Support Coordinators have an essential role in assisting participants to navigate the NDIS and implement their plan. Part of the Support Coordinator role includes assisting the participant to understand and undertake the NDIS review processes.
Many NDIS participants have never been exposed to the true financial cost of their supports. The moment a participant receives their first plan in the letterbox may be the first time they become aware of this cost. Some participants may feel very anxious as the funding maybe more or less than expected. Others may find it confronting to see their support needs reduced to a dollar figure.
The NDIS planning and implementation processes can feel completely overwhelming for participants. They can see the dollar figure and the plan duration on the plan but are unsure of what can be purchased and how this will meet their needs. One of the common question participants ask at this stage is “What if something changes in my situation, and my funding runs out?”.
Participants under the processes of the NDIS Act 2013 have the right to request a review of their plan. Unfortunately, the different terms and concepts around review can make the process quite confusing for participants and the people who assist them.
Our aim in this 2 part piece on Reviews is to help Support Coordinators better understand the process and their important role in it.
What are the different types of review and who can initiate a review?
Plan Review is a process in which the NDIA re-assesses a participant’s support needs and prepares a new plan for the participant. There are two types of Plan Reviews:
1) Scheduled review
This occurs as part of the usual planning cycle (which is generally 12 months but could be longer or shorter).
2) Unscheduled review
This type of review can occur at any time within the plan. There are two ways that unscheduled review can be initiated:
o The NDIA can initiate review if there is an error in the plan that needs to be corrected. A common reason this can occur if assessments for equipment have been submitted and funding needs to be added to the plan to enable the purchase.
o Participants can request a review at any time if they believe their circumstances have changed and their plan no longer meets their needs. Further information can be found here: https://ndis.gov.au/participants/understanding-your-plan-and-supports/change-circumstances.html
However, the NDIA then has 14 days to decide whether they will or will not conduct the review.
So, what happens if the NDIA decide not to grant the request for review? Well, that’s where the terminology gets confusing because the participant will need to apply for Review of a Reviewable Decision (commonly known as an Internal Review Decision). Further information can be found here: https://ndis.gov.au/participants/reasonable-and-necessary-supports/decision-review.html. This is a different concept and process to the two types of Plan Reviews described above. We will discuss Reviewable Decisions in more detail in next week’s blog.
So what is the role of support coordinator in the unscheduled review process?
• Help the person to understand their plan as their budgets may enable the person to meet their needs for the life of their plan without needing a review. This is an important step as you can assist a participant to collect evidence as to why the plan is incorrect or will not meet the person’s support needs or help prevent a review.
• Assist the participant to understand the review process and ensure they are aware of their review rights even if they are happy with their plan, as this is fundamental to helping build participant’s understanding of the NDIS.
• Ensure that a participant understands that a review, if accepted, looks at all the supports in the plan which may mean the plan can increase or decrease in value.
• Support participants in developing a clear summary of how their circumstances have changed, what you as a support coordinator have done to manage or resolve the crisis and if there is a plan in place what likely changes may been needed to an NDIA plan. It is also important to highlight any risk to the participant and any other urgent factors.
• Work with the person and their networks to implement the plan that they have even while under review. It is vital that a support coordinator is working with the person to ensure their current support needs are met to the extend that is possible with the plan.
I have assisted the participant to lodge a review and heard nothing – now what do I do?
The NDIA has a significant backlog of Unscheduled Reviews to work through. This issue was highlighted recently in a report by the Commonwealth Ombudsman who provided 20 recommendations which the NDIA have accepted. The report can be found here: http://www.ombudsman.gov.au/news-and-media/media-releases/media-release-documents/commonwealth-ombudsman/2018/15-may-2018-ombudsman-releases-ndia-reviews-report
If you are a Support Coordinator waiting for review to occur you should:
• Continue to empower participants to investigate mainstream and community supports that may meet their need
• Check back on the review request. Ensure that it clearly outlines:
o the participant’s situation
o what has changed
o how budget flexibility has been used to address the issue
o any plans in place to manage in the short term
o any risk to the participant or their support network and what you believe needs to happen to address this.
• Ensure you are following your organisation’s policies and procedures in reporting any critical incidents. Monitor and mitigate risks to the participant (including the risk they may be without funding for supports) and if necessary recontact the NDIA to highlight any changes in risk
• Support participants to make decisions that ensure their budget lasts through the whole plan period, unless doing so would cause them harm
• Maintain a positive approach in your communication with the NDIA, and focus on sharing factual, concise and relevant information about the participant’s situation.
Review is a complex part of the NDIS process. Support Coordinators can play a valuable role in supporting participants to navigate review while continuing to feel well supported.
PART 2 of this Blog will be posted NEXT WEEK…stay tuned. Please request to join our “Practical Help For Support Coordinators” Group on our Facebook page and we can answer any questions you may have.