When and how to ask for an NDIS plan reassessment?

An NDIS plan reassessment can be requested at any time during the life of a plan. It is very important to inform the NDIS about any significant changes that have occurred or that are likely to occur in the near future, as they might affect your eligibility for the NDIS, your status as a participant or your funded plan. Similarly if the plan is for a child, any changes in the family’s circumstances can impact the situation surrounding the child’s plan.

Changes that can affect your NDIS plan

There are changes in your circumstances that would fall into the ‘I need to inform the NDIS’ criteria.

For example:

  • Your contact details have changed
  • You have had an exacerbation of your disability and your support needs have changed
  • You may have experienced a decrease in your support needs
  • The informal supports you have been relying on have changed
  • Your living situation has or will change
  • Your work situation has or will change
  • You have received a compensation payout.

Some changes may be temporary and others may be permanent and some may trigger a new plan and others will require a simple plan variation. The NDIS will inform you as to whether the change is significant enough to warrant a full plan reassessment.

Changes don’t always mean the NDIA will conduct a plan review. Explore this article to understand when NDIS plans are reviewed. You can also learn more about how to request a review of your NDIS plans, should the situation arise.

For a full list of changes that need to be reported to the NDIS, visit the NDIS website.

Scheduled review versus unscheduled review

A participant or their plan nominee can request for a review of their NDIS plan at any time according to Section 48 (1) of the NDIS Act. When the participant requests the NDIS for a plan review because their circumstances have changed, the NDIA may decide to conduct an unscheduled plan review.

Contrarily, a scheduled plan review takes place when the NDIA reviews a participant’s plan as part of the normal planning cycle.

It’s important to note that the participant can’t request for an unscheduled review when their statement of participant of supports has been suspended. The NDIA might suspend a plan after:

  • You’re outside Australia for more than six weeks, unless the NDIA gives you more time
  • You don’t claim compensation you’re entitled to after the NDIA asks you to, for example after you’ve sustained an injury.

Find out more about why your plan might be suspended on the NDIS website.

How to inform the NDIS

There are a number of ways to inform the NDIS:

  1. Complete a ‘change of circumstance’ form, which can be found on the NDIS website at the link below.
  2. Email this form to: enquiries@ndis.gov.au
  3. Mail the form to: NDIA, GPO Box 700, Canberra ACT 2601
  4. Call the 1800 800 110 hotline
  5. Ring and speak to your LAC or an LAC office
  6. Visit your local NDIS office.

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How do I request a review of an NDIS decision

From July 1, 2022, some NDIS terminologies have been updated.

Navigating the NDIS and understanding how the NDIS works can be a baffling and frustrating process. Understanding your rights as an NDIS participant or their representative/nominee can be half the battle won. Understanding what’s possible, provides more of a sense of control and reduces the feelings of powerlessness and uncertainty.

It is therefore important to be aware of your rights as a participant, potential participant or their nominee, when it comes to what decisions made by the NDIA can be appealed. The good news is that at this point in time, pretty much every decision made by the Agency or one of its representatives can be reviewed.

If at any point along the journey to becoming an NDIS participant and then as an actual participant, it is believed that an NDIA decision is wrong, you can request a review of the decision.

Which NDIA decisions can be reviewed?

There are two main types of reviews that can occur within the NDIS landscape:

  1. An internal review of an NDIA decision
  2. A review of an NDIS plan (now called plan reassessment) – and there are a couple of different reviews that can be requested at a number of different points over the course of a plan.

Being really clear about the type of review you are requesting is paramount in knowing which approach to take and how to go about it.

An internal review of an NDIA decision

Under the NDIS legislation, at Section 99, there are 25 identified reviewable decisions. Once a decision is made that relates to any of these, it is possible to seek a review of that decision. This type of review is called a ‘review of a reviewable decision’ or RoRD or S100 review, as it falls under Section 100 of the Act.

There are therefore many decisions made by the Agency that can be challenged and a very common one occurs at the time of an access request, when the request for access to the NDIS has been denied. This decision can be appealed.

The other most common decisions that can be challenged occur at the time of plan reassessments. This may be because a specific support, piece of equipment or modification that was requested has not been funded in the plan. Once again, there is the opportunity to collect and submit more evidence to the NDIA Delegate and to request a review of this funding decision.

If you are seeking a RoRD review, you must submit a request within three months of receiving the eligibility decision.

A review of an NDIS plan (now called plan reassessment)

There are three main types of plan reassessments that can occur in relation to a person’s NDIS plan.

