START MODULE NDIS plan reviews Image of Transition Support Project logo Description This training is designed for people who may be supporting NDIS participants during the plan review process. The information in this module is general in nature. Every organisation does things differently and has different policies and procedures, so please interpret the content in this module with your organisation in mind and discuss any discrepancies with your line manager. Duration: Approximately 30 minutes (note. you can close the training and pick up where you left off at a later date). Last updated: 6 July 2020 Content and links in this training were correct at the time of publication. We check these regularly; however, if you find broken links or errors please contact
Topic 1 of 7 Training objectives Image of a light bulb Training objectives There are two types of plan reviews in the NDIS: scheduled and unscheduled. Scheduled review - end of plan Front of card Scheduled review – end of plan Click to flip Part of the standard review cycle for plans. They usually happen every 12 months (can be longer depending on the person's needs and goals). It is an opportunity to review the plan and make changes for the following plan cycle. Front of card Unscheduled review Click to flip A request to change a plan outside of the standard review cycle. Includes a request to change a plan due to a change of circumstance, or because the person doesn't think their plan is suitable. This training will provide an overview of the two review types. By the end of this module you will: • Understand how the NDIS review process works • Know what options are available to someone who needs to change their plan • Understand the role of providers in preparing for plan review This is an introductory training module for anyone providing NDIS services. It is designed to give you the knowledge to be able to answer participant questions about the processes and to understand how the NDIS system works. Image of an open book Assumed knowledge We have a number of individual training modules on the NDIS; this module assumes an understanding of the following aspects of the NDIS. If you have not yet completed these you can find them on the training page of our website. • NDIS explained • NDIS access and psychosocial disability • Preparing for NDIS planning meetings • Reasonable and necessary in the NDIS • Understanding NDIS plans
Topic 2 of 7 COVID-19 update COVID-19 changes The NDIA have made a number of short-term changes to the way that people can use their NDIS funding as a result of COVID-19. Some of the content discussed in these training modules may not apply to the current context. A summary of the major COVID-19 related changes is provided here, including links to further resources. These changes are likely to be reviewed in the coming months. Key changes New line items for support coordination From 25 March 2020, the support items for Support Coordination were temporarily duplicated into the Core Support Category – Assistance with Daily Life – so that participants can have greater access to support coordination services if they need them. Read more on the COVID-19 updates Support Coordination page. Increased plan flexibility Core funding is now completely flexible, people with any core funding can use this funding to purchase any services/supports across the four categories. There are also several new capacity building line items to provide further flexibility using capacity building budgets and an easier process to request a transfer of funds from capacity building to core if necessary. This is a continually evolving space, we recommend staying up to date by regularly checking the NDIS 'using your budget' updates. Phone planning Planning and review meetings are now held over the phone instead of face to face. Existing plans will be automatically extended by 12 months until a plan review can be scheduled. Read about planning on the 'your plan' page. Provider flexibility There are a number of changes to service delivery including broadening the criteria for charging for cancellations, and allowing an increased price loading in some circumstances. Visit the 'Advice for providers' page for a full summary, you can also refer to the Quality and Safeguard COVID updates page. All relevant information including updates, FAQs and information packs can be found on the NDIS Coronavirus information and support page. NDIS Coronavirus (COVID-19) information and support We know that participants, their families and NDIS providers may be looking for workers to deliver disability supports, and provide extra cover at the moment. For participants, there are a number of online matching platforms that can help you quickly and easily connect to support workers. READ MORE N.D.I.S.
