Any assistance must first satisfy all of the requirements outlined in the NDIS law about "reasonable and necessary" in order to be accepted and financed in an NDIS plan.
It may be simpler for the NDIA delegate to decide whether a service is reasonable and necessary if you are aware of and can refer to the reasonable and necessary criteria in the supporting documentation when filing an application to the NDIS.
What Is “Reasonable and Necessary” Criteria?
The standards for what services are deemed "reasonable and necessary" for the NDIS to provide are outlined in Section 34 of the NDIS Act.
In order to enable people to live "ordinary" lives and accomplish their objectives, the NDIS provides funding for reasonable and required services related to their disability. Support for work, education, gaining independence, housing arrangements, or overall health and well-being may fall under this category.
The NDIA Planner will discuss your needs and objectives with you at your planning appointment in order to determine which services are appropriate and required for you. Your planner will determine whether a request for assistance is:
- regarding your disability.
- not an expense from the mainstream that has nothing to do with your assistance requirements due to your impairment.
- economical value.
- most likely to work well and be advantageous to you.
They will also consider the unpaid, unofficial assistance that you have received from friends, family, and the community. They will also take into account formal assistance that is not financed by the NDIS, such as health and education services.
Example of “Reasonable and Necessary”
The assistance that will enable you to achieve your objectives, live a more independent life, engage in employment or social activities, and play an active role in your community are ultimately what constitute reasonable and required services.
These are a few instances of support that are often thought to be reasonable and necessary:
- support staff to assist with tasks related to personal care.
- Occupational therapy, speech therapy, and behavior support are examples of therapeutic supports.
- Employment assistance to assist you in finding or keeping a job.
- transportation to facilitate your participation in events.
- assistance with domestic tasks.
- assistance and equipment that help you perform tasks independently.
- house improvement.
- mobility aids to facilitate your daily activities.
Remember that this is not a full list. Even though funds for this assistance are generally available, each plan is unique, and your financing will always depend on your own circumstances.
How To Be Sure That NDIS Will Fund Your Request?
If you can respond YES to these questions, it is reasonable and necessary, and it is likely to be financed if it assists you in achieving your goals.
1. Will the assistance enable you to fulfill the objectives listed in your NDIS plan?
The assistance you purchase has to be connected to your disability and the support objectives and budgets in your current NDIS plan.
2. Is the assistance well-valued and priced fairly?
When compared to alternative solutions, the support should provide excellent value for the money. Recall that you have the option to spend more for higher-quality help that satisfies your requirements or to pay less and get more care.
3. Is the help within the limits of your support budget?
For the duration of your plan, your NDIS funding must be available. To ensure you know what you can afford, create a budget early on. This will assist you in monitoring your finances and deciding whether to adjust your assistance throughout the plan.
4. Will the assistance enable you to strengthen your bonds with family and friends and establish a stronger connection with your community?
The assistance you get should enable you to find and maintain employment, as well as enable you to engage in social activities with friends and neighbors.
5. Should the NDIS pay for the assistance rather than other government programs?
Support from other government agencies will not be included in the paid support in your NDIS plan. For instance, additional government services include housing, public transportation, education, health or hospital care, and dentistry.
6. Is the assistance secure?
You have to purchase legal assistance. It shouldn't hurt you or put you or others in danger.
Remember that the NDIS is intended to assist you in achieving the greatest possible outcomes based on your specific circumstances. The "reasonable and necessary" requirements guarantee that funds are allocated for services and assistance that will really improve your quality of life.