External Merits Review – Support Component

Overview

On 1 July 2013, the National Disability Insurance Scheme launched in the Barwon area of Victoria, the Hunter area in New South Wales, Tasmania and South Australia, and from July 2014 will launch in the Australian Capital Territory, the Barkly region of the Northern Territory and the Perth Hills area in Western Australia (the launch sites).

The National Disability Insurance Scheme will provide long-term, high quality individualised care and support that is reasonable and necessary to meet the needs of people with permanent disability, where their disability significantly affects their communication, mobility, self-care or self-management.  This may include an individual plan and an individually funded package.

The Australian Government has established the National Disability Insurance Agency to implement the first stage of the scheme.  The National Disability Insurance Agency will work closely with people with disability, governments, representative organisations, service providers and participating communities in launch sites to ensure the transition to the new arrangements take account of local needs and experience.

The National Disability Insurance Scheme Act 2013 creates the framework for the National Disability Insurance Scheme, including eligibility criteria, age requirements, and what constitutes reasonable and necessary support.  The framework set up by the legislation will be supported by detailed rules that keep it flexible and allow it to be adapted. 

A person who is not satisfied with a decision made by the National Disability Insurance Agency can apply to have the decision reviewed internally by the Agency. If the participant is still dissatisfied with a decision following an internal review, they can then apply to the Administrative Appeals Tribunal (AAT) for a review. The AAT is the external merits review body for the National Disability Insurance Scheme.

An application for an AAT review must be made within 28 days, but extensions can be granted.

The aim of external merits review is to ensure National Disability Insurance Agency decisions are fair and robust.  To ensure the external merits review process is accessible and as non-adversarial as possible for people with disability, a designated division of the AAT has been established, there is a fee waiver for applicants seeking a review of National Disability Insurance Agency decisions, and support services have been provided (the Support Component).

External Merits Review – Support Component Program Guidelines

The following is an outline of the components of the Program Guidelines and the purpose of each. 

Aims and objectives

The objective is to ensure that all people with disability and other affected persons have access to support when they are seeking review of National Disability Insurance Agency decisions in the AAT through:

•   access to a support person; and
•   access to legal services in limited circumstances - where a case raises complex or novel legal issues.

Target group

A person who is directly affected by a reviewable decision by the National Disability Insurance Agency may request review by the AAT under s103 of the National Disability Insurance Scheme Act 2013.

The primary participant group for External Merits Review - Support Component will be people with disability, but applicants may also be guardians and nominees of people with disability and carers and family members of people with disability.  The External Merits Review - Support Component will not be available to service providers.

Applicants will access the External Merits Review - Support Component once they have exhausted all avenues of review in the National Disability Insurance Agency and have made an application to the AAT.  Upon application to the AAT, a participant will be made aware of the availability of a support person. 

Services funded under the External Merits – Support Component

The Support Component provides support persons to assist applicants in navigating the process of AAT review of National Disability Insurance Agency decisions.  The support person’s role may involve attending AAT conferences and hearings with applicants, fostering self-advocacy for applicants to put their own cases before the AAT, or providing individual advocacy in cases where the person is unable to self-advocate.

Funding for the provision of support persons is directly provided to one National Disability Advocacy Program (NDAP) agency in each launch site.  The agencies selected to provide this service are as follows:

Victoria (Barwon) - Regional Information and Advocacy Council Inc 
New South Wales (Hunter) - Disability Advocacy NSW Inc 
South Australia - Brain Injury Network of South Australia Inc (BINSA)  
Tasmania - Advocacy Tasmania Incorporated 

While the focus is on non-legalistic self-advocacy services, there may be some cases where complex or novel legal issues are raised. Recognising this, the Support Component also provides limited funding to the legal aid commissions in launch sites for complex or novel matters.  Applications for assessment for eligibility against the Central Assessment Provider guidelines will be undertaken through the Department of Social Services. Referrals for assessment will be made through the support persons and through the legal aid commissions in the launch sites.

An External Merits Review pamphlet has been developed that briefly explains the process and includes contact details for each of the NDAP agencies providing support persons in the launch sites.  There is also an EMR Fact Sheet available with more information.

Contact

The Department can be contacted about the External Merits Review – Support Component via:

Post:

Department of Social Services,
Disability and Carers Group
Tuggeranong Office Park, Box 7576
Canberra Mail Centre ACT 2610

Email:

ExternalMeritsReview@dss.gov.au

Content Updated: 12 December 2013