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](/library/documents/3d07cb290efd-foi-24-25-1354-disclosure-log-documents/document-004__what-principles-do-we-follow-to-create-your-plan/)? the
What supports can you get? 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/)
[Changing your plan](/library/documents/441f065ae1c8-foi-24-25-1912-disclosure-log-documents/document-001__changing-your-plan/) under
Would we fund it? released
was document
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What principles do we follow to create your plan?
The NDIS was set up as a world first approach to disability support. It puts people with Agency disability at the centre of decision-making, through the principles of reasonable and necessary supports and individual choice and control.
As an insurance-based scheme, we take a lifetime approach to a participant’s support Insurance needs. We provide assurance to people with permanent and significant disability or developmental delay, and to people who might acquire disability or developmental delay, that they will get the support they need. Individual funding means we help participants topurchase services and supports from a competitive and consumer-driven marketplace. Disability
What supports can we fund? NationalNDIS supports should complement, not replace, other supports available to you. That’s why we consider: the
by the things you’re able to do for yourself
support you have from others in your network, including family members, relatives, 1982
friends, local community services and mainstream government services.
Act
One of our aims is to help maximise your independence by working with the local mainstream government and community services that help you live an ordinary life. We all do best when we’re connected to our communities.And as an active consumer, it’s important you are able to shop for and access providers who Information meet your needs. We can help you find providers who meet your needs. of
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 andnecessary. This means we will only fund a support if it meets all of the following criteria: Freedom
the support is related to your disability2 the
the support will help you pursue your goals and aspirations3 under
the support will help you undertake activities that will increase your social and
economic participation4 the support is value for money,5 which means that the costs are reasonable: released
- when compared to the benefits to be achieved, for example, whether was
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 document outcome at a similar or cheaper cost7
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the support is likely to be effective and beneficial for you, having regard to good
practice and evidence8 Agency 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 the support is most appropriately funded or provided by the NDIS10 Insurance
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 fund a support if it’s the responsibility of another service system. Disability
What supports don’t we fund? NationalWe do not fund a support if:12
the it is likely to cause harm to you or others13
by it is not related to your disability14
1982 it duplicates other supports delivered by the NDIS15
Act it is considered a day-to-day living cost (for example, rent, groceries or utility
costs like your water bill) that are not attributable or caused by your disability support needs16
providing the support would be against the law17 Information
it consists of income replacement18 of
it is the responsibility of other service systems to provide (for example, your
state government, the education system, or the health system).19 These different systems have different responsibilities, and are designed to complement each Freedom
other to form a government safety net. Like all Australians, NDIS participants the continue to have access to these systems. We can’t fund a support if it’s the responsibility of another service. under How do we manage the financial sustainability of the NDIS?
The NDIS is an insurance scheme, and one of our core functions is to manage the financial released sustainability of the Scheme.20 was document
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When we make decisions about the supports we fund in your plan, we must also consider our need to ensure the financial sustainability of the NDIS.21 This means we must workwithin our funding budget, set through agreements between the Australian, and State and Agency Territory governments.
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 of Insurance the National Disability Strategy relies on:
people accessing their informal support network to get the help they need from day to day Disability people using their personal income to pay for their day to day living expenses, as
is expected of all Australians National mainstream and community services being available from state and territory
governments, and other federal government programs such as Medicare the
by a fair distribution of NDIS supports to those who need them, provided within our
funding budget. 1982 Staying within our budget ensures the NDIS will be here to support generations of Act Australians and their families.
What principles do we use to create your plan?
We use the following 7 principles, to create plans that help you get the reasonable and Information necessary supports you need, and to make sure the Scheme is financially sustainable: of Fair for everyone, both today and for future generations
Fair funding to pursue your goals Freedom
Evidence-based best practice the Fair early investments
Fair support across service systems under
Fair supports for your disability needs
Fair assistance from multiple programs released
Fair for everyone, both today and for future generations was While we need to consider your individual circumstances and disability needs, we also need to make consistent decisions and treat people fairly. document
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This means participants with similar circumstances and disability needs should receive similar amounts of supports in their plans. We also need to ensure the total cost of allparticipant plans are within the overall NDIS budget set by governments. Agency
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 your situation and disability support needs. Insurance 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 Disability validation process.
The Typical Support Package also helps to guide the consistency of our decision makingprocess. We use these to check your overall plan to make sure that all your supports make National sense together, and that your support types and amounts will complement each other to help the you fulfil an ordinary life. by We may then increase or decrease the funding in your plan based on:
1982 our discussion with you
Act any reports or other information we have
applying the NDIS funding criteria.
This helps keep the system fair for everyone, and ensure we remain financially sustainable. InformationFair funding to pursue your goals of 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 specific barriers which may be stopping you pursuing your goals. Freedom This doesn’t mean we fund all support costs associated with you pursuing your goals. Also, the 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 underpursue your goals will be reasonable and necessary.
Other things to know about when setting your goals:
-
Setting more goals or bigger goals doesn’t mean we’ll provide more funding or released 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 was related needs. This might be a home modification to make your bathroom accessible. document
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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 ‘to have a more accessible bathroom’. Agency
2. 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, we wouldn’t usually fund this. Gym memberships are things that all people, with or Insurance without disability, might want or need.
- 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 Disability 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. If there is a shower commode that costs $3,000, and your occupational therapist National confirms this one will meet your needs, we are more likely to fund this one instead the because it is likely to deliver the same result at a lower cost. We may also look at by alternatives. Evidence-based best practice 1982 We only fund supports that will be, or are likely to be, effective and beneficial for you, having Act regard to current good practice.25 This means we consider if there is evidence that the support is effective and beneficial for someone with similar disability support needs.
