Planning and Assessment – Overview
Legislation
1.
Read ss.17A and 31 -38 of the National Disability Insurance Scheme Act 2013 (NDIS Act), and
National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Supports for
Participants Rule), National Disability Insurance Scheme (Plan Management) Rules 2013 (Plan
Management Rule) and National Disability Insurance Scheme (Facilitating the Preparation of
Participants’ Plans – NSW/Tas/SA/Vic) Rules 2013 (collectively referred to as the Facilitating the
Preparation of Participants’ Plans Rules).
Planning and assessment
2.
Planning and assessment leads to what many participants will see as the most important decision
that the National Disability Insurance Agency (NDIA) will make – the decision about their plan and
their supports. That is, the decision under s.33(2) of the NDIS Act to approve a statement of
participant supports.
3.
The NDIS Act and the NDIS Rules set out principles to guide delegates and legal criteria and
process that must be followed.
Principles to consider for planning and assessment
4.
In addition to the general principles in the NDIS Act which guide the NDIA’s conduct there are also
specific principles to guide delegates when preparing a participant’s plan. As far as reasonably
practicable a participant’s plan is to:
a.
Be individualised, and
b.
Be directed by the participant, and
c.
Where relevant, consider and respect the role of family, carers and other persons who are
significant in the life of the participant, and
d.
Where possible, strengthen and build capacity of families and carers to support participants
who are children, and
e.
If the participant and the participant’s carers agree—strengthen and build the capacity of
families and carers to support the participant in adult life, and
f.
Consider the availability to the participant of informal support and other support services
generally available to any person in the community, and
g.
Support communities to respond to the individual goals and needs of participants, and
h.
Be underpinned by the right of the participant to exercise control over his or her own life, and
i.
Advance the inclusion and participation in the community of the participant with the aim of
achieving his or her individual aspirations, and
j.
Maximise the choice and independence of the participant, and
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k.
Facilitate tailored and flexible responses to the individual goals and needs of the participant,
and
l.
Provide the context for the provision of disability services to the participant and, where
appropriate, coordinate the delivery of disability services where there is more than one
disability service provider.
See s.31 of the NDIS Act.
Contents
5.
Because planning and assessment is central to achieving NDIS outcomes and entails a number of
key steps and processes, below is an outline of this process and related operational guidelines to
assist delegates:
a.
The timeframes
b.
Obtaining information and reports to inform a participant’s plan
c.
The planning and assessment conversation
d.
The Plan – the participant’s statement of goals and aspirations
e.
The Plan – the statement of participant’s supports
f.
Assessment of a participant’s needs – the assessment tool
g.
The general, reasonable and necessary supports in the plan
h.
When to review the plan
i.
Risks and safeguards
j.
The decision – s.33(2) decision to approve a statement of participant’s supports
k.
After the decision – check the plan has all the s.33(2) elements, record a statement of reasons
for the decision and provide a copy to the participant within 7 days.
The timeframes
6.
There are three timeframes that must be met:
a.
The NDIA must commence facilitating a plan for each participant in accordance with the
Facilitating the Preparation of Participants’ Plans Rules, or if these do not set a timeframe, as
soon as reasonably practicable.
See s.32 of the NDIS Act and the Facilitating the Preparation of Participants’ Plans Rules.
b.
The delegate must decide whether to approve the statement of participant supports as soon
as reasonably practicable.
See s.33(4) of the NDIS Act.
c.
The delegate must provide a copy of a participant’s plan to the participant within 7 days of the
plan coming into effect.
See ss.37 - 38 of the NDIS Act .
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Obtaining information and reports to inform a
participant’s plan
7.
NDIA officers must draw on and reuse existing information. Where this is inadequate delegates
have the power, which must only be exercised in accordance with all NDIS requirements, to
request:
a.
That the participant, or another person, provide information that is reasonably necessary for
the purposes of preparing the statement of participant supports, or deciding whether to
approve the statement of participant supports,
b.
