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Reasonable and Necessary

NDIS ‘Reasonable and Necessary’ – what is all this fuss about…

If you are a NDIS participant or attached to the NDIS in any way you would have been exposed to the term ‘Reasonable and Necessary’. Here at NDSP we talk about it (live and breathe) it every day. In this blog we explore what the ‘Reasonable & Necessary’ fuss is all about…

NDIS is a system that supports eligible people with disability funded supports to help them achieve their goals and aspirations. In order for a support to be funded under the NDIS it must meet ‘Reasonable and Necessary’ which falls under Section 32 of the NDIS Act.

So that’s a key reason right there for all the fuss – ‘Reasonable and Necessary’ forms part of the NDIS law.

Well this is starting to make sense now because after all we are a lawful society in every other system so of course that needs to apply to NDIS too. NDSP are in full support of the NDIS laws because we see that unlawful society’s and systems don’t thrive and survive. We want NDIS to thrive and survive so that every state reaches full roll out because this means thousands of people who weren’t supported under the previous fractured state funded system will be supported under NDIS. NDIS means more people can get support now – how amazing is that!

The ‘Reasonable and Necessary’ legislation is law for every NDIS participant irrespective of the fund management option chosen? There have been misconceptions about this over time. So let’s clear that up now; regardless of whether the plan is NDIA managed, Self-Managed or Plan Managed – the ‘Reasonable and Necessary’ legislation applies. The good news for NDSPs Plan Managed customers is that we can help you to understand this legislation as we have vast experience in interpreting plans and the legislation to determine whether the support being sought meets ‘Reasonable and Necessary’.

As human beings and Aussie citizens we all have RIGHTS – it is a double-edged sword though as our RIGHTS come with RESPONSIBILITIES too. This is exactly the same when it comes to NDIS participants and the funds they receive in their NDIS plans – NDIS participants are responsible for their NDIS funds – they must be lawful with how they are spent.

In order for a support to be ‘Reasonable and Necessary’ NDIS considers the following;

Will the support…

  1. Assist the participant to pursue the goals objectives and aspirations agreed to in their plan
  2. Assist the participant’s social and economic participation
  3. Represent value for money
  4. Be, or likely to be, effective and beneficial for the participant
  5. Take into account of what is reasonable to expect families, carer’s, informal networks and the community to provide
  6. Be appropriate for the NDIS to fund or provide

Ok, so that’s a lot of words and NDIS lingo right there but that’s OK because NDSP speaks NDIS so let’s break those statements down;

  1. Is there a goal agreed to between NDIS and the participant that relates to this support?
  2. Does this support mean the participant can avoid isolation and contribute or be involved in everyday experiences such as work, education and being social?
  3. Is there a cheaper support/service option that achieves the same outcome? E.g. NDIS wont fund the Rolls Royce if the Hyundai version does the same thing
  4. Will the support work, is it safe or will it cause harm? – NDIS will not fund anything that will cause harm
  5. Is there someone else in the participants life who can/should provide the supports? E.g. what should or could family and friends or the community help with
  6. Is there another system that can support in this area already? Does the support fit in another government funded system? E.g. Medicare system (care plans)

NDSP claims and pays bills for supports and services that meet the ‘Reasonable and Necessary’ legislation for NDIS participants who have the Improved Life Choices support category (otherwise known as Plan Management). We build capacity in our customers and their support networks on a daily basis to help guide the light on whether the support they want has been funded in their NDIS plan.

Getting Plan Management in your plan is easy – all you have to do is ask for it at the planning meeting or ask for a light touch review to add it retrospectively. Once you have Plan Management approved, we can take the stress out of the NDIS and help you better understand your plan. Call NDSP’s supportive team on 1800 636 377 or email info@ndsp.com.au for more info.

Cherie Cordina
BD and Support Services Director
www.ndsp.com.au

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