type the person’s address into the Address field. Select the correct address from the list. If the address doesn’t appear, or the auto-fill information is incorrect, select Override Retrieved Address. This will allow you to manually enter or correct the address information.

Important: If you need to use the Override Retrieved Address function in PACE, it is important to note that the Local Government Authority also named, LGA, won’t

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automatically populate. You must confirm the correct LGA and manually type it into the field.

When you manually update address details in the Override Retrieved Address screen, you’ll need to wait 24 hours for the Modified Monash Model also named, MMM, to recognise the changes. If MMM doesn’t accept the changes, PACE will trigger a report to OCIO for resolution within 24 hours. An alert will be visible on the person record to let you know the issue has been reported.

An MMM rating is used to define whether a participant’s home address is metropolitan, rural, remote or very remote. The MMM rating for participants in remote and very remote areas will automatically override with the MMM rating. This override happens when there’s activity in the participant’s PACE record and only applies to participants living in remote or very remote areas. For more information on how the MMM is used by government agencies go to [Modified Monash Model (external)](Modified Monash Model (external)).

The MMM override tool in PACE won’t work for an incorrect address. This means any provider claims will reject automatically, and correspondence may not generate if the address is incorrect.

Note: Once MMM has accepted the updated address details, you’ll need to wait 24 hours before creating a draft budget for new plans, this ensures the right information is on the participants record. If you’ve updated an existing participant’s record using the MMM override tool, you’ll need to generate a plan change request. Read article [Prepare to submit a plan change request](Prepare to submit a plan change request).

  1. In Postal Address, select the check box if it’s the same as the Home Address, or complete the fields if required.
  2. To update Work Address or Alternate Home Address, select the arrow to view fields.
  3. Select Next.

Communication preferences (phone number and email)

  1. Add or change information on the Communication Preferences screen, as required.

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  1. Confirm if the person wants to be contacted for surveys. At Contact for Surveys, you can select or unselect the box. For more information about surveys, go to article Explain NDIS Surveys.
  2. If you’ve updated the person’s Primary Contact Method, make sure the related contact method field is completed.
  3. Select Next.

Note: If the person also has a person account in SAP CRM, updates made to a person’s communication details in PACE won’t automatically transfer to SAP CRM. You must check if the changes have been successfully transferred to SAP CRM. You’ll need to update them manually in SAP CRM.

Correspondence preferences (format and delivery method of correspondence)

  1. Add or change information on the Correspondence Preferences screen, as required.
  2. Select Next.

Note: If the person as a person account in SAP CRM, updates made to a person’s correspondence details in PACE won’t automatically transfer to SAP CRM. You must update them manually in SAP CRM.

Non-compliant behaviour

The non-compliant behaviour function is for use only by the Compliance/Fraud team. You can contact the Compliance/Fraud team for further support or information. Go to article Using the non-compliant behaviour screen in the update person account case.

Housing and accommodation

  1. Add or change information on the Housing & Accommodation screen, as required.
  2. Select Next.

Relationship information

This is used to add or cancel a relationship to the person’s account. If you want to add or change an authorised representative use the Manage Authorised Representatives case. For more information, use article Understand the articles to use for the Manage Authorised Representative case.

  1. Add a relationship on the Add Relationships screen, using guidance in article Add or cancel a relationship.

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Residency and visa information

  1. Add or change information on the Residency and Visa Information screen, as required.
  2. Select Next.

Note: Updates to Residency and Visa Information may require evidence to be attached. Use article Understand age and residence evidence.

Consents

  1. Update information on the Consent screen, as required, using the following guidance. To update:
  • Do you consent to the NDIA collecting your age and residence information from Centrelink using your Customer Reference Number (CRN)? go to article Consent to use Centrelink information
  • Collect personal information from an organisation authorised representative, go to article Applicant consent to collect information
  • Contact health professional organisations, service provider organisations and schools where relevant, to collect information about you, go to article Applicant consent to collect information
  • Share information about you with identified third party organisations to help with developing and implementing your plan, go to article Applicant consent to share information
  • Do you consent to the NDIA collecting, using and disclosing your personal and sensitive information for the above purposes, including to verify your identity with the document issuer or official record holder via third party systems, and in accordance with our Privacy Policy? go to article Consent to use document verification service.

