What else do you need to know about deciding if supports meet the NDIS funding criteria?

Why don’t we always fund what your health professionals recommend?
Why don’t we fund the same supports as your last plan?
What else do we consider when deciding what to include in your plan?
How do we think about an ordinary life when deciding what supports to include in your plan?
What other services or systems are responsible for providing supports?
How does the NDIS work with other government services?
What is reasonable adjustment and why is it important?
What about in-kind supports?

Although we take expert opinions into account, we can’t and don’t always fund everything your health professional might recommend. This is because every support we fund needs to meet all the NDIS funding criteria.

For example, your therapist might recommend a piece of equipment on the basis that it will be ‘effective and beneficial’ for you. But if there is something cheaper that will achieve the same outcome, we won’t be able to fund what the therapist recommended.

This is because it may not be value for money. We may be able to fund the cheaper option instead if it meets all the NDIS funding criteria.

We might fund different supports in your next plan. This is because we will fund supports in your plan based on how we use the NDIS funding criteria at that point in time.

Your needs and situation will most likely change over time. This means it’s likely your NDIS supports and needs for those supports will change over time.

For example, we may have funded supports to help you build your skills in a particular area. Once you have built those skills, you won’t need funding for that anymore. So, we probably won’t include that funding for those supports in your next plan.

Supports to build your skills may have met the NDIS funding criteria before, but the same supports might not meet the criteria in the future.

Or, your disability support needs might increase or decrease over time. This may mean we consider funding more or less supports as a result.

As far as possible, we have to act according to principles set out in the law for the NDIS . These principles guide us when we make decisions about what we can fund.

These principles don’t override or replace the NDIS funding criteria under the law for the NDIS. They can help us apply the funding criteria, by giving us more guidance when we decide what supports to approve in your plan.

The principles include the following:

You have the same right as other Australians to realise your potential for physical, social, emotional, and intellectual development.
You should be supported to take part in and contribute to social and economic life.
You should be supported to make choices about planning and how your supports will be delivered. This includes taking reasonable risks, so you can pursue your goals.
You have the same right as other Australians to decide your own best interests. You have the right to be an equal partner in decisions that affect your life.
Your privacy and dignity should be respected.
We must make sure the NDIS is financially sustainable.

The principles also tell us that the reasonable and necessary supports we fund should:

support you to pursue your goals and maximise your independence
support you to live independently and to be included in the community as a fully participating citizen
develop and support your capacity to do things that help you participate in the community and employment.

Just because a support helps you do these things doesn’t mean we’ll fund it in your plan. All supports we fund need to meet all the NDIS funding criteria.

We consider these principles set out in the law for the NDIS, along with the principles we follow to create your plan.

To help guide us in our decision-making about reasonable and necessary supports, we took advice from the NDIS Independent Advisory Council (The Council).

The Council represents people with disability and carers, bringing their own lived experience and expertise of disability. They give us advice on how the NDIS should work.

The Council advised us that all Australians, including people with disability, should have an ‘ordinary life’. They also told us we should think about the idea of an ordinary life when we apply our principles and use the NDIS funding criteria.

An ordinary life is a life where you have the same opportunities as people without a disability. An ordinary life is one that is typical or usual for everyone in modern day Australia. It’s a life where you can pursue your potential and participate in society on an equal basis with others.

An ordinary life will be different for different people. We are all different and come from different cultures and backgrounds. We each have our own values, experiences, beliefs, and goals.

But there are some common things that can improve the quality of our lives and help us participate equally. These are the things, such as the following, that make up an ordinary life:

Positive relationships with families and informal support networks.
Individual autonomy. This means being free and independent, and having the same opportunities as people without disability.
Active involvement in decision-making including the ability to make meaningful decisions, and exercise choice and control.
Using your strengths in ways that provide a challenge and enjoyment.
A sense of belonging to our families, friendship networks, communities, workplaces and society.
Active involvement and contribution to society and your community.

An ‘ordinary life’ in the context of the NDIS involves supporting you to:

have and maintain good relationships
belong and participate in your community
be involved in making choices about your own life.

