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 InsuranceNDIS plan. We call these the NDIS funding criteria. For example, supports need to relate to your disability, be value for money and effective and beneficial. We also need to make sure all supports are most appropriately funded or provided by us. Each support must meet thesecriteria individually, but the supports must also meet the criteria when considered as a Disability package.
Note: when we say ‘your plan’ we mean your NDIS plan. If you’re looking for information Nationalabout your community connections plan, go to Our Guideline – Community Connections. theIf you’re looking for information about your child’s early connections plan, go to Our byGuideline – Early Connections. 1982What’s on this page?
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This page covers:
What principles do we follow to create your plan?
What supports can you get? Information
What other principles do we consider when we decide what supports to include in of
your plan?
How do we decide what reasonable and necessary supports to include in your plan? Step 1: How do we describe a support in your plan? Freedom
the Step 2: How do we work out if an identified and described support meets the NDIS
funding criteria? under Step 3: How do we include the reasonable and necessary supports in your plan?
You may also be interested in: Mainstream Supports released
[Creating Your Plan](/library/documents/09235da91698-25-26-0529-disclosure-log-documents/document-004__creating-your-plan/) was
[Reviewing our decisions](/library/documents/210ccb4f97d1-foi-24-25-2381-disclosure-log-documents/document-007__reviewing-our-decisions/) document
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Would we fund it? Agency
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 disability at the centre of decision-making, through the principles of reasonable and Insurance necessary supports and individual choice and control.
As an insurance-based scheme, we take a lifetime approach to a participant’s support needs. We provide assurance to people with permanent and significant disability or Disability 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 to purchase services and supports from a competitive and consumer-driven marketplace. National What supports can we fund? the byNDIS supports should complement, not replace, other supports available to you. That’s why we consider: 1982
the things you’re able to do for yourself Act
support you have from others in your network, including family members, relatives, friends, local community services and mainstream government services.
One of our aims is to help maximise your independence by working with the localmainstream government and community services that help you live an ordinary life. We all Information do best when we’re connected to our communities. of
And as an active consumer, it’s important you are able to shop for and access providers who meet your needs. We can help you find providers who meet your needs. Freedom Once we’ve considered your circumstances, we need to follow the rules determined under thethe law for the NDIS in our planning decisions.1 We fund supports that are reasonable and necessary. underThis means we will only fund a support if it meets all of the following criteria:
the support is related to your disability2 the support will help you pursue your goals and aspirations3 released
the support will help you undertake activities that will increase your social and was
economic participation4
the support is value for money,5 which means that the costs are reasonable: document
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when compared to the benefits to be achieved, for example, whether purchasing the support is likely to reduce the cost of funding other supports in Agency the long term6
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when compared to alternative options that may provide you with the same outcome at a similar or lower cost7 Insurance the support is likely to be effective and beneficial for you, having regard to good practice and evidence8
the support is required to complement the informal supports you have available, by Disability
considering what is reasonable for families, carers, informal networks and the
community to provide9 the support is most appropriately funded or provided by the NDIS10 National
the 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 by a support if it’s the responsibility of another service system. 1982 What supports don’t we fund? Act We do not fund a support if:12
it is likely to cause harm to you or others13
it is not related to your disability14 Information
it duplicates other supports delivered by the NDIS15 of
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 Freedom needs16
the providing the support would be against the law17
it consists of income replacement18 under
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 other to form a released government safety net. Like all Australians, NDIS participants continue to have access to these systems. We can’t fund a support if it’s the responsibility of another was service. document
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How do we manage the financial sustainability of the NDIS? AgencyThe NDIS is an insurance scheme, and one of our core functions is to manage the financial sustainability of the Scheme.20
When we make decisions about the supports we fund in your plan, we must also considerour need to ensure the financial sustainability of the NDIS.21 This means we must work Insurance within our funding budget, set through agreements between the Australian, and State and Territory governments.It’s also important to know the NDIS is only one part of the broader National Disability Disability Strategy that supports people living with disability. The overall success and sustainability of
the National Disability Strategy relies on: people accessing their informal support network to get the help they need from day- National
to-day the
people using their personal income to pay for their day-to-day living expenses, as is by
expected of all Australians 1982 mainstream and community services being available from state and territory Act governments, and other federal government programs such as Medicare
a fair distribution of NDIS supports to those who need them, provided within our funding budget.Staying within our budget ensures the NDIS will be here to support generations of Information Australians and their families. of
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 Freedom necessary supports you need, and to make sure the Scheme is financially sustainable: the
Fair for everyone, both today and for future generations under Fair funding to pursue your goals
Evidence-based best practice
Fair early investments released
Fair support across service systems was
Fair supports for your disability needs
Fair assistance from multiple programs document
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Fair for everyone, both today and for future generations While we need to consider your individual circumstances and disability needs, we also need Agency to make consistent decisions and treat people fairly.
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 all Insurance participant plans are within the overall NDIS budget set by governments.
Each support in your plan must be reasonable and necessary. They also need to be reasonable and necessary as a package of supports. We approve your whole plan, not the Disability individual supports in your plan in isolation.22 Information about what supports we’d usually include in your plan helps guide this process.This information also helps to guide the consistency of our decision-making process. We use National it to check your overall plan and make sure all your supports make sense together. We’ll the check your support types and amounts will complement each other to help you fulfil an by ordinary life. We may then increase or decrease the funding in your plan based on: 1982
information you share with us 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. Information
of Fair funding to pursue your goals
Goals are important.23 The supports we fund need to help you maximise your independence and pursue your goals.24 This means your supports should help overcome any disability- Freedom specific barriers which may be stopping you from pursuing your goals. the This doesn’t mean we fund all support costs associated with you pursuing your goals. Also, you may have goals and aspirations we can’t fund supports for. This is because helping you underpursue your goals is only one of the NDIS funding criteria, so not all supports that help you to pursue your goals will be reasonable and necessary.
Other things to know about when setting your goals: released
1. Setting more goals or bigger goals doesn’t mean we’ll provide more funding or was fund more supports. For example, if your goal is to live independently in a house
with a swimming pool, we may fund home modifications that address your disability related needs. This might be a home modification to make your bathroom accessible. 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 Agency ‘to have a more accessible bathroom’.
- Setting a goal doesn’t mean we have an obligation to fund supports that help you pursue that goal. For example, if your goal is to get a gym membership to get fit, Insurance we wouldn’t usually fund this. Gym memberships are things that all people, with or
without disability, might want or need.
3. Setting a goal about an explicit type or amount of support you might want Disability doesn’t mean we have an obligation to fund that support or provide that amount
of funding. For example, you may tell us your goal is ‘to get a top model shower commode’ and you show us the one you want costs $4,000. National If there is a shower commode that costs $3,000, and your occupational therapist the confirms this one will meet your needs, we are more likely to fund this one instead by because it is likely to deliver the same result at a lower cost. We may also look at alternatives. 1982 Evidence-based best practice
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We only fund supports that will be, or are likely to be, effective and beneficial for you, having regard to current good practice.25 This means we consider if there is evidence that the support is effective and beneficial for someone with similar disability support needs.For example, we may already have information about whether the support is widely accepted Information to suit someone with your disability support needs.26 The primary source of evidence we rely of on, and give the greatest weight to, is evidence from sources that are reliable and widely recognised. This includes published and refereed literature, and any consensus of expert opinions. If there is no evidence to show a support is reasonable and necessary,27 we won’t Freedom fund the support. the You can find the types of evidence we need on our website, and in Our Guidelines.
Fair early investments under Having access to capacity-building supports early in your NDIS journey is considered to be an early investment. This early investment is intended to help increase your independenceand reduce your reliance on NDIS funding over time. released
This is an important concept we consider when we create your plan, and again at future plan was 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 any of the following: Agency your current functional capacity
the effectiveness of the capacity building supports28 Insurance value for money.29
When we say functional capacity we mean the things you can and can’t do for yourself.
