(a) increased number of hours per day of support worker assistance; > > (b) professional hairdressing services (rather than her support workers) to safely wash her hair; > > (c) professional services by a nail or beauty therapist (rather than her support workers) to safely trim her thick nails; > > (d) daily ironing services (including transport) (rather than her support workers undertaking ironing tasks); > > (e) regular cleaning services by professional cleaners (rather than her support workers undertaking the heavier household cleaning); > > (f) dental hygienist care/services; > > (g) supply of medicinal liquid soap; > > (h) supply of Tork Xpress flushable multi-fold handtowels; > > (i) supply of brown bags for personal waste products; > > (j) supply of hand sanitiser; > > (k) supply of nitrile gloves in different sizes to be used by her support workers; > > (l) supply of Medicom SafeMask Premier Procedure 3Ply Earloop Masks; > > (m) supply of Cello Underpads 5-Ply 20 Pads; > > (n) supply of small white Roar-branded wipes; > > (o) supply of Microlax enemas; > > (p) increased funding for one pair of custom footwear; > > (q) orthotic devices; > > (r) meal preparation and delivery (excluding the component for the cost of the food) (rather than her support workers undertaking meal planning and preparation); > > (s) increased weekly allowance for transport, to be used to hire taxis and transport; > > (t) increased number of hours for occupational therapy services, to be used for: > > > (i) therapy sessions; and > > > > (ii) assistive technology ('AT') (including wheelchairs) and home automation assessments; > > (u) speech pathology; > > (v) services by a "hand physiotherapist" (which is a request for hand therapy by an occupational therapist as clarified at the hearing); > > (w) services by a neuro-physiotherapist or "hydrotherapy with physio"; > > (x) services by a (standard) physiotherapist; > > (y) services by a Level 2 therapy assistant; > > (z) services by a chiropractor; > > (aa) the provision of "pain therapy"; > > (bb) increased podiatry services comprising foot and shoe care, foot maintenance, and "infection damage"; > > (cc) provision of "training for carers"; > > (dd) increased support coordination services; > > (ee) "ongoing service, maintenance and repairs" (including three callouts) of powered wheelchair; > > (ff) replacement of wheels and damper system of her powered wheelchair; > > (gg) replacement of "parts, motor and drive cables" of her powered wheelchair; > > (hh) two custom-made Endurafoam-branded cushions and covers for her powered wheelchair; > > (ii) replacement of the "backrest" for her powered wheelchair; > > (jj) "cable replacement" for her powered wheelchair; > > (kk) six "new tyres" for her powered wheelchair; > > (ll) "servicing and maintenance" (including three callouts per year) of her manual wheelchair; > > (mm) "callouts and deliveries" in respect of her manual wheelchair; > > (nn) "parts and motor cables" and also "stands" for her manual wheelchair; > > (oo) "cables and arm (side) guards and for armrests" for her manual wheelchair; > > (pp) "new cushion" for her manual wheelchair; > > (qq) replacement of one set of tyres for her manual wheelchair; > > (rr) replacement of the footplates (or "hangers") for her manual wheelchair; > > (ss) the cost of trialling a robotic arm; > > (tt) provision for "maintenance and repairs" to her shower chair/commode (which evolved to the cost of replacement of this item based on an exchange at the hearing); > > (uu) provision for maintenance and repairs to Ms Blesing's electric bed; > > (vv) replacements of Ms Blesing's mattresses (two per annum); > > (ww) additional leg straps (to be used during transfers); > > (xx) replacement of gantry hoist slings (two per annum); > > (yy) hire fees (and trial) of a suitable accessible van; > > (zz) purchase of an OBI feeding device; > > * (aaa) provision for the replacement of the battery for the gantry hoist; > * (bbb) provision for the replacement of hand controllers for the gantry hoist; and > > (ccc) one additional computer mouse headset per annum.

5. If these requested supports were added to Ms Blesing's NDIS plan, Ms Blesing (or those supporting her) estimate that her total NDIS funding would increase to between $2m and $3m per annum.[20]
6. The NDIA does not consider that the supports being requested by Ms Blesing meet the "reasonable and necessary supports" criteria under the NDIS Act. The NDIA also contends that the funding in Ms Blesing's NDIS plan should be plan managed, as specified in her Current SOPS. However, at the end of the hearing, the NDIA agreed that Ms Blesing's funding could revert to being "self-managed",[21] provided that the monthly funding periods and amounts in her Current SOPS remain in place and that all budgets in her plan are specified as being "Stated" budgets, meaning that Ms Blesing is unable to spend those funds, flexibly, to pay for supports in the other budgets in her Current SOPS.
7. The NDIA considers that the above two measures are required to assist Ms Blesing to spend her NDIS funding in accordance with the provisions of her current NDIS plan (as required by s 46 of the NDIS Act). The NDIA alleges that there is a history of the early depletion of NDIS funds from Ms Blesing's NDIS plans before the scheduled reassessment dates. In those past instances, the NDIA has exercised its discretion to approve a new plan for Ms Blesing, before the scheduled reassessment date, to ensure continuity of the provisions of her supports. The NDIA also alleges that there is a history of Ms Blesing using NDIS funds to purchase goods and services which are not provisioned for in her SOPS. These allegations were addressed at the substantive hearing and in submissions lodged by the parties. In short, Ms Blesing refutes these allegations and contends there is no proper basis for the NDIA's allegations about her NDIS funding expenditure history. Ms Blesing says that she should be permitted to self-manage the funding in her plan[22] and that there should be no discrete funding periods or amounts imposed and nor should there be an "Stated" budgets or supports.

1. The decisions under review in this proceeding (referred to collectively in this Statement of Reasons as the 'Decisions Under Review'), comprise:

(a) the internal review decision of a delegate of the CEO made on 25 August 2025 ('Internal Review Decision'), of an earlier decision made on 23 June 2023 by a different delegate of the CEO to approve a 12-month statement of participant supports ('SOPS') for Ms Blesing (total funding: $836,893.96);[23] and > > (b) subsequent decisions made by delegates of the CEO to approve subsequent SOPS for Ms Blesing including decisions to approve subsequent SOPS for Ms Blesing on the following dates: > > > (i) on 25 August 2023, for a notional period of 12 months (total funding: $897,311.07); > > > > (ii) on 11 December 2023, for a notional period of 12 months (total funding: $942,270.60); > > > > (iii) on 7 June 2024, for a notional period of six months (total funding: $471,135.3); > > > > (iv) on 26 September 2024, for a notional period of 12 months (total funding: $925,997.76); > > > > (v) on 16 April 2024, for a notional period of 12 months (total funding: $926,371.92); > > > > (vi) on 16 April 2025, the NDIA reportedly applied an "auto rollover" to reinstate the funding levels in Ms Blesing's NDIA plan to the level set out in her plan which commenced on 19 September 2024 (that is, total funding: $926,371.92); > > > > (vii) on 23 July 2025, for a notional period of 12 months (total funding: $1,226,001.68); and > > > > (viii) Ms Blesing's Current SOPS.

2. Ms Blesing lodged this application for review on 22 September 2023 and thereafter this proceeding has traversed a complex and protracted procedural path, both before and after it was constituted to the Tribunal for a substantive hearing. It is apparent there were some difficulties from the outset endeavouring to identify with precision the supports and plan management issues in dispute. There were also difficulties on both sides in respect of the parties lodging their evidence and submissions at various stages in the proceeding in compliance with the Tribunal's directions and in a manner which was capable of being followed and understood.
3. The Tribunal acknowledges that the parties were able to make some progress with the settlement negotiations which took place between them while this matter was on foot. They have reached agreement in respect of some of the supports and issues originally in dispute as set out further below.

1. On 10 January 2025, the Tribunal (differently constituted) made a set of procedural directions to commence preparing this matter for a substantive hearing. Those directions required Ms Blesing to confirm in writing the supports which had been requested by her and agreed to by the NDIA, and the supports which remained in dispute between them. In compliance with this direction, Ms Blesing's legal representatives at this time, that is, a lawyer from the Legal Services Commissioner of South Australia, on Ms Blesing's behalf, lodged a position paper dated on 24 January 2025 ('Ms Blesing's Position Paper') with the Tribunal and gave a copy to the NDIA. Directions were also made on 10 January 2025, for the parties to lodge their evidence and submissions in accordance with a procedural timetable mandated by the Tribunal, which was scheduled to end on 28 April 2025.
2. The Registry of the Tribunal arranged for this matter to be listed for a substantive hearing on 24 to 26 June 2025 and subsequently, constituted this matter to this Tribunal (as presently constituted) to conduct the substantive hearing. Upon constitution, the Tribunal (as presently constituted) reviewed the file in May 2025 in preparation for the proposed June 2025 hearing. The Tribunal identified that the procedural directions for the lodgement of the parties' evidence and submissions, referred to above, had not been complied with. The Tribunal referred the matter to be listed for an urgent non-compliance directions hearing.
3. At the non-compliance directions hearing, which took place on 26 May 2025, the NDIA was represented by Mills Oakley Lawyers and an NDIA Case Manager.
4. Ms Blesing was self-represented and appeared with:

(a) Ms Lisa Rake, who is her support coordinator; > > (b) Ms Catie Bartholomeus, who is her long-term support worker; and > > (c) Mr Thomas Hesketh, her long-term ad hoc support worker (who mainly assists her with matters relating to information technology and administration).

5. At the May 2025 directions hearing, the Tribunal was informed that Ms Blesing's legal representation had ended. Ms Blesing said she had received an email from Justice Net SA on 22 May 2025 to advise her that they would endeavour to find her a pro bono barrister for the hearing. This did not transpire, and Ms Blesing was self-represented at the substantive hearing with significant support at different stages, from Mr Hesketh, Ms Bartholomeus and her "bookkeeper", Mr Alastair Cameron.
6. Ms Blesing expressed that she felt significantly disadvantaged by the fact that she was self-represented, in light of the NDIA being represented by lawyers. The Tribunal made every endeavour and significant accommodations, to ensure that both parties were both afforded procedural fairness leading up to and throughout the substantive hearing, whilst ensuring that it met its statutory obligations under the Administrative Review Tribunal Act 2024 (Cth) ('ART Act').

1. At the directions hearing before the Tribunal in May 2025, Ms Blesing confirmed that she is seeking additional supports in her NDIS plan as specified in Ms Blesing's Position Paper.
2. Ms Blesing informed the Tribunal that she is not seeking funding for specialist disability accommodation ('SDA') and her preference is to stay living in her current community housing residence. Ms Blesing confirmed at the substantive hearing that this remains her preferred living arrangement. For this reason, the Tribunal is not required to make a decision in respect of whether SDA is a "reasonable and necessary support" for Ms Blesing under the NDIS Act. The NDIA has accepted that Ms Blesing meets the eligibility requirements for SDA as reflected in her Current SOPS by the additional of SDA (albeit for a provisional sum of $1.00, on account of Ms Blesing's current living arrangements being that she does not live in SDA).
3. At the Directions hearing on 26 May 2025, it was identified that Ms Blesing was seeking funding for 38 different categories of supports, with some of the categories containing numerous further individual items of support. Following a collaborative process involving both parties, the Tribunal made an order under s 53 of the ART Act listing the 38 categories of support in dispute between the parties and plan management issues identified by the parties, in order to provide a framework for the parties about the issues to be decided as part of this proceeding and to allow the parties to prepare their evidence and submissions for the hearing on the basis of those clearly identified issues in dispute.
4. The Tribunal subsequently revoked and reissued the s 53 Order to take into account the evolution of subsequent agreements reached between the parties to resolve some of the issues in dispute and also upon receipt from Ms Blesing of further clarification in relation to some of the supports she was seeking.[24]

1. In the final version of the s 53 Order issued on 21 October 2025, the Tribunal ordered that the issues and questions of fact and evidence in this proceeding be confined to the following:

(a) whether funding for the following categories of supports are "reasonable and necessary supports" under section 34 of the NDIS Act, and should be included in Ms Blesing's SOPS (specific details for each request are set out in her Position Paper dated 24 January 2025):[25]

Support No.1: 52 hours of support worker assistance per day (inclusive of active overnight support) as specified in Ms Blesing's Position Paper;

Support No.2: 3 hours per week for a professional to wash Ms Blesing's hair;

Support No.3: 18 hours per week for professional manicures/nail care;

Support No.4: 3 hours per day of ironing services (including Transport)(that is, $185 per day);

Support No.5: 9 hours per week for cleaning services (over 3 days);

Support No.6: $65 per month for dental hygienist care;

Support No. 7: $36,447.36 per annum for continence aids;

Support No.8: $3,345 per annum for one pair of custom footwear

Support No.9: $1,410 for orthotic devices;

Support No.10: $117 per week for meal preparation and delivery;

Support No.11: $575 per week for transport to hire taxis and transport;

Support No.12: Services provided by an occupational therapist including 146 hours per annum for occupational therapy sessions and assistive technology (AT) assessment, 10 hours per annum of OT home automation and 20 hours per annum for an OT wheelchair assessment;

Support No.13: 48 hours per annum for services to be provided by a speech pathologist;

Support No.14: 18 hours per annum for services to be provided by a hand physiotherapist;

Support No.15: 104 hours per annum for services to be provided by a neuro-physiotherapist or "hydrotherapy with physio";

Support No.16: 52 hours per annum for services to be provided by a physiotherapist;

Support No.17: 132 hours per annum for services to be provided by a Level 2 therapy assistant;

Support No.18: 52 hours per annum for services by a chiropractor;

Support No.19: 26 hours per annum for "pain therapy";

Support No.20: 26 hours per annum for psychology services [Agreed at the hearing that 15 hours of psychology services will be funded];

Support No.21: Podiatry services comprising 17 hours of podiatry, 4 hours of foot and shoe care at $150 per hour, $1,746 for 12 appointments per annum for foot maintenance, $600 for four appointments per annum for "infection damage";

Support No.22: 416 hours per annum for "training for carers" to be provided by the Applicant's senior support workers;

Support No.23: $1,000 for services by an "AT technical specialist";

Support No.24: 4 hours per week for Level 3 support coordination services;

Support No.25: AT - Wheelchair maintenance and repairs (including backrest and cushions);

Support No.26: AT - Robotic arm (trial) $7,000;

Support No.27: AT - "other maintenance and repairs" $8,000 to $10,000. As confirmed by the parties before the end of the hearing, this constitutes a request for funding in respect of seven different items of AT;

Support No.28: "Recreational AT" - quote pending [Agreed];

Support No.29: Modification to MWC and PWC straps/harnesses ($1,550) [Withdrawn - duplication of another requested support];

Support No.30: Trials for supplier input and parts for PWC customisation ($5,000 to $6,000 per trial) [Withdrawn - duplication of another requested support];

Support No.31: Modifications to wheelchair to provide consistent pelvic alignment and stability (approximately $695.00);

Support No.32: $1,096 for low-cost manual wheelchair or seating accessories [Withdrawn];

Support No.33: $21,840 to hire (and trial) a suitable accessible van;

Support No.34: Approximately $14,210.60 for an OBI feeding device;

Support No.35: [Removed - withdrawn by Ms Blesing on 18 August 2025] Trial of Tobii Dynavox I-16 I Gaze Interaction Eye Tracker ($6,541);

Support No.36: Backup portable hoist (quote pending) [Agreed];

Support No.37: $4,500 for repairs and maintenance to gantry hoist [Agreed];[26]

Support No.38: $2,800 for lifter battery and installation [Agreed];

Support No.39: one headset and freight costs [Agreed].

(b) whether the Tribunal should grant Ms Blesing's request to self-manage the funding in her NDIS plan (except for the funding provided for support coordination) and if so:

1. whether funding periods should be limited to one month or some other period less than the notional duration of the plan; and
2. whether any of the supports should be specified as "Stated" supports.

