So…You need a Plan Review!

Your NDIS Plan is finally approved! Yay! You get it in your hot little hand, excited but a little scared to have a look through it.
As you flip the pages, your excitement turns to frustration. This plan just isn’t right. There’s no funding for supports that you absolutely NEED. There is no way you can work with this level of funding, how will you be able to pay for all of the therapies you need? In fact, you think you will be worse off than you were with your old funding.

You need a Plan Review!

The bottom line is, if your plan isn’t right for you, you have every right to ask for a plan review. But before you do there are a few things you should know:

• If you are an ‘early entrant’ to the scheme, that is you have transitioned before the scheme is rolled out in your area, or you are an ECEI participant, there is no guarantee that you will get a second plan on review. They may decide that your needs do not warrant early intervention or early access.
• When you ask for a review because one category of your plan is not right, the whole plan gets reviewed. So, it is possible that your funding across one or more categories will be reduced. On the flipside, if you are happy to take a chance, one or more categories could be increased.
• All review requests must be evidence-based. You can’t just ask for a review because you are not happy with the numbers. You need to be able to relate your request back to outcomes. For example, a therapist report stating that Participant A requires X number of hours of Therapy B to achieve Outcome C. However, the current plan only allows for D number of hours which will not produce the desired outcome.

Unscheduled Plan Reviews – The Nitty Gritty

There are 3 types of Unscheduled Review; that is, a review that does not come at the end of your current plan:

Request for Review (Change of Circumstances)

If your circumstances change in one or more of the following ways, you must notify the NDIA as soon as possible, by phoning 1800 800 110, using the Participant Portal or using the Change of Circumstances form:

• your disability support needs have changed
• your informal care arrangements change significantly
• you apply for, receive, or are entitled to compensation for injury
• you plan on moving (or have moved) house
• you plan on moving (or have moved) overseas, or
• you plan on moving (or have moved) permanently into aged care residential accommodation.

A change of circumstances may result in your plan needing to be reviewed; however, it should be noted, lodging a Change of Circumstance form will not automatically trigger a plan review.
You can request a plan review by calling the NDIS or using the Plan Review Request form. If you fail to notify the NDIA of a change in circumstances and you continue to receive supports you are no longer entitled to, you may be asked to pay back the funds.

If you are unhappy with the outcome of the request for review, you can request a Review of a Reviewable Decision (Internal Review).

Review of a Reviewable Decision (Internal Review)

If you are not happy with an NDIA decision and would like a review, you can request a Review of a Reviewable Decision within 3 months of the notice of the decision. Many NDIA decisions are reviewable and can be found in the list of reviewable decisions in the NDIS Act.

When submitting a request for a Review of a Reviewable Decision, you need to:

• Detail why you are requesting the review
• Explain why you feel the decision is not appropriate
• Include evidence (Allied Health Reports, Assessments etc.)

You can use the NDIS Application for a Review of a Reviewable Decision form to request the review, or you can call the NDIS directly.
The NDIA staff member who works on your review will not have been involved in any earlier decisions in your planning process. Normally the NDIA will respond to a request to review a plan within 14 days, however, there appears to be a bit of a backlog at the moment, pushing this timeline out.

Administrative Appeals Tribunal (AAT)

So you have had your Review of a Reviewable Decision and you are still not happy! You can apply for an Administrative Appeals Tribunal (AAT) independent review.
The AAT can not review every decision the NDIA makes, only the ones the Act states can be reviewed. Any application for the AAT to review a decision must be made within 28 days of the NDIA decision.
You can get more information on the AATs Applying for review webpage.

We can help!

If you feel that you require assistance with the review process, or you are not quite sure if a review is right for you, CoAbility is here to help. We are NDIS experts and work tirelessly to ensure the NDIS journey is as pain-free as possible for all the participants we work with. We provide free advice regarding the review process and can help to point you in the right direction.