Wow! It’s been quite a year, hasn’t it?
With the National Disability Insurance Scheme (NDIS) Review, the NDIS Amendment Bill (which is now law), and a multitude of taskforces on the Disability Royal Commission, fraud, pricing, and provider and worker registration, 2024 has been a rollercoaster ride!
And amid all the uncertainty, the disability community has also been getting to grips with the changes arising from the rollout of the National Disability Insurance Agency’s (NDIA) PACE computer system and the Australian Government’s rules about the supports people can and can’t spend their NDIS funding on.
Lots of participants now have new-look plans and some have unfamiliar categories of funding and stated supports where flexibility previously existed. In most cases, it’ll just take time to learn how everything works, but for some people, a change of plan – or adjustments to the one they already have – will be needed.
So, how do you go about it? If you’re seeking a change, here’s a guide to help you understand the options available to you.
Usually initiated by the Agency a few months before your plan reassessment is due, a participant check-in provides an opportunity for you or your nominee to speak with the NDIA about your plan, your funding, your supports, and your experience as a participant in the NDIS.
The Agency uses check-ins to start the ball rolling for plan reassessments, so it’s important to be prepared. The things you discuss during a check-in might mean:
If you joined the Scheme to access supports you no longer need, this might be discussed during the check-in too.
Take a look at our article about check-ins and click on this page on the NDIS website to find out more.
To help you prepare for a check-in, you can also download NDIS booklets and fact sheets here.
Whether you initiate it, or the Agency does, your plan reassessment meeting is a milestone in the lifecycle of your NDIS plan.
Conducted face-to-face, over the phone, or even via a video call, plan reassessments involve you (and your nominee or support people, if you have them) and a representative of the NDIA talking about you, your plan, your funding, and how you use it.
You’ll be asked about things like what’s worked, what hasn’t, whether your circumstances have changed, the supports you use (or want to use), and the progress you’ve made – and the Agency will then decide whether any changes need to be made.
It’s important to prepare for your plan reassessment meeting, and that means making sure you’re on top of things like having your providers prepare assessments or progress reports, thinking about your supports and any changes you’d like the NDIA to make, and writing down any questions you want to ask during the meeting.
If you need changes made to your plan before your scheduled reassessment date, you can contact the NDIA at any time to ask whether adjustments are possible.
If you lodge a request for a plan reassessment without clear evidence, it may be declined, so be sure to have everything ready to present to the Agency. If you ask the NDIA to reassess your plan, you’ll get a response within 21 days to let you know if it will be varied or replaced, or if it will stay the same.
You can find out more about plan reassessments here.
Sometimes a change can be made to your plan without a plan reassessment. If that happens, it’s called a plan variation.
Variations are usually quite small changes – like correcting minor errors, changing details related to an existing stated support, or setting a new reassessment date – but the NDIS Act also allows plans to be varied in crisis or emergency situations, or if new information is provided in response to a request from the Agency.
Things change – that’s just part of life – but if those changes affect the NDIS supports you receive, you should let the NDIA know.
The Agency needs to know about changes to things such as:
Think a change in circumstances might apply to you? This page on the NDIS website has the information you need.
If you’re not happy with a decision the NDIA makes, you can ask the Agency to reconsider it by requesting an internal review of a decision.
There are some decisions the NDIA can review, and some it can’t – but if it agrees to an internal review, the Agency will check to see that the right decision was made under the law by looking at the facts and circumstances at the time of the internal review.
If more information is needed, you’ll be contacted, but you can also provide additional information when you ask for a review.
If you want to request an internal review of a decision, you have three months to do it from the date you received the original decision from the NDIA in writing. Find out more about internal reviews here. You can submit a request here.
These Guidelines will tell you more about the process and what to do if you don’t get the outcome you’re after.
If you’ve been through the internal review process and you’re still not satisfied, there are other options available to you – including asking the Administrative Review Tribunal (ART) to look at the NDIA’s decision. This is known as an external review.
The ART, which has replaced the Administrative Appeals Tribunal, can consider most internal review decisions. It’s completely separate from the NDIA and the NDIS Quality and Safeguards Commission, and it exists to make sure the decisions that both those make are legally correct and fair.
The ART can look at matters including:
You can find out more about external reviews here.
Want to apply? You have 28 days from the time the NDIA makes its internal review decision to do so. Click here to get started or contact the ART for more information.
If you’re feeling overwhelmed at the thought of an external review or you just need a bit of extra support, you don’t have to go it alone. The NDIS Appeals Program was set up by the Department of Social Services to help people with disability and others affected by reviewable decisions of the NDIA.
To access support, you just need an outcome from an internal review of a decision, and then you’re on your way.
There are two types of supports available via the program:
For more information about the NDIS Appeals Program, click here.
