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Understanding Reasonable & Necessary

  • 3 mins

In this brief article we will provide you with some general information about the NDIA’s definition of Reasonable and Necessary. This information is relevant for all team members who provide services to NDIS participants and is important to understand.

Reasonable & Necessary

NDIS funds reasonable and necessary supports to help a person with a disability reach their goals.

‘Reasonable’ means something that is fair. ‘Necessary’ means something you must have.

Understanding Reasonable & Necessary will assist you to understand common questions around what the NDIS pays for while supporting a participant. For example, you may have been asked by a participant, “Will the NDIS pay for my ticket to go to a football game/movie/concert?”

The answer, in this case, is no, the NDIS will not pay for any tickets to social events that are not disability specific. This is because the NDIS does not provide funding for everyday costs and social activities that the broader community would pay for themselves.

However, the NDIS will pay for the time of a support worker to attend the event with the participant. This funding will come under the line item ‘Assistance to access community, social and recreational activities’ in the participant’s NDIS plan.

Real-life example

Ahmed is an adult with an NDIS Plan. One of Ahmed’s NDIS goals is to increase his independence when participating in community events. Ahmed would like to go to the Drake concert but is not able to attend by himself due to his disability. Ahmed decides to engage a support worker to help him achieve this goal. Ahmed is matched with a support worker to attend the concert with him.
NDIS pays for:

• The support worker’s time in supporting Ahmed.
Ahmed pays for:
• His own admission to the Drake Concert.
• If Ahmed has a Companion Card and the venue accepts the card, then the support worker does not need to pay. If Ahmed doesn’t have a Companion Card, Ahmed is responsible for paying for his support worker’s admission.
• If they use the support worker’s car to get to the concert, Ahmed pays for the transport ($0.88/km). Ahmed is also responsible for the cost of the car parking (if applicable).
• If they catch public transport and Ahmed has a Companion Card, the support worker does not need to pay. If Ahmed doesn’t have a Companion Card, Ahmed will need to pay for the support worker’s ticket

The Support Worker pays for:

• The cost of any food or beverages that the support worker consumes during the outing. This cost is not the responsibility of Ahmed.

This example can be applied to any social outing including going to the zoo, movies, football game, a comedy event or festival.

The NDIS only covers the cost of your time working as a support worker. It does not include the cost of admission or the purchase of goods & services.

 

If you find yourself in a situation and are unsure if a particular request is Reasonable & Necessary, please call your Coordinator on 1300 764 433.
More information about Reasonable and Necessary can also be found on the NDIS website, click here to access.

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