Note: For information about sharing the participant’s plan information with providers read Understand sharing the participant’s plan information with providers. 2. Select Next.

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My NDIS contact

  1. Update the my NDIS contact using guidance in article Update the my NDIS contact.
  2. Select Next.

To learn more, read article Understand and check the my NDIS contact.

Disabilities

Partners can’t update disabilities in the update person account case. If you can’t see the disabilities screen and you need to make changes to the disabilities recorded in the person account, go to article Request a participant disability change.

  1. Follow steps in the article Add a new primary disability.
  2. Select Next.

Review and submit

  1. Once you’ve made the required updates select Next.
  2. Review the details and select Submit, or select Previous to make any changes.

Update a person account using the Update Details button

You can update some personal details using the update details button. This button is a shortcut, so you don’t have to create a new update person account case. A record of the changes you make will still be visible in the cases tab. You can update the following details using the Update Details button:

  • person details - name, gender identity, indicators
  • addresses
  • communication preferences - phone number, email and survey preferences
  • correspondence preferences - format and delivery method of correspondence. Note: You can still update these details, and make other changes, by creating a new update person account case, if needed. When entering the person’s name, make sure you spell and use capitalisation correctly. If names are spelt with all capitals or all lowercase letters, this will be visible in PACE and correspondence. To update a person’s account details, complete the following steps:
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  1. Select Update Details button.
  2. In the Who is Making the Request? screen:
    • make a selection in Requested By?
    • make a selection in Case Origin
    • then select Next.
  3. In the screen What would you like to update?, select all the details you want to change. You can update multiple areas by selecting all relevant checkboxes. Refer to the What would you like to update? section above for more information.

Note: To update other details not listed here, refer to section Update a person account by creating a new Update Person Account case. 5. Select Next. 6. Complete the updates required, then select Next. 7. Review the details and select Submit, or select Previous to make any changes.

Note: In most cases, updates made to a person’s communication or correspondence details in PACE won’t automatically transfer to SAP CRM. If the person has a SAP CRM record, you must check if the changes have been successfully transferred to SAP CRM. In most cases you’ll need to update them manually in SAP CRM.

Help the participant update their own contact details

If the person is a participant, you can help the participant update their email, address, or phone number for their NDIS record through MyGov.

Update contact details in myplace

To update details in myplace tell the participant, they can: - go to their myplace participant portal from MyGov - select and update My Contact Details.

Changes in myplace are saved straight away but won’t update other linked MyGov services, such as Centrelink, Medicare, and the Australian Taxation Office.

Update contact details in MyGov

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If the participant wants these changes recorded for all their linked services, tell them they can:

  • go to MyGov
  • select Linked services
  • select Contact details
  • make edits in the Update contact details with linked services screen. It can take up to 15 minutes for the information recorded to appear in myplace.

Next steps

  1. If you had contact with a person with disability, participant, their provider, or authorised representative, you must log an activity. If you’ve updated a person account, make sure you include details of the reason you made the update. Use article Log an activity or internal note. Note: You can’t log an activity if you use the update details button. To log an activity, you need to use the update person account case.

Article labels – internal use only

PACE user role names

Add: Delete:

Topics

Add: Delete:

Case names

Add: Delete:

Ownership

Add: Delete:

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Version control

Version Amended by Brief Description of Change Status Date
1.0 AGK382 Approved with amendments APPROVED 2023-02-22
2.0 EMN960 Class 1 approved
Added guidance about option to update personal details using the Update Details button on Details page.		 APPROVED 2023-07-04
3.0 EMN960 Class 1 approved.
Updated for continuous improvement.
Title changed from ‘Update personal details’ to ‘Update a person account’.		 APPROVED 2023-10-11
4.0 EMN960 Class 1 approval to publish APPROVED 2023-10-26
5.0 EMN960 Class 1 approval APPROVED 2023-11-21
6.0 CW0032 Class 2 approval APPROVED 2024-03-07
7.0 JC0088 BM Class 2 Approval APPROVED 2024-04-29
8.0 VFK746 Class 1 approval APPROVED 2024-07-16

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Create an enquiry case

Guidance in this document is not approved for use unless you view it in PACE.