  1. Full plan reassessments, which occurs towards the end of the current plan. This is standard practice and should occur prior to the expiry date of the plan.
  2. A plan reassessment can be requested when an NDIS plan does not meet the expectations of the participant. This must be requested by the participant or their nominee within three months of a plan being activated.
  3. A ‘change of circumstance’ (also called plan reassessment now) can be requested at any time during the life of a plan, if something has changed significantly for the participant.

How do I request a review of a decision?

Each time a decision is made by the Agency, you will be notified in writing. Along with the decision, you will be provided with information about how to request a review if you are not happy with a decision that has been made.

You can submit a written request to:

Chief Executive Officer
National Disability Insurance Agency
GPO Box 700
Canberra ACT 2601

You can also talk to someone at an NDIS office, call the 1800 800 110 hotline, send an email to: enquiries@ndis.gov.au.

In your communication, explain what decision you are seeking to have reviewed and provide information about why you believe the decision that has been made is not correct or reasonable.

What happens if I’m not happy about the outcome of a review?

If you are not happy with the outcome of an internal review, you can apply for an Administrative Appeals Tribunal (AAT) review. This is a tribunal that sits outside the NDIA and can review a range of decisions made by the NDIA, but only after an internal review undertaken by the Agency.

The list below includes some of the Agency decisions that can be taken to the Tribunal.

For example, the Agency may have decided:

  • A person does not meet the access criteria
  • Not to review a participant’s plan
  • To make, or not to make, a determination about who may do things on behalf of a child
  • To make, or not to make, a determination that a person has parental responsibility for a child
  • To appoint a plan nominee or a correspondence nominee.

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When are NDIS plans reviewed

All NDIS plans are going to be reviewed and renewed at some point. No one’s life is set in stone and situations and circumstances change. Therefore, the funded plan supporting that life needs to be flexible enough to change when and as required.

Following the recent changes to the NDIS Act, the way plans are reviewed and renewed and the language used to describe what is happening, has changed.

The word ‘review’ had multiple meanings in the original NDIS Act 2013 and caused confusion to many people. The new NDIS Act 2021, has attempted to reduce this confusion by only using the word ‘review’ when an actual decision made by the NDIA is being challenged.

The participant is then requesting a ‘review of a reviewable decision’. Not all plan changes come as the result of a decision challenge. A plan can be changed at three main times during the life of the plan:

  1. At the end of the current plan
  2. If the participant is not happy with the content of their plan
  3. Any time during the life of a plan.

New options for changing and renewing an NDIS plan

  • New plan with the same supports
  • New plan with minor changes – plan variation – allows for minor or ‘technical’ changes
  • Plan reassessment – if more major changes required (usually involves change to funding)
  • Reviewable decision – internal review of a decision made by the Agency.

  1. At the end of the current plan

    As the current plan approaches its reassessment date, it’s a good idea to start thinking about the next 12 months or so and decide if anything needs to change. Plans can be of varying lengths depending on the age and circumstance of the participant. Children tend to have shorter length plans than adults, so a plan length can vary between 6 months, up to 2-3 years in length.

    At this time, every part of the plan should be considered – from the Participants Statement, to the short term and medium to long term goals, the length of the plan, the plan management type, the form and intensity of support required and therefore, the allocated funding amount will likely change. Because of this, it is really important to go into this process well prepared.

    About six weeks before the the reassessment date of a plan, in preparation for a meeting with an LAC or Planner, other things to consider are:

    – the impact the disability is having. Has the impact increased, decreased or is it pretty stable?
    – Is the person going to be starting something new i.e. work or a sport or a new recommended therapy?
    – Are the person’s personal circumstances changing, i.e. they are wanting to move; has an informal support changed?
    – Is the participant a child under seven years?

    Having done this thinking will help to ascertain which option is the right one for the participant and their plan – new plan with the same supports; can it be a plan variation – as only minor changes are needed; or is a plan reassessment required, as support needs or circumstances have changed.

  2. If the participant is not happy with their plan

    Even the best prepared participants can be caught out by a new plan that arrives full of unwelcome surprises.

    This is generally due to two things.

    Firstly, simple administrative mistakes do occur — dates are wrong, content is missing, the management type for the plan is incorrect. These mistakes can be rectified via a ‘plan variation’. In this instance, it is best to contact the person who conducted the review meeting and bring the mistakes to their attention. The mistakes can be corrected without changing anything substantive in the plan.