Topic 3 of 7 Scheduled plan reviews Scheduled reviews happen regularly as part of the NDIS funding cycle. They are an opportunity for participants to: • Consider how they are progressing toward their personal goals • Explore new goals • Consider which supports are working well • Identify supports that are not working well or are no longer needed • Discuss any changes in their life What to expect from a plan review meeting Tab 1 of 4 who will be there? Tab 2 of 4 what happens at the meeting Tab 3 of 4 when will it be held? Tab 4 of 4 where will it be held? Tab 1 who will be there? A representative of the NDIA (either a planner or an L. A. C. NDIA community partner) will be at the meeting. Where possible, the NDIA will aim to ensure the NDIA representative has specialist knowledge of psychosocial disability. Participants can also choose to bring other people with them to the meeting. Trusted others can include their support worker, carer, family or friends. Tab 2 what happens at the meeting? The plan review meeting is an opportunity for the participant and the NDIA representative to meet and discuss the person's plan and their support needs over the next year. The NDIA will ask questions about: Goals: how a person has used their plan to work toward their goals, how this is going and if the goals need to change. Supports: what supports have been accessed, if there have been any difficulties accessing supports, which need to continue and which new ones need to be added. Functional impairments: usually the WHODAS functional assessment will be conducted at every review meeting. If there are changes to the person's disability support needs this can be discussed as well. If the person has recently completed a functional assessment (e.g., the WHODAS or the LSP-16) they can bring this to the meeting. The NDIA will use the information collected at the planning meeting to determine what supports should be funded in the next plan. It is a good idea for people to think about their goals and support needs in advance of this meeting and bring along any new assessments or other evidence that may support a request for ongoing or changing supports. If participants have a support coordinator funded in their plan, the support coordinator can often help with the preparation. Tab 3 when will it be held? The participant's plan will say when the current plan expires. The NDIA representative will contact participants before this time to schedule the plan review meeting date. Often people start preparing for their plan review (e.g., gathering supporting information, thinking about their goals and supports) a few months before their review meeting. Tab 4 where will it be held? The participant is in charge of where the meeting will be held. It will most often be face-to-face unless the person requests otherwise. The participant can choose to attend their local NDIA office or ask the NDIA representative to meet them at a location where they feel comfortable. During COVID-19 all plan review meetings are happening over the phone. Sometimes plans will be automatically extended to allow service continuity. See the NDIS website for more information. What is the difference between the first plan meeting and plan review meetings? Front of card First plan meeting Click to flip This was the first time the person had met with the NDIA. The first plan is an opportunity to see what the NDIS can do. It may have been the first time a person was asked to think about their goals for the NDIS. In most instances people used their experience with existing supports to decide what types of things they wanted in their plans. Front of card Plan review meeting Click to flip At this point people are more familiar with the NDIS. They may have had a chance to try a new type of support, or have started thinking about new, bigger goals. They will also have had an opportunity to use NDIS funding and understand the new system a bit more. What to bring Interactive image, click on the ticks Image 1 tick box Planning workbooks Planning booklets like: • Reimagine my life (go to website) • NDIS participant booklet 2 (go to website) These are great participant resources that help people think about their goals and their support needs. Writing everything down can help keep the meeting on track and make sure th person addresses everything they need to. Image 2 tick box Assessments New reports or assessments that have been conducted during the plan period are really helpful. They can show the NDIA if a person’s disability support needs have changed or be used as supporting evidence for a request to increase or add supports. Image 3 tick box Provider reports Most providers will keep notes on the services they have delivered in the NDIS and may be able to prepare a summary to bring to a plan review meeting. This can help when a person wants to continue using a service in their next plan. Helpful information from providers includes: • What supports have been provided to date • How they are supporting someone to achieve their goals • What they plan to do in the future to keep progressing toward the goal or address new goals. After the plan review meeting the person will be provided with a new NDIS plan. The supports included in the new plan will be decided by applying the reasonable and necessary criteria. This means that the next plan may include different support budgets than the first plan. Knowledge check If a person hasn't spent all of their funding, this will be rolled over in to the next plan. • True • False SUBMIT Provider role when preparing for review Front of card Support coordinator Click to flip Support coordinators can help people to prepare for their plan review. This often involves filling out a report with the person about their service use and their goals. They will also need to report on their role including how they have linked the person in with NDIS, informal, community and mainstream supports. If support coordination is needed in subsequent plans they can also provide evidence to support this. Front of card NDIS service provider Click to flip Service providers can be really helpful in preparing reports or assessments that participants can use to support their request for new or ongoing supports. Unspent funds Image of a jar tipped over with coins flowing out If a person hasn't spent their NDIS funding it can give the impression that the supports weren't needed. Often however, it means that a person couldn't find the right provider or had some other difficulties finding ways to spend the funding. If this is the case, make sure it is very clear why the money couldn't be spent, including what was done to try and find suitable providers. Scenario Preparing for plan review Click through to see an example of how