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

  • understand types of enquiry cases
  • create an enquiry linked to a person account
  • create the enquiry case
  • cancel or complete the enquiry case
  • understand next steps.

Recent updates

4 November 2024 Guidance added for cancelling or completing an enquiry case if required.

Before you start

You have:

  • received an enquiry
  • identified if there’s a relevant open case. If so, continue working on the open case. Then use article Log an activity or internal note to determine whether creating an internal note is needed instead of creating an enquiry case.
  • considered if there’s a more relevant case to create. For example, if the participant is calling to update their address, use create an Update Person Account case instead of an enquiry case
  • considered if there’s a follow-up action or review needed for an open enquiry case. If there is, don’t create a new enquiry case. Continue working in the open case and use article Log an activity or internal note to record the actions you’ve taken.

Types of enquiry cases

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An enquiry case is for new enquiries received in relation to a participant or provider. Examples of enquiry cases include:

  • new enquiries that require action
  • recording questions or issues received that need further investigation
  • an enquiry case that can be created even if it’s not linked to any specific person’s account in PACE, such as provider registration and requests from media. If the enquiry doesn’t relate to a person account, go to the article Create an enquiry case with no person account
  • logging an activity, which is sometimes used to add information to existing open cases.

To see a full list of the types of enquiry cases, use article Manage an enquiry – Understand enquiry type categories – APPENDIX.

Note: You can add notes to the enquiry tab of an enquiry case up to 5 times.

Most enquiries must be linked to a person account. Others, such as provider enquiries, may not relate to a specific person.

When there’s an existing case for the enquiry, continue to work with that enquiry. You don’t need to create a new enquiry case, this will help you avoid creating duplicate enquiry cases.

Create the enquiry case

You may receive an enquiry from one of the following origins:

  • email
  • phone
  • web
  • internal
  • in-person
  • provider portal
  • webchat.

When you receive an enquiry, if you have the relevant permission, you should create the appropriate case type and action the enquiry.

You should only create an enquiry case if:

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  • no open case type exists for this enquiry and further action is needed from another business area
  • an enquiry case has been incorrectly closed and further action is needed from another business area
  • you’ve received multiple enquiries that can’t be resolved in one enquiry case referral.

If the enquiry is about an open case or no follow-up action or review is required, you should Log Activity using article Log an activity or internal note.

Create the enquiry case from the Person Account

Follow the steps below to create an enquiry case from the Person Account:

  1. Select the Details tab.
  2. Select Create Enquiry. A pop-up box will appear. Note: Creating the enquiry case from the Person Account is always the preferred process. However, if you’ve created the enquiry case using the Cases tab and experience a situation where you must cancel it: Go to section Cancel or complete an Enquiry case.
  3. From the drop-down options, complete mandatory fields Requested by, which is who’s making the enquiry, and Case origin, which is how you received the enquiry. Note: If the enquiry is made by an authorised representative or organisation, select the representative from the available options.
  4. Select Next.
  5. If another enquiry case exists on the Person Account that has the same category and sub category, the Duplicate Check screen will appear. Note: If you’ve created the enquiry case using the Cases tab, then the Duplicate Check screen won’t appear. Instead, if PACE detects a duplication, an error message will appear in the New Case screen once you select Save.
  6. If you find an enquiry case that has already been created but is identified as a duplicate:

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  • Check the open cases and determine which case should be the parent enquiry case.
  • Close any duplicate cases using step 17 and link them as child enquiry cases to the parent enquiry case. Use article Create a link between related cases in PACE to link the cases.
  • Leave a closure comment explaining why you closed the duplicate case to complete the process.

Where possible, use the original enquiry case. Only create a new enquiry case if the existing case can’t be opened or is unresponsive. To create a new enquiry case, close the error message in the New Case screen and select the Allow Duplicate box. Then select Save to create the case.

