Families and individuals with disabilities rely on the NDIS (National Disability Insurance Scheme) for a wide range of supports, from employment services to house cleaning and even equine therapy. Understanding what is considered “reasonable and necessary” under the NDIS is crucial to ensure that your claims are appropriate and successful. This article will delve into the criteria and limitations that define reasonable and necessary supports, helping you navigate the NDIS landscape effectively.
What We Will Learn
- Definition and criteria of “reasonable and necessary” under NDIS
- Key guidelines for claimable supports
- Practical examples of claims
- How SAN Support can assist in managing your NDIS claims
Understanding “Reasonable and Necessary”
The NDIS aims to provide additional supports to people living with disabilities, supplementing the formal and informal supports already available through healthcare, education, family, and community services. To determine if a support is “reasonable and necessary,” it must meet the following definitions:
- Reasonable: A service or item that is considered fair.
- Necessary: A service or item needed due to the person’s disability.
While each claim is unique, the NDIS generally covers supports that help individuals:
- Pursue goals, objectives, and aspirations
- Increase independence
- Enhance community and workplace participation
- Develop the ability to actively participate in the community
NDIS Guidelines for Claimable Supports
1. Directly Related to a Person’s Disability
Anything claimed under NDIS must be directly related to the claimant’s disability. For example, podiatry services for those with cerebral palsy or Down syndrome are claimable, while general podiatry for non-disability-related issues is not. The NDIS offers flexibility when evidence supports the benefits of certain treatments for specific disabilities.
2. Not a Normal Day-to-Day Living Cost
The NDIS does not cover fundamental living costs such as food, clothing, and shelter, which are common to everyone. However, supports related to these costs that are specific to the disability may be claimable. For instance, while food itself isn’t covered, the preparation and delivery of meals may be.
3. Represents Value for Money
Value for money involves evaluating both the short-term and long-term benefits of a support. A more expensive item that saves money in the long run can be considered good value. However, if a cheaper alternative that performs the same function is available, the NDIS may require participants to choose that option.
4. Considered Effective
Supports must be backed by evidence of their effectiveness. The NDIS has strict guidelines about what constitutes effective treatment for individuals. Some items, such as high-risk equipment like weighted blankets, require prior approval from the NDIA (National Disability Insurance Agency).
5. Not Provided by Other Government Departments
NDIS supports are meant to complement existing programs, not replace them. Services already covered by other government departments, such as Medicare for doctor’s visits, cannot be claimed under the NDIS. Ensure that a resource is not available through another agency before expecting NDIS coverage.
Examples of Claimable and Non-Claimable Supports
- Claimable: Specialized equipment for disability-related needs, therapies tailored to specific disabilities, and supports that enhance community participation.
- Non-Claimable: General medical treatments covered by Medicare, everyday living expenses not related to the disability, and services provided by other government programs.
Assessing Your Claim: Is It Reasonable and Necessary?
Determining whether your claim meets the NDIS criteria can be challenging. Here are some steps to help assess your claim:
- Evaluate the Direct Relation to Your Disability: Ensure the support is specifically for your disability-related needs.
- Consider the Cost: Compare the value for money, considering both short-term and long-term benefits.
- Check for Effectiveness: Look for evidence that supports the effectiveness of the item or service.
- Review Other Government Programs: Confirm that the support isn’t provided by another government agency.
How SAN Support Can Help
Navigating the NDIS can be overwhelming, but SAN Support is here to assist. Our team of professionals works with participants and providers across Australia, offering independent, professional, and reliable service. We help you understand what is or isn’t covered under the NDIS, ensuring your claims are reasonable, necessary, and successful.
For more information and personalized assistance, reach out to SAN Support Plan Management. We are dedicated to helping you get the most out of your NDIS plan and achieving your goals.
Conclusion
Understanding whether your NDIS claim is reasonable and necessary is essential for making successful claims and effectively utilizing your NDIS funds. By following the guidelines and consulting with professionals like SAN Support, you can navigate the NDIS landscape with confidence and ensure that your supports are tailored to your unique needs.
At-last, if you want more detailed information and assistance with your NDIS plan, reach out to SAN Support, your trusted partner in NDIS services, reach out to us today and take the first step towards a brighter future.