5 Steps to Becoming Funded Under the NDIS

The National Disability Insurance Agency (NDIS) has an NDIS Access Checklist that is useful for thinking about whether you meet the access requirements. However, the only way to find out if you are eligible to access NDIS funded supports is to complete an Access Request Form and provide supporting evidence.

By now you would have spent some time thinking about your goals and aspirations and how you would like to reimagine your life. You’ve identified the supports and supporters that will be necessary to make this happen. It is important to communicate your goals and aspirations clearly and effectively in this stage of the process. The information you provide the National Disability Insurance Agency (NDIA) will allow them to facilitate the supports in line with your needs and goals.

All of this information can be used to write your application to be submitted to the NDIA to determine if you are eligible to access the NDIS. The process of submitting an application for the NDIS is called access request.

The evidence you will need to provide must be recent (less than one-year-old) and could be in the form of existing information that you already have, like letters, assessments or other reports from a health professional, support provider or family.

If you do not have recent existing evidence you will need to have an assessment completed. An occupational therapist, psychologist or social worker can help with this. Under a government initiative called Better Access you can get a number of sessions that are covered by a Medicare rebate. For more information check out the Department of Health’s Better Access webpage. You also have the option of going to your local GP (general practitioner) or other medical professional like a psychiatrist.

The National Disability Insurance Agency will contact you to let you know their decision within 21 days of your application being “lodged”. An application is considered lodged when they have received the application and all supporting evidence. This means that if you have given the National Disability Insurance Agency permission to contact other people to get additional information, they will contact you with a decision 21 days after they have received all the information they need from those people.

If there is a delay in assessing your application for any reason, they will let you know why there is a delay. If you do not hear from them within 21 days of all information being lodged, you should follow up for an update and to ensure there are no problems. You can ask another person to help you do this.

If the National Disability Insurance Agency has found you not to be eligible, they will provide information explaining their decision. If you do not understand why you are not eligible you can ask for more information. You can ask for this in writing.

The letter will also tell you how to request a review if you do not agree with the National Disability Insurance Agency’s decision. You will need to make this review request within three months of being notified of the decision. If you do not do this within three months and want to apply, then you will need to make a new access request.

The statement of participant supports must include a statement which specifies how the management of the funding for supports under the plan is to be managed.

Managing the funding for supports under a participant’s plan means:

• purchasing the supports identified in the plan, including any applicable indirect costs, for example taxes, associated with the supports.
• receiving and managing any funding provided by the NDIA and
• acquitting any funding provided by the NDIA.

For each participant, someone (or more than one person) will be identified as managing the funding for supports under a participant’s plan.

A participant’s plan must specify that the funding for supports under the plan be managed wholly, or to a specified extent, by:

• the participant;
• a registered plan management provider;
• the NDIA; or
• the participant’s plan nominee.

Note, unless a participant’s plan is managed by the NDIA, there is no restriction on who may provide supports under their plan. Participants are able to exercise choice about the selection of their providers. It is only when funding for a participant’s supports is managed by the Agency that the supports must be provided by a registered provider of supports. See Operational Guideline on Registered Providers.

The decision about how the funding under a participant’s plan will be managed is to be made having regard to the general principles that guide actions under the NDIS Act. In particular:

• people with disability should be supported to exercise choice, including in relation to taking reasonable risks, in the pursuit of their goals and the planning and delivery of their supports; and
• people with disability have the same right as other members of Australian society to be able to determine their own best interests, including the right to exercise choice and control, and to engage as equal partners in decisions that will affect their lives, to the full extent of their capacity.

You will receive most of your National Disability Insurance Scheme (NDIS) supports from providers. Providers are people or businesses that provide your disability supports — a service or product. You have choice and control of the providers you use.

You will normally need to make a written agreement with your provider(s) that sets out what supports will be provided and how they will be delivered. It should also explain each party’s responsibilities and obligations and how to resolve any problems that may arise. The written agreement you make with a provider is called a Service Agreement.

Service Agreements should be simple and can be made between you and your provider, or between another person (like a family member or friend) and your provider.

Service Agreements are different from your NDIS plan. Your plan lists your NDIS supports whereas a Service Agreement is about delivering those supports.

When making a Service Agreement, you should take a copy of your NDIS plan. If you like, you can attach the copy of your NDIS plan to your Service Agreement(s). This will help your provider deliver you the right supports in the right way.

Things you can put in your Service Agreement include:

• the supports provided under the Service Agreement
• the cost of those supports
• how, when and where you would like your supports to be provided
• how long you need the supports to be provided
• when and how your Service Agreement will be reviewed
• how any problems or issues that may arise will be dealt with
• your responsibilities under the Service Agreement — such as letting your provider know if you cannot make an appointment
• your provider’s responsibilities under the Service Agreement — such as working with you to deliver your supports in the right way
• how you or your provider may change or end the Service Agreement.

Remember, you have choice and control in the delivery of your supports. This means having choice over who provides your supports and how they are provided. It also means being responsible and reasonable in your expectations and dealings with providers.

The National Disability Insurance Agency (NDIA) has created a model Service Agreement. With it you can make Service Agreements with your provider(s) and change it to suit your needs.

If you are successful in accessing the NDIS, there may be times when you do not agree with other decisions made about your plan.

The majority of decisions made by the National Disability Insurance Agency under the NDIS Act (2013) are “reviewable decisions”. For more information about decisions that can be reviewed by the National Disability Insurance Agency or Administrative Appeals Tribunal (AAT), please contact the National Disability Insurance Agency or the AAT.

The process for requesting a review of other decisions about your plan is similar to the review of decisions about access:

• First you need to ask the National Disability Insurance Agency for an internal review of a decision.
• After the internal review, if you are still not happy with the National Disability Insurance Agency’s decision you can apply for an external review by the Administrative Appeals Tribunal (AAT).
• You can also get help from the National Disability Advocacy Program (NDAP).

Workers at the Commonwealth Ombudsman’s Office do not have a role in decisions about your plan other than access. They can direct you to other Government Departments who do.