Category Archives for "NDIS Reviews and Changes"

Nov 27 2018

Your 57 NDIS Review Questions. Answered.

These are the broad topics you’ll find in this post.
You can also find a whole series of posts at https://www.thegrowingspace.com.au/library/
  1. Reports and preparation for reviews
  2. Funding
  3. Types of reviewsReview
  4. The review process
  5. How to get a review
  6. How to chase up a review or, When you need to go higher
  7. Plan expiry
  8. Random Stuff

Reports and preparation for reviews

  1. I’d like help with the format for making clear what would be helpful to ask for and why.

This is just so individual – every person with disability has different goals and different ways to achieve them. If you’re stuck on what a typical life looks like, check out this awesome document produced by the NDIA Independent Advisory Council: https://bit.ly/2Ky6ymp and if you’re stuck for what skills are typical of different age groups, check out http://media.focusonthefamily.com/fotf/pdf/magazine/checklist-4-lifeskills.pdf  (It’s American, and most of you won’t need to worry about learning to shovel snow, but there are some great ideas in this list)

  1. What do they ACTUALLY want to see??

I THINK they want to see your great grandmother’s first pet cockatiel’s remains. I dunno, but I reckon this would be a good start: https://www.valid.org.au/10-steps-excellent-ndis-therapy-reports

  1. How much ahead should I prepare?

As soon as you request a review, you should start gathering evidence to support your requests, and provide it to the Agency. For scheduled regular annual reviews, I’d be asking therapists etc 8-12 weeks before the plan ends to start writing! They can be slow to respond, and if you only give them a week’s notice because you just got a call to schedule your appointment next week, you’re really giving them an unreasonable timeframe. They may not be able to give your report the justice it deserves.

  1. Which reports should I get ready?

Reports are great for all of your Capacity Building support categories – that usually means therapists, but, that depends on how you’ve used your funding to work toward your goals. Always. Be. Working. Towards. Your. Goals.

  1. Examples of how we should word needs and ways we can use 1 goal to work for 2 or 3 goals in one at the reviews 

I’ll write another whole post about goals. NDIS are starting to use “SMART GOALS” now – here’s a cool presso about developing goals in the meantime: http://www.dhs.state.il.us/CBL/DDWritingMeaningfulGoalsandMeasureableObjectivesVersion2.pdf and googling “SMART Goals” will help too.
And so will think link from the awesome Disability Services Consulting gang. http://www.disabilityservicesconsulting.com.au/resources/why-language-matters

  1. We provided paper and electronic copies of assorted reports at annual review, I also uploaded them in the portal. Yet I do not know if ANY of them were looked at and considered. I suspect they were, but….

Mwahahahahahaha. That upload feature? I call it “The Black Hole” but you should be OK if you emailed and gave paper copies in person. It will depend on the planner’s workload, and maybe on whether her partner yelled at her that morning, though you’d like to think that wasn’t the case, we’re all human. At The Growing Space, we tend to “assist” at the planning meeting by pointing out relevant bits in the reports as we go along, with the least dangerous assumption, which is that the reports may not be read later. I think they are though, usually.

  1. Hubby’s review is coming up early next year. I’m scared that the funding he received that pays for his therapy, personal training etc will be cut (he will have used every last cent of it by the time his review is due). Apart from submitting reports from his therapists, what else can we do to try to get the same amount of funding for next year?

We all get scared about this. I hear you. It’s not good for our mental health! One option is to request a new 12 month plan rollover without a formal review with the funding remaining the same – sometimes this will be granted. If not, make sure your Hubby’s goals are fully in line with the supports and services you want funded, especially for any capacity building therapy type support needs. Good luck!

  1. Can you explain the purpose of goals? I’ve heard people say things like ‘you can’t access house cleaning if it’s not in your goals to live in a clean house’. Is it really necessary to specify a goal like this, in my mind it should be assumed an adult pwd would want to live in a clean house???

Yeah, It’s a weird one. The NDIS act says (in different words) that funding must be tied to goals, so I always suggest that at least one broad goal, like “I want to live an independent life” will cover most of that kind of common sense “core” stuff.

  1. Aside from therapist reports, who can provide evidence that the planner might consider? Eg, teachers, “mainstream” (not NDIA funded) mental health workers, sports coaches? Is there a link to a guide that will help them say what needs to be said in language NDIA will understand?

