Explained: what’s ‘reasonable and necessary

Explained: what’s ‘reasonable and necessary’?

Gaining access to the right supports is a core goal for most participants. Not all supports, though, are going to be funded by the NDIS.

One of the most common questions we receive as a plan manager is, ‘Will this be funded within my plan?’

The answer isn’t always straightforward. We’ve created a helpful guide to ensure you, or your participant, can know what will and won’t be covered.

For more information, we also recommend taking a look at the NDIS website.

1. Does this support relate to the disability?

The first question to ask when considering a support is whether it relates to the disability. Non-disability related requests will not be covered by the NDIS.

2. Does this support help you achieve your goals?

Any supports funded under an NDIS plan must also relate specifically to a goal in your plan.

Say, for example, you’d like access to an iPad, you’ll need to show why that iPad will help support your disability-related goals––the iPad could be essential for you to access telehealth services.

3. Should this support be covered by the NDIS?

The NDIS doesn’t cover all supports even if they relate to a goal in your plan. That’s because they may be better funded elsewhere.

Professions including sonography, dental care, osteopathy, audiology, and chiropractic, for example, are not covered by the NDIS but by other funding sources.

4. Is the support value for money?

The NDIA considers it important to use funding for supports that are value for money. If there’s a lower-cost alternative, then the support may not be funded.

By taking a long-term view, the NDIA will also consider whether a particular support may reduce a participant’s need for funding in the future.

Having access to a balance ball at home, for example, may reduce the need for travel costs to a specific therapist for balance therapy.

5. Are there sufficient funds available in the plan category?

To have a support approved there must be enough funds in the correct category to pay for it.

It’s helpful to keep track of spending and budget accordingly to avoid overspending in any one category. Fortunately, at myAutonomy, we can help with budgeting to keep you on track.

6. Does the item require written NDIA approval?

Some supports require specific approval from the NDIA before they are funded. Meal preparation and delivery services, for example, require approval first.

7. Do you have a supporting letter from a qualified and appropriate allied health professional?

It’s also helpful to have a letter of support written by a qualified allied health professional.

The letter can bolster your claim and help clarify how the item or service requested helps overcome the impact of the disability.

Use the checklist

Since it can be tricky to decipher what’s eligible, it might be helpful to use our checklist below.

1. At least one of the following is required:

  • The support is listed in the participant’s plan, OR
  • The support relates clearly to a goal in the participant’s plan, OR
  • The support is approved in writing by a LAC or planner

2. All of the following are required:

  • The support relates to the participant’s disability
  • The support is value for money
  • There is sufficient funding to cover the support
  • NDIA approval has been given (if required)
  • The support is accurately provided by the NDIS (and not another source)

Have a question?
Contact us at 1300 60 33 89 or at [email protected] and we can help.

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