FOI 24.25 0368 Document 2 Disclosure Log.pdf

DISCLOSURE LOG - FOI 24/25-0368
DOCUMENT 2
When to refer the participant for an
eligibility reassessment
SGP KP Publishing
Exported on 2024-10-09 07:58:52
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DISCLOSURE LOG - FOI 24/25-0368
SGP KP Publishing – When to refer the participant for an eligibility reassessment
Table of Contents

1
Recent updates .................................................................................................................... 4
2
Before you start .................................................................................................................... 5
3
Consider an eligibility reassessment ................................................................................. 6
3.1
Automatic eligibility reassessment referrals ....................................................................... 6
3.2
Manual eligibility reassessment referrals ........................................................................... 6
4
Complete an eligibility pre-check by reviewing available information ........................... 7
4.1
Check the participant has received funding for 14 months ................................................ 7
4.2
Check for any open ER or Leaving cases .......................................................................... 7
4.3
Review evidence on the participant record ........................................................................ 7
4.4
Review the participants original access decision and information ..................................... 8
5
When to refer the participant for an eligibility reassessment ......................................... 9
5.1
Commence an eligibility reassessment referral.................................................................. 9

Table of Contents – 2
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DISCLOSURE LOG - FOI 24/25-0368
SGP KP Publishing – When to refer the participant for an eligibility reassessment
This article provides guidance for a local area coordinator, early childhood partner or planner
delegate to:
  consider an eligibility reassessment
  complete an eligibility pre-check by reviewing available information
  understand when to refer the participant for an eligibility reassessment.
Recent updates – 3
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DISCLOSURE LOG - FOI 24/25-0368
SGP KP Publishing – When to refer the participant for an eligibility reassessment
1  Recent updates
3 October 2024
Guidance updated:
  to reflect legislation changes from 3 October 2024
  title has been updated from 'Understand eligibility reassessment referral requirements'
to 'When to refer the participant for an eligibility reassessment'
  content from article Complete and eligibility reassessment referral, relating to
referral decisions has been placed here
  content on creating the case and contacting the participant has been moved to article
Complete an eligibility reassessment referral.
Recent updates – 4
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DISCLOSURE LOG - FOI 24/25-0368
SGP KP Publishing – When to refer the participant for an eligibility reassessment
2  Before you start
You have read and understood:
  Our Guideline – Applying to the NDIS (external)
  Our Guideline – Leaving the NDIS (external) section Are you still eligible for the
NDIS?
Early childhood partners have read and understood articles:
  EC: Guide – Check-in eligibility conversations for children younger than 6 with
developmental delay
  EC: Guide – Evidence sources to demonstrate if an impairment is likely to be
permanent for children who previously met access for developmental delay.
To learn more about leaving the NDIS read:
  Our Guideline – Reviewing our decisions (external)
  article Understand the leaving case.
Before you start – 5
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DISCLOSURE LOG - FOI 24/25-0368
SGP KP Publishing – When to refer the participant for an eligibility reassessment
3  Consider an eligibility reassessment
We may need to check a participant's eligibility if information shows they may no longer be
eligible, or their disability support needs, or situation has changed. We call this an eligibility
reassessment. For more information see Our Guideline – Leaving the NDIS (external).

If the participant met disability requirements, we don't need to check their eligibility at every plan
reassessment. We only need to check if we get evidence they may no longer be eligible.

If the participant met the early intervention requirements, an automatic referral may be created.
3.1  Automatic eligibility reassessment referrals
An eligibility reassessment case will be generated automatically when the participant:
  with developmental delay turns 6
  with global development delay turns 7
  who is eligible under the early intervention requirement has a primary impairment of
hearing loss and turns 26.
If an automatic case has been generated, the participant's my NDIS contact will be notified via
the Omni-Channel to start an eligibility reassessment checklist. They will consider all
information to determine if an eligibility reassessment is needed.

When completing an automatic referral, check for more information about the participant before
completing the referral.
1.  Complete section Review evidence on the participant record.
2.  Complete section Review the participants original access decision and
information.
3.  Then continue to article Complete an eligibility reassessment referral.
3.2  Manual eligibility reassessment referrals
Sometimes you will need to manually create an eligibility reassessment referral. For example, if
you receive a report from the participant's treating professional that says their disability support
needs have changed.