  1. At Duplicate Check review the table and select the case number to view the existing case or cases. If the existing cases are:
    • open and related to your enquiry: select Cancel Enquiry. Log Activity in the original enquiry case using article Log an activity or internal note and capture in your note why you’ve closed the enquiry
    • open and not related to your enquiry: continue creating a new enquiry case. Select Next to continue
    • closed and related to your enquiry: continue creating the new enquiry case. Select Next to continue. Select Follow-up and enter the Parent Case number of the closed enquiry in the Parent Case field.

For more information about parent and child cases in PACE, go to article Create a link between related cases in PACE. 8. From Enquiry Details, select the date and time the enquiry was received. 9. Select the type of enquiry you’ve received from the Enquiry Type drop-down. To learn more about the different enquiry types, use article Manage an enquiry – Understand enquiry type categories - APPENDIX. 10. Select the options that most closely match the enquiry from the Category and Sub category drop-down lists. 11. Select Next.

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  1. At Risk Matrix, select Yes to see a list of risks and select all that apply. Otherwise, select No if there are no risks.

If you’re prompted to complete the Request Questionnaire, go to article Prepare to submit a plan change request for more information. At this step, an error in on screen guidance refers to s47 (change in situation) this should be s47A (plan variation). If you’re not completing a plan change, complete the Risk Matrix and go to step 12.

  1. Select Next.

  2. At Notes and Next Steps, follow Next Action recommendations. Next Action recommendations may include to refer, resolve, or escalate the enquiry.

Note: If you need to escalate the enquiry, create a new case. For further information on when to escalate an enquiry, use article Escalate or prioritise an enquiry case.

  1. Add a description of the enquiry in the Enquiry Notes free text field.

  2. Select an Enquiry outcome.

  3. Depending on the action you’re taking, you can:

  • continue following the steps below to reassign the case to another user or queue
  • select a closure reason to close the case and go to step 21. Note: You can also close the enquiry case by selecting Complete on the top right of the Enquiry case screen. To complete the case, you must finish each step in the enquiry case flow.
  • keep the enquiry open and go to step 21.

  1. To reassign the case to a user or a queue, select Re-assign this enquiry to another user.

  2. Select a Case Re-assignment Reason. Note: If the participant is streamed intensive or super-intensive and not supported by a partner do not select Referral to Partner. Select the relevant reason from the options available in the drop down list to assign to the agency.

  3. Select User or Queue.

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  1. At Case Owner, search for the relevant user or queue.
  • If the participant doesn’t have a my NDIS contact, find their local partner queue.
  • If unsure, search the participant’s postcode using the PACE partner referral matrix on the Resources for partners intranet page.
  • Where the result is unclear or gives you multiple local government areas or queues, use the state and territory booklets on The NDIS in each state (external) website to find the closest partner organisation.

  1. Select Next.

  2. Review the enquiry information and select Submit.

Cancel or complete an Enquiry case

You can cancel or close the Enquiry case in the Enquiry Outcome screen. You can also use the Cancel case or Complete Case button in the top right of the Enquiry case.

Cancel an Enquiry case

The Cancel Case button is available when:

  • the Enquiry case is in the status New or In Progress.

IMPORTANT: An enquiry case should only be cancelled for a closure reason below. In all other circumstances the case should be completed.

  1. Select the Cancel Case button in the top right hand corner of the Enquiry Case screen.
  2. Select a Closure Reason from the following options:
  • Cancelled – Duplication
  • Cancelled – Incorrect categorisation
  • Cancelled – Internal error
  • Unable to contact
  1. At Closure Comments enter any information as required. This is optional.
  2. Select Confirm. A note will state the case has been cancelled successfully.
  3. Select Done. The case is now cancelled.

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Complete an Enquiry case

Note: You can only use the Complete Case button after you’ve entered the details of the enquiry.

  • Select Keep enquiry open – Do not reassign at step 17 above and follow the process from this point to submit the case.

