What is a 'reasonable and necessary' support?

The NDIS funds a wide range of supports and services, but how is a support or service considered 'reasonable and necessary' to be funded in your plan?

The NDIS has established a set of criteria for what supports and services are to be considered 'reasonable and necessary' for them to cover. There are six points to this criteria and understanding these points will provide a more realistic expectation of what the NDIS will and will not cover under your plan.

1. The support will assist the participant to pursue the goals, objectives and aspirations outlined in their participant statement.

This means that a support must be something that directly relates to a goal, objective or aspiration that you have set in your participant statement in the planning stage. It is critical that at this planning stage and at each subsequent review that your goals accurately reflect what you hope to achieve through your NDIS plan, so that you are able to receive funding for these areas.

2. The support will assist the participant to undertake activities, facilitating social and economic participation.

Is your proposed support allowing you to go into the community, participate in activities or events you want to, and/or spend your money how you want to spend it? Then you have met this point.

3. The support represents value for money.

'Value for money' can be taken in two different ways. It can be said that making a more expensive purchase that will save money in the long-run is representing value for money. It can also mean that where there are cheaper alternatives that produce the same or similar result, those options need to be explored first.

4. The support is beneficial for the participant, while also being considered current good practice.

If there is no evidence that something will provide benefit to you, then it is very unlikely that the NDIS would fund it. If the proposed support is established and has supporting evidence either through separately published reports or from your own first-hand experience, then it is more likely that the NDIS would consider funding.

5. The support takes into account what is reasonable to expect of families, informal networks and the community to provide.

The support should not serve as a 'stand-in' for what should be reasonably provided by other parties. For example, with a young child, it is reasonable to expect that their parents or carers would feed and bath them. However, with an adult it would not be reasonable to expect their parents or carers to feed and bath them. Therefore, the NDIS would fund the required supports if the particular adult required support in those areas.

6. The support is most appropriately funded through the National Disability Insurance Scheme (NDIS).

The NDIS does not fund supports that are more appropriately funded under other government departments, e.g. Medicare, Private Healthcare, Department of Education, Department of Transport, Department of Justice, Department of Health etc.

If a support or service meets all the above criteria, it is categorised as 'reasonable and necessary' and should be approved for funding under the NDIS.

However, there is no one-size-fits-all, which means something you think ticks all the boxes still might not be approved. All supports or services approved for funding will be related to the participant's disability and must not include day-to-day living costs that aren't related to your disability support needs (e.g. groceries). You should always be prepared when going to any planning meeting and don't be reluctant to appeal a decision made by the NDIS.

If you have plan management included in your plan, you can ask your plan manager for advice at any time. My Solutions Plan Management is happy to speak with anyone who has questions about 'reasonable and necessary' criteria. Head over to our contact page to ask any questions you may have.