We will consider different types of evidence when making decisions and we won’t need anexpert report for every support, as we can often rely on other information or evidence. Information of For 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- Freedomrecognised. This includes published and refereed literature, and any consensus of expert opinions. If there is no evidence to show a support is reasonable and necessary,27 we won’t the fund the support.
You can find the types of evidence we need on our website, and in [Our Guidelines](/library/documents/00f65f731f26-foi-25-26-1877/document-004__our-guidelines/). under
Fair early investments
Having access to capacity-building supports early in your NDIS journey is considered to be released an early investment. This early investment is intended to help increase your independence, and reduce your reliance on NDIS funding over time. was
This is an important concept that we consider when we create your plan, and again at future plan reassessments. When we reassess your plan, we reassess all the supports you require to meet your disability support needs at that time. document
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Over time, your capacity building supports may no longer be reasonable and necessary, in regard to your current functional capacity, the effectiveness of the capacity buildingsupports,28 and value for money.29 Agency
If your overall funding level goes down from one plan to the next, it may be because you no longer need the same type or amount of supports, such as capacity building supports. Also, if the capacity building investment has been successful at building your independence, then Insurance your need for other supports may also decrease, for example core supports.
So other things being equal, you should expect your overall plan value to reduce over time as the benefits of capacity building are realised. Disability Fair support across service systems
The support you need may be the responsibility of another government service, such as Nationaleducation 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. the byFair supports for your disability needs
When we make decisions about which supports we can fund, we consider whether a support 1982 is reasonable and necessary for you and apply the NDIS funding criteria. Sometimes, you Actmight ask for supports to help with impairments that were not part of your Access eligibility assessment. When this happens, we need to make sure the support will help you address needs that arise from an impairment that meets the same eligibility criteria we consider at
Access. Information
You don’t need to make a new Access request if you ask for supports to help with an of impairment 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 Freedomrequested support is reasonable and necessary. We will apply the NDIS funding criteria based on the impairments that would meet our Access criteria. the
By funding the right disability supports for your permanent impairments that meet our Accesscriteria, we are ensuring the system is fair for everyone, and that the NDIS remains under financially sustainable.
Fair assistance from multiple programs released NDIS funding can’t duplicate other funding or supports you may receive due to your disability. was
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 document
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another program or insurance scheme, for example, Worksafe or the Transport Accident Commission. AgencyWe 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.
What supports can you get? Insurance When we create your plan with you, we’ll discuss what supports you need for your disability. We want to help you pursue your goals, increase your independence, and help you work, study and join social activities. Disability There are many supports you can get outside the NDIS. Other government and community 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. National We can fund supports you need for your disability if they meet certain criteria. These are the called ‘reasonable and necessary supports’. Your plan and supports will be just for you, so by you have more choice and control over how you use them. 1982 This guideline explains how we decide what reasonable and necessary supports we’ll include in your plan. There are lots of things we have to consider, which we’ll explain in Act detail.
We also have a Would we fund it guide. It has examples of how we decide whether we fund different types of NDIS supports. Information What supports can you get outside the NDIS? of
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 Freedominformation-gathering step. For example, there may be mainstream, community and informal supports that suit you. the
Mainstream supports are other government services such as employment, education,health and family support services. They are often really helpful, and are available to under everyone including people without disability. There are many ways they can help you learn new skills or live as independently as possible. releasedCommunity 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 was 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. document
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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 othersupports can’t. Agency
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 these supports, so you don’t have to do it all on your own. Insurance 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. Disability 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. NationalIt’s important we gather this information and help you access these services before we consider what reasonable and necessary supports we can fund. That way, we can help the make sure you’re able to access mainstream, community and informal supports wherever by possible. This can help you become as independent as possible. 1982 What are reasonable and necessary supports?
Act
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.
NDIS supports are the services, items and equipment we can fund or provide under theNDIS. Information of There are two types of NDIS supports. We call them ‘general supports’ and ‘reasonable and necessary supports’.31
General supports Freedom
General supports are the coordination, strategic or referral services and activities we the 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 undermainstream, community and informal supports. Learn more in Creating your plan.
Reasonable and necessary supports
Reasonable and necessary supports are the supports we fund in your plan to meet your released disability support needs.33 You can use this funding to buy supports from service providers. was 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 NDIS funding criteria.35To meet the NDIS funding criteria, a support must meet both the following criteria:36 document
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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 Agency
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 criteria. Your whole plan as a package of supports must also meet the NDIS funding criteria. Insurance 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 help you fulfil an ordinary life.39 Disability 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: not include the new support in your plan National
include the new support in your plan, but also reduce the other supports in your plan. the
by For example, a home modification may reduce your need for other supports. If we plan to fund a home modification, we will need to take that home modification into account when 1982 considering what other supports are reasonable and necessary, such as the amount of care you need at home. Act
What other principles do we consider when we decide what supports to include in your plan? Information As far as possible, we have to act according to principles set out in the law for the NDIS.40 of These are the things that guide us when we make decisions about what we fund.
