Change 7: Updates to “Reasonable and Necessary Supports”
Most consumers of the NDIS would be familiar with the NDIS term ‘Reasonable and Necessary criteria’. In the known version of the NDIS, in order for a support to be funded, the NDIS Participant must be able to show that the support is both reasonable and necessary via addressing the criteria. However, there are changes being made to the reasonable and necessary criteria.
New versus Old Criteria
Below is a table that outlines the new and old criteria.
| New Criteria | Old Criteria |
|---|---|
| A. the support is necessary to address needs of the participant arising from an impairment in relation to which the participant meets the disability requirements or the early intervention requirements | Must be related to a participant's disability |
| B. the support will assist the participant to pursue the goals, objectives and aspirations included in the participant’s statement of goals and aspirations | Must not include day to day living costs not related to your disability support needs, such as groceries |
| C. the support will assist the participant to undertake activities, to facilitate the participant’s social and economic participation | - |
| D. 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 support | Should represent value for money |
| E. the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice | Must be likely to be effective and work for the participant |
| F. the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide | Should consider support given to you by other government services, you family, carers, networks and the community |
| G. the support is a NDIS support for the participant | - |
How does this differ from the supports that are an NDIS support list?
- The new support lists will list all the supports that are an NDIS support that a NDIS participant could possibly receive. However, not all NDIS participants have access to all these supports.
- The reasonable and necessary criteria are different – they are a list of requirements that the NDIS participant must demonstrate they meet to receive funding for a support that is an approved NDIS support.
What does this mean for NDIS participants?
- All supports need to meet each of the reasonable and necessary criteria before the NDIA can fund them in a participants plan. The new criteria is more detailed than the previous iteration, and so in some cases, more information may be required for a planner to see that the reasonable and necessary criteria have been met.
- Participants may need to ensure that their providers are aware of the new reasonable and necessary criteria.
Want to know more? Contact Us
REFERENCES:
(a) – National Disability Insurance Scheme. (2024). National Disability Insurance Scheme (Getting the NDIS Back on Track No.1) Act 2024 Impact on reviews in the Administrative Appeals Tribunal. https://www.dss.gov.au/system/files/resources/ndis-bill-no-1-factsheet-aat-reviews-final.pdf
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