1. At the May 2025 directions hearing, the NDIA's legal representative acknowledged that his firm, on behalf of the NDIA, had not complied with the previous procedural directions of the Tribunal (dated 10 January 2025) and that the NDIA had not yet lodged its statements of facts, issues and contentions, joint hearing tender bundle or a joint witness schedule in readiness for the substantive hearing, explaining that there had been a change of solicitor from his firm who had carriage of this matter.
2. In light of the non-compliance by the NDIA, Ms Blesing applied for an adjournment of the scheduled substantive hearing on 24 to 26 June 2025 inclusive. Ms Blesing said she also wanted to wait until a pro bono barrister had been appointed to represent her, and to enable her to participate in a further alternative dispute resolution ('ADR') conference at the Tribunal to explore a potential settlement or at least, to endeavour to narrow the scope of the supports/issues in dispute. The NDIA indicated it was not opposed to Ms Blesing's adjournment application.
3. The Tribunal considered it appropriate to adjourn the matter to afford Ms Blesing procedural fairness given that the NDIA had not lodged its case materials. The adjournment provided an opportunity for the NDIA's evidence and submissions to be duly lodged with the Tribunal and provided to Ms Blesing for her consideration before the substantive hearing.
4. Regarding the suggestion that this proceeding be returned to the Tribunal's ADR processes, the Tribunal informed the parties that this matter had been "exited" from the Tribunal's ADR processes and in accordance with current practice, it would not be referred back for a further conciliation before a Registrar of the Tribunal. Instead, the Tribunal informed the parties that the matter would proceed to a substantive hearing, and a final decision would be made, particularly in light of this application having first been lodged in 2023. The Tribunal pointed out that there was nothing to prevent the parties from continuing to engage in settlement discussions directly with one another. The parties indicated a preparedness to arrange an informal conference directly between them, in an endeavour to explore whether a settlement may be reached or the issues narrowed. The Tribunal made it clear to the parties that the hearing would proceed once it was rescheduled, irrespective of whether Ms Blesing was able to secure legal representation. As advised to the parties at the hearing, it is not always possible for applicants (including NDIS participants) to secure legal representation and so it is not uncommon for applicants to be self-represented at hearings before the Tribunal. The Tribunal conveyed to the parties that it is under a statutory obligation (among others) to progress the application in a timely manner.
5. The Tribunal gave instructions to reschedule the substantive hearing to the following dates: 18 to 22 August 2025 and 25 to 29 August 2025 inclusive. During the rescheduled substantive hearing, it became appropriate to adjourn the final tenth day of the hearing and to list the matter for a further two hearing days at a later stage, on account of some further procedural fairness issues arising. Difficulties were still being encountered in ascertaining with clarity the specific supports being sought by Ms Blesing (and in particular, her requests for numerous items relating to assistive technology and how they may overlap and relate to one another). Another evidentiary issue arose in respect of the identification of errors in the extensive NDIS funding expenditure data which had been lodged by the NDIA being relevant to the plan management issues in dispute. The NDIA re-lodged some of the evidence to correct those identified systemic errors. Ms Blesing was provided with an opportunity to respond to the further evidence, and she clarified and supplemented her evidence in respect of some of the other issues in dispute.
6. At the resumed hearing, a further short adjournment became appropriate because the parties had not identified or lodged some (recently introduced) new applicable NDIS rules and a Ministerial determination bearing upon the plan management issues. This was attended to during the adjournment and the parties were provided with an opportunity to make submissions about the implications of those rules and the determination.
7. Finally, a further opportunity was provided to the parties to lodge submissions and evidence in relation to a discrete number of the items of consumables which were not fully addressed at the substantive hearing.

1. For the reasons set out in this Statement of Reasons, the Tribunal sets aside the Decisions Under Review and remits this matter to the NDIA with a direction that it facilitates the approval of a new SOPS for Ms Blesing containing some, but not all, of the requested supports.
2. The Tribunal accepts the NDIA's contentions in respect of the plan management issues and has directed that the plan management specifications in the Current SOPS be changed to being "self-managed" as requested by Ms Blesing and that the monthly funding periods and that Ms Blesing supports are specified as being "Stated" supports. The Tribunal is satisfied that those funding restrictions will assist Ms Blesing to fulfil her obligations under s 46 of the NDIS Act, given the demonstrated irregularities in her previous history of NDIS funding expenditure.

1. On 24 October 2024, the NDIA lodged a set of documents in accordance with its obligation under s 37 of the former Administrative Appeals Tribunal Act 1975 (Cth) ('T-Documents'). On 25 July 2025, the NDIA lodged a joint hearing tender bundle ('Joint HTB'). On 11 August 2025, Ms Blesing lodged an individual hearing tender bundle ('Ms Blesing's First HTB'). On 26 August 2025, the NDIA lodged an individual hearing tender bundle ('NDIA Supplementary HTB').[27] On 29 September 2025, the NDIA lodged an individual hearing tender bundle ('NDIA's Further Supplementary HTB').[28] On 17 October 2025, the NDIA lodged an individual hearing tender bundle ('NDIA's Second Further Supplementary HTB') containing 21 NDIS plans for Ms Blesing between the period of June 2018 to July 2026 and data in relation to Ms Blesing's expenditure history from 11 December 2024 to July 2025 (as well as some operational guidelines issued by the NDIA).[29] On 14 October 2025, the NDIA lodged an Affidavit sworn by Mr Liam Dennis (solicitor for the NDIA who had carriage of this matter) which annexes evidence relevant to the history of expenditure of funding from Ms Blesing's NDIS plans.[30] On 17 October 2025, Ms Blesing lodged a spreadsheet showing data about plan expenditure.[31]
2. On 19 October 2025, Ms Blesing lodged:

(a) a witness statement (dated 17 October 2025 and finalised by her on 19 October 2025), about "Self-Management of Funding";[32] > > (b) a document setting out information about her NDIS funding during the period during which Ms Blesing was self-managing her NDIS plan.[33]

3. On 27 October 2025, Ms Blesing lodged an individual hearing tender bundle totalling 443 pages ('Ms Blesing's Second HTB'), comprising a copy of 21 NDIS plans, and information contained in a NDIS "MyPlace" participant portal capture, in respect of the period September 2019 to December 2023.
4. On 6 February 2026, the NDIA lodged the NDIA's Third Further Supplementary Hearing Tender Bundle, containing further service provider NDIS rules, indicators and guidelines, updated Price Guide and Consumables Code Guide and a new document entitled "Disability Support Worker Cost Model Assumptions and Methodology 2025-26" released on 16 June 2025.
5. At the hearing, the Tribunal received into evidence the following documents or sets of documents ('Exhibit Table'):

Signed letter by Elisz Ilieva, Practice Manager, DRJ Dental Group

Witness Statement by Dianne Blesing (signed version)

Report by Erica Elliot, Hand Therapist, Adelaide Hand Therapy

Table prepared by Ms Blesing of requested supports and supporting evidence

Curriculum Vitae for Ms Glenda Noble (to be provided by witness)

Curriculum Vitae for Sarah Clifton, Speech Pathologist

Further letter from Mr Sean Murphy, Podiatrist (signed)

Further Witness Statement (in email form) by Ms Blessing attaching medical reports including radiological reports (9 pages)

Proposed schedule of weekly travel prepared by Ms Blesing in relation to her claims for a transport allowance or hire vehicle

Quotation by Brazier Mobility dated 10 July 2025 for hire of WC accessible vehicle

Quotation by Brazier Mobility for the purchase of WC accessible vehicle

Statement by Ms Blesing in relation to her request for laundry services

Undated and unsigned by Ms Blesing confirmed at the hearing it was drafted by her.

Quotation by Green Cleaners dated 26 August 2025 in relation to Ms Blesing's request for cleaning services

Letter from Madame Josephine Hairdressers, Adelaide

Letter by Emmanuel Clironomos, Adelaide Podiatry Centre (signed version)

NDIA's Supplementary HTB lodged by the NDIA containing information published on NDIA website, NDIA policy guidance and other government websites, as well as legislation and rules post-Oct 2024 amendments

Unsigned witness statement of Mr Cameron including Annexures

Statement of Ms Joanne Blessing (signed) 12 September 2025

Quotation by Aidacare for a backup portable hoist ($4,005.00)

Quotation from Xtracare dated 17 September 2025 for chest straps which will be used as leg straps when Ms Blesing is using the harness

Quotation from Medimart dated 24 September 2025 for a mattress

Document from Ms Blesing providing evidence of invoices and payments made in respect of the laundry services

NDIA's Further Supplementary HTB, lodged by the NDIA containing NDIA OGs, NDIA system data about expenditure from Ms Blesing's NDIS plan, NDIS (Management of Funding) Rules 2024 (Cth)

NDIA's Second Further Supplementary HTB, lodged by the NDIA containing NDIS plans, expenditure data and NDIA OGs

Witness statement of Liam Dennis (lawyer with carriage of the matter on behalf of the NDIA)

Ms Blesing's Witness Statement about Self-Management of Funding

17 October 2025 (statement revised in blue font on 19 October 2025)

Ms Blesing's Supporting Funding numbers for Self-Management of Funding

Excel Spreadsheet prepared by Mr Alistair Cameron showing various data about plan expenditure revised on 17 October 2025

Finalised 17 October 2025 before reviewing Liam's latest table - sent to NDIA at 8:20pm Sydney time on Friday, 17 Oct 2025

Product information sheet about the Molift Air 205 Motor Ceiling Hoist on Medimart letterhead downloaded on 20 October 2025 by Ms Blesing from the Medimart website[34]

Medimart Invoice issued on 7 October 2025 in respect of replacement of battery on 6 October 2025 in the gantry hoist[35]

Medimart Invoice issued on 19 September 2025 in respect of replacement of the hand controller on 18 September 2025 in the gantry hoist[36]

Plan utilisation excel spreadsheet prepared by Mr Dennis based on information obtained from the 21 NDIS plans and the data sourced from the CRM and PACE computer systems at the NDIA

Set of agreements between Ms Blesing and some of her support workers

NDIA's Third Further Supplementary HTB containing NDIS Rules, Indicators and Guidelines, updated Price Guide and Consumables Code Guide and a new document entitled "Disability Support Worker Cost Model Assumptions and Methodology 2025-26" released on 16 June 2025

Ms Blesing's Second HTB, containing numerous NDIS plans and data captured from her myplace portal

1. On 24 July 2025, the NDIA lodged its statement of facts, issues and contentions ('NDIA's SFIC') and a breakdown of the funding approved in Ms Blesing's NDIS plan current as of that date.
2. On 11 August 2025, Ms Blesing lodged her statement of facts, issues and contentions dated 7 August 2025 ('Ms Blesing's SFIC').
3. On 14 October 2025, the NDIA lodged a set of submissions about the plan management issues and imposition of monthly funding periods ('NDIA's Plan Management Submissions').
4. On 20 October 2025, at the request of the Tribunal, the NDIA lodged:

(a) a table which has a list of the supports in dispute between the parties and that each party has populated to indicate their respective positions relating to each of the supports and to indicate the evidence each of them relies upon in respect of those supports ('Combined Table of Supports'); > > (b) a table which lists supports numbered 25 to 38 in the s 53 Order, that each party has populated to indicate their respective positions relating to each of the supports and to indicate the evidence each of them relies upon in respect of those supports ('Combined Table of AT Supports Nos. 25 to 38'); > > (c) a plan utilisation excel spreadsheet prepared by Mr Dennis based on information obtained from the 21 NDIS plans and the data sourced from the CRM and PACE computer systems at the NDIA.[37]

5. On 29 October 2025, the NDIA lodged a table listing the supports (combined version) which are agreed as between the parties as of that date ('Table of Agreed Supports').
6. On 29 October 2025, the NDIA lodged a set of closing submissions ('NDIA's Closing Submissions'). On 5 November 2025, Ms Blesing lodged with the Tribunal a closing statement ('Ms Blesing's Closing Statement').[38]
7. On 21 January 2026, the NDIA sent an email to the Tribunal attaching further documents in response to an enquiry by the Tribunal. On 27 January 2026, Ms Blesing sent an email to the Tribunal containing further submissions in answer to some questions posed by the Tribunal seeking clarification in relation to some of her evidence before the Tribunal.
8. On 6 February 2026, the NDIA lodged further guidance documents with the Tribunal,[39] some of which had not previously been before the Tribunal, as well as further submissions, at the request of the Tribunal, in relation to Ms Blesing's requests for extra hygiene liquid soap and hand sanitiser, Microlax enemas and nitrile gloves. Ms Blesing was provided with an opportunity to respond to this new material. On 11 February 2026, Ms Blesing lodged final submissions in reply.

1. The substantive hearing took place over 13 days on 18 to 22 August 2025, 25 to 28 August 2025, 30 September 2025, 1 October 2025, 20 October 2025 and 21 October 2025. Ms Louise Martin appeared as counsel for the NDIA.
2. Ms Blesing called the following witnesses to give oral evidence at the hearing:

(a) herself; > > (b) Mr Jonathan Draysey, treating chiropractor. > > (c) Ms Dianne Blesing ('Ms D. Blesing'), Ms Blesing's mother;[40] > > (d) Dr Yvan Tooth, one of Ms Blesing's support workers,[41] "trainer" and a qualified chiropractor; > > (e) Ms Rake, Ms Blesing's support coordinator; > > (f) Mr Hesketh; > > (g) Ms Catie Bartholomeus, one of Ms Blesing's support workers; > > (h) Ms Glenda Noble, treating occupational therapist, OTInnovate; > > (i) Ms Sarah Clifton, treating speech pathologist; > > (j) Dr Nicholas Chia, treating neurologist (specialising in MS); > > (k) Ms Teresa Beltrame, treating neurological physiotherapist; > > (l) Ms Lisa Harman, treating (standard) physiotherapist; > > (m) Mr Alistair Cameron, Ms Blesing's "bookkeeper"; and > > (n) Mr John Voumard, who is Ms Blesing's lawyer and will be responsible for setting up a "Microboard" for her to assist in managing the expenditure of NDIS funds.

3. The NDIA called one witness, namely, Mr Christian Burden, independent occupational therapist, to give oral evidence at the hearing. Mr Burden was engaged by the NDIA to undertake a functional capacity assessment of Ms Blesing. Mr Burden issued an 80-page functional capacity assessment report on 12 November 2024 ('Mr Burden's Report').[42]
4. The first stage of the hearing was focussed on the supports in dispute between the parties and in the second stage, the plan management issues in dispute.

Living circumstances, family and other supports

1. Ms Blesing is 59 years old. She lives in a two-bedroom apartment in Adelaide, South Australia. Ms Blesing is not partnered, nor does she have any children or other persons living with her.
2. Ms Blesing enjoyed a successful career in design and business and is now involved in community projects, such as organising fashion parades to challenge perceptions of disability in the fashion industry.[43]
3. Ms Blesing has a supportive mother, Ms D. Blesing.[44] Ms Blesing's father recently passed away. Ms Blesing was previously married and had a stepchild. Her ex-husband, stepchild, sister and friends live in Melbourne.[45] Ms Blesing moved back to Adelaide due to her MS.[46] Ms Blesing told Mr Burden that she no longer contacts her friends and family in Melbourne, due to physical difficulties.[47]
4. Ms Blesing told Mr Burden that she has a network of friends and colleagues who have supported her over the years, and she is an active member of her community. She has made connections through her volunteer work. Ms Blesing is an active disability advocate creating a "supportive environment" through her "image shift" program.[48]

1. Ms Blesing's NDIS goals are identified in her Current SOPS as follows (with a caveat on page 17 of her Current SOPS that an "update" of Ms Blesing's goals would be completed at the "next full plan review"):

(a) "I need paid supports to increase my capacity and level of independence through various Assistive Technologies and therapies"; > > (b) "I need paid supports to re-establish pre-accident mobility, functionality, independence and physical ability; specifically, standing, wheelchair independence, active engagement in inclusive design and project management, attending appointments independently, engagement with the community"; > > (c) "To have paid supports to assist me in my home with everyday personal activities maintain my house and keep me safe"; > > (d) "I want to live in my own purpose-built SDA house that I own and be funded to have a housing assessment so that I can have help to understand clearly what all my long and short term housing options are"; > > (e) "To have paid supports to assist me to re-establish capacity to engage locally, interstate and internationally in my professional career"; > > (f) "To have paid supports so that I can establish my own businesses and contribute to society which will increase my health and wellbeing"; > > (g) "To have paid supports to help me re-engage with the community and help keep me safe when out of my home at all times".