Your overall funding amount could go down from one plan to the next. This may be because Disability 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 your need for other supports may also decrease. For example, as you National develop your skills you may not need as many Core supports. the So other things being equal, you should expect your overall plan value to reduce over time by as the benefits of capacity building are realised. Fair support across service systems 1982 The support you need may be the responsibility of another government service, like Act education or health. We don’t fund these services. We need to think about the supports you should receive from these services when we determine the supports in your plan.
Fair supports for your disability needs Information When we make decisions about which supports we can fund, we consider whether a support of is reasonable and necessary for you and apply the NDIS funding criteria. Sometimes, you might 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 Freedomthe needs that arise from an impairment that meets the same eligibility requirement we consider at Access. the
You don’t need to make a new Access request if you ask for supports to help with animpairment which was not part of your Access eligibility assessment. We’ll work out if you under need the support to address an impairment which would meet our eligibility requirements. We may ask you to provide evidence to help us work this out. We will decide if the requested support is reasonable and necessary. We’ll apply the NDIS funding criteria based on the released impairments which meet our eligibility criteria. was We fund the right disability supports for your permanent impairments which meet our eligibility criteria. By doing this we make sure the system is fair for everyone, and the NDIS remains financially sustainable. document
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Fair assistance from multiple programs NDIS funding can’t duplicate other funding or supports you may receive due to your Agency disability.
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 Insurance another program or insurance scheme, for example Work safe, Lifetime Care and Support or the Transport Accident Commission.
We don’t duplicate this funding, or these supports. We may reduce the total value of your Disability NDIS plan to account for compensation you receive, or we may not fund certain supports.
What supports can you get? National When we create your plan with you, we’ll discuss what supports you need for your disability. the We want to help you pursue your goals, increase your independence, and help you work, by study and join social activities. 1982There 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, Act family, and other people you know can often be your best supports.
We can fund supports you need for your disability if they meet certain criteria. These are called ‘reasonable and necessary supports’. Your plan and supports will be just for you, soyou have more choice and control over how you use them. Information of 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 detail. Freedom We also have a Would we fund it guide. It has examples of how we decide whether we fund thedifferent types of NDIS supports. What supports can you get outside the NDIS? under
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 importantinformation-gathering step. For example, there may be mainstream, community and informal released supports that suit you. was Mainstream supports are other government services such as employment, education, health and family support services. They are often really helpful, and are available to document
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everyone including people without disability. There are many ways they can help you learn new skills or live as independently as possible. Agency Community services offer a wide range of supports that may help with your disability support needs. Community supports are things open to everyone in the community, like sporting clubs, community colleges, activity groups, libraries or community gardens. They Insuranceare often a great way to get involved in your local community, meet new people and learn new skills.
Informal supports, like your family, friends and other people you know in your community, Disabilitycan sometimes be your best supports. They know you and can often help in ways other supports can’t.
Your my NDIS contact or support coordinator will talk with you about what services are National available for you outside the NDIS. We can also help link you with these supports, so you thedon’t have to do it all on your own. by 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 1982 of us. It’s important you get to access them the same as everyone else.
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When it comes time to talk about what reasonable and necessary supports we can fund, you’ll know how mainstream, community and informal supports can help you.
It’s important we gather this information and help you access these services before weconsider what reasonable and necessary supports we can fund. That way, we can help Information make sure you’re able to access mainstream, community and informal supports wherever of possible. This can help you become as independent as possible.
What are reasonable and necessary supports? Freedom An NDIS support is the practical description of how you will be assisted under the NDIS.30 the 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 the under NDIS.
There are two types of NDIS supports we can include in your NDIS plan. We call them ‘general supports’ and ‘reasonable and necessary supports’.31 released General supports was General supports are the coordination, strategic or referral services and activities we provide, or arrange to be provided, for you.32 They’re how we help you develop your NDIS document
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plan and connect with supports and activities in your community. This includes your mainstream, community and informal supports. Learn more in Creating your plan. Agency Reasonable and necessary supports
Reasonable and necessary supports are the supports we fund in your plan to meet your disability support needs.33 You can use this funding to buy supports from service providers. Insurance 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.35 Disability To meet the NDIS funding criteria, a support must meet both the following criteria:36
It must not be a type of support the law says we can’t fund or provide.37 National
It must meet the reasonable and necessary criteria.38 the
We call supports that meet the NDIS funding criteria ‘reasonable and necessary supports’. by
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. 1982
We check your overall plan to make sure all your supports make sense together. This means Act we check that your supports and the amount of supports will complement each other to help you fulfil an ordinary life.39 Learn more about reasonable and necessary supports.
If you need a new support, which now means your overall package of supports doesn’t meet Informationthe NDIS funding criteria anymore, we may either: of not include the new support in your plan
include the new support in your plan, but also reduce the other supports in your plan. FreedomFor 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 the considering what other supports are reasonable and necessary, such as the amount of care you need at home. under
What other principles do we consider when we decidewhat supports to include in your plan? released As far as possible, we have to act according to principles set out in the law for the NDIS.40 was These are the things that guide us when we make decisions about what we fund. document
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These principles don’t override or replace the NDIS funding criteria under the law for the NDIS. They can help us apply the funding criteria, by giving us additional guidance when we Agency decide what supports to approve in your plan.
The principles include the following:
You have the same right as other Australians to realise your potential for physical, Insurance
social, emotional and intellectual development.41
You should be supported to take part in and contribute to social and economic life.42 Disability You should be supported to make choices about planning and how your supports will
be delivered. This includes taking reasonable risks, so that you can pursue your goals.43 National You have the same right as other Australians to decide your own best interests. You the have the right to be an equal partner in decisions that affect your life.44 by Your privacy and dignity should be respected.45 We must make sure the NDIS is financially sustainable.46 1982 The principles also tell us that the reasonable and necessary supports we fund should:47 Act
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 participating citizen Information
develop and support your capacity to do things that help you participate in the of
community and in employment.
Just because a support helps you do these things doesn’t mean we’ll fund it in your plan. All Freedomsupports we fund need to meet all the NDIS funding criteria. theWe consider these principles set out in the law for the NDIS, along with the principles we follow to create your plan. under How do we think about an ordinary life when deciding what supports to include in your plan?To help guide us in our decision making about reasonable and necessary supports, we took released advice from the NDIS Independent Advisory Council. was 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. document
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The Council advised us that all Australians, including people with disability, should have an ‘ordinary life’. They also told us we should think about the idea of an ordinary life when we Agency 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. An ordinary life is one that is typical or usual for everyone in modern day Australia. It’s a life Insurancewhere 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 different cultures and backgrounds. We each have our own values, experiences, beliefs and Disabilitygoals.
But there are some common things that can improve the quality of our lives and help us participate equally. These are the things, such as the following, that make up an ordinary life: National
Positive relationships – with families and informal support networks. the
Individual autonomy – being free and independent, and having the same opportunities by
as people without disability. 1982 Active involvement in decision-making – including the ability to make meaningful decisions, and exercise choice and control. Act
Using your strengths in ways that provide a challenge and enjoyment.
A sense of belonging – to our families, friendship networks, communities, workplaces and society. Information
Active involvement and contribution to society and your community. of
An ‘ordinary life’ in the context of the NDIS involves supporting you to:
have and maintain good relationships Freedom
belong and participate in your community the
be involved in making choices about your own life. underOne way we can help you have an ordinary life is to support you to access mainstream,
community or informal supports wherever possible. These are the usual supports that everyone in the community uses. released When we fund reasonable and necessary supports under the NDIS, we need to make sure they meet the NDIS funding criteria. was document
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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 Agency how the supports will best help you to live an ordinary life.
How do we decide what reasonable and necessary Insurance supports to include in your plan?
What information do we consider to work out what reasonable and Disabilitynecessary supports to fund in your plan?
The most important information we gather about what supports to include in your plan comes from you. National When we create your plan, we will talk with you about: the
your goals and aspirations48 by
your strengths, capacity and individual circumstances49 1982
any barriers, limitations and restrictions you face in undertaking activities or things Act
that stop you from living an ‘ordinary life’50
your disability support needs51
any risks and safeguards we may need to think about when considering your support needs.52 Information
of We use this information to create your plan with you. Generally, we’ll discuss this information before you become an NDIS participant. We’ll continue to discuss it when we check-in with you once you have your plan. Learn more about check-ins in Our Guideline – Your plan. Freedom We want to get a good understanding of your disability support needs. We know you’re the theexpert in your own life, and we use your lived experience as much as we can. When we ask for information from you, we encourage you to involve anyone you want to help you give usthis information. under
We’ll also think about other information we have such as medical or therapy reports, or assessments you’ve had.53 released We look at different types of evidence for different types of supports. We may need a report or assessment from your doctor or health professional who specialises in helping you was manage your disability. document
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Reports and assessments may tell us why you need the support and how the support relates to your disability support needs. For example, an occupational therapist may send us a letter Agency about why you need a specific type of wheelchair.
When we create a new plan for you during a reassessment we think about the supports in your current plan. We’ll check if you need any changes to these supports to help you pursue Insuranceyour goals in your next plan. We use information from your providers to let us know how the supports they are providing have helped you work towards your goals.
We’ll look at the evidence we get to make sure we have enough information to decide if the Disabilitysupport meets the NDIS funding criteria. Sometimes we may ask for further information and assessments, if we need them to help us work out your support needs when we approve your plan.54 National Learn more about the types of evidence we can use when we create your plan. the To help us work out what supports to consider for people aged 9 years and older we also by use a ‘Typical Support Package’. 55 We worked with people with disability, professionals and subject matter experts to develop the Typical Support Package. 1982 It helps us work out the types of supports we’d usually expect to include in your plan. It’s Act based on your situation and support needs.
We then amend the supports suggested by the Typical Support Package to include more, less or different supports if we need to. We may adjust the funding for those supports up ordown based on our discussion with you, the information you share with us Information any reports or other information we have, and when we apply the NDIS funding criteria. of
For children younger than 9, we consider the child’s current functioning across development areas when we work out the reasonable and necessary supports that should be funded in a Freedomchild’s NDIS plan. Learn more about the Early Childhood Early Intervention approach. theHow do we consider your goals when we work out your reasonable and necessary supports? underBefore we create your plan, we’ll discuss your current goals and personal details, including things like your living arrangements and current supports. We’ll include this information in your plan.56 Your goals are your own personal desires about what you’d like to do. released You can set any goals you like, even if they’re about things we won’t fund supports for. You can also change your goals at any time.57 We consider how your funded supports will help was you pursue your goals when we decide to approve your plan.58 document
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Reasonable 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 Agency 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. Insurance There are some things to remember when setting goals:
Setting more and bigger goals doesn’t mean we’ll fund more and bigger funded supports. Disability Setting a goal doesn’t mean we have an obligation to fund supports that help you pursue that goal. National 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. the by This is because helping you pursue your goals is only one of the NDIS funding criteria.60 A support must meet all of the NDIS funding criteria to be funded under the NDIS. So not all 1982 supports that help you to pursue your goals will be reasonable and necessary supports.
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Learn more about setting your goals and how we consider your goals under the NDIS funding criteria.
What if your plan needs to change? Information If it’s not your first plan, we also consider how well the supports funded in your previous of plans worked for you.61 This means we’ll ask about how your current plan has worked for you. We look at the supports in your current plan and see whether any changes need to be made to these to help you pursue your goals in your next plan. Freedom This will help us decide whether these supports continue to meet your needs and the NDIS thefunding criteria. Learn more about changing your plan. How do we use the information we have to work out what reasonable and under necessary supports to fund?
We consider all the information we have gathered to decide what reasonable and necessary releasedsupports to fund in your plan. We use the information you give us and follow the steps below: was document
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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 Agency (known as ‘stated supports’ or ‘fixed’ supports).62
Step 2: Work out if the support identified and described meets the NDIS funding criteria. Insurance Step 3: We include the supports that meet the NDIS funding criteria in your plan.
When we approve your plan we make sure all your supports meet the NDIS funding criteriaindividually and as a package of supports.63 Disability
Step 1: How do we describe the types of supports in your Nationalplan? the Sometimes we need to describe a specific support to be included in your plan. Or we might by include funding more generally within a support category64. Where we have included funding in a support category, you can generally choose which supports you buy from that category 1982 to meet your disability-related support needs.
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Supports we describe generally or specifically must meet the NDIS funding criteria.
We look at all the evidence of your support needs to help us identify what supports to
consider in your plan. We use: the information you give us when you apply for the NDIS, during a check-in or when Information
you contact us of
any assessments or other information we have
For reassessments we’ll look at the supports in your previous plan and check how well they Freedom are working for you. For your first plan we use the Typical Support Package to think about thewhat supports we’d usually expect to include in your plan based on your situation and disability support needs. under When we say support we mean funding for a service, item or equipment you need to help with your disability support needs.
We think about: released
what the outcome of the support will be was
how the support helps with your disability
whether the support meets the NDIS funding criteria. document
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whether we need to specifically describe the supports in your plan. Agency
How do we describe support in your plan?
We divide your supports into 4 different budgets:
Core supports Insurance
These supports help you with everyday activities, like help to take part in activities in the community. This budget is mostly flexible so you can use funding from one support category to pay for something in another support category. Disability Capacity building supports
These supports help you build your skills and increase your independence and reduce National the need for the same level of support in the future. Your progress and outcomes from
these supports will be shared at each plan reassessment. Capacity building supports the are stated so you won’t be able to use funding from one support category to pay for by
something in another support category. 1982 Capital supports
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Includes high-cost assistive technology, equipment, vehicle modifications, home modifications and specialist disability accommodation. Capital supports are stated. You can only use this funding to buy approved individual supports in this support category. Information
Recurring supports of
These supports are paid by us on a regular basis, so you don’t need to claim for these. Your funding for your recurring supports will be paid regularly to your nominated bank account. This funding is not included anywhere else in your budget Freedom and includes mainly transport supports. the Each budget is divided into a number of support categories. Support categories have more detail about what supports you can buy with your funding. We can describe the support under categories in your plan as one of the following:
Flexible: Under the law for the NDIS, this is when we describe supports in a category generally. You have greater flexibility over what disability supports you can buy within released the description of the support. When we describe your support categories as flexible, you can usually choose what supports you buy within the descriptions for each was support category. document
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Stated: Under the law for the NDIS, this is when we describe the supports in a support category specifically. It means you must buy supports in the way we have Agency described in your plan.65 We sometimes call this a fixed support in your plan.
You must act according to your plan, and buy supports according to how we described them in your plan. This means you can’t use the funding in your plan to buy supports that fall Insuranceoutside the description of the support in your plan.66
We describe most support categories as flexible when we can. You have greater flexibility over the support you can buy in your flexible budgets. When support categories are Disabilitydescribed as stated, you have less flexibility.
If we describe a support category as stated, you must use the funding in your plan to buy the supports exactly how we describe them. This includes how the support is provided. For National example, we will sometimes require the support to be provided: the
by a particular service provider by
by a particular qualified person 1982
through a particular delivery mode or method, or in a special way.
Act
Your Core supports budget is the most flexible. You can usually use your funding across all the support categories 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 When we decide whether to describe supports as stated or flexible, we think about:
how much the support costs67 if the support will help reduce the cost of other supports over time,68 for example Freedom
providing more supports early so you don’t need as many supports later in life the
any risks with supplying the support, for example if the support would create risks to under your health and safety or if it doesn’t comply with state or territory laws69
if you need a particular support to pursue your goals or to use other supports in your plan effectively70 released if you need a specialist support, for example if your support must be delivered by a qualified person, or in a special way71 was
if you are eligible for the NDIS under the early intervention criteria.72 document
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When do we describe supports as stated? AgencyWe usually describe high-cost supports, or supports with more risk, as stated. For example, we might describe supports as stated if you need to use those particular supports to ensure
your health and safety. This includes supports such as: high-cost assistive technology Insurance
complex home modifications
behaviour support, or supports that involve restrictive practices such as restraint Disability
Specialist Disability Accommodation.