These principles don’t override or replace the NDIS funding criteria under the law for the FreedomNDIS. They can help us apply the funding criteria, by giving us additional guidance when we decide what supports to approve in your plan. the
The principles include the following: under You have the same right as other Australians to realise your potential for physical,
social, emotional and intellectual development.41
You should be supported to take part in and contribute to social and economic life.42 released
You should be supported to make choices about planning and how your supports will was be delivered. This includes taking reasonable risks, so that you can pursue your
goals.43
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.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 reassessed? 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 changing your plan. 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 your plan? Agency
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 exactly what 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, we use: 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:
what the outcome of the support will be 1982
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 description of the support.65 Freedom
Fixed: Under the law for the NDIS, this is when we describe the support specifically. It the
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 falloutside the description of the support in your plan.68 released
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 Support, 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 yourfunding or use a registered plan manager. Learn more about the different plan management Agency options.
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 Insurance way to provide the support. This only happens when:
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 Disability
complex home modifications83
you need support from a particular person with specialist qualifications, for example a National health professional84
the you need support delivered in a certain way.85 by Sometimes, we’ll arrange the support ourselves, if it’s more cost effective than getting another provider to deliver the support. For example, we may bulk buy a support.86 If so, we 1982 will state this in your plan. Act What about in-kind supports?
We agreed that state and territory governments will keep providing some supports for a period of time. We call these ‘in-kind supports’. InformationIf we fund in-kind supports like specialist school transport or personal care in schools, you of will need to use state or territory government providers for these supports. These supports are most efficiently and effectively provided by state and territory government providers.87 Learn more about Work and study supports. Freedom For most other in-kind supports, you can choose your provider if you don’t want to use your thein-kind provider anymore. We can let you choose another provider if we consider that the support isn’t most effectively and efficiently provided by the in-kind provider. underWe usually let you choose another provider if:
another provider can give you the same support or level of support as the in-kind provider released the supports with the new provider still meet the NDIS funding criteria, including was that they’re value for money compared to the in-kind support
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.
While this is one of the NDIS funding criteria, we’re not responsible for ensuring your documentsupports are legal. We’re not responsible to ensure that all supports in your plan comply with
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all the relevant legal and administrative requirements. This is your responsibility and your provider’s responsibility. AgencyFor 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 responsibility to ensure they are registered and comply with the conditions of their registration. This includes complying with all laws and seeking the necessary Insurance authorisations.99
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 Disability you’re concerned about a provider’s compliance with legal obligations.
Is the support ‘income replacement’? NationalWe don’t fund income support or income replacement.100 This means NDIS funding can’t replace or add to money you’d usually earn from working, or income payments you get from the Centrelink. by
For more information and resources on income support, check out income support payments 1982such as the Disability Support Pension. ActIf you are interested in getting help to find a job, check out Disability Employment Services or NDIS-funded Work and study supports.
Is the support likely to cause harm?We can’t fund any supports that are likely to either:101 Information
cause harm to you of
be a risk to other people.
We need to consider this for all supports, such as support workers, therapies or equipment. Freedom It also means we won’t fund supports that involve a regulated restricted practice, such as the restraint, unless it follows the requirements of the NDIS Quality and Safeguards Commission. under To help us decide if the support is likely to cause harm, we may need information from a professional. 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 releasedsafe for you to use. Of course everything we do in life comes with some risk. We all make our own choices about was how much risk we want to take in our lives. You should also be able to choose how much risk you want to take in your life. document
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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 yourown choices wherever possible. Agency
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 Insurance
safe for you
safe for other people. Disability
You and your provider will also need to manage any risks of harm that arise. For more information, contact the NDIS Quality and Safeguards Commission.Is the support related to your disability? National We can’t fund a support if it’s not related to your disability.102 This means there must be a the direct link or a connection between your disability and the supports we fund. by
We look at whether the support addresses your disability support needs. Your disability 1982 support needs are those that arise from, or are caused by, your disability.
Act
For example, we wouldn’t usually fund things like:
standard televisions
standard household furniture such as dining chairs Information
upgrades to assistive technology and home modifications that are not related to of
disability needs, such as marble tiling or leather materials
flights to go on a holiday a car to get to work because there are no public transport options Freedom
the a gym membership to get fit
a swimming pool to relax in summer. under
This is because you’re unlikely to need these supports as a result of your disability support needs. 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 released support needs. Having a disability doesn’t usually affect whether someone needs or wants wasthese types of things.
Example
Alan needs some changes to his house, so he can use his bathroom and kitchen in his documentwheelchair. He also wants to set up an outdoor entertainment area for when his friends visit.
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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 Agency 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 Insurance would like so he can have his friends over for a barbecue.
Is the support related to a ‘day-to-day living cost’?We can’t fund supports related to day-to-day living costs that everyone has to pay, and aren’t Disability caused by or result from your disability support needs.103 This means we don’t fund things
like: National rent
the groceries
by utilities such as electricity, water, gas and internet bills
the general cost of owning a home, like renovations, mortgage repayments, repairs 1982
and maintenance. Act In some situations, we can fund supports related to your day-to-day living costs. We can do 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: Information you have additional living costs that are solely and directly as a result of your disability
of support needs105
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 Freedom the under released was document
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Example
Nigel has a goal to do his grocery shopping on his own. He needs a shopping basket to Agencyattach 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. But Nigel only needs this specialised basket for his wheelchair because of his disabilitysupport needs. Insurance
If it meets the other NDIS funding criteria, we may fund the shopping basket attachment in his plan. DisabilityDoes 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 National For example, if we’re providing support through your early childhood partner or local area the coordinator, we usually won’t fund Support Coordination in your plan. by This is because your early childhood partner or local area coordinator is already funded to provide similar supports. If we funded the same Support Coordination, we would be 1982 duplicating a support we’re already providing you as general supports. Act However if you need extra support, we may be able to fund additional Support Coordination in your plan. We may do this if it’s above the amount of support your early childhood partner or local area coordinator are able to provide. Your early childhood partner or local areacoordinator will work together with the Support Coordinator to help you connect with Information supports in your community. of
Does the support meet the reasonable and necessary criteria?All NDIS supports need to meet all the reasonable and necessary criteria.108 Freedom This means that before we can include an NDIS support in your plan, we need to be satisfied the
it meets all the following criteria:
support will assist you to pursue your goals in your plan.109 under The
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, released by reducing the disability-related barriers that prevent you from participating in things
such as social outings, recreation, work and study. was document
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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 supports.111 This means we need to consider the costs and benefits of the support, as Agency
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 current good practice.112 This means we consider if there is evidence the support Insurance 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 Disability accepted to suit someone with your disability support needs.113 We also consider your
lived experience.