1. As mentioned above, Ms Blesing is currently funded for $1,163,095.66 to pay for her NDIS supports over a 12-month period. Based on the information in the Current SOPS and the Breakdown of Supports, the NDIA has approved a total budget for "Core Flexible" of $1,043,273.60. This budget is specified as being "plan-managed", and the NDIA has imposed monthly funding periods restricting expenditure of this budget to $86,939.51 per month, with any unspent funding to be rolled over to the next month. This funding is to be used "flexibly" for the following group of supports:

(a) assistance with self-care activities including assistance with daily life; > > (b) personal domestic activities and household tasks; > > (c) assistance with social, economic and community participation; and > > (d) consumables including wound and pressure care and low-cost assistive technology, including hearing and disability-related health equipment.

2. A total budget of $77,416.00 has been approved for Ms Blesing for "Capacity Building Supports" comprising:

(a) the cost to engage a registered plan manager ("choice and control" budget); > > (b) improved daily living skills; and > > (c) a budget for Support Coordination and Psychosocial Recovery Coaches.

3. A sum of $3,456.00 has been approved for recurring Transport allowance.
4. Finally, $38,950.06 has been approved for "Capital supports", comprising:

(a) assistive technology and maintenance, repair or rental of assistive technology; and > > (b) Specialist Disability Accommodation ('SDA') budget of $1.00

5. The Tribunal notes that the Current SOPS included an additional type of support in this category being "Transport ("Supports to allow [Ms Blesing] to pay a provider to transport [her] to an activity that is not itself a support - or to a support that is delivered by another provider. This enables [Ms Blesing] to travel to and from appointments or [her] place of work"). However, this was not included in the Breakdown of Supports, so it appears not to be an available support for Ms Blesing currently.

(a) whether the remaining 55 individual supports in dispute are "reasonable and necessary supports" for Ms Blesing, within the meaning of the NDIS Act and should be included in her SOPS forming part of his NDIS plan; and > > (b) whether the plan management specifications should be changed to being self-managed as requested by Ms Blesing; > > (c) whether monthly funding periods and amounts should be imposed in respect of the NDIS budgets or supports in Ms Blesing's SOPS; and > > (d) whether the budgets or supports in Ms Blesing's SOPS should be specified as being "Stated" budgets or supports.

1. The NDIS was established under the NDIS Act and operates in pursuit of the objectives set out in s 3 of the NDIS Act. Section 4 establishes general principles guiding actions to be taken under the NDIS Act.
2. Section 31 of the NDIS Act establishes a set of general principles that apply to the preparation, variation, reassessment, and replacement of a NDIS participant's plan, as reproduced below:

The preparation, variation, reassessment and replacement of a participant's plan, and the management of the funding for supports under a participant's plan, should so far as reasonably practicable:

(c) where relevant, consider and respect the role of family, carers and other persons who are significant in the life of the participant; and

(ca) where relevant, recognise and respect the relationship between participants and their families and carers; and

(d) strengthen and build capacity of families and carers to support participants who are children; and

(da) if the participant and the participant's carer agree - strengthen and build the capacity of families and carers to support the participant in adult life; and

(e) consider the availability to the participant of informal support and other support services generally available to any person in the community; and

(f) support communities to respond to the individual goals and needs of participants; and

(g) be underpinned by the right of the participant to exercise control over his or her own life; and

(h) advance the inclusion and participation in the community of the participant with the aim of achieving his or her individual aspirations; and

(i) maximise the choice and independence of the participant; and

(j) facilitate tailored and flexible responses to the individual goals and needs of the participant; and

(k) provide the context for the provision of disability services to the participant and, where appropriate, coordinate the delivery of disability services where there is more than one disability service provider.

1. Section 31 of the NDIS Act sets out several principles that apply to the development of an NDIS plan for a participant. The purpose of the plan is to state how the funds provided are to be managed. The plan is the instrument that governs the funding the participant is entitled to receive under the NDIS.
2. Each plan must have in it an approved SOPS; and a plan does not take effect until a SOPS forming part of the plan has been approved by the CEO under s 33(4) of the NDIS Act. Specifically, s 33 of the NDIS Act sets out certain matters that must be included in a participant's plan, including their statement of goals and aspirations (s 33(1)) and a SOPS, which is required to be prepared with the participant and approved by the CEO (or his or her delegate), in accordance with s 33(2) of the NDIS Act.
3. Section 33(5) of the NDIS Act provides as follows:

(5) In deciding whether or not to approve a statement of participant supports under subsection (2), the CEO must:

(a) have regard to the participant's statement of goals and aspirations; and

(b) have regard to relevant assessments conducted in relation to the participant; and

(c) be satisfied as mentioned in section 34 in relation to the reasonable and necessary supports that will be funded and the general supports that will be provided; and

(d) apply the National Disability Insurance Scheme rules (if any) made for the purposes of section 35; and

(e) have regard to the principle that a participant should manage his or her plan to the extent that he or she wishes to do so; and

(f) have regard to the operation and effectiveness of any previous plans of the participant; and

(g) have regard to whether section 46 (acquittal of NDIS amounts) was complied with in relation to any previous plan for the participant.

1. The "NDIS rules" referred to in s 33(5)(d) of the NDIS Act, include the National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth) ('Supports Rules'). Part 5 of the Supports Rules sets out the "General criteria for supports, and support that will not be funded or provided". Specifically, r 5.1 of the NDIS Supports Rules provides that a support will not be provided or funded under the NDIS if:

(a) it is unlikely to cause harm to the participant or to pose a risk to others (r 5.1(a);

(b) it is not related to the participant's disability (r 5.1(b));

(c) it duplicates other supports delivered under alternative funding through the NDIS (r 5.1(c)); 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 (r 5.1(d)).

1. Section 34(1) of the NDIS Act provides as follows:

(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.

(a) the time at which the disability requirement 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.

1. The Tribunal also notes the observations of Mortimer J in McGarrigle v National Disability Insurance Agency (2017) 157 ALD 520 at [43], as follows:

The rules are legislative instruments to be made by the Minister: see s 209. Section 209, sub-paras (4) to (7) constrain the rule-making power to preserve the federal characteristics of the NDIS. The National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth) (the 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, within the federalism constraints imposed in s 209, some policy decision-making about the nature and extent of supports to be provided or funded under the NDIS.

1. In 2023, Colvin J in Public Trustee of South Australia (as litigation representative for Isherwood) v National Disability Insurance Agency (No 2) [2023] FCA 852 ('Public Trustee of South Australia') at [17] to [23], decided that there is a two-stage process for a decision-maker to deploy the concept of "reasonable and necessary supports" in the NDIS Act as a whole. The first stage is to decide whether it is a reasonable and necessary support considering the provisions of the NDIS Act as a whole, including the guiding principles set out in s 4 of the NDIS Act. The second stage is for the decision-maker to reach an affirmative state of satisfaction as to each of the criteria set out in subsection 34(1) of the NDIS Act. Those criteria are concerned with the extent to which it may be appropriate for a reasonable and necessary support to be funded under the NDIS.
2. The Tribunal has also considered the following policy guidance and price guides/codes issued by the NDIA:

(a) NDIS Operational Guidelines entitled "Your plan" (dated 15 May 2025);[49]

(b) NDIS Operational Guidelines entitled "Creating your plan" (dated 23 June 2025);[50]

(c) NDIS Operational Guidelines entitled "Principles we follow to create your plan" (dated 7 April 2025);[51]

(d) NDIS Operational Guidelines entitled "Reasonable and necessary supports" (dated 28 March 2025);[52]

(e) NDIS Pricing Arrangements and Price Limits 2025-2026;[53]

(f) NDIS Assistive Technology (equipment, technology and devices) (dated 20 December 2023);[54]

(g) NDIA Assistive Technology, Home Modifications and Consumables Code Guide 2025-26 (dated 24 November 2025);[55]

(h) NDIS Assistive Technology - Guide for funding of annual repairs and maintenance funding;[56]

1. Rules 7.4 and 7.5 of the Supports Rules deal with what the NDIS will and will not be responsible when it comes to health-related supports. These rules are reflected in the subsequent issuing of the National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (NDIS Supports) Transitional Rules 2024 ('NDIS Supports Transitional Rules') which are addressed further below. Rules 7.4 and 7.5 are reproduced below (emphasis added):

7.4 The NDIS will be responsible for supports related to a person's ongoing functional impairment and that enable the person to undertake activities of daily living, including maintenance supports delivered or supervised by clinically trained or qualified health practitioners where these are directly related to a functional impairment and integrally linked to the care and support a person requires to live in the community and participate in education and employment.

(a) the diagnosis and clinical treatment of health conditions, including ongoing or chronic health conditions; or

(b) other activities that aim to improve the health status of Australians, including general practitioner services, medical specialist services, dental care, nursing, allied health services (including acute and post-acute services), preventive health, care in public and private hospitals and pharmaceuticals or other universal entitlements; or

(c) funding time-limited, goal-oriented services and therapies:

(i) where the predominant purpose is treatment directly related to the person's health status; or

(ii) provided after a recent medical or surgical event, with the aim of improving the person's functional status, including rehabilitation or post-acute care; or

(d) palliative care.

1. This proceeding also raises significant issues about the interpretation of the descriptions of certain items declared to be an "NDIS support" and "not an NDIS support", as contained within Schedule 1 and Schedule 2 respectively of the NDIS Supports Transitional Rules, for the purpose of assessing whether the mandatory criterion in s 34(1)(f) (as worded following the October 2024 amendments to the NDIS Act) is met.
2. The Tribunal has taken into account the following when considering the plan management issues arising in this matter:

(a) National Disability Insurance Scheme (Management of Funding) Rules 2024 (Cth); and > > (b) National Disability Insurance Scheme (Old Framework Plans) Determination 2024.

1. The Tribunal has considered the submissions and evidence of lived experience lodged by Ms Blesing with the Tribunal including (without limitation) the following key documents:

(a) statement of issues dated 1 March 2024 ('Ms Blesing's March 2024 SLE');[57] > > (b) statement dated 5 August 2025 ('Ms Blesing's 5 August 2025 SLE');[58] > > (c) statement dated 12 August 2025 setting out her goals ('Goal Statement');[59] > > (d) further statement dated 24 August 2025 attaching medical reports and radiology reports ('Ms Blesing's 24 August 2025 Statement');[60] > > (e) schedule of proposed weekly travel (undated);[61] > > (f) schedule of equipment maintenance dated 21 August 2025;[62] > > (g) statement in relation to her request for laundry services (undated and unsigned);[63] > > (h) statement signed by Ms Blesing on 12 September 2025 ('Ms Blesing's September 2025 SLE');[64] > > (i) statement about self-management of funding added 17 October 2025 and revised on 19 October 2025;[65] > > (j) supporting funding numbers for self-management of funding;[66] > > (k) the further submissions and evidence provided by Ms Blesing while this matter was reserved.

2. Ms Blesing's treating neurologist, Dr Nicholas Chia, was called as a witness at the hearing. Dr Chia has issued medical reports dated 7 June 2024, 28 July 2024,[67] and 21 May 2025. Dr Chia told the Tribunal the last time he had seen Ms Blesing was on 21 May 2025.
3. Dr Chia said that in Ms Blesing's case, there is "particularly severe MS-related damage to her spinal cord, particularly in the cervical spine" (that is, the neck). Dr Chia explained that this is why Ms Blesing has "such severe physical disability" in her arms and legs and "basically, the whole body". Dr Chia referred to Ms Blesing having "relatively preserved cognition, memory and thinking and capacity and those sorts of things". Dr Chia said that when it comes to Ms Blesing's neurological disability, much of it is related to "weakness, as well as spasticity". He said that there is a tightness in Ms Blesing's muscles, as a result of a disconnection between the muscles in her limbs and the normal control centres in the brain.
4. Dr Chia confirmed that the physical consequences of Ms Blesing's MS include:

(a) immobility;

(b) "very severe physical weakness";

(c) "severe weakness in her arms and legs";

(d) "very close to no effective function in her arms or legs" (she has a little bit of wrist movement that she can use to operate her wheelchair);

(e) "very severe spasticity";

(f) limited motion of multiple joints in her arms and legs starting to cause some contractures and issues with her fingers and with her legs.

1. Dr Chia gave evidence that "things like pain, can increase the severity of spasticity and muscle dysfunction". He said it is hoped that "with time and slow rehabilitation", acknowledging that these are not conditions that improve quickly", there would be "some improvement in the overall muscle symptoms in the hands". Dr Chia clarified that he is not referring to the recovery of strength but rather improvement in Ms Blesing's spasticity and stiffness, her muscle discomfort and the pain that is associated with it.
2. Dr Chia said that over the time he has known Ms Blesing, that it did not seem like these symptoms, the severity of them or her level of dysfunction, had worsened.
3. Dr Chia opined that it is "very common" that neck movement and positioning can make neurological symptoms from MS significantly worse sometimes, and this can be "quite a rapid sort of dynamic change". He said that this can certainly be uncomfortable, painful and can even cause worsening of the weakness, and all of the symptoms experienced by Ms Blesing below the neck. He did not agree that this would directly affect vision (being a matter raised by Ms Blesing with Dr Chia during examination-in-chief - Ms Blesing told Dr Chia at the hearing that when she spasms or when she puts her shoes on the bed and twists her back, that she loses her eyesight). Dr Chia said he did not think this was "neurological" or that neck movements would cause a dramatic sudden change in visual symptoms relating to MS. He said that this is not to say that Ms Blesing does not have visual symptoms arising from her MS.
4. Dr Chia gave evidence that MS is a disorder that has different phases of illness that are somewhat arbitrarily divided and often co-exist. He said there are two phases of MS. The first stage is the "relapsing disease, or relapsing remitting disease" and the second phase is called "progressive disease". He said that most people will start with the relapsing phase where they will develop new lesions either in the brain, spinal cord or the nerves which go to the brain. He said that those lesions are often associated with the "sudden onset, over hours or days of new neurological symptoms". He said that this can be the way in which a person with MS will develop new neurological deficits and disabilities.
5. Dr Chia said that some people who experience a relapse will recover (being the remission), but some will not.
6. Dr Chia explained that the second progressive phase of MS is where there are lesions that are already within the nervous system from previous relapses, that were either symptomatic or asymptomatic. He said that those lesions start to deteriorate slowly over time.
7. Dr Chia explained that people with MS can have either or both of the relapses and progression and can transition from relapses to progression. He said that it is probable that most people at some phase of their illness, at least historically, will enter a progressive phase of MS. He said it is possibly "a little bit different with in younger people now", where the treatment is quite different to how it used to be. He said that most people who have had MS for a long time, end up in a progressive phase of MS and this leads to a slow worsening over time, which is considered degenerative in nature.
8. Dr Chia said that people who have had "secondary progressive MS" (being a person who starts off with relapses and go into progression), will not necessarily deteriorate at a constant rate and that probably, there is a degree to which they will plateau in terms of their progression. He explained that this might occur because the person has already lost so much function through the areas of damage, that there is not much more function left to lose. He said that this is part of the reason why there has not been any significant change in respect of Ms Blesing, except for the recent deterioration due to the changes in her therapy.
9. Dr Chia's evidence was consistent with the results of Magnetic Resonance Imaging ('MRI') performed on 25 July 2019 reporting that there were "stable appearances of the brain and cervical cord compared to MRI of 18/12/2013".[68]
10. Dr Chia referred to Ms Blesing having relatively few lesions on her brain so there is minimal effect (of her MS) above her spinal cord. He said her memory and cognition are generally working quite well.
11. Dr Chia opined that Ms Blesing has "inactive disease", that is, she is "not getting new lesions". He opined that it is "very unlikely" that Ms Blesing will "get significant new lesions going forward", because of her history of MS where people who have had secondary progressive MS and who are getting older, do not generally get many more or any more lesions for the rest of their lives. He said that Ms Blesing had secondary progressive MS but the rate of progression is essentially minimal, probably because she has had the bulk of her progression over the last 10 to 15 (or so) years. He said that he considered Ms Blesing to be "stable".
12. At the hearing, Ms Blesing invited Dr Chia to comment about her reported hypersensitivity. Dr Chia stated that when a person has a traumatic spinal cord injury, they often have complete sectioning of the spinal cord and its pathways, which means there is no sensation (or movement) going up or down between the arms or legs and the brain. Dr Chia said that there are still some fibres remaining (in Ms Blesing's case). They are insufficient to provide normal function and may cause function in an abnormal way. He explained that people who would normally feel a light touch of something across the skin is interpreted by the brain as pain, because the signals are abnormal as they are going through the damaged parts of the spinal cord. Dr Chia said that this leads to "often quite severe pain". He said it is "not an uncommon experience" with people who have MS and other neurological conditions.
13. Dr Chia gave evidence that spasms are a "variable experience" by different people with MS. He said that they can sometimes be painless but typically, they are painful. He said they tend to lead to "uncoordinated excessive contraction". He said the normal mechanisms that the body has to relax, are not working because of the disconnection between the brain and the cells in the spinal cord that would normally modulate and control the level of activity of those muscles. He said this leads to spasticity which is "an overall increase in the tightness and the rigidity of the muscles that leads to difficulty moving joints, even passively, let alone volitionally, sort of intentionally doing it yourself, or even just a passive movement, for example, a physiotherapist moving an elbow or a wrist or fingers". He said that this can also be associated with a "superimposed active spasm" which is "often the part that is very painful". Dr Chia gave evidence that people with severe spasticity often favour some muscle groups more than others, because of the way the brain and spinal cord are wired. He said this can lead to a fixed deformity, such as the fingers being clasped shut. Ms Blesing has experienced this. Dr Chia said that this leads to tendon shortening and scarring in the muscles and can lead to the hand being unable to be opened by passive movements. Dr Chia confirmed that Ms Blesing has spasms that affect her arms as well as the legs. He said he could not recall if he had asked her whether she experienced spasms of her trunk.
14. Dr Chia gave evidence that Ms Blesing does not have control over her spasms except to say that there are certain stimuli which may trigger a spasm such as pain or certain attempts to move or position the body. He said that touch can also trigger a spasm due to the abnormal sensation being transmitted through the nervous system. In those circumstances, he said he does not think there is anything Ms Blesing can do to prevent the spasms. He said the treatment for spasms is aimed at trying to reduce the tone through physical therapy, which can reduce the likelihood that those sorts of stimuli will set off spasms.
15. Dr Chia gave evidence that (generally) it is not uncommon for people with a spinal cord injury to have dysfunction of their autonomic nervous system, which is responsible for things such as temperature regulation and mechanisms for sweating. He said that excessive sweating is a "fairly common problem in people who have spinal cord disease in general, both in MS and otherwise".
16. Dr Chia said that Ms Blesing's breathing difficulties are almost certainly related to neuromuscular dysfunction (relating to a weakness of the diaphragm and impairment of the respiratory signals being communicated to her brain), as opposed to a primary problem with her lungs. He confirmed that the introduction of medications which can cause sedation, for example, many muscle relaxants, are likely to be, potentially, "very dangerous" in that it could reduce the excursion of the diaphragm, the inspiratory force and "lead to respiratory failure". He said this could be fatal, in severe circumstances.
17. Dr Chia's medical opinions were not challenged by either party. The Tribunal accepts Dr Chia's evidence as outlined above, and in particular, concludes that Ms Blesing's disability is unlikely to deteriorate into the future and there may be some improvements to be engaged if she undertakes capacity building therapies (addressed below).
18. Consistent with Dr Chia's evidence, Mr Burden described Ms Blesing's main area of impairment include "severe spasticity, hypersensitivity, and limited mobility". He stated that she "experiences significant muscle spasms and pain, which are exacerbated by movement".[69]
19. Ms Blesing uses a wheelchair at all times when mobilising. Ms Blesing owns a Levo C3 powered wheelchair which is equipped with a sit-stand function allowing for her to be re-positioned regularly to prevent pressure sores from developing.[70] Mr Burden states that Ms Blesing's wheelchair is "facilitated by a loop around her right hand to manoeuvre the joystick".[71] Ms Blesing uses a standard K Care mobile shower chair when showering featuring swing-up armrests and a weight-bearing footplate.[72] Ms Blesing uses an Arjo Enterprise 5000 hospital-style electric bed.[73] Mr Burden states that this bed is used to adjust Ms Blesing's positions to aid in circulation, reduce pain and to provide comfort.[74] Mr Burden also stated that this bed's adjustability is important for Ms Blesing's night-time case, allowing for re-positioning without the need for multiple carers.[75]
20. Mr Burden summarised Ms Blesing's medical conditions and impairments/symptoms as follows based on the reports by others as to her diagnoses and conditions (bearing in mind that Mr Burden is an allied health therapist and not a medical practitioner):[76]

Multiple Sclerosis and lives with Quadriparesis (with sensation), Lumbar disc prolapse, Chronic Pain, MRSA, Spasticity (upper and lower limbs), Suprapubic catheter, Constipation and regular bowel accidents, Panic attacks and Sensory hypersensitiveness.

21. Mr Burden identified that the height of the ceiling in Ms Blesing's apartment is too low to facilitate the use of a ceiling hoist for transfers.[77] Instead, Ms Blesing has a gantry hoist (comprising a gantry frame and motor).[78] Mr Burden states that the gantry hoist allows Ms Blesing's carers to move her safely between her bed, wheelchair and shower chair, to minimise the risk of injury to Ms Blesing and her carers.[79]
22. Ms Blesing uses other assistive technology including:[80]

(a) GlassOuse wireless handsfree head mouse, used in conjunction with a bite switch, which is used to control her computer, iPad and iPhone; > > (b) voice-activated devices such as Alexa and that built-in iOS voice control setting on her iPad and iPhone; > > (c) a second-skin body suit to provide trunk support to maintain an upright posture; > > (d) custom footwear, strapping and orthotics; > > (e) straws, to assist her to drink more independently following setup.

23. Mr Burden described Ms Blesing as having "extensive" support needs, and that she relies heavily on a network of carers due to her severe disability.[81] He states that Ms Blesing's condition has left her "effectively quadriplegic" and has "impaired her motor functions, leaving her dependent on carers for all activities of daily living".[82] Mr Burden states that Ms Blesing "requires careful management to prevent pressure sores and to maintain her comfort".[83]
24. Mr Burden records in his report that Ms Blesing has "MRSA". It is unclear what he meant by this and on the evidence more broadly, it is unclear whether Ms Blesing presently suffers from MRSA colonisation which might cause her to be potential infectious to those around her, specifically, her support workers who are in constant physical contact with Ms Blesing. This issue is relevant to considering Ms Blesing's assertions that she requires a high level of hygiene and cleanliness in her apartment, daily ironing of her linen and her/her support worker's clothing, and regular cleaning of her home by external cleaners.
25. While this matter was reserved, the Tribunal instructed the Registry of the Tribunal to write to Ms Blesing inviting her to provide references to the medical or clinical evidence already lodged with the Tribunal of a diagnosis of an ongoing MSSA and/or MRSA colonisation, and recommendations made to prevent infection arising from any such colonisation.
26. Ms Blesing referred to the following evidence before the Tribunal and clarified the clinical context of those documents. Under the heading "Evidence of MRSA diagnosis", Ms Blesing said suggested that a diagnosis of "MRSA" was contained in Mr Burden's Report. However, Mr Burden is an allied health therapist and not qualified to make a medical diagnosis, so the Tribunal has not placed any weight on this evidence. Further, the Tribunal was seeking evidence of a diagnosis that Ms Blesing has an MSSA or and MRSA colonisation at the present time. This is different from "MRSA" which is a reference to a type of bacteria found generally in the environment which is different from a colonisation of this bacterium in the body, which would increase a person's risk of infection.
27. Ms Blesing also referred the Tribunal to the medical records held by the Royal Adelaide Hospital ('RAH'), which she said was lodged with the Tribunal (EPAS Sunrise records and Volume 2 extract). Ms Blesing states that:

these records contain infection alerts and clinical notes reflecting my MRSA/MRO status being recorded and carried across hospital admissions. These records evidence that the diagnosis was identified within the public hospital system and retained on my clinical file.

28. Ms Blesing also referred to pathology section records of MRSA Screen NAT Swab (nasal swabs) on multiple dates, including 6 February 2020, 13 February 2020, 8 March 2020, 21 March 2020. Ms Blesing suggests that these entries confirm "formal MRSA screening within the hospital system and ongoing monitoring during admission". Ms Blesing refers to the MRSA Screen NAT Swab results (on page 1063) demonstrating formal identification and monitoring of MRSA within a public hospital setting.
29. Ms Blesing also provided references in relation to her assertion that indwelling devices increase the infection risk, specifically: nursing handover notes confirming long-term suprapubic catheter (SPC) and IV antibiotics. Ms Blesing states that this is clinically relevant because indwelling devices are a recognised factor preventing the clearance of an MRSA/MRGN colonisation.
30. Ms Blesing states that the presence of repeated MRSA screening, IV antibiotics, septic screening, and long-term catheter use (pages 87, 1063, 1186-1187) supports the need for ongoing infection-control precautions, consistent with SA Health policy.
31. Ms Blesing asserts that "ongoing infection-control precautions are evidenced within the same lodged materials", including Mr Burden's Report and the RAH hospital records, which demonstrate that once MRSA/MRO status is identified, it is maintained as an ongoing alert within hospital systems and managed through standard and transmission-based precautions, rather than through repeated re-testing or clearance.
32. Ms Blesing asks the Tribunal to note that this approach is consistent with SA Health infection-prevention policy, under which routine repeat screening is not required, there is no agreed clearance protocol for many multi-resistant organisms, and patient records retain infection-control alerts unless formally "de-alerted". She suggests that this explains why her hospital records reflect enduring precautions, rather than repeated confirmatory testing.
33. The Tribunal was unable to identify any medical evidence confirming that Ms Blesing currently has a MRSA or MRGN colonisation in her body. Despite this the Tribunal accepts that the hospital appears to consider there to be a high enough level of risk in Ms Blesing's case prompting them to undertake MRSA screening during periods of admission. The Tribunal also notes that Ms Blesing has a catheter in place on an ongoing basis. Ms Blesing is also, essentially, immobile due to her disabilities, meaning that her circulation is compromised and that she also has a propensity to develop pressure wounds which may increase her risk of infection. For these reasons, the Tribunal accepts that Ms Blesing has a higher than usual risk of infection and that it is important that her living environment is kept hygienic.
34. At the hearing, the Tribunal observed that Ms Blesing's breathing, and the flow of her speech was impaired. Ms Blesing's speech was weak (specifically, Ms Blesing spoke at a low volume and could not sustain long sentences without pausing to take another breath mid-sentence). The Tribunal was able to understand Ms Blesing, however, on many occasions, it was necessary to ask Ms Blesing to repeat what she had said.
35. In 2020, Ms Blesing experienced a fall from her wheelchair causing fractures to both of her legs requiring surgical repair. Mr Burden stated that this incident had impacted Ms Blesing's mobility and has led to an extensive period of rehabilitation.[84] Ms Blesing attributes this fall from her wheelchair to have resulted from the NDIA having refused to upgrade her wheelchair in a timely manner.

CONSIDERATION - SUPPORT NO.1 (SUPPORT WORKER ASSISTANCE)

1. Support No.1 in the s 53 Order is a request for funding for the provision of 52 hours of support work assistance per day, inclusive of active overnight support as specified by Ms Blesing in her Position Paper (lodged with the Tribunal on 24 January 2025) ('Support Worker Supports').[85]

Stage One: Whether the request for Support Worker Supports are "****reasonable and necessary supports", taking into account the NDIS Act as a whole

1. As mentioned above, the decision in Public Trustee of South Australia stands as authority for the proposition that the Tribunal is required to consider, as a first stage, whether the Support Worker Supports are "reasonable and necessary supports" in light of the provisions of the NDIS Act as a whole, including the guiding principles set out in s 4 of the NDIS Act.
2. The stated objectives under the NDIS Act include, under subsection 3(1)(a) of the NDIS Act, to give effect to Australia's obligations under the Convention on the Rights of Persons with Disabilities,[86] which includes a principle of "respect for inherent dignity". Another objective, under s 3(1)(c), is to support the independence and social participation of people with disability and under subsection 3(1)(d), to provide reasonable and necessary supports for participants in the NDIS. Further, an objective under subsection 3(1)(g) is to promote the provision of high quality and innovative supports that enable people with disability to maximise independent lifestyles.
3. The guiding principles in s 4 of the NDIS Act include the principles in subsection 4(1), which provides that people with a disability have the same right as other members of the Australian society to realise their potential for physical, social, emotional, and intellectual development; and in subsection 4(11), which provides that reasonable and necessary supports for people with disability should support them to maximise their independence and live independently.
4. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of the Support Worker Supports, could be reasonable and necessary supports, as the provision of each such supports is aligned with the objectives and principles referred to in the above paragraphs. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support Worker Supports.

Stage Two: Whether the Support Worker Supports meet the criteria under subsection 34(1) of the NDIS Act

1. In the NDIA's Closing Submissions (prepared on 29 October 2025 by Ms Martin), the NDIA contends that a total of 35 hours per day of support worker assistance (at the high intensity rate "requiring a greater level of skill") for Ms Blesing are "reasonable and necessary supports", comprising:[87]

(a) 4 hours per day of 3:1 support (that is, a total of 12 hours of assistance per day); > > (b) 3 hours per day of 2:1 support (that is, a total of 6 hours of assistance per day); > > (c) 9 hours per day of 1:1 support for the remaining daytime hours each day (that is, a total of 9 hours of assistance per day); and > > (d) 8 hours of active of 1:1 onsite, overnight support (that is, a total of 8 hours of assistance per day.

2. The following day, on 30 October 2025, the NDIA approved a new SOPS for Ms Blesing being the Current SOPS referred to above.