One way we can help you have an ordinary life is to support you to access mainstream, community, or informal supports wherever possible. These are the usual supports that everyone in the community uses.

When we fund reasonable and necessary supports under the NDIS, we need to make sure they meet the NDIS funding criteria.

When we apply the NDIS funding criteria and make decisions about reasonable and necessary supports, we’re guided by the principles in the law for the NDIS. We also consider how the supports will best help you to live an ordinary life.

We have to be satisfied that the support is considered an NDIS support which means the support is something that can be funded or provided through the NDIS. Some supports are not considered an NDIS support because they’re more appropriately funded or provided through:

other service systems or supports offered by a person, agency or body (like a State or Territory Statutory Scheme)
services or supports offered as part of a universal service obligation (like the health or education system)
services or supports offered in line with reasonable adjustments required under discrimination laws (like your employer, or the health or education system).

We won’t fund the support if the support should be provided by someone else, even if the other service system doesn’t actually provide it. We don’t make up for other organisations and systems that don’t provide the supports they should.

The list of goods and services that are not NDIS supports includes supports that are considered the responsibility of service systems such as:

Health
Mental health
Child protection and family support
Early childhood development
School education
Higher education and vocational education and training
Employment
Housing and community infrastructure
Transport
Justice.

For more information, go to Mainstream and community supports.

We call supports provided by other government services, including those provided as part of a universal service obligation, ‘mainstream supports’. When we talk about mainstream supports, we mean supports available to everyone in your state or territory, or across Australia, regardless of if you have a disability.

This includes services provided by state and federal governments, related to health care, education and mental health services.

You have the same right as all Australians to access these services. There are certain things that mainstream services have to do to make their services accessible for people with disability. Using mainstream supports can also help you be part of your community, or to work or study.

When we fund NDIS supports, we won’t fund supports that are not considered NDIS supports because the support is more appropriately funded or provided by a mainstream service or system, such as the education system or health system. Under the law for the NDIS, we can’t fund supports that should be provided by a mainstream service.

The Australian federal, state and territory governments agreed on responsibilities for funding different types of supports. The law for the NDIS has an outline of funding responsibilities and were developed with the agreement of each State and Territory.

Learn more about who is responsible for the supports you need.

People with a disability can sometimes face barriers that make it harder to do the same things as people who don’t have a disability. For example, it might be harder to find and keep a job. Or it might be harder to get in and around places, or to get the same services as other people.

It’s against the law to discriminate against people with a disability in many areas. This includes in employment, when providing goods and services, and when accessing public places.

This means organisations or people who are responsible for providing these services have to make what are called ‘reasonable adjustments’. They have to make sure people with a disability have equal access to the services they provide, as far as is reasonable.

They have to do reasonable things that will make their services equally available to everyone, whether or not you have a disability.

Reasonable adjustments do not mean they have to provide everything you need because of your disability. It means they have to do what’s reasonable to make sure you have equal access to employment, public spaces or services. This takes into account what they can afford to do and what is reasonable to expect them to provide in the circumstances.

When we decide what supports to include in your plan, we need to consider what should be provided through reasonable adjustments. Under the law for the NDIS, we can’t fund a support if it should be provided by someone else through reasonable adjustments.

We agreed that state and territory governments will keep providing some supports for a period of time. We call these ‘in-kind supports’.

If we fund in-kind supports like specialist school transport or personal care in schools , you will need to use state or territory government providers for these supports. These supports are most efficiently and effectively provided by state and territory government providers.

Learn more about Work and study supports.

For most other in-kind supports, you can choose your provider if you don’t want to use your in-kind provider anymore. We can let you choose another provider if we consider that the support isn’t most effectively and efficiently provided by the in-kind provider.

We usually let you choose another provider if:

another provider can give you the same support or level of support as the in-kind provider
the supports with the new provider still meet the NDIS funding criteria, including that they’re value for money compared to the in-kind support
there are no serious risks with changing providers.

Learn more about in-kind supports .

What else do you need to know about deciding if supports meet the NDIS funding criteria?

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