The funding of the support takes account of what it is reasonable to expect families, National
carers, informal networks and the community to provide.114 This means we need to the consider what support is reasonable for your family, friends and community to by provide.
The support is most appropriately funded or provided through the NDIS, and is not 1982
more appropriately funded or provided through:115
Act
-
other general systems of service delivery, or support services offered by a person, agency or body (for example, a State or Territory Statutory Scheme)
- systems of service delivery or support services offered as part of a universal service obligation (for example, the health or education system) Information
of - systems of service delivery or support services offered in accordance with
reasonable adjustments required under discrimination laws (for example, your employer, or the health or education system). FreedomThe law for the NDIS sets out things that we need to consider when we apply the reasonable and necessary criteria.116 the
We must be satisfied that each support is reasonable and necessary individually, but we undermust also be satisfied that the supports are reasonable and necessary as a package of supports.117
For example, a home modification may reduce your need for other supports. If we plan to releasedfund 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 was you need at home.
If the home modification will reduce your care needs, we may need to reduce the amount of care we fund, as a higher amount may not be reasonable and necessary when the whole documentpackage of supports is considered.
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Does the support help you pursue your goals?
We need to be satisfied that the support will help you pursue the goals, objectives and Agencyaspirations in your NDIS plan.118 This helps us determine if the support is necessary.119
While we only fund supports that help you pursue your goals, objectives and aspirations, we understand that different people express themselves in different ways. InsuranceYou are free to choose your own goals and express them in your own words.
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. Disability You 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’. National Learn more about setting your goals in Creating Your Plan and the Setting Goals fact sheet. the Reasonable and necessary supports should help you pursue your goals,120 but you don’t by need a specific goal for every support in your plan. When we decide if a support will help you pursue your goals, we consider your whole situation. 1982 We look at how a support will address your disability support needs, and the disability Act specific barriers that prevent you from pursuing your goals.
A support that addresses your disability related support needs is most likely to help you pursue your goals, objectives and aspirations in your plan. Information Setting a goal in your plan doesn’t mean we’ll provide funding to pursue it. For example: of setting more and bigger goals doesn’t mean we have an obligation to fund more and
bigger funded supports in your plan setting a goal doesn’t mean we have an obligation to fund supports that help you Freedom
pursue that goal the setting a goal about an explicit type or amount of support you might want doesn’t mean we’ll fund that support or in that amount. under
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 allsupports that help you to pursue your goals will be reasonable and necessary supports. released For example, we only fund reasonable and necessary supports that are value for money,121 was 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 address your disability related needs. However, we won’t fund supports related to day-to document
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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 AgencyAlso, choosing a different goal ‘to have a more accessible home’ won’t change the supports we could fund in your plan.
Achieving goals usually takes many different kinds of supports. NDIS supports will mostlikely be just one kind of support that helps you work toward your goals. Insurance
Learn more about setting goals.
Example Disability
Morgan is ready to look for work and she has a goal in her plan to get a job. She has built up her 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. National However, because of her disability, Morgan will need personal care supports to help her get the up and ready for work in the morning. We will consider: by
how Morgan’s disability support needs relate to her goals 1982 whether funding supports that address these disability support needs will help Morgan
pursue her goals. Act
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.
However, Morgan’s planner then needs to look at whether the support meets the other NDIS Information funding criteria. of We don’t fund all the supports that relate to Morgan’s employment goals. We only fund the supports we consider are reasonable and necessary – that is, when they meet all the NDIS funding criteria. Freedom Does the support help you do activities that will help your social and economic the participation? We need to be satisfied that the support will help you to do activities, which make it easier for under you to participate socially and economically.125
Social participation means doing things you enjoy, like going out with friends, playing sport orgoing on holiday. It also means doing the things you need to do, like going to school or released medical appointments. was Economic participation usually means being involved in things that help you work towards getting 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. document
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Social and economic participation are important to most people. They are critical to living an ordinary life. AgencyTo work out if a support meets this requirement, we look at the purpose of the support and how it will help you.
We fund reasonable and necessary supports that reduce the barriers that prevent you fromundertaking activities. This will help you increase your social and economic participation. Insurance
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. Disability
Other supports help you to undertake activities like self-care, which indirectly help your economic and social participation. National
Example
the Sue is going to university next year. She has a vision impairment, and has been working with by her Guide Dog Mobility Instructor to decide if a dog guide is right for her. A dog guide can help her leave her home safely and independently, and travel to and from university. 1982 A dog guide could also help her go out with friends and join in other community activities. As Act long as it meets the other funding criteria, we could fund a dog guide for Sue. It will help her to undertake activities of daily living.