We will also check if you were eligible for the NDIS through the early intervention criteria.73 Ifso, we might decide to describe the supports as stated for some types of early intervention National supports.74 If you’re not sure whether you met the disability criteria or the early intervention the criteria, check the letter we sent you when we decided you’re eligible. by Example 1982 John just received his first plan. His plan describes support for assistive technology as flexible, including $2,000 of funding. John can choose what assistive technology to buy with Act this 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. InformationJohn’s plan also has a fixed support for a wheelchair with special features, and funding of of$8,000. John will need to use this funding for the specific wheelchair we listed on his plan. 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? Freedom Sometimes your plan may say who must provide the support. We do this when you need a the certain provider to make sure the supports are delivered safely, or to achieve a certain outcome. under For some supports, you must use an NDIS registered provider. These include:
Specialist Behaviour Support, if the provider will undertake a behaviour support assessment or develop a behaviour support plan75 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/),76 was
either interim or ongoing
Plan Management document
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Specialist Disability Accommodation. You must use registered providers for these supports even if your plan doesn’t say you need Agency to. You must also use registered providers for these supports, even if you self-manage your funding or use a registered plan manager. Learn more about the different plan management options. Insurance For other supports, we’ll decide that the support must be provided by a particular person, provider, or delivered in a certain way.77 We’ll do this if it’s the most efficient and effective way to provide the support. This only happens when: Disability we have an agreement with a particular provider to provide the support78
we decide you must use an NDIS registered provider due to the risks, for example complex home modifications79 National
the you need support from a particular person with specialist qualifications, for example a
health professional80 by
you need support delivered in a certain way.81 1982
Sometimes, we’ll arrange the support ourselves, if it’s more cost effective than getting Act another provider to deliver the support. For example, we may bulk buy a support.82 If so, we will state this in your plan.
What about in-kind supports?We agreed that state and territory governments will keep providing some supports for a Information period of time. We call these ‘in-kind supports’. of
If we fund in-kind supports like specialist school transport or personal care in schools, you will need to use state or territory government providers for these supports. These supports Freedomare most efficiently and effectively provided by state and territory government providers.83 Learn more about Work and study supports. the
For most other in-kind supports, you can choose your provider if you don’t want to use yourin-kind provider anymore. We can let you choose another provider if we consider that the under support isn’t most effectively and efficiently provided by the in-kind provider.
We usually let you choose another provider if: released another provider can give you the same support or level of support as the in-kind provider was
the supports with the new provider still meet the NDIS funding criteria, including that they’re value for money compared to the in-kind support document
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there are no serious risks with changing providers. Learn more about in-kind supports. Agency
Step 2: How do we work out if an identified and describedsupport meets the NDIS funding criteria? Insurance
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.84 Disability
It must meet the reasonable and necessary criteria.85
Each support must be reasonable and necessary individually, but the supports must also be Nationalreasonable and necessary when considered as a package of supports. the What types of supports can’t be funded or provided under the NDIS? by Under the law for
the NDIS, there are things we can’t fund or provide.86 We can’t fund or 1982provide supports that:
are not legal87 Act
are income replacement88
are likely to cause harm to you, or pose a risk to other people89 Information are not related to your disability90
of 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.91 Freedom
duplicate other supports provided by the NDIS under alternative funding.92 the
Is the support legal?
We can’t fund a support if it does not comply with the law.93 This includes both: under
an Australian government law: a law that applies to all of Australia
a State or Territory government law: a law that only applies in your state or territory. released
For example, we won’t be able to fund supports involving: was a restrictive practice where it’s not authorised in your state or territory document
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assistive technology or home modifications that don’t meet Australian laws, such as
State and Territory Acts and Regulations, the National Construction Code, and Agency
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 Insurance supports are legal. We’re not responsible to ensure that all supports in your plan comply with all the relevant legal and administrative requirements. This is your responsibility and your provider’s responsibility. Disability For example, if a support is likely to require the use of a restrictive practice, the provider must be registered with the NDIS Quality and Safeguards Commission.94 It’s the provider’s responsibility to ensure they are registered and comply with the conditions of their National registration. This includes complying with all laws and seeking the necessary theauthorisations.95 by 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 1982 you’re concerned about a provider’s compliance with legal obligations.
Act
Is the support ‘income replacement’?
We don’t fund income support or income replacement.96 This means NDIS funding can’t replace or add to money you’d usually earn from working, or income payments you get fromCentrelink. Information of For more information and resources on income support, check out income support payments such as the Disability Support Pension.
If you are interested in getting help to find a job, check out Disability Employment Services or Freedom NDIS-funded Work and study supports. the Is the support likely to cause harm?
We can’t fund any supports that are likely to either:97 under cause harm to you
be a risk to other people. released
We need to consider this for all supports, such as support workers, therapies or equipment. It also means we won’t fund supports that involve a regulated restricted practice, such as was restraint, unless it follows the requirements of the NDIS Quality and Safeguards Commission. document
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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 Agency wheelchair. If so, we would need a report from an occupational therapist to show that it’ll be safe for you to use.
Of course everything we do in life comes with some risk. We all make our own choices about Insurancehow 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.
So we try to balance this when we decide what we can and can’t fund. We can’t fund things Disabilitythat are likely to cause harm. But we will try and balance this with enabling you to make your own choices wherever possible.
While this is one of the NDIS funding criteria, you also have some responsibilities. It’s still National your responsibility and your provider’s responsibility to ensure the supports we fund are: the
used correctly by
safe for you 1982
safe for other people.
Act
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?We can’t fund a support if it’s not related to your disability.98 This means there must be a Information direct link or a connection between your disability and the supports we fund. of
We look at whether the support addresses your disability support needs. Your disability support needs are those that arise from, or are caused by, your disability. Freedom For example, we wouldn’t usually fund things like: the standard televisions
standard household furniture such as dining chairs under
upgrades to assistive technology and home modifications that are not related to
disability needs, such as marble tiling or leather materials released flights to go on a holiday
was a car to get to work because there are no public transport options
a gym membership to get fit document
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a swimming pool to relax in summer. This is because you’re unlikely to need these supports as a result of your disability support Agency 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 support needs. Having a disability doesn’t usually affect whether someone needs or wants Insurance these types of things.
ExampleAlan needs some changes to his house, so he can use his bathroom and kitchen in his Disability wheelchair. He also wants to set up an outdoor entertainment area for when his friends visit.
We may be able to fund home modifications so he can access areas of his home such as his Nationalbathroom or kitchen. He needs the home modifications because he can’t access those areas due to his disability and needing to use a wheelchair. Alan needs the support because of his the specific disability support needs. by
Alan will need to pay for the outdoor entertainment area, as it’s not related to his disability. 1982He doesn’t need the entertainment area because of his disability. It’s just something he would like so he can have his friends over for a barbecue. Act
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 caused by or result from your disability support needs.99 This means we don’t fund things Information like: of rent
groceries Freedom
utilities such as electricity, water, gas and internet bills the the general cost of owning a home, like renovations, mortgage repayments, repairs and maintenance. under 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.100 This means we may fund supports that relate to day-to-day living costs where either: released
you have additional living costs that are solely and directly as a result of your disability was support needs101
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.102 document
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Example
Nigel has a goal to do his grocery shopping on his own. He needs a shopping basket to Agency attach 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 disability Insurance support needs.
If it meets the other NDIS funding criteria, we may fund the shopping basket attachment in his plan. Disability Does the support duplicate other supports funded through the NDIS?
We can’t fund a support if it duplicates other supports delivered under alternative funding Nationalthrough the NDIS.103 theFor example, if we’re providing support through your early childhood partner or local area bycoordinator, we usually won’t fund Support Coordination in your plan.
