What is reasonable and neccessary?
For any support to be approved and funded in an NDIS plan, it must first meet all of the ‘reasonable and necessary’ criteria as defined in NDIS legislation.
When making an application to the NDIS it is useful to understand and reference the reasonable and necessary criteria in the supporting evidence, as this can make it easier for the NDIA delegate to determine if a support is reasonable and necessary.
The six NDIS reasonable and necessary criteria can be summarised as follows:
The support will help the participant to pursue their NDIS goals and aspirations.
The support will help the participant to undertake activities that will increase their social and economic participation.
The support is value for money, which means that the costs are reasonable:
- when considering the potential benefits achieved by the funded support (for example, whether purchasing the support is likely to reduce the cost of other supports in the long term); and
- when compared with alternative options that may provide the same outcome at a similar or cheaper cost.
The support is likely to be effective and beneficial for the participant with regard to good practice and evidence.
The support is required to complement the informal supports available to the participant by taking into account what is reasonable for families, carers, informal networks and the community to provide. AND
The support must be most appropriately funded or provided by the NDIS, meaning that the support is not more appropriately funded by another service system, agency, person or body, such as the education system or the health system.
Tip: You must be able to tick off all 6 to pass the reasonable and necessary test!
In addition to the reasonable and necessary criteria, knowing what the NDIS will not fund is helpful. The NDIA will not fund supports if:
It is likely to cause harm
It is not related to the person’s disability
It duplicates other supports delivered by the NDIS
It is considered a day-to-day living cost (for example, rent, groceries or utility costs) that is not attributable or caused by disability support needs
Providing the support would be against the law
It consists of income replacement
It is the responsibility of other service systems to provide (for example, your state government, the education system or the health system).