This guide was written for therapists, but equally applies to others who might write reports for your review. https://www.valid.org.au/10-steps-excellent-ndis-therapy-reports  At The Growing Space, we work hard to steer people to innovative ways to meet their goals, so your question is a good one for my team to think about too. Thank you!

  1. Also, Carer’s statements. Are they really worth the time and effort? I keep getting told to do one but I feel like I have to spend hours prepping to tell them everything verbally and have it completely ignored, why should I have to put it in writing?

Yes.  Do it.  Then recycle and edit it next year. It’s a baitch. It’s painful, it drags up grief for many, but planners need to know what’s going on for you that might impact the care the person you love is getting. Do it with a friend, and chocolate, and scotch, or gin. Write a silly one, and then cry and write a serious one. It could also be valuable if you end up at the AAT. The lawyers do read it and interpret it according to the law. Which can be somewhat different to the Agency’s approach at times.

  1. Last question might be a bit niche but if your child is diagnosed with a second disability after entry to ndis, what is generally required to demonstrate this and have it make a difference to planning?

It could well make a difference to your funding. If you’re autistic, and then lose your vision, for example, your needs and funding will, be necessity, be quite different. If the new diagnosis isn’t for something newly acquired though, and you’re just collecting labels, that’s probably not gonna make much difference. But it might. It won’t hurt to give the Agency a copy of the formal diagnosis from the relevant professional.  It could also be valuable if you end up at the AAT. The lawyers do read it and interpret it according to the law.

  1. Can you insist on a face to face meeting for a review of a reviewable decision?

Good question. I don’t know. I don’t think so, as often the review goes interstate etc to be reviewed by someone with fresh eyes and you don’t actually ever talk to anyone. I’m *fairly* sure there’s nothing in the NDIS Act that requires the Agency to allow this (but anyone, please correct me if I’m wrong)

  1. Can you ask for a specific planner to review the plan?

You can ask, but I’m would be almost 100% certain it would be denied. One point of a RORD is that someone new makes a decision based on the available evidence (which is why you should always submit new/better/awesomer evidence when you request a RORD.

  1. What should therapist reports include? 

Here’s a link to an awesome guide to therapist reports https://www.valid.org.au/10-steps-excellent-ndis-therapy-reports

  1. What assessments tools do they want to see that will make it easier to support higher level of support needs? (ASD Level 3 and Severe ID).

That stuff will depend on the age and needs of the person. I’d be looking at an updated DSM5 diagnosis for both ASD and ID, or just some really good reports from an OT or similar therapist, with an emphasis on functional impairment, rather than just IQ numbers etc. An ABAS can be useful – there’s a huge range of tools – a therapist with lots of NDIS experience is probably best to ask. Not me. I’m just a daft Support Coordinator with a Certificate IV.

Funding

  1. What if you, for some reason, couldn’t use the funds, can it be documented to show you you have attempted to or don’t have the services available to use them?

If you needed that funding, and didn’t use it for valid reasons, I suggest you document those reasons, in writing, and make sure the planner has that answer, in writing. Otherwise, you run the risk of someone internally, higher up the food chain, cutting the plan because they don’t have that information. Providing that documentation doesn’t mean you will get the funds again, but it might increase your chances.

  1. Happy with first plan…. how can you go about review to have a continuation of that level of funding?

You kinda can’t, though when you are called to make a regular scheduled plan review meeting, you can always let them know nothing has changed and you are happy for another 12 month plan with the same goals and funding. Whether they honour that or not, is up to the Gods.

  1. How can you effectively request a plan that lasts longer than 12 months?

“My disability support needs are stable and I’d like a plan that last two years please.” Request it in writing and in person at your review. There are no guarantees, and it’s less likely to happen for a first plan, but there’s certainly no harm in trying! Be careful though, you might find the plan comes back with less than what you need and you might be stuck waiting for a review for longer…

  1. If there is money left over at the end of a plan because you haven’t been able to access relevant therapies, is this detrimental to what you will get in the next plan? Will it be less?
    😉

It should only affect the new plan if you haven’t used it because you didn’t need it, not if you couldn’t find providers, didn’t understand the plan, were in hospital etc. That doesn’t mean the new plan won’t have less – each review looks afresh at your situation, goals and needs.