someone might prepare for a plan review meeting. START Step 1 Meet Zoe Image of a person sitting and writing into a notebook Zoe is about to go to her first plan review meeting. She is preparing for it reflecting on the services she used this year and thinking about her goals. One of Zoe's goals is to be able to access the community independently. She has severe social anxiety and has struggled to use public transport. She has been using some of her funding to pay for public transport training and for support to increase her social skills. Step 2 Is the goal still relevant? Image of rugby goal posts are a rugby game with spectators Zoe has found the supports useful and is now able to use public transport when her carer is with her. She would like to to continue working toward this goal so that she may be able to go out without her carer in the future. Step 3 Supporting evidence Image of person with laptop writing into a notebook Zoe would like to continue working with the same service providers to continue with this goal in her next plan. She asks each of them to prepare a brief summary of the work that they did with Zoe this year and how they will continue to support her to work toward her goal in the future. Zoe brings these reports along to her review meeting. Summary This was quite a simple example of how to think about supports for future plans by reflecting on an existing plan. Thinking about how the funding has been used in relation to goals (and where it should continue, increase or decrease) for each funding category is a good way to prepare for a plan review meeting. START AGAIN
Topic 4 of 7 Unscheduled plan reviews Unscheduled reviews occur when something needs to change during the plan period which would require a new plan to be developed before the scheduled review. The steps for an unscheduled review are as follows: • One Determine why the change is needed • Two Contact the NDIA to discuss the change request • Three NDIA will advise next steps depending on the nature of the change • Four If the change request is not granted the person may choose to review the decision During COVID-19 there are new processes in place to help people who need to make changes to their plans to accommodate the changing environment, visit the NDIS website for more information. What type of change? Tab 1 of 3 Administrative Tab 2 of 3 Change of circumstance Tab 3 of 3 plan not suitable Click on Tab 1 Administrative Administrative changes e.g., changes to a funding type from agency to self-managed, changes to the names of contact people on plans and so forth can usually be made quite quickly and easily without needing to complete any paper work. Click on Tab 2 change of circumstance A change of circumstance is when the person's circumstances change enough to warrant a change to the type of NDIS services they access. The kinds of things that would warrant a change of circumstance review include: • if living arrangements change • if informal care arrangements change significantly • if disability support needs change Changes to a person's financial circumstances alone would not be sufficient to warrant a review (because the NDIA does not determine support needs based on income). To support a change of circumstance on the basis of disability support needs you would need to have new evidence regarding the person's disability needs that was not presented at the original planning meeting. You can read more about changes of circumstance in the NDIS operational Guidelines. Click on tab 3 plan not suitable If the plan simply isn't suitable (e.g., plan didn't include sufficient funding, something important was left off a plan) for the person's needs then a person can contact the NDIA to see if an unscheduled review can be considered. Plans are unlikely to be considered for an unscheduled review if: • Extra funding is being requested because the original funding was not managed appropriately (e.g., due to poor budgeting or misuse of funds) • The person is requesting a service or new equipment because they learned another participant has been funded for these supports • The request could be met by informal, community or mainstream supports • There is no new evidence to support their need for new supports. Provider role in unscheduled reviews Image of two people sitting with a laptop talking A request for an unscheduled review must come from the participant. However, as a provider you can play an important role in talking to people about their plans and how their funding can be used, which can help them to make a decision about asking for an unscheduled review. You may also be able to support them to contact the NDIA, depending on your role/relationship with the person. When is an unscheduled review appropriate? When requesting an unscheduled review the NDIA will want to see evidence that: • There is a clear need for additional support (e.g., what is the impairment the person wants to address, what are the goals, any supporting evidence) • That the support need cannot be addressed with the existing plan (e.g., by using the funding flexibly) • That the support need cannot be addressed through the mainstream, community or informal support systems. Example Mark wants to request an increase in his core funding from $10,000 to $15,000 so he can pay for a gardener and a cleaner. A friend of his has this in his plan and he has $15,000 of core funding. What would you do next? (tick all that apply) • Talk to Mark about his goals and impairments. Does he need the gardener and cleaner because of his disability? • Talk to Mark about his current core funding. How is he currently spending it and could it be changed? • Talk to Mark about how the NDIS allocate funding on an individual basis, and this means that his friend may have different funding amounts. • Support Mark to call the NDIA to review his plan. SUBMIT Look at the plan and consider how the funding could be used flexibly to meet a person's needs. Perhaps another support needs to be modified/reduced in order to be able to pay for a new support. Also don't forget mainstream and community services - perhaps the support required can be accessed through another system. Provider tip What if the change request is denied? Reviewing a decision If a person requests the NDIA conduct an unscheduled plan review and the NDIA say no, this becomes a 'reviewable decision'. If the person wishes to pursue the decision, the following steps apply. START Step 1 Internal Review The participant can request an internal review of the decision. This means a new NDIA representative will review the decision and see if they think the plan should be changed or if they agree with the original decision. Step 2 External review If, following an internal review, the NDIA still