If the participant's situation has changed and you think they need an eligibility reassessment,
you can manually make an eligibility reassessment referral. This can take place:
  as part of the plan reassessment process
  at check-in
  at any other time.
First you need to complete an eligibility pre-check to confirm whether you need to create an
eligibility reassessment referral. Continue to section Complete an eligibility pre-check by
reviewing available information.
Consider an eligibility reassessment – 6
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DISCLOSURE LOG - FOI 24/25-0368
SGP KP Publishing – When to refer the participant for an eligibility reassessment
4  Complete an eligibility pre-check by reviewing
available information
4.1  Check the participant has received funding for 14 months
1.  Go to the participant's Person Account.
2.  Go to the Account Timeline in the navigation pane.
3.  Find the first Plan Approval case in the Timeline.
Note: this will usually be at the bottom of the list.
4.  Check the date of the Access Decision date. Is this more than 14 months ago?
Note: If there is no date in PACE, check SAP CRM for this information. If:
o  Yes: continue to section Check for any open ER or Leaving cases.
o  No: the eligibility reassessment will not continue to be considered until after the
participant has received NDIS funding for 14 months. It will remain in the
Eligibility Reassessment Hold Queue until the 14 months are up. If you choose
to continue with the referral, go to section Check for any open ER or Leaving
cases.
4.2  Check for any open ER or Leaving cases
1.  Go to the participant's Person Account, Cases tab.
2.  Check Open Cases for an existing:
o  Eligibility Reassessment case
o  Leaving the NDIS case
3.  Is there an existing case in progress? If:
o  Yes: they cannot be referred for an eligibility reassessment. End of process.
o  No: continue to section Review evidence on the participant record.
4.3  Review evidence on the participant record
1.  Check all available information to make sure you give an accurate referral based on the
participant's current situation. Check:
o  any relevant documents on the participant's record
o  medical, clinical, diagnostic or assessment reports
o  provider reports and assessments such as progress reports
o  early childhood partner documents
o  information from family members and carers, such as a carer impact statement.
Note: You don't need to ask the participant to give any new or additional
information to pre-check eligibility.
Complete an eligibility pre-check by reviewing available information – 7
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DISCLOSURE LOG - FOI 24/25-0368
SGP KP Publishing – When to refer the participant for an eligibility reassessment
4.4  Review the participants original access decision and
information
The Decisions, Justifications and Evidence (DJE) framework of the Access Decision case
records evidence used. It helps record decisions to meet the requirements of the participant
service guarantee and the NDIS Act (2013).
1.  Go to the participant's Person Account, Decisions tab.
2.  In the Decision Name column, select Access Decision.
3.  Review all information within the Details tab to understand how the participant met the
access criteria for the NDIS.
4.  Go to the Decisions tab, and review all Justifications and sub-criterion decisions
made for the access decision.
5.  Review all Evidence/explanation, read the type of evidence and documents recorded
to support the access decision.
6.  In Sub-decisions, read the Decision Name and how the participant met the access
criteria for the NDIS.
Complete an eligibility pre-check by reviewing available information – 8
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DISCLOSURE LOG - FOI 24/25-0368
SGP KP Publishing – When to refer the participant for an eligibility reassessment
5  When to refer the participant for an eligibility
reassessment
1.  Has the participant's support needs or circumstances changed? If:
o  Yes, continue to step 2.
o  No, they cannot be referred for an eligibility reassessment. End of process.
2.  Check whether the participant that met access under the disability requirements, now
appears to no longer meet residence requirements, or no longer meet the disability and
early intervention requirements. If:
o  Yes: continue to section Commence an eligibility reassessment referral.
o  No: they cannot be referred for an eligibility reassessment. End of process.
3.  Check whether the participant that met access under the early intervention
requirements, and now they are likely to no longer meet residence requirements, or no
longer meet the early intervention requirements, and now meet disability requirements.
If
o  Yes, go to section Commence an eligibility reassessment referral.
o  No, they cannot be referred for an eligibility reassessment. End of process.

Note: A participant can meet both the disability and early intervention
requirements.
5.1  Commence an eligibility reassessment referral
1.  Create a new eligibility reassessment case using article Complete an eligibility
reassessment referral.
When to refer the participant for an eligibility reassessment – 9
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