• 20/10/2015
• Joanne Cregan

I have been contacted by three families in the past two weeks requiring help with the National Disability Insurance Agency (NDIA) review process. In two cases the families had not actually completed an internal review when they thought that they had. The entire “review” process is very confusing and it has been enlightening to be able to offer clarity to these families by explaining exactly what kind review has been completed. Once we are on the same page, in the same book, we can then look at how to appeal the decision that the NDIA has made.

There are four kinds of NDIS reviews:

1. A scheduled review which occurs near the end of the participants plan where the needs are discussed to look at what supports will be funded in the next plan;
2. A plan review, where circumstances may have changed over the duration of the plan and the participant (or their parents) are requesting to change one or more of the supports in the plan. This kind of review can occur at anytime over the duration of the plan.
3. A Review of a Reviewable Decision. This is an official process whereby a participant (or their parent/carer) is not satisfied with a decision made by the NDIS. It is officially requesting the NDIA to reconsider a decision made in accordance with Section 99 of the legislation. This is an appeal process, also known as an Internal Review. It is completely different to the plan review (point 2) as a plan review is not asking the NDIA to reconsider a decision made under the legislation.
4. An External Merits Review (EMR), which can only occur after a Review of a Reviewable Decision (point 3). If a participant is not satisfied with the outcome of a Review of a Reviewable Decision they can either submit a second Review of a Reviewable Decision or submit an EMR. This process is conducted by the Administrative Appeals Tribunal (AAT).

So with four different kinds of reviews it is no wonder this process is confusing. I would like to see the language changed to give four clearly distinct phrases to describe each situation.

My suggestions are as follows:

1. A review, done just before the plan nears its completion, could become a “Plan Analysis”.
2. Plan review could be a “Plan Reconsideration”.
3. A Review of a Reviewable Decision is simply an “Internal Review”.
4. An External Merits Review is just an “External Review”.

It is not clear to me why the same term, namely “review”, is used to describe four distinctly different situations. I’m planning, in the coming weeks, to prepare a guideline outlining the differences between these processes and the order in which they can occur to help people understand what the terms mean and how these processes work.

If you are unhappy with your child’s plan and are unsure how to proceed, please contact Lifelong Pathways. We can provide you with clarity on the review process and guide you through it should you wish to take that pathway.