Provider Choice NDIS Plan Reassessments User Guide
- June 10, 2024
- Provider Choice
Table of Contents
Provider Choice NDIS Plan Reassessments
Specifications
- Product Name: NDIS Plan Reassessments Guide
- Publication Date : November 2021
- Website for Updates : www.ndis.gov.au
Product Usage Instructions
Requesting a Review
Plan Variation
Use this review when you only need to make small changes to your plan without significantly changing the total funding you have.
- How to do it: Contact your Local Area Coordinator or NDIA Planner and ask for those small changes. Alternatively, call the NDIS directly on 1800 800 110.
- What happens next: If the NDIA approves your request, they will send you a new plan with the small changes requested within 28 days.
Plan Reassessment (formerly called Plan Review)
Use this review when you need a new plan due to a substantial change in your circumstances.
- How to do it: Download and complete the change of circumstances form and submit it to your LAC/NDIA Planner or directly to the agency. You can also call the NDIS on 1800 800 110 to request a plan reassessment.
FAQ
- Q: Can I request a reassessment at any time?
- A: Yes, you can request a reassessment at any time for plan variations or plan reassessments. However, there are specific timeframes for internal and external reviews.
- Q : How long does it take to receive a new plan after requesting a plan variation?
- A: If the NDIA deems your request reasonable and necessary, they aim to send you a new plan with small changes within 28 days. If you only want to change your goals, the agency must provide a new plan within 7 days of receiving your updated goals statement.
This guide was originally published in November 2021. To stay updated on changes to the Plan Reassessment process please visit www.ndis.gov.au.
When your current plan isn’t working for you anymore, you can ask the NDIS to
change it. This is called ‘asking for a plan reassessment’ (previously known
as a ‘plan review’). You can request a reassessment at any time. You don’t
need to wait until your next official plan reassessment meeting or check-in
conversation.
Why change your plan?
Here are some of the common reasons why you might need to change your plan:
- To add a new goal
- To change from Agency- to Self-Management or Plan Management
- To quickly repair or replace critical assistive technology that has broken down
- You had an accident and need more support, fast
- You received a new disability diagnosis
- Your health is deteriorating
- Your living arrangements have changed
- Your primary care arrangement has changed
Why change your plan?
There are four different types of reviews in the NDIS (see table on next
page).
- Plan variation – when you only need small changes to your plan.
- Plan reassessment – when you need a significant change in funding.
- Internal review – when you’re unhappy with the outcome of a plan reassessment.
- External review – when you disagree with the outcome of an internal review.
NDIS reviews
How to request a review
Plan variation
Use this review when you only need to make small changes to your plan without
significantly changing the total funding you have.
Examples
- Adding a housing goal to explore new living options
- Changing your address
- Changing to self-management to have more choices over providers
- Anticipating your assistive technology will need repairs over the next 12 months
How to do it
Contact your Local Area Coordinator or NDIA Planner and ask for those small
changes. Or call the NDIS directly on 1800 800 110.
What happens next?
Plan changes: If the NDIA thinks your request is reasonable and necessary, it
will send you a new plan with the small changes you asked for. It has
committed in its Participant Service Guarantee to getting this done within 28
days.
Goals: If you just want to change your goals, the agency must send you a new
plan within 7 days of receiving your changed statement of goals (see NDIS Act,
section 47 (3)).
Plan reassessment formerly called Plan Review
Use this review when you need a new plan because of a substantial change in
your circumstances. This involves some paperwork. Ask your Support Coordinator
to help if you have one.
How to do it
Download and complete this change of circumstances form and send it to your
LAC/NDIA Planner or directly to the agency
([email protected]). You can also call the
NDIS on 1800 800 110 and request this plan reassessment.
Give as much detail and evidence as possible
- Explain how your circumstances have changed. Include any medical records, health assessments and other written evidence you have.
- Explain how the new situation affects your ability to manage everyday tasks now and in the future.
- Describe how your support needs have changed as a result of the new situation.
- Explain which reasonable and necessary supports you need to help you manage your life now and reach the goals in your plan.
- If you need specific new support, get a medical specialist or allied health professional to back up your request in a written assessment.
What happens next?
The agency will check your request. If it agrees that it’s reasonable and
necessary for you to have a different funding package, it will create a new
one for you and send you a new plan. It may refuse your request for a plan
review.
Timings
The agency has promised it would decide in no longer than 21 days whether to
start a participant-requested plan reassessment. If it agrees, it may take
several weeks before the agency has finished its reassessment and created a
new plan.
Internal review
Use this review when the NDIS has made a decision about your plan, and you are
unhappy with the outcome.
Examples
- You received a new plan, but are unhappy with the funding package because it does not meet your needs.
- You requested a plan reassessment, but the NDIA declined. You think this decision is wrong. If this is the case, you can ask the NDIA to review the matter again. This is known as an internal review.
How to do it
Download and complete the official form to request an internal review and send
it to [email protected]. You can also call
the NDIS and start the internal review process over the phone (1800 800 110).
Ask your Support Coordinator to assist you in this process if you have one.
Explain in detail which NDIS decision you want to challenge, and why. How has
it affected you? What are you hoping to achieve? Do you think the agency
overlooked important facts? Give as much evidence as you can.
What happens next?
The NDIA cannot refuse an internal review request. It must ask one of its
staff – a separate person to the one who made the decision you’re challenging
– to revisit the case. The new reviewer has three options:
- Confirm the previous decision;
- Partly change the old decision;
- Make an entirely new decision.
Timings
Participants must request an internal review within 3 months after receiving
the NDIS decision they disagree with. The NDIA aims to complete all internal
reviews within 60 days of receiving your request.
External review (Administrative Appeals Tribunal)
If the internal review is over and you still disagree with the outcome, you
can call for another review – this time by external legal experts at the
Administrative Appeals Tribunal (AAT). The AAT is an independent tribunal that
reviews decisions made by the Australian Government.
The AAT can only review a decision after the NDIA has completed its internal
review.
How to do it
You can apply online for an Administrative Appeals Tribunal review by filling
out the application form here.
What happens next?
The Tribunal will call the participant within 3 days of receiving the request
to talk about the next steps. It will also notify the NDIA.
External reviews may involve a private meeting and a hearing to help you and
the NDIA reach an agreement. The Tribunal usually makes its final decision
after the hearing.
Timings
You must apply for an external (AAT) review within 28 days of receiving the
outcome of the NDIA’s internal review.
Further reading
Read more about reviewing your plan and goals on the NDIS website here.
Provider Choice is a national plan manager with a focus on providing proactive
support to participants and their support coordinators. Our systems,
processes, plan managers and community engagement managers are all PACE ready.
If you would like to speak with your local community engagement manager,
please get in touch:
CONTACT
- [email protected]
- www.providerchoice.com.au
- phone 1300 776 246