  1. I’m seeking a review of a reviewable decision due to severe cuts to funding. What can/should I be providing to help get what I want, considering it was all provided at the annual review and they ignored it?

Definitely approach your local funded advocacy agency – you can find your local ones by plugging in your postcode here: https://disabilityadvocacyfinder.dss.gov.au/disability/ndap/

  1. How do I ask for a review where the support under an NDIS plan is less than the supports that I’m currently receiving, before transitioning? There is supposed to be no disadvantage to changing over.

Once you have an NDIS Plan, you have already “transitioned” and state funding stops the day your NDIS plan starts. For you, the process will be the same as any review of a reviewable decision. There are a tonne of links and answers to that question above, and you might find more help at https://www.thegrowingspace.com.au/library/ I wish you all the best!

  1. Why did they reduce my sons funding?

Could be any of a HUGE number of reasons – your son aged out of early intervention, he made progress on his goals, the planner didn’t like your haircut, he didn’t make progress on his goals with the funding last year, the scheme actuary is worried the scheme is overspending, you got too much in the last plan… I wish I could answer that better.

  1. My review question is how best to state that my daughter got $120,000 last year but only used $60,000 then received only $30,000 this plan but needs what was spent last year..namely $60,000.
    How best to achieve this?

If you needed that funding, and didn’t use it for valid reasons, I suggest you document those reasons, in writing, and make sure the planner has that answer, in writing. Otherwise, you run a greater  risk of someone internally, higher up the food chain, cutting the plan as you’ve experienced. Proving that documentation doesn’t mean you will get the funds again, but it might increase your chances.

  1. ID like to know how they decide how much funding you get and how they decide which category?

That’s a topic for another post, but googling “NDIS ACT section 34 reasonable and Necessary” will give you a good start. In general terms, however, factors taken into consideration when figuring out your funding include your age, stage of life, primary disability, functional impairment, living situation and natural supports. The category funding will be figured out by linking the supports required with your goals.

  1. Why do LACs and call centres say to spend whatever funds you need while waiting for a review of reviewable decision outcome? What happens if your review does not result in increased funding and you have spent a year’s funding in 6 months?
    1. Because they do not live with disability nor care for someone with disability.
    2. You’re stuffed. If it’s really life-threatening stuff though, the Agency will eventually come to the party, if you haven’t stroked out with stress in the meantime. Sorry. Bad form disability reference there. It’s late. I’m tired. I’m on my seventh of eleven pages of answering review related questions tonight.

26. What are the reasons you don’t get what you have asked for when you have reasonable requests requested by trained professionals. Instead of reviews can they just let you know what areas they need more info about. For example, if they cut funds due to lack of use can they just have you write a letter explaining wait times in the country, therapist change overs or being unable to use funds due to ndis mistakes!

This is a big question, and out of scope for this post.  https://www.thegrowingspace.com.au/ndis-tips-how-did-they-come-up-with-the-dollars-in-my-plan/ Has some of what you are looking for – You’ll need to subscribe to read it, but a free subscription will work for this article, and if you want to read more, you can claim the subscription fee on your NDIS plan if you’re self or plan managed with a good plan manager.

Types of reviews

  1. What’s the difference between change of circumstances review and the review of reviewable decision..

A Review of reviewable Decision (RORD) is when you don’t like a decision the agency has made, like the amount of funding in a particular category, or a category was missed etc.

A change of circumstances review is when your plan was OK, but major stuff happened (moved house, lost a job, got a job, carer family member died etc) and  you need your plan reviewed for more funds, or funding in different buckets, for example.

  1. Yes, process of reviews how to do a review – what they are called and time period – for example what is a lite review – desktop review – review of reviewable decision – review based on circumstance changing 

There’s a bunch of posts on that here: https://www.thegrowingspace.com.au/category/ndis/ndis-reviews-and-changes/  You’ll have to sign up to see them – some are free, for others you’ll have to pay a subscription (which you can then claim from your plan if you are self managed, or have a good plan manager). And here’s some info from the horse’s mouth, too https://www.ndis.gov.au/medias/documents/h6d/h24/8804044996638/Plan-Review-Participant-FAQ.pdf

  1. Hi Sam, any idea why Feros care are conducting the plan reviews?

Because that is part of their job as the Local Area Coordinator. 80% of plans and reviews will be done by LACS, only 20% will be done by the NDIA, though the NDIA does all approvals.

