1. What is the purpose of this operational guideline?
This Operational Guideline provides guidance when determining whether a person with disability meets the access criteria to become a participant in the National Disability Insurance Scheme (NDIS).
It also seeks to ensure the National Disability Insurance Agency (NDIA) focus is centered on people with disability living in Australia with the most unmet need intended to benefit from the support under the NDIS.
2. What is the relevant legislation?
- Sections 3, 4, 5, 6, 9, 18 – 30, 32, 51, 99, 100 and 197 of the National Disability Insurance Scheme Act 2013 (External website) (NDIS Act);
- National Disability Insurance Scheme (Becoming a Participant) Rules 2016 (External website) (Becoming a Participant Rules);
- National Disability Insurance Scheme (Timeframes for Decision Making) Rules 2013 (External website) (Timeframes for Decision Making Rules);
- National Disability Insurance Scheme (Prescribed Programs—New South Wales) Rules 2016 (External website) (NSW Prescribed Programs Rules);
- Sections 41.3 and 45.3 of the Aged Care Act 1997 (External website) ;and
- Residential Care Subsidy Principles 1997 (the Subsidy Principles).
Access to the NDIS is determined by three separate and distinct legal requirements:
- the age requirements;
- the residence requirements; and
- the disability requirements or early intervention requirements.
These requirements are referred to as the NDIS access criteria. To access the NDIS a person must meet the access criteria (section 21).
The access criteria are designed to determine whether people with disability have a current need for support under the NDIS, based on one or more permanent impairments that have consequences for their daily living and social and economic participation on an ongoing basis.
A person will satisfy the access criteria when they meet both the age and residence requirements, and satisfy either the disability requirements or the early intervention requirements.
- a person will meet the disability requirements if they have a disability that is attributable to an impairment that is permanent or likely to be permanent and that results in substantially reduced functional capacity (rule 2.5(a) of the Becoming a Participant Rules);
- alternatively, a person can access the NDIS through the early intervention requirements without having substantially reduced functional capacity. Instead, the early intervention requirements consider the likely trajectory and impact of a person's impairment over time and the potential benefits of early intervention on the impact of the impairment on the person's functional capacity. The NDIA may consider a range of evidence in deciding the potential benefit of early intervention on a person's impairment (rule 2.5(b) of the Becoming a Participant Rules).
Once a decision is made under the NDIS Act, a person is an NDIS participant and they usually remain one for life. However, in some circumstances a person may cease being a participant.
3.1 NDIS full scheme progressive rollout
The NDIS commenced on 1 July 2013. It was initially commenced on a trial basis but is now being implemented nationally.
For the first three years (1 July 2013 to 30 June 2016), the NDIS was introduced in certain launch areas made up of specific geographical locations, known as trial sites. This period of time is referred to as the NDIS 'launch' or 'trial'.
From 1 July 2016 to 30 June 2018, the NDIS will be introduced progressively in all Australian states and territories (except Western Australia). This period is referred to as 'NDIS full scheme roll out' or 'transition'.
As a result, access to the NDIS during 'trial' and 'transition' will only be available to people who live in a particular location at a particular time, and for certain locations only to people of a particular age.
For further information please refer to the age requirements and the additional.