Reasonable and Necessary Supports Agency
Quick summary: The Australian Government made laws about what we can fund under the NDIS. All supports need to meet the criteria in these laws before we can fund them in your plan. We call these the NDIS funding criteria. For example, supports need to be related to Insurance your disability, value for money, effective and beneficial, and most appropriately funded or provided by us. Each support must meet these criteria individually, but the supports must also meet the criteria when considered as a package. Disability What’s on this page?
This page covers: National
[What principles do we follow to create your plan](#source-page-1)? the
[What supports can you get](#source-page-8)? by
What other principles do we consider when we decide what supports to include in 1982
your plan?
Act
How do we decide what reasonable and necessary supports to include in your plan?
Step 1: How do we identify and describe a support in your plan?
Step 2: How do we work out if an identified and described support meets the NDIS Information funding criteria?
of Step 3: How do we include the reasonable and necessary supports in your plan?
You may also be interested in: Freedom Mainstream Supports
the [Creating Your Plan](/library/documents/09235da91698-25-26-0529-disclosure-log-documents/document-004__creating-your-plan/)
Reviewing Your Plan under
Reviews of Decisions
Would we fund it? released
What principles do we follow to create your plan? was The NDIS was set up as a world first approach to disability support. It puts people with disability at the centre of decision-making, through the principles of reasonable and necessary supports and individual choice and control. document
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As an insurance-based scheme, we take a lifetime approach to a participant’s support needs. We provide assurance to people with permanent and significant disability ordevelopmental delay, and to people who might acquire disability or developmental delay, Agency that they will get the support they need. Individual funding means we help participants to purchase services and supports from a competitive and consumer-driven marketplace. What supports can we fund? Insurance
NDIS supports should complement, not replace, other supports available to you. That’s why we consider: Disability the things you’re able to do for yourself
support you have from others in your network, including family members, relatives, friends, local community services and mainstream government services. National
One of our aims is to help maximise your independence by working with the local the mainstream government and community services that help you live an ordinary life. We all by do best when we’re connected to our communities. 1982And as an active consumer, it’s important you are able to shop for and access providers who meet your needs. We can help you find providers who meet your needs. Act
Once we’ve considered your circumstances, we need to follow the rules determined under the law for the NDIS in our planning decisions.1 We fund supports that are reasonable and necessary. This means we will only fund a support if it meets all of the following criteria: Information the support is related to your disability2 of the support will help you pursue your goals and aspirations3
the support will help you undertake activities that will increase your social and economic participation4 Freedom
the support is value for money,5 which means that the costs are reasonable: the
- when compared to the benefits to be achieved, for example, whether under purchasing the support is likely to reduce the cost of funding other supports in
the long term6
- when compared to alternative options that may provide you with the same released outcome at a similar or cheaper cost7
was the support is likely to be effective and beneficial for you, having regard to good
practice and evidence8 document
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the support is required to complement the informal supports you have available, by
taking into account what is reasonable for families, carers, informal networks and the community to provide9 Agency
the support is most appropriately funded or provided by the NDIS10
the support is not more appropriately funded by another service system, agency, person or body, such as the education system or the health system.11 We can’t Insurance
fund a support if it’s the responsibility of another service system.
What supports don’t we fund? Disability We do not fund a support if:12
it is likely to cause harm to you or others13 National
it is not related to your disability14 the
it duplicates other supports delivered by the NDIS15 by
it is considered a day-to-day living cost (for example, rent, groceries or utility 1982 costs like your water bill) that are not attributable or caused by your disability
support needs16 Act providing the support would be against the law17
it consists of income replacement18 it is the responsibility of other service systems to provide (for example, your Information
state government, the education system, or the health system).19 These different of systems have different responsibilities, and are designed to complement each other to form a government safety net. Like all Australians, NDIS participants continue to have access to these systems. We can’t fund a support if it’s the Freedom responsibility of another service. the How do we manage the financial sustainability of the NDIS? underThe NDIS is an insurance scheme, and one of our core functions is to manage the financial sustainability of the Scheme.20
When we make decisions about the supports we fund in your plan, we must also consider released our need to ensure the financial sustainability of the NDIS.21 This means we must work within our funding budget, set through agreements between the Australian, and State and was Territory governments. document
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It’s also important to know the NDIS is only one part of the broader National Disability Strategy that supports people living with disability. The overall success and sustainability ofthe National Disability Strategy relies on: Agency people accessing their informal support network to get the help they need from
day to day people using their personal income to pay for their day to day living expenses, as Insurance
is expected of all Australians
mainstream and community services being available from state and territory governments, and other federal government programs such as Medicare Disability
a fair distribution of NDIS supports to those who need them, provided within our funding budget. National Staying within our budget ensures the NDIS will be here to support generations of the Australians and their families. by What principles do we use to create your plan? 1982 We use the following 7 principles, to create plans that help you get the reasonable and Actnecessary supports you need, and to make sure the Scheme is financially sustainable:
Fair for everyone, both today and for future generations
Fair funding to pursue your goals Information Evidence-based best practice
of Fair early investments
Fair support across service systems Freedom Fair supports for your disability needs
the Fair assistance from multiple programs
Fair for everyone, both today and for future generations under While we need to consider your individual circumstances and disability needs, we also need to make consistent decisions and treat people fairly.This means participants with similar circumstances and disability needs should receive released similar amounts of supports in their plans. We also need to ensure the total cost of all was participant plans are within the overall NDIS budget set by governments. document
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We use Typical Support Packages to help us do this. The Typical Support Package give us an indication of what supports we’d usually expect to include in your plan, based on yoursituation and disability support needs. Agency
Each support in your plan must be reasonable and necessary, but they also need to be reasonable and necessary as a package of supports. We approve your whole plan, not the individual supports in your plan in isolation.22 The Typical Support Package helps guide this Insurance validation process.
The Typical Support Package also helps to guide the consistency of our decision making process. We use these to check your overall plan to make sure that all your supports make Disability sense together, and that your support types and amounts will complement each other to help you fulfil an ordinary life. We may then increase or decrease the funding in your plan based on: National
our discussion with you the
by any reports or other information we have
applying the NDIS funding criteria. 1982
This helps keep the system fair for everyone, and ensure we remain financially sustainable. Act Fair funding to pursue your goals
Goals are important.23 The supports we fund need to help you increase your independence and pursue your goals.24 This means your supports should help overcome any disability- Informationspecific barriers which may be stopping you pursuing your goals. of This doesn’t mean we fund all support costs associated with you pursuing your goals. Also, you may have goals and aspirations we can’t fund supports for. This is because helping you pursue your goals is only one of the NDIS funding criteria, so not all supports that help you to Freedom pursue your goals will be reasonable and necessary. the Other things to know about when setting your goals:
-
Setting more goals or bigger goals doesn’t mean we’ll provide more funding or under fund more supports. For example, if your goal is to live independently in a house with a swimming pool, we may fund home modifications that address your disability related needs. This might be a home modification to make your bathroom accessible. released We won’t fund the swimming pool because this isn’t related to your disability support needs. The funding in your plan might be similar to someone else who has a goal of was ‘to have a more accessible bathroom’.
-
Setting a goal doesn’t mean we have an obligation to fund supports that help you pursue that goal. For example, if your goal is to get a gym membership to get fit, document
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we wouldn’t usually fund this. Gym memberships are things that all people, with or
without disability, might want or need. Agency 3. Setting a goal about an explicit type or amount of support you might want
doesn’t mean we have an obligation to fund that support or provide that amount of funding. For example, you may tell us your goal is ‘to get a top model shower commode’ and you show us the one you want costs $4,000. Insurance If there is a shower commode that costs $3,000, and your occupational therapist confirms this one will meet your needs, we are more likely to fund this one instead because it is likely to deliver the same result at a lower cost. We may also look at Disability alternatives.
Evidence-based best practice NationalWe only fund supports that will be, or are likely to be, effective and beneficial for you, having regard to current good practice.25 This means we consider if there is evidence that the the support is effective and beneficial for someone with similar disability support needs. by
We will consider different types of evidence when making decisions and we won’t need an 1982expert report for every support, as we can often rely on other information or evidence. ActFor example, we may already have information about whether the support is widely accepted to suit someone with your disability support needs.26 The primary source of evidence we rely on, and give the greatest weight to, is evidence from sources that are reliable and widely recognised. This includes published and refereed literature, and any consensus of expertopinions. If there is no evidence to show a support is reasonable and necessary,27 we won’t Information fund the support. of
You can find the types of evidence we need on our website, and in Our Guidelines.
Fair early investments Freedom Having access to capacity-building supports early in your NDIS journey is considered to be the an early investment. This early investment is intended to help increase your independence, and reduce your reliance on NDIS funding over time. under This is an important concept that we consider when we create your plan, and again at future plan reviews. When we review your plan, we reassess all the supports you require to meet your disability support needs at that time. released Over time, your capacity building supports may no longer be reasonable and necessary, in wasregard to your current functional capacity, the effectiveness of the capacity building supports,28 and value for money.29
If your overall funding level goes down from one plan to the next, it may be because you nolonger need the same type or amount of supports, such as capacity building supports. Also, document
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if the capacity building investment has been successful at building your independence, then your need for other supports may also decrease, for example core supports. AgencySo other things being equal, you should expect your overall plan value to reduce over time as the benefits of capacity building are realised.