That the participant do either, or both, of the following:
i.
Undergo an assessment and provide to the delegate the report, in the approved form, of
the person who conducts the assessment,
ii.
Undergo, whether or not at a particular place, a medical, psychiatric, psychological or
other examination, conducted by an appropriately qualified person, and
iii.
Provide to the delegate the report, in the approved form, of the person who conducts the
examination.
See s.36 of the NDIS Act.
8.
Information requested under s.36 of the NDIS Act does not necessarily require the participant to
provide diagnostic or medical information, but could come from other sources that the delegate can
reasonably rely on e.g. Centrelink or existing provider of services.
9.
The delegate may prepare or approve a statement of participant supports before all the information
and reports requested are received by the delegate but the delegate must give the participant a
reasonable opportunity to provide them. If information is likely to take a long time to be provided, it
would be appropriate to approve the plan with a review date of when the further information
becomes available so that the participant is not disadvantaged.
See s.36 of the NDIS Act.
The planning and assessment conversation
10. An important part of developing a participant’s plan is the planning and assessment conversation.
11. The planning conversation will involve the delegate facilitating a participant-led discussion based on
the participant’s statement of goals and aspirations. The delegate is to take an active listening role,
gaining a rich picture of the participant’s goals, aspirations, current life circumstances and supports
to the extent the participant wishes to engage. The focus of the planning conversation will be on
strengths and abilities which can be maximised or enabled. The conversation may occur over more
than one meeting and will include use of the NDIS assessment tools. The participant may involve
others in their conversation such as carers, family and advocate and where necessary be
supported to enable their participation to be maximised.
12. The conversation and consideration that goes to formulating the statement of supports is to be fully
documented.
See Operational Guideline - Planning and Assessment – The Planning Conversation and
Operational Guideline - Planning and Assessment – Facilitating the Participant’s Statement of Goals and Aspirations.
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The Plan - the participant’s statement of goals and
aspirations
13. A participant’s plan has two parts. The first part is the participant’s statement of goals and
aspirations.
14. To maximise choice and control the statement is to be prepared by the participant (with or without
support) to the fullest extent possible in the circumstances subject to participant preference. The
statement is to specify:
a.
The goals and aspirations of the participant to enable increased participation, and
b.
The environmental and personal context of the participant’s living, including the participant’s:
i.
Living arrangements, and
ii.
Informal community supports and other community supports, and
iii.
Social and economic participation.
See s.33(1) of the NDIS Act and the operational guidelines on Planning and Assessment – Facilitating the Participant’s Statement
of Goals and Aspirations, Planning and Assessment – Supports in the Plan and
Planning and Assessment – The Plan Management Decision.
15. The participant’s statement of goals and aspirations can be in any form the participant wishes. If the
participant has an existing statement of goals and aspirations that covers the information required
by the NDIS Act this statement can be used for the NDIS. If the statement has not been supplied,
the NDIA officer will record the statement as part of the planning and assessment conversation.
The Plan - the statement of participant supports
16. The second part of the plan is the statement of participant supports. The statement is prepared by
the delegate with input from the participant, important others and the available assessments and
specifies:
a.
The general supports (if any) that will be provided to, or in relation to, the participant, and
b.
The reasonable and necessary supports (if any) that will be funded under the NDIS, and
c.
The date by which, or the circumstances in which, the NDIA must review the plan, and
d.
The arrangements for management of the funding for supports under the plan, and
e.
The management of other aspects of the plan.
See s.33(2) of the NDIS Act and the operational guidelines on Planning and Assessment – Facilitating the Participant’s Statement
of Goals and Aspirations, Planning and Assessment – Supports in the Plan and
Planning and Assessment – The Plan Management Decision.
17. If a participant has existing supports (either from previous NDIS plans or a Commonwealth, state or
territory scheme) it may be appropriate for these to form the basis of their statement of participant’s
supports if they represent reasonable and necessary supports. The delegate should seek to
minimise disruption to the participant’s supports.