    Secondly, decisions have been made by an NDIA representative that do not reflect your expectations. This is where a plan may not have specific support included that you were expecting, like therapy funding, or you were expecting some funding for consumables and they are completely absent. It may be that you don’t believe the plan reflects the evidence you provided at the time of the recent meeting and the subsequent support budget is totally inadequate. If this is the case then you will need to request a ‘review of a reviewable decision’ review.

    This review must be requested within three months of a new plan being activated.

  3. At any time during the life of a plan

    A significant change of circumstance can be a good reason to request a plan reassessment or plan variation at any time within the life of a plan. It can be triggered by a number of factors such as:

    – A change in support needs
    – A change to informal supports
    – A change to living arrangements
    – Compensation you are applying for or have received
    – A significant change of any nature

    Evidence will be required to demonstrate what has changed and how the change is impacting the person in order to justify the request for a plan reassessment or plan variation.

How to request a meeting

Online

Phone

In person

  • Visit a Local Area Coordinator, Early Childhood Partner or NDIS office in your area.

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Using your NDIS funding to connect with supports

Here we are — from applying for the NDIS to having your first NDIS meeting to getting your NDIS plan approved, you are finally ready to put your plan into action by using your NDIS funding to find the best support for yourself or your loved one.

The question is: How do you find support using your NDIS funding?

To answer that question, you first need to answer: How do you manage your NDIS funding?

NDIS plan management options

There are three ways to manage your NDIS funding: self-managed, plan-managed and NDIA/agency-managed. Find out in detail what each style of management involves.

If you are self-managed or plan-managed, there are different ways to build a support team of independent support workers on Mable.

NOTE: If you’ve chosen to have your NDIS plan managed by the NDIA (also referred to as agency-management), the National Disability Insurance Agency (NDIA) is responsible for managing payments and keeping payment records of spending using your NDIS plan funding. If your NDIS funding is managed by the NDIA, you can only use NDIS-registered providers for your support. This means you cannot use Mable to book support.

Finding support if your NDIS funding is plan-managed

If you have a plan manager assisting you with your NDIS plan, you can create your own profile on Mable and inform your plan manager that you’d like to find support through Mable. If you don’t have a plan manager yet but want to get one, find out what to look for when choosing a plan manager.

A plan manager like Leap in!, Australia’s leading NDIS plan manager, can help by paying providers on your behalf, tracking your spending and making it easier to use your funding on platforms like Mable. 

When organising your support through a plan manager, you will need to stick to the NDIS Price Limits. This means when you connect with an independent support worker on the platform, you will need to both agree to an hourly payment rate that falls within the NDIS line item price limits relevant to your plan.

Finding support if your NDIS funding is self-managed

By self-managing your funds, you can create your own Mable profile, begin booking support workers, and pay for your supports from your chosen bank account.

When you self-manage your funding, you do not have to adhere to NDIS line item price limits, meaning you and your worker can work together to choose an hourly rate that suits you both.

If you’d like to have more control over your disability support system, you can always contact your planner or Local Area Coordinator (LAC) to organise a review of your current management plan. To get in touch with your LAC, you should visit the NDIS portal on myGov.

Is Mable registered with the NDIS?

Mable is not a traditional support provider organisation, it is an online platform. Mable does not provide support, so it does not fit into any of the currently available provider registration categories.

Mable is an online platform that uses technology to connect people – including older Australians, people with disability or their carers – with independent support workers and support service providers in their community. These sole traders and small businesses may or may not be NDIS-registered.

By providing an online platform with safeguards where people can find, connect and manage their support teams, they have more choice and control over the support they receive and can pay lower hourly rates for support than NDIS reference rates. You can pay less and workers can earn more. Learn how Mable’s pricing works for everyone.

How to pay for supports received through Mable

After you’ve found a support worker on Mable, your worker will send you a service agreement to review and, once accepted, you can begin receiving support. After a support session, your worker will submit support hours which, once approved, are converted into an invoice by the Mable platform.

Mable will invoice your plan manager each week for any support hours that have been approved in the previous week (7-day payment terms) and they’ll make payments on your behalf or, If your plan manager requires your approval before paying invoices, we’ll invoice you directly and you’ll forward invoices to them. Then, once we’ve received payment from your plan manager, we’ll process the payment and send it to your worker within two business days.

Start connecting with supports through Mable

You can connect with support workers by either posting a job in the online community or by searching for workers in your local area who suit your support requirements. Learn more about how to book support workers.

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What if I’m not happy with my new NDIS plan

A new plan has arrived and you are not happy with it. There can be many reasons not to be satisfied with a plan. Maybe there are gaps in the types of support you were hoping to see in the plan? Perhaps there is equipment you requested or modifications you need that have not been funded? Whatever your circumstance, decisions have been made by an NDIS delegate/representative and you disagree with those decisions.

