New Rules: Plan Variation and Reassessment

Last week, the Department of Social Services (DSS) released two new NDIS Rules. The new Rules cover plan variations and reassessments and the management of NDIS funds. This article will focus on the plan variation and reassessment Rules.

If you want to learn more about the Management of Funding Rules, check out our article: New Management of Funding Rules.

Rules are legislative instruments that provide more detail about how the Act should be operationalised. You could call it the meat on the bones - though being a vegetarian I should really come up with a new metaphor.

Under the NDIS Act, participants can request the NDIA vary or reassess their plan* at any time, but the NDIA has to decide whether or not to agree. The NDIS Act and Rules outline conditions and considerations for when the NDIA can vary or reassess a plan.

*The difference between plan variation and reassessment is:

Plan variation- when the NDIA changes the existing plan.
Plan reassessment- when the NDIA creates a new plan with a new end date.

Importantly, these Rules apply to plans that are being developed right now- or what the Act calls old framework plans. When new framework plans begin to roll out (expected from later this year), new Rules will be developed.

Plan Variation - Significant changes requiring crisis or emergency funding

The NDIA can vary a plan if a person needs crisis or emergency funding because of changes in their life circumstances. The Rules clarify that all of these criteria must be met:

A person’s support needs have significantly changed, and this has resulted in a significant change in the NDIS supports they require, and:
The changes are to the person’s:
- Functional capacity
- Informal supports
- Living arrangements
The support needed is either:
- For a specific amount of time. This can mean either a set length of time (like a month) or until an event occurs (like an informal support gets back from hospitals or until the plan is reassessed).
- The support is a once-off.
The plan needs to be changed urgently.
The funding is best provided by the NDIS and not another government system.

If the change is permanent or long-term, a participant might then need a plan reassessment to develop a new plan.

Minor variations in a plan

The Rules clarify that if the variation adds a new support to the plan (so for example, the participant requests funding for physio for the first time), the NDIA can vary the plan if:

The support is for a specific time period or is a one of payment, and
The support is different to supports already in a plan, or achieves different outcomes, and
The support is:
- To replace, repair or maintain assistive technology in the plan (or in a previous plan), or
- Urgently required to support the person’s economic participation for a time period (for example, if someone needs additional support because they get a new job), or
- Urgently required to build the person’s capacity for a life transition (for example, if a person enrols in university and needs travel training to learn the route).

The NDIA can also vary a plan to increase funding supports already in the plan but only for certain supports, including:

Home modifications, design or construction
Vehicle modifications
Assistive technology

The NDIA can only top up one of these budgets if one or more of these circumstances are met:

The support is no longer reasonably available at the same cost listed.
The support can no longer be provided in the way that was expected when the plan was developed. For example, a person may now need to pay for delivery or to have the support fitted.
The support requires extra services, materials or information (eg. assessments or quotes) than what was expected. The DSS summary gives the example of termite damage being discovered after home modifications have begun. Going to need trigger warnings before anxiety-inducing examples like that, DSS.

Variations to change a plan reassessment date

The NDIA can also vary a plan to change the plan reassessment date. As long as the variation won’t result in the person going more than 5 years without a plan reassessment.

Plan Reassessments

The NDIA can decide to undertake a plan reassessment following a request by a participant or on their own initiative. In making this decision, the Rules clarify that the NDIA must consider:

If there has been a significant change in the participant’s support needs relating to their:
- Functional capacity
- Informal supports
- Living arrangements
- A major life change or transition, including beginning or leaving school, higher education or employment.
If there has been a change in the participant’s right to compensation or a personal injury insurance scheme.
When the next reassessment is scheduled. For example, if the plan is due to be reassessed in one month anyway, they might just wait.
Anything the participant asks to be considered which the NDIA agrees is important.
Anything else the NDIA thinks is important.

Reviewable decisions

The new Rules don’t change a person’s review rights. Under the Act, the following are reviewable decisions:

The decision to vary a plan
The decision not to vary a plan
The decision not to conduct a reassessment

If the person disagrees with one of these decisions, they can request an internal review and, if they are still not satisfied, appeal to the Administrative Review Tribunal.

Learn more

You can find the plan variation and reassessment Rules, plain English summaries and an Easy Read version on the DSS website.

Remember to also check out our article on the New Plan Management Rules.

And, if you want to learn more about the new NDIS Act, check out our previous coverage: