What doesn't the NDIS Fund?
In determining what it will fund, the NDIA will apply the Reasonable and Necessary criteria in section 34 of the NDIS Act and consider the NDIS Supports for Participants Rules.
While there is no set list of supports that the NDIS will not fund, the Rules state that the NDIS does not fund supports that are:
the responsibility of another system, such as health or justice
related to day-to-day living expenses, such as groceries or utility bills*
unrelated to a person’s disability
reasonable adjustments required of services or employers
likely to cause harm
*Note, the NDIA may still fund day-to-day living costs when: they arise solely and directly from a person’s disability; or when the day-to-day living cost is ancillary to another support funded or provided in the plan and the participant would otherwise not have to pay that cost.
Would we fund it?
What the NDIA may consider a reasonable and necessary support for one person may not be for another, so there is no blanket list of ineligible support items. However, the NDIA has released a resource called “Would we Fund It” as part of their operational guidelines. These provide circumstances where a person would or would not be eligible for a support.
Another resource that might be drawn in making a determination is the Applied Principles and Tables of Support (APTOS). The APTOS is an agreement between the Commonwealth and State and Territory governments that outlines which supports are funded by the NDIS and which are the responsibility of health, early childhood, child protection, education, employment, housing, transport, justice and aged care. It is a resource for participants and providers to know what they can expect, and to help planners create consistent plans.
These principles are not law; they are extrinsic materials. This means, like the Operational Guidelines and Would We Fund It resource, they should be followed by the NDIA unless they are in conflict with the NDIS Act. In the case of a conflict, the NDIS act is more authoritative in determining whether a support is reasonable and necessary.
If a participant disagrees with the NDIA's determination of reasonable and necessary supports, they can request an internal review.
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