Preparing for the later decision
18. To ensure delegates are properly prepared to make the decision under s.33(2) to approve a plan it
is important that throughout the planning and assessment process delegates keep in mind the
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criteria in the legislation that they will have to apply later when making the decision. These criteria
are:
a.
The things that must be specified in a plan (see s.33(1) and (2) of the NDIS Act, set out in
paragraphs 14 and 16 above), and
b.
The things that must be done when deciding whether to approve a statement of participant’s
supports. These are set out below and in s.33(5) of the NDIS Act and r.4.1 of the Supports for
Participants Rule.
Assessment of a participant’s needs – the
assessment tool
19. The NDIA CEO has issued an assessment tool to be used to assist in making decisions about a
participant’s supports by determining a participant’s support needs.
See s.209(2A) of the NDIS Act and r.4.4 of the Supports for Participants Rule.
20. In deciding whether to approve a statement of participant’s supports the delegate is required to
consider any relevant assessments conducted for the participant including any undertaken by the
delegate using the Support Needs Assessment Tool (Assessment Tool), where this is necessary.
21. Details of other assessments that are used must be recorded as an input to the development of the
plan.
See s. 33(5)(b) of the NDIS Act.
22. In addition to using the Assessment Tool, the delegate may also consider it necessary to obtain a
specialist needs assessment.
See Operational Guideline - Planning and Assessment – Assessment of Participant’ Needs.
The general and reasonable and necessary supports
in the plan
23. The participant’s plan must include any general or reasonable and necessary supports that will be
provided or funded as part of the plan. The delegate must be satisfied that each support meets the
criteria set out in s.34 of the NDIS Act.
24. In particular delegates must ensure that supports provide value for money, supports cannot be
supplied in a more cost effective way and that there is no duplication of supports in plans. Ensuring
responsible decision making will enable a sustainable scheme into the future.
See s.34 of the NDIS Act.
25. Every individual participant will be unique and therefore the contents of their plan will reflect their
environment, goals, supports needed to participate and ameliorate the impact of their disability to
the extent possible and life stage. It is therefore reasonable to expect differences between plans for
participants of similar age or condition. Delegates are to explain to the participant and where
relevant their family and carer, the consideration that has gone into a plan.
26. Supports can be described generally or specifically which affects the flexibility with the
implementation of the supports.
See Part 6 of the Plan Management Rules.
27. Certain supports will never be funded under the scheme. A support will not be provided or funded
under the NDIS if:
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a.
it is likely to cause harm to the participant or pose a risk to others; or
b.
it is not related to the participant’s disability; or
c.
it duplicates other supports delivered under alternative funding through the NDIS; or
d.
it relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not
attributable to a participant’s disability support needs.
See r.5.1 of the Supports for Participants Rules.
28. The following supports will not be provided or funded under the NDIS:
a.
b.
a support the provision of which would be contrary to:
i.
a law of the Commonwealth, or
ii.
a law of the state or territory in which the support would be provided, or
a support that consists of income replacement.
See r.5.3 of the Supports for Participants Rules.
29. In deciding whether or not to approve a statement of participant supports the delegate must have
regard to relevant assessments conducted in relation to the participant.
See s. 33(5)(b) of the NDIS Act.
The date to review the plan
30. Delegates have flexibility when setting the date to review the plan. The date can be specified as a
particular day or as a circumstance or both. The delegate should set the date or circumstance that
is most appropriate to the participant given their individual context and the likely evolution of their
needs. Delegates may wish to include both a date and circumstance in some cases. For example,
the plan is to be reviewed four weeks after the participant moves into employment or after one year
– whichever is sooner (note that the system will record the date as one year).
31. Participants can request a review of a plan ahead of the date set out in the plan however the
delegate must decide whether this is reasonable. The delegate will take into account whether
support needs have changed in the time since the plan approval or whether material information
was not considered that would potentially result in a different support plan.
