Provider Choice NDIS Plan Reassessments User Guide

: June 10, 2024
: Provider Choice

Table of Contents

Provider Choice NDIS Plan Reassessments
Specifications
Product Usage Instructions
FAQ
NDIS reviews
Plan variation
Internal review
Further reading
CONTACT
References
Read User Manual Online (PDF format)
Download This Manual (PDF format)

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

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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 (enquiries@ndis.gov.au). 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 enquiries@ndis.gov.au. 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.