Access to the NDIS

4. General matters relating to access requests

4.1 What is the meaning of access?

The term 'access' refers to the process of considering a person's request to become a participant in the NDIS.

Access involves the first key decision in the participant pathway and is central to ensuring that access is only granted to those persons who meet the access criteria in the NDIS Act.

4.2 What is an access request?

An access request is a request made by a person to the NDIA indicating that they wish to become a participant in the NDIS.

Receipt of a valid access request by the NDIA begins the formal process of deciding whether the person meets the access criteria.

4.3 Who can make an access request?

A person, or someone who is able to act on their behalf, may make an access request to the NDIA to become a participant in the NDIS (section 18).

4.4 When can an access request be made?

A person can make an access request at any time.

A decision that a person does not meet the access criteria at one point in time does not prevent a person from making a further access request.

However, a person is not able to make a further access request when the NDIA's decision to refuse an earlier access request is in the process of being reviewed internally or externally (section 19(2)).

4.5 What must the NDIA do when it receives an access request?

Once an access request is received, the NDIA must check the access request and any information or documents accompanying the request to determine whether a valid access request has been made.

4.6 What constitutes a valid access request?

A valid access request must:

  • have been received by the NDIA;
  • be in the form approved by the NDIA (if a specific form has been approved for use) and contain the information required by the form (section 19(1)(a));
  • include any additional information or documents required by the NDIA (section 19(1)(b)); and
  • be certified by the person, or their representative with legal authority, to include all the information and supporting documents which are in the possession or control of the person (section 19(1)(c)).

After a person makes a valid access request, a person becomes a 'prospective participant' under the NDIS Act (section 9).

4.7 What will the NDIA do if an access request is not valid?

If an access request is not valid, the NDIA will do everything reasonably possible to work with the person who made the request to ensure that any requirements for making a valid access request are met.

At this stage, the NDIA cannot make one of the formal requests for information or request the person undergo further assessment or examination as this kind of request can only be made once a person has made a valid access request. Until a valid access request is made the NDIA is informally requesting information to assist the person, or their representative, to make a valid access request.

The NDIA is not required to make an access decision until a valid access request is received (i.e. a request in the approved form, which includes any additional information or documents required) (section 197(1))

4.8 What are the timeframes for deciding access requests?

Upon receiving a valid access request, the NDIA has 21 days to:

  • determine whether the prospective participant meets the access criteria (section 20); or
  • make one of the following requests (section 20):
    1. that the prospective participant, or another person, provide information that is reasonably necessary for deciding whether or not the prospective participant meets the access criteria (section 26(1)(a)); or
    2. that the prospective participant do either or both of the following:
    • undergo an assessment and provide the report to the NDIA (section 26(1)(b)(i)); or
    • undergo a medical, psychiatric, psychological or other examination conducted by an appropriately qualified person, and provide the report to the NDIA (section 26(1)(b)(ii)).

For further information regarding making one of the above requests, please refer to requesting further information or reports to inform the access decision.

When further information or a report is requested, the NDIA must give the prospective participant a minimum of 28 days to provide the information.

If one of the above requests is made and the information or report is received within 28 days (or within any longer period specified in the request), the NDIA must within 14 days of the last information or report being received, determine whether the prospective participant meets the access criteria or make a further request (section 26(2)).

If one of the above requests is made and the information or report is not received within 28 days (or within any longer period specified in the request), the access request is considered to have been withdrawn, unless the NDIA is satisfied that it was reasonable for the prospective participant not to have complied (section 26(3)).

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)).

4.9 Extended timeframes for deciding access requests in NDIS areas

Part 3 of the Timeframes for Decision Making Rules provide that if an access request is made:

  • by a prospective participant who resides in an NDIS area; and
  • within 12 months after the first day on which a person who resides in that NDIS area would have met the additional residence requirements,

an extended timeframe for deciding the request applies.
In the above circumstances, upon receiving a valid access request, the NDIA must within 42 days:

  • determine whether the prospective participant meets the access criteria (section 20); or
  • make one of the following requests (section 20):

that the prospective participant, or another person, provide information that is reasonably necessary for deciding whether or not the prospective participant meets the access criteria (section 26(1)(a)); or

  1. that the prospective participant do either or both of the following:
    • undergo an assessment and provide the report to the NDIA (section 26(1)(b)(i)); or
    • undergo a medical, psychiatric, psychological or other examination conducted by an appropriately qualified person, and provide the report to the NDIA (section 26(1)(b)(ii)).

If the NDIA makes a request and the information or report is received within 28 days (or such longer period as is specified in the request), the NDIA must within 28 days of the last information or report being received, determine whether the prospective participant meets the access criteria or make a further request.

However, where the access request was made by a person whose need for assistance is urgent, it is expected that the NDIA will meet the normal timeframes outlined in section 4.8 of this Operational Guideline.

4.10 Failure of the NDIA to decide access request within time

If the NDIA does not:

  • within 21 days (or 42 days if the extended timeframe applies) of receiving a valid access request; or
  • within 14 days (or 28 days if the extended timeframe applies) of a prospective participant complying with one of the above requests:
    • determine whether a prospective participant meets the access criteria; or
    • make a further request;

the NDIA will be taken to have decided that the person does not meet the access criteria, and an internal review of that decision will automatically commence (sections 21(3) and 100(5)).

4.11 Prioritising prospective participants with urgent circumstances

In urgent circumstances, the NDIA may determine whether a prospective participant meets the access criteria sooner than the timeframe set out in the NDIS Act.

Urgent circumstances include, but are not limited to, where a prospective participant's accommodation or care arrangements have broken down, are unsustainable, fragile, at risk of breakdown or where a prospective participant is at risk of harm or is re-entering a community setting and has few or no supports in place.