As a result, it’ll increase her social and economic participation. For example, the support will help her get to her university so she can study, and will help her social life. Information Is the support value for money? of
All supports we fund under the NDIS need to be value for money.126 This means the cost of the support is reasonable, when we consider the benefits of the support and the cost of other Freedomsupports. theMaking sure that your supports are value for money is one of the ways we keep the NDIS financially sustainable. This means we make careful decisions about funding so that wemake sure the NDIS exists for future generations. It’s also one of our principles.127 under
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 released
means there should be a real or material difference in cost was if there’s evidence that the support will substantially improve your life stage outcomes and benefit you in the long term129
if the support will likely reduce the cost of other supports over time130 document
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how the cost compares to other supports of the same kind in your area131
if the support will make you more independent, and mean you won’t need as many Agency supports in future,132 for example, in some circumstances [home modifications](/library/documents/bc455e3f7247-foi-24-25-0515-documents/document-008__home-modifications/) may
reduce the need for home care.
When we consider the likely cost of supports, we consider the cost over the long term. Weconsider if the support will help you to achieve milestones at different ages or stages of your Insurance life, and have long term benefits.
For example, some supports such as home modifications may be expensive now, comparedto other supports. But getting these supports now may mean you need much less support in Disability a few years, or later in life. Or, it may delay the need for other more costly supports.133
When we determine the cost of the support, we consider: National the prices for NDIS supports in the NDIS Price Guide the
supports suggested by the Typical Support Package by
quotes for specific or high risk supports. 1982
It’s important we consider the cost of the support. This will be the level of funding we include Actin your plan, if we decide the support is reasonable and necessary.
When we fund equipment or modifications, we also need to consider:134
how the cost of buying the equipment or modifications compares against the cost of renting them Information
if it’s appropriate to fund the equipment or modifications you want, based on your of
circumstances and any expected changes in technology.
Learn more about how we consider value for money when we fund assistive technology, Freedomhome modifications and vehicle modifications. theExample
Elias needs a shower commode. under He got an assessment and sent us a quote for one that will suit his needs. As part of the process to work out if we can fund it, his planner considers other similar shower commodes.There’s a second commode that’s $5,000 cheaper than the one Elias has asked for. But it released won’t meet Elias’ needs, as it won’t provide enough back support. That is, it won’t achieve wasthe 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. document
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Elias’ planner decides to fund the commode that’s $1,000 cheaper. It’ll deliver the same result at a substantially lower cost. AgencyIs the support effective and beneficial?
We need to be satisfied that the support will be, or is likely to be, effective and beneficial, when we consider current good practice. InsuranceWe need to work out if the support is likely to be both:
effective – it will do what you need it to do135
beneficial – the support will help you do things you can’t otherwise do and meets Disability
your support needs.136
It can also be effective and beneficial if it will help you maintain your current level offunctioning. That is, it will help you keep doing the things you can currently do. And, it’ll help National you maintain your work, study and social life as much as you can.137 the When we decide if a support is effective and beneficial, we look at what is current good by
practice. This means we look at whether there is evidence that the support works for
someone with similar disability support needs to you. We won’t need an expert opinion or 1982
report for every support, as we can often rely on other evidence. Act For example:
We may have information already about whether the support is widely accepted to
suit someone with your disability support needs.138 For example, we could rely on Information academic research and other literature. This could include university studies on
of therapies that have been published and refereed in academic journals, evidence based practice resources, or clinical practice guidelines.
If you or other participants have used the support before, we can consider your Freedom
experience using the support and the experience of your family members and the carers.139
We may consider things we have learnt from other participants in the NDIS with under 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 can. released For example, we will talk to you about any supports that have helped you do things you can’t wasotherwise do. Or, some supports may have helped maintain your ability to be as independent as possible. document
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If 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 youneed it to. Agency
Your evidence can be particularly useful when it’s consistent with other evidence, or if we don’t have expert evidence.We will look at the opinions held by the majority of experts and what they generally agree Insurance 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. Disability
Example
Vivek is 12 and has a goal to improve his communication skills. He and his family want him National to improve his social skills with the kids in his class. the When he was younger, Vivek’s family tried speech therapy, and believe it really helped him by improve his communication. His family told his planner about how it helped Vivek learn how to respond to different social settings. 1982 Vivek’s speech therapist also believes it could work well for him now, and help him interact Act with his classmates.
When deciding whether the therapy is effective and beneficial, Vivek’s planner will consider:
how speech therapy has assisted Vivek in the past, including first-hand information Information from Vivek, his family members and carers
of the views of his speech therapist on the effectiveness and benefits of speech therapy for Vivek
other information or expert evidence about the effectiveness and benefits of speech Freedom
therapy, including for a child of the same age, and with the same impairments and the functional capacity.
Based on this information and evidence, Vivek’s planner decides the speech therapy is under effective and beneficial. If it meets the other funding criteria, we will be able to fund speech therapy in Vivek’s plan. released was document
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Is the support something we would reasonably expect your informal supports, like family or friends, to provide? AgencyWe 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
To make sure we understand how disability supports might work for you, we consider: Insurance 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. Disability 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 an ordinary person would think is reasonable to expect friends, family or the community to National provide for you.144 the Informal supports are the help and support you get from friends, family and the community. by They are called ‘informal’ because you don’t pay for them, and they’re not part of a formal agreement. They are the usual things friends and family do for us, and with us. 1982 Most of us get some kind of help and support from friends and family. In our society, we Act expect that friends, family and our community will support each other and help each other 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, Information make sure they are safe and drive them around places. of
Grandparents, uncles and aunties often have a role to play in supporting young children as well. Neighbours and friends might also help care for the child. FreedomAs 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 the learning needs.