Can you appeal an NDIS decision?

Yes, any planning decision made by an NDIS representative can be appealed. You are asking the NDIS to review the internal decisions that have been made.

A word of caution: Before you do anything, really consider the plan that you have. Could you live with it? Could you rejig things a bit so that it does actually work? Think about whether things might change significantly during the life of the plan…if so, you could accept the current plan and then seek a plan reassessment later on?

It may be that you do all this thinking and still decide to go ahead and request a plan review, as the plan in its current form is just not adequate. There is no guarantee that a review will result in a perfect plan, but if it’s not adequate anyway, it is worth trying.

How to prepare for this type of review

Firstly, if you can, speak to the person who conducted the meeting and explain to them your concerns about the new plan. Ask for an explanation as to why a particular support or service that was present in the previous plan is not in the new plan, if this was your expectation. Mistakes are made and it may be that some important piece of information has been missed. Some mistakes are easily corrected and some aren’t, so it will be up to you and the person you are dealing with to decide whether this might be a quick fix resulting in a plan variation or a more formal review process is required.

If you do decide to request a review of a decision, go back over any material that you provided to the LAC or Planner. Does the plan reflect the reports/quotes or recommendations made in those reports? Check that they were received and considered? Do you need to provide additional information to the LAC or Planner to provide further evidence for the supports/services you believe are essential?

Can a light touch review help with your NDIS plan?

A light-touch review is an informal name given to a process for participants who want to make a small change, or switch the financial management of their plan.

It’s designed to avoid extended delays you might face in requesting a full review. If you have an agency-managed plan and you are interested in switching to plan or self-management, then requesting a light touch review might be the best option for you. You can contact the NDIA directly to see whether this is possible.

How to request a review of a decision

Each time a decision is made by the NDIA, you will also receive information on how to request for a review. You can either submit a written request to the CEO of the NDIA, talk to someone at the NDIS, call the NDIS hotline or send an email. Explore this article to read in detail how to request a review of an NDIS decision.

In your communication, explain what decision you are seeking to have reviewed and provide information about why you believe the decision that has been made is not correct or reasonable.

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I’ve been approved for NDIS, now what?

The day the National Disability Insurance Agency (NDIA) decides you’re eligible for the National Disability Insurance Scheme (NDIS), you become an NDIS participant. You will receive a letter to let you know that you’re eligible, whether you met the disability requirements/early intervention requirements, and the next steps.

If you’re an adult or a carer supporting an adult who’s been approved as eligible for the NDIS, the next step is to have an NDIS plan arranged. The NDIA will contact you within 21 days of you receiving the letter to organise your first NDIS planning meeting.

This includes information about you and your goals, what supports you need, and funding that the NDIS will give you to pay for these supports and services. Your plan will be reviewed, and once NDIS plan approval is given by the NDIA, you can start working towards the goals agreed upon in your NDIS plan.

How do I make an NDIS plan?

To make your NDIS plan, you’ll be contacted by the person who is your Local Area Coordinator (LAC) or a NDIA Planner. This person will arrange a date and time that suits you for a planning meeting, and whether you want to meet in person or talk on the phone.

What should be included in my NDIS plan?

The following information needs to be included in your NDIS plan, and will be discussed at your planning meeting:
  • Your name
  • Your date of birth
  • Your NDIS participant number (you can find this in your access letter)
  • Your disability – what your disability is and how this affects your daily life
  • Where you live
  • Who you live with
  • Your day-to-day life – what activities you do, if you have a job, if you use any aids
  • Your community – family, friends, support workers, people you work with
  • Your current supports – your doctor, school/uni, transport you use and how often
  • What you enjoy about life right now
  • What you want to change
  • If you want to try something new
  • Your short-term goals – e.g. learning how to use public transport by yourself
  • Your long-term goals – e.g. moving out of home or getting a job
  • Managing your NDIS funding – self-managed, plan-managed, NDIA-managed/Agency-managed.
There’s a helpful and easy to read NDIS planning meeting booklet you can use, to record these details you will need for your planning meeting. The NDIS ‘Planning’ booklet has pages you can write on or type in your answers to the dot points above.

What happens in a planning meeting?

In a planning meeting, you will discuss and decide on goals with your LAC or NDIA Planner about what you want to continue doing, and may want to do in the future. This person will also help you choose the best way to manage your NDIS funds for your needs and circumstances. At the end of your planning meeting you will be told what the next steps are, and the NDIS plan approval timeframe.