This is because your early childhood partner or local area coordinator is already funded to 1982 provide similar supports. If we funded the same Support Coordination, we would be Actduplicating a support we’re already providing you as general supports.
However if you need extra support, we may be able to fund additional Support Coordination 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 area Information coordinator will work together with the Support Coordinator to help you connect with of supports in your community.
Does the support meet the reasonable and necessary criteria? Freedom All NDIS supports need to meet all the reasonable and necessary criteria.104 the This means that before we can include an NDIS support in your plan, we need to be satisfied it meets all the following criteria: under The support will assist you to pursue your goals in your plan.105
The support will assist you to undertake activities, to facilitate your social and economic participation.106 This means the support will help you to undertake activities, released
by reducing the disability-related barriers that prevent you from participating in things was such as social outings, recreation, work and study.
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 Agency supports.107 This means we need to consider the costs and benefits of the support, as well as the costs and benefits of alternative supports.
The support will be, or is likely to be, effective and beneficial for you, having regard to Insurance
current good practice.108 This means we consider if there is evidence the support 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.109 We also consider your
lived experience. National The funding of the support takes account of what it is reasonable to expect families,
carers, informal networks and the community to provide.110 This means we need to the consider what support is reasonable for your family, friends and community to by provide. 1982 The support is most appropriately funded or provided through the NDIS, and is not more appropriately funded or provided through:111 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 Information
service obligation (for example, the health or education system) 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). Freedom The law for the NDIS sets out things that we need to consider when we apply the reasonable the and necessary criteria.112 We must be satisfied that each support is reasonable and necessary individually, but we under must also be satisfied that the supports are reasonable and necessary as a package of supports.113For example, a home modification may reduce your need for other supports. If we plan to released fund a home modification, we will need to take that home modification into account when was considering what other supports are reasonable and necessary, such as the amount of care you need at home. document
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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 Agency package of supports is considered.
Does the support help you pursue your goals?
We need to be satisfied that the support will help you pursue the goals, objectives and Insurance aspirations in your NDIS plan.114 This helps us determine if the support is necessary.115
While we only fund supports that help you pursue your goals, objectives and aspirations, we understand that different people express themselves in different ways. Disability You 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 Nationalabout anything you want to work towards. theYou may express your goals broadly, or you may have specific goals. For example, you may byexpress one of your goals as ‘living independently’. Someone else may express their goal as ‘to have an accessible bathroom’. 1982 Learn more about setting your goals in Creating Your Plan and the Setting Goals fact sheet.
Act
Reasonable and necessary supports should help you pursue your goals,116 but you don’t 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.We look at how a support will address your disability support needs, and the disability Information specific barriers that prevent you from pursuing your goals. of
A support that addresses your disability related support needs is most likely to help you pursue your goals, objectives and aspirations in your plan. Freedom Setting a goal in your plan doesn’t mean we’ll provide funding to pursue it. For example: the setting more and bigger goals doesn’t mean we have an obligation to fund more and bigger funded supports in your plan under setting a goal doesn’t mean we have an obligation to fund supports that help you pursue that goal
setting a goal about an explicit type or amount of support you might want doesn’t released
mean we’ll fund that support or in that amount. was This is because helping you pursue your goals is only one of the NDIS funding criteria. A support must meet all of the NDIS funding criteria to be funded under the NDIS. So not all supports that help you to pursue your goals will be reasonable and necessary supports. document
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For example, we only fund reasonable and necessary supports that are value for money,117 effective and beneficial118 and relate to disability support needs.119 Agency 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 day-living costs like rent or utilities. These costs aren’t incurred solely and directly as a result Insuranceof your disability support needs, so they don’t meet other funding criteria.120
Also, choosing a different goal ‘to have a more accessible home’ won’t change the supports we could fund in your plan. Disability Achieving goals usually takes many different kinds of supports. NDIS supports will most likely be just one kind of support that helps you work toward your goals.Learn more about setting goals. National Example the byMorgan 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 1982Morgan to find work, so we can’t fund this support for Morgan. ActHowever, because of her disability, Morgan will need personal care supports to help her get up and ready for work in the morning. We will consider:
how Morgan’s disability support needs relate to her goals whether funding supports that address these disability support needs will help Morgan Information
pursue her goals. of
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. Freedom However, Morgan’s planner then needs to look at whether the support meets the other NDIS funding criteria. the
We don’t fund all the supports that relate to Morgan’s employment goals. We only fund the undersupports we consider are reasonable and necessary – that is, when they meet all the NDIS funding criteria.
Does the support help you do activities that will help your social and economic releasedparticipation? We need to be satisfied that the support will help you to do activities, which make it easier for was you to participate socially and economically.121 document
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Social participation means doing things you enjoy, like going out with friends, playing sport or going on holiday. It also means doing the things you need to do, like going to school or Agency medical appointments.
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 Insurancetrying work experience. Research tells us that work can lead to health benefits and improve our quality of life. Learn more about the Health Benefits of Good Work.
Social and economic participation are important to most people. They are critical to living an Disabilityordinary life.
To work out if a support meets this requirement, we look at the purpose of the support and how it will help you. National We fund reasonable and necessary supports that reduce the barriers that prevent you from the undertaking activities. This will help you increase your social and economic participation. by 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 and 1982 recreation supports and Work and study supports. Act Other supports help you to undertake activities like self-care, which indirectly help your economic and social participation.
Example Information
Sue is going to university next year. She has a vision impairment, and has been working with of 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.
A dog guide could also help her go out with friends and join in other community activities. As Freedom long as it meets the other funding criteria, we could fund a dog guide for Sue. It will help her theto undertake activities of daily living.
As a result, it’ll increase her social and economic participation. For example, the support will under help her get to her university so she can study, and will help her social life.
Is the support value for money?All supports we fund under the NDIS need to be value for money. This means the cost of the released support is reasonable, when we consider the benefits of the support and the cost of other wassupports. document
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Making 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 we Agency make sure the NDIS exists for future generations. It’s also one of our principles.122
When we decide if the support is value for money, we consider:
if other supports would achieve the same result at a substantially lower cost123 – this Insurance
means there should be a real or material difference in cost
if there’s evidence that the support will substantially improve your life stage outcomes and benefit you in the long term124 Disability if the support will likely reduce the cost of other supports over time125
how the cost compares to other supports of the same kind in your area126 National
if the support will make you more independent, and mean you won’t need as many the
supports in future, for example, in some circumstances home modifications may by reduce the need for home care. When we consider the likely cost of supports, we consider the cost over the long term. We 1982 consider if the support will help you achieve milestones at different ages or stages of your life Act and have long term benefits.
For example, some supports such as home modifications may be expensive now, compared to other supports. But getting these supports now may mean you need much less support in a few years, or later in life. Or, it may delay the need for other more costly supports.127 Information When we determine the cost of the support, we consider: of
the prices for NDIS supports in the NDIS Pricing Arrangements and Price Limits supports suggested by the Typical Support Package Freedom quotes for specific or high risk supports. the It’s important we consider the cost of the support. This will be the level of funding we include in your plan, if we decide the support is reasonable and necessary. under When we fund equipment or modifications, we also need to consider:128
how the cost of buying the equipment or modifications compares against the cost of renting them released
if it’s appropriate to fund the equipment or modifications you want, based on your was
circumstances and any expected changes in technology. document
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Learn more about how we consider value for money when we fund assistive technology, home modifications and vehicle modifications. Agency
Example
Elias needs a shower commode.He got an assessment and sent us a quote for one that will suit his needs. As part of the Insurance 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 itwon’t meet Elias’ needs, as it won’t provide enough back support. That is, it won’t achieve Disability the same result as the one Elias has asked for.
Finally, there’s a third commode that’s $1,000 cheaper. The planner contacts his Nationaloccupational therapist who confirms the cheaper commode will meet Elias’ needs. theElias’ planner decides to fund the commode that’s $1,000 cheaper. It’ll deliver the same byresult at a substantially lower cost.
