10. Determining whether a prospective participant meets the access criteria
A person meets the access criteria if the NDIA is satisfied the person meets the age and residence requirements, and either the disability or the early intervention requirements (section 21).
If a prospective participant does not meet one or more of the disability requirements, the NDIA will consider whether the prospective participant can become a NDIS participant under the early intervention requirements.
For all children under 7 years of age (except children diagnosed with a condition on List A), the NDIA will first consider whether the child meets the early intervention requirements, before considering the disability requirements.
10.1 Assessing all the available information
In considering whether a prospective participant meets the access criteria, the NDIA will develop a comprehensive view of the person's circumstances including by:
examining all relevant information provided by the prospective participant (such as the information provided on the access request form and any diagnostic or assessment information provided);
considering information and evidence from a range of different sources, including from the prospective participant, family members, carers, medical and allied health practitioners and/or service providers (Note, to reduce the overall assessment burden on the participant, the NDIA will only gather the minimum amount of evidence required to determine a person's eligibility to the NDIS. See also requesting further information or reports to inform the access decision); and
talking with the prospective participant and, with the prospective participant's consent, their family and/or carers.
In some circumstances, judgments about the weight or value of particular pieces of evidence will often need to be made. The source of the evidence and the purposes for which it is being used will have an impact on the value of the evidence. For example, evidence from a doctor on a specific medical matter would be given considerable weight.
10.2 Requesting further information or reports to inform the access decision
The NDIA will only request further information or require a prospective participant undergo an assessment or examination and provide a copy of the report to the NDIA where it is reasonably necessary to determine whether the prospective participant meets the access criteria (section 26).
The need for an assessment or examination would only be expected to arise in limited circumstances, such as where other sources of information have been exhausted, where there is inconsistent information, where medical information is outdated or a specific matter needs to be resolved.
Where further information is being sought from the prospective participant the request should clearly specify:
what information is required from the person or what action is required to be taken;
how the person should provide the information or document;
the timeframe for providing the document or performing the action; and
the NDIA contact person to provide the information or document to.
Where the NDIA has made a request that a prospective participant undergo an assessment or examination, the NDIA will support the prospective participant to comply with the request by providing assistance, including financial assistance where appropriate (section 6).
The NDIA will not reimburse prospective participants for any costs associated with obtaining assessments or examinations which were not directly requested by the NDIA. For example, costs incurred relating to reports, assessments or examinations which were previously obtained for other incidental purposes.
Generally, if the NDIA makes a request for information in order to make a decision under the NDIS Act and the information is not provided, the NDIA is not required to make the decision until the information is provided (section 197(2)).
The power to request information or to require a prospective participant to undergo an assessment or examination must be exercised carefully and in accordance with the objects and principles in the NDIS Act.