Current approved funding for support worker assistance

1. In the Breakdown of Supports, the NDIA has confirmed that $1,024,648.56 of NDIS funding is currently available to Ms Blesing relating to the provision of support worker assistance, includes the following:

Assistance with self-care activities > > assistance with daily life (number of hours unspecified in the Current SOPS but specified in the Breakdown of Support as follows: > > Assistance With Self-Care Activities - Standard - Weekday Daytime - total $211,813.68. This may include: 58 hours per week for 52 weeks, delivered as a 1:1 individual support at the rate $70.23; > > Assistance With Self-Care Activities - Standard - Sunday - total $66,263.60. This may include: 10 hours per week for 52 weeks, delivered as a 1:1 individual support at the rate $127.43; > > Assistance With Self-Care Activities - Standard - Saturday - total $51,391.60. This may include: 10 hours per week for 52 weeks, delivered as a 1:1 individual support at the rate $98.83; > > Assistance With Self-Care Activities - Standard - Weekday Daytime - total $241,029.36. This may include: 22 hours per week for 52 weeks, delivered as a 3:1 individual support at the rate $210.69; > > Assistance With Self-Care Activities - High Intensity - Saturday - total $66,724.32. This may include: 4 hours per day for 52 days, delivered as a 3:1 individual support at the rate $320.79; > > Assistance With Self-Care Activities - Standard - Sunday - total $79,516.32. This may include: 4 hours per week for 52 weeks, delivered as a 3:1 individual support at the rate $382.29; > > Assistance With Self-Care Activities - Standard - Weekday Daytime - total $109,558.80. This may include: 15 hours per week for 52 weeks, delivered as a 2:1 individual support at the rate $140.46. > > Personal domestic activities > > Assistance with Personal Domestic Activities - total $110,560.32. This may include: 36 hours per week for 52 weeks at the rate $59.06; > > Household tasks > > House Cleaning And Other Household Activities - total $48,280.96. This may include: 16 hours per week for 52 weeks at the rate $58.03; > > assistance with social, economic and community participation $39,509.60 (specified in the Current SOPS as being 10 hours per week for 52 weeks of community activities and particularised in the Breakdown of Supports as follows): > > Access Community Social and Rec Activ - High Intensity - Weekday Daytime - total $39,509.60. This may include: 10 hours per week for 52 weeks, delivered as a 1:1 individual support at the rate $75.98.

2. The above funding equates to the provision of a total of 37.1 hours per day of support worker assistance for Ms Blesing (including assistance with activities of daily life, community access, personal domestic activities and household cleaning), mostly at the "standard" rate, a small proportion at the "high intensity" rate and none of it at the applicable "evening" or "night" support rate under the NDIS Pricing Arrangements and Price Limits 2025-2026 ('NDIS Price Guide').

Ms Blesing's increased request for support worker assistance

1. In Ms Blesing's Position Paper, she requested 52 hours per day of support worker assistance (as of January 2025). This request falls short of the number of hours which she is funded for under her current NDIS plan. At the hearing, Ms Blesing increased her request for funding to between 62 and 64 hours of support worker assistance per day for "complex needs" support worker assistance (which the Tribunal understands to mean support workers paid at the "high intensity" rate referred to in the NDIS Price Guide). Slightly different variations of Ms Blesing's request for support worker assistance were requested by her in the Combined Table of Supports and subsequently in her Closing Statement (see details below). In the final submissions lodged by Ms Blesing on 11 February 2026, Ms Blesing states that the "evidence before the Tribunal supports a requirement of approximately 54 to 64 hours of billable, ratio-adjusted support".[88]
2. As a preliminary issue, the NDIA objected to the Tribunal considering any request by Ms Blesing for more than 52 hours per day of support worker assistance. The NDIA stressed that it had proceeded to present its case at the hearing, on the basis of the Tribunal's s 53 order which confined the issues and evidence to a consideration of whether 52 hours per day of support worker assistance for Ms Blesing are "reasonable and necessary supports". At the hearing, the Tribunal deferred making a ruling in relation to this objection, because ultimately, if the Tribunal were to decide that an amount of funding of equal to or less than 52 hours per day of support worker assistance for Ms Blesing are "reasonable and necessary supports" for her, it would serve no practical purpose for the Tribunal to devote its time dealing substantively with Ms Blesing's request to revoke and re-issue the s 53 order to increase the nominated number of hours for this support. The Tribunal undertook to notify the parties before handing down its decision, if it reached a view that more than 52 hours per day of support worker assistance are "reasonable and necessary supports" for Ms Blesing. Ms Blesing was given liberty to formally apply for an amendment to the number of hours referred to in Support No.1 of the s 53 Order upon such notice being given to her. As set out below, the Tribunal has concluded that a total of 46.5 hours per day of support worker assistance for Ms Blesing are "reasonable and necessary supports" for her, and so the parties were not notified in accordance with the footnote to Support No.1 in the Final s 53 Order.

Ms Blesing's contentions in her Closing Statement

1. In Ms Blesing's Closing Statement dated 5 November 2025 (that is, lodged with the Tribunal after the conclusion of the hearing), Ms Blesing contends that the NDIA's position in relation to Support No.1 is inconsistent with the recommendations of the expert witnesses who have undertaken comprehensive functional capacity assessments in her home. These recommendations are referred to in more detail below. Ms Blesing states that she requires "continuous 24/7 support, clinical hygiene management, and specialised daily supports" and provided the following breakdown:[89]

(a) Core Daily Supports (ADL/Domestic) - "Personal care, mobility, transfers, repositioning, and daily living (4:1, 3:1, 2:1 ratios)" - approximately 378 hours per week (which equates to 54 hours per day); > > (b) Social and Community Participation - "High-intensity engagement (5.25 hrs/day x 7 days)" (that is, 5.25 hours per day); and > > (c) Administration Support - "Rostering, payroll, record-keeping, plan compliance" - 8 hours per week (which equates to 1.14 hours per day); > > (d) IT and Computer Support - "Communications, compliance tracking, and care coordination" - 4 hours per week (which equates to 0.57 hours per day); > > (e) Clinical cleaning (Infection Control) - "Environmental sterilisation and hygiene cleaning to prevent hypersensitivity and MRSA" - 6 hours per week (which equates to 0.86 hours per day); > > (f) Clinical Ironing (Sterilisation and Infection Prevention) - "Sterilising and preparing all garments, bedding, and transfer sh... prevents spasms and infection" - 21 hours per week (which equates to 3 hours per day).

2. There was one other item in the list provided by Ms Blesing that related to Allied Health and Capacity Building ("Physiotherapy, OT, therapy assistant, and chiropractic") of approximately 8.8 hours per week. This is a request by Ms Blesing for therapeutic intervention/capacity building supports, rather than a request for support worker services so this request will not be considered under Support No.1 but rather under the other requests for capacity building supports. Further, the last two items in subparagraphs [122(e) and (f)] above, will be considered separately as they are requested as Supports No.4 and No.5 of the Final s 53 Order.
3. Based on the Tribunal's calculations, subparagraphs [122(a) to (d)] comprise a request by Ms Blesing for a total of 64.82 hours per day of support worker assistance.

Medical evidence which is relevant to Ms Blesing's need for support worker assistance

1. Dr Alice Wilson, general practitioner, issued a report in respect of Ms Blesing (which includes some radiology reports), on 28 November 2023.[90] Dr Wilson states she has known Ms Blesing for many years at her prior practice. She states that Ms Blesing has a "severe disability" due to her MS and is "effectively quadriplegic". Dr Wilson states that Ms Blesing has "retention of sensation and some spasticity". Dr Wilson states that Ms Blesing is able to mobilise in her wheelchair due to her limited wrist movement, however, she said that if Ms Blesing's arm is "knocked out of position" and when driving her wheelchair regularly, she will require repositioning. The Tribunal accepts this evidence.
2. Dr Wilson states that Ms Blesing is unable to walk, dress herself, brush her teeth or hair, shower or bathe herself, roll herself or adjust her position in bed, adjust herself positionally in the wheelchair, toilet or feed herself. Dr Wilson states that Ms Blesing is unable to clean her house, wash her clothes and linen or to make her bed. The Tribunal accepts this evidence. The Tribunal was able to observe that Ms Blesing has extremely limited ability to move virtually all parts of her body.
3. Dr Wilson states in her report that movement adjustments in the bed and wheelchair are important in preventing pressure areas. The Tribunal accepts this evidence and finds that it applies to Ms Blesing. Dr Wilson notes in her report that Ms Blesing requires "more than one support worker for positioning" in her bed and wheelchair "to ensure management re risk pressure areas".[91] Dr Wilson opines that Ms Blesing needs one-to-one support overnight.[92] The Tribunal considers that the evidence of the occupational therapists and physiotherapists who have undertaken functional capacity and manual handling assessments of Ms Blesing are better positioned than Dr Wilson to give recommendations about how many support workers are required to undertake transfers of Ms Blesing, because the allied health therapists having undertaken assessments of Ms Blesing in her home.
4. Dr Wilson states that Ms Blesing has struggled with sensitivity and spasms and has opted for non-pharmaceutical routes, given the potential impacts of medication on her function. The Tribunal accepts this evidence. Dr Wilson reports that the treatment options for Ms Blesing include physiotherapy, occupational therapy, chiropractor and podiatry with a focus on maintaining her functional capacity, involvement with the greater community, her quality of life, independence and sense of worth and meaning. These options are addressed below when dealing with the requested capacity building supports.
5. Dr Wilson confirms that due to Ms Blesing's disability, she has "bowel issues", is unable to toilet "normally" and requires daily enemas to ensure her bowels are empty. She said that Ms Blesing requires suppository insertion. Dr Wilson states that even with the daily enemas, Ms Blesing "runs the risk of bowel incontinence and the ongoing impacts to her dignity involved in this", albeit "significantly" reduced through management with the enemas.[93] The Tribunal accepts this medical evidence.
6. Dr Wilson confirms that Ms Blesing requires management of her catheter and bowel management because she cannot manage them independently. Dr Wilson states in her report that Ms Blesing requires someone to empty and manage her catheter and bag. This evidence is accepted by the Tribunal.
7. Dr Wilson states that "support for IT issues is more significant for Ms Blesing" in light of her "communication pathways" being "significantly impaired". Dr Wilson states that the support required to ensure the smooth running of her IT is "more integral for her ability to communicate" compared to persons without her disability.[94] The Tribunal accepts Dr Wilson's evidence in this regard, and at was not challenged by the NDIA.

Recommendations by Ms Harman, treating physiotherapist

1. Ms Blesing relies upon the recommendations of her treating physiotherapist, Ms Harman, (amongst others) in support of her request for increased hours of support worker assistance. Ms Harman's title is stated to be "Clinical Director and Principal Physiotherapist & Director of Safe Work Practices and EquipT to Thrive".[95] Ms Harman is the owner of the business EquipT to Thrive which she states is an NDIS-registered service provider.[96] Ms Harman states that she has had 17 years of experience working as a physiotherapist, "supporting individuals with physical disability, namely neurological conditions".[97]
2. On 8 December 2023, Ms Harman issued a "Manual Handling Care Plan" ('Ms Harman's Manual Handling Plan'),[98] and a "Letter of Clinical Need in respect of Ms Blesing" on EquipT to Thrive letterhead ('Ms Harman's 2023 Letter').[99] This letter does not quantify the total number of hours of support worker assistance that Ms Blesing requires each day but it does provide an opinion about the appropriate ratio of support workers required depending the type of activity which is being engaged in, varying from between 1:1 and 3:1. There is no recommendation by Ms Harman for a 4:1 ratio of support workers in this letter.
3. On 11 January 2024, Ms Harman issued a comprehensive 87-page "Holistic Functional Capacity Report for the National Disability Insurance Agency" on EquipT To Thrive letterhead ('Ms Harman's FCA Report').[100] In Ms Harman's FCA Report, she states that Ms Blesing requires "a very high level of person to person support due to her spasticity associated with her MS" including "3:1 support for manual handling (4:1 support at times where spasticity is challenging) and a large number of different equipment items".[101] Ms Harman states that Ms Blesing's current home is "too small" to enable her to utilise "more effective" assistive technology to decrease her formal support requirements. Ms Harman states that if a ceiling hoist is implemented, there are times where 3:1 supports could potentially be reduced to 2:1 supports and Ms Blesing could utilise "on call support" for the second support worker, "rather than needing to roster longer shift lengths for additional workers to meet EBA requirements, all together saving the NDIS costs in future plans due to reduction of SIL supports".[102]
4. In summary, Ms Harman recommends that Ms Blesing be provided with a total of 69.64 hours of support worker services per day, comprising:[103]

(a) 297.5 hours per week of support worker services for assistance with daily living at the "standard intensity rate" - (equating to 42.5 hours per day); > > (b) 126 hours per week of support worker services at the "high intensity rate" for assistance with supported independent living (equating to 18 hours per day); > > (c) "passive sleepover per weeknight" which is a further 40 hours per week at the inactive sleepover rate (equating to 5.71 per day); and > > (d) 24 hours per week of support worker services at the "high intensity rate" for "social and community support" - (equating to 3.43 hours per day).

5. Ms Harman provided a breakdown in relation to specific daily tasks:[104]

(a) 2 hours per day of 2:1 assistance with rolling and repositioning Ms Blesing in her bed (without performing any other task); > > (b) 5 hours per day of 3:1 assistance with hoist transfers (application and removal of sling; transfer; positioning in equipment pre- and post-transfer); > > (c) 15 minutes per day of 1:1 assistance with mobilising outdoors; > > (d) 30 minutes per day of 2:1 assistance with morning preparation between 5am and 5.30am; > > (e) 1.5 hours per day of 3:1 assistance with undressing and dressing Ms Blesing; > > (f) 15 minutes per day of 1:1 assistance with dressing the wheelchair ready for dressing Ms Blesing's body; > > (g) 15 minutes per day of 1:1 assistance with shower set-up and clean-up; > > (h) 15 minutes per day of 2:1 assistance with washing Ms Blesing in the shower; > > (i) 15 minutes per day of 1:1 assistance with bathing Ms Blesing's face: > > (j) 15 minutes per day of 2:1 assistance with drying Ms Blesing; > > (k) 45 minutes per day of 2:1 assistance with applying "AFO's stockings, shoes and socks"; > > (l) 2.25 hours per day of 3:1 of "high intensity" assistance with "morning bowel routine" between 5.30am and 7:45am; > > (m) 2.5 hours per day of 3:1 assistance and a further 0.5 hours of 2:1 assistance to "f_reshen and manage mensuration_"; > > (n) 10 minutes per day of 1:1 assistance with tooth brushing; > > (o) 20 minutes per day of 1:1 assistance with hair care ("styling only"); > > (p) 10 minutes per day of 1:1 assistance with "body maintenance (shaving, nail cutting etc); > > (q) 25 minutes per day of 1:1 assistance with "medication administration"; > > (r) 1 hour and 45 minutes per day of "high intensity support" assistance with "oral food and fluid intake"; > > (s) 55 minutes per day of 1:1 of "high intensity support" assistance with catheter care; > > (t) 1.25 hours per day of 1:1 of "high intensity support" assistance with "application and care of orthoses/splints/strapping"; > > (u) 35 minutes per day of 1:1 assistance with the use of communication devices (Augmentative and Alternative Communication ('ACC')); > > (v) 60 minutes per day of 2:1 of "In home therapy"; > > (w) 10 minutes per day of 1:1 assistance with menu planning; > > (x) 12.5 minutes per day of 1:1 assistance with grocery shopping, ordering and delivering online; > > (y) 30 minutes per day of 1:1 assistance with restocking and reordering medical and consumable supplies; > > (z) 3 hours per day of 1:1 assistance with main meal preparation; > > (aa) 30 minutes per day of 1:1 assistance with drinks and snacks; > > (bb) 1 hour per day of 1:1 assistance with "clean up (i.e. dishes, wiping benches, sterilising straws etc); > > (cc) 5 minutes per day of 1:1 assistance with budgeting/finances; > > (dd) 15 minutes per day of 1:1 assistance with "home security (locking/unlocking blinds; lights)"; > > (ee) 1 hours per day of 1:1 assistance with correspondence (mail/email/phone calls); > > (ff) 15 minutes per day of 1:1 assistance with planning/organising household routines and responsibilities; > > (gg) 1 hour per day of 1:1 assistance with general house cleaning (i.e. vacuuming, mopping, cleaning, wet areas, dusting etc); > > (hh) 1 hour per day of 1:1 assistance with laundry with the added comment as follows: "[Ms Blesing] requires daily laundering as she utilises the following per day as a result of her hypersensitivity: 16 handtowels from shower, 7 hand towels from bowel care, linen change to bed, clothing, sling. Ironing needs to occur as creases cause trigger to hypersensitivity. [Ms Blesing] has dust, allergen and bacterial allergies and requires more than a weekly clean. High touch surfaces and her bedroom/bathroom (immediate environment) needs to be sanitised at least daily and sheets changes"; > > (ii) 12 hours per day of 1:1 assistance to attend activities in the community or at home with a support worker, in a "social context"; and > > (jj) 6 hours per day of 2:1 assistance to attend activities in the community or at home with a support worker, "when tasks are required to be done".