The Complete Case button is available when:

  • The Enquiry case is in the status New or In Progress.
  1. Open the relevant Enquiry Case. Select the Complete Case button in the top right hand of the screen.
  2. At Closure Reason select one of the following from the drop down list:
  • Unable to contact
  • Completed
  • Completed – Another Case Commenced.
  1. At Closure Comment enter details in the free text field as required. This is optional.
  2. Select Confirm.
  3. A note will state the case has been completed successfully.
  4. Select Done. The case is now closed.

Next Steps

  1. To understand next steps for the enquiry type, refer to article Manage an enquiry – Understand enquiry type categories - APPENDIX.

Article labels – internal use only

PACE user role names

No change

Topics

No change

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Version Amended by Brief Description of Change Status Date
5.0 JS0082 Class 1 Approval pending one formatting comment being actioned APPROVED 2024-01-19
6.0 JC0088 Class 1 approved. An enquiry case is not required if there no further follow-up action or review required. APPROVED 2024-04-29
7.0 IIW664 Class 1 Approval APPROVED 2024-05-20
8.0 JC0088 Class 2 approval APPROVED 2024-09-06
9.0 CS0074 Class 2 approval APPROVED 2024-10-28

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Impairment categories guide

Guidance in this document is not approved for use unless you view it in PACE.

This article provides guidance for an access delegate to:

  • understand what impairment categories to select for a person that meets the eligibility requirements.

Recent updates

14 October 2024 New guidance to:

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

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 they think and learn.

To learn more about impairment categories go to article Descriptions of impairment categories. The following list provides you with information on:

  • the condition
  • the ICD 10 Code
  • the required impairment category for access assessors to select
  • optional impairment categories to select as relevant, based on evidence provided with access request.

Conditions

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Autism (ASD)

  • Autism – includes Rett and Asperger Syndrome
    • ICD 10 Codes: F84.0, F84.2, F84.5
    • Required impairment category: Neurological
    • Optional impairment categories: Intellectual, cognitive, physical, psychosocial

Acquired brain injury

  • Glioblastoma

    • ICD 10 Code: G71.9
    • Required impairment category: Neurological
    • Optional impairment categories: Cognitive, physical, psychosocial

  • Hypoxic brain injury

    • ICD 10 Code: 93.1
    • Required impairment category: Neurological
    • Optional impairment categories: Physical, psychosocial

  • Traumatic brain injury – also called head injury and acquired brain damage

    • ICD 10 Code: T90
    • Required impairment category: Neurological
    • Optional impairment categories: Cognitive, physical, psychosocial

Intellectual disability

  • Mild intellectual disability

    • ICD 10 Codes: F70
    • Required impairment category: Intellectual
    • Optional impairment categories: Cognitive

  • Moderate intellectual disability

    • ICD 10 Codes: F71
    • Required impairment category: Intellectual
    • Optional impairment categories: Cognitive, physical, psychosocial

  • Severe intellectual disability

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ICD 10 Codes: F72 Required impairment category: Intellectual Optional impairment categories: Cognitive, physical, psychosocial 4. Profound intellectual disability ICD 10 Codes: F73 Required impairment category: Intellectual Optional impairment categories: Cognitive, physical, psychosocial 5. Unspecified intellectual disability ICD 10 Codes: F79 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, physical, psychosocial 6. Pervasive developmental disorder ICD 10 Codes: F84.8 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, psychosocial 7. Microcephaly ICD 10 Codes: Q02 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical 8. Other congenital brain conditions – for example, tuberous sclerosis ICD 10 Codes: Q04 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, physical 9. Spina bifida ICD 10 Codes: Q05 Required impairment category: Physical Optional impairment categories: Intellectual, cognitive, sensory, neurological 10. Foetal alcohol syndrome ICD 10 Codes: Q86.0 V1.0 2024-10-10 Impairment categories guide – 473023269 Page 3 of 16 This document is uncontrolled when printed OFFICIAL Page 104 of 117

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Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, sensory, physical, psychosocial

  1. Foetal alcohol spectrum disorder (FASD) ICD 10 Codes: Q86.0D

Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, sensory, physical, psychosocial

