Tribunal: Deputy President James Constance

The applicant was a participant in the National Disability Insurance Scheme (NDIS) and applied for a review of her plan to include additional support in the form of assistance from a registered nurse to administer the doses of insulin she required to control her diabetes. The National Disability Insurance Agency (NDIA) refused the inclusion of the additional support and affirmed the decision after the applicant requested an internal review. The applicant applied to the AAT for a review of the decision.

The applicant had a severe intellectual disability, was blind, hearing impaired and non-verbal.  Registered nurses had administered the applicant with doses of insulin since 2009 but funding for the support, provided by the NSW Department of Ageing, Disability and Home Care, ceased. This led to her application to NDIS for funding of the support.

The main issue in this matter concerned the requirement that supports funded by the NDIS are reasonable and necessary.[1] There are requirements an applicant must meet for the support to be considered reasonable and necessary including that the:

  • support requested is most appropriately funded or provided through the NDIS[2]
  • the support requested represents value for money.[3]

The first requirement largely concerns the nature of the applicant’s treatment for her condition and after considering all the evidence and the relevant rules[4], the AAT concluded that the treatment was most appropriately funded by the NDIS.

The second requirement regarding value for money must be viewed relative to the benefits the support will achieve and the cost of alternative support.[5] Based on the evidence before it including a report by the applicant’s treating practitioner, the AAT found that the support represented value for money.

The AAT concluded that the applicant satisfied the requirements and set aside the NDIA’s decision, substituting a decision granting the applicant the additional support.

Read the full decision on AustLII.

 

 

[1] Section 34 of the National Disability Insurance Scheme 2013 (Cth).

[2] Subsection 34(1)(f) of the National Disability Insurance Scheme 2013 (Cth).

[3] Subsection 34(1)(c) of the National Disability Insurance Scheme 2013 (Cth).

[5] Subsection 34(1)(c) of the National Disability Insurance Scheme 2013 (Cth).