Risks and Safeguards
32. The assessment of risks and safeguards is part of the plan decision and where relevant may
influence the supports in the plan, the timeframe for reviews and potentially the management of the
funds under a plan. The Support for Participants Rules state that delegates, when considering
whether to approve a statement of participant’s supports, must assess risks and safeguards in
relation to the participant.
See r.4.1(c) of the Support for Participants Rules and
Operational Guideline - Planning and Assessment – Risks and Safeguards.
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The reviewable decision – the decision to approve a
statement of participant’s supports
33. The planning and assessment process outlined above leads to what many participants will see as
the most important decision NDIA will make – the decision under s.33(2) of the NDIS Act to
approve their statement of participant supports, whether or not the plan includes funded supports.
34. The legislation is designed so that one decision is made on the entire statement of supports for a
participant and parts of the statement of support cannot be separated from the global decision on
the supports for a participant. The delegate needs to consider the individual components (including
the mix of any supports) that go toward a plan together to make the best decision.
35. The decision under s.33(2) to approve a statement of participant supports is reviewable by the
Administrative Appeals Tribunal.
See s. 99(d) of the NDIS Act.
36. Following the assessment and planning process outlined above the delegate can now turn to apply
the criteria in the NDIS Act and the NDIS Rules and make a decision.
37. In deciding whether or not to approve a statement of participant supports the delegate must:
a.
Have regard to the participant’s statement of goals and aspirations, and
b.
Have regard to relevant assessments conducted in relation to the participant, and
c.
Be satisfied as mentioned in s.34 in relation to the reasonable and necessary supports that
will be funded and the general supports that will be provided, and
d.
Have regard to the criteria set out in Parts 3 and 5 and Schedule 1 of the Supports for
Participants Rule in relation to the manner in which the reasonable and necessary supports
will be funded; and
e.
Have regard to the principle that a participant should manage his or her plan to the extent that
he or she wishes to do so; and
f.
Have regard to the operation and effectiveness of any previous plans of the participant.
See s.33(5) of the NDIS Act and the Supports for Participants Rule.
38. In considering whether to approve a statement of participant’s supports the delegate must also:
a.
Consider the participant’s goals, aspirations, strengths, capacity, circumstances and context,
and
b.
Apply the methods in Part 4 of the Supports for Participants Rule about the assessment tool
and assess activity limitations, participation restrictions and support needs arising from a
participant’s disability, and
c.
Assess risks and safeguards in relation to the participant, and
d.
Relate support needs to the participant’s statement of goals and aspirations.
See r.4.1 of the Supports for Participants Rule.
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Approving a statement where there is an urgent need
for supports
39. If a participant has an urgent need for supports the requirements of the NDIS Act as set out above
do not change and must be met. However the level of detail in a plan will be guided by the time
available. For example, the participant’s statement of goals and aspirations will contain the level of
detail desired by the participant and need not be provided to the NDIA in writing and the statement
of supports can be approved ahead of all the information or assessments being provided or
conducted. In these circumstances it would be expected that the plan would have a short time set
for review of the plan to allow for a more fulsome planning and assessment conversation once the
urgency has passed.
See ss.33(5), 33(8) and 36 of the NDIS Act.
At the time of the decision
40. At the time of making the decision delegates are to:
a.
Check that the criteria in the legislation have been properly considered and followed – the
things that must be specified in a plan (s.33(1) and (2) of the NDIS Act) and the things that
must be done when deciding whether to approve a statement of participant’s supports (s.33(5)
of the NDIS Act and r.4.1 of the Supports for Participants Rule).
b.
Prepare a statement of reasons for the decision (the letter that accompanies the provision of
the plan) and follow all procedures to fully document the decision and store all important
documents. This statement must be consistent with the verbal explanation provided to the
participant and where relevant their family and carer.
c.
Provide a copy of the plan to the participant within 7 days.
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