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Reasonable & Necessary

 

(R&N Criteria)

'Reasonable and necessary' support is the key component of the NDIS. Section 34 of the NDIS Act establishes the criteria for what supports are considered "reasonable and necessary" for the NDIS to  help participants live and ordinary life & achieve their goals

 

1. Reasonable is something that is fair

2. Necessary is something you have to have because of you disability 

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The support represents value for money, relative to benefits achieved and costs of alternative supports.

The funding of supports takes account of what it is reasonable to expect families, carers, informal networks and the community to provide. This applies to a number of scenarios including: 

  • The support can be provided by informal or community supports

  • The support is a parental responsibility (e.g. parents without a disability would be expected to pay for a particular support)

  • The support is part of the normal caring responsibility expected to be provided by friends and family

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The support represents value for money, relative to benefits achieved and costs of alternative supports

The support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;This may apply when:

  • The same outcome can be achieved at a substantially lower costs

  • The cost of funding the supports will be cheaper in the long-term.

  • The support represent value for money when you consider the benefits you’ll receive.

  • The support has the potential to avoid or delay reliance on more costly supports over your lifetime.

  • Modifications to your home or vehicle may reduce the need to rely on other ongoing (and costly) care.

  • An alternative support might provide more benefit and value

  • making a more expensive, short-term investment that will save money in the long run.

  • Cheaper options are available and are likely to achieve the same benefits.

The support will assist a participant to reach the goals and aspirations outlined in their participant statement.

I'he support assists the participant to pursue their goals, objectives and aspiration (i.e. there is a clear and direct link between the support and one or more of the goals in the participant’s statement of goals and aspirations.

The support will facilitate the participant's social and economic participation.

The supports builds on  the capacity of the individual to  undertake activities to participate, be independent & access the community with minimal assistance. This includes:

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  • Spending one's money how they choose to

  • Participating in desired activities

  • Having assistance to communicate positively with peers to help engage socially.

  • Engaging socially in the mainstream community

  • Enabling a participate to contribute to their community via economic means (i.e. employment) or volunteering

  • Assisting one to communicate with peers, and/or regulate your emotions in a positive way to maintain positive relationships

The support is most appropriately funded through the National Disability Insurance Scheme.

The supports are appropriately funded through the NDIS and not through a mainstream or community service or daily living cost. If the support is more appropriately funded through other general systems of service delivery it is not reasonable and necessary. Services remaining the purview of the Commonwealth and State Departments of Health include:

 

  • The health system

  • The mental health system,

  • Early childhood or child protection Services

  • Family support services

  • School education

  • Higher education and vocational training

  • Employment services

  • Housing

  • Community infrastructure & transport or

  • The Justice system

The support is considered good practice and is likely to be beneficial to the participant.

The supports will be, or is likely to be effective and beneficial, having regard to current best practice for functional improvement. It is important that the support:

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  • Does not cause harm to the participant

  • Does not pose risk to others

  • There is evidence to suggest that the support will not work

  • A support has had a proven benefit for that participant. 

  • Has been proven to be effective through consensus of expert opinion and research

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There must be reliable and high quality evidence and supporting information that the support will substantially improve the life stage outcomes, be of long-term benefit and be effective for other people in similar circumstances.

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