What is meant by reasonable and necessary supports?

Reasonable and necessary supports can be funded by the NDIS in a participant’s plan to enable them to achieve their goals. These goals may relate to a range domains including education, employment, social participation, independence, living arrangements and health and wellbeing. Specifically, the supports that are funded will assist 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^[1].

^[1] Source - NDIA website Supports funded by the NDIS

How does the NDIA know what is reasonable and necessary?

The NDIA makes decisions based on the National Disability Insurance Scheme Act 2013 and rules made under the NDIS Act. The operational guidelines also provide practical guidance for decision makers.

In general for a support to be funded in a participants plan the support must first meet the following criteria to be considered reasonable and necessary:

• be related to the functional impact of 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,
• take into account informal supports given to participants by families, carers, networks, and the community, and
• is not more appropriately funded or provided through other service systems^[1].

^[1] NDIA website Reasonable and necessary supports

What types of supports will the NDIS fund for participants?

The NDIA Price Guides provide a comprehensive and itemised list of the supports the NDIS will fund. They are a useful resource for practitioners to understand what supports are funded under the NDIS. In addition, they are also a useful resource should their patients request their assistance with preplanning activities before they meet with the NDIA to develop their NDIS Plan. The following items provide an overview of the types of supports that the NDIS may fund for participants:

• 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^[1].

^[1] Source - NDIA website Supports funded by the NDIS

What are the 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. For example, the NDIS does not fund health care. 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 are the costs of NDIS supports?

The success of this ambitious reform will depend heavily on a diverse and innovative disability market developing and having capacity to respond to the needs and preferences of its new customers. To ensure participants receive value for money, particularly in emerging markets and where there are limited support options, prices are regulated by the NDIA and the Price Guides provide the limits to what providers may charge for certain supports and services.

In recognition that there are additional costs to deliver supports and services in remote areas, the Modified Monash Model is used to define remoteness regions, with price limits increased accordingly. In addition, a price guide specifically for Specialist Disability Accommodation (SDA) supports incentivises the development of new, innovative housing models, while states have been grouped to support different legislative and other requirements. NDIS Price Guides are available for the following areas:

• NSW/VIC/QLD/TAS
• WA/SA/ACT/NT
• Remote
• Very Remote
• Supported Disability Accommodation

How are supports structured within the NDIA Price Guides?

Funded NDIS supports fall into three Support Purpose Categories outlined below. Within each Support Purpose Category there are Support Categories that contain the itemised support items.

How does the NDIS Outcomes Framework relate to NDIS supports?

The NDIA have developed the NDIS Outcomes Framework to enable to NIDA to measure the outcomes of the scheme and outcomes of participants’ NDIA plans. The NDIS Outcomes Framework is comprised of the following eight Outcome Domains

1. Daily Living
2. Home
3. Health and Well-Being
4. Lifelong learning
5. Work
6. Social and Community Participation
7. Relationships
8. Choice and Control

There are fifteen Support Categories that align to the Support Purpose and Outcomes Framework in the NDIA Price Guides. The table below ^[1] provides an example of how the Support Purpose categories, Outcomes Framework and Support Categories align.

^[1] NDIS Price Guide (PDF) 2019-20 Version 2.2 (published 25/03/2020), p.7

How is a participant’s funding allocated?

Each NDIS Plan has a budget allocated to each of the three Support Purposes and can be expended in a prescribed manner for each one.

A periodically updated list of itemised supports (line items) is provided in the NDIS Price Guides in the Support Catalogue. The itemised support items change over time. They may not include all available supports nor prescribe the only supports funded under the NDIS. Providers are able to claim payments under support items that align most closely to the support they provided.

The following NDIS case study illustrates how NDIS supports can be applied in a participant’s plan including: Capital - Assistive Technology; Core – transport; Capacity Building - therapy services.

Case Study - Types of NDIS support

Tania: Home with her family where she belongs

Tania is a proud Awabakal woman and active member of the NDIA Hunter Local Advisory Group who is passionate about improving the lives of young people residing in aged care.

After having a stroke at the age of 39, Tania lived in an aged care facility for three years, where she was confined to her bed, unable to take part in her community and separated from her husband and daughter, who is now 16.

When Tania became an NDIS participant, she began to reclaim her independence and achieve her goals. First she was provided with an electric wheelchair that gave her back her freedom. 'I was in bed all day every day. When I first had my stroke I couldn't talk, walk, move or see. I remember the first day I went outside (in my wheelchair) it was just amazing feeling the sun and seeing the grass, the things you miss.'

'Then I was given some travel allowance so that I could go home and see my daughter. Until then I could only see her once a week and she hated visiting the nursing home.'

In Tania's second NDIS plan her goal was to move back home with her husband and daughter. With the support of her NDIS planner and her LAC, Tania obtained an electric bed, an electric shower chair, physiotherapy and occupational therapy supports. Because of these supports, she now lives at home with her family.

'The NDIS is just fantastic I cannot thank them enough for what they have done. It has changed my life. It has given me my daughter back and everything back to me that I ever wanted.^[1]'

^[1] Source - This case study is sourced directly and replicated from the NDIA 2014/15 Annual Report