Fair support across service systems InsuranceThe support you need may be the responsibility of another government service, such as education or health. We don’t fund these services, and need to consider the supports you should receive from these services when determining the supports in your plan. DisabilityFair supports for your disability needs
When we make decisions about which supports we can fund, we consider whether a support is reasonable and necessary for you and apply the NDIS funding criteria. Sometimes, you National might ask for supports to help with impairments that were not part of your Access eligibility theassessment. When this happens, we need to make sure the support will help you address byneeds that arise from an impairment that meets the same eligibility criteria we consider at Access. 1982 You don’t need to make a new Access request if you ask for supports to help with an Actimpairment that was not part of your Access eligibility assessment. We will work out if you need the support you have asked for to address an impairment that would meet our Access criteria. We may ask you to provide evidence to help us work this out. We will decide if the requested support is reasonable and necessary. We will apply the NDIS funding criteriabased on the impairments that would meet our Access criteria. Information of By funding the right disability supports for your permanent impairments that meet our Access criteria, we are ensuring the system is fair for everyone, and that the NDIS remains financially sustainable. Freedom Fair assistance from multiple programs the NDIS funding can’t duplicate other funding or supports you may receive due to your disability. under For example, you may have received a lump-sum payment or receive regular payments as a form of compensation for an accident. Or, you may be receiving ongoing supports from another program or insurance scheme, for example, Worksafe or the Transport Accident released Commission. wasWe don’t duplicate this funding or these supports. We may reduce the total value of your NDIS plan to account for compensation you receive, or we may not fund certain supports. document
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What supports can you get?
When we create your plan with you, we’ll discuss what supports you need for your disability. Agency We want to help you pursue your goals, increase your independence, and help you work, study and join social activities.
There are many supports you can get outside the NDIS. Other government and community Insurance services provide supports to all Australians, including people with disability. And your friends, family, and other people you know can often be your best supports.
We can fund supports you need for your disability, if they meet certain criteria. These are Disability called ‘reasonable and necessary supports’. Your plan and supports will be just for you, so you have more choice and control over how you use them.
This guideline explains how we decide what reasonable and necessary supports we’ll National include in your plan. There are lots of things we have to consider, which we’ll explain in thedetail. by We also have a Would we fund it guide. It has examples of how we decide whether we fund different types of NDIS supports. 1982 ActWhat supports can you get outside the NDIS?
Before we decide what reasonable and necessary supports to fund in your NDIS plan, we’ll first discuss what other supports may be available outside the NDIS. This is an important information-gathering step. For example, there may be mainstream, community and informal Information supports that suit you. of Mainstream supports are other government services such as employment, education, health and family support services. They are often really helpful, and are available to everyone including people without disability. There are many ways they can help you learn Freedom new skills or live as independently as possible. the Community services offer a wide range of supports that may help with your disability support needs. Community supports are things open to everyone in the community, like under sporting clubs, community colleges, activity groups, libraries or community gardens. They are often a great way to get involved in your local community, meet new people and learn new skills. released Informal supports, like your family, friends and other people you know in your community, can sometimes be your best supports. They know you and can often help in ways other was supports can’t. document
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Your planner, Local Area Coordinator or Early Childhood Partner will talk with you about what services are available for you outside the NDIS. We can also help link you with thesesupports, so you don’t have to do it all on your own. Agency
Accessing these supports is a good way to work toward your goals. You get to do it with other people and be involved in your community. Using these supports is part of life for most of us. It’s important you get to access them the same as everyone else. Insurance When it comes time to talk about what reasonable and necessary supports we can fund, you’ll know how mainstream, community and informal supports can help you.It’s important we gather this information and help you access these services before we Disability consider what reasonable and necessary supports we can fund. That way, we can help make sure you’re able to access mainstream, community and informal supports whereverpossible. This can help you become as independent as possible. National theWhat are reasonable and necessary supports? by An NDIS support is the practical description of how you will be assisted under the NDIS.30 Supports are the things we provide or fund to help to meet your disability support needs. 1982 NDIS supports are the services, items and equipment we can fund or provide under the Act NDIS.
There are two types of NDIS supports. We call them ‘general supports’ and ‘reasonable and necessary supports’.31 InformationGeneral supports of General supports are the coordination, strategic or referral services and activities we provide, or arrange to be provided, for you.32 They’re how we help you develop your NDIS plan and connect with supports and activities in your community. This includes your Freedom mainstream, community and informal supports. Learn more in Creating Your Plan. the Reasonable and necessary supports
Reasonable and necessary supports are the supports we fund in your plan to meet your under disability support needs.33 You can use this funding to buy supports from service providers.
The Australian Government made laws about what we can fund under the NDIS.34 All supports we fund in a plan need to meet the criteria set out in these laws. We call these the released NDIS funding criteria.35 was To meet the NDIS funding criteria, a support must meet both the following criteria:36
It must not be a type of support the law says we can’t fund or provide.37
It must meet the reasonable and necessary criteria.38 document
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We call supports that meet the NDIS funding criteria ‘reasonable and necessary supports’.
Each individual reasonable and necessary support in your plan must meet the NDIS funding Agencycriteria. Your whole plan as a package of supports must also meet the NDIS funding criteria.
We check your overall plan to make sure all your supports make sense together. This means we check that your supports and the amount of supports will complement each other to helpyou fulfil an ordinary life.39 Insurance
If you need a new support, which now means your overall package of supports doesn’t meet
the NDIS funding criteria anymore, we may either: Disability not include the new support in your plan
include the new support in your plan, but also reduce the other supports in your plan.For example, a home modification may reduce your need for other supports. If we plan to National
fund a home modification, we will need to take that home modification into account when the considering what other supports are reasonable and necessary, such as the amount of care by you need at home. 1982 What other principles do we consider when we decide Act what supports to include in your plan?
As far as possible, we have to act according to principles set out in the law for the NDIS.40 These are the things that guide us when we make decisions about what we fund. Information These principles don’t override or replace the NDIS funding criteria under the law for the of NDIS. They can help us apply the funding criteria, by giving us additional guidance when we decide what supports to approve in your plan.
The principles include the following: Freedom
You have the same right as other Australians to realise your potential for physical, the
social, emotional and intellectual development.41
You should be supported to take part in and contribute to social and economic life as under
much as you can.42
You should be supported to make choices about planning and how your supports will released be delivered. This includes taking reasonable risks, so that you can pursue your
goals.43 was You have the same right as other Australians to decide your own best interests. You have the right to be an equal partner in decisions that affect your life to the full extent of your ability.44 document
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Your privacy and dignity should be respected.45
We must make sure the NDIS is financially sustainable.46 Agency The principles also tell us that the reasonable and necessary supports we fund should:47
support you to pursue your goals and maximise your independence support you to live independently and to be included in the community as a fully Insurance
participating citizen
develop and support your capacity to do things that help you participate in the community and in employment. Disability
Just because a support helps you do these things doesn’t mean we’ll fund it in your plan. All supports we fund need to meet all the NDIS funding criteria. National We consider these principles set out in the law for the NDIS, along with the principles we thefollow to create your plan. by
How do we think about an ordinary life when deciding what supports to 1982include in your plan?
To help guide us in our decision making about reasonable and necessary supports, we took Act advice from the NDIS Independent Advisory Council.
The Council represents people with disability and carers, bringing their own lived experience and expertise of disability. They give us advice on how the NDIS should work. Information The Council advised us that all Australians, including people with disability, should have an of ‘ordinary life’. They also told us we should think about the idea of an ordinary life when we apply our principles and use the NDIS funding criteria.An ordinary life is a life where you have the same opportunities as people without a disability. Freedom An ordinary life is one that is typical or usual for everyone in modern day Australia. It’s a life the where you can pursue your potential and participate in society on an equal basis with others.
An ordinary life will be different for different people. We are all different, and come from under different cultures and backgrounds. We each have our own values, experiences, beliefs and goals.
But there are some common things that can improve the quality of our lives and help us released participate equally. These are the things, such as the following, that make up an ordinary life: was Positive relationships – with families and informal support networks.
Individual autonomy – being free and independent, and having the same opportunities as people without disability. document
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Active involvement in decision-making – including the ability to make meaningful
decisions, and exercise choice and control. Agency Using your strengths in ways that provide a challenge and enjoyment.
A sense of belonging – to our families, friendship networks, communities, workplaces and society. Insurance Active involvement and contribution to society and your community.
An ‘ordinary life’ in the context of the NDIS involves supporting you to: have and maintain good relationships Disability
belong and participate in your community
be involved in making choices about your own life. National
One way we can help you have an ordinary life is to support you to access mainstream, the community or informal supports wherever possible. These are the usual supports that by everyone in the community uses. When we fund reasonable and necessary supports under the NDIS, we need to make sure 1982 they meet the NDIS funding criteria. Act When we apply the NDIS funding criteria and make decisions about reasonable and necessary supports, we’re guided by the principles in the law for the NDIS. We also consider how the supports will best help you to live an ordinary life. Information How do we decide what reasonable and necessary of supports to include in your plan? FreedomWhat information do we consider to work out what reasonable and necessary supports to fund in your plan? the
The most important information we gather about what supports to include in your plan comesfrom you. under
When we create your plan, we will talk with you about:
your goals and aspirations48 released
your strengths, capacity and individual circumstances49 was
any barriers, limitations and restrictions you face in undertaking activities or things that stop you from living an ‘ordinary life’50
your disability support needs51 document
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any risks and safeguards we may need to think about when considering your support needs.52 AgencyWe want to get a good understanding of your disability support needs. We encourage you to involve anyone in the planning process you want to help you.