We also usually expect the role of family in providing personal care for a child would reduce under
as they get older and develop new skills and independence. But families are usually still responsible for things like food, emotional support, decision-making and providing a safehome. released
It’s a similar idea for adults. Our society expects that adults – like family, friends and was neighbours – will provide some support to each other. This might be things like taking a friend with you to the football game, or providing emotional support if someone is upset. document
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NDIS 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. Agency
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 and families become your paid carers. Insurance To make sure we understand how disability supports might complement your circumstances,
we consider: the things you are able to do for yourself Disability
any support you have from others in your network including family members, relatives, friends and local community services. National We also have to consider the benefits you may get from your informal supports. For theexample, your family and friends may be more effective at helping you meet other people, or byhelping 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 1982 example, we may be able to fund training for your informal supports, so they can help you Actbuild your skills.
We also think about the capacity of your informal supports to continue caring for you, for example if they’re ageing or sick.There are different things the law for the NDIS says we need to consider for adults and Information children. of
If you’re under 18, we consider what support is reasonable to expect parents to provide at your age. It’s normal for parents to provide substantial care and support for children.147 Weconsider that it’s usual for parents to provide almost all the care and support that young Freedom children need. the For 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 under disability would typically reduce as they get older.
For children under 18, we consider: released if your needs are ‘substantially greater’ because of your disability, compared to other
children the same age148 – that is, you need much more disability support was any risks to the wellbeing of people providing informal support to you149
if including funding for the support will help build your skills and capacity in the future, or reduce any risks to you.150 document
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For example, we consider any health, safety or other impacts resulting from what’s involved in meeting your disability support needs. AgencyIf you’re over 18, we consider:
if there are any risks to you or your informal supports if you rely on them to provide
the support you need151 Insurance how much your informal supports would help improve or reduce your independence
and other outcomes152
We also consider the suitability of informal supports to provide the supports you need,153 Disability including:
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 National
caring role155 the
the intensity and type of support you need, and if it’s appropriate for your informal by
supports to provide this, based on their age and gender156 1982 any long-term risks to the wellbeing of your informal supports.157
Act
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.For example, we wouldn’t expect a child to have their schooling affected because they need Information to provide care. We also wouldn’t expect an elderly parent to be responsible for physical of activities, if it may result in injury.158
We generally don’t fund family members to provide supports funded under the NDIS. Thereare very limited situations where we can consider this. Learn more about Sustaining Informal Freedom Supports. the Example 1
Simon is getting his first NDIS plan. For the last 15 years, Simon and his wife Jan’s under
preference was that Jan provide all the physical support he needs at home, such as toileting and showering. releasedBut 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. was Jan and Simon think it might be best for someone else to provide the personal care support that Simon needs. Their children have moved out of home, and it’s not reasonable to expect them to help Simon with personal care. document
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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 andothers to provide. If the personal care support meets the other funding criteria, we may fund Agency the personal care support for Simon.
Simon and Jan still prefer Jan to do the other support Simon needs though, such as helping Simon eat his meals. At this time, we wouldn’t fund a support worker in Simon’s plan to help Insurance 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.
Example 2 Disability
Qing is 14 and wants to join a local footy club. Like most 14 year old’s in this situation, she needs someone to drop her off and pick her up from the Saturday matches and theweeknight training sessions. National But unlike most 14 year old’s, she needs someone to help her get dressed before she can the go to the match. Her parents have been doing this, but as Qing is getting older she no longer by wants her family to help her get dressed. 1982It’s reasonable to expect her family or other informal supports to drop Qing to and from the match and training sessions. So we wouldn’t fund transport in Qing’s plan. Act
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 support takes into account what is reasonable for family and others to provide. If it meets the Information other funding criteria, we may fund personal care support in her plan. of Is the support more appropriately funded or provided through the NDIS, and not through other service systems or support services?We have to be satisfied that the support is most appropriately funded or provided through the Freedom NDIS. This means it’s not more appropriately funded or provided through: the other general systems of service delivery, or support services offered by a person, agency or body (such as a State or Territory Statutory Scheme) under systems of service delivery or support services offered as part of a universal service
obligation (such as the health or education system) released systems of service delivery or support services offered in accordance with reasonable
adjustments required under discrimination laws (such as your employer, or the health was or education system).159
In short, we won’t fund the support if it should be provided by someone else. document
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We won’t fund the support if the support should be provided by someone else, even if the other service system doesn’t actually provide it. We’re not the funder of last resort, so wedon’t make up for other organisations and systems that don’t provide the supports they Agency should.
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 Insurance consider for the following service systems:
(a) Health (b) Mental health Disability
(c) Child protection and family support
(d) Early childhood development National (e) School education the (f) Higher education and vocational education and training by
(g) Employment 1982 (h) Housing and community infrastructure
Act
(i) Transport
(j) Justice.
How does the NDIS work with other government services? Information We call supports provided by other government services, including those provided as part of of a universal service obligation, ‘mainstream supports’. When we talk about mainstream supports, we mean supports available to everyone in your state or territory, or across Australia, regardless of whether or not you have a disability. Freedom This includes services provided by state and federal governments, like health care, the education and mental health services.
