Making Sense of 'Reasonable and Necessary' under NDIS"

With the potential changes looming in the NDIS structure, it's an opportune moment to plunge into one of the most discussed terms in NDIA legislation: "Reasonable and necessary.”

According to the dictionary "reasonable" is an adjective denoting something moderate or tolerable. Also, an adjective “necessary” describes something required for a specific purpose. Combining the two, we get a rough definition of a tolerable requirement.

However, applying these definitions directly to the NDIS doesn't provide us with a comprehensive understanding. While the NDIS might use the basic meanings of the two adjectives, the interpretation is adjusted to fit the framework of NDIA legislation. This is where "reasonable and necessary" becomes a subject open to interpretation.

How can we guide our customers to comprehend the term and its relevance to their funding situation?

The NDIS stipulates that the support: *

• Must be directly associated with the participant's disability.

• Must exclude everyday living expenses not tied to disability needs, such as groceries.

• Should offer value for money.

• Should be effective and beneficial for the participant.

• Should consider aid provided by other government agencies, family, caregivers, and the community.

Under the 'reasonable and necessary' legislation, these supports should:

• Assist in achieving their goals.

• Foster their independence.

• Enable them to participate in community activities.

• Assist their involvement in social events.

• Support them in leading a normal life.

How does the NDIS determine what to include in a plan based on what is reasonable and necessary?

The NDIS considers the following factors about your customer:

1. Their dreams and objectives.

2. Their abilities, potential, and current situation.

3. Any obstacles or constraints that prevent them from leading a normal life.

4. Their specific needs related to their disability.

5. Any present risks and protective measures that need to be implemented.

Customers will come to you to ask about a particular item or service they wish to purchase and by seeking advice, they are on the first step towards making a decision.

In requesting guidance, they're seeking an answer and need clarification.as their support coordinator, you will either have the knowledge and experience from previous questions about the same type of purchase or you will have to do some research.

Perhaps one of the under-utilised areas of expertise in what can be funded are plan managers. They need to be compliant and most understand the NDIS reasonable and necessary criteria. They will often have a handy sheet to provide your customer. This checklist helps you and the customer understand whether or the NDIS will see the purchase as reasonable and necessary.

GREY AREAS

There are often purchases that may or may not be reasonable and necessary and this is where your customer will be the one to decide. This is under their choice and control and neither a plan manager nor a support coordinator have the authority to stop a purchase being made.

Either can only advise that the NDIS may not see the purchase as reasonable and necessary and the customer will take the risk that the NDIS may ask for the funding from the item, to be returned.

Let's look at a straightforward example:

Damon, who lives with an intellectual disability, has a goal to participate in more social events. His passion for concerts is legendary amongst those that know him, and he's thrilled that one of his favourite artists is performing in 3 months. Damon wants the NDIS to pay for the experience and is adamant that is what his funding is for.

However, with explanations, Damon learns that the NDIS won't fund things like concert tickets, food, drink, or merchandise. Instead, they will support Damon by covering the expenses of a support worker. This includes transportation to and from the concert, as well as the worker's attendance. Fortunately, Damon discovers that his support worker can join him for free, thanks to a companion card.

Looking ahead to the concert, which is a few months away, Damon can receive assistance in budgeting for his ticket and a concert T-shirt. This way, he can actively plan and prepare for the event with the support of his NDIS-funded services. Damon can build capacity to understand what his funding can buy and further his skills in learning how to manage his money.

Whilst most purchase/services can be justified in some way to get round the reasonable and necessary criteria, it is always wise to assist your customers to go back to basics. The NDIS planning book 3 is a good starting point.

Sample questions from the NDIS booklet 3 and used by some plan managers:

Question	Yes	No
Will the purchase/service help me to pursue my current goals? List the goals you have in plan and how these match against the purchase
Is the cost of this purchase/support value for money - compared to other supports? Please make some notes and have some quotes or invoices that show how?
Will this purchase/support help me to improve my life? If yes, make some notes on how this ties in with your current plan goals.
Could this purchase/support be funded by another government agency instead. Such as dental, hospital, health services, health services or housing? Make some notes about how it will help you meet your short or long term goals.
Will the purchase/support help me to participate in the Community. If yes, please explain how?
Is the purchase/support safe - will it cause me or others harm?
Can I afford the purchase /support within my current NDIS budget? Remember your plan needs to last over the its period.

The intention of the NDIS is to bridge the gap between having a disability and not having a disability.

For further reading on the topic, please head to the NDIS website link below.

NDIS Guidelines.

*Source NDIS

We wish you well, as always.

The Lama Care Team