Adjudicating reasonable and necessary funded supports in the National Disability Insurance Scheme: A critical review of the values and priorities indicated in the decisions of the Administrative Appeals Tribunal

Abstract

Beyond the initial euphoria of the National Disability Insurance Scheme (NDIS), tough choices will be needed for sustainability. Although the spirit of the NDIS is to deliver choice and control, the Australian government's objective is to ensure that rights and aspirations are proportionate to expectations of best practice, aptness of mainstream services and cost effectiveness. The position in this paper is that this test of ‘reasonable and necessary’ when determining funded supports, raises value dilemmas for government and citizens. The objective is to demonstrate this through a critical scrutiny of the reviews and decisions regarding reasonable and necessary funded supports of the Administrative Appeals Tribunal (AAT). In this paper, a synthesis and critique of 35 appeals to the AAT and one Federal Court Appeal are used to make explicit the decisional ambiguities and contestations in the scheme and the values and priorities that are currently dominant in the allocation of reasonable and necessary support. This in turn is used as a basis for a discussion about the operation of rights in the scheme and what counts as legitimate support. The benefit is for scheme transparency and fairness but also broader debate about core principles and values to inform decisions about scarce resources in society.

Case study discussion: The important partnership role of Disability Nurse Navigators in the context of abrupt system changes because of COVID-19 pandemic

“…Instead, the NDIS funds evidence-based reasonable and necessary support that relate to an individual's functional impairment and that enables them to live and participate in the community ( Commonwealth of Australia, 2013 ). However, determining what is reasonable and necessary functional health support, how it is valued, and who funds it, are unclear and contested across jurisdictional boundaries ( Venning, Hummell, Foster, Burns, & Harris Rimmer, 2020 ; Wallace, 2018 ). In the context of this case study, reasonable and necessary health support was determined prior to the onset of the pandemic.…”

Citizens or consumers? Seeking personhood through ‘personalised’ care in the National Disability Insurance Scheme

“…Importantly, they illuminate the degree to which personhood is facilitated, against other, sometimes conflicting objectives. In one of the few peer‐reviewed analyses exclusively focusing on these NDIS disputes, Venning et al (2021) examine how ‘reasonable and necessary’ has been operationalised through Tribunal decisions. In a ‘critical review’ of 36 cases, Venning et al (2021, p. 108) highlight ‘dominant operating values for determining reasonable and necessary supports’.…”

“…In one of the few peer‐reviewed analyses exclusively focusing on these NDIS disputes, Venning et al (2021) examine how ‘reasonable and necessary’ has been operationalised through Tribunal decisions. In a ‘critical review’ of 36 cases, Venning et al (2021, p. 108) highlight ‘dominant operating values for determining reasonable and necessary supports’. In identifying ‘decisional ambiguities’, the macro scope of their study focuses on points of connection and departure between cases, with little attention to the meaning produced within each individual case.…”

“…NDIS disputes are inherently a site of adversarial dialogue. In‐depth analysis of the processes of reasoning unfolding at an individual level affords insight into the patterns in decision making which Venning et al (2021) identify at the macro level. Venning et al (2021, p. 109) call for ‘critical scrutiny of the values and social norms in decision‐making’.…”

Young people in residential aged care: Is Australia on track to meet its targets?

“…The NDIS Act (Cth) legislated an entitlement for eligible people aged under 65 to individualised funding for any and all “reasonable and necessary” disability support. Although there is ambiguity in the concept of “reasonable and necessary” (Foster et al, 2016; Venning et al, 2020), there is arguably an implied entitlement to funding for disability support services sufficient to meet needs within an age‐appropriate setting. As such, the NDIS was expected to greatly ameliorate the problem of young people in RAC.…”