At the core of the NDIS is the principle that people with disabilities should be able to access the support they need to live a full and independent life. This includes support for daily living, employment, social inclusion, and community participation. However, not all support is considered reasonable and necessary under the NDIS guidelines.
So, what is considered reasonable and necessary?
Reasonable and necessary support is defined as support that is:
· Directly related to the participant's disability
· Likely to achieve the participant's goals and aspirations
· Represents value for money
The NDIS considers a range of factors when deciding whether support is reasonable and necessary, including:
· The participant's individual needs and circumstances
· The impact of the participant's disability on their daily life
· The likelihood of the support achieving the participant's goals
· The availability of alternative support
· The cost-effectiveness of the support
· The impact on informal supports, such as family and friends
· The impact on mainstream services, such as health and education services.
It is important to note that the NDIS is not designed to fund everyday living expenses, such as rent, groceries, and bills. The scheme is designed to fund reasonable and necessary support that enables participants to achieve their goals and live independently.
How do I lodge a reasonable and necessary claim?
Lodging a reasonable and necessary claim can be a complex process. To ensure that your claim is considered, it is essential to provide as much information as possible about your disability and your support needs. This includes information about:
· Your disability and how it affects your daily life
· Your goals and aspirations
· The support you currently receive
· The support you need to achieve your goals
· The cost of the support
· Any alternative support that is available
· The impact on your informal supports and mainstream services.
When lodging a claim, it is important to provide evidence that the support you are requesting is reasonable and necessary. This can include medical reports, assessments, and quotes for services.
What are the limitations of the NDIS?
While the NDIS is designed to provide support for people with disabilities, there are limitations to what the scheme can fund. Some of these limitations include:
· Support that is not directly related to a participant's disability
· Support that is not likely to achieve a participant's goals and aspirations
· Support that is not considered value for money
· Everyday living expenses, such as rent, groceries, and bills
· Support that is available through other government services, such as health and education services.
It is important to understand the limitations of the NDIS when lodging a claim. This can help you to ensure that your claim is considered reasonable and necessary.
Conclusion
Understanding the NDIS guidelines, criteria, and limitations when lodging a claim is essential for ensuring that your claim is considered reasonable and necessary. The NDIS is designed to provide support that is directly related to a participant's disability, is likely to achieve their goals and aspirations, and represents value for money. When lodging a claim, it is important to provide as much information as possible about your disability and your support needs, including evidence that the support you are requesting is reasonable and necessary. By understanding the limitations of the scheme, you can ensure that your claim is considered and that you receive the support you need to live a full and independent life.
If you would like to know more about why some of your invoices get rejected check out our blog on The Ultimate Guide to NDIS Invoices for Service Providers.
For more information please check out https://ourguidelines.ndis.gov.au/how-ndis-supports-work-menu/reasonable-and-necessary-supports
If you would like more information on how Simplified Plan Management can help you with your Plan Management, give us a call at 0491 090 747 or email us at info@simplifiedpm.com.au