Learn more about what information we ask for when we Create Your Plan. InsuranceWe also consider other information we have such as medical or therapy reports, or assessments that you have had.53
We may also ask for further information and assessments, if we need them to help us work Disabilityout your support needs.54
To help us work out what supports to consider for people aged 7 years and older, we also use a ‘Typical Support Package’.55 We worked with people with disability, professionals and National subject matter experts to develop the Typical Support Package. the It helps us work out the types of supports we’d usually expect to include in your plan. It’s by based on your situation and support needs. We then amend the supports suggested by the Typical Support Package to include more, 1982 less or different supports if we need to. We may adjust the funding for those supports up or Act down based on our discussion with you, any reports or other information we have, and when we apply the NDIS funding criteria.
For children younger than 7, we consider the child’s current functioning across developmentareas when we work out the reasonable and necessary supports that should be funded in a Information child’s NDIS plan. Learn more about the Early Childhood Early Intervention approach. of
How do we consider your goals when we work out your reasonable and necessary supports? FreedomWhen we create your plan, you set your goals and tell us what information about your life you want in your plan.56 Your goals are your own personal desires about what you’d like to the do. You can set any goals you like, even if they’re about things we won’t fund supports for. You under can also change your goals at any time.57 We consider how your funded supports will help you pursue your goals when we decide to approve your plan.58 releasedReasonable and necessary supports should help you pursue your goals,59 but you don’t need a specific goal for every support in your plan. When we decide if a support will help you was pursue your goals, we consider your whole situation.
We look at the disability specific barriers that prevent you from pursuing your goals, and how the support will address your disability support needs. document
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There are some things to remember when setting goals:
Setting more and bigger goals doesn’t mean we’ll fund more and bigger funded Agency supports.
Setting a goal doesn’t mean we have an obligation to fund supports that help you pursue that goal. Insurance Setting a goal about an explicit type or amount of support you might want doesn’t mean we have an obligation to fund that support or in that amount.
This is because helping you pursue your goals is only one of the NDIS funding criteria.60 A Disability support must meet all of the NDIS funding criteria to be funded under the NDIS. So not all supports that help you to pursue your goals will be reasonable and necessary supports.
Learn more about setting your goals and how we consider your goals under the NDIS National funding criteria. the What if your plan is being reviewed? by
If it’s not your first plan, we also consider how well the supports funded in your previous 1982 plans worked for you.61 This means we’ll ask about how your current plan has worked for Actyou.
This will help us decide whether these supports continue to meet your needs and the NDIS funding criteria. Learn more about plan reviews. InformationHow do we use the information we have to work out what reasonable and of necessary supports to fund?
We consider all the information we have gathered to decide what reasonable and necessary supports to fund in your plan. Freedom We use the information you give us and follow the steps below: the Step 1: Identify and describe the supports to be considered. The support will be described either generally (known as ‘flexible’ funding for supports) or specifically under (known as ‘stated supports’ or ‘fixed’ supports).62
Step 2: Work out if the support identified and described meets the NDIS funding criteria. released
Step 3: We include the supports that meet the NDIS funding criteria in your plan. was
When we approve your plan we make sure all your supports meet the NDIS funding criteria individually and as a package of supports.63 document
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Step 1: How do we identify and describe a support in Agencyyour plan?
The first step in deciding what reasonable and necessary supports we can fund is to properly identify and describe the support.64 This is an important step. We need to be clear on exactlywhat support we’re considering, before we can decide if the support meets the NDIS funding Insurance criteria in Step 2.
When we assess your support needs and identify what supports to consider in your plan, weuse: Disability
the information you give us at your planning meeting
any assessments or other information we have National
the Typical Support Package for people aged 7 years and older. the
We identify a support as the service, item or equipment you need to help with your disability by support needs. We think about: 1982 what the outcome of the support will be
Act
how the support helps with your disability
whether the support meets the NDIS funding criteria.
How do we describe supports? Information We can describe the supports in your plan as one of the following: of
Flexible: Under the law for the NDIS, this is when we describe the support generally.
You have greater flexibility over what disability supports you can buy within the Freedom description of the support.65
the Fixed: Under the law for the NDIS, this is when we describe the support specifically. It
means you must buy the support in the way we have described in your plan.66 We sometimes call this a ‘stated support’.67 under
You must act according to your plan, and buy supports according to how we described them in your plan. This means you can’t use the funding in your plan to buy supports that fall releasedoutside the description of the support in your plan.68 So if we describe the support as fixed, you must comply with how we describe it. This was includes how the support is provided. For example, we will sometimes require the support to be provided:
by a particular service provider document
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by a particular qualified person
through a particular delivery mode or method, or in a special way. Agency
We describe most supports as flexible when we can. When supports are described as flexible, you will have greater flexibility over the support you can buy that falls within the description of the support in the plan. When supports are described as fixed, you will haveless flexibility. Insurance
We divide your supports into 3 different budgets:
Core Supports – supports for everyday activities Disability
Capacity Building Supports – supports to help you build your skills and increase
your independence Capital Supports – supports such as assistive technology, vehicle modifications, National
home modifications and Specialist Disability Accommodation. the Each budget is divided into a number of support categories. Support categories have more by detail about what supports you can buy with your funding. When we describe your supports 1982as flexible, you can usually choose what supports you buy within the descriptions for each support category. Act Your Core Supports budget is the most flexible. You can usually use your funding across all the support categories except transport in the Core Supports budget if:
we described the supports as flexible Information
you have the same plan management options for your Core Supports. of
Learn more about the support budgets and support categories in your plan.
When we decide whether to describe supports as fixed or flexible, we consider: Freedom how much the support costs69 the if the support will help reduce the cost of supports over time,70 for example providing more supports early so you don’t need as many supports later in life under any risks with supplying the support, for example if the support would create risks to
your health and safety or if it doesn’t comply with state or territory laws71 released if you need a particular support to pursue your goals or to use other supports in your
plan effectively72 was if you need a specialist support, for example if your support must be delivered by a qualified person, or in a special way73
if you were eligible for the NDIS under the early intervention criteria.74 document
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When do we describe supports as fixed?
We usually describe high-cost supports, or supports with more risk, as fixed. For example, Agency we might describe supports as fixed if you need to use those particular supports to ensure your health and safety. This includes supports such as:
high-cost assistive technology Insurance
high-cost home modifications
behaviour support, or supports that involve restrictive practices such as restraint [Specialist Disability Accommodation](/library/documents/00f65f731f26-foi-25-26-1877/document-003__specialist-disability-accommodation/). Disability
We will also check if you were eligible for the NDIS through the early intervention criteria.75 If so, we might decide to describe the supports as fixed for some types of early intervention Nationalsupports.76 If you’re not sure whether you met the disability criteria or the early intervention criteria, check the letter we sent you when we decided you’re eligible. the byExample
John just received his first plan. His plan describes support for assistive technology as 1982 flexible, including $2,000 of funding. John can choose what assistive technology to buy with Actthis funding. John talks to his occupational therapist about what assistive technology he should buy with this funding. For example, he could buy a shower chair, or low-cost items like a slip-resistant bathmat.
John’s plan also has a fixed support for a wheelchair with special features, and funding of Information $8,000. John will need to use this funding for the specific wheelchair we listed on his plan. of He can’t use this funding for another support, like a shower chair, instead.
What if you need a specific provider to provide the support?Sometimes your plan may say who must provide the support. We do this when you need a Freedom certain provider to make sure the supports are delivered safely, or to achieve a certain the outcome. For some supports, you must use an NDIS registered provider. These include: under Specialist Behaviour Supports, if the provider will undertake a behaviour support
assessment or develop a behaviour support plan77 released supports where it’s likely a provider will need to use a [regulated restricted practice](/library/documents/596cb75514ef-foi-25-26-3703-documents/document-017__regulated-restrictive-practices/),78
either interim or ongoing was
Plan Management79
Specialist Disability Accommodation.80 document
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You must use registered providers for these supports even if your plan doesn’t say you need to. You must also use registered providers for these supports, even if you self-manage orplan-manage your funding. Learn more about the different plan management options. Agency
For other supports, we’ll decide that the support must be provided by a particular person, provider, or delivered in a certain way.81 We’ll do this if it’s the most efficient and effective way to provide the support. This only happens when: Insurance we have an agreement with a particular provider to provide the support82
we decide you must use an NDIS registered provider due to the risks, for example complex home modifications83 Disability
you need support from a particular person with specialist qualifications, for example a health professional84 National
you need support delivered in a certain way.85 the
Sometimes, we’ll arrange the support ourselves, if it’s more cost effective than getting by another provider to deliver the support. For example, we may bulk buy a support.86 If so, we will state this in your plan. 1982 What about in-kind supports? Act We agreed that state and territory governments will keep providing some supports for a period of time. We call these ‘in-kind supports’.
