Reasonable & Necessary - What does it really mean?
If you're an NDIS participant then you're likely familiar with the term reasonable & necessary. It's the framework for determining whether a particular item or support can be funded or not. But how does one determine whether a support is reasonable and necessary?
There are certain questions that should be asked and considered when determining whether a support is reasonable and necessary, the questions that should be considered are:
Does the support assist you to pursue the goals in your plan?
This one is quite straightfoward - will the support help you reach a particular goal or goals in your plan? When considering if a support will help you pursue your goals, it's important to consider your whole situation, as you may not have goals that are relevant to every specific support in your plan. A support that addresses your disability related support needs is most likely to help you pursue your goals.
Does the support assist you to undertake activities, to facilitate your social and economic participation?
Social participation means doing things you enjoy, like going out with friends, playing sport or going on a holiday. Economic participation generally means being involved in things that will help you work towards getting and keeping a job. It's important to note that economic participation may not be relevant to every NDIS participant who is determining whether a support is reasonable and necessary.
Does the support represent value for money?
This means the cost of the support must be reasonable when consdering the benefits of the support and the cost of other supports. It's important to consider:
- If other supports would achieve the same result at a substantially lower cost;
- If there's evidence that the support will substantially improve your life stage outcomes and benefit you in the long term;
- If the support will likely reduce the cost of other supports over time;
- How the cost compares to other supports of the same kind in your area;
- If the support will make you more independent, and mean you won't need as many supports in the future.
Is the support likely to be effective and beneficial for you, having regard to current good practice?
This asks you to consider if the support is likely to be effective - i.e. will it do what you need it to do? And beneficial - i..e will the support help you do things you can't otherwise do and meet your support needs?
Support can be considered beneficial if it helps maintain your current level of functioning, meaning it will help you keep doing the things that you currently do.
Does the funding of the support take into account what is reasonable to expect families, carers, informal networks and the community to provide?
When NDIS packages are funded, it's generally taken into account what support is expected from family and other imformal supports. If the support is likely something that may be responsibility expected of a family member then it may not be seen as reasonable & necessary. This is especially important for participants who are under 18, the NDIS will consider what support is reasonable to expect for parents or guardians to provide at the participant's age.
Is the support something that is appropriately funded or provided through the NDIS? Or is it more appropriately funded or provided through another agency?
This asks you to consider whether it may be more appropriate for another service or agency to provide the funding for this specific support.
Is the support related to your disability?
It's important to be able to draw a link to why your disability requires you to need this support. If that link can't be drawn then it's unlikely that the support is reasonable & necessary under the NDIS.
Does it include day-to-day living costs that are not related to your disability support needs?
The most prominent example of this would be for participants who are funded for meal prep. Most meal prep services include the cost of labour for preparing the meal but also the cost of ingredients for the meals. The NDIS won't fund day-to-day living costs, so the cost of the ingredients would not be covered, but the cost of labour for preparing the meals may be.
If you consider the above questions and can determine that the support is reasonable and necessary, then it most likely is.