You have the same right as all Australians to access these services. There are certain things under 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 to work or study. released When 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 was health system.161 Under the law for the NDIS, we can’t fund supports that should be provided by a mainstream service. document
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The Australian federal, state and territory governments agreed on responsibilities for funding different types of supports. The law for the NDIS has an outline of funding responsibilitiesand were developed with the agreement of each State and Territory.162 Agency
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 or provide the support. The law for the NDIS sets out the matters we should consider when we Insurance decide who is more appropriate to provide or fund a support.163
Learn more about how we decide if the support is best funded or provided by us or another part of government. Disability 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 National funded by the NDIS.164 the What is reasonable adjustment and why is it important? by
People with a disability can sometimes face barriers that make it harder to do the same 1982things 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 Act people.
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. Information of This means organisations or people who are responsible for providing these services have to make what are called ‘reasonable adjustments’. They have to make sure people with a disability have equal access to the services they provide, as far as is reasonable. Freedom They have to do reasonable things that will make their services equally available to theeveryone, whether or not you have a disability.
Reasonable adjustments do not mean they have to provide everything you need because of underyour 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 can afford to do and what is reasonable to expect them to provide in the circumstances. released 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 was support if it should be provided by someone else through reasonable adjustments. document
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What if you’re transitioning to the NDIS in Western Australia?
The federal and Western Australian governments made a commitment for people receiving Agency supports before becoming a participant in the NDIS.
They committed that you shouldn’t be disadvantaged by your transition to the NDIS. We call this the ‘principle of no disadvantage’. Insurance 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 get supports in the same way. Disability 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.
If we can’t fund those supports, we’ll see how we can help you meet the same outcomes as National you did before the NDIS. the This may mean we include other supports in your plan that address your disability support by 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. 1982 When we create your plan, we consider whether or not you’re disadvantaged overall by Act joining the NDIS.
What else do you need to know about working out if supports meet the NDIS funding criteria? Information From our experience, we learned there are some common misunderstandings about how we of work out what supports meet the NDIS funding criteria.
Why don’t we always fund what your health professionals recommend? Freedom Although we take expert opinions into account, we can’t and don’t always fund everything your health professional might recommend. This is because every support we fund needs to the meet all the NDIS funding criteria. underFor 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. releasedThis is because it won’t be value for money. We may be able to fund the cheaper option instead if it meets all the NDIS funding criteria. was 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 in your plan based on how we use the NDIS funding criteria at that point in time. document
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Your needs and situation will most likely change over time. This means it’s likely your NDIS supports and funding for those supports will change over time. AgencyFor example, we may have funded supports to help you build your skills in a particular area. 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.Supports to build your skills may have met the NDIS funding criteria before, but the same Insurance supports might not meet the criteria in future.
Or, your disability support needs might increase or decrease over time. This may mean weconsider funding more or less supports as a result. Disability
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 National meet the NDIS funding criteria in your next plans. the If you haven’t used all the funding by the end of your plan, it doesn’t mean we’ll reduce the by funding in your next plan. There may be very good reasons why you weren’t able to buy the supports we funded. 1982 When we reassess your plan, we’ll talk about any problems you had buying the supports Act funded in your plan. We’ll also see how we can help you use your funding if we need to.
But 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. Forexample, they may not be ‘effective and beneficial’ for you if you’re not actually using them. Information We will talk to you about this when we reassess your plan. of
Learn more about changing your plan Step 3: How do we include the reasonable and necessary Freedom supports in your plan? the
Once we’ve identified the supports, and decided they meet the NDIS funding criteria, we can under 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 plan. We may consider if a differently described support meets the NDIS funding criteria released instead. wasWhen we approve your plan we will also make sure all your supports are reasonable and necessary when considered as a package of supports.167 document
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Sometimes you might not need any supports under the NDIS. For example, your informal supports may meet all your disability support needs. If so, we’ll approve a plan with nofunded supports. Agency
Learn more about how we create and approve your plan.
Learn more about using the funding in your plan. Insurance What happens if we don’t include the supports you want?
If we decide a support doesn’t meet the NDIS funding criteria, we can’t include the support inyour plan. Also, if the amount of support you want doesn’t meet the criteria, we can’t include Disability that amount in your plan.
But, we’re committed to our principles and helping you live an ordinary life. Even if we can’tfund a particular support we may still be able to help. National If the support doesn’t meet the NDIS funding criteria, we can consider if a different support the meets the NDIS funding criteria. We might be able to consider describing the support by differently, or funding a different type of support. 1982 Or, we may be able to connect you to mainstream or community supports that can help. Mainstream and community supports are available to everyone. They can be a good way to Act 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 can do this at any time. We may be able to help before we approve your plan. Information We’ll give you the reasons for our decision to approve your plan in writing.168 You can of contact us if you’d like more detail about the reasons for our decision.
If you don’t agree with the supports we approve in your plan, you can ask for an internal review of our decision.169 You’ll need to ask for an internal review within 3 months of getting Freedom your plan.170 171Learn more about internal and external review of decisions. the under released was document
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Reference List
Agency
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).5 Insurance NDIS Act s 34(1)(c). 6 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 Disability NDIS Act s 34(1)(f).