If we fund in-kind supports like specialist school transport or personal care in schools, you Informationwill need to use state or territory government providers for these supports. These supports of are most efficiently and effectively provided by state and territory government providers.87 Learn more about Work and study supports.
For most other in-kind supports, you can choose your provider if you don’t want to use your Freedom in-kind provider anymore. We can let you choose another provider if we consider that the thesupport isn’t most effectively and efficiently provided by the in-kind provider.
We usually let you choose another provider if: under another provider can give you the same support or level of support as the in-kind provider
the supports with the new provider still meet the NDIS funding criteria, including released
that they’re value for money compared to the in-kind support was there are no serious risks with changing providers.
Learn more about in-kind supports. document
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Step 2: How do we work out if an identified and described support meets the NDIS funding criteria? Agency
To meet the NDIS funding criteria, a support must meet both the following criteria:
It must not be a type of support the law says we can’t fund or provide.88 Insurance It must meet the reasonable and necessary criteria.89
Each support must be reasonable and necessary individually, but the supports must also be reasonable and necessary when considered as a package of supports. Disability What types of supports can’t be funded or provided under the NDIS?
Under the law for the NDIS, there are things we can’t fund or provide.90 We can’t fund or National provide supports that: the
are not legal91 by
are income replacement92 1982
are likely to cause harm to you, or pose a risk to other people93
Act
are not related to your disability94
relate to a ‘day-to-day living cost’, such as groceries, rent or utilities, that are not attributable to your disability support needs. These are costs that are not caused by or as a result of your disability support needs.95 Information
duplicate other supports provided by the NDIS under alternative funding.96 of
Is the support legal?
We can’t fund a support if it does not comply with the law.97 This includes both: Freedom
an Australian government law: a law that applies to all of Australia the
a State or Territory government law: a law that only applies in your state or territory. underFor example, we won’t be able to fund supports involving:
a restrictive practice where it’s not authorised in your state or territory
[assistive technology](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-005__assistive-technology/) or home modifications that don’t meet Australian laws, such as released
State and Territory Acts and Regulations, the National Construction Code, and was relevant Australian Standards
supports for illegal activities, such as support for criminal behaviour or illegal drugs. document
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While this is one of the NDIS funding criteria, we’re not responsible for ensuring your supports are legal. We’re not responsible to ensure that all supports in your plan comply withall the relevant legal and administrative requirements. This is your responsibility and your Agency provider’s responsibility.
For example, if a support is likely to require the use of a restrictive practice, the provider must be registered with the NDIS Quality and Safeguards Commission.98 It’s the provider’s Insurance responsibility to ensure they are registered and comply with the conditions of their registration. This includes complying with all laws and seeking the necessary authorisations.99 Disability We’re not responsible for ensuring the provider is registered and complies with their conditions of registration. You can contact the NDIS Quality and Safeguards Commission if you’re concerned about a provider’s compliance with legal obligations. National Is the support ‘income replacement’? the We don’t fund income support or income replacement.100 This means NDIS funding can’t by replace or add to money you’d usually earn from working, or income payments you get from Centrelink. 1982 For more information and resources on income support, check out income support payments Act such as the Disability Support Pension.
If you are interested in getting help to find a job, check out Disability Employment Services or NDIS-funded Work and study supports. Information Is the support likely to cause harm? of We can’t fund any supports that are likely to either:101
cause harm to you Freedom be a risk to other people.
the We need to consider this for all supports, such as support workers, therapies or equipment. It also means we won’t fund supports that involve a regulated restricted practice, such as underrestraint, unless it follows the requirements of the NDIS Quality and Safeguards Commission.
To help us decide if the support is likely to cause harm, we may need information from a releasedprofessional. For example, you may need high cost assistive technology, like a powered wheelchair. If so, we would need a report from an occupational therapist to show that it’ll be was safe for you to use. document
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Of course everything we do in life comes with some risk. We all make our own choices about how much risk we want to take in our lives. You should also be able to choose how muchrisk you want to take in your life. Agency
So we try to balance this when we decide what we can and can’t fund. We can’t fund things that are likely to cause harm. But we will try and balance this with enabling you to make your own choices wherever possible. Insurance While this is one of the NDIS funding criteria, you also have some responsibilities. It’s still
your responsibility and your provider’s responsibility to ensure the supports we fund are: used correctly Disability
safe for you
safe for other people. National
You and your provider will also need to manage any risks of harm that arise. For more the information, contact the NDIS Quality and Safeguards Commission. by Is the support related to your disability? 1982 We can’t fund a support if it’s not related to your disability.102 This means there must be a direct link or a connection between your disability and the supports we fund. Act
We look at whether the support addresses your disability support needs. Your disability support needs are those that arise from, or are caused by, your disability.
For example, we wouldn’t usually fund things like: Information
standard televisions of
standard household furniture such as dining chairs
upgrades to assistive technology and home modifications that are not related to Freedom
disability needs, such as marble tiling or leather materials the flights to go on a holiday
a car to get to work because there are no public transport options under
a gym membership to get fit
a swimming pool to relax in summer. released
This is because you’re unlikely to need these supports as a result of your disability support wasneeds. They are things that all people, with or without disability, might want or need.
Usually, there won’t be a direct link or connection between these things and your disability support needs. Having a disability doesn’t usually affect whether someone needs or wantsthese types of things. document
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Example
Alan needs some changes to his house, so he can use his bathroom and kitchen in his Agencywheelchair. He also wants to set up an outdoor entertainment area for when his friends visit.
We may be able to fund home modifications so he can access areas of his home such as his bathroom or kitchen. He needs the home modifications because he can’t access those areasdue to his disability and needing to use a wheelchair. Alan needs the support because of his Insurance specific disability support needs.
Alan will need to pay for the outdoor entertainment area, as it’s not related to his disability.He doesn’t need the entertainment area because of his disability, it’s just something he Disability would like so he can have his friends over for a barbecue.
Is the support related to a ‘day-to-day living cost’? National We can’t fund supports related to day-to-day living costs that everyone has to pay, and aren’t thecaused by or result from your disability support needs.103 This means we don’t fund things bylike:
rent 1982
groceries Act
utilities such as electricity, water, gas and internet bills
the general cost of owning a home, like renovations, mortgage repayments, repairs and maintenance. Information In some situations, we can fund supports related to your day-to-day living costs. We can do of this if the costs are attributable to, or caused by, your disability support needs.104 This means
we may fund supports that relate to day-to-day living costs where either: you have additional living costs that are solely and directly as a result of your disability Freedom
support needs105 the the living costs are connected to another support that is funded or provided in your plan, and you wouldn’t incur that cost if it wasn’t in your plan.106 under
Example
Nigel has a goal to do his grocery shopping on his own. He needs a shopping basket to releasedattach to his wheelchair to help him carry the items in the supermarket. Shopping bags and baskets are things we all pay for, whether or not we have a disability. was But Nigel only needs this specialised basket for his wheelchair because of his disability support needs. document
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If it meets the other NDIS funding criteria, we may fund the shopping basket attachment in his plan. AgencyDoes the support duplicate other supports funded through the NDIS?
We can’t fund a support if it duplicates other supports delivered under alternative funding through the NDIS.107 InsuranceFor example, if we’re providing support through your Early Childhood Partner or Local Area Coordinator, we usually won’t fund Support Coordination in your plan.
This is because your Early Childhood Partner or Local Area Coordinator is already funded to Disabilityprovide similar supports. If we funded the same Support Coordination, we would be duplicating a support we’re already providing you as general supports.
However if you need extra support, we may be able to fund additional Support Coordination National in your plan. We may do this if it’s above the amount of support your Early Childhood Partner theor Local Area Coordinator are able to provide. Your Early Childhood Partner or Local Area byCoordinator will work together with the Support Coordinator to help you connect with supports in your community. 1982 Does the support meet the reasonable and necessary criteria? Act All NDIS supports need to meet all the reasonable and necessary criteria.108
This means that before we can include an NDIS support in your plan, we need to be satisfied it meets all the following criteria: Information
The support will assist you to pursue your goals in your plan.109 of
The support will assist you to undertake activities, to facilitate your social and
economic participation.110 This means the support will help you to undertake activities, by reducing the disability-related barriers that prevent you from participating in things Freedom
such as social outings, recreation, work and study. the The support represents value for money in that the costs of the support are reasonable relative to both the benefits achieved and the cost of alternative under supports.111 This means we need to consider the costs and benefits of the support, as
well as the costs and benefits of alternative supports. The support will be, or is likely to be, effective and beneficial for you, having regard to released
current good practice.112 This means we consider if there is evidence the support was works for someone with similar disability support needs. We won’t need an expert
report for every support, as we can often rely on other information or evidence. For example, we may have information already about whether the support is widely document
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accepted to suit someone with your disability support needs.113 We also consider your
lived experience. Agency The funding of the support takes account of what it is reasonable to expect families,
carers, informal networks and the community to provide.114 This means we need to consider what support is reasonable for your family, friends and community to provide. Insurance The support is most appropriately funded or provided through the NDIS, and is not
more appropriately funded or provided through:115 - other general systems of service delivery, or support services offered by a person, Disability
agency or body (for example, a State or Territory Statutory Scheme)
- systems of service delivery or support services offered as part of a universal National service obligation (for example, the health or education system)
the - systems of service delivery or support services offered in accordance with
by reasonable adjustments required under discrimination laws (for example, your employer, or the health or education system). 1982 The law for the NDIS sets out things that we need to consider when we apply the reasonable Actand necessary criteria.116
We must be satisfied that each support is reasonable and necessary individually, but we must also be satisfied that the supports are reasonable and necessary as a package of supports.117 Information For example, a home modification may reduce your need for other supports. If we plan to of fund a home modification, we will need to take that home modification into account when considering what other supports are reasonable and necessary, such as the amount of care you need at home. Freedom If the home modification will reduce your care needs, we may need to reduce the amount of the care we fund, as a higher amount may not be reasonable and necessary when the whole package of supports is considered. under Does the support help you pursue your goals?
