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Sydney & Online, March 26-27

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NDIS News & Analysis

UPDATED Myth Busting - “NDIS won’t fund that”

Chris Coombes

We’ve updated our hugely popular 2021 article to include another 37 new Administrative Appeals Tribunal (AAT) decisions that busted myths about supports the NDIS won’t fund.  

 When chatting with colleagues, planners, or even looking at NDIS resources such as the “Would we fund it” page, you might come away with the impression that the NDIS doesn’t fund a specific support, that it’s forbidden. For example, someone might tell you, “the NDIS does not fund chiropractic”, or “the NDIS does not fund support worker hours for anyone under seven/psychology for someone in prison without a release date/yachts/yoga/spaceships/ ex toys,” or… whatever. But the NDIS Act is silent on the specific supports that it won’t fund. These myths can become problematic when, upon learning of a so-called forbidden support, a participant withholds requests in a planning meeting.

 The table below lists 73 times where the NDIS has rejected a support, only to have the AAT overturn that decision (Please note: this list is not commenting on the validity of any supports). All supports funded by the NDIS need to meet the reasonable and necessary criteria in the NDIS Act. Reasonable and necessary decisions are individualised, considering the person’s unique circumstances and the evidence provided.

 If a participant disagrees with an NDIA funding decision, they can request an internal review. And if they are still not happy with the outcome, they can appeal the NDIA’s decision to the AAT. The vast majority of matters are resolved without a hearing using informal dispute resolution meetings.

 If a person goes all the way to a hearing, the AAT - acting as an external and neutral party - will decide whether a support is reasonable and necessary for that person. AAT decisions are not legal precedents and a support that is reasonable and necessary for one person, might not be for another. That said, AAT decisions can inform people about what supports have been funded in the past, the circumstances under which it was funded, and what evidence they needed to collect.

 People who have gone to the AAT have not only helped other participants, Allied Health therapists, and planners to consider outside-the-box supports. They’ve also led to decisions that shape policy. For example, Mazy and the National Disability Insurance Agency invited the NDIA to reconsider where to draw the line between health and disability.

 Busted myths

Myth No. #1

The NDIS doesn’t fund: Chiropractic

Myth No. #2

The NDIS doesn’t fund: 14–16 support worker hours per day for a young child living with parents here and here

Myth No. #3

The NDIS doesn’t fund: Gym memberships

Myth No. #4

The NDIS doesn’t fund: eyewear here and here

Myth No. #5

The NDIS doesn’t fund: literacy course here

Myth No. #6

The NDIS doesn’t fund: Transport above the NDIA’s imagined “Level 3” category here

Myth No. #7

The NDIS doesn’t fund: The faster, riskier wheelchair  

Myth No. #8

The NDIS doesn’t fund: Taxi fares to and from TAFE and the gym

Myth No. #9

The NDIS doesn’t fund: Music therapy

Myth No. #10

The NDIS doesn’t fund: Personal training

Myth No. #11

The NDIS doesn’t fund: Mileage for private vehicle use here and here

Myth No. #12

The NDIS doesn’t fund: Aeroplane tickets for carer to travel with participant twice a year

Myth No. #13

The NDIS doesn’t fund: Registered nurse to deliver insulin

Myth No. #14

The NDIS doesn’t fund: Portable lounge suction pump and oral hygiene devices

Myth No. #15

The NDIS doesn’t fund: Multidisciplinary Cognitive Assessment

Myth No. #16

The NDIS doesn’t fund: Applied Behaviour Analysis here, here and here

Myth No. #17

The NDIS doesn’t fund: 2 hours per week of speech therapy here and here

Myth No. #18

The NDIS doesn’t fund: sex work (AAT and Federal Court)

Myth No. #19

The NDIS doesn’t fund: scooter repairs and maintenance

Myth No. #20

The NDIS doesn’t fund: air conditioner

Myth No. #21

The NDIS doesn’t fund: interstate travel and accommodation to fit prosthesis

Myth No. #22

The NDIS doesn’t fund: driveway modifications

Myth No. #23

The NDIS doesn’t fund: 160 hours per year of psychology

Myth No. #24

The NDIS doesn’t fund: 110 hours per year of behaviour support

Myth No. #25

The NDIS doesn’t fund: Medical Alert (life buzzer) ongoing costs

Myth No. #26

The NDIS doesn’t fund: Identification and training of assistance dog here, here, here, here & here

Myth No. #27

The NDIS doesn’t fund: Dance classes here and here

Myth No. #28

The NDIS doesn’t fund: Additional costs for operation of a modified vehicle

Myth No. #29

The NDIS doesn’t fund: Stair-climber

Myth No. #30

The NDIS doesn’t fund: Trial of one alternative therapy, including:

  • Art therapy

  • Horse therapy

  • Yoga

  • Pilates

Myth No. #31

The NDIS doesn’t fund: Visual Alert System

Myth No. #32

The NDIS doesn’t fund: internet

Myth No. #33

The NDIS doesn’t fund: A vehicle and vehicle modifications

Myth No. #34

The NDIS doesn’t fund: Specialist Disability Accommodation, apartment or villa single or dual occupancy

Myth No. #35

The NDIS doesn’t fund: Modifications for independent space on family residential block

Myth No. #36

The NDIS doesn’t fund: Single occupancy Specialist Disability Accommodation (SDA)

