When Is NDIS Therapeutic Support Reasonable and Necessary?

Navigating the National Disability Insurance Scheme (NDIS) can be complex, especially when determining what qualifies as “reasonable and necessary” therapeutic support. Understanding these criteria is crucial for individuals with disabilities to ensure they receive the support they need for their daily activities and long-term well-being. This article explores key factors in NDIS therapeutic support, the decision-making process, and how to ensure compliance with NDIS guidelines.

What is NDIS reasonable and necessary support?

When the NDIS refers to “reasonable and necessary” support, it relates to services deemed essential to a participant’s well-being and ability to achieve their goals. The NDIS sets guidelines to fund only supports that directly benefit a participant’s disability.

Here’s what makes therapeutic support reasonable and necessary:

• Supports that assist with daily living activities, such as mobility aids, speech therapy, or physiotherapy, are essential to the participant’s daily functioning.
• Supports that work towards achieving specific goals, like learning new skills or improving independence.
• Cost-effective services, ensuring the NDIS budget is allocated appropriately to provide maximum benefit to participants.

Why does NDIS have specific criteria for therapeutic support?

The NDIS has developed specific criteria to ensure that therapeutic supports are effective, fair, and equitable. These criteria help allocate resources in a way that best supports individuals and addresses their unique needs.

• Ensures that NDIS funding is spent responsibly and benefits as many participants as possible.
• Prevents misuse or waste of resources by setting clear guidelines about what counts as “reasonable and necessary.”
• Promotes a focus on practical outcomes, ensuring that therapy helps the participant live a better, more independent life.

By setting these criteria, NDIS aims to create a fair and sustainable system that maximises the impact of its funds for those in need of therapeutic support.

Can therapeutic support be changed or adjusted under NDIS?

Yes, therapeutic support can be reviewed and adjusted as necessary under the NDIS. As your condition, goals, or circumstances change, your needs for therapeutic support may evolve, and it is essential to adapt the NDIS plan accordingly.

• Participants can request a plan review if they feel their current therapeutic support isn’t addressing their evolving needs.
• NDIS reviews may be triggered by changes in health, new therapies, or shifts in long-term goals, ensuring support remains relevant.
• Communicating with your NDIS planner is essential to ensure your support remains relevant and adequate over time.

Regularly reviewing your NDIS plan ensures that your therapeutic support effectively addresses your needs and enhances your quality of life.

Is NDIS therapeutic support the same for all disabilities?

NDIS therapeutic support is tailored to meet the individual needs of each participant. The type of support you receive varies depending on the nature of your disability and personal circumstances.

Therapeutic support is not one-size-fits-all; it adapts to help individuals live independently and achieve their goals.

Can NDIS decline therapeutic support?

Yes, the NDIS can decline funding for therapeutic support if it doesn’t meet the “reasonable and necessary” criteria. Common reasons for a declined request include:

• Lack of evidence: If there isn’t sufficient documentation or professional recommendations supporting the need for a particular therapy.
• Non-disability-related services: If the requested support is not directly related to the participant’s disability or goals.
• Excessive cost: If the requested service exceeds what is considered cost-effective for the NDIS.

To prevent declines, submit detailed documentation and collaborate with your NDIS planner to justify the necessity of each requested service.

Which types of therapeutic support are most commonly covered by NDIS?

The NDIS covers various therapeutic support services tailored to each participant’s needs. Some of the most common types include:

• Physiotherapy: For individuals with physical disabilities or mobility impairments, physiotherapy helps improve movement, strength, and overall physical health.

• Speech therapy helps with communication, language, and swallowing issues, and individuals with developmental delays or neurological conditions commonly use it.
• Occupational therapy: Focuses on improving daily living skills, such as self-care, household tasks, and work-related activities.
• Behavioural therapy: Often used for participants with intellectual disabilities or autism, this therapy helps manage and modify behaviours that may impact daily life.
• Early childhood intervention: Targets children with developmental delays or disabilities to help them achieve milestones and maximise their potential.

When deemed reasonable and necessary, these therapies are supported under NDIS funding.

How does NDIS determine reasonable and necessary therapeutic support?

The NDIS considers various factors when determining if therapeutic support is reasonable and necessary. These include:

• Relevance: How closely the support relates to the person’s disability and goals.
• Effectiveness: Whether the support will effectively address the participant’s needs.
• Cost-effectiveness: Whether the support offers value for money, considering its outcomes.
• Alternatives: If similar supports are already available or if other sources of funding could cover the service.

These factors help NDIS planners ensure that funds are properly allocated to services that genuinely benefit participants and align with their goals.

Ensuring you get the support you need

Understanding when therapeutic support is “reasonable and necessary” is crucial for maximising the benefits of your NDIS plan. By knowing the criteria and working closely with your NDIS planner, you can ensure that the supports you need are included and funded. Always provide clear documentation, keep your goals in mind, and seek professional advice to help guide your decisions.

At Australian Disability Services, we specialise in providing personalised NDIS support and therapy for people with disabilities across Sydney, NSW. Our team of experts helps you navigate the NDIS system and ensure you receive therapeutic support. Whether you need speech therapy, occupational therapy, or behavioural support, we’re here to assist you every step of the way. Contact Australian Disability Services today to discuss how we can help you get the most out of your NDIS plan!