6. Ms Harman states that Ms Blesing's mobility and transfers are "extremely complex due to hypersensitivity" and when triggered, will result in "significant muscle spasticity and adverse experiences to pain".[105] This evidence is consistent Dr Chia's medical opinions as set out above and the Tribunal accepts that a high degree of care and skill is required by the support workers to complete safe and effective transfers of Ms Blesing due to her hypersensitivity which may trigger severe spasms.
7. In the Manual Handling Plan, Ms Harman opines that Ms Blesing requires "a minimum of 3:1 support for all transfers if all workers are trained with how to support her and her spasticity is manageable".[106] Ms Harman also states that "there are frequent times" when Ms Blesing requires 4:1 support, "largely due to the operation of the hoist controls with the other 3 people counteracting the effects of her spasticity at her trunk/arms and her legs. Transfers can be done with 3:1 support, however, there are risks that can exist where spasticity is strong and a worker needs to free up a hand for hoist operation. The higher ratios of support are required when staff are not familiar with [Ms Blesing]'s unique support needs and when her spasticity is strong or frequent in occurrence. [Ms Blesing] transfers via a hoist sling and is unable to weight bear, even in her standing wheelchair".[107]
8. Ms Harman further elaborates in her FCA Report as follows (emphasis added):[108]

The time and number of support people it takes to complete transfers is significantly greater for [Ms Blesing] compared to other people who require hoists to transfer due to the sensitivity of her triggers, intensity of spasticity and risk of injury to [Ms Blesing] and her support staff if performed incorrectly, if triggers are not managed and if spasticity is not reduced. > > In terms of rostering, the task of transferring can sometimes take 4:1 support, if [Ms Blesing's] spasticity does not enable the third worker to safely let [Ms Blesing] go with one hand to operate the lifter. As such, whilst 3:1 is required for the transfer, often a fourth person is required to operate the hoist remote. Due to the other tasks needing to be completed in the household concurrently to this task (such as getting a shower ready, or dressing a chair prior to transfer), there are often 4:1 people required to transition through subtasks. > > As such, this accounts for the need for 4:1 people on some shifts, where documentation clearly states a need for 3:1 for certain tasks. It is simply not accounting for the fact that tasks need to occur concurrently to meet [Ms Blesing]'s needs.

9. Ms Harman also issued a more recent letter entitled "RE: Jo Blesing Functional Capacity Report Recommendations", dated 23 January 2025 ('Ms Harman's 2025 Letter').[109] Ms Harman expresses her "deep concern" in this letter about Ms Blesing's capacity building hours having been "drastically cut".[110] In this letter, Ms Harman discloses that she has not visited Ms Blesing in her home since "the few home visits in 2023" but she had been corresponding with Ms Blesing throughout 2024 and 2025 about how her needs had changed and how she was not managing at home.[111]
10. In Ms Harman's 2025 Letter she states as follows:[112]

(a) Ms Blesing transfers via a hoist lifter with the use of a hoist sling and 3:1 support; > > (b) work, health and safety legislation recommends 2:1 support for all individual transfers "as a baseline" and that Ms Blesing requires 3:1 support to manage her spasticity and to move the equipment into its final position prior to lowering Ms Blesing, to prevent her falling from her chair and to ensure that her spasticity does not cause harm to herself or those supporting her; > > (c) Ms Blesing's wrists and elbow joints have previously subluxed[113] with poor manual handling practices, causing her intense pain and so it is crucial that her body be supported appropriately: > > (d) using restrictive practices such as limb restraints is not ethical, nor would it be in the best interests of Ms Blesing and concur with best manual handling practices. The Tribunal notes that one of the requests for assistive technology made by Ms Blesing is for leg straps which would be used during transfers so it would appear that Ms Blesing consents to this practice and that it is a strategy that is used or will be used by Ms Blesing; > > (e) other comparable assistive technology solutions for transfer that Ms Harman has included considered include: > > > (i) a "pat slide" or a "hover mat", which is an air-based device, similar to a "pat slide", that transfers a person from a flat surface to another flat surface. Ms Harman states this would work for Ms Blesing if she was transferring bed to bed or bed to bath trolley, however she is required to be transferred into a seated position and so this option is not viable; or > > > > (ii) a "stand aid" or a "stand lifter", which are mechanical devices used to assist a person to "semi-stand", with the use of a standing sling. Ms Harman states that due to Ms Blesing's low tone in the trunk and high tone in her limbs, she is unable to independently manage her trunk control and is unable to grasp and release her palms on command and so this option is not viable.

Recommendations of Ms Noble, treating occupational therapist

1. Ms Blesing also relies upon the recommendations of her treating occupational therapist, Ms Noble, reported as having worked with Ms Blesing for over 20 years. Ms Noble gave oral evidence at the hearing, and her opinions and recommendations are also set out in a number of documents in evidence before the Tribunal, notably, Ms Noble's:

(a) report dated 24 August 2019;[114] > > (b) report dated 20 November 2021;[115] > > (c) "Occupational Therapy Functional Capacity Assessment" report dated 16 April 2023 ('Ms Noble's April 2023 Report');[116] > > (d) "Assessment Template - General Assistive Technology - OBI Meal Assist" dated 15 June 2023;[117] > > (e) "Occupational Therapy Functional Capacity Assessment" report dated 30 June 2023 ('Ms Noble's 2023 FCA Report');[118] > > (f) "Occupational Therapy Assistive Technology Audit" dated 9 January 2025;[119] > > (g) "Occupational Therapy Functional Capacity Assessment" report dated 7 February 2025 (or 12 February 2025, watermarked "Draft") ('Ms Noble's 2025 FCA Report');[120] > > (h) "Occupational Therapy Report" containing recommendations that Ms Blesing be funded for a power wheelchair and manual wheelchair, dated 18 March 2025;[121] and > > (i) "Occupational Therapy Functional Capacity Assessment - NDIS Support Justification - Morning Care Routine for Joanne Blesing" report dated 17 July 2025 (Ms Blesing's July 2025 Report').[122]

2. In Ms Noble's 2023 FCA Report, she states that Ms Blesing's transfer requirements have not changed. She states that two support works will roll Ms Blesing towards them, using their hands on her shoulder, hip and knees (specifically, one support worker will have their hands on her shoulder and hips and one support worker have their hands on her hips and knees). Ms Noble says that a third support worker is on the other side of the bed and assists to roll Ms Blesing away from that side and will place the sling along Ms Blesing's spine and pushes the straps under her body as far as they will go. She states that Ms Blesing is then rolled onto her back and the sling is pulled out flat under her. She sates that if Ms Blesing is not in the right position, she is rolled again to reposition the sling.
3. In Ms Noble's 2023 FCA Report, she recommends that Ms Blesing be provided with a total of 52 hours per day of support worker assistance, comprising:[123]

(a) a total of 273 hours per week (equating to 39 hours per day) of support worker assistance in respect of assisting her with:[124] > > > (i) "breakfast including preparation of drinks and food in accordance with Speech Pathologist" being 1:1 support for 2 hours each day, to prepare her breakfast and to clean up - 14 hours per week; > > > > (ii) "lunch" being 1:1 support for 1.5 hours per day to prepare her lunch and clean up - 10.5 hours per week; > > > > (iii) "dinner" being 1:1 support for 1.5 hours to prepare and cook her dinner - 10.5 hours per week; > > > > (iv) "showering, grooming and dressing - including Second Skin Suit" being 4:1 support for 4 hours per day for all personal care tasks, dressing and daily bowel care for 4 hours based on Ms Noble's observations that moving and positioning Ms Blesing can be "very difficult and dangerous" - 84 hours per week. The Tribunal notes that the reference to 84 hours per week is a mathematical error because 4 x 4 x 7 = 112 and not 84; > > > > (v) "getting Joanne ready for bed" being 3:1 support for 3 hours per day for all personal care tasks, changing clothes and preparing and positioning her in bed - 63 hours per week; > > > > (vi) "passive overnight support" being 1:1 support for 8 hours per day with a note by Ms Noble that Ms Blesing should not be left alone in an apartment that does not have overnight support available to her - 56 hours per week; > > > > (vii) "laundry, ironing and heavy cleaning including animal care" being 1:1 support for 4 hours per day to wash her personal clothes, towels, bed clothes, vacuuming, dusting and general tidying with a note by Ms Noble that "fresh air and environment control is important for Ms Blesing" - 20 hours per week. The Tribunal notes that the reference to 20 hours per week is a mathematical error because 1 x 4 x 7 = 28 and not 20; > > > > (viii) "medication support" being 1:1 support for 1 hour per day to administer her medication in a timely manner and to ensure that her scripts are up-to-date and filled appropriately - 7 hours per week; and > > > > (ix) "training new staff (this is critical to [Ms Blesing]'s safety and wellbeing)" being 4 hours per week for two support workers - 8 hours per week. > > (b) a total of 91 hours per week (equating to 13 hours per day) of support worker assistance in respect of assisting Ms Blesing with "community access and capacity building" including:[125] > > > (i) "shopping, paying bills, attending appointments" being 1:1 support for 3 hours on 3 days per week because Ms Blesing "is unable to access the community in her wheelchair and needs support workers to go with her" - 9 hours per week; > > > > (ii) "studying marketing and public relations" being 8 hours twice a week to assist Ms Blesing with meals and personal care "while she is at Uni" - 16 hours per week; > > > > (iii) "immersion therapy" being one support worker for 5 hours twice a week and one support worker for 90 minutes twice a week, because Ms Blesing "would like assistance to attend immersion therapy"[126] - 13 hours per week;[127] > > > > (iv) "diving" being two support workers for three hours once a week because Ms Blesing "would like to learn how to dive" and "this will give her a feeling of weightlessness"- 6 hours; > > > > (v) "hydrotherapy" being two support workers for two hours once a week because Ms Blesing has previously attended hydrotherapy and would like to resume in the future. Ms Noble states hydrotherapy will assist with pain and flexibility - 4 hours per week; > > > > (vi) "[Ms Blesing] would like to become involved in Politics and Teaching" being one support worker for 4 hours twice a week to support Ms Blesing to attend these classes - 8 hours per week; > > > > (vii) "future employment prospects" being 1:1 support for two hours 5 times per week because Ms Blesing would "like support running her clothing design business and explore opportunities" - 10 hours per week; > > > > (viii) "[Ms Blesing] will require support to run her business (AT and Support Coordination)" being 1:1 support for two hours on 5 days per week for Ms Blesing "to make contact with appropriate people who can assist her with her business" - 10 hours per week; > > > > (ix) "Joanne will require support to attend personal outings" being 1:1 assistance to attend social outings and to access the community - 15 hours per week.

4. Ms Noble states that Ms Blesing "wants to be able to spend some time alone without having other people constantly talking to her and asking questions" and that "having her own private space in the past has been important to [Ms Blesing]" and "she can go into her office and have private time while the cleaners are there or maintenance people working on the building".[128] Ms Noble states that Ms Blesing was able to use her computer independently, access the internet and use her phone prior to her accident and is "now just getting back to her pre accident level".[129] Ms Noble reports that Ms Blesing is using a computer access system which requires a mouthpiece for selection of commands, and "she is finding this particular difficult as it causes pain and ulcers in her mouth".[130]
5. In Ms Noble's 2025 FCA Report, she has recommended that Ms Blesing be provided with "24-hour support and assistance to maintain her pre accident function level once it is regained" and "to be able to participate in activities that she was able to partake in prior to her accident".[131] Ms Noble states that Ms Blesing requires investigation into appropriate housing options and that her current accommodation is not appropriate and does not meet her needs. Ms Noble asserts that Ms Blesing is isolated and unable to get in and out of the property on her own. She states that Ms Blesing has 24-hour care needs and "the facilities" are not appropriate for support workers who need to remain on the premises overnight. Because of this, Ms Noble states that the overnight support would need to be "active" until appropriate facilities are sourced. Ms Noble states that Ms Blesing is currently left overnight alone, without any way of getting the support that she needs in the event of an emergency.[132]
6. In Ms Noble's July 2025 Report, she states there are four stages of Ms Blesing's "detailed morning care routine" from 4.30am to 6:30am.
7. Ms Noble reports that stage one involves the tasks of "in-bed continence and personal care". Ms Noble states that this is performed entirely in bed and employs a three-person roll technique with two carers at the front of Ms Blesing and one at the back, to stabilise and reposition her. Ms Noble states that two to three enemas and oral laxatives are administered, and the placement of the bed pan occurs. Ms Noble states that "skin and wound care is conducted in bed, using a sterile, nurse-guided process".[133] Ms Noble states that "A 4-person roll technique is used to remove the bedpan safely and to manage spasms triggered by movement and touch".[134]
8. Ms Noble reports that stage two involves the tasks of "In-Bed Repositioning and Transfer Preparation" involving Ms Blesing being repositioned using a transfer sling. Ms Noble indicates that correct positioning in the sling is critical for spinal alignment and will determine Ms Blesing's posture and pressure distribution in her wheelchair for the day. Ms Noble does not state in her July 2025 Report, how many support workers are required to undertake the repositioning and transfer preparation stage. Ms Noble states that the transfers must be performed in a structured, sequenced manner to avoid triggering full-body seizure-like spams, which are "unpredictable" and "medically dangerous". Ms Noble states that the "fourth carer clears hazards, readies the shower chair or electric wheelchair, and assists with lift operation, reducing the risk of mispositioning or injury".[135]
9. Ms Noble reports that stage three involves the tasks of a transfer and shower, if the qualified lead carer is available to assist. This involves Ms Blesing being transferred to a shower chair and her dressing is "pre-prepared" to enable a single-movement dressing process to avoid Ms Blesing needing to be transferred back into bed. Ms Noble states that three carers assist with Ms Blesing's body washing, catheter care, limb stabilisation and spasm management. Ms Noble states that the fourth support worker will "act as a nurse assistance and is responsible for maintaining sterility, preparing supplies, and responding to spasm-related movement or distress".[136]
10. Ms Noble reports that stage four involves dressing Ms Blesing and her being transferred into her wheelchair. Ms Noble states that the dressing of Ms Blesing is performed in the shower[137] or on the powered wheelchair, based on the competency of the carer (and safety) on the day. Ms Noble states that the "lead carer" will manage the dressing, harness fitting and spasm response, while other carers will maintain her position and support her limbs. Ms Noble does not state in her July 2025 Report how many carers are required for this stage. Ms Noble reports that the final transfer into Ms Blesing's chair "requires exact pelvic alignment and spinal support, with support workers operating the harness and positioning tools under the supervision of most experienced staff".[138]
11. From 6.30am onwards, Ms Noble reports there is a fifth stage which involves the completion of activities of daily living ('ADLs') and the transition to a daytime routine. Ms Noble states that "carers complete the remaining ADLs, including oral hygiene, hair care, and appropriate weather layering". Ms Noble states that the third support worker will "move" Ms Blesing to the kitchen "for breakfast and medication" and the fourth support worker "transitions into domestic and environmental care duties".[139]
12. Ms Noble states that the use of support workers for Ms Blesing's morning routine is not only "clinically justified", but "essential for safety, hygiene, dignity, and the avoidance of preventable hospitalisation".[140] She elaborates that tasks such as bowel management, personal hygiene, transfers and positioning require a team with specialist knowledge, especially in managing quadriplegia and high spasm reactivity.[141]

