1. DRAS, NDIS & the EMR through the AAT
The new world with the NDIS is a world of acronyms and initials that hide a huge amount of information and a new way of thinking for people with a disability and service providers- and potentially a new way of operating for agencies such as DRAS. We need to get used to the ‘alphabet soup’.
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2. 1. The NDIS
Turns what we’re used to in terms of disability services provision on its head
Customer driven
Choice and control
Reasonable and necessary
More people will receive services than previously
eg: service provision will no longer be driven by what medical and allied health professionals decide or what budgets allow. There won’t be three year waiting lists for essential equipment or set limits on types of therapy – such as only so many hours of speech therapy per year according to a statewide formula. Each individual will have a Plan, and while many are similar, they are all drawn up as a collaborative process between the NDIS, the individual with a disability and therapist assessment.
Individuals have the right to join the NDIS or not and to choose not to engage in some recommended therapies. Individuals have the right to ask for what they believe they need.
Scheme participants have a choice about who they receive services from (no more block funding to support organisations for example, with ‘clients’ being allocated to one). They also have a choice as to how much control they want to take over their funding. They can have the NDIS handle all billing etc, they can choose to pay bills to an approved provider or they may choose to employ and pay their own support workers.
Supports that are funded must be reasonable (eg: no wildly experimental therapies or extravagant purchases). NDIS will not fund what is someone else’s responsibility such as school expenses or a new vehicle for a family. They won’t fund swimming lessons, but they might fund a support worker to attend swimming lessons with a Scheme participant. Supports must also be necessary. For example, if a person is able to walk with a frame, the NDIS won’t fund a mobility scooter.
As the Scheme has rolled out in SA, almost double the number of children as estimated have applied, with about 80% of applications being approved.
Nationally, plans have ranged from $400K p/a to a few thousand, with the average being $50K.
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3. 2. The Practical changes for individuals
Can manage own funds or choose NDIA to manage for you or choose an advocate to do so (eg: parent for child).
Some small businesses will emerge that will do all invoice processing on behalf of scheme participants.
Can choose service providers from an approved list or if fully self-managed, they can choose who they like.
Disability organisations who currently support people with disabilities are all NDIS Providers, so people can stay with their current service – or choose to change.
Note on 2nd dot point: Where businesses have done this during the self-managed funding trial they failed. Plus, it may constitute a breach of NDIS funding rules. And why would you bother with this when NDIA will process all invoices for you?
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4. Can choose own worker(s)
Can choose own relatives for respite and they can be paid (in some circumstances)
Even if staying with a particular disability support service, can choose medical & allied health professionals outside who the Disability Support Organisation has partnerships with.
Practicality of choosing own workers comes with its issues. Insurance, leave entitlements, tax, superannuation etc become an issue.
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5. Over time…
Families are already realising their purchasing power and leaving existing service providers.
People are seeking support to ‘break up’ with their current service provider and seeking advocacy support.
People will act more on their right to complain and advocates will be needed for this work.
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6. 3. The Process (1)
Apply for information pack (up to 6 months before eligible).
Gather supporting materials and lodge application.
If accepted, work with a Planner at NDIA to develop a plan of services and support to meet the needs related to your disability.
If not accepted into the Scheme, appeal through an IR. 
If appeal is not accepted, lodge an application with the AAT for an EMR. 
NDIA: National Disability Insurance Scheme – the organisation the administers the Scheme.
IR: Internal Review, where a person other than the Planner who made the eligibility decision or drafted the Plan reviews the decision.
AAT: Administrative Appeals Tribunal, a Commonwealth Government body that reviews decisions made by Commonwealth Government bodies.
EMR: External Merits Review, where the AAT reviews the decisions made by the NDIA. You can’t seek an EMR until after an IR has been conducted.
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7. The Process (2)
The Plan does not have all the elements you believe you need to meet your needs and support social and economic inclusion.
Lodge an IR. 
