Reasonable and Necessary

The Australian government have created laws about what kind of support can be funded under the NDIS. All supports need to meet the criteria in these laws before they can be funded in an NDIS plan.

This list of is called the NDIS funding criteria. For example, supports need to relate to your disability, be effective and beneficial, and be good value for money.

One of the key principles of the NDIS is that support and services must be “reasonable and necessary” in order to be approved and funded by the NDIS.

Each support must meet these criteria individually, but the supports must also meet the criteria when looking at them as a whole.

Reasonable and necessary supports can be most easily described as supports that will help you:

• Pursue your goals and aspirations
• Be more independent
• Take part in social activities and work
• Actively take part in the community
• Enjoy an ordinary life

These supports and services can include education, employment, social participation, independence, living arrangements and health and wellbeing.

Reasonable and Necessary Support – the Nitty Gritty?

First – let’s understand what supports mean. Supports under the NDIS framework is a practical description of how you’ll be assisted by the NDIS. Supports are the services, items and equipment that are funded through or provided by the NDIS.

There are two types of support that can be included in an NDIS plan:

General supports

These are the coordination, strategic or referral services and activities provided by, or arranged by the NDIS. They are how the NDIS helps connect participants with supports and activities in their communities. These include your mainstream, community, and informal support.

Reasonable and Necessary Supports

These are the supports that the NDIS funds in your plan to meet your disability support needs. This funding can be used to purchase, or access supports from service providers, such as Help at Hand Support. There are laws about what can be funded under the NDIS. To meet the NDIS funding criteria, a support must meet both of the following:

• It must not be a type of support the law says we can’t fund or provideIt must meet the reasonable and necessary criteria.

In simple terms, it means that the support or service must be necessary for you to achieve your goals, and it must be reasonable in terms of cost and effort.

For example, if a participant has a goal of increasing their independence in daily living, the NDIS may fund support such as assistance with personal care or home modifications. However, if a participant wants a luxury item like a swimming pool, it would not be considered reasonable and necessary as it is not necessary for the participant to achieve their goals and it would be too costly. The aim of the NDIS is to help people become more independent.

Does my Support Meet the Reasonable and Necessary Criteria?

All supports under the NDIS must adhere to the reasonable and necessary criteria. This entails ensuring that a support meets the following conditions before it can be included in your plan:

1. The support aligns with your goals as outlined in your plan.
2. It facilitates your social and economic participation by reducing barriers that impede your involvement in activities such as social outings, recreation, work, and study.
3. The support offers value for money, where the costs are reasonable relative to the benefits gained and compared to alternative supports.
4. It is expected to be effective and beneficial for you, considering current good practice and evidence of its suitability for individuals with similar support needs.
5. The funding of the support considers what is reasonable to expect from families, carers, informal networks, and the community.
6. The support is best suited for funding through the NDIS and not through other general service systems, statutory schemes, universal service obligations, or discrimination law requirements.

The NDIS law outlines factors to consider when applying the reasonable and necessary criteria. Each support must individually meet these criteria, while also considering them as part of a comprehensive package of supports.

For instance, if a home modification reduces the need for other supports, such as caregiving, the NDIS will take this into account. Funding for home modifications might result in adjustments to other supports, ensuring that the overall package remains reasonable and necessary.

It’s important for you to be aware of what is considered reasonable and necessary when working with you care team planning your support. Your support team should be clear on your individual goals, and understand that the NDIS will only fund support that is directly related to achieving those goals.

The NDIS also encourages participants to be actively involved in the planning process and to make informed choices about your own support. This means that you, as the participant, should be informed about the different types of support that are available, and should understand how they can be used to achieve your goals.

What if I still have questions?

Many of these questions might not be so simple as a yes or no, we get it. While it’s ultimately up to the NDIS, speaking to an expert like Help at Hand Support can help you understand whether a support meets the criteria of being reasonable and necessary. ?

Contact our team of care experts on 1300 822 190 so we can if you would like support in understanding whether something is reasonable or necessary.?