austlii:cth/ARTA/2025/723
General information, not legal advice.
ARTA
2025-06-12
Original judgment source is linked above.
Annuscheit and National Disability Insurance Agency (NDIS) [2025] ARTA 723 (12 June 2025)
Respondent: CEO, National Disability Insurance Agency
Decision: The Tribunal affirms the decision under review.
NATIONAL DISABILITY INSURANCE SCHEME -participant supports - 1:1 support - short term accommodation - reasonable and necessary supports - consideration of section 34 National Disability Insurance Scheme Act 2013 (Cth) - decision affirmed
Administrative Review Tribunal (Consequential and Transitional Provisions No. 1) Act 2024
National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No 1) Act 2024
National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (Miscellaneous Provisions) Transitional Rules 2024
National Disability Insurance Scheme (Becoming a Participant) Rules - 2016, Access Rules
National Disability Insurance Scheme (Supports for Participants) Rules - 1 July 2013, Supports Rules
Beezley v Repatriation Commission (2015) FCAFC 165
McGarrigle v National Disability Insurance Agency [2017] FCA 308
NDIA v KKTB, by her litigation representative CVY22 [2022] FCAFC 181
National Disability Insurance Agency v WRMF [2020] FCAFC 79; (2020) 276 FCR 415
QDKH, by his litigation representative BGJF v National Disability Insurance Agency [2021] FCAFC 189
Re Drake v Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 60
SCHW and National Disability Insurance Agency [2021] AATA 591
NDIS - Operational Guidelines - Reasonable and necessary supports, 22 September 2024.
NDIS - Principles we follow to create your plan, 22 September 2024.
NDIS Pricing Arrangements and Price Limits, 2024/25
(i) 5 hours per week of support worker assistance with personal domestic duties; > > (ii) 6 hours per week assistance with community, social, recreational activity participation; > > (iii) 3 hours per month of support worker assistance for house/yard maintenance
Reasonable and necessary supports > > (1) For the purposes of specifying, in a statement of participant supports, the general supports that will be provided, and the reasonable and necessary supports that will be funded, the CEO must be satisfied of all of the following in relation to the funding or provision of each such support: > > (aa) the support is necessary to address needs of the participant arising from an impairment in relation to which the participant meets the disability requirements (see section 24) or the early intervention requirements (see section 25); > > (a) the support will assist the participant to pursue the goals, objectives and aspirations included in the participant's statement of goals and aspirations; > > (b) the support will assist the participant to undertake activities, so as to facilitate the participant's social and economic participation; > > (c) the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support; > > (d) the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice; > > (e) the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide; > > (f) the support is an NDIS support for the participant. > > Note: For the purposes of (aa): > > (a) the time at which the disability requirements or the early intervention requirements need to be met is the time the CEO decides to approve the statement of participant supports; and > > (b) a participant's disability support needs arising from an impairment in relation to which the participant meets the disability requirements or the early intervention requirements may be affected by a variety of factors, including environmental factors or the impact of another impairment in relation to which the participant does not meet either of those requirements. > > (2) The National Disability Insurance Scheme rules may prescribe methods or criteria to be applied, or matters to which the CEO is to have regard, in deciding whether or not he or she is satisfied as mentioned in any of paragraphs (1)(aa) to (f). (Tribunal emphasis to indicate amendments)
Supports that are NDIS supports > > (1) Subject to subsections (4) and (9), a support is an NDIS support for a person who is a participant or prospective participant if the support is declared by National Disability Insurance Scheme rules made for the purposes of this subsection to be an NDIS support for : > > (a) participants or prospective participants generally; or > > (b) a class of participants or prospective participants that includes the person. > > Note: The National Disability Insurance Scheme rules may declare a support for the purposes of this subsection by identifying a class of supports (see subsection 13(3) of the Legislation Act 2003 ). > > (2) Before making National Disability Insurance Scheme rules declaring a support for the purposes of