  1. I’m in a situation where I’ve grounds for both change of circumstances and internal review. Ie the plan wasn’t sufficient and things have changed. Is the process the same for both? Do both go to the same level of expertise to review? Is one quicker? Is one more thorough? Will one get a better result?

Yes. Yes. Sometimes a CoC will be quicker if the change means someone is a great risk ie: leaving jail, becoming homeless etc. Probably not – depends on the change of circumstance.

  1. How does one do a “light touch review”? Through LAC or contact NDIS directly?

Either, but I have heard that some LAC’s tell people to go to the NDIS to request it, and I’ve heard some NDIS offices tell people to go to their LAC’s. F*ck knows, really.

  1. Steps to getting a review, types of reviews.

There’s a bunch of posts on that here: https://www.thegrowingspace.com.au/category/ndis/ndis-reviews-and-changes/  You’ll have to sign up to see them – some are free, for others you’ll have to pay a subscription (which you can then claim from your plan if you are self managed, or have a good plan manager). And here’s some info from the horse’s mouth, too https://www.ndis.gov.au/medias/documents/h6d/h24/8804044996638/Plan-Review-Participant-FAQ.pdf

The review process

  1. How does the review actually work? Do you get to speak to someone directly to clarify what was in the plan/planning meeting? I believe a lot of our stuff was taken the wrong way. What about the items that were not included in the plan (assisted technology etc) do they just ignore what they don’t want. What about the OT reports that were included but the recommendations not followed? It’s so confusing? The amount we received didn’t even cover his current costs. Thank you 🙏

Hmmmm… There doesn’t seem to be a lot of consistency. If you ask for a RORD you might find that the whole thing just “happens” like magic, and you had no further input, other than your original RORD request. You should not expect that the NDIS will contact you to gather more information about the reasons you are requesting review, nor more reports to justify your request etc. If you ask for a RORD, I recommend that you provide all the evidence the agency might need to give you a fair answer, in writing, at the time you ask for your review, or very soon afterwards.

  1. Can we see a draft of the plan before it is finalised please?

Pretty Please? This is actually a part of the much heralded new “New Participant Pathway”, coming soon to a location near you. Sometime. Hopefully soon. Don’t hold your breath, you may die. But it is coming, and is already happening in some areas. Yay!

  1. Can we request, do we have a right to view our plan before it is approved? If we have cuts/are denied things, do they have to list reasons?
    1. I WISH. (this is however, a feature of the “New participant pathway” so hopefully you will be able to, soon.)
    2. I reckon they do, if you ask for a review and are denied on review. But other here have been told differently. Sorry. The Agency is, at least, consistently inconsistent?.. (cocking my head to one side like a cavalier puppy)

36. How long will my old plan be active?

Payment requests can generally be made from the old plan for about a month or so (I don’t *think* there’s any consistency on this). If, however, you miss the boat, don’t wig out, you can send in a manual payment request form like this:  https://www.ndis.gov.au/medias/documents/self-manage-payment-request-docx/Form-My-Plan-Purchase-Payment-Request.docx  (I’m sorry the NDIS have a shit website and this link is so long. It’s not their fault. DSS made them do it that way).

If your plan is Agency managed, your provider can send in a manual payment request too, so don’t you get lumbered with doing that.

  1. If the Participant has a DSMIV ASD Diagnosis, is it true that if they get it reconfirmed under DSMV (with a severity level) they won’t have to go through all the functionality questions at each review?

Most probably. Usually. They are not 100% consistent about this.

  1. Can I still use the funds from my old plan even if/ until my new one comes in?

You can only claim for stuff during the life of each plan. If you’ve had a gap between plans, when your new plan starts, the old plan will (it might take a week or so) be extended up to the day before the new one starts. You’ll need to make claims from the appropriate plan that corresponds to the dates you used/bought the support.

  1. What should I should do if my review hasn’t come back and my old plan has expired? 

Sweat. And call, drop in and email, and then contact your MP if you need to.

  1. Are annual reviews done face to face with LAC? Why are plans done with LAC then passed to someone else to complete and sign off? Too much information gets lost in “chinese whisper” and or documents not read in their entirety.

