What are reasonable and necessary supports?
This video will help you understand what the NDIS means when they talk about reasonable and necessary supports and permanent and significant disability.
A participant's reasonable and necessary supports take into account any informal supports already available to the individual (informal arrangements that are part of family life or natural connections with friends and community services) as well as other formal supports, such as health and education.
Reasonable and necessary supports are funded by the NDIS in a range of areas, which may include education, employment, social participation, independence, living arrangements and health and wellbeing. These supports will help participants to:
- pursue their goals, objectives and aspirations
- increase their independence
- increase social and economic participation, and
- develop their capacity to actively take part in the community.
How does the NDIA know what is reasonable and necessary?
The NDIA makes decisions based on the National Disability Insurance Scheme Act 2013 (NDIS Act) and the rules made under the NDIS Act. The operational guidelines also provide practical guidance for decision makers.
When the NDIA makes decisions about which supports would be reasonable and necessary for a particular participant, we refer to the particular operational guideline that relates to each specific support. In order to be considered reasonable and necessary, a support must:
- be related to the participant's disability
- not include day-to-day living costs that are not related to a participant's disability support needs
- represent value for money
- be likely to be effective and beneficial to the participant, and
- take into account informal supports given to participants by families, carers, networks, and the community.
What types of supports are funded?
The types of supports that the NDIS may fund for participants include:
- daily personal activities
- transport to enable participation in community, social, economic and daily life activities
- workplace help to allow a participant to successfully get or keep employment in the open or supported labour market
- therapeutic supports including behaviour support
- help with household tasks to allow the participant to maintain their home environment
- help to a participant by skilled personnel in aids or equipment assessment, set up and training
- home modification design and construction
- mobility equipment, and
- vehicle modifications.
Dysphagia and mainstream health supports
The Commonwealth Government recently decided that, as an interim measure, the NDIS will fund the ongoing development, assessment and monitoring of meal plans for NDIS participants with dysphagia who aren’t in a hospital or acute care setting.
Dysphagia related care and supports are required by participants who have difficulty swallowing. This interim arrangement will include the initial and ongoing assessment, development and monitoring of meal plans until a final decision on roles and responsibilities of the NDIA and health systems is made, expected by Governments in early 2019.
In addition, the Disability Reform Council has also clarified interim arrangements regarding funding of mainstream health supports in participant plans.
Read the Minster’s media release: NDIS supports participants with dysphagia.
There are some kinds of supports that will not be funded or provided by the NDIS
The NDIS Act and the rules made under the NDIS Act also tell us which supports will not be funded by the NDIS. A support will not be funded if it:
- is not related to the participant's disability
- duplicates other supports already funded by a different mechanism through the NDIS
- relates to day-to-day living costs that are not related to a participant's support needs, or
- is likely to cause harm to the participant or pose a risk to others.
What choice and control do I have over my funded supports?
You have choice and the control over how you use funded supports in your plan. That includes choice of how the supports are given and which service providers you use.
In some cases the NDIA or others will manage the funding for supports. For example, where there is an unreasonable risk to a participant.
What if I don't agree with the decision about the supports in my plan?
You can contact the NDIA and ask us to review your plan. Usually, a review of a plan happens when there have been big changes to your circumstances or at your next scheduled plan review.
When the NDIA reviews a participant's plan it will look at all of the funded supports in the plan, not just one of them. This helps to make sure there are no gaps in your plan.
You can also ask for an internal review of the decision to approve your statement of participant supports in your plan. This request needs to be made within three months after you are notified of this decision.
What is the principle of 'no disadvantage'
Governments made a commitment - through the Intergovernmental Agreement for the NDIS Launch (IGA) - that if you were receiving supports before becoming a participant in the NDIS you should not be disadvantaged by your transition to the NDIS.
The commitment is that people who become participants in the NDIS should be able to achieve at least the same outcomes under the NDIS.
This does not mean that you will always have the same level of funding or supports provided in the same way. You will have access to reasonable and necessary supports consistent with the NDIS Act.
Where the NDIS does not fund a support you previously received under another program, the Agency will seek to identify alternative supports or refer you to other systems with a view to ensuring you are able to achieve substantially the same outcomes as a participant in the NDIS.
For more information read the guideline about no disadvantage.