Whether you’re new to the NDIS or been involved for some time, you’ve possibly heard the term ‘Reasonable & Necessary’.
Reasonable & Necessary Supports (R&N), are a set of six conditions written into the NDIS Act 2013, that must be met in order for you to use your NDIS funding. Even before your plan is granted, your NDIA planner must satisfy each of the six criteria when allocating funding to your plan.
In usual NDIS style, the criteria are a touch ambiguous with a wide scope for interpretation.
To break it down in super simple terms the NDIA must be convinced that the supports:
- Assists you in meeting the goals as stated in your plan
- Assists you to undertake activities allowing you to be included in the community
- Represents value for money
- Is likely to be effective and beneficial for you
- Is reasonable to expect families, carers and the community to provide
- Is not a service that is more appropriately funded outside of the NDIS eg. Medicare Private Healthcare, Department of Education
In addition to these six criteria, the support/service or equipment:
- Must be related to your disability
- Not include day-to-day living costs or items that would be considered ‘everyday items most Australians use for everyday life’
- Takes into account informal and formal support given to you by family/friends and the community
There’s a super little video on the NDIS website that explains the ideas above in more detail, called Reasonable & Necessary Supports. Check it out if you need more clarification.
When you’re considering purchasing a piece of equipment or service through your plan, please read over the two lists above and think about if it meets each of the criteria.
The two main points to consider are:
- Is this service/product directly related to my disability?
- Is there some evidence to support the connection between the service/product and my disability?
Here are a few examples of recent client queries we’ve had and the outcomes:
Greg, a single leg amputee, was finding it hard to shower, dress and support himself within the community. He has now hired a support worker to assist him in and outside the home to help maintain his independence and access community activities. This service is definitely related to Greg’s limitations within his disability and would meet the R&N test.
Kathy, a psychosocial participant, was recommended massage by her psychologist as a form of relaxation to assist with her anxiety. Although it would certainly benefit Kathy, massage is not considered ‘directly related to her disability’ and also, more appropriately funded through Private Healthcare. Many Australian’s (without disabilities) whom suffer anxiety also enjoy the benefits of massage. In this instance, massage would not meet the R&N, as it is not disability specific.
Cynthia, who had suffered an ABI (Acquired brain injury), was struggling to prepare food in the kitchen for herself and her family. Her OT recommended some modified/easy to use kitchen utensils and minor home modifications to assist her with cooking. These ‘low risk’ items had specific functions that assisted Cynthia with the limitations she was experiencing due to her disability. They were directly related to her disability, provided value for money and assisted Cynthia in achieving her NDIS goal ‘to maintain my independence within my home’, and would satisfy the R&N.
John, suffering early onset dementia, enjoyed gardening. He was often finding it hard to balance and was using his wheelie walker more and more. His wife suggested purchasing raised garden beds to assist John with his desire to continue gardening. Although, the raised garden beds would certainly assist John in his NDIS goals, they would be considered an everyday item for most Australians who enjoy gardening, and not disability specific. Personal garden infrastructure might also be more appropriately funded through the family. The garden beds were deemed not R&N and not funded through John’s NDIS plan.
The R&N is quite a mixed bag! We’ve seen equipment and services approved for some clients and not others. Whether a service or product is approved through a plan is very individual and based on the specific disability you have, the challenges you’re facing, the evidence available to back your claim and the planner’s interpretation of the R&N guidelines.
Ultimately, only the NDIA can approve services/products through an NDIS plan. If you’re still unsure whether a service/product would be funded through your plan, please reach out to the NDIS help desk on 1800 800 110. They’ve been fantastic is assisting so many of our clients (and us) understand what might and might not be funded through your plan.
Now, I’d LOVE to hear from you!! If you’re brave enough, please leave a comment and share your story on what types of services/products have been approved and what has not have been approved. Each side of the story is just as important. The more we learn, the more we can assist you and the TCPM community!
So much love your way! ❤️
Jude x
Hi Jude . Autism level 2 learning difficulties with my granddaughter Kialla- jade . Does an iPad for voice to text considered necessary. Or do I pay for it. kJ home schools .kialla-jade Can not cope with learning at school or bullies in the playground
Thanks
Suzy
Hi Susie, Unfortunately, the NDIS doesn’t cover items related to Education, however, if Kialla-Jade needs an iPad to access her allied health services during COVID-19, while the social distancing restrictions are in place, check out this link on the NDIA website to see if she’s fits Low Cost Assistive Technology for Support Continuity during coronavirus (COVID-19) https://www.ndis.gov.au/participants/home-equipment-and-supports/assistive-technology-explained. You’ll need a recommendation letter from a therapists prior to approval. Hope that helps!
Thank you Jude for your invaluable information. Helen
Thank Helen! Love to you! ❤️
Would not John be at risk of falls if he continued his gardening therefore relating to his disability people with dementia are an increased risk of falls and are known to suffer balance problems hence the WW. If he were unable to continue his gardening then he would also be at risk of further more imminent decline. I do not agree with this decision made by ndis. I am a retired Dementia specific nurse in nursing homes residents are provided raised beds to attend gardening activities. I see no problem him being allowed to contiue this in his own home.
Hi Kerry, thanks so much for your feedback! I’ve talked to a couple of NDIA planners regarding this query. The feedback is, raised garden beds might be a useful piece of equipment for most Australians. I suspect the Nursing Home may have paid for the raised beds in the establishment you worked for. The planners I talked to suggested that the NDIS would fund a support worker to assist with gardening activities, however the capital infrastructure is more appropriately funded outside the NDIS. Please note: every NDIS participant is viewed as an individual, so this isn’t a blanket ‘no’ to all participants, I was just sharing a recent experience. If a raised garden bed is important for an individual participant, please touch base with your specific planner for approval.
Thanks Jude, as usual all the information you send through is of great benefit to us and helps us understand our plan more and more. We have had a few issue with Sam having the severe brain injury, with items that have not been covered eg an iPad. He can’t talk or communicate very well, he can’t type sentences because of his shakey hands from a stroke, his vision impairment (he has double vision) being able to focus on keyboard letters and doesn’t even know how to spell words over about four letters so an iPad for communication and being able to keep in contact or meet new people through social media, etc is ideal for Sam as he can swipe but not have to type. we feel an iPad is essential -reasonable and necessary -for his daily living but we have been knocked back on an iPad several times.
Hi Marg, Great to hear from you! That’s SUPER disappointing to hear an iPad for communication can’t be funded through Sam’s plan! I agree, it doesn’t make sense! However, you may like to check out the newly released information regarding purchasing AT equipment during COVID-19 social distancing restrictions. If Sam needs an electronic device to maintain allied health services through Telehealth, he may be eligible for a device. Here’s the link if you’d like to know more: Low Cost Assistive Technology for Support Continuity during coronavirus (COVID-19) https://www.ndis.gov.au/participants/home-equipment-and-supports/assistive-technology-explained. As I mentioned the Suzy, you’ll need a letter of recommendation by your therapist prior to purchase. Also, communication apps are generally funded without going through the normal AT approval process. Hope that helps! Jude xx❤️
You have my 2 adults kids. Which both get 1 on 1 . 4 times a week. For community access, bush walking and public transport which helps so much. As 1 has mind C/Palasy and the other mental health/social anxiety.
So great to hear from you Melody! Thank you so much for sharing your positive experience with the NDIS! ❤️
Hi Jude. John and myself are very happy with everything related to his plan and very grateful to have you as his Plan Manager.
Always so helpful!
Good to read all this info.
Thank you
Thanks so much Pat! We’re blessed to have you and John in our TCPM community! 😃
Thanks for passing on this information Jude…always handy to be kept up to date with NDIS