The NDIS ACT: Reasonable and Necessary

Horse whispering, soul counselling, and energy healing all being funded through the NDIS. Sound familiar? If yes, then you might have had the misfortune of reading Natasha Bites' takedown of the NDIS in the Daily Telegraph. For sanity and accuracy's sake, when you hear such claims, it is time to repeat to yourself "Section 34" over and over again until you feel ready to deal with the world again.

Section 34 of the NDIS Act establishes the criteria for what supports are considered "reasonable and necessary" for the NDIS to cover. It is essential for you as service providers to know this Section so well that you are reciting it in your sleep. It will allow you to understand what supports you can offer to your customers to enable them to have realistic expectations of what the NDIS will cover.

There are six criteria points you need to know. We have summarised them here:

1. The support will assist a participant to reach the goals and aspirations outlined in their participant statement.

This criterion is just one of the reasons why the goals section in the participant's statement is so important. The goals set by participants help determine what supports you can provide them. Therefore, it is crucial that we work with participants to ensure their goals accurately reflect what they hope to achieve with the support of the NDIS.

It is worth noting that with My First Plan this criterion is not being consistently enforced. Instead, we often see participant's supports transitioning into NDIS, without necessarily being aligned to goals.

2. The support will facilitate the participant's social and economic participation.

Facilitating increased social and economic participation is one of the underlying principles behind the NDIS. So it naturally follows that every support should work towards this goal. Increased economic participation does not mean that a person has to be working towards employment if this is not their goal nor does social participation mean they need to be pub-crawling on Friday nights. Instead, this criterion can be met if the participant is now able to go into the community, spend their money how they choose to and participate in the activities they want to do.  

3. The support represents value for money, relative to benefits achieved and costs of alternative supports.

We all know that cheaper is not always better. The headphones I bought at a variety store were cheap, but every time I try to listen to the latest musical soundtrack I hear a rough buzzing in my left ear. Luckily, the Act does not require participants to have to sing along to "Let It Go" with invisible bees. When choosing services, quality counts. Value for money might include making a more expensive, short-term investment that will save money in the long run. However, when cheaper options are available and are likely to achieve the same benefits, such as with group supports, a participant may be required to explore these alternatives.

4. The support is considered good practice and is likely to be beneficial to the participant.

The NDIS will not fund supports if there is evidence to suggest that it will not work. The exception to this rule would be if a support has had a proven benefit for that participant. In 2015, the AAT allowed a participant to receive chiropractic treatment under the NDIS because that individual provided documented evidence that they had benefited from it. Nevertheless, another participant, who cannot prove a measurable benefit, might be unable to access this support.

5. The support takes into account what is reasonable for parents, carers, informal networks and the community to provide.

When a child is two years old, it is reasonable to expect their parents or carer to bath them. When that same child is 40, it might start to become pretty strenuous for the parents. The NDIS, therefore, will often provide more funding for daily living when a child gets older. This allows children with disabilities to start gaining independence from their parents at the same age as their peers.

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

The NDIS does not get any other government agency off the hook from their duties to people with disabilities. The Departments of Health, Education, Transport, Justice and all others still have to ensure their services are accessible to people with disabilities. Moreover, the NDIS will not fund the diagnosis and treatment of conditions that cause disability.  They remain the purview of the Commonwealth and State Departments of Health. For example, if a participant requires an amputation, then surgery, medication, and short-term rehabilitation will be the responsibility of the Health system. The NDIS might then provide ongoing prosthetic aids and home modifications.

When terms are non-specific like ‘reasonable and necessary', it is tempting to think of them as a matter of gut instinct. However, in this case, they are not. Section 34 sets out the legal criteria for how it is defined. The better we all know this Section, the more smoothly we will be able to navigate the NDIS world.