subsection (1), the Minister must be satisfied: > > (a) for rules to which paragraph (1)(a) applies--that the support is appropriately funded or provided through the National Disability Insurance Scheme for participants or prospective participants generally; or > > (b) for rules to which paragraph (1)(b) applies--that the support is appropriately funded or provided through the National Disability Insurance Scheme for participants, or prospective participants, in the relevant class. > > (3) National Disability Insurance Scheme rules may declare a support for the purposes of subsection (1) only if at least one of the following applies: > > (a) the declaration of the support implements Australia's obligations under: > > (i) the Convention on the Rights of Persons with Disabilities done at New York on 13 December 2006; or > > (ii) any other agreement with one or more other countries; > > (b) the declaration of the support enables the provision of sickness benefits. > > Note: For subparagraph (a)(i), the Convention on the Rights of Persons with Disabilities is in Australian Treaty Series 2008 No.12 ([2008] ATS 12) and could in 2024 be viewed in the Australian Treaties Library on the AustLII website (http://www.austlii.edu.au). > > Supports that are not NDIS supports > > (4) The National Disability Insurance Scheme rules may declare that a support is not an NDIS support for: > > (a) participants or prospective participants generally; or > > (b) a class of participants or prospective participants. > > Note: The National Disability Insurance Scheme rules may declare a support for the purposes of this subsection by identifying a class of supports (see subsection 13(3) of the Legislation Act 2003 ). > > (5) Before making National Disability Insurance Scheme rules declaring a support for the purposes of subsection (4), the Minister must be satisfied: > > (a) for rules to which paragraph (4)(a) applies--that the support is not appropriately funded or provided through the National Disability Insurance Scheme for participants or prospective participants generally; or > > (b) for rules to which paragraph (4)(b) applies--that the support is not appropriately funded or provided through the National Disability Insurance Scheme for participants, or prospective participants, in the relevant class. > > (6) The CEO may determine, in writing, that a support is taken to not be declared under subsection (4) in relation to a participant if: > > (a) the support is prescribed by the National Disability Insurance Scheme rules for the purposes of this paragraph; and > > (b) the support would, apart from subsection (4), be an NDIS support for the participant; and > > (c) the participant applies to the CEO in accordance with subsection (7) for the determination; and > > (d) the CEO is satisfied that: > > (i) the support would replace one or more other supports that are NDIS supports for the participant; and > > (ii) the cost of the support is the same or lower than the total of the costs of the supports it would replace; and > > (iii) the support would provide the same or a better outcome for the participant than the supports it would replace; and > > (iv) any other conditions specified in the National Disability Insurance Scheme rules for the purposes of this subparagraph are met in relation to the support, the participant, or both. > > Note 1: A determination may be revoked under subsection 33(3) of the Acts Interpretation Act 1901 . > > Note 2: The National Disability Insurance Scheme rules may prescribe a support for the purposes of paragraph (a) by identifying a class of supports (see subsection 13(3) of the Legislation Act 2003 ). > > (7) An application under paragraph (6)(c) must: > > (a) be in the form (if any) approved by the CEO; and > > (b) include any information, and be accompanied by any documents, required by the CEO; and > > (c) be made in accordance with any other requirements specified in the National Disability Insurance Scheme rules for the purposes of this paragraph, which may include requirements as to the circumstances in which an application may, or may not, be made. > > (8) The National Disability Insurance Scheme rules may make provision for determining any matter for the purposes of subsection (6), including by prescribing requirements with which the CEO must comply, methods or criteria that the CEO is to apply, or matters that the CEO may, must or must not take into account, in deciding whether to make a determination under that subsection. > > (9) A support is not an NDIS support for a participant or prospective participant if the support consists of the provision of: > > (a) sexual services; or > > (b) alcohol; or > > (c) drugs, the possession of which is a contravention of a law of the Commonwealth, a State or a Territory.
