How to Request NDIS Plan Reviews and Get Better Support

Key Points

  • NDIS participants can request plan reviews at any time if their circumstances change or current supports are inadequate
  • Successful plan reviews require clear evidence of changed needs, detailed documentation, and well-prepared justifications
  • The review process typically takes 3-6 months from request to new plan implementation
  • Proper preparation, including gathering evidence and setting clear goals, significantly improves review outcomes

Understanding NDIS Plan Reviews

NDIS plan reviews are formal processes where the National Disability Insurance Agency (NDIA) reassesses a participant’s support needs and funding allocations. Unlike scheduled plan renewals that occur automatically, reviews can be requested by participants when circumstances change or when current supports prove inadequate.

Types of NDIS Reviews

Scheduled Plan Reviews

  • Regular Reviews: Standard plan reviews at the end of plan periods (typically 12-24 months)
  • Automatic Process: Initiated by NDIA as plan expiry approaches
  • Comprehensive Assessment: Full reassessment of all support needs and goals
  • Timeline: Usually scheduled 3-4 months before plan expiry

Unscheduled Plan Reviews

  • Participant Requested: Reviews initiated by participants due to changed circumstances
  • Immediate Need: Reviews for urgent changes in support requirements
  • Circumstance-Based: Triggered by significant life changes or events
  • Timeline: Can be requested at any time during the plan period

Plan Reassessments

  • Detailed Reviews: Comprehensive reassessment including new assessments and reports
  • Complex Changes: For significant changes in disability, circumstances, or goals
  • Extended Process: More thorough process involving multiple assessments
  • Timeline: May take 6-12 months to complete

When to Request a Plan Review

Significant Changes in Circumstances

Health and Disability Changes
  • Deteriorating Condition: Worsening disability or new health issues
  • New Diagnoses: Additional disabilities or co-occurring conditions
  • Medical Events: Significant medical events requiring increased support
  • Surgery or Treatment: Major medical interventions affecting support needs
Life Situation Changes
  • Housing Changes: Moving homes, especially to less accessible environments
  • Family Changes: Changes in informal support networks or family circumstances
  • Education/Employment: Starting school, university, or employment
  • Relationship Changes: Marriage, separation, or changes in living arrangements

Inadequate Current Supports

Insufficient Funding
  • Budget Exhaustion: Consistently running out of funding before plan renewal
  • Unmet Needs: Important support needs not covered by current plan
  • Service Gaps: Inability to access necessary services within current funding
  • Quality Issues: Need for higher quality or more specialized services
Changed Support Requirements
  • Increased Care Needs: Requiring more frequent or intensive support
  • New Support Types: Need for support categories not in current plan
  • Assistive Technology: Need for equipment not covered by current funding
  • Environmental Changes: New accessibility requirements or modifications

Preparing for Your Plan Review

Gathering Evidence and Documentation

Medical and Clinical Evidence

Updated Medical Reports
  • Recent Assessments: Medical reports from the last 6-12 months
  • Specialist Reports: Updates from relevant medical specialists
  • Functional Assessments: Current occupational therapy or physiotherapy assessments
  • Psychology Reports: Mental health assessments and recommendations
Progress Reports
  • Therapy Reports: Updates from current therapists on progress and ongoing needs
  • Support Worker Reports: Input from current support providers about needs and challenges
  • Allied Health Assessments: Recent assessments from all relevant health professionals
  • School or Work Reports: Educational or employment support requirements

Evidence of Changed Needs

Daily Living Challenges
  • Capability Changes: Documentation of increased difficulty with daily tasks
  • New Limitations: Evidence of new functional limitations or restrictions
  • Safety Concerns: Documentation of safety issues or risks
  • Independence Changes: Evidence of reduced independence or increased support needs
Support Utilization Records
  • Budget Analysis: Records showing how current funding is being used
  • Service Usage: Documentation of current service utilization and gaps
  • Unmet Needs Log: Records of needs not being met by current supports
  • Quality Issues: Documentation of problems with current service quality

Setting Clear Goals and Objectives

Short-Term Goals (6-12 months)

  • Immediate Needs: Urgent support requirements that need addressing
  • Safety Goals: Ensuring safe living and community participation
  • Health Goals: Managing health conditions and preventing deterioration
  • Daily Living Goals: Improving independence in personal care and household tasks

Medium-Term Goals (1-2 years)

  • Skill Development: Building capacity and independence
  • Community Participation: Increasing engagement in community activities
  • Education/Employment: Educational or career objectives
  • Relationship Goals: Improving social connections and relationships

Long-Term Goals (2+ years)

