Schedule 1, Part 2
When a participant can force a plan reassessment
A participant can no longer request a reassessment at will. From 27 August 2026 the request is only available where a significant and ongoing change to support needs meets the conditions in new section 48A, and the CEO then has 90 days rather than 21.
What does the provision require?
New section 48A sets out the conditions for a reassessment on a participant's request. There must be a significant change to the ongoing support needs that arise from the impairment for which the person meets the disability or early intervention requirements, and the change must come from an alteration in functional capacity or in personal or environmental circumstances. An alteration in functional capacity must be significant and ongoing, must relate directly to an existing impairment or arise from a new or acquired one, and must come with a substantial reduction in the ability to perform daily activities. An alteration in circumstances means a significant and ongoing change in living, education or work arrangements, or in the network of informal support.
A request must be in the approved form and include the information and documents the CEO requires. The CEO must decide within 90 days, and if no decision is made in that time the CEO is taken to have refused to reassess. The CEO may instead give notice that the participant is to move to new framework plans, which displaces the 90 day decision.
Why does it matter to an insurer or a provider?
The change removes the open ended reassessment request that used to be available to a participant and replaces it with a test that a claim file can actually be measured against. For an insurer the useful part is the evidence: a file that shows a substantial reduction in daily activity, tied to a named impairment and dated, is the only kind that satisfies the new conditions. A file that describes hardship, a change of address or a carer's difficulty does not, unless it also meets the personal or environmental limb.
What did the amendment change?
The old subsection 48(3) gave the CEO 21 days to decide a participant's reassessment request. The new subsection 48(3) gives 90 days, and subsection 48(4) turns silence into a refusal. Section 48(2) is replaced so that a request is only available where section 48A is satisfied. Section 45(6) removes any doubt that an exception elsewhere in the Act extends to a reassessment that is not conducted.
Suggested evidence
These are the publisher's control suggestions, not statutory requirements. The provision's own requirement is above; an auditor or regulator decides what is sufficient.
- The request in the approved form, with the date received
- The clinical or functional material that shows the alteration is significant and ongoing
- The link between the alteration and the impairment for which the person qualifies
- The record of the substantial reduction in daily activities
- For a circumstances based request, evidence of the living, education, work or informal support change
- The decision notice and the date, if the 90 day period ran out
What should be done before the date?
- Rewrite the claims file checklist so a reassessment argument names the limb it relies on
- Diarise the 90 day period where a reassessment decision affects a reserve
- Treat a deemed refusal as a decision that can be reviewed, and record the review path
What the text does not say
The text does not define significant, ongoing or substantial. It does not set the approved form. It does not say whether the CEO must give reasons for a deemed refusal beyond the notice that section 100 requires.
Where this sits
section 48 amended, and section 48A inserted, by items 18 and 21 in Schedule 1, Part 2, Limit unscheduled plan reassessments (items 12 to 27). Read the official text at https://www.legislation.gov.au/C2026A00066/latest/text. The record was read on 21 October 2026.
Not legal advice; does not certify. This page is a reading of the provision in our own words, not a reproduction of it, and not advice on your own facts.