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NDIS "Reasonable and Necessary" - Explained Simply
You may have heard the NDIS use the words reasonable and necessary. These words help explain how the NDIS decides which disability supports it can fund.
But what do they actually mean?
Put simply, the NDIS looks at whether a support meets your disability-related needs, is likely to help you and offers value for money. It must also be an eligible NDIS support or an approved replacement support.
Here's how it works.
What makes a support reasonable and necessary?
When deciding whether to fund a support, the NDIS looks at whether it:
- Relates to your disability.
- Helps you work towards your goals.
- Helps you take part in work, study or social activities.
- Offers value for money.
- Is likely to help you.
- Works alongside other supports available to you.
- Is an eligible NDIS support or an approved replacement support.
The NDIA also looks at evidence about your needs.
The NDIS considers support you already receive from family, community services and other systems, such as health and education. It also considers how each support fits with the rest of your NDIS plan.
Can you give me an example?
Imagine you need help getting dressed because of your disability. A support worker may be funded to help you with that task. Or you might need equipment that makes dressing easier.
The NDIS would consider your needs, the likely benefit and the cost.
It doesn't mean everyone with the same disability gets the same funding.
Your plan is based on your own circumstances.
Does reasonable and necessary mean I can buy anything helpful?
No.
Something can be helpful without being an eligible NDIS support. For example, a holiday might help you feel better, but the NDIS generally doesn't pay for holidays.
The NDIS has lists of what it can and cannot fund.
Even if something helps you, it must still be an eligible NDIS support or an approved replacement support.
In limited cases, the NDIA may approve a replacement support instead of an existing NDIS support in your plan.
You must get written approval before buying a replacement support with NDIS funding.
Read the NDIS guide to eligible supports and the NDIS guide to replacement supports.
What if the NDIS says no?
Ask the NDIA to explain why the support wasn't approved. If you disagree with a reviewable decision, you can ask for an internal review.
You generally have three months from receiving the decision to request this.
You can also provide more evidence about your disability-related needs.
If your circumstances have changed since your plan was approved, you may need to ask for a plan change instead.
Need help understanding your NDIS budget?
Kismet Healthcare can help plan-managed participants track their budgets and eligible provider invoices.
Learn more about Kismet Plan Management.