We need to be satisfied that the support will help you pursue the goals, objectives andaspirations in your NDIS plan.118 This helps us determine if the support is necessary.119 released
While we only fund supports that help you pursue your goals, objectives and aspirations, we was understand that different people express themselves in different ways.
You are free to choose your own goals and express them in your own words. document
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Your goals can be big or small, short term or long term, simple or complex. They can be about anything you want to work towards. AgencyYou may express your goals broadly, or you may have specific goals. For example, you may express one of your goals as ‘living independently’. Someone else may express their goal as ‘to have an accessible bathroom’.Learn more about setting your goals in Creating Your Plan and the Setting Goals fact sheet. Insurance
Reasonable and necessary supports should help you pursue your goals,120 but you don’t need a specific goal for every support in your plan. When we decide if a support will help youpursue your goals, we consider your whole situation. Disability
We look at how a support will address your disability support needs, and the disability specific barriers that prevent you from pursuing your goals. National A support that addresses your disability related support needs is most likely to help you thepursue your goals, objectives and aspirations in your plan. by Setting a goal in your plan doesn’t mean we’ll provide funding to pursue it. For example:
setting more and bigger goals doesn’t mean we have an obligation to fund more and 1982
bigger funded supports in your plan Act setting a goal doesn’t mean we have an obligation to fund supports that help you pursue that goal
setting a goal about an explicit type or amount of support you might want doesn’t Information mean we’ll fund that support or in that amount.
of This is because helping you pursue your goals is only one of the NDIS funding criteria. A support must meet all of the NDIS funding criteria to be funded under the NDIS. So not all supports that help you to pursue your goals will be reasonable and necessary supports. Freedom For example, we only fund reasonable and necessary supports that are value for money,121 the effective and beneficial122 and relate to disability support needs.123
This means that if your goal is to ‘live independently’, we may fund home modifications that under address your disability related needs. However, we won’t fund supports related to day-to day-living costs like rent or utilities. These costs aren’t incurred solely and directly as a result of your disability support needs, so they don’t meet other funding criteria.124 released Also, choosing a different goal ‘to have a more accessible home’ won’t change the supports we could fund in your plan. was
Achieving goals usually takes many different kinds of supports. NDIS supports will most likely be just one kind of support that helps you work toward your goals.Learn more about setting goals. document
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Example
Morgan is ready to look for work and she has a goal in her plan to get a job. She has built up Agencyher skills and knows what she wants to do. Disability Employment Services are helping Morgan to find work, so we can’t fund this support for Morgan.
However, because of her disability, Morgan will need personal care supports to help her getup and ready for work in the morning. We will consider: Insurance
how Morgan’s disability support needs relate to her goals
whether funding supports that address these disability support needs will help Morgan Disability
pursue her goals.
Morgan’s planner believes the personal care supports meet this criteria. The supports that address her personal care needs will help Morgan to pursue her employment goals. National However, Morgan’s planner then needs to look at whether the support meets the other NDIS the funding criteria. by
We don’t fund all the supports that relate to Morgan’s employment goals. We only fund
the 1982supports we consider are reasonable and necessary – that is, when they meet all the NDIS
funding criteria. Act Does the support help you do activities that will help your social and economic participation?
We need to be satisfied that the support will help you to do activities, which make it easier for Informationyou to participate socially and economically.125 of Social participation means doing things you enjoy, like going out with friends, playing sport or going on holiday. It also means doing the things you need to do, like going to school or medical appointments. Freedom Economic participation usually means being involved in things that help you work towards thegetting and keeping a job. This might be things like volunteering, study, learning new skills or trying work experience. Research tells us that work can lead to health benefits and improveour quality of life. Learn more about the Health Benefits of Good Work. under
Social and economic participation are important to most people. They are critical to living an ordinary life. released To work out if a support meets this requirement, we look at the purpose of the support and how it will help you. was
We fund reasonable and necessary supports that reduce the barriers that prevent you from undertaking activities. This will help you increase your social and economic participation. document
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Some supports help economic and social participation directly. There are lots of supports we can fund to directly help with social and economic participation. Learn more about Social andrecreation supports and Work and study supports. Agency
Other supports help you to undertake activities like self-care, which indirectly help your economic and social participation.Example Insurance
Sue is going to university next year. She has a vision impairment, and has been working with her Guide Dog Mobility Instructor to decide if a dog guide is right for her. A dog guide canhelp her leave her home safely and independently, and travel to and from university. Disability
A dog guide could also help her go out with friends and join in other community activities. As long as it meets the other funding criteria, we could fund a dog guide for Sue. It will help her Nationalto undertake activities of daily living. theAs a result, it’ll increase her social and economic participation. For example, the support will byhelp her get to her university so she can study, and will help her social life.
Is the support value for money? 1982 All supports we fund under the NDIS need to be value for money.126 This means the cost of Act the support is reasonable, when we consider the benefits of the support and the cost of other supports.
Making sure that your supports are value for money is one of the ways we keep the NDISfinancially sustainable. This means we make careful decisions about funding so that we Information make sure the NDIS exists for future generations. It’s also one of our principles.127 of
When we decide if the support is value for money, we consider:
if other supports would achieve the same result at a substantially lower cost128 – this Freedom means there should be a real or material difference in cost
the if there’s evidence that the support will substantially improve your life stage outcomes and benefit you in the long term129 under if the support will likely reduce the cost of other supports over time130
how the cost compares to other supports of the same kind in your area131 released if the support will make you more independent, and mean you won’t need as many
supports in future,132 for example, in some circumstances home modifications may was reduce the need for home care. document
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When we consider the likely cost of supports, we consider the cost over the long term. We consider if the support will help you to achieve milestones at different ages or stages of yourlife, and have long term benefits. Agency
For example, some supports such as home modifications may be expensive now, compared to other supports. But getting these supports now may mean you need much less support in a few years, or later in life. Or, it may delay the need for other more costly supports.133 Insurance When we determine the cost of the support, we consider:
the prices for NDIS supports in the NDIS Price Guide Disability supports suggested by the Typical Support Package
quotes for specific or high risk supports.It’s important we consider the cost of the support. This will be the level of funding we include National
in your plan, if we decide the support is reasonable and necessary. the When we fund equipment or modifications, we also need to consider:134 by
how the cost of buying the equipment or modifications compares against the cost of 1982
renting them
Act
if it’s appropriate to fund the equipment or modifications you want, based on your circumstances and any expected changes in technology.
Learn more about how we consider value for money when we fund assistive technology, home modifications and vehicle modifications. Information Example of
Elias needs a shower commode.
He got an assessment and sent us a quote for one that will suit his needs. As part of the Freedom process to work out if we can fund it, his planner considers other similar shower commodes. the There’s a second commode that’s $5,000 cheaper than the one Elias has asked for. But it won’t meet Elias’ needs, as it won’t provide enough back support. That is, it won’t achieve under the same result as the one Elias has asked for.
Finally, there’s a third commode that’s $1,000 cheaper. The planner contacts his occupational therapist who confirms the cheaper commode will meet Elias’ needs. released Elias’ planner decides to fund the commode that’s $1,000 cheaper. It’ll deliver the same wasresult at a substantially lower cost. document
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Is the support effective and beneficial?
We need to be satisfied that the support will be, or is likely to be, effective and beneficial, Agencywhen we consider current good practice.
We need to work out if the support is likely to be both:
effective – it will do what you need it to do135 Insurance
beneficial – the support will help you do things you can’t otherwise do and meets your support needs.136
It can also be effective and beneficial if it will help you maintain your current level of Disability functioning. That is, it will help you keep doing the things you can currently do. And, it’ll help you maintain your work, study and social life as much as you can.137When we decide if a support is effective and beneficial, we look at what is current good National practice. This means we look at whether there is evidence that the support works for the someone with similar disability support needs to you. We won’t need an expert opinion or by report for every support, as we can often rely on other evidence. For example: 1982 We may have information already about whether the support is widely accepted to Act suit someone with your disability support needs.138 For example, we could rely on academic research and other literature. This could include university studies on
therapies that have been published and refereed in academic journals, evidence based practice resources, or clinical practice guidelines. Information
of If you or other participants have used the support before, we can consider your experience using the support and the experience of your family members and carers.139 Freedom We may consider things we have learnt from other participants in the NDIS with the similar support needs to you.140
We know you’re the expert in your own life, and we use your own experience as much as we undercan.
