Access - Decision Tree for Disability and Early Intervention Requirements

Operational Guideline – Access – Decision Tree for Disability Requirements and Early Intervention Requirements

Planner’s name:

Person’s name:

Date:

Person ID:

Criteria to meet disability requirements (s.24) / Is requirement met? / Consideration: indicate evidence used and record in Siebel comments field
A person will meet the disability requirements, which are part of the access criteria to become a participant of the NDIS, if they meet Criterion 1 and 2 and 3 and 4 and 5:
Note: A delegate must also be satisfied that a person meets the applicable age and residency requirements.
Criterion 1 (Section 24(1)(a))

Does the person have a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to one or more impairments attributable to a psychiatric condition?

and / ☐Yes at least one condition on List B
☐Yes
☐No / In reaching this conclusion, I have had regard to [insert evidence considered, i.e. planner observation, self-report from person, diagnostic information and/or other sources].
The reason for this conclusion is that [insert reason why you are satisfied or not satisfied that this criterion is met, including an evaluation of the conflicting evidence if necessary].
Criterion 2 (Section 24(1)(b))

Are the person’s impairment(s) permanent (or likely to be permanent)?That is, is it the case that:

there is no known, available and appropriate evidence based clinical, medical or other treatments that would be likely to remedy the impairment(s); and
the impairment(s)do not require further medical treatment or review in order to demonstrate permanency (or likely permanency)

Note:An impairment may be permanent notwithstanding that the severity of its impact on functional capacity may fluctuate or there are prospects that the person’s functional capacity, including psychosocial functioning, may improve.
and / ☐Yes at least one condition on List B
☐Yes
☐No / In reaching this conclusion, I have had regard to [insert evidence considered, i.e. planner observation, self-report from person, diagnostic information and/or other sources].
The reason for this conclusion is that [insert reason why you are satisfied or not satisfied that this criterion is met, including an evaluation of the conflicting evidence if necessary].
Criterion 3 (Section 24(1)(d))

Do the impairment(s) affect the person’s capacity for social and economic participation?

and / ☐Yes
☐No / In reaching this conclusion, I have had regard to [insert evidence considered, i.e. planner observation, self-report from person, diagnostic information and/or other sources].
The reason for this conclusion is that [insert reason why you are satisfied or not satisfied that this criterion is met, including an evaluation of the conflicting evidence if necessary].
Criterion 4 (Section 24(1)(e))

Is the person likely to require support under the NDIS for their lifetime?

Note: An impairment that varies in intensity (for example because the impairment is of a chronic episodic nature) may be permanent, and the person is likely to require support under the NDIS for their lifetime despite the variation.
Note: This requires consideration of the person’s likely need for both general supports and reasonable and necessary funded supports.
and / ☐Yes
☐No / In reaching this conclusion, I have had regard to [insert evidence considered, i.e. planner observation, self-report from person, diagnostic information and/or other sources].
The reason for this conclusion is that [insert reason why you are satisfied or not satisfied that this criterion is met, including an evaluation of the conflicting evidence if necessary].
Criterion 5 (Section 24(1)(c))

Do the impairment(s) results in substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, activities in one or more of the areas of communication, social interaction, learning, mobility, self-care or self-management? That is, is it the case that:

the person is unable to participate effectively or completely in the activity, or to perform task or actions required to undertake or participate effectively or completely in the activity without assistive technology, equipment (other than commonly used items such as glasses) or home modifications; or
the person usually requires assistance on most days (including physical assistance, guidance, supervision or prompting) from other people to participate in the activity or to perform task or actions required to undertake or participate in the activity; or
the person is unable to participate in the activity or to perform task or actions required to undertake or participate in the activity, even with assistive technology, equipment, home modifications or assistance from another person.

/ ☐Yes
☐No / In reaching this conclusion, I have had regard to [insert evidence considered, i.e. planner observation, self-report from person, diagnostic information and/or other sources].
The reason for this conclusion is that [insert reason why you are satisfied or not satisfied that this criterion is met, including an evaluation of the conflicting evidence if necessary].
Were all of Criterion 1, 2, 3, 4 and 5 met? / ☐Yes
☐No

If the person meets Criterion 2 but not 1, 3, 4 or 5 then consider the early intervention requirements below.

Children under 7 years of agemaybe considered against the early intervention requirements before the disability requirements.

Note: Where a child is diagnosed with a condition on List A at Appendix A of the Operational Guideline – Access – Disability Requirements, they may generally be regarded as meeting the disability requirements.

