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Understanding reasonable and necessary

If you're a participant in the NDIS or a family member of a participant, you will know all about the term reasonable and necessary. And you will also know just how confusing a term it can be. It causes a lot of issues in the planning process. It's not clear what it means or how it's used when budget decisions are made and it's the source of a whole lot of anxiety and stress.

This is where we want to do things very differently. The scheme should see you as a whole person, not a series of medical diagnoses. Reasonable and necessary, should consider the whole person. It should consider the individual circumstances. It should look at what they are supporting. Needs are not just their support needs based on the primary disability, and it should be applied to the whole budget, not just each line item.

Getting reasonable and necessary right is an important change. It means that people with disability will be treated fairly and that decision making in the scheme will be transparent.

We have heard a lot about how confusing the term ‘reasonable and necessary’ is. You have told us that you want fairness, transparency, and certainty around the definition of ‘reasonable and necessary supports’.

We think the lack of a shared understanding of what is reasonable and necessary is one of the reasons the NDIS planning process has become so confusing and contested. Without a shared clear definition, it is almost impossible to know what to expect from the scheme.

The NDIS should provide a clear, fair, and consistent definition of reasonable and necessary supports that applies to a participant's budget. This will help everyone understand the scheme better. It will also help make sure the planning process is focused on actual planning rather than negotiation.

Reasonable and necessary should be based on:

  • seeing a whole person, their needs and their circumstances with with an assessment of support needs mapped to function.
  • the whole budget for participants, not line by line decision making.

This means people with disability are treated fairly and decision-making is transparent.

This was the original intention of the scheme. It was designed to provide an overall budget that is ‘reasonable and necessary’ then give participants control and choice over how they spend their budget. We should move back to this ideal.

This challenge was also covered in the Magic Pudding Dilemma speech.

Participants must understand how reasonable and necessary funding decisions are made, how individual needs and goals will be taken into account, and how they will then be supported to maximise choice and control, when spending their budgets.

Clearly defining what is reasonable and necessary is critical for a better, fairer experience for all participants.

Budget setting discussions are less adversarial and traumatising, as decision makers understand how to apply reasonable and necessary consistently and participants know what to expect.

Until next time, 
Bruce and Lisa

Public submissions available to view

Many comments, discussions and submissions commented on reasonable and necessary. 

"The clarification of the definition of Reasonable and Necessary is a critical starting point for addressing other issues raised in the "What we have heard report."

David SUB-H3Q1-002819

"Necessary means to me to able to live a normal standard of life.  Reasonable would be reasonable of what a normal person without a disability would expect."  

Lee SUB-M4S2-001888

"Knowing exactly what the NDIA expect in regards to "evidence" when making decisions would be beneficial... we can provide 100s of pages of evidence and still be told we dont have enough or it is not specific enough, then told to provide more evidence without being told what they actually want/is required to obtain the supports/funding we are requesting."  

Hayley SUB-W1Z7-002298

“ took many months to get a handrail installed next to my steps by the time an OT assessed the risk, prepared her report and sourced quotes; and yet I still had to traverse the steps several times a day which was extremely anxiety inducing.”

Anonymous participant