Reasonable and necessary explained for the NDIS
Reasonable and necessary is the legal test in section 34 of the NDIS Act 2013 that the NDIA applies when deciding what to fund in a participant's plan. A support must relate to the person's disability, help them pursue their goals, be value for money, be effective and beneficial, and be something the NDIS, rather than family, community or another service system, should fund.
National Disability Insurance Scheme Act 2013 (Cth), sections 10 and 34
National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Act 2024
NDIA, What is reasonable and necessary
NDIS Operational Guidelines, Reasonable and necessary supports
The section 34 criteria
Section 34 lists the things the NDIA must be satisfied of before it funds a support. The support must assist the participant to pursue the goals in their plan. It must help their social and economic participation. It must represent value for money, taking into account the benefits and the cost of alternatives. It must be likely to be effective and beneficial, having regard to good practice and evidence. It must take account of what is reasonable to expect families, carers, informal networks and the community to provide. And it must be most appropriately funded by the NDIS rather than another system such as health, education or housing. All criteria must be met, not just most.
The 2024 change: NDIS supports
From 3 October 2024, amendments to the NDIS Act added a further requirement. A funded support must also be an NDIS support as defined in section 10, which points to lists made under transitional rules setting out what is in and what is out. Everyday living costs, holidays, and services that mainstream systems provide are excluded. If a participant wants to use their funding for something on the excluded list, they can ask the NDIA to approve a replacement support in limited cases. The reasonable and necessary test still applies on top, so a support can be an NDIS support and still be refused if it fails section 34.
How the NDIA applies it
Planners and delegates apply the test to each support, using the participant's evidence, their goals and the NDIA's Operational Guidelines. Good evidence matters: reports that link the support to the person's functional impact, show why cheaper options will not work, and explain the expected benefit. For support coordinators and providers, the practical job is helping participants gather that evidence and frame requests around goals and function rather than diagnosis. The test is also used when the NDIA reviews spending in existing plans, and it will continue to shape the new planning framework and support needs assessments as they roll out.
If a decision goes the wrong way
A participant who disagrees with a decision about reasonable and necessary supports can ask the NDIA for an internal review within the time allowed, and if still unhappy can apply to the Administrative Review Tribunal. The reviewer looks at the decision fresh against section 34 and section 10. Many decisions turn on evidence, so it is worth strengthening reports before asking for review. Free advocacy services funded under the National Disability Advocacy Program can help. The rules about what counts as reasonable and necessary are set nationally, so they do not differ between states and territories.
Ask Mandy this, and thousands more.
Get instant, cited answers on the NDIS, aged care, health and more, in plain English.
Try Ask Mandy