If the IR doesn’t satisfy you, lodge an application for an EMR with the AAT. 
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8. 4. The SA Picture Staged, statewide rollout
Started with 0-5 year olds and has been progressing up the age-range to full rollout which will begin final stage on 1 April 2018.
Will finally cover birth to 64 years*
By end December 2016, entry into the NDIS of children aged between 0 and 14 will be completed. EXCEPT: Scheme is running behind + more children with disabilities are born, are diagnosed and acquire disabilities over time, so entry & participant numbers is fluid. From 1 January 2017, the NDIS began to be available to young people aged between 15 and 17. From 1 July 2017, adults aged 18 to 64 will begin to enter the NDIS based on where they live. Initially this will occur in Adelaide’s northern suburbs + Lower north/Barossa. Last regions to be opened to the Scheme will be in April 2018.
*Some participants will be over 64, but they will have acquired their disability before age support needs will be met with a split between aged care and Aged Care system depending on which aspect the need for support is caused by. Otherwise covered by the aged care system.
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9. NDIS Full Scheme Rollout (DRAS Regions)
Date
Local Government Area
1 July 2017
City of Playford
City of Salisbury
City of Port Adelaide Enfield (EAST)
Town of Gawler (+ Barossa Council, Light Regional, District Council of Mallala)
1 October 2017
City of Tea Tree Gully
District Council of Grant
Kingston District Council
Naracoorte Lucindale Council
District Council of Robe
Tatiara District Council
Wattle Range Council
Berri Barmera Council
The Coorong District Council
District Council of Loxton Waikerie
Southern Mallee District Council
District Council of Karoonda East Murray
Mid Murray Council
The Rural City of Murray Bridge
District Council of Renmark Paringa
1 January 2018
City of Holdfast Bay
City of Marion
City of Mitcham
City of Onkaparinga
1 April 2018
City of Adelaide
City of Burnside
City of Campbelltown
City of Norwood, Payneham & St Peters
City of Prospect
City of Unley
Corporation of the Town of Walkerville
City of Charles Sturt
City of West Torrens
City of Port Adelaide Enfield (WEST)
Adelaide Hills Council
District Council of Mt Barker
Probably any/all External Merit Reviews supported by DRAS will be associated with the 1st tranche because of the time it takes to progress through the application and internal review. This has staffing implications for northern Adelaide.
Application process can begin 6 months before eligibility, so many will be ready to go as soon as the scheme becomes available.
People who receive services from Disability SA will receive priority to join the Scheme.
DRAS can expect requests for support with Internal Reviews from shortly after Scheme start date in each region. These cases are funded through regular DRAS funding and not through the additional EMR funds.
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10. 5. Current Trends for Advocacy Support
Support with internal reviews
Denial of access to the Scheme.
Inappropriate support package has been offered.
Children in receipt of Early Intervention services have their package reduced once they have reached developmental milestones in range of their peers.
Internal Reviews are conducted by an NDIS Planner under supervision of a Manager, who was NOT involved in the decisions related to the original application.
Must be lodged by a person directly affected by the decision: eg pwd, parent, guardian
Request for an Internal Review must be made within three months of the original decision.
Early Intervention services might be intensive speech therapy for a year for example. Or services that might be required for children who have unexplained developmental delay, which is corrected by the early intervention services.
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11. 6. Coming Advocacy Trends
Plans are reviewed every 12 months and new Plans may provide less than previously.
As needs change, or perhaps were underestimated, a review can be requested by the participant or their advocate.
As the Scheme becomes embedded, it is expected that this will be a growing area for advocacy support, though how DRAS would become involved is something to be examined within the service contracts’ boundaries. Most likely DRAS would only take a role if the outcome of these processes constituted a complaint against the NDIA in terms of an IR or was viewed to discriminatory. For example, if an adverse decision was made because the individual’s disability didn’t allow them to express themselves well enough or they were allowed to enter the process without the cognitive skills to represent themselves.
