REVIEWS BLOG – Reviewable Decisions and what I need to know as a Support Coordinator (Part 2)

By June 12, 2018News

Reviewable Decisions are part of the NDIS Act and enable participants to as for an independent Review of a decision.

There are 22 different NDIA decisions that are “Reviewable Decisions”. Some of the most commonly reviewed include:

  • the Access decision
  • the decision about what is funded in the Statement of Supports in the participant’s plan
  • the decision about whether to grant a Plan Review
  • the decision about whether a participant can Self Manage

If a participant asks for an Internal Decision Review, the NDIA must conduct it. That’s right – if a participant is asking for an Unscheduled Plan Review because of a change in their circumstances, the NDIA considers whether the review is necessary. This is where the Internal Decision Review is different, if requested by a participant the NDIA don’t have a choice – they must conduct the Internal Decision Review.

 

The participant is unhappy with an aspect of their new plan? That’s an Internal Decision Review – not Plan Review.

 

Participants sometimes request at the planning meeting that a specific support be funded in their plan. From the participant’s point of view, a trampoline might be a reasonable and necessary support. However, the NDIA may disagree and provide a plan that doesn’t include funding for the trampoline.

 

The participant in this scenario can opt to request an Internal Review. This request must be made within 3 months of the original plan decision date. Further information and forms can be found here:  https://ndis.gov.au/participants/reasonable-and-necessary-supports/decision-review.html

 

Just to reiterate, this is not a request for Plan Review. The participant is not saying that their circumstances and needs have changed – they are saying they believe the Reasonable and Necessary funding decision is wrong.

 

The Internal Review of the Reviewable Decision can’t be undertaken by the same person who made the original decision. The request will be allocated to a different planner, who will reconsider the Reasonable and Necessary decision. It’s important to note that this could result in changes to the plan as the planner reconsiders all the supports in the plan.

 

If the participant is unhappy with the outcome of the Internal Review process, they can request External Review via the Administrative Appeals Tribunal (the AAT). The AAT is an independent decision maker that reviews whether NDIA decisions are correct. As part of this process the participant will be allocated a contact person at the AAT who will assist them to understand the process. The AAT often asks participants and the NDIA to go through a mediation process for resolution of the issue. If this process is unsuccessful the case will go to the tribunal for a decision. The AAT publishes decisions that have been made and these can be viewed at: http://www.austlii.edu.au/cgi-bin/sinosrch.cgi?method=boolean&meta=%2Fau&mask_path=au%2Fcases%2Fcth%2FAATA&mask_world=&query=national+disability+insurance&results=20&submit=Search&rank=on&callback=off&legisopt=&view=relevance&max

 

The AAT provides their reasoning for each decision including the information considered and the AAT must be confident that it has the authority to be reviewing the decision. If the processes described earlier have not been followed it can refer the matter back to the NDIA. Once it is determined it can proceed information may be provided by the participant, the NDIA, a Specialist such as a medical professional or using the NDIS Act, NDIS Rules or Operational Guidelines. The AAT can make a decision that confirms the NDIA decision was correct or overturn an NDIA decision if it was incorrect and make a new decision.

 

What’s the Support Coordinator role in request for Internal Review of the Reasonable & Necessary decision?

  • Before considering whether to make a request, Support Coordinators have a responsibility to help participants understand their plan, including the flexibility available in their funding. For example, a family may have requested respite. The participant’s plan will not mention respite, but if they have a budget for core supports, there are multiple ways for the family to achieve a respite effect. In other scenarios, Support Coordinators should support participants to consider whether outcomes can be achieved through connection to community and mainstream supports.
  • Support Coordinators can support participants to navigate the Internal Decision Review process, including helping participants complete and lodge the Internal Decision request if necessary. It’s important that participants implement their plan while the Decision Review process is in progress so that they aren’t without essential supports. Implementing the plan makes it no more or less likely that the Decision Review outcome will be favourable.
  • As a support coordinator there is a limit to the amount of support you will be able to provide through this process so it worth considering assisting the participant to link with advocacy organisations that can assist them with the review process – https://www.dss.gov.au/disability-and-carers/programs-services/for-people-with-disability/ndis-appeals#03. These organisations are funded to provide support to participants of the NDIS and can support participants through the Internal and External review processes.
  • Continue to work with the participant to work towards their goals, linking to mainstream and community and implementing funded supports that are available in the plan while these processes are occurring.
  • Support Coordinators are integral to supporting participants to understand their rights of review under the NDIS.

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