Is the support effective and beneficial? 1982 We need to be satisfied that the support will be, or is likely to be, effective and beneficial, Act when we consider current good practice.
We need to work out if the support is likely to be both:
effective – it will do what you need it to do129 Information
beneficial – the support will help you do things you can’t otherwise do and meets of
your support needs.130
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 Freedom you maintain your work, study and social life as much as you can.131 the When we decide if a support is effective and beneficial, we look at what is current good practice. This means we look at whether there is evidence that the support works for under someone with similar disability support needs to you. We won’t need an expert opinion or report for every support, as we can often rely on other evidence.
For example: released We may have information already about whether the support is widely accepted to was suit someone with your disability support needs.132 For example, we could rely on academic research and other literature. This could include university studies on document
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therapies that have been published and refereed in academic journals, evidence based practice resources, or clinical practice guidelines. Agency If you or other participants have used the support before, we can consider your experience using the support and the experience of your family members and carers.133 Insurance We may consider things we have learnt from other participants in the NDIS with similar support needs to you.134 We know you’re the expert in your own life, and we use your own experience as much as we can. Disability For example, we will talk to you about any supports that have helped you do things you can’t otherwise do. Or, some supports may have helped maintain your ability to be as independent as possible. National If it’s a new support such as new assistive technology, we might fund a trial. This is so we the can learn from your experience of using the support. To check if it’s likely to do what you by need it to. Your evidence can be particularly useful when it’s consistent with other evidence, or if we 1982 don’t have expert evidence. Act We’ll look at the opinions held by the majority of experts and what they generally agree on.135 Sometimes we will have to seek expert opinion or report to make a decision.136
Example Information
Vivek is 12 and has a goal to improve his communication skills. He and his family want him of to improve his social skills with the kids in his class.
When he was younger, Vivek’s family tried speech therapy, and believe it really helped him improve his communication. His family told his planner about how it helped Vivek learn how Freedom to respond to different social settings. the Vivek’s speech therapist also believes it could work well for him now, and help him interact with his classmates. under When deciding whether the therapy is effective and beneficial, Vivek’s planner will consider:
how speech therapy has helped Vivek in the past, including first-hand information from Vivek, his family members and carers released
the reports or assessments from his speech therapist on the effectiveness and was
benefits of speech therapy for Vivek document
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other information or expert evidence about the effectiveness and benefits of speech therapy, including for a child of the same age, and with the same impairments and Agency functional capacity.
Based on this information and evidence, Vivek’s planner decides the speech therapy is effective and beneficial. If it meets the other funding criteria, we will be able to fund speech Insurancetherapy in Vivek’s plan.
Is the support something we would reasonably expect your informal supports, like family or friends, to provide? Disability We need to be satisfied that funding the support takes into account what is reasonable to expect families, carers, informal networks and the community to provide.137To make sure we understand how disability supports might work for you, we consider: National
the things you’re able to do for yourself the
by any support you have from others in your network – including family members,
relatives, friends and local community services. 1982 When we fund supports under the NDIS, we have to think about whether it’s reasonable to
Act
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 provide for you.138
Informal supports are the help and support you get from friends, family and the community. Information They are called ‘informal’ because you don’t pay for them, and they’re not part of a formal of agreement. They are the usual things friends and family do for us, and with us.
Most of us get some kind of help and support from friends and family. In our society, we expect that friends, family and our community will support each other and help each other Freedom out when they need it. the A good example is families who have young children. In our community, we expect families will provide most of the support a young child needs.139 They will change a child’s nappy, under make sure they are safe and drive them around places.
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. released As a child gets older, our society’s expectations of the role of the family and community in was caring for the child changes. For example, we expect schools to help support the child’s learning needs. document
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We also usually expect the role of family in providing personal care for a child would reduce as they get older and develop new skills and independence. But families are usually still Agency responsible for things like food, emotional support, decision-making and providing a safe home.
It’s a similar idea for adults. Our society expects that adults – like family, friends and Insuranceneighbours – 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.
NDIS supports won’t ever replace the support people like your friends and family provide to Disabilityyou. This support is given freely because people care, and is often quite different to supports bought with NDIS funding.
You have a special bond with your friends and family that’s different from your relationship National with paid carers. And there are potential risks and problems for you if your friends and thefamilies become your paid carers. by To make sure we understand how disability supports might complement your circumstances, we consider: 1982
the things you are able to do for yourself Act
any support you have from others in your network including family members, relatives, friends and local community services.
We also have to consider the benefits you may get from your informal supports. For Informationexample, your family and friends may be more effective at helping you meet other people, or of helping to build your social skills, than paid supports can.
We consider if we can help these relationships so that you get the support you need.140 For example, we may be able to fund training for your informal supports, so they can help you Freedombuild your skills. the We also think about the capacity of your informal supports to continue caring for you, for example if they’re ageing or sick. under There are different things the law for the NDIS says we need to consider for adults and children.
If you’re under 18, we consider what support is reasonable to expect parents to provide at released your age. It’s normal for parents to provide substantial care and support for children.141 We consider that it’s usual for parents to provide almost all the care and support that young was children need. document
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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 Agency disability would typically reduce as they get older.
For children under 18, we consider:
if your needs are ‘substantially greater’ because of your disability, compared to other Insurance
children the same age142 – that is, you need much more disability support
any risks to the wellbeing of people providing informal support to you143 Disability if including funding for the support will help build your skills and capacity in the future,
or reduce any risks to you.144
For example, we consider any health, safety or other impacts resulting from what’s involved National in meeting your disability support needs. the If you’re over 18, we consider: by if there are any risks to you or your informal supports if you rely on them to provide the support you need145 1982
how much your informal supports would help improve or reduce your independence Act
and other outcomes.146
We also consider the suitability of informal supports to provide the supports you need,147 including: Information
how old your carers are and their capacity to provide the support148 of
if other family members and the community can help your informal supports in their
caring role149 the intensity and type of support you need, and if it’s appropriate for your informal Freedom
supports to provide this, based on their age and gender150 the
any long-term risks to the wellbeing of your informal supports.151 underWhen 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. released For example, we wouldn’t expect a child to have their schooling affected because they need to provide care. We also wouldn’t expect an elderly parent to be responsible for physical was activities, if it may result in injury.152 document
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We generally don’t fund family members to provide supports funded under the NDIS. There are very limited situations where we can consider this. Agency Learn more about Sustaining Informal Supports.
Example 1Simon is getting his first NDIS plan. For the last 15 years, Simon and his wife Jan’s Insurance preference was that Jan provide all the physical support he needs at home, such as toileting and showering.But as Jan is getting older, it’s not safe for her to keep lifting Simon. It’s becoming risky for Disability her to keep providing this support.
Jan and Simon think it might be best for someone else to provide the personal care support Nationalthat Simon needs. Their children have moved out of home, and it’s not reasonable to expect them to help Simon with personal care. the byBased on this information and other evidence, Simon’s planner decides that the personal care support meets this criteria. It takes into account what is reasonable for his family and 1982others to provide. If the personal care support meets the other funding criteria, we may fund the personal care support for Simon. Act
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 him eat his meals. It’s reasonable to expect Jan to help Simon with this, as it’s what they Informationwant to do and it’s not a safety risk for Jan. of Example 2
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 the Freedom weeknight training sessions. the But unlike most 14 year old’s, she needs someone to help her get dressed before she can go to the match. Her parents have been doing this, but as Qing is getting older she no longer under wants her family to help her get dressed.
