reasonable and necessary

What Is Considered Reasonable and Necessary?

The NDIS provides funding for anything considered reasonable and necessary. There are quite a few guidelines under what the NDIS deems reasonable and necessary. They are as follows:

  • The request must be related to a participant’s specific disability.
  • The request must not include day-to-day living costs not related to a disability support needs.
  • The request should represent value for money.
  • The request must be likely to be effective and meet the required needs of the participant.
  • The request should take into account support available from other government services, family, carers, networks, and the community.

We are going to look into each one and explain exactly what they mean.

The request must be related to a participant’s specific disability.

The best way to know if a support is considered reasonable and necessary, is if it’s something that is directly going to help your disability.

For example, if your disability hinders you from driving yourself or using public transport to go somewhere, you can use a specialist transport that will be deemed reasonable and necessary.  

The request must not include day-to-day living costs not related to a disability support needs.

This can often be confusing, but if the request is related to your day-to-day living costs, it will not be accepted.

For example, your groceries, phone bills and internet bills will not be funded by the NDIS.

The request should represent value for money.

While the NDIS does not expect you to buy the cheapest of everything, they do expect that the product or service is reasonably priced.

For example, if you need a laptop for telehealth – you should get the basic model, instead of the expensive model that has added features.

The request must be likely to be effective and meet the required needs of the participant.

When you want to buy a piece of equipment, the NDIS want to make sure that it will be safe and not cause harm. When we purchase a piece of equipment with your funding, we want to know that it’ll be better, won’t have any risks associated with it and it will be the right thing for you.

For example, if you need a trailer for a mobility scooter, you shouldn’t have to climb off the trailer because you might fall over and hurt yourself. So, the NDIS need to know that the equipment that is selected is fit for purpose.  

The request should take into account support available from other government services, family, carers, networks, and the community.

If there is another organisation or person that should support your request, for example Medicare, Veteran Affairs, or a state government program, the NDIS will most likely not approve your request.

For example, if your pediatrician is funded by Medicare, NDIS won’t fund your gap fees.

Are you still unsure?

We know all this information can be overwhelming, which is why you might still have questions. As plan managers we are here to help you navigate through this. You can call us on 1300 60 33 89 or email us at info@myautonomy.com.au.