Recommendations of Mr Burden, independent occupational therapist

1. As mentioned above, the NDIA engaged Mr Burden, occupational therapist, to undertake an independent functional capacity assessment of Ms Blesing in her home and to prepare a report. At the hearing, Mr Burden gave evidence that he did not observe the main transfers in the morning as they had already been completed by the time he arrived to undertake the assessment.
2. In Mr Burden's Report, he states at the outset that Ms Blesing's clinical presentation on the day of the assessment was that her condition has led to significant impairments in motor function, meaning she requires comprehensive support ranging from 2:1 to 4:1 assistance for all activities of daily living. Mr Burden states that during the assessment, it was evident to him that Ms Blesing's daily routine requires the assistance of multiple carers. Mr Burden states that "four carers were observed to be needed to ensure safe transfers and positioning, which reduced to two carers following the heavy transfer, and Ms Blesing reportedly will reduce to one for ongoing monitoring and support throughout the day. Her care routine had been meticulously planned to manage her spasticity and prevent complications such as pressure sores and muscle spasms, with Ms Blesing providing verbal instruction throughout what is a highly physical process of completing her personal care and transferring".[142]
3. In Mr Burden's Report he states that Ms Harman's functional capacity assessment report provides a comprehensive and largely accurate portrayal of Ms Blesing's functional capacity. Mr Burden outlined "Ms Blesing's average daily routine, detailing the activities she engages in, the type of assistance required, and the ratio of care needed for each task", as follows:[143]

(a) 4:30am to 5:00am - physical assistance at a 1:1 ratio, with the administration of medication in preparation for personal care (total - 0.5 hours); > > (b) 5:00am to 5:30am - physical assistance at a 3:1 ratio, with the toileting process for support with rolling (total - 1.5 hours); > > (c) 5:30am to 8:00am - physical assistance at a 4:1 ratio, with the transfer out of bed, shower chair in shower, getting dressed and ready (total - 10 hours); > > (d) 8:00am to 10:30am - physical assistance at a 3:1 ratio, with domestic tasks, feeding, drinking, cleaning up, laundry, personal care (total - 7.5 hours); > > (e) 10:30am to 6:00pm - physical assistance and guidance at a 2:1 ratio, with work, outings, general activities, community access (total - 15 hours); > > (f) 6:00pm to 8:00pm - supervision on a 1:1 ratio, with "potentially alone or reduced carer availability" (total - 2 hours); > > (g) 8:00pm to 12.00am - physical assistance at a 3:1 ratio, with "personal care, preparing for bed" (total - 12 hours); > > (h) 12.00am to 4:30am - active overnight care: supervision on a 1:1 ratio, with "sleeping" (total - 4.5 hours).

4. The total sum of hours of support worker assistance referred above add up to 53 hours per day. Ms Blesing contends that this number of hours of support worker assistance for her per week is insufficient. The Tribunal notes that this is one hour more than the recommendation by Ms Noble that Ms Blesing requires 52 hours per day of support worker assistance (see above at paragraph [122]).
5. In Mr Burden's Report he states that Ms Blesing requires comprehensive support both during the day and overnight due to her severe disability resulting from MS.[144] He states that during the day, she requires continuous assistance, quantified as 24/7 support, with specific tasks requiring varying levels of care. For instance, he states that during her morning routine, including medication administration, toileting, and personal care, she requires a high ratio of support workers due to her hypersensitivity and spasticity, requiring 3:1 or 4:1 support. He states that she requires this higher intensity of support during periods of the day where she needs to complete transfers and her personal care. Mr Burden states that overnight, Ms Blesing requires at least 1:1 support to ensure safety and manage any immediate needs. Mr Burden states Ms Blesing cannot be left unattended due to her significant physical impairments and the risk of severe spasms and hypersensitivity. He states that Ms Blesing's condition requires constant monitoring to prevent injury and to ensure her safety, particularly during transfers and personal care activities. He states that "the causative factors include her inability to self-mobilise, manage her spasticity, and perform essential daily tasks independently. Even a basic requirement such as getting a drink requires the environment to be setup around her with a straw close by in order to facilitate her ability to have a drink of water. Her reliance on assistive technology for virtual communication also necessitates the presence of trained support workers to assist with any technical issues that may arise".[145]
6. As set out in the NDIA's Closing Submissions, the NDIA states that it accepts that Mr Burden, in his Report, has recommended that Ms Blesing be funded for 2.5 hours of 4:1 support (that is, 10 hours per day); 7 hours of 3:1 support (that is, 21 hours per day); 7.5 hours of 2:1 support (15 hours per day); 2.5 hours of 1:1 support (awake) (2.5 hours per day); and 4.5 hours of 1:1 support (active overnight) (4.5 hours per day). This adds up to 53 hours of support worker assistance per day.
7. In Mr Burden's Report, he states that Ms Blesing's movement is highly dependent on the assistance of her carers and that her condition, which he characterised as quadriplegia and significant spasticity, requires a coordinated effort from her care team to facilitate any movement. He states that she in unable to "weight bear or to adjust her position independently".[146] The Tribunal accepts this evidence.
8. At the hearing, Mr Burden gave evidence that when Ms Blesing experiences a spasm, her "whole body goes into complete spasm, which is uncontrolled" muscular contraction. He said that it is an intense period and in order to control the spasm, the support workers have to apply pressure to Ms Blesing's limbs. Mr Burden said there was one support worker holding each leg and another managing the torso. He said that another support worker was "kind of filling in gaps", where needed. Mr Burden said that based on his observations, it may take between two or three minutes or up to ten minutes to control a spasm.
9. Mr Burden said the support workers will also assist with applying wraps to Ms Blesing. Once stabilised, Mr Burden said that the spasms would lessen. He remarked that it took a long time to position Ms Blesing appropriately, moving her from the bed to her sling and then, into her chair. He said it was a one- to two-hour process. Mr Burden gave evidence that the intensive periods of support for Ms Blesing are required in the morning and the evening.

1. At the hearing, Ms Blesing gave the following oral evidence:

(a) that her day starts at 4:30am every day and finishes at midnight; > > (b) at 4:30am, the first thing that happens is that her carer will give her some tablets because she has not had any since 9:00pm the night before and she is "shaking in pain"; > > (c) her carer will "get the tea on" using a special laxative tea and will set everything up for toileting; > > (d) her second carer will arrive 15 minutes later; > > (e) the carers will work on getting everything ready including the equipment; > > (f) her third carer will arrive 15 minutes later; > > (g) it will normally take "three lifters for one"; > > (h) normally, seven or eight litres are evacuated a day due to her bladder incontinence; > > (i) if the catheter is blocked, it will need to be unblocked by flushing it with special syringes; > > (j) the catheter bags need to be emptied every three hours; > > (k) they have to use "sterile hand procedures" and use "gloves"; > > (l) the above tasks take place in the first hour and 10 minutes; > > (m) after that the "rolling toileting" occurs during which she can spasm at any moment. Ms Blesing said this is an "epilepsy of the muscles" causing the body to contract and she can twist backwards so she can fall off of her bed at any moment; > > (n) these spasms happen all the time which is part of her condition; > > (o) Ms Blesing said it takes three carers to roll her or hold her and the fourth carer holds onto the bedpan or holds the harness or holds whatever else; > > (p) it is not just about her being rolled. Ms Blessing said that the "everything" is being organised in the bathroom, bedroom and living room such as the bedding, getting the bathroom ready, the shower, the chair and "it's everything that you would expect to have ready in a hospital"; > > (q) Ms Blesing said that "Even with the amount of time in the shift, there's so much to be done considering how much how sick I am and how much there is just part of what medically is required to be done during morning" and "Then you've got every time I move, we need to have the same procedures and how much it takes just to do anything with me physically"; > > (r) Ms Blesing will only have one bowel movement in the morning of each day; > > (s) Ms Blesing said she has irritable bowel syndrome ('IBS') so if someone has touched her food or there is any sort of contamination, and she experiences diarrhoea, she has a bowel movement while she is in her wheelchair, she will be sitting in it and it will require cleaning. She said this is exacerbated if she "enters into the cold weather or cold air". She said she then has the whole team there in the middle of the day to clean her up; > > (t) if there is an "accident", it may take 8 to 10 minutes for her carers to clean it up. When toileting on the bed, she states it might take 10 or 20 minutes for the relaxant to work and then about half an hour after that to clean up, by the time she is rolled, wiped and rolled again; > > (u) Ms Blesing only has two carers who are capable of showering her. One of them has been with her for 16 years and other one for a bit less than that. Ms Blesing said she does not have a shower if those carers are not in attendance. She said that if she gets wet on her neck, she can go into a spasm on the shower chair, lock up and start gagging. She said it "takes people" to hold me and that she can push her chair across the room if she spasms; > > (v) Ms Blesing is transferred first from her bed to the shower chair and then from her shower chair to her electric wheelchair and she gets "dressed on the way back to the main electric chair"; > > (w) after her shower, Ms Blesing said that her unit is "like a bombshell has hit it" and that "everything" is "everywhere". She said that when she "is moving", they do not have time to clean up along the way because it is "too dangerous" and that she can "go into spasm".

Tribunal's approach to considering Support No.1

1. In the Combined Table of Supports, which was finalised on 20 October 2025 (that is, before Ms Blesing's Closing Statement), Ms Blesing provided a detailed breakdown of her request for support worker assistance, based on the following periods throughout the day:[147]

(a) between 4:30am and 6:30am each day, Ms Blesing seeks 2 hours of 4:1 support worker assistance (with three of the support workers to be paid at the "high intensity" rate) (equates to 6 hours per day at the high intensity rate and 2 hours per day at the standard intensity rate) ('First Component'); > > (b) between 6:30am and 10:30am, Ms Blesing seeks 4 hours of 3:1 support worker assistance (with two of the support workers to be paid at the high intensity rate, and one of them to be paid at the low intensity rate) (equates to 8 hours per day at the high intensity rate and 4 hours per day at the standard intensity rate) ('Second Component'); > > (c) between 10:30am and 7:30pm, Ms Blesing seeks 9 hours of 2:1 support worker assistance (with one of the support workers to be paid at the high intensity rate, and one of them to be paid at the low intensity rate) (equates to 9 hours per day at the high intensity rate and 9 hours per day at the standard intensity rate) ('Third Component'); > > (d) between 8:00pm and 12:00am, Ms Blesing seeks 4 hours of 3:1 support worker assistance (with two of the support workers to be paid at the high intensity rate, and one of them to be paid at the low intensity rate) (equates to 8 hours per day at the high intensity rate and 4 hours per day at the standard intensity rate) ('Fourth Component'); > > (e) between 12:00am and 4:30am, 4.5 hours of "active" overnight 1:1 support ('Fifth Component'); > > (f) at other unspecified times: > > > (i) one support worker for 8 hours per week to assist her with "admin" and for 4 hours per week to assist her with "computer" (which equates to 1.71 hours per day) ('Sixth Component'); > > > > (ii) 3 hours per day of 1:1 support at the high intensity rate ('Seventh Component'); > > > > (iii) 16 hours per week of support for "Social SCCP" at the high intensity rate (equates to 2.29 hours per day) ('Eighth Component').

2. Ms Blesing also sought 8 hours per week for "training" (specifically, two 4-hour sessions or four 2-hour sessions) (equates to 1.14 hours per day), however, this request will be dealt with separately below (see Support No.22).
3. Ms Blesing has calculated the above supports to amount to a total of 60.14 hours per day of support worker assistance.[148] According to the Tribunal's calculations, the total number of hours per day of support worker assistance for the First to Eighth Components being requested by Ms Blesing, is 61.5 hours per day. There is also a slight discrepancy between the number of hours Ms Blesing has requested in the Combined Table of Supports and in Ms Blesing's Closing Statement. The Tribunal considers it appropriate to approach its consideration of this matter by stepping through each of the requested components of support worker assistance that Ms Blesing has requested in the Combined Table of Supports.
4. In the Combined Table of Supports, Ms Blesing has referred the Tribunal to a checklist of tasks performed by her support workers during the more intensive morning routine. This checklist is found in Ms Blesing's First HTB at page 1302 and 1303. The Tribunal has taken those duties into account as described by Ms Blesing. The Tribunal was referred to a further roster of requirements of Ms Blesing for 15-minute intervals each day in a checklist type matrix, at page 1314 of Ms Blesing's First HTB. This document does not provide any particulars in respect of the tasks each support worker will be performing. There are two further particularised task checklists of the "morning shift" on pages 1159 and 1160 of Ms Blesing's First HTB and the later shift described as "Dinner 7pm-930 (or shower 7:pm to 10:30pm)". The Tribunal will refer to these documents collectively as the 'Support Worker Level Roster and Task Checklists'.

1. Ms Blesing has requested 2 hours of 4:1 support from 4:30am to 6:30am each morning (with three of the four support workers to be paid at the "high intensity" rate).
2. The Tribunal notes from Mr Burden's report that:

(a) between 4:30am and 5:00am, Ms Blesing is reported to engage in the activities of having her medicine administered and being prepared for personal care. The specific tasks undertaken by Ms Blesing are particularised on page 1302 of Ms Blesing's First HTB and they include raising Ms Blesing's head using the hand control, changing her drain bag, preparing wipes, bag and "blueys" and placing them in the bedroom, turning on the "towel rail" and preparing the towels, lowering the blinds and turning the lights on ; > > (b) between 5:00am and 5:30am, she undertakes the toileting process involving rolling techniques. The specific tasks involved in this process are outlined on page 1302 of Ms Blesing's First HTB. It is apparent from this checklist that the fourth support worker's role is to wait outside the bedroom door, observe and assist if requested to do so; and > > (c) between 5.30am and 6.30am (and in fact up until 8am) that Ms Blesing is transferred out of bed into her shower chair, has a shower and gets dressed and ready. The specific tasks involved in this process are outlined on page 1302 and 1303 of Ms Blesing's First HTB. It is apparent from this checklist that the fourth support worker's stated role is to observe and assist.

3. The Tribunal accepts Mr Burden's evidence as set out in the above paragraph and will address each of those three separate periods within the First Component of Support No.1.

4:30am to 5:00am each day - Tribunal's conclusion: 0.5 hour per day for 1:1 support at the standard rate

1. Between 4:00am and 5:00am each day, Mr Burden describes Ms Blesing as requiring "physical assistance" with "the administration of medication in preparation for personal care". The Tribunal has considered the evidence of Ms Blesing, Ms Harman, Ms Noble and Mr Burden detailed above, and was unable to reach a state of satisfaction that Ms Blesing requires assistance by four support workers between 4.30am and 5am each morning. The tasks described by Mr Burden are low intensity tasks and not complex. The Tribunal notes Ms Blesing's evidence that this will typically involve getting the laxative tea ready and that she is administered her medication to relieve her pain. The toileting process or first transfer for the day, has not yet commenced before 5am. Based on the recommendation of Mr Burden in respect of this period, which the Tribunal accepts, the Tribunal finds that the activities between 4:30am to 5:00am each day are able be completed by one support worker at the standard rate, because the more intensive tasks have not yet commenced.