For example, we will talk to you about any supports that have helped you do things you can’t otherwise do. Or, some supports may have helped maintain your ability to be as independent released as possible. wasIf it’s a new support such as new assistive technology, we might fund a trial. This is so we can learn from your experience of using the support, to check if it’s likely to do what you need it to. document
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Your evidence can be particularly useful when it’s consistent with other evidence, or if we don’t have expert evidence. AgencyWe will look at the opinions held by the majority of experts and what they generally agree on.141 Sometimes we will have to seek expert opinion or report to make a decision.142
For example, we may need the views of doctors or health professionals who may bespecialists in managing your disability. Insurance
Example
Vivek is 12 and has a goal to improve his communication skills. He and his family want him Disabilityto improve his social skills with the kids in his class.
When he was younger, Vivek’s family tried speech therapy, and believe it really helped him improve his communication. His family told his planner about how it helped Vivek learn how National to respond to different social settings. the Vivek’s speech therapist also believes it could work well for him now, and help him interact by with his classmates. When deciding whether the therapy is effective and beneficial, Vivek’s planner will consider: 1982
how speech therapy has assisted Vivek in the past, including first-hand information Act
from Vivek, his family members and carers
the views of his speech therapist on the effectiveness and benefits of speech therapy
for Vivek Information
other information or expert evidence about the effectiveness and benefits of speech of
therapy, including for a child of the same age, and with the same impairments and functional capacity.
Based on this information and evidence, Vivek’s planner decides the speech therapy is Freedom effective and beneficial. If it meets the other funding criteria, we will be able to fund speech the therapy in Vivek’s plan.
Is the support something we would reasonably expect your informal supports, like under family or friends, to provide?
We need to be satisfied that funding the support takes into account what is reasonable to expect families, carers, informal networks and the community to provide.143 released To make sure we understand how disability supports might work for you, we consider: was the things you’re able to do for yourself
any support you have from others in your network – including family members, relatives, friends and local community services. document
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When we fund supports under the NDIS, we have to think about whether it’s reasonable to expect your informal supports to provide that support. We can’t fund supports that anordinary person would think is reasonable to expect friends, family or the community to Agency provide for you.144
Informal supports are the help and support you get from friends, family and the community. They are called ‘informal’ because you don’t pay for them, and they’re not part of a formal Insurance agreement. They are the usual things friends and family do for us, and with us.
Most of us get some kind of help and support from friends and family. In our society, we expect that friends, family and our community will support each other and help each other Disability out when they need it.
A good example is families who have young children. In our community, we expect familieswill provide most of the support a young child needs.145 They will change a child’s nappy, National make sure they are safe and drive them around places. the Grandparents, uncles and aunties often have a role to play in supporting young children as by well. Neighbours and friends might also help care for the child. 1982As a child gets older, our society’s expectations of the role of the family and community in caring for the child changes. For example, we expect schools to help support the child’s Act learning needs.
We also usually expect the role of family in providing personal care for a child would reduce as they get older and develop new skills and independence. But families are usually stillresponsible for things like food, emotional support, decision-making and providing a safe Information home. of
It’s a similar idea for adults. Our society expects that adults – like family, friends and neighbours – will provide some support to each other. This might be things like taking a Freedomfriend with you to the football game, or providing emotional support if someone is upset. theNDIS supports won’t ever replace the support people like your friends and family provide to you. This support is given freely because people care, and is often quite different to supportsbought with NDIS funding. under
You have a special bond with your friends and family that’s different from your relationship with paid carers. And there are potential risks and problems for you if your friends andfamilies become your paid carers. released To make sure we understand how disability supports might complement your circumstances, was we consider:
the things you are able to do for yourself document
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any support you have from others in your network including family members, relatives, friends and local community services. AgencyWe also have to consider the benefits you may get from your informal supports. For example, your family and friends may be more effective at helping you meet other people, or helping to build your social skills, than paid supports can.We consider if we can help these relationships so that you get the support you need.146 For Insurance example, we may be able to fund training for your informal supports, so they can help you build your skills.We also think about the capacity of your informal supports to continue caring for you, for Disability example if they’re ageing or sick.
There are different things the law for the NDIS says we need to consider for adults and Nationalchildren. theIf you’re under 18, we consider what support is reasonable to expect parents to provide at byyour age. It’s normal for parents to provide substantial care and support for children.147 We consider that it’s usual for parents to provide almost all the care and support that young 1982children need. ActFor example, it’s reasonable to expect parents to provide transport to and from their child’s after-school activities. Of course, the amount of care and support for a child without a disability would typically reduce as they get older.
For children under 18, we consider: Information
if your needs are ‘substantially greater’ because of your disability, compared to other of
children the same age148 – that is, you need much more disability support
any risks to the wellbeing of people providing informal support to you149 Freedom
if including funding for the support will help build your skills and capacity in the future, or reduce any risks to you.150 the
For example, we consider any health, safety or other impacts resulting from what’s involved underin meeting your disability support needs.
If you’re over 18, we consider:
if there are any risks to you or your informal supports if you rely on them to provide released
the support you need151 was how much your informal supports would help improve or reduce your independence and other outcomes152 document
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We also consider the suitability of informal supports to provide the supports you need,153
including: Agency how old your carers are and their capacity to provide the support154
if other family members and the community can help your informal supports in their caring role155 Insurance the intensity and type of support you need, and if it’s appropriate for your informal supports to provide this, based on their age and gender156
any long-term risks to the wellbeing of your informal supports.157 Disability
When we consider the risks for people over 18, we consider if the supports are sustainable for your informal supports. We consider the health, safety and other impacts on family and carers in the long term. National For example, we wouldn’t expect a child to have their schooling affected because they need the to provide care. We also wouldn’t expect an elderly parent to be responsible for physical by activities, if it may result in injury.158 We generally don’t fund family members to provide supports funded under the NDIS. There 1982 are very limited situations where we can consider this. Learn more about Sustaining Informal Act Supports.
Example 1
Simon is getting his first NDIS plan. For the last 15 years, Simon and his wife Jan’s Informationpreference was that Jan provide all the physical support he needs at home, such as toileting of and showering.
But as Jan is getting older, it’s not safe for her to keep lifting Simon. It’s becoming risky for her to keep providing this support. Freedom Jan and Simon think it might be best for someone else to provide the personal care support the that Simon needs. Their children have moved out of home, and it’s not reasonable to expect them to help Simon with personal care. under Based on this information and other evidence, Simon’s planner decides that the personal care support meets this criteria. It takes into account what is reasonable for his family and others to provide. If the personal care support meets the other funding criteria, we may fund released the personal care support for Simon. Simon and Jan still prefer Jan to do the other support Simon needs though, such as helping was Simon eat his meals. At this time, we wouldn’t fund a support worker in Simon’s plan to help him eat his meals. It’s reasonable to expect Jan to help Simon with this, as it’s what they want to do and it’s not a safety risk for Jan. document
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Example 2
Qing is 14 and wants to join a local footy club. Like most 14 year olds in this situation, she Agencyneeds someone to drop her off and pick her up from the Saturday matches and the weeknight training sessions.
But unlike most 14 year olds, she needs someone to help her get dressed before she can goto the match. Her parents have been doing this, but as Qing is getting older she no longer Insurance wants her family to help her get dressed.
It’s reasonable to expect her family or other informal supports to drop Qing to and from thematch and training sessions. So we wouldn’t fund transport in Qing’s plan. Disability
But at age 14, it’s not reasonable to expect her family to help her get dressed.
Based on this information and other evidence, Qing’s planner finds that the personal care National support takes into account what is reasonable for family and others to provide. If it meets the theother funding criteria, we may fund personal care support in her plan. by Is the support more appropriately funded or provided through the NDIS, and not through other service systems or support services? 1982 We have to be satisfied that the support is most appropriately funded or provided through the Act NDIS. This means it’s not more appropriately funded or provided through:
other general systems of service delivery, or support services offered by a person,
agency or body (such as a State or Territory Statutory Scheme) Information systems of service delivery or support services offered as part of a universal service
obligation (such as the health or education system) of
systems of service delivery or support services offered in accordance with reasonable
adjustments required under discrimination laws (such as your employer, or the health Freedom or education system).159
theIn short, we won’t fund the support if it should be provided by someone else.
We won’t fund the support if the support should be provided by someone else, even if the under other service system doesn’t actually provide it. We’re not the funder of last resort, so we don’t make up for other organisations and systems that don’t provide the supports they should. released The law for the NDIS sets out a number of things we need to consider, when we decide who is most appropriate to fund or provide of the support.160 There are different things we was consider for the following service systems:
(a) Health (b) Mental health document
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(c) Child protection and family support
(d) Early childhood development Agency (e) School education
(f) Higher education and vocational education and training
(g) Employment Insurance
(h) Housing and community infrastructure
(i) Transport Disability (j) Justice.