Annual reviews are generally done face to face, whether with LAC’s or NDIS planners. If you’re asked to do a phone review and you don’t want to, please ask for a face to face review.

  1. Why do some participants find that asking a question on the telephone to NDIA ends in a review being processed, without the participant realising that this question equates to requesting a review. A review is then spat out and the participants only recourse then is to ask for an AAT review. The participant did not get the opportunity to provide any evidence/reports to back up what they were asking in the question, a review was simply processed and a letter issued advising of this with the next step AAT as section 100. If there was a better process in place, maybe the AAT’s time and advocates time may not be wasted if the initial question was not taken to be a review request and a review could actually have been done by NDIA. Crazy.

I have a quiet solution to this. Don’t ask the NDIS stuff. So sorry you went through this. Anytime you make a complaint about something that is a reviewable decision (there’s a list of them in the NDIS Act) it could be taken as a verbal request for review. Not that the NIDS need you to request a review for that to happen. The NDIS Act gives the Agency the power to review your plan at any time, even without your request. Yikes!

  1. When should I hear from NDIA about my review? 

When “should” or when “will”? You “should” hear within a few months, but it could be a few days, or more likely, many months. The NDIS is understaffed. The people in there are working headless, day and night. If you haven’t heard in three months, I’d start nagging a little, and at six months, I’d be knocking on the door of the AAT and/or my local federal politician. Good luck!

  1. How do you know if the LAC has taken the necessary steps to trigger a review when requested.

You don’t. Sorry. It sucks. There have been many suggestions made to the NDIA to have a “tracker” of some kind available through the portal, so that a participant/nominee can check at any time what stage of any internal processes you’re at within the NDIS. Fingers crossed that when the NDIA hopefully is able to wrench the website away from DSS and get their hands on their own portal, we’ll see these kinds of improvements. Feel free to send an email to the NDIS making this suggestion at feedback@ndis.gov.au

  1. We didn’t get our review of a reviewable decision because my daughters new plan will be done on the 10th of dec, can I still make a complaint or will this be used in her new plan to help get the funds she needs this time.. (if that makes sense)

It does make sense. There’s conflicting info about the answer though. The AAT have basically said that you shouldn’t give up your right to review because you’ve started a new plan, and that the AAT’s decision should be reflected in the new plan. I don’t know how that’s panning out in real life though. Sorry I’m not more help on this one.

  1. What paperwork should I receive after what I think was a RoRD interview?? I just received a new plan.

Just your new plan usually. If you were denied something you asked for, you can ask for the reasons why in writing, and you could then  se this if you decide to go to AAT for further review.

  1. Who does the review of the reviewable decision?

An NDIS planner delegate who has “fresh eyes” for your plan.

How to get a review

  1. If you have an issue with your plan, what is the best way to let NDIS know.,?
    Visit the local office or phone or email?

Yes. All of the above.

 How to chase up a review or, When you need to go higher

  1. What rights do I have in choosing my planner?

Yeah nah. Although, if you have a horrendous time with a planner, or she’s your ex’s new partner, or your old boss and you hate his guts, it is very fair to ask for a different one. I’ve found the Agency to be obliging when there are genuine valid reasons for requesting a different planner (and same for LAC’s)

  1. What should I do if I haven’t heard from them?

If you’re able to drop into an NDIS office, do it. Otherwise you’ll likely be sending emails into the black hole, or leaving phone messages that get sent to the same place. Sorry. And I’m extra sorry for regional, rural and remote peeps who have no option. I’m sorry this extra sucks for you.

  1. I’m not happy with the outcome of my review. What can I do about it?

You can make a request to take your review to the Administrative Appeals Tribunal (AAT). Most (95% of people who go to the AAT are offered and accept a settlement before reaching the actual tribunal). This saves you having to go to the full Tribunal and potentially having your life exposed to the world, and also means the NDIS doesn’t have to risk losing at tribunal which they may not want set as a precedent for others.

  1. I think it might be helpful also to have a list of key precedents from AAT cases summarised with they key elements they got an outcome on in case people want to use these as part of their review application for justification.

