Reasonable & Necessary

2018-03-13T01:49:40+00:00

Can I or can’t I?

It’s still early days in regards to what Self-Managing will really look like, long-term.  However, the concepts are clear.  

Those outlined here in this NDIA video https://youtu.be/baU45jGnWS4

We nod our heads in agreement with the notion that we’re aiming for maximum choice & control over our funding.  Yet, the most frequently asked question to NDIA staff, on facebook forums and in community workshops is – “am I allowed to…” “can I spend my funding on….” “will the NDIA pay for …..”

Sure, really valid questions.  However, aren’t we able to answer these questions ourselves?  Isn’t this the intention of self-directed supports?  So what are our parameters for how we spend our NDIA funds?

Reasonable and Necessary Guidelines have been outlined by the NDIA.  They are our first port of call for choosing supports. https://www.ndis.gov.au/medias/documents/hf5/hae/8799191105566/Reasonable-necessary-supports-fact-sheet.pdf

The 5 key aspects:

  • be related to the participant’s disability
  • not include day-to-day living costs that are not related to a participant’s disability support needs
  • represent value for money
  • be likely to be effective and beneficial to the participant, and
  • take into account informal supports given to participants by families, carers, networks, and the community.

These guidelines are broad because they are considered within the context of people’s individual goals & circumstances.  Meaning that an identical paid support may be reasonable & necessary for one person, but not another.

So when considering a paid support for my 2 boys.  These are the 3 questions I ask myself –

  1. How does this support relate to their plan goals?
  2. What’s written as the description on the plan?  That’s the text box underneath the dollar figure is given for that Support Area. It’s important to check as this will be where planners make note of their intention when allocating this funding.  It will also be noted if there are any STATED supports. (STATED funds can ONLY be spent on that item. There is no further flexibility)
  3. Is this support in-line with Reasonable & Necessary principles?

Whenever I become bogged down in the agency mumbo-jumbo – I take a step back.

Why does this funding exist?

Well, it’s part of a bigger picture.  Helping my kids to develop their good life includes a range of supports.  NDIS funding sits alongside local community supports, informal networks, and larger govt infrastructure.  It exists to enhance my boys’ participation and ultimately the quality of life.

 

3 Comments

  1. Paul April 9, 2018 at 11:04 pm - Reply

    I think a common experience, especially with Autism, is to wonder ‘what road blocks will I hit that no-one has told me about yet’. That’s why I like specific answers e.g. can I get funding for … or does this service qualify as…. if there are criteria then surely some things will be ‘ok’ and some things won’t. Who makes that decision and who do we go to for answers to specific questions? Hopefully as the system becomes more mature this information become more readily available. At the moment is seems like the only way to find out is to ‘try it and see’.

  2. Sarah Harvey April 10, 2018 at 2:37 am - Reply

    I agree Paul! There is certainly an element of ‘try it and see’. I also see us in a unique position as we are participating in carving out what self-management will look like. It’s still very much taking shape. So by –
    * giving voice to what’s meaningful for us as individuals.
    * feeding back our experiences directly to the agency
    * sharing our experiences with the audit process, once that begins in earnest
    So yes….interesting times.

  3. Valentin June 2, 2018 at 3:45 am - Reply

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