Myth No. #37

The NDIS doesn’t fund: Transport costs for medical appointments

Myth No. #38

The NDIS doesn’t fund: 2 bedroom, single occupancy SDA

Myth No. #39

The NDIS doesn’t fund: Orthoptist, road safety program

Myth No. #40

The NDIS doesn’t fund: Improved liveability, 2 residents, SDA with sprinklers

Myth No. #41

The NDIS doesn’t fund: Feeding therapy, percussion class funding gap

Myth No. #42

The NDIS doesn’t fund: Thermomix, car fridge, power inverter, garden shed kit

Myth No. #43

The NDIS doesn’t fund: Security camera and Bellman system

Myth No. #44

The NDIS doesn’t fund: Assistance with household tasks, including garden maintenance

Myth No. #45

The NDIS doesn’t fund: Mollii suit

Myth No. #46

The NDIS doesn’t fund: Hydrotherapy, yoga, level 3 transport

Myth No. #47

The NDIS doesn’t fund: Car boot opener

Myth No. #48

The NDIS doesn’t fund: Funding for travel, including to GP

Myth No. #49

The NDIS doesn’t fund: Single occupancy, 2 bedroom SDA

Myth No. #50

The NDIS doesn’t fund: 12,480km of mileage

Myth No. #51

The NDIS doesn’t fund: support worker for 4 year old; 20 hours Clinical leadership

Myth No. #52

The NDIS doesn’t fund: CPAP Machine

Myth No. #53

The NDIS doesn’t fund: school day support at 2:1; 14 hours weekly therapy assistance; home mods; specialist SC

Myth No. #54

The NDIS doesn’t fund: Lighting, appliances and other assistive technology

Myth No. #55

The NDIS doesn’t fund: more ABA therapy here, here, and here (with provider travel)

Myth No. #56

The NDIS doesn’t fund: three year plan for child

Myth No. #57

The NDIS doesn’t fund: swimming lessons and car seat

Myth No. #58

The NDIS doesn’t fund: Single occupant, 2 bedrooms SDA

Myth No. #59

The NDIS doesn’t fund: Up to $110,000 for an independent housing unit on parent’s land

Myth No. #60

The NDIS doesn’t fund: Feeding therapy; percussion class gap funding

Myth No. #61

The NDIS doesn’t fund: Hydrotherapy pool

Myth No. #62

The NDIS doesn’t fund: 1 bed SDA

Myth No. #63

The NDIS doesn’t fund: 2:1 and 3:1 support

Myth No. #64

The NDIS doesn’t fund: 15 hours weekly Early Childhood therapy, plus weekly speech and OT

Myth No. #65

The NDIS doesn’t fund: 4 weeks STA; a support worker 42 hours per week

Myth No. #66

The NDIS doesn’t fund: Construction of a pathway; minor home modifications including ensuite

Myth No. #67

The NDIS doesn’t fund: Continence nurse assessment; 60 hours of therapies; 5 hours per week cleaning

Myth No. #68

The NDIS doesn’t fund: 8 hours per week ABA; weekly speech and OT

Myth No. #69

The NDIS doesn’t fund: Maintenance of assistance dog

Myth No. #70

The NDIS doesn’t fund: 14 hours per week Early Intensive Behaviour Intervention; 2 hours per week speech; 18 hours per year of school consultation; dietician

Myth No. #71

The NDIS doesn’t fund: 20 hours per week of ABA, and 4 hours per week of provider travel

Myth No. #72

The NDIS doesn’t fund: 80 km per day of transport

Myth No. #73

The NDIS doesn’t fund: 3 hours per week of cleaning; 2 hours per week psychology

Decisions in favour of the NDIA

You’ll notice I’ve left out decisions where the AAT agreed with the NDIA about a support not being reasonable and necessary. Even where the AAT agrees that the support is not reasonable and necessary in one circumstance, doesn’t mean it wouldn’t be in another. So decisions in favour of the NDIA aren’t really ‘myth busting.’

New appeals process

Change is here. The government last year announced that it is replacing the AAT with a new thing that will be called the Administrative Review Tribunal. The government has released detail about this here. Stay tuned for more analysis on what this will mean for the NDIS.

More resources

I'm not a lawyer and this is not legal advice, so please do seek individualised advice. Non-legal advocacy can be found here. Hit up your state legal aid service and ask for a referral to their NDIS reviews team. DASH is also a new initiative through Disability Gateway that offers some one-off support – check them out here or call 1800 643 787.

DSC has collaborated with several amaze-balls experts in the NDIS Appeals/law area to release a FREE resource on navigating the AAT – you can find it here. Love free stuff.

Sara Gingold's brilliant analysis of Assistance Animals V NDIA is here and Art therapy here.

Todd Winther’s dissection of single resident Specialist Disability Accommodation AAT matter is here.

Wouldn’t fund it: Gym Memberships is here.

Wouldn’t fund it: Alternative therapies is here.

Stunning analysis of case law contained in 2021 AAT decisions by two leading NDIS lawyers, Chadwick Wong and Dr. Darren O’Donovan, can be found here.

PIAC’s 2022 analysis of AAT caselaw can be found here.

Author

Chris Coombes

Chris entered the sector as a support worker 13 years ago. Early on, Chris was working alongside a person who was unnecessarily detained in a prison. The injustice ignited a fire in his belly for a fairer system and drove him to study social policy. Completing a masters from the London Sch...

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