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Tribunal: Member Ian Thompson

The National Disability Insurance Scheme Act 2013 (the Act) governs the provision of reasonable and necessary support for participants in the National Disability Insurance Scheme (NDIS). The scheme is administered by the National Disability Insurance Agency (NDIA). Section 34 of the Act provides guidance about what constitutes ‘reasonable and necessary support’.[1]

Relevant background information to this matter includes that prior to transferring to the NDIS, the applicant received services from Orthotics and Prosthetics South Australia (OPSA) for the previous 20 years. During that period, it was established that due to the complexity of the applicant’s situation, the only suitable prosthetics fitter was based in Queensland. Whenever the applicant needed new prosthetics he would travel to Queensland and stay in temporary accommodation while a quote was prepared. After transferring to the NDIS, OPSA continued providing services to the applicant, under the participant plan created by the NDIA, however OPSA could only provide prosthetic maintenance services.

In this case, it appears that while the NDIA agreed that the applicant needed a new prosthetic following surgery on his knee, in order to ensure compliance with section 34 of the Act, funding was refused for the applicant to travel to Queensland to have the fitting. Instead, the decision was made that the fitting should be carried out by a fitter in South Australia so travel and accommodation would not be required.

Subsequently, the NDIA appears to have reconsidered and identified other parts of the applicant’s plan, where funding could be utilised for the purposes of travel, accommodation and obtaining a quote from the Queensland fitter. The applicant and OPSA expressed concern about the delay, the necessary steps to take to obtain a quote from prosthetic providers and they were unsure whether this would be approved by the Agency. In these circumstances the OPSA funded the assessment, prescription, manufacture and fitting of the new prosthesis for the applicant as a crisis funding case. The AAT on review agreed that the most appropriate fitter would be the one based in Queensland, and agreed that the existing provisions for travel, accommodation and the provision of a quote were suitable.

Another issue for the AAT to consider was whether the NDIS plan review date should be extended. The applicant’s plan has not been replaced by another plan. Therefore the applicant can only receive funding from his current plan. Any invoices for future maintenance and support of his new prosthesis would have to be invoiced to the applicant’s NDIS plan by OPSA, an NDIS provider. These are unexpended funds in the current plan. Therefore the AAT varied in part the decision to extend the review date of the applicant’s plan to February 2020.

Read the full decision AustLII.

 

[1] Section 34, National Disability Insurance Scheme Act 2013