UNDERSTANDING THE NDIS & REVIEWS We would like to acknowledge all Aboriginal and Torres Strait Islander peoples, their Elders and Respected Persons (past, present and emerging) as the Traditional Custodians of the land on which we meet today. This presentation remains the intellectual property of Rights Information & Advocacy Centre Inc. (RIAC) and may not be copied, or used without their prior written approval. Use of any material within this document must be accredited to Rights Information & Advocacy Centre Inc. (RIAC)
OVERVIEW 1. Why are we here? 2. Access to NDIS 3. Not Eligible for NDIS? 4. Your NDIS Plan 5. Reasonable and Necessary Criteria 6. Internal Reviews and Appeals 7. Evidence Tips 8. Plan Review Request 9. External Review Appeal 10. Complaints 11. How can RIAC Support This presentation remains the intellectual property of Rights Information & Advocacy Centre Inc. (RIAC) and may not be copied, or used without their prior written approval. Use of any material within this document must be accredited to Rights Information & Advocacy Centre Inc. (RIAC)
1. WHY ARE WE HERE? • To build the capacity of participants, carers and the workforce. • To assist people to gain further knowledge to actively navigate and understand the NDIS the review process. • Increased demand for Internal Review requests (Also known as Review of Reviewable Decisions (RORDs) causing high demand on advocacy services. • Tips and tools to self-advocate
2. KEY WORDS National Disability Insurance Agency (NDIA): government organisation that runs the NDIS a. National Disability Insurance Scheme (NDIS) : social welfare scheme of the Australian Government that funds costs associated with b. disability NDIA Planner/Delegate: employed by the NDIA to build participant plans and make decisions for the NDIA c. Administrative Appeals Tribunal (AAT): provides independent review of decisions made by the NDIA d. Internal Review: section 100 NDIS Act 2013 also known as a Review of a Reviewable Decision (RORD) first step in review process of an e. NDIA decision External Review: review process for an unfavorable NDIA Internal Review decision f. Local Area Coordinator (LAC) g. Partnered with the NDIA to deliver the NDIS for participants 7 years and older h. LAC is a participant’s main point of contact for NDIS matters, gathers information and helps to understand and implement the NDIS a. plan Links to community and mainstream services for non-NDIS participants b. Early Childhood Early Intervention (ECEI) i. Partnered with the NDIA to deliver the NDIS to participants 0-6 years who have a developmental delay or disability j.
2. ACCESS TO NDIS • If you have a disability and would like access to the NDIS you must meet the NDIS eligibility criteria • First consider – what do I want the NDIS to support me with? • You can apply as many times as you like Eligibility Criteria in s.24 NDIS Act 2013: - Must have a permanent (?) disability that substantially (?) affects your ability to take part in everyday activities - Less than 65 years old - S. 25 Early intervention – permanent disability or be a child aged 0-6 years with significant developmental delay This presentation remains the intellectual property of Rights Information & Advocacy Centre Inc. (RIAC) and may not be copied, or used without their prior written approval. Use of any material within this document must be accredited to Rights Information & Advocacy Centre Inc. (RIAC)
2. ACCESS TO NDIS What does Permanent mean? • To prove a disability is permanent (or likely to be permanent) the evidence must include the following: • What assessments/treatments have been performed, or are currently being performed? • Are further tests or treatments required? • Are there any further available and appropriate treatments that are likely to improve the impairment? NOTE: An impairment/s may be categorised as permanent and continue to be treated eg. Impairment may be degenerative and treatment is slowing down impact of degeneration. If a health condition has caused a permanent impairment and hence a ‘disability’, this may become an NDIS recognised disability Example: Diabetes related supports: health system Amputation as a result of diabetes: NDIS This presentation remains the intellectual property of Rights Information & Advocacy Centre Inc. (RIAC) and may not be copied, or used without their prior written approval. Use of any material within this document must be accredited to Rights Information & Advocacy Centre Inc. (RIAC)
2. ACCESS TO NDIS What does “Substantial” Impact on Function mean? Evidence needs to show a substantially reduced functional capacity to undertake any of the following as a result of impairments: • communication, or; • social interaction, or; • learning, or; • mobility, or; • self-care, or; • self-management Substantial: Unable to participate in activities effectively or perform actions without aids, modifications or assistance This presentation remains the intellectual property of Rights Information & Advocacy Centre Inc. (RIAC) and may not be copied, or used without their prior written approval. Use of any material within this document must be accredited to Rights Information & Advocacy Centre Inc. (RIAC)
3. NOT ELIGIBLE FOR NDIS ACCESS? Engage with an NDIS Community Based Partner • Local Area Coordinator (LAC) • Early Childhood Early Intervention (ECEI) • These services can assist to link you in with other services including community services, local councils, Mental Health Recovery services, hospitals, libraries, health centres, community groups, charities, community centres. This presentation remains the intellectual property of Rights Information & Advocacy Centre Inc. (RIAC) and may not be copied, or used without their prior written approval. Use of any material within this document must be accredited to Rights Information & Advocacy Centre Inc. (RIAC)
4. YOUR NDIS PLAN Planning information is gathered by either: • NDIA Planner/Delegate (complex cases) • Local Area Coordinator (LAC) (above 7) • Early Childhood Early Intervention (ECEI) (0-6 years) Final approval goes to an NDIA “Delegate” This presentation remains the intellectual property of Rights Information & Advocacy Centre Inc. (RIAC) and may not be copied, or used without their prior written approval. Use of any material within this document must be accredited to Rights Information & Advocacy Centre Inc. (RIAC)
4. YOUR NDIS PLAN • Your NDIS plan will provide you with supports that are directly related to your disability • Once you are a participant your overall disability support needs should be considered Eg. if you gain access for a psychosocial disability but also have epilepsy you may receive funding for all epilepsy related support needs BUT … support requests must meet the Reasonable and Necessary criteria (see next slide) NOTE: “Primary” and “Secondary” disabilities are not part of NDIS legislation. All your disabilities are relevant! This presentation remains the intellectual property of Rights Information & Advocacy Centre Inc. (RIAC) and may not be copied, or used without their prior written approval. Use of any material within this document must be accredited to Rights Information & Advocacy Centre Inc. (RIAC)
5. REASONABLE AND NECESSARY CRITERIA 1. Does it support you to achieve your NDIS Plan goals? 2. Does it assist your social and economic participation? 3. Is it value for money? 4. Is it effective and beneficial and has regard to current good practice? 5. Does it takes into account what is reasonably expected for families, carers, informal networks and the community to provide? 6. Is the support most appropriately funded through other systems? eg health, education, child protection etc. This presentation remains the intellectual property of Rights Information & Advocacy Centre Inc. (RIAC) and may not be copied, or used without their prior written approval. Use of any material within this document must be accredited to Rights Information & Advocacy Centre Inc. (RIAC)
6. INTERNAL REVIEWS AND APPEALS Process & Timeframes: 1. Internal review (also known as Review of a Reviewable Decision) – Within 3 months of receiving decision from NDIA (outside 3 months can request an exemption to NDIA) 2. Internal review decision from NDIA – no timeframe 3. Appeal to Tribunal – within 28 days of receiving a decision from NDIA (outside 28 days can request an exemption) 4. Tribunal process – has various stages and no timeframes This presentation remains the intellectual property of Rights Information & Advocacy Centre Inc. (RIAC) and may not be copied, or used without their prior written approval. Use of any material within this document must be accredited to Rights Information & Advocacy Centre Inc. (RIAC)
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