Value for money > > 3.1 In deciding whether the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, the CEO is to consider the following matters: > > (a) whether there are comparable supports which would achieve the same outcome at a substantially lower cost; > > (b) whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long-term benefit to, the participant; > > (c) whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports); > > (d) for supports that involve the provision of equipment or modifications: > > (i) the comparative cost of purchasing or leasing the equipment or modifications; and > > (ii) whether there are any expected changes in technology or the participant's circumstances in the short term that would make it inappropriate to fund the equipment or modifications; > > (e) whether the cost of the support is comparable to the cost of supports of the same kind that are provided in the area in which the participant resides; > > (f) whether the support will increase the participant's independence and reduce the participant's need for other kinds of supports (for example, some home modifications may reduce a participant's need for home care). > > Effective and beneficial and current good practice > > 3.2 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to consider the available evidence of the effectiveness of the support for others in like circumstances. That evidence may include: > > (a) published and refereed literature and any consensus of expert opinion; > > (b) the lived experience of the participant or their carers; or > > (c) anything the Agency has learnt through delivery of the NDIS. > > 3.3 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to take into account, and if necessary seek, expert opinion. > > General criteria for supports > > 5.1 A support will not be provided or funded under the NDIS if: > > (a) it is likely to cause harm to the participant or pose a risk to others; or > > (b) it is not related to the participant's disability; or > > (c) it duplicates other supports delivered under alternative funding through the NDIS; or > > (d) it relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to a participant's disability support needs. > > 5.2 The day-to-day living costs referred to in paragraph 5.1(d) do not include the following (which may be funded under the NDIS if they relate to reasonable and necessary supports): > > (a) additional living costs that are incurred by a participant solely and directly as a result of their disability support needs; > > (b) costs that are ancillary to another support that is funded or provided under the participant's plan, and which the participant would not otherwise incur.
'The [supports rules] are an important element of the legislative scheme, introducing the ability to modify the operation of ss 33 and 34 by, for example, excluding certain kinds of supports from inclusion in participant plans. It is through the Rules that the executive is able to implement...some policy decision-making about the nature and extent of supports to be provided or funded.'
The phrase is a composite phrase. ... each limb of the phrase should be given work to do. That task is not difficult, or complicated with these two particular words, which are readily understood as conveying different meanings. However, the Parliament has chosen to use a composite phrase rather than to stipulate two distinct requirements, and therefore, as Gleeson CJ cautioned in XYZ v Commonwealth [2006] HCA25; (2006) 227 CLR532 at [19], '[t]here are many instances where it is misleading to construe a composite phrase simply by combining the dictionary meanings of its component parts'. > > ...Both adjectives qualify the noun "support", but they do so as a composite phrase. It is not fruitful to split them off and consider them separately, just as it is neither fruitful nor appropriate to attempt any exhaustive or authoritative judicial definition of them. > > Nevertheless, there is no doubt that the contextual use of the phrase in this Act links it to public funding to be provided to a participant. In that context, the phrase connotes supports which meet a threshold which justifies - by reference to the context, objects and guiding principles of the Act and the facts of the case - the expenditure of public funds for that support, for a particular participant. As we have already explained, the phrase also needs to be understood taking into account what has qualified a person as a participant, and the links between a person's impairment and their full participation in the community, in the same variety of ways as persons without a disability might choose to participate.
'full-time carers and coordinate the supports for [our] three children ...with extremely complex and rare disabilities, while managing [our] own serious health conditions. It is unreasonable and outside the realm of [our] capabilities to [support him];[22]
Dr Nektarios Alexi, psychologist, Adult Autism Assessment Clinic
Ms Samantha Crane, Occupational Therapist ('OT'), Gain Occupational Therapy
Ms Leila Wheib, behaviour support practitioner and psychotherapist, Supportive Choices Pty Ltd, and the Good Place Psychotherapy & Behaviour Consulting
Ms Ellen Chang, psychologist, Elysium psychology
Ms Amy Connolly, occupational therapist, Recovery In Mind Occupational Therapy
Ms Felicity Fay, Occupational Therapist, Take Charge Assessment & Therapy
Mr Elliott Mate, Occupational Therapist, Axiom Pty Ltd
Support you to pursue your goals and maximise your independence > > Support you to live independently and to be included in the community as a fully participating citizen > > Develop and support your capacity to do things that help you participate in the community and in employment.[93]
Short term accommodation 21 days per year including respite
I certify that the preceding 106 (one hundred and six) paragraphs are a true copy of the reasons for the decision herein of General Member S Smith.