11 NDIS Act s 34(1)(f). 12 NDIS (Supports for Participants) Rules part 5. 13 NDIS (Supports for Participants) Rules r 5.1(a).14 NDIS (Supports for Participants) Rules r 5.1(b). National 15 NDIS (Supports for Participants) Rules r 5.1(c). 16 NDIS (Supports for Participants) Rules r 5.1(d). the 17 NDIS (Supports for Participants) Rules r 5.3(a). by 18 NDIS (Supports for Participants) Rules r 5.3(b). 19 NDIS Act s 34(1)(f).20 NDIS Act s 118(1)(b). 1982 21 NDIS Act s 4(17). 22 NDIS Act s 33(2). Act 23 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. Information 29 NDIS Act s 34(1)(c); NDIS (Supports for Participants) Rules r 3.1.
30 of 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. 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) Freedom Rules and NDIS (Plan Management) Rules. 35 NDIS Act ss 33(2)(b), 34; NDIS (Supports for Participants) Rules. the 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). under 39 NDIS (Supports for Participants) Rules r 2.4; NDIS Act s 33(5)(c). 40 NDIS Act ss 4, 31. 41 NDIS Act s 4(1). 42 NDIS Act s 4(2).43 NDIS Act s 4(4). released 44 NDIS Act s 4(8). 45 NDIS Act s 4(10). was 46 NDIS Act s 4(17). 47 NDIS Act s 4(11). 48 NDIS Act s 33(5)(a); NDIS (Supports for Participants) Rules r 4.1(a). 49 NDIS (Supports for Participants) Rules r 4.1(a). 50 NDIS (Supports for Participants) Rules r 4.1(b). document
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51 NDIS (Supports for Participants) Rules rr 4.1(b), (d). 52 NDIS (Supports for Participants) Rules r 4.1(c).53 NDIS Act s 33(5)(b). Agency 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). Insurance 59 NDIS Act s 34(1)(a). 60 NDIS Act s 34(1)(a). 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). Disability 64 NDIS Act s 33(3). 65 NDIS Act s 33(3); NDIS (Plan Management) Rules r 6.2. 66 NDIS Act s 33(3); (NDIS (Plan Management) Rules r 6.3.
67 NDIS (Plan Management) Rules pt 6.68 National NDIS Act s 46(1).
69
NDIS Act (Plan Management) Rules r 6.4(a). the70 NDIS (Plan Management) Rules r 6.4(b).
71 NDIS (Plan Management) Rules r 6.4(c). by 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). 1982 75 NDIS (Plan Management) Rules r 6.4(f). 76 NDIS (Plan Management) Rules r 6.4(f). Act 77 NDIS (Provider Registration and Practice Standards) Rules r 7(3). 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. Information 83 NDIS (Plan Management) Rules r 6.7. of 84 NDIS (Plan Management) Rules r 6.7. 85 NDIS (Plan Management) Rules r 6.7. 86 NDIS (Plan Management) Rules r 6.5. 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. Freedom 89 NDIS Act s 34(1). 90 NDIS (Supports for Participants) Rules r 5. the 91 NDIS Act ss 33(5)(d), 35(1)(b); NDIS (Supports for Participants) Rules r 5.3(a). 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). under 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).
97 NDIS (Supports for Participants) Rules r 5.3(a).98 released 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). was 101 NDIS (Supports for Participants) Rules r 5.1(a). 102 NDIS (Supports for Participants) Rules r 5.1(b). 103 NDIS (Supports for Participants) Rules r 5.1(d). 104 NDIS (Supports for Participants) Rules r 5.1(d). document
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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). Agency 108 NDIS Act ss 33(5)(c), 34(1). 109 NDIS Act s 34(1)(a). 110 NDIS Act s 34(1)(b). 111 NDIS Act s 34(1)(c). 112 NDIS Act s 34(1)(d). Insurance 113 NDIS (Supports for Participants) Rules r 3.2(a). 114 NDIS Act s 34(1)(e). 115 NDIS Act s 34(1)(f). 116 NDIS (Supports for Participants) Rules pts 3, 4.117 NDIS Act s 33(5)(c). Disability 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).122 National NDIS Act s 34(1)(d).
123
NDIS (Supports for Participants) Rules r 5.1(b). the124 NDIS (Supports for Participants) Rules r 5.1(d).
125 NDIS Act s 34(1)(b). by 126 NDIS Act s 34(1)(c). 127 NDIS Act ss 3(3)(b), 4(17).128 NDIS (Supports for Participants) Rules r 3.1(a). 1982 129 NDIS (Supports for Participants) Rules r 3.1(b). 130 NDIS (Supports for Participants) Rules r 3.1(c). Act 131 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). 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]. Information 137 McCutcheon and NDIA [2015] AATA 624. of 138 NDIS (Supports for Participants) Rules r 3.2(a). 139 NDIS (Supports for Participants) Rules r 3.2(b). 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. Freedom 143 NDIS Act s 34(1)(e). 144 NDIS Act s 34(1)(e). the 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). under 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 released NDIS (Supports for Participants) Rules rr 3.4(b)(i), (ii).
152 NDIS (Supports for Participants) Rules r 3.4(b)(iii). 153 NDIS (Supports for Participants) Rules r 3.4(b)(ii). was 154 NDIS (Supports for Participants) Rules r 3.4(b)(ii). 155 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(A). 156 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(B). 157 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(C). document
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158 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(C). 159 NDIS Act s 34(1)(f).160 NDIS (Supports for Participants) Rules rr 3.5-3.7 and Schedule 1. Agency 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. 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. 165 Disability Discrimination Act 1992 (Cth); Discrimination Act 1991 (ACT); Anti-Discrimination Act 1977 (NSW); Insurance 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).168 NDIS Act s100(1). Disability 169 NDIS Act s100. 170 NDIS Act s100(2).
National
the by 1982
Act
Information
of
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the under released was document
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