What’s considered reasonable and necessary under the National Disability Insurance Scheme (NDIS)?

Posted on 25 February 2016 by Yooralla

The NDIS talks a lot about support that is reasonable and necessary to provide in a person’s plan.

In fact, it is probably one of the most important concepts in the scheme that people and families who are starting their planning journey need to understand. So what does reasonable and necessary mean? Let’s take a look in more detail.

The NDIS states that when determining what support will be included in a person’s plan, goals and aspirations will be balanced by what is considered to be reasonable and necessary. This means that the things that people identify as goals, and the support they need to achieve these goals, will be measured against the NDIS’s definition of what is reasonable and necessary to decide if funding will be provided or not.

Firstly let’s look at the description of reasonable and necessary provided by NDIS.

The National Disability Insurance Scheme Act 2013 sets out the rules for the insurance scheme.  The operational guideline that sets out the things NDIS staff must consider says that support must meet the following criteria to be considered reasonable and necessary.

Support must:

  • be related to the person’s disability
  • not include day-to-day living costs that are not related to a person’s disability support needs
  • represent value for money
  • be likely to be effective and beneficial to the person, and
  • take into account informal supports given to the person by families, carers, networks, and the community.

When considering possible areas for support, you can ask yourself the following questions to reflect on what could be reasonable and necessary.

Is the support related to a person’s disability?

Supports should directly relate to a functional need connected to the person’s disability. Things such as individualised support, aids and equipment, support at school or work related to disability may meet this requirement.  It’s important that people think about this carefully when planning to make sure they can maximise the benefit from their plan. 

Could this be considered to be a day to day living cost?

People with disability will continue to use their income to pay for things such as rent, food, utilities and personal phones.  Income might be the Disability Support Pension or another benefit, or salary and wages for paid work.

Recreational activities such as going to the theatre or going on holidays will need to be paid for by the person.

Does the support represent value for money?

The NDIS is an insurance scheme that relies on practical use of money to make sure that everyone can access the support they need.  This means that plans will not include things that are ‘extras’ that have no direct value to the person or are not really required.

Is the support likely to be beneficial and effective?

Supports in a plan should relate to individual goals and deliver outcomes to the person.  The NDIS has developed an outcomes framework that will be used to make sure that people are receiving support that assists them to work towards things they want to do.

Is this support already covered by informal supports, from family members, carers, networks or the community?

Most people access some support from family, people they share a house with, partners or spouses or other people in their network.  This might be a little support where the postman brings mail to the door instead of to the letter box; or a lot of support where family member assists a person with personal care tasks because there is no other option.

The NDIS will work with people and their networks to make sure that the informal support they currently receive is realistic, sustainable and reasonable.  In a nutshell, they will not replace what is working well.

When planning for transition for the NDIS, it’s important to think about how goals and aspirations can be supported in a reasonable and necessary way.

To make the most of the scheme, people should think about what they want to do and what support they would need to achieve these goals.  Thinking outside of the box – and beyond the scope of traditional disability support – is strongly encouraged for people looking to improve their everyday life.

This could include thinking about learning, working, and living arrangements, social aspects like relationships and friendships, and also reflecting on things that are enjoyable or things that could be better.

The NDIS aims to fund the supports people with disability need to achieve their goals, so that in turn, they can access the same opportunities as people without disability.

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