  • Independence: Maximizing autonomy and self-direction
  • Life Outcomes: Achieving major life goals and aspirations
  • Community Integration: Full participation in community life
  • Quality of Life: Improving overall wellbeing and life satisfaction

Preparing Your Review Request

Written Request Components

Request Letter Elements
  • Clear Request: Explicit request for plan review
  • Reasons for Review: Detailed explanation of why review is needed
  • Changed Circumstances: Specific changes since last plan
  • Evidence Summary: Overview of supporting documentation
  • Urgency Indicators: Any urgent needs requiring immediate attention
Supporting Documentation List
  • Medical Reports: Current and relevant medical documentation
  • Functional Assessments: Recent occupational therapy or other assessments
  • Provider Reports: Input from current service providers
  • Budget Analysis: Analysis of current funding utilization
  • Goal Statements: Clear statements of new or revised goals

The Plan Review Process

Initial Review Request

Submitting Your Request

Submission Methods
  • Online Portal: Submit through myNDIS participant portal
  • Phone Request: Call NDIS contact center to request review
  • Written Request: Send formal letter to local NDIA office
  • LAC/Support Coordinator: Request assistance from Local Area Coordinator or Support Coordinator
Required Information
  • Participant Details: Full name, NDIS number, and contact information
  • Current Plan Information: Plan dates and current funding details
  • Request Reason: Clear explanation of why review is needed
  • Supporting Documents: All relevant evidence and documentation

NDIA Response and Timeline

Acknowledgment Process
  • Initial Response: NDIA acknowledgment within 5-10 business days
  • Review Decision: Decision on whether to proceed with review
  • Timeline Advice: Expected timeframes for review process
  • Contact Assignment: Assignment of NDIA planner or LAC
Possible Outcomes
  • Full Review: Complete reassessment of plan and funding
  • Plan Variation: Minor adjustments to current plan
  • Decline: Decision not to conduct review with reasoning
  • Additional Information: Request for more evidence before proceeding

Assessment and Planning Phase

Planning Meeting Preparation

Pre-Meeting Activities
  • Document Review: NDIA review of submitted evidence
  • Assessment Scheduling: Arrangement of any required assessments
  • Goal Clarification: Clarification of participant goals and objectives
  • Provider Input: Gathering input from current service providers
Meeting Scheduling
  • Meeting Format: Face-to-face, phone, or video conference
  • Location Options: NDIA office, participant’s home, or neutral venue
  • Support People: Including family members, advocates, or support coordinators
  • Interpreter Services: Arranging language or communication support if needed

Planning Meeting Process

Meeting Structure
  • Introductions: Meeting participants and roles
  • Review Purpose: Discussion of review reasons and objectives
  • Current Situation: Assessment of current supports and outcomes
  • Changed Needs: Discussion of new or changed support requirements
  • Goal Setting: Establishing goals for the new plan period
Evidence Review
  • Document Analysis: Review of all submitted evidence
  • Clarification Questions: NDIA questions about evidence and needs
  • Additional Information: Requests for any missing information
  • Professional Input: Input from attending health professionals or advocates

Additional Assessments

When Additional Assessments Are Required
  • Complex Changes: Significant changes in disability or circumstances
  • New Support Categories: Requests for previously unfunded support types
  • High-Cost Supports: Requests for expensive assistive technology or modifications
  • Specialist Supports: Need for specialized services or accommodation
Types of Additional Assessments
  • Functional Capacity Assessments: Comprehensive evaluation of capabilities
  • Allied Health Assessments: Occupational therapy, physiotherapy, or speech therapy
  • Psychology Assessments: Mental health and behavioral assessments
  • Independent Assessments: Third-party professional assessments

Strategies for Successful Plan Reviews

Building a Strong Case

Evidence-Based Approach

Objective Documentation
  • Measurable Changes: Quantifiable evidence of changed needs
  • Professional Opinions: Clear recommendations from qualified professionals
  • Consistent Messages: Aligned evidence from multiple sources
  • Timeline Documentation: Clear progression of changes over time
Comprehensive Coverage
  • All Life Areas: Evidence covering all relevant life domains
  • Multiple Perspectives: Input from various professionals and support people
  • Current and Relevant: Recent evidence reflecting current circumstances
  • Specific Examples: Concrete examples of needs and challenges

Goal-Focused Planning

SMART Goals Development
  • Specific: Clear, specific goals and objectives
  • Measurable: Goals with quantifiable outcomes
  • Achievable: Realistic goals given current circumstances
  • Relevant: Goals aligned with individual priorities and needs
  • Time-Bound: Goals with clear timeframes for achievement
Goal Justification
  • Need Connection: Clear links between goals and support needs
  • Evidence Support: Goals supported by assessment evidence
  • Outcome Focus: Emphasis on positive outcomes and life improvements
  • Progression Planning: Logical progression from current to desired state