Check out this AAT Quarterly report at https://www.latrobe.edu.au/lids/resources/aat-ndis-decision-digest

Also, check out his twitter feed if you’re a twit https://twitter.com/darrenodonovan

And check out this awesome blog too: https://ndiscases.blogspot.com/

  1. My question is why was I taken off self managed for $7500 and put on plan managed for $4000 as cost of manager is $970?? Whom I can’t find either n have rang ndia asking for light review.. Got more forms spoke again ..still waiting..son has had no appt.or help for over a month now ..like we don’t have enough to do!! Single mum here with yr12 grad n 9 yrold help!!

ARRRGGH!!! I feel your pain! If you can get into the office and cry, that might help. I don’t really mean that. Wait, yes I do. I don’t know. Make sure they know how urgent this is and that your kids are missing out on services because they haven’t made this change yet. Make your request in writing, via email if you can as a follow up too.

  1. A clear interpretation of the Review of Decisions Operational Guideline , specifically Sections 5.8, 5.9, 5.10. My interpretation is very different to the Planner’s they have advised that they do not have to provide written notice of the Review of Reviewable decision and they do not have to provide a statement of reasoning for the decision. Planner reviewed a plan made changes, verbally instructed the participant of the changes and declined the request to provide written notice statement with reasoning for the changes. Participant is not happy and does not have details of reasoning as planner spoke so fast details could not be documented. This is frequently happening in the Hunter one planner advised a colleague that they had received a directive not to acknowledge Review of a Reviewable decisions and to only put through unscheduled reviews.

Yuck. I’m not a lawyer though. The NDIS Act trumps the guidelines though. I’d be rereading The Act. I think they do need to provide a reason though. Maybe go above them and ask?

  1. This is what happened to me. I went to AAT for a review just to find that there was no paper trail and hence no decision made and could not pursue it any further through the system. I was left with another delay tactic which is to apply for another section 100 on the new plan.

This crap makes my blood boil. A review request can be made by email, letter, phone, in person or bloody carrier pigeon or even fax if needed (does the NDIS have a fax machine? “What *is* a fax machine?” asks all the millennials). Regardless, in writing is ALWAYS a safer bet – by email. Or even go into an office if there’s one close enough, and ask then to give you a receipt for your correspondence.

  1. I’ve had my review in the AAT and am now waiting for the NDIA to implement the decision of the court which must be done “as soon as practicable”. How long would it be for the NDIA to be in contempt of court? 

Great question. Luckily, smarter people than me have answered it as per: https://twitter.com/darrenodon…/status/1063205551704698880
Unfortunately, with NDIA it seems to be strings all the way down. Which is the most outrageous, awful injustice… At AAT you should always request that a new plan is activated within a specific length of time e.g. 14 days. (not my words –Sam)

Plan expiry

  1. What do they plan on doing about the “gap” especially when providers are refusing to provide services during the gap.

I have already written a post about this at https://www.thegrowingspace.com.au/ndis-plan-expiry/  You need to be a paid subscriber to read it though, but most people who are self or plan managed can claim that subscription on their plan.

Just quietly though, if you didn’t pay your plumber for a month, would she keep coming back to serve you? Providers are (often) human too, and we have bills to pay, staff to pay and children to feed too. We can’t keep serving people for no fee. Did you know that apparently the Tax Office (ATO) has a whole NDIS division set up just to support providers who can’t meet their BAS bills because of non-payment of NDIS services. ☹

And from another poster: “By law, they are not allowed to leave current participants without funding between plans. You have every right to ask for a plan extension and pro rata funding, until the new plan is activated. I have always done this through the finance officer at my local office – as they seem to get things done more effectively. If this does not occur, you should contact the Ombudsman. It is unreasonable for the NDIA to expect providers to cover the costs, when the funding is not guaranteed.”

Random Stuff

  1. Why does it take so long to get an agency managed plan back to a self managed one when I requested self managed at the review?

Just because. Which is my way of saying who knows. It’s bizarre. I get some of these back in hours, and others take months. I don’t imagine to know how they prioritise this stuff, if indeed, they do prioritise. I’m sorry. In case you didn’t, make sure to make that request IN WRITING at your next planning meeting. Leave NOTHING to chance.

Sam Paior, The Growing Space

Copyright November 2018 – This post can’t be copied, or redistributed in any form without explicit permission from The Growing Space. This took me AGES and I don’t want it nicked.