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Access and Eligibility

Introducing the National Disability Insurance Scheme

The National Disability Insurance Scheme provides individualised support for people with permanent and significant disability, as well as their families and carers.

The NDIS represents significant reform to disability services in Australia and is underpinned by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).

The primary purpose of the NDIS is to change the lives of people with disability, their families and carers for the better, enabling them to fully participate in the social and economic life of the nation and to live ordinary lives. (NDIS Corporate Plan 2013-16)

The NDIS website has a wealth of information and we highly recommend you become familiar with the content in depth. In particular, the information around eligibility, access and planning are important.

Helplines
1800 800 110 8am – 8pm Monday to Friday

There are also helplines for people with hearing and speech loss or who need help with English.

National Disability Insurance Agency
The National Disability Insurance Agency (NDIA) is the independent statutory agency, whose role it is to implement the National Disability Insurance Scheme Act 2013 (NDIS).

NDIS Quality and Safeguards Commission
The NDIS Quality and Safeguards Commission is a new independent agency established to improve the quality and safety of NDIS supports and services.

Some key concepts in the NDIS

Accessing the NDIS

To become an NDIS participant you must:

Have a permanent impairment that significantly affects your ability to take part in everyday activities or have a developmental delay

Is the NDIS available in my area?

After a trial phase, the NDIS commenced full scheme rollout from 1 July 2016 in parts of NSW and Victoria. Other states will follow and by the end of 2019, the NDIS will have rolled out right across Australia. To find out whether it is already available in your area check this website.

Accessing the NDIS

Pathways to access the NDIS

There are two pathways to access the NDIS depending on the age of the participant

If you or your child is over the age of 7, access to the NDIS is via the NDIS Pathway. Follow the NDIS pathway to understand:

  • What is the NDIS?
  • Can I access the NDIS?
  • My first plan
  • Reviewing my plan

If your child is aged 0-6 years, they will access the NDIS via the Early Childhood Early Intervention (ECEI) pathway. The ECEI pathway:

  • Provides early intervention for a child with developmental delay or disability
  • Acknowledges that early intervention leads to better long term outcomes
  • Uses a family-centred approach that supports greater inclusion in mainstream settings and builds child and family capacity
  • Connects families to services via access partners

As an insurance scheme, the NDIS uses effective early intervention to reduce its medium to long term liability.

NDIS Eligibility for Autism Spectrum Disorder

The latest version of the Diagnostic and Statistical Manual (DSM-5) categorises Autism Spectrum Disorder into 3 levels:

  • Level 1 – Requires Support
  • Level 2 – Requires Substantial Support
  • Level 3 – Requires Very Substantial Support

NDIS eligibility is based on reduced Functional Capacity in one or more of the following areas; Communication, Mobility, Social Interaction, Learning, Self-Care and Self-Management. Whilst a diagnosis of Autism at any level is likely to meet the access criteria, the NDIA have Lists A-E to assist them to determine eligibility.

Read Section 8.3 of the NDIS Operation Guidelines for more information on ‘Functional Capacity’

List A – conditions that are likely to automatically meet disability requirements (outlined in Section 24 of the NDIS Act) with no further assessments required:

Autism diagnosed by a specialist multi-disciplinary team, paediatrician, psychiatrist or clinical psychologist experienced in the assessment of Pervasive Developmental Disorders, and assessed using the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria as having severity of Level 2 (Requiring substantial support) or Level 3 (Requiring very substantial support)

List B – permanent conditions for which functional capacity is variable and further assessment of functional capacity is generally required:

  • Pervasive developmental disorders not meeting severity criteria in List A or List C
  • Asperger syndrome
  • Atypical autism
  • Childhood autism

List C – refers to defined programs

List D – Permanent Impairment/Early Intervention, under 7 years – no further assessment required

List E – Qualifying programs

  • Better start for Children with Disability
  • Helping Children with Autism

Strategy for success in accessing the NDIS

  • Know the level of Autism Spectrum Disorder in accordance with the DSM-5 (level 1, 2 or 3)
  • Note how the level of ASD corresponds with the NDIA eligibility lists (A, B, C, D or E)
  • Understand Functional Capacity and insist that your allied health and medical specialists use the categories of communication, social interaction, mobility, learning, self-management and self-care to define the impact of autism on everyday living.