  1. Cornelia de Lange syndrome ICD 10 Codes: Q87.1

Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

  1. Prader Willi syndrome ICD 10 Codes: Q87.1

Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, physical, psychosocial

  1. Coffin-Lowry syndrome ICD 10 Codes: Q87.8

Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

  1. Other congenital conditions (causing intellectual disability) ICD 10 Codes: Q89

Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

  1. Edwards syndrome ICD 10 Codes: Q91

Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

  1. Patau syndrome ICD 10 Codes: Q91

Required impairment category: Intellectual

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Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

Cri du Chat syndrome

ICD 10 Codes: Q93.4 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, physical

Angelman syndrome

ICD 10 Codes: Q93.5 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, physical

Other chromosomal syndromes (including Kabuki & Williams syndromes)

ICD 10 Codes: Q99 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

Fragile X syndrome

ICD 10 Codes: Q99.2 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

Cerebral Palsy

  • Cerebral palsy ICD 10 Codes: G80 Required impairment category: Physical Optional impairment categories: Intellectual, cognitive, neurological, sensory

Down Syndrome

  • Down syndrome ICD 10 Codes: Q90 Required impairment category: Intellectual Optional impairment categories: Cognitive, physical

Hearing Impairment

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Hearing loss

  • ICD 10 Codes: H90
  • Required impairment category: Sensory
  • Optional impairment categories: Cognitive

Congenital hearing condition

  • ICD 10 Codes: Q16.9
  • Required impairment category: Sensory
  • Optional impairment categories: Cognitive

Visual Impairment

Albinism

  • ICD 10 Codes: E70.3
  • Required impairment category: Sensory
  • Optional impairment categories: Not applicable

Visual impairment (including blindness)

  • ICD 10 Codes: H54
  • Required impairment category: Sensory
  • Optional impairment categories: Not applicable

Congenital eye conditions

  • ICD 10 Codes: Q15.9
  • Required impairment category: Sensory
  • Optional impairment categories: Not applicable

Other Sensory - Speech

Other sensory - speech

  • ICD 10 Codes: R47
  • Required impairment category: Sensory
  • Optional impairment categories: Physical

Multiple Sclerosis

Multiple Sclerosis

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ICD 10 Codes: G35

Required impairment category: Neurological

Optional impairment categories: Cognitive, physical, psychosocial

Other Neurological

1. Alzheimer’s disease

  • ICD 10 Codes: F00
  • Required impairment category: Cognitive
  • Optional impairment categories: Neurological, physical, psychosocial

2. Unspecified dementia

  • ICD 10 Codes: F03
  • Required impairment category: Cognitive
  • Optional impairment categories: Neurological, physical, psychosocial

3. Huntington disease

  • ICD 10 Codes: G10
  • Required impairment category: Physical
  • Optional impairment categories: Cognitive, neurological, psychosocial

4. Motor neurone disease

  • ICD 10 Codes: G12.2
  • Required impairment category: Physical
  • Optional impairment categories: Cognitive, neurological, sensory, psychosocial

5. Parkinson’s disease

  • ICD 10 Codes: G20
  • Required impairment category: Neurological
  • Optional impairment categories: Cognitive, physical, psychosocial

6. Epilepsy – Mandatory TAPIB

  • ICD 10 Codes: G40
  • Required impairment category: Neurological
  • Optional impairment categories: Intellectual, cognitive, psychosocial

7. Muscular dystrophy

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ICD 10 Codes: G71.0

Required impairment category: Physical Optional impairment categories: Neurological

  1. Other Neurological – List A and List C

    ICD 10 Codes: G99

    Required impairment category: Neurological Optional impairment categories: Cognitive, sensory, physical

Stroke

  1. Stroke

    ICD 10 Codes: I69

    Required impairment category: Physical Optional impairment categories: Cognitive, neurological, sensory, psychosocial

Other Physical

  1. Rheumatoid arthritis

    ICD 10 Codes: M05

    Required impairment category: Physical Optional impairment categories: Not applicable

  2. Other arthritis – mandatory TAPIB

    ICD 10 Codes: M12

    Required impairment category: Physical Optional impairment categories: Not applicable

  3. Other physical

    ICD 10 Codes: M95

    Required impairment category: Physical Optional impairment categories: Psychosocial

