Understanding what’s reasonable and necessary
Once you start getting into the details of the NDIS, you will come across the term ‘reasonable and necessary’ fairly often. These two simple words are the foundation of how the NDIS determines what kind of support will be included in your NDIS plan.
But what does the term really mean, and how do you determine whether your supports are ‘reasonable and necessary’?
The framework of reasonable and necessary might sound vague, but it’s actually pretty straightforward. In fact, if you examine the criteria and understand how it’s applied by the NDIS, you might even be able to use it to your advantage and get the funding you need to achieve your goals and dreams.
In this blog post, we break down what reasonable and necessary means and give some top tips of our own.
What is reasonable and what is necessary?
The NDIS was created to give people with disability more choice and control over how they use their funding. But how does the NDIS decide what exactly it should fund?
The answer: reasonable and necessary.
Before the NDIS will fund a support in your plan, it must meet the criteria of being both reasonable and necessary. While these terms are open to interpretation and assessed on a case by case basis, there are very specific criteria around what does – or doesn’t – meet the standard.
How are supports assessed?
In short, for something to be reasonable and necessary, it must be directly related to your disability and represent value for money. Section 34 of the NDIS Act breaks this down further, establishing 6 specific criteria that we’ll take a closer look at now.
For a support to be reasonable and necessary, it must:
- Help you achieve the goals and aspirations you identified in your NDIS Plan
- Get you more connected to your community; either socially or economically
- Represent tangible value for money; particularly if it’s priced above the NDIS price guide
- Use established, science-based methods and be likely to provide a real benefit
- Not serve as a stand-in for what should reasonably be provided by other parties, such as family members, carers or the community
- Not fund a support that could be funded by another, more appropriate method, such as another Government body.
If a support meets all these six criteria, it’s deemed to be reasonable and necessary and should be approved for funding under the NDIS. While there’s no black and white guide to what will and won’t be funded, that flexibility can work in your favour, as you can use these six criteria to help justify the funding of a support for your specific situation.
Tips to get prepared
Now we’ve outlined exactly how the NDIS assesses whether a support is reasonable and necessary, here are some of our team’s top tips that you can use to help get the most out of your NDIS funding.
- Keep the criteria in mind – When asking for a support, remember to always tie it back to the reasonable and necessary criteria. Ask yourself, how is this going to help me achieve my goals and how is it related to my disability? This helps differentiate it from day-to-day expenses which aren’t funded.
- Be prepared – When going to a planning meeting, take any documentation with you that will help you argue your case. If you’re worried a support might not obviously pass the reasonable and necessary criteria, you can get your therapist to write a recommendation ahead of your meeting stating why he/she thinks that the support is reasonable and necessary. Having all your supporting documentation with you in the planning meeting will help get supports written into your plan.
- Appealing a decision – If the NDIS deems a support to have not met the reasonable and necessary criteria, you can appeal the decision. Make sure you build a case around why you believe the support should be funded, and gather any supporting documentation to argue your position. You can request a review by contacting the NDIA by phone (1800 800 110), email (email@example.com) or by submitting a written request to Chief Executive Officer, National Disability Insurance Agency, GPO Box 700 , Canberra ACT 2601. There are also advocacy groups who can assist with this process, should you feel you’d like some assistance.
- Speak to an expert – If you’re still unsure about what you can or can’t get funded under the NDIS or need some more assistance understanding the framework of reasonable and necessary, call Plan Partners and speak to one of our helpful experts.