Addressing Common Challenges

Budget Increase Requests

Justification Strategies
  • Clear Need Demonstration: Obvious connection between increased needs and funding
  • Cost-Benefit Analysis: Demonstrating value of increased investment
  • Alternative Comparison: Showing current approach is insufficient
  • Long-term Benefits: Highlighting long-term positive outcomes
Evidence Requirements
  • Service Usage Data: Current utilization rates and shortfalls
  • Provider Quotes: Detailed quotes for additional services
  • Professional Recommendations: Clinical support for increased funding
  • Outcome Predictions: Expected improvements from additional support

New Support Category Requests

Category Justification
  • Gap Identification: Clear identification of unmet needs
  • Professional Support: Clinical recommendations for new supports
  • Trial Evidence: Results from trials or pilot programs where possible
  • Integration Planning: How new supports fit with existing plan
Implementation Planning
  • Provider Identification: Available providers for new support types
  • Service Coordination: How new supports will coordinate with existing services
  • Progress Monitoring: Plans for measuring effectiveness of new supports
  • Review Timeline: When to assess effectiveness of new supports

Working with Support Coordinators and Advocates

Support Coordinator Assistance

Review Preparation Support
  • Evidence Gathering: Help collecting and organizing documentation
  • Goal Development: Assistance developing appropriate goals
  • Meeting Preparation: Support preparing for planning meetings
  • Documentation Review: Review of all materials before submission
Advocacy Support
  • Meeting Attendance: Support coordinator presence at planning meetings
  • Communication Assistance: Help articulating needs and goals
  • Technical Knowledge: Understanding of NDIS processes and requirements
  • Follow-up Support: Assistance with post-meeting activities

Independent Advocacy

When to Consider Independent Advocacy
  • Complex Reviews: Complicated circumstances or multiple issues
  • Previous Difficulties: Problems with previous NDIA interactions
  • High-Stakes Reviews: Reviews involving significant funding or support changes
  • Communication Barriers: Difficulty articulating needs or understanding processes
Advocacy Support Services
  • Case Preparation: Comprehensive preparation of review case
  • Meeting Representation: Professional representation at planning meetings
  • Appeal Support: Assistance if review outcomes are unsatisfactory
  • Rights Protection: Ensuring participant rights are protected throughout process

After the Review Decision

Understanding Review Outcomes

Possible Outcomes

Plan Approval
  • New Plan: Implementation of new plan with revised supports
  • Timeline: Usually effective from current plan expiry date
  • Transition Planning: Arrangements for transitioning to new supports
  • Provider Coordination: Coordination with new or existing providers
Plan Variation
  • Minor Changes: Adjustments to current plan without full review
  • Immediate Effect: Changes typically effective quickly
  • Limited Scope: Usually covers specific, straightforward changes
  • Documentation: Updated plan documents reflecting changes
Review Declined
  • Current Plan Continues: Existing plan remains in effect
  • Reasoning: NDIA explanation for declining review
  • Alternative Options: Suggestions for addressing concerns within current plan
  • Appeal Rights: Information about appeal processes if disagreed

Review Decision Timeline

Processing Timeframes
  • Simple Reviews: 4-8 weeks for straightforward reviews
  • Complex Reviews: 8-16 weeks for reviews requiring additional assessments
  • Urgent Reviews: Expedited processing for urgent circumstances
  • Appeal Delays: Additional time if appeals or disputes arise
Implementation Timeline
  • Plan Activation: When new plans take effect
  • Service Transitions: Time needed to arrange new services
  • Provider Changes: Timeline for changing service providers
  • Equipment/Modifications: Timeframes for new equipment or modifications

Implementing Your New Plan

Service Transitions

New Service Setup
  • Provider Research: Finding appropriate service providers
  • Service Agreements: Establishing agreements with new providers
  • Service Scheduling: Coordinating service delivery times
  • Quality Monitoring: Ensuring services meet expectations
Existing Service Changes
  • Service Modifications: Adjusting current services to match new plan
  • Provider Negotiations: Discussing changes with existing providers
  • Schedule Adjustments: Modifying service delivery schedules
  • Performance Monitoring: Ensuring modified services remain effective

Plan Monitoring and Adjustment

Early Implementation Review
  • Initial Assessment: Early evaluation of new plan effectiveness
  • Issue Identification: Identifying any problems or gaps
  • Quick Adjustments: Making minor modifications as needed
  • Provider Feedback: Gathering input from service providers
Ongoing Monitoring
  • Regular Reviews: Scheduled check-ins on plan progress
  • Goal Progress: Monitoring progress toward established goals
  • Budget Tracking: Monitoring funding utilization and effectiveness
  • Outcome Measurement: Measuring improvements in quality of life