  4. Multiple traumatic amputations

    ICD 10 Codes: T05

    Required impairment category: Physical

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Optional impairment categories: Psychosocial

  1. Myopathy
    • ICD 10 Codes: G72.9
    • Required impairment category: Physical
    • Optional impairment categories: Not applicable

Psychosocial disability

  1. Schizophrenia

    • ICD 10 Codes: F20
    • Required impairment category: Psychosocial
    • Optional impairment categories: Cognitive

  2. Schizoaffective disorder

    • ICD 10 Codes: F25.9
    • Required impairment category: Psychosocial
    • Optional impairment categories: Cognitive

  3. Bipolar affective disorder

    • ICD 10 Codes: F31
    • Required impairment category: Psychosocial
    • Optional impairment categories: Cognitive

  4. Major depressive illness

    • ICD 10 Codes: F32
    • Required impairment category: Psychosocial
    • Optional impairment categories: Cognitive

  5. Other anxiety disorders

    • ICD 10 Codes: F41
    • Required impairment category: Psychosocial
    • Optional impairment categories: Cognitive

  6. Obsessive-compulsive disorder

    • ICD 10 Codes: F42
    • Required impairment category: Psychosocial

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Optional impairment categories: Not applicable

Post traumatic stress disorder

ICD 10 Codes: F43 Required impairment category: Psychosocial Optional impairment categories: Cognitive

Borderline personality disorder

ICD 10 Codes: F60.3 Required impairment category: Psychosocial Optional impairment categories: Not applicable

Tourette syndrome

ICD 10 Codes: F95.2 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial

Other psychosocial disorders

ICD 10 Codes: F99 Required impairment category: Psychosocial Optional impairment categories: Cognitive

Anorexia

ICD 10 Codes: R63 Required impairment category: Psychosocial Optional impairment categories: Cognitive, physical

Spinal Cord Injury

Malignant neoplasm of spinal cord complete and incomplete

ICD 10 Codes: C72.5, C72.7 Required impairment category: Physical Optional impairment categories: Neurological, sensory

Spinal cord injury (complete)

ICD 10 Codes: T09.5 Required impairment category: Physical

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Optional impairment categories: Neurological, sensory, psychosocial

  1. Spinal cord injury (incomplete)

    ICD 10 Codes: T09.7

    Required impairment category: Physical

    Optional impairment categories: Neurological, sensory, psychosocial

Other

  1. Malignant neoplasm of brain

    ICD 10 Codes: C71

    Required impairment category: Neurological

    Optional impairment categories: Cognitive, psychosocial

  2. Metastatic cancer

    ICD 10 Codes: C79.9

    Required impairment category: Physical

    Optional impairment categories: Cognitive

  3. Malignant neoplasm of blood or immune disease

    ICD 10 Codes: C96

    Required impairment category: Physical

    Optional impairment categories: Cognitive

  4. Autoimmune disorders

    ICD 10 Codes: D89.9

    Required impairment category: Physical

    Optional impairment categories: Cognitive

  5. Obesity – mandatory TAPIB

    ICD 10 Codes: E66

    Required impairment category: Physical

    Optional impairment categories: Psychosocial

  6. Classical phenylketonuria

    ICD 10 Codes: E70.0

    Required impairment category: Cognitive

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Optional impairment categories: Psychosocial

  1. Disorders of pyruvate metabolism and gluconeogenesis ICD 10 Codes: E74.4 Required impairment category: Intellectual Optional impairment categories: Neurological, physical

  2. Other metabolic disorders ICD 10 Codes: E88 Required impairment category: Intellectual Optional impairment categories: Neurological, physical

  3. Dementia – rapidly progressing ICD 10 Codes: F03.9 Required impairment category: Cognitive Optional impairment categories: Not applicable

  4. Functional neurological disorder (FND) – mandatory TAPIB ICD 10 Codes: F44.4 Required impairment category: Neurological Optional impairment categories: Cognitive, sensory, physical

  5. Other language disorder ICD 10 Codes: F80 Required impairment category: Cognitive Optional impairment categories: Not applicable