It’s reasonable to expect her family or other informal supports to drop Qing to and from the match and training sessions. So we wouldn’t fund transport in Qing’s plan. released But at age 14, it’s not reasonable to expect her family to help her get dressed. was 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 other funding criteria, we may fund personal care support in her plan. document
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Is the support more appropriately funded or provided through the NDIS, and not through other service systems or support services? Agency We have to be satisfied that the support is most appropriately funded or provided through the NDIS. This means it’s not more appropriately funded or provided through:
other general systems of service delivery, or support services offered by a person, Insurance
agency or body (such as a State or Territory Statutory Scheme)
systems of service delivery or support services offered as part of a universal service obligation (such as the health or education system) Disability systems of service delivery or support services offered in accordance with reasonable
adjustments required under discrimination laws (such as your employer, or the health or education system).153 National
In short, we won’t fund the support if it should be provided by someone else. the byWe 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 we 1982 don’t make up for other organisations and systems that don’t provide the supports they should. Act
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.154 There are different things we consider for the following service systems: Information (a) Health of (b) Mental health
(c) Child protection and family support Freedom (d) Early childhood development the (e) School education
(f) Higher education and vocational education and training under (g) Employment
(h) Housing and community infrastructure released (i) Transport was (j) Justice. document
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How does the NDIS work with other government services? We call supports provided by other government services, including those provided as part of Agency 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. Insurance This includes services provided by state and federal governments, like health care, education and mental health services.
You have the same right as all Australians to access these services. There are certain things Disability 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. National When we fund NDIS supports, we need to check that the support is not more appropriately the funded or provided by a mainstream service or system, such as the education system or by health system.155 Under the law for the NDIS, we can’t fund supports that should be provided by a mainstream service. 1982 The Australian federal, state and territory governments agreed on responsibilities for funding Act different types of supports. The law for the NDIS has an outline of funding responsibilities and were developed with the agreement of each State and Territory.156
We can only fund supports that are the responsibility of the NDIS. We can’t fund supportsthat are the responsibility of other government services, even if they don’t actually fund or Information provide the support. The law for the NDIS sets out the matters we should consider when we of decide who is more appropriate to provide or fund a support.157
Learn more about how we decide if the support is best funded or provided by us or anotherpart of government. Freedom The Applied Principles and Tables of Support also has information on what the governments the agreed are the responsibilities of the NDIS and other government services. However, it doesn’t override what we consider when we decide if the support is most appropriately under funded by the NDIS.158
What is reasonable adjustment and why is it important? releasedPeople with a disability can sometimes face barriers that make it harder to do the same things as people who don’t have a disability. For example, it might be harder to find and keep was a job. Or it might be harder to get in and around places, or to get the same services as other people. document
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It’s against the law to discriminate against people with a disability in many areas.159 This includes in employment, when providing goods and services, and when accessing public Agency places.
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 Insurancedisability have equal access to the services they provide, as far as is reasonable.
They have to do reasonable things that will make their services equally available to everyone, whether or not you have a disability. Disability Reasonable adjustments do not mean they have to provide everything you need because of your disability. It means they have to do what’s reasonable to make sure you have equal access to employment, public spaces or services. This takes into account what they can National afford to do and what is reasonable to expect them to provide in the circumstances. the When we decide what supports to include in your plan, we need to consider what should be by provided through reasonable adjustments. Under the law for the NDIS, we can’t fund a support if it should be provided by someone else through reasonable adjustments. 1982 What else do you need to know about working out if supports meet the Act NDIS funding criteria?
From our experience, we learned there are some common misunderstandings about how we work out what supports meet the NDIS funding criteria. Information Why don’t we always fund what your health professionals recommend? of
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 tomeet all the NDIS funding criteria. Freedom For example, your therapist might recommend a piece of equipment on the basis that it will the 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. under This 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. releasedWhy 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 was 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. Agency For 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 anymore. So, we probably won’t include that funding for those supports in your next plan. Insurance Supports to build your skills may have met the NDIS funding criteria before, but the same supports might not meet the criteria in future.
Or, your disability support needs might increase or decrease over time. This may mean we Disability consider funding more or less supports as a result.
What happens if you don’t use all your funding in your NDIS plan? NationalWe will consider how you have used your NDIS funding to help us work out what supports meet the NDIS funding criteria in your next plans. the byIf you haven’t used all the funding by the end of your plan, it doesn’t mean we’ll reduce the funding in your next plan. There may be very good reasons why you weren’t able to buy the 1982supports we funded. ActWhen we reassess your plan, we’ll talk about any problems you had buying the supports funded in your plan. We’ll also see how we can help you use your funding if we need to.
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. For Information example, they may not be ‘effective and beneficial’ for you if you’re not actually using them. of We will talk to you about this when we reassess your plan.
Learn more about changing your plan Freedom Step 3: How do we include the reasonable and necessary the supports in your plan? underOnce we’ve identified the supports, and decided they meet the NDIS funding criteria, we can include the description and funding for the support in your plan.
If the support doesn’t meet the NDIS funding criteria, we can’t include the support in your releasedplan. We may consider if a differently described support meets the NDIS funding criteria instead. was When we approve your plan we will also make sure all your supports are reasonable and necessary when considered as a package of supports.160 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 no Agency funded supports.
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 in Disability your plan. Also, if the amount of support you want doesn’t meet the criteria, we can’t include that amount in your plan. But, we’re committed to our principles and helping you live an ordinary life. Even if we can’t National fund a particular support we may still be able to help. the If the support doesn’t meet the NDIS funding criteria, we can consider if a different support by meets the NDIS funding criteria. We might be able to consider describing the support 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. Act Mainstream and community supports are available to everyone. They can be a good way to connect with your local community, learn new skills and gain independence.
There are lots of ways we might be able to help, so talk to us if you’re in this situation. Wecan do this at any time. We may be able to help before we approve your plan. Information of We’ll give you the reasons for our decision to approve your plan in writing.161 You can 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 Freedom review of our decision.162 You’ll need to ask for an internal review within 3 months of getting theyour plan.163 164Learn more about internal and external review of decisions. 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 s34(1)(a).4 Insurance NDIS Act s34(1)(b). 5 NDIS Act s34(1)(c). 6 NDIS (Supports for Participants) Rules r 3.1(c). 7 NDIS Act s34(1)(c); NDIS (Supports for Participants) Rules r 3.1(a). 8 NDIS Act s34(1)(d).9 Disability NDIS Act s34(1)(e). 10 NDIS Act s34(1)(f). 11 NDIS Act s34(1)(f). 12 NDIS (Supports for Participants) Rules part 5.13 NDIS (Supports for Participants) Rules r 5.1(a). National 14 NDIS (Supports for Participants) Rules r 5.1(b). 15 NDIS (Supports for Participants) Rules r 5.1(c). the 16 NDIS (Supports for Participants) Rules r 5.1(d). by 17 NDIS (Supports for Participants) Rules r 5.3(a). 18 NDIS (Supports for Participants) Rules r 5.3(b).19 NDIS Act s34(1)(f). 1982 20 NDIS Act s118(1)(b). 21 NDIS Act s4(17) Act 22 NDIS Act s33(2). 23 NDIS Act s33(5)(a). 24 NDIS Act s34(1)(a). 25 NDIS Act s34(1)(d). 26 NDIS (Supports for Participants) Rules r 4.1(d).27 NDIS Act s34(1). Information 28 NDIS Act s34(1)(d); NDIS (Supports for Participants) Rules, r 3.2-3.3. of 29 NDIS Act s34(1)(c); NDIS (Supports for Participants) Rules r 3.1. 30 McGarrigle v National Disability Insurance Agency (2017) 252 FCR 121 at [88]. 31 NDIS Act ss 33(2)(a), 33(2)(b), 33(5)(c), 34. 32 NDIS Act ss 13, 33(2)(a).33 NDIS Act ss 33(2)(b), 34. Freedom 34 NDIS Act and delegated legislation made under the NDIS Act, especially NDIS (Supports for Participants) Rules and NDIS (Plan Management) Rules. the 35 NDIS Act ss 33(2)(b), 34; NDIS (Supports for Participants) Rules. 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. under 38 NDIS Act s 34(1). 39 NDIS (Supports for Participants) Rules r 2.4; NDIS Act s 33(5)(c). 40 NDIS Act ss 4, 31. 41 NDIS Act s 4(1).42 NDIS Act s 4(2). released 43 NDIS Act s 4(4). 44 NDIS Act s 4(8). was 45 NDIS Act s 4(10). 46 NDIS Act s 4(17). 47 NDIS Act s 4(11). document
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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). Agency 50 NDIS (Supports for Participants) Rules r 4.1(b). 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).54 NDIS Act ss 36, 50. Insurance 55 NDIS (Supports for Participants) Rules rr 4.2-4.6. 56 NDIS Act s 33(1). 57 NDIS Act s 47(1). 58 NDIS (Supports for Participants) Rules r 4.1(d).59 NDIS Act s 34(1)(a). Disability 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).64 National NDIS Act s 33(3).