decide not to change the plan, the person can apply for an external review by the Administrative Appeals Tribunal (AAT). This is when a group of people who are not employees of the NDIA will consider the request to change the plan and determine if they think a change could be made based on the NDIA rules. Step 3 Review in the Federal Court of Australia If internal and external reviews have been exhausted a person may be able to appeal to the Federal Court of Australia to question the decision on a matter of law. This option is not automatically available: the person would need to make an application to the court for their consideration. Summary A person cannot request external reviews without first pursing internal reviews (i.e., all steps must be followed). Advocacy services are available to support participants through the NDIA appeals process. You can find out more about plan reviews and changes by reading the NDIS Planning Operational Guideline. For more information on the review process visit the NDIS website. START AGAIN Pre-planning is key! Image of person writing into a red notebook Never underestimate the importance of pre-planning. We have a training module that covers this if you need a refresher. The more information that is provided in the initial planning meeting the more likely it is that the plan will adequately match the participant's needs. FAQ How long does it take for the NDIA to make changes to plans? The time taken for the NDIA to approve changes will vary depending on the change. Recent changes at the NDIA mean that administrative reviews can now be done quite quickly. The NDIA have also recently hired more staff to reduce some of the long wait times for plan reviews. The NDIA is still growing and sometimes there may be delays; the NDIA are aware of the concerns in this area and are working to address them. However, it is important to be aware that sometimes reviews may take some time. This is why you should continue to access services while you wait. Is it better to wait for the scheduled review? Sometimes it might be advisable to wait until the scheduled review to address concerns with a plan, particularly if you don't have long to wait until the next review. Other times, for example if a key support category is missing, it won't be in the person's best interests to wait. You need to weigh up these options with the person. Should a person continue to use their plan while waiting for a decision? Yes, it is fine to keep using the NDIS plan while waiting for the NDIA to make a decision. When determining how to use the funding during this time you will need to weigh up the person's immediate support needs, but also keep in mind that the request to review the plan may not be approved (so don't count on extra funding being available).
Topic 5 of 7 Advocacy in the NDIS Plan reviews are often a time when participants might need some extra support. As a provider, it is helpful to know how you can help and when you should refer on. Advocacy in the NDIS Front of card What is advocacy? Click to flip Broadly speaking, disability advocacy is: "acting, speaking or writing to promote, protect and defend the human rights of people with a disability" - Australian Government Department of Social Services, Disability Advocacy fact sheet Go to DSS Disability Advocacy Fact Sheet Image of person lying in a field with their hand up The NDIS does not provide funding in NDIS plans for disability advocacy services. This means that if you are providing NDIS supports you should not provide formal advocacy services as part of this support. A lot of your work may feel like it fits the general definition of advocacy, after all you are always working in the best interest of the person. The key distinction in the NDIS is between building capacity for self-advocacy (e.g., supporting people to build skills and knowledge to make decisions) and formal advocacy (speaking for people and acting on their behalf). Click on the cards below to learn more about the types of activities that you can do as an NDIS provider, and the things that should be referred to an advocacy provider. Front of card Blue tick sign1 Click to flip Can: • provide support with decision making • educate people about the NDIS • help people to implement their NDIS supports • build skills and knowledge for people to stand up for their rights • work with providers to ensure appropriate service delivery Front of card Image of red cross sign Click to flip Can't • resolve issues associated with government benefits or support services • act on a person's behalf at a tribunal for example for guardianship or tenancy disputes • campaign for improvements to existing public services • act on someones's behalf to resolve complaints What advocacy supports are available for NDIS participants? The Australian Government offers a free and independent disability advocacy service for people who require advocacy supports. You can read more about their service on the National Disability Advocacy Program website Advocacy and plan reviews Consider what you know about advocacy in the NDIS and the things a provider might do when supporting someone with their plan review. When might you need to step back and engage a formal advocate? CONTINUE FOR ANSWER You can certainly work with people to understand their review options, to prepare them for a review meeting (e.g., by gathering evidence for supports) and to help people make decisions about their supports. Here are a few areas where you will need to refer the person to a formal advocate. • If the person chooses to review an NDIA decision and proceed to an external review, an independent advocate can support them through this process and help with legal representation. • If the person wants a new support or significant increase in supports at their plan review meeting and is not able to ask for this themselves, an independent advocate can be asked to attend the meeting. Takeaway Image of a hand in pointing motion It is important to understand what you can do as an NDIS service provider and where you should engage other services. This is a big shift from block funding models where providers often wore multiple hats. Advocacy support is available if a person is having trouble getting the supports that they want from the NDIA. You can find advocacy providers online using the DSS disability advocacy provider tool. DSS Disability Advocacy Finder The Disability Advocacy Finder is a tool that can help you find an advocate. An advocate is a person who is there to help. They provide support, encourage you to make informed decisions, and help people with a disability to learn about their human rights and how to access them. READ MORE DSS
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