What is reasonable and necessary?
The NDIS will only fund supports that it considers reasonable and necessary. Because this is open to interpretation, many people find it a confusing concept. This guide breaks down the criteria the NDIS use to assess whether a support is reasonable and necessary.
If you can answer yes to the questions that are most relevant to the support in question, then there’s a good chance that it can be funded by the NDIS.
1. Is it directly related to your disability?
You should be able to connect your NDIS supports with your disability, which essentially means that the reason you need the product or service is because of your disability.
For example: If your disability prevents you from cleaning your house, it would be necessary for you to hire a cleaner with your NDIS funding.
2. Is it something other than a day-to-day living expense?
Day-to-day living expenses are those everyday costs like groceries, public transport tickets or phone bills. Because paying for these is a part of daily life for everyone, the NDIS doesn’t consider it reasonable to fund them.
For example: While the NDIS can fund an iPad that allows you to access remote therapy, it won’t fund your internet bill, as this is a day-to-day living expense.
3. Does it offer value for money?
All NDIS supports should be reasonably priced or represent value for money. This doesn’t necessarily mean they have to be cheap, but if there’s a cheaper option that serves the same purpose, then the NDIS expects you go for the cheaper option over the more expensive one.
For example: If you need noise cancelling headphones to manage sensory concerns, a top of the line or luxury brand may not be considered reasonable and necessary as there are cheaper options with the noise cancelling feature.
4. Does it help you achieve your NDIS goals or become more active in the community?
If a support can be linked to the goals in your plan, help you build your independence or become more active in the community, then it meets this criteria. This is why we recommend having broad NDIS goals, which apply to more supports.
For example: Pottery classes may be considered necessary if one of your NDIS goals was “to learn how to express myself through creativity”.
5. Is it unreasonable for your informal support network to provide the support?
The NDIS expect people’s informal networks – like partners, family and carers – to play a role in the support they receive. If your informal network can realistically deliver your support, the NDIS may not consider it reasonable to fund it.
For example: If you live with others who are able to clean the house or maintain the garden, the NDIS may only consider it reasonable to pay for a professional to service your room or part of the house and likely won’t consider it reasonable to service the entire property.
6. Is the NDIS the only way you can fund the support?
There are several Government bodies and programs that provide support to people, including Medicare, the Department of Housing and the Department of Transport. Generally, the NDIS will not consider it necessary to fund a support if there’s another way to fund it.
For example: If you partially pay for a psychology visit with your GP mental health plan, the NDIS won’t consider it necessary to pay the difference with your NDIS funds.
What if I’m still unsure?
As you can see, many of these questions might not have a clear yes or no answer. While the ultimate decision is up to the NDIS, speaking to an expert like Plan Partners can help you determine whether a support meets the criteria of being reasonable and necessary.
Have more questions?
- Reasonable and necessary relates to your personal situation. What’s reasonable and necessary for you, might not be for another person, and vice versa.
- Ensuring you have good NDIS goals makes it much easier to meet the reasonable and necessary criteria.
- Support Coordination can help you understand what’s possible with your plan
- Your Plan Manager can help provide information about how to determine what’s reasonable and necessary but in the end, the decision is up to the NDIS.
- The NDIS may ask you to justify the products and services you’ve paid for with your NDIS funding. If this happens, you will need to show why they are all reasonable and necessary. The more evidence you can produce to support your claim, the better.
Have a query? We’d love to hear from you.