Criteria to meet early intervention requirements (s.25) / Is requirement met? / Consideration: indicate evidence used and record in Siebel comments field
A person will meet the early intervention requirements, which are part of the access criteria to become a participant of the NDIS, if they meet Criterion6 and 7 and 8 and 9:
Note: A delegate must also be satisfied that a person meets the applicable age and residency requirements.
Criterion 6 (Section 25(1)(a)(i), (ii) and (iii))

Does the person have:

one or more identified intellectual, cognitive, neurological, physical or sensory impairments that are permanent or likely to be permanent? or
one or more identified impairments attributable to a psychiatric condition that are permanent or likely to be permanent?or
Is the person a child who has developmental delay?

Note:A person is generally taken to have a permanent impairment if:

there is no known, available and appropriate evidence based clinical or medical or other treatments that would be likely to remedy the impairment; and
it does not require further medical treatment or review in order to demonstrate permanency (or likely permanency);

Note:An impairment may be permanent notwithstanding that the severity of its impact on the functional capacity of the person may fluctuate or there are prospects that the person’s functional capacity may improve.
See rs 6.4 to 6.7 of the Becoming a Participant Rules.
and / ☐Yes at least one condition on List B
☐Yes
☐No / In reaching this conclusion, I have had regard to [insert evidence considered, i.e. planner observation, self-report from person, diagnostic information and/or other sources].
The reason for this conclusion is that [insert reason why you are satisfied or not satisfied that this criterion is met, including an evaluation of the conflicting evidence if necessary].
Criterion 7 (Section 25(1)(b))

Are you satisfied that the provision of early intervention supports is likely to benefit the person by reducing the person’s future needs for supports in relation to disability?

Note:Delegates should consider:

the likely trajectory and impact of the person’s impairment over time, and
the potential benefits of early intervention supports on the impact of the impairment on the person’s functional capacity and in reducing their future needs for support, and
evidence from a range of sources.

Are you satisfied that the provision of early intervention supports is likely to benefit this person by:

mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self-care or self-management or
preventing the deterioration of such functional capacity; or
improving such functional capacity; or
strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer;

Note: In certain circumstances, a person with a degenerative condition could meet the early intervention requirements and therefore become a participant.
and / ☐Yes
☐No / In reaching this conclusion, I have had regard to [insert evidence considered, i.e. planner observation, self-report from person, diagnostic information and/or other sources].
The reason for this conclusion is that [insert reason why you are satisfied or not satisfied that this criterion is met, including an evaluation of the conflicting evidence if necessary].
Criterion 9 (Section 25(3))

Are you satisfied that early intervention supports are most appropriately funded or provided through the NDIS and are not most appropriately funded or provided through:

other general systems of service delivery or support services offered by a person, agency or body, or
through systems of service delivery or support services offered as part of a universal service obligation; or in accordance with reasonable adjustments under a law dealing with discrimination on the basis of disability?

Note: In determining whether early intervention supports would be more appropriately funded or provided through a different service system delegates should consider paragraphs 7.8 to 7.10 of the National Disability Insurance Scheme (Supports for Participants) Rules 2013(Supports for Participants Rules) outlined below:
See r.7.5 of the Supports for Participants Rules.
The NDIS will be responsible for:

Personalised supports, specific to a child’s disability (or developmental delay), which are additional to the needs of children of a similar age and beyond the reasonable adjustment requirements of early childhood development service providers.
Early interventions for children with disability (or developmental delay) which are:

specifically targeted at enhancing a child’s functioning to undertake activities of daily living, but not supports which are specifically for the purpose of accessing a universal health service; and
likely to reduce the child’s future support needs, which would otherwise require support from the NDIS in later years, including through a combination and sequence of supports.

See rs 7.8 to 7.9 of theSupports for Participants Rules.
The NDIS will not be responsible for:

supports, which are clinical in nature provided in the health system, including acute, ambulatory or continuing care; or
new-born follow-up provided in the health system, including child and maternal health services.

See rs 7.10(b) and (c) of the Supports for Participants Rules. / ☐Yes
☐No / In reaching this conclusion, I have had regard to [insert evidence considered, i.e. planner observation, self-report from person, diagnostic information and/or other sources].
The reason for this conclusion is that [insert reason why you are satisfied or not satisfied that this criterion is met, including an evaluation of the conflicting evidence if necessary].
Were all of Criterion 6 and 7 and 8 and 9 met? / ☐Yes
☐No

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Operational Guideline
Access - Decision Tree for Disability and Early Intervention Requirements (v 2.2)

Publication date: 6 February 2015