Who can attend my NDIS planning meeting?

Who attends your NDIS meeting with you is up to you. You can invite family members, friends, advocates or current providers you want to work with. You can also choose to attend on your own. It’s a good idea to invite someone you know and trust to help you remember all your details and discussion points. If you require someone to contribute evidence of your specific support needs, you can bring them along too.

How do I prepare for my planning meeting?

To get ready for your planning meeting, it’s helpful to know what to bring and what your LAC or NDIA Planner will talk about. This person will want to get to know you and your goals, and the support you need to reach these goals. You will also need to bring proof of your identity, like a driver’s licence or passport, as well as your myGov details. The information from this planning meeting will then be used to make your NDIS plan.

You will also discuss what style of plan management you prefer. To know more, explore this article about the different ways you can manage your NDIS plan.

Find out more about how to prepare for your first meeting with the NDIS.

What do I need to bring to my NDIS planning meeting?

You’ll need to bring the following to your meeting:

  • Proof of your identity. You can find the Proof of Identity fact sheet on the NDIS website for more information.
  • Your bank account details, if you’re considering self-managing all or some of your NDIS funding.
  • Any other information or reports completed by health professionals or service providers who have worked with you for at least 6 months for the NDIS to understand the impact of your disability, and your personal circumstances.
  • A list of any assistive technology that you use, for example, a wheelchair, modified cutlery or communication device (if not already completed in this booklet).
  • Your myGov login and password details (if you need help with this, talk to your early childhood partner, Local Area Coordinator or NDIA planner).
  • To make sure you have all your bases covered, download the NDIA’s NDIS planning meeting checklist.

How do I know if my NDIS plan has been approved?

After your planning meeting, your NDIS plan will be submitted, and the NDIA will decide whether or not to give you the NDIS plan approval. If your NDIS plan is approved, you will receive your NDIS approval letter in person or in the mail or through myplace, a secure website portal you can use to see and manage your NDIS plan.

What if I’m not happy with my NDIS plan?

If you’re not happy with your NDIS plan, or don’t agree with the goals approved in your NDIS plan, you can contact your LAC or NDIA Planner. This person will explain how to ask for a review, and help you find an advocate if you want one. You will need to ask for a review within three months of receiving your plan. If you don’t agree with the NDIA’s review, you can ask the Administrative Appeals Tribunal (AAT) to review the decision.

How do I manage my NDIS plan?

There are three different ways to manage your NDIS plan: self-managed, plan-managed and Agency/NDIA-managed. Learn in more detail about each of these ways to manage your NDIS plan.

If you choose plan management, you can work with a plan manager like Leap in!, Australia’s leading NDIS plan manager, who can help pay providers on your behalf, keep track of your budget and reduce the admin involved in managing your funding.

If your NDIS funding is managed by the NDIA:

  • You can only use NDIS-registered providers for your support
  • You can’t use your NDIS funding to book independent support workers on Mable.

If you’ve chosen to have your NDIS plan managed by the NDIA (also referred to as agency-management), the National Disability Insurance Agency (NDIA) is responsible for managing payments and keeping payment records of spending using your NDIS plan funding. If your NDIS funding is managed by the NDIA, you can only use NDIS-registered providers for your support. This means you cannot use Mable to book support.

If you choose plan management or self-management for your NDIS funding, you can book independent support workers on Mable with your NDIS funding. Learn more about using your NDIS funding to connect with supports through Mable.

What next?

When you get your NDIS plan approval, and you’re involved in managing your NDIS plan, you aren’t limited to receiving support only through NDIS-registered providers. You can book independent support workers through Mable by using your NDIS funding.

If you’re ready to get more from your plan, consider using your NDIS funding to connect with supports and see how easy it can be to build a support team tailored for you.

FAQs

During every plan review meeting, the NDIA will verify that your details are up to date, and that you continue to meet NDIS eligibility requirements. The NDIS may find during a review that you no longer meet the early intervention requirements because you have built your skills and capacity, and aren’t benefiting anymore from early intervention supports. Children with developmental delay will usually leave the NDIS after they turn six. If you’re no longer eligible, the NDIS may help you connect with other services in your community if you need them. Alternatively, if you still need support services, you can connect with Mable’s community of Independent Support Workers and pay privately for support.

If there’s a significant change of circumstances, you need to inform the NDIA. Change in circumstances can be due to a number of factors such as a change in support needs, a change to living arrangements, a change to informal supports, etc. Find out in detail when NDIS plans are reviewed and how to request a meeting.

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