How does the NDIS work with other government services?We call supports provided by other government services, including those provided as part of National a universal service obligation, ‘mainstream supports’. When we talk about mainstream the supports, we mean supports available to everyone in your state or territory, or across by Australia, regardless of whether or not you have a disability. This includes services provided by state and federal governments, like health care, 1982 education and mental health services. Act You have the same right as all Australians to access these services. There are certain things that mainstream services have to do to make their services accessible for people with disability. Using mainstream supports can also help you be part of your community, or towork or study. Information ofWhen we fund NDIS supports, we need to check that the support is not more appropriately funded or provided by a mainstream service or system, such as the education system or health system.161 Under the law for the NDIS, we can’t fund supports that should be providedby a mainstream service. Freedom The Australian federal, state and territory governments agreed on responsibilities for funding the different types of supports. The law for the NDIS has an outline of funding responsibilities and were developed with the agreement of each State and Territory.162 under We can only fund supports that are the responsibility of the NDIS. We can’t fund supports that are the responsibility of other government services, even if they don’t actually fund orprovide the support. The law for the NDIS sets out the matters we should consider when we released decide who is more appropriate to provide or fund a support.163 was Learn more about how we decide if the support is best funded or provided by us or another part of government. document
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The Applied Principles and Tables of Support also has information on what the governments agreed are the responsibilities of the NDIS and other government services. However, itdoesn’t override what we consider when we decide if the support is most appropriately Agency funded by the NDIS.164
What is reasonable adjustment and why is it important?People with a disability can sometimes face barriers that make it harder to do the same Insurance things as people who don’t have a disability. For example, it might be harder to find and keep a job. Or it might be harder to get in and around places, or to get the same services as other people. Disability It’s against the law to discriminate against people with a disability in many areas.165 This includes in employment, when providing goods and services, and when accessing publicplaces. National This means organisations or people who are responsible for providing these services have to the make what are called ‘reasonable adjustments’. They have to make sure people with a by disability have equal access to the services they provide, as far as is reasonable. 1982They have to do reasonable things that will make their services equally available to everyone, whether or not you have a disability. Act
Reasonable adjustments do not mean they have to provide everything you need because of your disability. It means they have to do what’s reasonable to make sure you have equal access to employment, public spaces or services. This takes into account what they canafford to do and what is reasonable to expect them to provide in the circumstances. Information of When we decide what supports to include in your plan, we need to consider what should be provided through reasonable adjustments. Under the law for the NDIS, we can’t fund a support if it should be provided by someone else through reasonable adjustments. Freedom What if you’re transitioning to the NDIS in Western Australia? the The federal and Western Australian governments made a commitment for people receiving supports before becoming a participant in the NDIS. under
They committed that you shouldn’t be disadvantaged by your transition to the NDIS. We call this the ‘principle of no disadvantage’. released When we create your plan, we must use our best endeavours to follow government agreements.166 This doesn’t mean you’ll always have the same level of funding, or that you’ll was get supports in the same way.
All supports we fund must meet all the NDIS funding criteria. So we may not be able to fund supports you received before the NDIS, if they don’t meet the funding criteria. document
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If we can’t fund those supports, we’ll see how we can help you meet the same outcomes as you did before the NDIS. AgencyThis may mean we include other supports in your plan that address your disability support needs and help you pursue your goals. Or, we could help you connect with other government services that can provide the supports you received before the NDIS.When we create your plan, we consider whether or not you’re disadvantaged overall by Insurance joining the NDIS.
What else do you need to know about working out if supports meet the Disability NDIS funding criteria?
From our experience, we learned there are some common misunderstandings about how we work out what supports meet the NDIS funding criteria. National Why don’t we always fund what your health professionals recommend? the Although we take expert opinions into account, we can’t and don’t always fund everything by your health professional might recommend. This is because every support we fund needs to 1982meet all the NDIS funding criteria. ActFor example, your therapist might recommend a piece of equipment on the basis that it will be ‘effective and beneficial’ for you. But if there is something cheaper that will achieve the same outcome, we won’t be able to fund what the therapist recommended.
This is because it won’t be value for money. We may be able to fund the cheaper option Information instead if it meets all the NDIS funding criteria. of Why don’t we fund the same supports as your last plan?
We might fund different supports in your next plan. This is because we will fund supports inyour plan based on how we use the NDIS funding criteria at that point in time. Freedom Your needs and situation will most likely change over time. This means it’s likely your NDIS the
supports and funding for those supports will change over time.
For example, we may have funded supports to help you build your skills in a particular area. under
Once you have built those skills, you won’t need funding for that any more. So, we probably won’t include that funding for those supports in your next plan. releasedSupports to build your skills may have met the NDIS funding criteria before, but the same supports might not meet the criteria in future. was Or, your disability support needs might increase or decrease over time. This may mean we consider funding more or less supports as a result. document
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What happens if you don’t use all your funding in your NDIS plan?
We will consider how you have used your NDIS funding to help us work out what supports Agencymeet the NDIS funding criteria in your next plans.
If you haven’t used all the funding by the end of your plan, it doesn’t mean we’ll reduce the funding in your next plan. There may be very good reasons why you weren’t able to buy thesupports we funded. Insurance
When we review your plan, we’ll talk about any problems you had buying the supports funded in your plan. We’ll also see how we can help you use your funding if we need to. DisabilityBut if you consistently don’t buy all the supports we fund and use all of your NDIS funding, we need to think about whether the supports really do meet the NDIS funding criteria. For example, they may not be ‘effective and beneficial’ for you if you’re not actually using them. NationalWe will talk to you about this when we review your plan. theLearn more about plan reviews. by Step 3: How do we include the reasonable and necessary 1982 supports in your plan? Act Once we’ve identified the supports, and decided they meet the NDIS funding criteria, we can include the description and funding for the support in your plan.
If the support doesn’t meet the NDIS funding criteria, we can’t include the support in your Informationplan. We may consider if a differently described support meets the NDIS funding criteria instead. of
When we approve your plan we will also make sure all your supports are reasonable and necessary when considered as a package of supports.167 Freedom Sometimes you might not need any supports under the NDIS. For example, your informal thesupports may meet all your disability support needs. If so, we’ll approve a plan with no funded supports. under Learn more about how we create and approve your plan.
Learn more about using the funding in your plan. releasedWhat happens if we don’t include the supports you want? wasIf we decide a support doesn’t meet the NDIS funding criteria, we can’t include the support in your plan. Also, if the amount of support you want doesn’t meet the criteria, we can’t include that amount in your plan. document
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But, we’re committed to our principles and helping you live an ordinary life. Even if we can’t fund a particular support we may still be able to help. AgencyIf the support doesn’t meet the NDIS funding criteria, we can consider if a different support meets the NDIS funding criteria. We might be able to consider describing the support differently, or funding a different type of support.Or, we may be able to connect you to mainstream or community supports that can help. Insurance Mainstream and community supports are available to everyone. They can be a good way to connect with your local community, learn new skills and gain independence.There are lots of ways we might be able to help, so talk to us if you’re in this situation. We Disability can do this at any time. We may be able to help before we approve your plan.
We can also give you reasons for our decision to approve your plan. We can put these Nationalreasons in writing. You can always contact us. theIf you don’t agree with the supports we approve in your plan, you can also request an byinternal review of our decision. Learn more about internal and external review of decisions. 1982Reference list
Act
1 NDIS Act and delegated legislation made under the NDIS Act, especially NDIS (Supports for Participants) Rules and NDIS (Plan Management) Rules. 2 NDIS (Supports for Participants) Rules r 5.1(b). 3 NDIS Act s 34(1)(a). 4 NDIS Act s 34(1)(b). Information 5 NDIS Act s 34(1)(c). 6 of NDIS (Supports for Participants) Rules r 3.1(c). 7 NDIS Act s 34(1)(c); NDIS (Supports for Participants) Rules r 3.1(a). 8 NDIS Act s 34(1)(d). 9 NDIS Act s 34(1)(e).
10 NDIS Act s 34(1)(f).11 Freedom NDIS Act s 34(1)(f).
12 NDIS (Supports for Participants) Rules part 5. the 13 NDIS (Supports for Participants) Rules r 5.1(a). 14 NDIS (Supports for Participants) Rules r 5.1(b).
15 NDIS (Supports for Participants) Rules r 5.1(c).16 under NDIS (Supports for Participants) Rules r 5.1(d).
17 NDIS (Supports for Participants) Rules r 5.3(a). 18 NDIS (Supports for Participants) Rules r 5.3(b). 19 NDIS Act s 34(1)(f).20 NDIS Act s 118(1)(b). released 21 NDIS Act s 4(17)(b).
22 NDIS Act s 33(2).23 was NDIS Act s 33(5)(a).
24 NDIS Act s 34(1)(a). 25 NDIS Act s 34(1)(d). 26 NDIS (Supports for Participants) Rules r 4.1(d). 27 NDIS Act s 34(1).28 NDIS Act s 34(1)(d); NDIS (Supports for Participants) Rules, rr 3.2-3.3. document
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29 NDIS Act s 34(1)(c); NDIS (Supports for Participants) Rules r 3.1. 30 McGarrigle v National Disability Insurance Agency (2017) 252 FCR 121 at [88].31 NDIS Act ss 33(2)(a), 33(2)(b), 33(5)(c), 34. Agency 32 NDIS Act ss 13, 33(2)(a). 33 NDIS Act ss 33(2)(b), 34. 34 NDIS Act and delegated legislation made under the NDIS Act, especially NDIS (Supports for Participants) Rules and NDIS (Plan Management) Rules. 35 NDIS Act ss 33(2)(b), 34; NDIS (Supports for Participants) Rules. Insurance 36 NDIS Act ss 33(5)(d), 35(1)(b); NDIS (Supports for Participants) Rules r 5.3. 37 NDIS (Supports for Participants) Rules pt 5. 38 NDIS Act s 34(1). 39 NDIS (Supports for Participants) Rules r 2.4; NDIS Act s 33(5)(c).40 NDIS Act ss 4, 31. Disability 41 NDIS Act s 4(1). 42 NDIS Act s 4(2). 43 NDIS Act s 4(4).
