There are two types of review under the NDIS system – a Plan Review s48 (scheduled and unscheduled) and an Internal Review s100. Here we'll help you figure out the differences and how they can apply to your personal situation.
National Disability Insurance Scheme Act 2013 - Section 48
Scheduled Review
Your NDIS plan is generally in place for 12-36 months, at which time a scheduled plan review will be conducted by your Local Area Coordinator (LAC) or Early Childhood Early Intervention (ECEI) partner or NDIA Planner. You can request an unscheduled plan review at any time, which will bring your scheduled plan review date forward. This usually occurs where there has been a change in your circumstances/situation.
Unscheduled Review
In recognition that a person’s needs may change prior to the date of a scheduled review, the National Disability Insurance Scheme Act 2013 (NDIS Act) provides a mechanism for a person to request a review at any time (an unscheduled review) (s48 NDIS Act).
Your plan may need to be changed for many reasons. If your situation changes, your disability support needs may change. You might need more supports, less supports or different supports. There are different ways the NDIA can change your plan. In certain situations, they might be able to vary your current plan. If major changes are required, The NDIA will complete a plan reassessment, and you’ll get a new plan.
The Agency used to call this a plan review. The NDIA check in with you during your plan to see if you need any changes to your plan and talk with you about your situation and look at any information you have given them to work out if a change is needed. If it is, the NDIA then decide what type of change they need to do based on their decision making criteria.
ISA can assist you to ask the NDIA for a change to your plan at any time and they can also decide to do a change to your plan at any time. A change to your plan isn’t used to review a decision the NDIA have already made. The Agency work with you to complete the change to your plan. They will talk with you about your situation to work out what change is needed. The NDIA will then either update your plan or create a new a plan.
National Disability Insurance Scheme Act 2013 - Section 100
Review of a Reviewable Decision
The decision-maker of a reviewable decision must give written notice of the reviewable decision, and of the reasons for the reviewable decision, to each person directly affected by the reviewable decision. A person who is directly affected by a reviewable decision may request the decision-maker to review the reviewable decision. If the person is given a notice under subsection (1) the person must make the request within 3 months after receiving the notice.
Within 3 months of that initial decision, you can request an Internal Review (done by a different delegate at NDIA). This is also called a Review of a Reviewable Decision (RoRD) or a S100 review. An internal review is a process you can go through when you think the NDIA’s decision about your NDIS plan is wrong. An appeal is a process you can go through at the Administrative Appeals Tribunal if you are unhappy with the outcome of your internal review.
When you ask for a review, you will need to explain why you think the decision is incorrect. Visit the Review your access decision page to download the application form. You don’t have to use this form, but it can help you describe why you want an internal review of the decision. www.ndis.gov.au/participants/how-review-planning-decision
To assist you to understand the NDIA decision making process, ISA can support you to request a copy of your Participant Information Access (PIA) form about your plan (this is similar to a Freedom of Information request). This outlines the information that the NDIA planner/delegate relied on to make their decision about your plan. https://www.ndis.gov.au/about-us/policies/access-information/participant-information-access-request
You will need evidence (usually new or updated) to substantiate to the Internal Reviewer on which reasonable & necessary supports you require and why (Section 34 of the NDIS Act 2013).
This can include reports or letters of support from:
Treating Clinicians
Educators
Provider/Carer Impact Statements
Allied health therapists (A Functional Capacity Assessment from an OT is often a key document of evidence).
A piece of evidence often needed for this review is a Carer (Impact) Statement or Statement of Lived Experience. Inclusive Solutions Australia have a great deal of experience in NDIS reviews can advise you on how to get all the documents & evidence together that you will need to support the review.
If you or those under your care need assistance navigating your NDIS plan and the options available to you, talk to the friendly and professional ISA team today!