Solicitors for the Respondent: Ms E Baggett, Mills Oakley
[2] The unit contains a bedroom, kitchen, and bathroom. EB-1, page 37. Ms Crane OT report.
[4] Pursuant to section 33(2) NDIS Act. EB-1, pages 81-94.
[6] EB-1, T1. Section 103 of the NDIS Act in combination with section 25 of the AAT Act.
[8] EB-3. Ms Collins referred to a 'change of circumstances form submitted to the Agency on 17 February 2024.
[10] Frugtniet v Australian Securities and Investment Commission [2019] HCA 16; (2019) 266 CLR 250 at [51]; QDKH, by his litigation representative BGJF v National Disability Insurance Agency [2021] FCAFC 189 [7].
[11] See section 3(3)(b) of the NDIS Act.
[12] Section 129 Amending Act. NDIS Amendment (Getting the NDIS Back on Track No 1) Act 2024.
[13] See Beezley v Repatriation Commission (2015) FCAFC 165 at [68]. Per North, Tracey and Mortimer JJ. See also National Disability Insurance Agency v WRMF [2020] FCAFC 79; (2020) 276 FCR 415 at [201]- [202].
[14] McGarrigle v National Disability Insurance Agency [2017] FCA 308 ('McGarrigle') [43].
[15] National Disability Insurance Agency v WRMF [2020] FCAFC 79 ('WRMF') [149]-[151].
[16] WRMF [141]. Cited with approval in NDIA v KKTB, by her litigation representative CVY22 [2022] FCAFC 181 [129].
[17] See SCHW and National Disability Insurance Agency [2021] AATA 591 [13] where DP Constance referred to Re Drake and Minister for Immigration and Ethnic Affairs (No 2) [1979] AATA 179; (1979) 2 ALD 634.
[18]Operational guidelines: 'Reasonable and necessary supports' on 22 September 2024; 'Principles we follow to create your plan' on 22 September 2024; 'Your Plan' on 24 September 2024; and 'Creating your plan' on 28 February 2025.
[22] Closing submissions of Ms Collins, page 3.
[27] Ms Connolly reported that Mr Annuscheit completed a Certificate IV in hospitality, with 'a significant level of support' from Ms Collins. EB-1, page 200.
[30] EB-4. Oral evidence of Ms Collins.
[33] Closing submissions of Ms Collins, pages 1-3.
[34] Closing submissions of Ms Collins, page 1. See also EB-3.
[57] EB-1, page 555. Oral evidence of Mr Mate.
[58] EB-1, page 551. Oral evidence of Mr Mate.
[60] EB-1, page 518. See also pages 512-515.
[61] Oral evidence of Mr Mate. EB-1, page 525.
[63] EB-1, pages 514, 522 - 531. Oral evidence of Mr Mate.
[68] Oral evidence of Mr Mate. EB-1, pages 532, 545, 546.
[69] Oral evidence of Mr Mate. EB-1, pages 509, 523-524.
[72] EB-1, page 546. Oral evidence of Mr Mate.
[74] EB-1, pages 532-533. Also pages 548-549.
[75] Agency closing submissions [4]. Dr Alexi, EB-1, page 326.
[76] Closing submissions of Ms Collins, page 2.
[79] EB-1, page 514. Oral evidence of Mr Mate.
[82] Closing submissions of Ms Collins, page 3.
[84] Agency closing submissions [25].
[86] Oral evidence of Mr Mate. EB-1, page 518.
[90] Goals also focus on independence and seeking employment and upholds the objectives and purposes of the NDIS Act. See section 3(1)(c) and (g) of the NDIS Act objectives regarding independence.
[93] Operational guidelines - reasonable and necessary supports (22 September 2024), page 17.
[94] Oral evidence of Ms Collins. EB-3, page 4. Ms Collins completed 'Caleb's daily support hours' regarding STA.
[95] Ms Collins closing submissions, page 3.
[96] Oral evidence of Ms Collins. Agency closing submissions [26].
Beezley
Repatriation Commission
(2020) 276 FCR 415
(2019) 266 CLR 250