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Participant check-ins and NDIS plan reassessments: know your options
July 25, 2022

 

This article, from Fighting Chance’s Lisa Duffy, will help you understand your options and rights around NDIS plan reassessments (previously known as plan reviews). Lisa has a fifteen year career in the disability sector, a detailed understanding of the intricacies of the NDIS, and a passion for empowering the people she supports to advocate for themselves and be “the most informed person in the room.”

A plan reassessment can be an opportunity to provide evidence to justify the funding you require to meet your support needs and goals. On the other hand, it is often a time that generates uncertainty, anxiety, inconsistency, and change. But one thing is for sure: knowing how to ‘talk the talk’ and understand how some NDIS funding decisions are made can help you feel more prepared and less uncertain.

These are Lisa’s must-knows for NDIS plan reassessments:

  1. Understanding the new “participant check-in” process
  2. Know your options for a plan reassessment, should you choose one
  3. Know your rights about plan lengths/plan periods
  4. Understand how funding decisions are made, and be sure the evidence you request and collate for your plan reassessment address all requested and recommended funding against the 6 reasonable and necessary criteria summarised in Section 34 of the NDIS Act.

What is a participant check-in?
According to the NDIS website, your ‘plan review experience will start with a participant check in,’ where a representative from the National Disability Insurance Agency (NDIA) will contact you or your Plan Nominee near the current plan end date, to book in the plan reassessment meeting if necessary.

What should happen during your participant check-in?
A representative of the National Disability Insurance Agency (NDIA) will make contact with the NDIS Participant and/or their plan nominee, and discuss your current situation: checking on your wellbeing and making sure your NDIS supports and other supports are meeting your needs. Depending on your individual circumstances and your check-in conversation, the outcome of the check-in with either be:

  • Plan Variation: A new NDIS plan with the same or similar supports,
  • Plan Variation: A new NDIS plan with minor changes to current supports, or;
  • A full Plan Reassessment (previously known as a full plan review)

If you choose a full plan reassessment, you should be able to book in a time at a later date to have the meeting, so that you have time to collect all of the evidence, supporting letters, and reports that you need.

So, the learning here is that if you choose to have a full plan reassessment, be sure only to book this in and have the meeting if you are fully prepared with the evidence you need to justify your reasonable and necessary supports. If your LAC or Planner tries to proceed with a plan review on the phone during your check-in, you are fully within your rights to refuse to go ahead with it there and then.

When should I choose a full plan reassessment?
Not everyone needs a full plan reassessment. Many people will be able to continue with the same supports in a new plan, or with only minor changes.
According to the NDIS, you are only likely to need a full plan review if:

  • If the impact of your disability on your life has changed
  • If your goals and support needs have changed
  • If you have started a new life stage such as school or work
  • There is a significant change in your personal circumstances and/or living arrangements
  • Children younger than 7 with changing goals and developmental needs whose support needs have changed.

Read more detail from the NDIS on who will need a plan review here.

Reasonable and necessary supports
If you opt for a full plan reassessment, you will need to be sure that the supports you are asking for are “reasonable and necessary”. Section 34 of the NDIS Act 2013 details six critical “reasonable and necessary” criteria that must be met before funded supports may be approved in an NDIS Plan.

You can find the six criteria in the NDIS guidelines here.

Every single criteria must be met before an NDIS Planner may consider approving the funding in an NDIS Plan. Therefore, be sure to review and check all supporting documentation, reports and quotes from your treating professionals and service providers, to ensure the supports and funding they are recommending for your next plan period are indeed justified against the reasonable and necessary criteria.

Now that you’ve got the knowledge to decide whether you need a plan reassessment, book one in and prepare your evidence, I have one final tip…….

How long should your plan period be?

An update on the NDIS website in April 2021 explained that 24 month plans were going to become more ‘the norm’: to simplify the planning process and improve the experience of participants. It goes on to say: Longer plans will give you the time, flexibility, stability and certainty you need to set meaningful, long-term goals that give you greater choice and control over how you live.

That’s why we are taking steps to make 24-month plans or longer the norm. You can choose to have a plan of up to 36 months if your support needs are stable.

However: please know that if you have a disability where your current support needs and goals are not stable, and there is likely to be a change in your support needs, and/or if you are living within a significant period of transition or change, you have the right to request a shorter plan period (eg 12 months). You have the right to request a different plan length even though this may not be presented as an option in your participant check-in or plan reassessment meeting (as the current default plan length is 2 years/24 months).

Good luck with your participant check-in and plan reassessment – and don’t be afraid to advocate for yourself now you know your options. Until next time!

Watch the replay of Lisa’s webinar on understanding changes (as of July 22) to the NDIS plan review process.