65
NDIS Act s 33(3); (NDIS (Plan Management) Rules r 6.3. the66 NDIS Act s 46(1).
67 NDIS Act (Plan Management) Rules r 6.4(a). by 68 NDIS (Plan Management) Rules r 6.4(b). 69 NDIS (Plan Management) Rules r 6.4(c).70 NDIS (Plan Management) Rules r 6.4(d). 1982 71 NDIS (Plan Management) Rules r 6.4(e). 72 NDIS (Plan Management) Rules r 6.4(f). Act 73 NDIS (Plan Management) Rules r 6.4(f). 74 NDIS (Plan Management) Rules r 6.4(f). 75 NDIS (Provider Registration and Practice Standards) Rules r 7(3). 76 NDIS (Provider Registration and Practice Standards) Rules r 7(2). 77 NDIS (Plan Management) Rules rr 6.6-6.7.78 NDIS (Plan Management) Rules r 6.6. Information 79 NDIS (Plan Management) Rules r 6.7. of 80 NDIS (Plan Management) Rules r 6.7. 81 NDIS (Plan Management) Rules r 6.7. 82 NDIS (Plan Management) Rules r 6.5. 83 NDIS (Plan Management) Rules r 6.6.84 NDIS Act ss 33(5)(d), 35(1)(b); NDIS (Supports for Participants) Rules pt 5. Freedom 85 NDIS Act s 34(1). 86 NDIS (Supports for Participants) Rules r 5. the 87 NDIS Act ss 33(5)(d), 35(1)(b); NDIS (Supports for Participants) Rules r 5.3(a). 88 NDIS Act ss 33(5)(d), 35(1)(b); NDIS (Supports for Participants) Rules r 5.3(b).89 NDIS Act ss 33(5)(d), 35(1)(a); NDIS (Supports for Participants) Rules r 5.1(a). under 90 NDIS Act ss 33(5)(d), 35(1)(a); NDIS (Supports for Participants) Rules r 5.1(b). 91 NDIS Act ss 33(5)(d), 35(1)(a); NDIS (Supports for Participants) Rules r 5.1(d). 92 NDIS Act ss 33(5)(d), 35(1)(a); NDIS (Supports for Participants) Rules r 5.1(c).
93 NDIS (Supports for Participants) Rules r 5.3(a).94 released NDIS (Provider Registration and Practice Standards) Rules 2018 r 7(2).
95 NDIS Act s 73F(2)(a).96 NDIS (Supports for Participants) Rules r 5.3(b). was 97 NDIS (Supports for Participants) Rules r 5.1(a). 98 NDIS (Supports for Participants) Rules r 5.1(b). 99 NDIS (Supports for Participants) Rules r 5.1(d). document
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100 NDIS (Supports for Participants) Rules r 5.1(d).101 NDIS (Supports for Participants) Rules r 5.2(a). Agency 102 NDIS (Supports for Participants) Rules r 5.2(b). 103 NDIS (Supports for Participants) Rules r 5.1(c). 104 NDIS Act ss 33(5)(c), 34(1). 105 NDIS Act s 34(1)(a).106 NDIS Act s 34(1)(b). Insurance 107 NDIS Act s 34(1)(c). 108 NDIS Act s 34(1)(d). 109 NDIS (Supports for Participants) Rules r 3.2(a). 110 NDIS Act s 34(1)(e).111 NDIS Act s 34(1)(f). Disability 112 NDIS (Supports for Participants) Rules pts 3, 4. 113 NDIS Act s 33(5)(c). 114 NDIS Act s 34(1)(a).
115 McGarrigle v National Disability Insurance Agency (2017) 252 FCR 121 at [91].116 National NDIS Act s 34(1)(a).
117
NDIS Act s 34(1)(c). the118 NDIS Act s 34(1)(d).
119 NDIS (Supports for Participants) Rules r 5.1(b). by 120 NDIS (Supports for Participants) Rules r 5.1(d). 121 NDIS Act s 34(1)(b).122 NDIS Act ss 3(3)(b), 4(17). 1982 123 NDIS (Supports for Participants) Rules r 3.1(a). 124 NDIS (Supports for Participants) Rules r 3.1(b). Act 125 NDIS (Supports for Participants) Rules r 3.1(c). 126 NDIS (Supports for Participants) Rules r 3.1(e). 127 NDIS (Supports for Participants) Rules r 3.1(c). 128 NDIS (Supports for Participants) Rules r 3.1(d). 129 McCutcheon and NDIA [2015] AATA 624 at [34].130 McCutcheon and NDIA [2015] AATA 624 at [34]. Information 131 McCutcheon and NDIA [2015] AATA 624. of 132 NDIS (Supports for Participants) Rules r 3.2(a). 133 NDIS (Supports for Participants) Rules r 3.2(b). 134 NDIS (Supports for Participants) Rules r 3.2(c). 135 NDIS (Supports for Participants) Rules r 3.3.136 NDIS (Supports for Participants) Rules r 3.3. Freedom 137 NDIS Act s 34(1)(e). 138 NDIS Act s 34(1)(e). the 139 NDIS (Supports for Participants) Rules r 3.4(a)(i). 140 NDIS (Supports for Participants) Rules r 3.4(c).141 NDIS (Supports for Participants) Rules r 3.4(a)(i). under 142 NDIS (Supports for Participants) Rules r 3.4(a)(ii); JQJT and National Disability Insurance Agency [2016] AATA 478 at [39]. 143 NDIS (Supports for Participants) Rules r 3.4(a)(iii).
144 NDIS (Supports for Participants) Rules r 3.4(a)(iv).145 released NDIS (Supports for Participants) Rules rr 3.4(b)(i), (ii).
146 NDIS (Supports for Participants) Rules r 3.4(b)(iii).147 NDIS (Supports for Participants) Rules r 3.4(b)(ii). was 148 NDIS (Supports for Participants) Rules r 3.4(b)(ii). 149 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(A). 150 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(B). document
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151 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(C).152 NDIS (Supports for Participants) Rules r 3.4(b)(ii)(C). Agency 153 NDIS Act s 34(1)(f). 154 NDIS (Supports for Participants) Rules rr 3.5-3.7 and Schedule 1. 155 NDIS Act s 34(1)(f). 156 NDIS (Supports for Participants) Rules rr 3.5-3.7, Schedule 1; NDIS Act ss 209(4), (8) item 1.157 NDIS (Supports for Participants) Rules rr 3.5-3.7, Schedule 1. Insurance 158 NDIS (Supports for Participants) Rules rr 3.5-3.7, Schedule 1. 159 Disability Discrimination Act 1992 (Cth); Discrimination Act 1991 (ACT); Anti-Discrimination Act 1977 (NSW); Anti-Discrimination Act 1996 (NT); Anti-Discrimination Act 1991 (Qld); Equal Opportunity Act 1984 (SA); Anti Discrimination Act 1998 (Tas); Equal Opportunity Act 2010 (Vic); Equal Opportunity Act 1984 (WA).160 NDIS Act s 33(5)(c). Disability 161 NDIS Act s100(1). 162 NDIS Act s100. 163 NDIS Act s100(2). National the by 1982
Act
Information
of
Freedom
the under released was document
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