The term reasonable and necessary are used a lot in the NDIS context. We’re breaking down what they mean and how they will impact your NDIS journey.
What does “reasonable and necessary” mean?
Reasonable refers to something being fair and appropriate. Necessary is something that is needed. Under the NDIS, reasonable and necessary can be understood to mean whether a support is needed due to your disability and whether it is an appropriate or fair use of your NDIS funding.
Reasonable and necessary supports are ones that bridge the gap between your disability and achieving goals. They do not include everyday living expenses that are not related to your disability.
For example, a reasonable or necessary support may be having a support person accompany you to the cinema. However, the purchasing of movie tickets and popcorn wouldn’t be considered reasonable and necessary, as this is a day-to-day expense encountered by everyone.
It’s important to remember that what’s deemed reasonable and necessary for one person may not be considered reasonable and necessary for another - it all depends on your unique situation.
The NDIA looks at various factors during the planning phase of your NDIS plan to determine whether the supports you have requested are reasonable and necessary.
They consider how the support relates to your disability and whether it is needed to help you move towards your goals. They evaluate how likely it is to help you achieve your goals and desired level of independence.
The NDIA will investigate whether the support is directly related to your disability, and is not covering standard day-to-day living costs.
They also consider the value for money the support provides, and what other supports you may already have such as family and community supports.
What happens if the NDIA decides a support I need is not reasonable and necessary?
It a support you believe is important in helping you gain independence is not deemed reasonable or necessary by the NDIA, you have the option to appeal. There are both internal and external review processes which can be initiated by phone or letter if required.
When appealing, it’s important to review your application and consider the above points that are considered when this decision was made. Make sure you can clearly explain how the support will help you pursue your goals. Outlining clearly how the support is related to your disability and contributes to your wellbeing will put you in a good position to have the NDIA assess your request.
Need help managing the day-to-day admin of your NDIS plan? The Bright Plan Management team are here to help. Get in contact today!