44 NDIS Act s 4(8).45 National NDIS Act s 4(10).
46
NDIS Act s 4(17). the47 NDIS Act s 4(11).
48 NDIS Act s 33(5)(a); NDIS (Supports for Participants) Rules r 4.1(a). by 49 NDIS (Supports for Participants) Rules r 4.1(a). 50 NDIS (Supports for Participants) Rules r 4.1(b).51 NDIS (Supports for Participants) Rules rr 4.1(b), (d). 1982 52 NDIS (Supports for Participants) Rules r 4.1(c). 53 NDIS Act s 33(5)(b). Act 54 NDIS Act ss 36, 50. 55 NDIS (Supports for Participants) Rules rr 4.2-4.6. 56 NDIS Act s 33(1). 57 NDIS Act s 47(1). 58 NDIS (Supports for Participants) Rules r 4.1(d).59 NDIS Act s 34(1)(a). Information 60 NDIS Act s 34(1)(a). of 61 NDIS Act s 33(5)(f). 62 NDIS Act s 33(3) and NDIS (Plan Management) Rules. 63 NDIS Act s 33(5)(c). 64 NDIS Act s 33(3).65 NDIS Act s 33(3); NDIS (Plan Management) Rules r 6.2. Freedom 66 NDIS Act s 33(3); (NDIS (Plan Management) Rules r 6.3. 67 NDIS (Plan Management) Rules pt 6. the 68 NDIS Act s 46(1). 69 NDIS Act (Plan Management) Rules r 6.4(a).70 NDIS (Plan Management) Rules r 6.4(b). under 71 NDIS (Plan Management) Rules r 6.4(c). 72 NDIS (Plan Management) Rules r 6.4(d). 73 NDIS (Plan Management) Rules r 6.4(e).
74 NDIS (Plan Management) Rules r 6.4(f).75 released NDIS (Plan Management) Rules r 6.4(f).
76 NDIS (Plan Management) Rules r 6.4(f). 77 NDIS (Provider Registration and Practice Standards) Rules r 7(3). was 78 NDIS (Provider Registration and Practice Standards) Rules r 7(2). 79 NDIS Act s 42(2)(b). 80 NDIS (Provider Registration and Practice Standards) Rules r 7(1). 81 NDIS (Plan Management) Rules rr 6.6-6.7. 82 NDIS (Plan Management) Rules r 6.6. document 83 NDIS (Plan Management) Rules r 6.7.
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84 NDIS (Plan Management) Rules r 6.7. 85 NDIS (Plan Management) Rules r 6.7.86 NDIS (Plan Management) Rules r 6.5. Agency 87 NDIS (Plan Management) Rules r 6.6. 88 NDIS Act ss 33(5)(d), 35(1)(b); NDIS (Supports for Participants) Rules pt 5. 89 NDIS Act s 34(1). 90 NDIS (Supports for Participants) Rules r 5. 91 NDIS Act ss 33(5)(d), 35(1)(b); NDIS (Supports for Participants) Rules r 5.3(a). Insurance 92 NDIS Act ss 33(5)(d), 35(1)(b); NDIS (Supports for Participants) Rules r 5.3(b). 93 NDIS Act ss 33(5)(d), 35(1)(a); NDIS (Supports for Participants) Rules r 5.1(a). 94 NDIS Act ss 33(5)(d), 35(1)(a); NDIS (Supports for Participants) Rules r 5.1(b). 95 NDIS Act ss 33(5)(d), 35(1)(a); NDIS (Supports for Participants) Rules r 5.1(d).96 NDIS Act ss 33(5)(d), 35(1)(a); NDIS (Supports for Participants) Rules r 5.1(c). Disability 97 NDIS (Supports for Participants) Rules r 5.3(a). 98 NDIS (Provider Registration and Practice Standards) Rules 2018 r 7(2). 99 NDIS Act s 73F(2)(a).
100 NDIS (Supports for Participants) Rules r 5.3(b).101 National NDIS (Supports for Participants) Rules r 5.1(a).
102
NDIS (Supports for Participants) Rules r 5.1(b). the103 NDIS (Supports for Participants) Rules r 5.1(d).
104 NDIS (Supports for Participants) Rules r 5.1(d). by 105 NDIS (Supports for Participants) Rules r 5.2(a). 106 NDIS (Supports for Participants) Rules r 5.2(b).107 NDIS (Supports for Participants) Rules r 5.1(c). 1982 108 NDIS Act ss 33(5)(c), 34(1). 109 NDIS Act s 34(1)(a). Act 110 NDIS Act s 34(1)(b). 111 NDIS Act s 34(1)(c). 112 NDIS Act s 34(1)(d). 113 NDIS (Supports for Participants) Rules r 3.2(a). 114 NDIS Act s 34(1)(e).115 NDIS Act s 34(1)(f). Information 116 NDIS (Supports for Participants) Rules pts 3, 4. of 117 NDIS Act s 33(5)(c). 118 NDIS Act s 34(1)(a). 119 McGarrigle v National Disability Insurance Agency (2017) 252 FCR 121 at [91]. 120 NDIS Act s 34(1)(a).121 NDIS Act s 34(1)(c). Freedom 122 NDIS Act s 34(1)(d). 123 NDIS (Supports for Participants) Rules r 5.1(b). the 124 NDIS (Supports for Participants) Rules r 5.1(d). 125 NDIS Act s 34(1)(b).126 NDIS Act s 34(1)(c). under 127 NDIS Act ss 3(3)(b), 4(17)(b). 128 NDIS (Supports for Participants) Rules r 3.1(a). 129 NDIS (Supports for Participants) Rules r 3.1(b).
130 NDIS (Supports for Participants) Rules r 3.1(c).131 released NDIS (Supports for Participants) Rules r 3.1(e).
132 NDIS (Supports for Participants) Rules r 3.1(f). 133 NDIS (Supports for Participants) Rules r 3.1(c). was 134 NDIS (Supports for Participants) Rules r 3.1(d). 135 McCutcheon and NDIA [2015] AATA 624 at [34]. 136 McCutcheon and NDIA [2015] AATA 624 at [34]. 137 McCutcheon and NDIA [2015] AATA 624. 138 NDIS (Supports for Participants) Rules r 3.2(a). document 139 NDIS (Supports for Participants) Rules r 3.2(b).
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140 NDIS (Supports for Participants) Rules r 3.2(c). 141 NDIS (Supports for Participants) Rules r 3.3.142 NDIS (Supports for Participants) Rules r 3.3. Agency 143 NDIS Act s 34(1)(e). 144 NDIS Act s 34(1)(e). 145 NDIS (Supports for Participants) Rules r 3.4(a)(i). 146 NDIS (Supports for Participants) Rules r 3.4(c). 147 NDIS (Supports for Participants) Rules r 3.4(a)(i). Insurance 148 NDIS (Supports for Participants) Rules r 3.4(a)(ii); JQJT and National Disability Insurance Agency [2016] AATA 478 at [39]. 149 NDIS (Supports for Participants) Rules r 3.4(a)(iii). 150 NDIS (Supports for Participants) Rules r 3.4(a)(iv).151 NDIS (Supports for Participants) Rules rr 3.4(b)(i), (ii). Disability 152 NDIS (Supports for Participants) Rules r 3.4(b)(iii). 153 NDIS (Supports for Participants) Rules r 3.4(b)(ii). 154 NDIS (Supports for Participants) Rules r 3.4(b)(ii).
155 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(A).156 National NDIS (Supports for Participants) Rules r 3.4(b)(ii)(B).
157
NDIS (Supports for Participants) Rules r 3.4(b)(ii)(C). the158 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(C).
159 NDIS Act s 34(1)(f). by 160 NDIS (Supports for Participants) Rules rr 3.5-3.7 and Schedule 1. 161 NDIS Act s 34(1)(f).162 NDIS (Supports for Participants) Rules rr 3.5-3.7, Schedule 1; NDIS Act ss 209(4), (8) item 1. 1982 163 NDIS (Supports for Participants) Rules rr 3.5-3.7, Schedule 1. 164 NDIS (Supports for Participants) Rules rr 3.5-3.7, Schedule 1. Act 165 Disability Discrimination Act 1992 (Cth); Discrimination Act 1991 (ACT); Anti-Discrimination Act 1977 (NSW); Anti-Discrimination Act 1996 (NT); Anti-Discrimination Act 1991 (Qld); Equal Opportunity Act 1984 (SA); Anti Discrimination Act 1998 (Tas); Equal Opportunity Act 2010 (Vic); Equal Opportunity Act 1984 (WA). 166 NDIS Act s 118(2). 167 NDIS Act s 33(5)(c). Information of
Freedom
the under released was document
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