If the NDIS were to have a catch phrase, it would probably be “as long as it’s reasonable and necessary”. It’s a well-known fact that every funding category, piece of AT, or support claimed under the NDIS must be considered reasonable and necessary… or is it?
What is R&N?
Reasonable and necessary is the term the NDIA use to categorise whether a support can be funded by the NDIS. In order to be considered reasonable and necessary, a support or service:
Must be related to a participant’s disability
Must not include day-to-day living costs not related to disability support needs
Should be considered value for money
Must be effective and work for the participant
Should consider support provided by other government services, family, carers, networks and the community
How does the NDIA determine reasonable and necessary?
The NDIA need to base their decision making on the reasonable and necessary criteria and the information provided by the participant that showcases they fit the reasonable and necessary criteria. This is why sharing as much supporting evidence with the NDIA can work in your favour – it gives the NDIA a better understanding of your disability and support needs.
Are there any exceptions?
Yes… and no.
The NDIA base every decision on reasonable and necessary when it comes to your plan funding. Although the NDIA states that funding for plan management is “separate to the reasonable and necessary funding of a participant’s NDIS disability supports”, this is because plan management can be considered reasonable and necessary by default.
Plan management does not technically fall under reasonable and necessary for one simple reason - if a participant requests plan management they do not need to provide any supporting evidence to justify why they need this support. For all other support funding, participants must provide supporting evidence to show why a support is reasonable and necessary.
In other words, there is actually only one type of support that is ALWAYS reasonable and necessary – plan management.
That’s not to say there aren’t rare circumstances where plan management may be denied. This action only occurs if the NDIA believe there would be an “unreasonable risk of harm” by a participant being plan managed.
What are the benefits of plan management?
There are plenty of benefits when it comes to plan management, here are our top four:
Reduce stress and save time by having a professional manage the processing and paying of invoices on your behalf
More choice and control over your providers with access to both NDIS registered and non-registered providers
Having all your invoices, payments and monthly statements managed in one place
It’s free!*
*When a participant is plan managed, the plan manager receives an establishment fee and a monthly processing fee. It comes at no extra cost to NDIS participants, and it doesn’t take any funding from your other funding supports. Although plan management is included in a participant’s plan, funding for this is claimed directly from the NDIA.
Plan management, self-management & combination plans
Whether plan management, self-management or a combination is best for you depends on your preferences.
Plan management offers flexibility to choose from registered and non-registered providers while also providing support with administrative tasks and invoice processing, claiming, and paying. There are no out of pocket expenses for plan management and capped pricing mean that some supports might be cheaper under plan management than they would be under self-management.
Self-management also provides greater flexibility, choice, and control, however there are more responsibilities. Typically, a separate bank account is needed to manage funding, budgets, invoice claims and payments will need to be managed by yourself. Pricing is not capped which means that you could end up paying more for supports than the amount outlined in the NDIS Pricing Arrangements.
Both options give you the benefit of accessing support from NDIS registered and non-registered providers. The real determining factor is – how active do you want to be when it comes to managing your funding and keeping detailed records.
Read more about the benefits of working with an independent, professional Plan Manager. Alternatively, contact our friendly team on 1300 322 273 or support@first2care.com.au.