  6. Peripheral neuropathy – does NOT require TAPIB ICD 10 Codes: F90.0 Required impairment category: Neurological Optional impairment categories: Sensory, physical

  7. Oppositional defiant disorder (ODD) ICD 10 Codes: F91.3 Required impairment category: Cognitive Optional impairment categories: Psychosocial

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Other hereditary ataxias

  • ICD 10 Codes: G11.8
  • Required impairment category: Neurological
  • Optional impairment categories: Cognitive, sensory, physical

Dementia – early onset

  • ICD 10 Codes: G30.0
  • Required impairment category: Cognitive
  • Optional impairment categories: Not applicable

Plegia

  • ICD 10 Codes: G83.1
  • Required impairment category: Physical
  • Optional impairment categories: Neurological

Chronic pain – mandatory TAPIB

  • ICD 10 Codes: G89.4
  • Required impairment category: Physical
  • Optional impairment categories: Sensory, psychosocial

Postural Orthostatic Tachycardia Syndrome (POTS) – mandatory TAPIB

  • ICD 10 Codes: I49.8
  • Required impairment category: Neurological
  • Optional impairment categories: Physical

Lymphoedema – mandatory TAPIB

  • ICD 10 Codes: I89.0
  • Required impairment category: Physical
  • Optional impairment categories: Not applicable

Chronic lung disease

  • ICD 10 Codes: J44.9
  • Required impairment category: Physical
  • Optional impairment categories:

Chronic Obstructive Pulmonary Disease (COPD) – mandatory TAPIB

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ICD 10 Codes: J44.9A Required impairment category: Physical Optional impairment categories: Not applicable 22. Osteoarthritis – mandatory TAPIB ICD 10 Codes: M19.9 Required impairment category: Physical Optional impairment categories: Not applicable 23. Systemic lupus erythematosus ICD 10 Codes: M32 Required impairment category: Physical Optional impairment categories: Not applicable 24. Ankylosing spondylitis ICD 10 Codes: M45 Required impairment category: Physical Optional impairment categories: Not applicable 25. Fibromyalgia ICD 10 Codes: M79.7 Required impairment category: Physical Optional impairment categories: Sensory 26. Renal failure ICD 10 Codes: N18 Required impairment category: Physical Optional impairment categories: 27. Ehlers Danlos – does NOT require TAPIB ICD 10 Codes: Q79.6 Required impairment category: Physical Optional impairment categories: Not applicable 28. Dyslexia ICD 10 Codes: R48 V1.0 2024-10-10 Impairment categories guide – 473023269 Page 14 of 16 This document is uncontrolled when printed OFFICIAL Page 115 of 117

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  • Required impairment category: Cognitive
  • Optional impairment categories: Psychosocial
  1. Childhood apraxia of speech
  • ICD 10 Codes: R48.2
  • Required impairment category: Neurological
  • Optional impairment categories: Cognitive
  1. Short stature
  • ICD 10 Codes: R62.5
  • Required impairment category: Physical
  • Optional impairment categories: Not applicable
  1. Amputation – single limb or upper/lower limb
  • ICD 10 Codes: Z89
  • Required impairment category: Physical
  • Optional impairment categories: Cognitive, sensory, psychosocial
  1. Amputation – multiple
  • ICD 10 Codes: Z89.1
  • Required impairment category: Physical
  • Optional impairment categories: Cognitive, sensory, psychosocial

Article labels

PACE user role names

Add: dc_users_accessdelegate

Topics

No change.

Case names

Add: dc_case_accessrequest

Ownership

Add: own_sgapplyingandengaging

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Version Amended by Brief Description of Change Status Date
0.1 VFK746 Draft transfer of endorsed Attachment A - Descriptions of impairment categories to KA - required for legislation updates DRAFT 2024-10-03
0.2 TCM150 Peer review DRAFT 2024-10-03
0.3 VFK746 Implementation of Peer Review DRAFT 2024-10-03
0.4 JM0122 EL1 review and approval DRAFT 2024-10-07
0.5 VFK746 Class 1 endorsement - progress to BM DRAFT 2024-10-08
1.0 JC0088 Class 3 approval to QA and publish APPROVED 2024-10-10

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