Appealing Review Decisions

When to Consider Appeals

Grounds for Appeal

Procedural Issues
  • Process Errors: Mistakes in review process or procedures
  • Evidence Ignored: Failure to consider submitted evidence
  • Inadequate Assessment: Insufficient assessment of needs
  • Timeline Failures: Unreasonable delays in review process
Substantive Issues
  • Inadequate Funding: Insufficient funding for identified needs
  • Missing Supports: Failure to include necessary support categories
  • Inappropriate Goals: Goals that don’t reflect participant priorities
  • Service Limitations: Restrictions that prevent appropriate service access

Appeal Process Overview

Internal Review

Request Process
  • Timeline: Must be requested within 3 months of decision
  • Written Request: Formal written request for internal review
  • Evidence: Additional evidence supporting appeal
  • Reasoning: Clear explanation of disagreement with decision
Review Process
  • Independent Reviewer: Different NDIA staff member conducts review
  • Evidence Review: Comprehensive review of all evidence
  • Decision Timeline: Usually completed within 60 days
  • Outcome Communication: Written communication of review outcome

Administrative Appeals Tribunal (AAT)

When AAT Review Applies
  • Internal Review Completed: Must complete internal review first
  • Continuing Disagreement: Ongoing disagreement with NDIA decision
  • Timeline: Application must be made within 28 days
  • Legal Representation: Option to have legal representation
AAT Process
  • Independent Review: Tribunal conducts independent assessment
  • Hearing Process: May include formal hearings
  • Evidence Submission: Opportunity to present additional evidence
  • Binding Decisions: AAT decisions are binding on NDIA

Frequently Asked Questions

How often can I request a plan review?

You can request a plan review at any time if your circumstances have significantly changed since your last plan. However, the NDIA will only conduct reviews when there’s genuine evidence of changed needs. Frequent review requests without substantial evidence of change may be declined. It’s best to wait until you have clear evidence of changed circumstances and gather comprehensive documentation before requesting a review. Most successful reviews involve waiting at least 6-12 months between requests unless urgent circumstances arise.

What evidence is most important for a successful plan review?

The most important evidence includes recent medical or allied health reports (within 6-12 months), functional capacity assessments, and detailed documentation of how your current supports are inadequate. Professional recommendations from occupational therapists, doctors, or other clinicians carry significant weight. Evidence should clearly demonstrate changed needs, document specific challenges you’re facing, and show how additional or different supports would address these issues. Quantifiable evidence (like budget exhaustion rates or measurable functional changes) is particularly compelling.

How long does the plan review process typically take?

Plan review timeframes vary significantly based on complexity. Simple reviews with clear evidence may take 6-8 weeks from request to new plan. More complex reviews requiring additional assessments typically take 3-6 months. Reviews involving high-cost supports or significant plan changes may take longer. Urgent reviews can sometimes be expedited, but this requires clear evidence of immediate risk or safety concerns. The NDIA should provide estimated timeframes when acknowledging your review request.

Can I get support to help with my plan review?

Yes, several support options are available. Support coordinators can help prepare review requests, gather evidence, and attend planning meetings. Independent advocates can provide specialized assistance, particularly for complex reviews or if you’ve had difficulties with previous NDIA interactions. Local Area Coordinators (LACs) can provide some assistance, though their capacity may be limited. Family members or carers can also attend meetings and provide support. Consider your needs and the complexity of your review when deciding what level of support to access.

What happens if my plan review is declined?

If your review is declined, the NDIA should provide clear reasons for the decision. You can request an internal review within 3 months if you disagree with the decision. Focus on addressing the specific reasons for decline by gathering additional evidence or clarifying information. Sometimes a decline indicates you need more comprehensive evidence or that your request needs to be restructured. You can also seek support from advocates or support coordinators to strengthen a future request. Consider whether the timing was appropriate and whether you had sufficient evidence to support your case.

Can I request an urgent plan review for immediate needs?

Yes, urgent reviews are possible in circumstances involving immediate risk to health, safety, or wellbeing. Examples include sudden health deterioration, loss of informal supports, housing emergencies, or safety concerns. Urgent requests require clear evidence of immediate risk and documentation of why waiting for scheduled review would be harmful. Contact the NDIA immediately by phone rather than waiting for written processes. Have medical or professional evidence readily available to support the urgency of your request. Even urgent reviews require appropriate evidence, though processing may be expedited.