What is ‘reasonable and necessary’

What is ‘reasonable and necessary’?

To thrive on an NDIS plan it’s essential to gain access to the right supports for you while working towards your goals. Not all supports you’d like access to though, are necessarily funded by the NDIS.

At myAutonomy, one of the most common questions we receive is, “Is this funded?” The answer to this is, it depends.

We’ve created a helpful guide to ensure you, or your participant, know what is and isn’t funded.

The ‘reasonable and necessary’ test

When considering whether something is reasonable and necessary, it’s necessary to ask the following questions.

1. Does this support relate to the disability?

All supports must relate to the disability; non-disability-related requests are not covered by the NDIS. Therefore, this is the first and most important question to ask.

2. Does this support help you achieve your goals?

All supports funded within your NDIS plan must relate specifically to the goals you have set out. Therefore, it’s essential to consider how the support helps you to achieve your goals.

Say, for example, you’d like access to a physical therapist, you’ll need to show why a physical therapist will help support your disability-related goals. Physical therapy, for example, could be related to a goal in your plan to improve balance and mobility.

3. Should this support be covered by the NDIS?

Keep in mind that 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 dental care, osteopathy, audiology, and chiropractic care, are not covered by the NDIS but by other funding sources.

4. Is the support value for money?

It’s also important to examine whether a support is value for money. The NDIA considers this an important factor when deciding if a support is covered.

If there’s a lower-cost alternative to the support you are requesting, then the support may not be funded.

The NDIA also takes a long-term view to consider whether a support may reduce funding needs for a participant in the future.

Having access to an iPad for example, could enable a participant to access remote therapy and reduce the need for travel costs in the future.

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

For a support to be covered, there must also be sufficient funding in the right category to pay for it.

Tracking your spending and budgeting accordingly is essential to ensure you have sufficient funds to pay for the supports you need.

So you know, at myAutonomy, we help you keep track of your budgeting so you don’t have to.

6. Does the item require written NDIA approval?

Sometimes it’s necessary to have specific approval from the NDIA before a support is covered. 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?

If you don’t meet the above test, but you still feel that a support should be reasonably covered, it can be 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.

The reasonable and necessary checklist

To ensure you know how to decipher whether something is eligible or not, we’ve created this handy checklist.

  1. At least one of the following is required:
  2. 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 an LAC or planner

  3. All of the following are required:
  4. 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)

We’re a call away

At myAutonomy, it’s our goal to help you thrive. If you’re curious about whether something is funded, reach out and we can help.

Contact us at 1300 60 33 89 or at [email protected]