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12. 8. The Good News…
Individual staff at the NDIA want to meet the needs of Scheme participants.
Individual staff all have personal and long standing professional connections to disability.
The NDIA very much want applicants and Participants to have support through the process.
All this means they are less likely to be adversarial toward advocates.
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13. 9. Who can Request a Review?
Any person affected by a decision made by the NDIA, including:
a prospective participant;
a participant (including participants who are children);
one or more persons with parental responsibility for a child;
a child’s representative, or a person seeking to a be a child's representative;
a child's guardian;
a plan or correspondence nominee*, or a person appointed, or seeking to be appointed as a plan or correspondence nominee;
A registered provider of supports, or a person or organisation who applies to be a registered provider of supports; or
a person who owes a debt to the NDIA.
*A nominee is a person who is appointed in writing, at the request of a participant, or on the initiative of the NDIA, to act on behalf of, or make decisions on behalf of a participant for the purposes of the NDIS Act.
The NDIS Act requires and permits participants to do a range of different things for the purposes of the National Disability Insurance Scheme (NDIS). For example, participants must prepare a statement of goals and aspirations, and may make a plan management request. Unlike a participant who is a child, a participant who is over 18 years of age will be presumed, so far as is reasonable in the circumstances, to have capacity to determine their own best interests and make decisions that affect their own lives. As far as is possible, the NDIA's focus will be on supporting and building the capacity of participants to make their own decisions for the purposes of the NDIS Act.
Where it is not possible for a participant to make their own decisions, or be supported to make their own decisions, the National Disability Insurance Agency (NDIA) can appoint a nominee to act on behalf of, or make decisions on behalf of a participant. Most participants who need a nominee already have some kind of formal or informal arrangement in place to help them live their lives. The NDIS is not intended to replace these support networks. Rather, the focus of the NDIA will be on strengthening and, where necessary, formalising the existing support networks of a participant. Two types of nominees which can be appointed under the NDIS Act, namely a plan nominee and a correspondence nominee. An appointment can be made at the request of a participant, or on the initiative of the NDIA. Whichever way the appointment of a nominee comes about, the NDIA must have regard to the matters which are relevant in determining how the NDIA will decide whether it is necessary to appoint a nominee and if so, who should be appointed as nominee. (For further information, see appointment of nominees). The NDIS Act and the Nominees Rules impose duties which nominees are required to adhere to. These duties are also relevant when determining whether a nominee should be appointed, suspended or cancelled.
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14. 10. External Merits Review
Only available as an option after an IR.
The AAT will put themselves in the shoes of the original decision maker and consider the decision from a fresh perspective.
The AAT will consider the same legal framework as the NDIA, together with any additional information of relevance, and has all the same powers to make changes as the NDIA has.
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15. External Merits Review
A person must make a request for external review within 28 days of receiving written notice of an IR decision from the NDIA
If this timeframe has passed, a person can apply directly to the AAT for an extension of time by filling out a form on the AAT website or by writing directly to the AAT.
Extension may or may not be granted.
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16. External Merits Review
When the AAT reviews an IR decision made by the NDIA it can:
affirm the decision (meaning the decision is not changed); or
vary the decision (meaning part of the decision is changed); or
set aside the decision, and make a new decision in its place or send the case back to the NDIA to make a new decision
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17. 11. DRAS & EMR
Don’t need to have a case of discrimination or infringement of rights in order to access the EMR appeals process.
Just need to disagree with an NDIA decision, even after an IR.
Can be accessed just for advice; doesn’t need to follow through to a full EMR in the AAT.
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18. DRAS & EMR
May involve supporting the individual right through the AAT process:
Provide advice on pathways and possible consequences.
Steer people through the AAT process.
Provide individual advocacy.
Find more information should it be needed for the Tribunal.
Support an applicant at hearings and relevant meetings.
Assist an applicant to access funding for legal assistance should it be required.
Assist applicants to self-advocate.
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