5:00am to 5:30am each day - Tribunal's conclusion: 0.5 hour per day for 3:1 support at the high intensity rate

1. Between 5:00am and 5:30am each day, Mr Burden describes that Ms Blesing requires physical assistance with "the toileting process for support with rolling".
2. Mr Burden has recommended that Ms Blesing be provided with three support workers to assist her with the reported toileting process using rolling techniques while Ms Blesing is in her bed. The Tribunal has taken into account the description provided in relation to what is involved in this process including the administration of the enemas and the placement of the bedpan, as well as the wiping process at the end. The hoist is not used at this stage. The Tribunal accepts that careful positioning of Ms Blesing using the rolling techniques is required and the support workers will need to move Ms Blesing in a skilled fashion to minimise triggering any spasms.
3. The Tribunal accepts the recommendations by Mr Burden that three support workers are required between 5:00am and 5:30am to assist with completion of the toileting process using the rolling techniques, given that this process takes place in Ms Blesing's bed which supports her weight throughout the process. Two support workers can be on one side of the bed as described by Ms Noble and the third support worker can be on the other side of the bed to optimise Ms Blesing's safety when the rolling techniques are employed. The wipes and bedpan can be placed in a convenient position on the bed before the toileting process begins, making those items easy to reach by the support workers assisting to roll Ms Blesing.
4. The Tribunal finds that this process is a high intensity activity and that all three support workers should be paid at the "high intensity" rate between 5:00am and 5:30am. This means they should possess the skill and expertise commensurate of a support worker being paid at the "high intensity" rate. It is also appropriate or expected that only those support workers who are presently skilled and sufficiently experienced to undertake these tasks, be engaged or employed by Ms Blesing to assist her during this period.
5. The Tribunal understands that Ms Blesing may face difficulties from time to time finding sufficiently skilled support workers to assist her. However, Ms Blesing is being funded for 200 hours per annum of support coordination services so it is reasonable to expect that Ms Blesing's support coordinator/s will attend to the task of linking Ms Blesing with sufficiently skilled and experienced support workers throughout the year to adequately carry out the task required by Ms Blesing between 5:00am and 5:30am each morning as a team of three "high intensity" support workers.
6. The Tribunal was unable to accept the evidence of Ms Harman and Ms Noble about the assistance required by Ms Blesing during this period, because their recommendations contained a number of inconsistencies and lacked clarity including in relation to the issue about whether they considered that four rather than three support workers were required to undertake high intensity activities of the type undertaken between 5:00am and 5:30am each morning.
7. Accordingly, the Tribunal concludes that between 5:00am and 5:30am each day, Ms Blesing is to be funded for support worker assistance at a 3:1 ratio at the "high intensity" rate (in accordance with the NDIS Price Guide).

5:30am to 6:30am each day - Tribunal's conclusion: 1.0 hour per day for 3:1 support at the high intensity rate

1. Mr Burden states that between 5:30am and 6:30am each day, Ms Blesing commences a process of "transfer out of bed, shower chair in shower, getting dressed and ready" - this involves a hoist assisted transfer from Ms Blesing's bed to her shower chair/commode, her having a shower and then getting dressed and "ready". It was not in dispute that this is the time of the day when Ms Blesing's disability-related care needs are at their highest. The Tribunal accepts Ms Harman's evidence about why certain options that might otherwise assist with the transfer process (or to make it more efficient) are unable to be utilised in Ms Blesing's case (see paragraph [141(e)]). However, the support workers are being assisted with the transfer/s by a gantry hoist which is funded by the NDIS (that is, it is not an entirely manual transfer). The Tribunal accepts the evidence that this transfer from the bed to the shower chair, the showering itself, the dressing any further transfer to the wheelchair if this occurs during this period, is extremely complex due to Ms Blesing hypersensitivity and her propensity to experience severe spasms if she is not handled skilfully by her support workers, or controlled properly if she does experience a spasm.
2. The Tribunal notes that in Mr Burden's Report, he referred to the Manual Handling Plan and that "transfers" of Ms Blesing, "typically require a minimum of 3:1 assistance, with an increase to 4:1 when staff are not familiar with her unique needs. This is due to the need to manage her spasticity and ensure her safety during the transfer process".[149] The NDIA contends that Mr Burden qualified his opinion when he gave oral evidence at the hearing, by giving evidence that the ratio of support workers required to transfer Ms Blesing from her bed could be 3:1, when the support workers are "experienced".[150] The NDIA also highlighted that Mr Burden had said he had observed some inefficiencies in Ms Blesing's transfer from her bed, due to the support workers having to swap around and to change positions, to accommodate the less experienced support workers.[151]
3. The NDIA refers to the opinion of Ms Noble that the physical act of transferring Ms Blesing only takes three persons, and that fourth support worker's role is to remove hazards, "such as taking away bed pans, wipes and rubbish from the bedroom, and disposing of material, while the other workers undertook the transfer".[152] The NDIA contends that Ms Blesing's support workers are funded to receive payment at the "high intensity" rate and for this reason, they should have the ability to undertake Ms Blesing's bed transfers "as efficiently as possible" and to prepare "a safe path clear from obstructions prior to transfers taking place". The NDIA highlights that Ms Noble and Mr Burden gave oral evidence to the effect that this was not occurring. The Tribunal agrees with the NDIA's contentions in this regard and is satisfied that a fourth support worker is not required to facilitate the transfers in and out of Ms Blesing's bed safely in the mornings and at night, and that three support workers with an adequate level of skills and experience commensurate for a support worker being paid at the "high intensity" rate, will suffice and will meet Ms Blesing's disability-related support needs during this period.
4. For these reasons, the Tribunal is not satisfied that Ms Blesing's request for support worker assistance at the ratio of 4:1 for two hours per day is necessary or meets the criterion under s 34(1)(d) of the NDIS Act, because the provision of funding for the fourth support worker is excessive to Ms Blesing's disability-related needs and is not, or not likely to be, effective or beneficial for Ms Blesing. The Tribunal concludes that the mandatory criterion under s 34(1)(d) is not met in respect of Component 2. The criteria under s 34(1) are cumulative so it is not necessary for the Tribunal to proceed to a consideration of whether the other criteria under s 34(1) of the NDIS Act are met in respect of the First Component.
5. In conclusion, the Tribunal is satisfied that the provision of 3:1 support worker assistance at the "high intensity" rate for two hours per day between 4:30am to 6:30am, is a "reasonable and necessary support" for Ms Blesing as this level of assistance is required to assist Ms Blesing with her morning transfers and showering/dressing routine. The NDIA agrees that this level of support for the First Component meets the "reasonable and necessary supports" criteria under s 34(1) of the NDIS Act. The Tribunal concludes that Ms Blesing should be funded for the First Component of Support No.1 based on a 3:1 ratio (and not 4:1 ratio) at the "high intensity" rate (in accordance with the NDIS Price Guide).

1. Ms Blesing is seeking 4 hours of 3:1 support worker assistance (with two of the support workers to be paid at the "high intensity" rate, and one of them to be paid at the "standard" rate) as the Second Component of Support No.1.

6:30am to 8:00am each day - Tribunal's conclusion: 1.5 hour per day for 3:1 support at the high intensity rate

1. Between 6:30am and 8:00am each day, Mr Burden states that the activities being undertaken are "transfer out of bed, shower chair in shower, getting dressed and ready". This is part of the same process which takes place between 5:30am and 6:30am each day. For the same reasons as set out in paragraphs [179] and [183], the Tribunal does not accept Ms Blesing contention that 4:1 support is required during those periods and concludes instead that Ms Blesing requires 3:1 support at the "high intensity" rate.

8:00am to 10:30am each day - Tribunal's conclusion: 2.5 hour per day for 3:1 support at the high intensity rate

1. Between 8:00am and 10:30am each day, Mr Burden states that the activities being undertaken to assist Ms Blesing include "domestic tasks, feeding, drinking, cleaning up, laundry, personal care". The Tribunal accepts Ms Blesing's evidence that her routine can be unpredictable. For this reason, the Tribunal finds that the activities described by Mr Burden are undertaken during this period and it is possible that the processes referred to above involving the transfers of Ms Blesing and her showering and dressing routines may also still be underway or being completed. The Tribunal is satisfied that this is still a high intensity period for Ms Blesing and her support workers, based on Ms Blesing's account at the hearing, and that Ms Blesing requires the assistance of three support workers during this period at the "high intensity" rate, for the same reasons as mentioned above and also because Ms Blesing requires high levels of active physical assistance to assist her with feeding at breakfast time, doing her teeth, grooming, attending other personal care activities and the routine cleaning of her living environment after the busy morning routine and showering and toileting processes. The Tribunal concludes that 2.5 hour per day for 3:1 support at the high intensity rate is a "reasonable and necessary support" for Ms Blesing and should be funded under her NDIS plan.

Third Component - 10:30am to 7:30pm each day (and additional period between 7:30pm and 8:00pm)

1. Ms Blesing is seeking 9 hours of 2:1 support worker assistance (with one of the support workers to be paid at the high intensity rate, and one of them to be paid at the low intensity rate) between 10:30am and 7:30pm each day as the Third Component of Support No.1.[153]

10:30am to 6:00pm each day - Tribunal conclusion: 2:1 support at the high intensity rate

1. Mr Burden describes that between 10:30am and 6:30am each day, that Ms Blesing requires "physical assistance and guidance" with her "work, outings, general activities and community access".
2. The Tribunal considers that some of the priorities for Ms Blesing during the day include that she is repositioned adequately at periodic intervals during this period to prevent the development of pain, spasms or pressure sores, her catheter is cared for appropriately and her catheter bags are emptied regularly, meals and fluids are prepared and given to Ms Blesing when she is ready to have them, that her home is kept very clean, her laundry is washed and ironing is completed (these last two items are addressed by the Tribunal in detail further below), she is supported to leave her apartment, to access and participate in activities in the community throughout the day and to undertake significant levels of day-to-day personal administration involved in the administration tasks related to her NDIS plan and also noting her involvement as a disability advocate and involvement in other community-based projects.
3. In the Combined Table of Supports, the NDIA asserts that Mr Burden had given evidence at the hearing that it would require two support workers to move (or reposition) Ms Blesing in her wheelchair or only one, if "tilting". Specifically, at the hearing, Mr Burden gave evidence that based on the observations he made, there are periods where two-to-one support worker assistance is "reasonable, to allow for some repositioning". Mr Burden agreed with a proposition put to him at that between the hours of 6:00pm and 8:00pm there may not be much repositioning of Ms Blesing, and that "incidental support might be required". Ms Blesing maintains that this task will require three support workers, or two, if "tilting".[154]
4. Ms Blesing is unable to move. She requires another person or persons to do virtually all physical actions on her behalf except for the movement of her wrist to control her powered wheelchair if her arm is correctly positioned by her support workers and except for being able to bring the bite switch into her mouth, provided the bite switch has been correctly positioned by her support workers. The bite switch is used to control her communication devices into her mouth.
5. Ms Blesing requires regular repositioning. On balance, the Tribunal finds that Ms Blesing requires two people to assist her with repositioning, particularly given her present weight.
6. Ms Blesing requires physical assistance and support to compete everyday actions, for instance, when she wants to drink she requires someone to place the drink with a straw in it, in the correct position for her to drink through the straw. When she wants to eat, a support worker is required to feed her. Ms Blesing requires someone to open her laptop if she wishes to use it and to help her if she is having trouble with her communications devices and other assistive technologies.
7. If Ms Blesing leaves the apartment, she is able to manipulate the controls to move the powered wheelchair, but she requires support workers to be with her in case she requires repositioning of her body or objects, such as her laptop, food and drinks, during a community visits. At the present time, Ms Blesing requires doors to be opened or held open for her at different times. The support workers may also need to change the catheter bag and attend to any other unexpected bowel movements if they occur during the community visits. The Tribunal accepts Ms Blesing's evidence that from time to time she can experience symptoms from her condition of IBS.
8. During this period between 10:30am to 6:00pm each day, Ms Blesing will either be in her apartment or shall be out of her apartment accessing the community. At times when she is in her apartment, one support worker is able to attend to her personal needs as set out above. A second support worker will be able to join the first support worker at times when repositioning is required or unexpected toileting may occur. At other times, the second worker is able to attend to household cleaning tasks and meal preparation for Ms Blesing and to assist her with any other administrative tasks within their capabilities. The Tribunal considers it appropriate that both of the two support workers assisting Ms Blesing during this period should be paid at the "higher intensity" rate so that they are sufficiently skilled and experienced to undertake whatever task is required whether that be assisting Ms Blesing with regular repositioning, feeding, meal preparation, cleaning, laundry, ironing, change the catheter bag, wound care, household cleaning to a hygienic standard and administration tasks.
9. The Tribunal is satisfied that the provision of support worker assistance at a 2:1 ratio at the "high intensity" rate between 10:30am and 6:00pm each day meets the "reasonable and necessary supports" criteria under s 34(1) and is a "reasonable and necessary support" for Ms Blesing. The Tribunal concludes that this support should be added to Ms Blesing's New SOPS to implemented in accordance with this Decision.

6:00pm to 7:30pm each day - Tribunal conclusion: 1:1 support at the standard rate

1. Mr Burden describes that between 6:00pm and 8:00pm each day, that Ms Blesing requires "supervision" at a 1:1 ratio with "potentially alone or reduced carer availability". The Tribunal accepts Ms Noble's evidence at paragraph [148] above that it important that Ms Blesing has sometime in the day when she can be alone. At the hearing, Ms Blesing confirmed that this is correct. Mr Burden and her treating allied health therapists have stressed that Ms Blesing should not be left alone in her apartment given her mobility issues. The Tribunal agrees with this. The Tribunal finds that during this period, Ms Blesing does not require any direct hands-on assistance from a support worker. However, she requires at least one support worker present in the apartment (and they can be in a different room to Ms Blesing) in case there is an emergency in the building (such a fire) and they need to immediately ensure that Ms Blesing is able to exit the building. During this time, the support worker on duty is able to attend to "food preparation, household cleaning, laundry and ironing" and it is appropriate that they be paid at the "standard" rate.
2. The Tribunal is satisfied that the provision of support worker assistance at a 1:1 ratio at the "standard" rate between 6:00pm and 7:30pm each day meets the "reasonable and necessary supports" criteria under s 34(1) and is a "reasonable and necessary support" for Ms Blesing. The Tribunal concludes that this support should be added to Ms Blesing's New SOPS.

7:30pm to 8:00pm each day - Tribunal conclusion: 1:1 support at the standard rate

1. Ms Blesing has not requested any support between 7:30pm and 8:00pm each day.[155] However, the Tribunal agrees with Mr Burden and Ms Blesing's treating allied health specialists that Ms Blesing should not be left alone in her apartment given her mobility issues and the risk she may experience a spasm, and that she requires constant supervision, even if the support worker is not present in the same room of Ms Blesing's apartment with her at this time. As mentioned above, the support worker can be attending to other household and cleaning duties or with food preparation or planning, as required. The appropriate rate for this period is "standard" because the Tribunal is not satisfied that high intensity tasks will be carried out.
2. The Tribunal is satisfied that the provision of support worker assistance at a 1:1 ratio at the "standard" rate between 7:30pm and 8:00pm each day meets the "reasonable and necessary supports" criteria under s 34(1) and is a "reasonable and necessary support" for Ms Blesing. The Tribunal concludes that this support should be added to Ms Blesing's New SOPS.

Fourth Component - 8:00pm to 12:00am midnight each day

1. Ms Blesing is seeking 4 hours of 3:1 support worker assistance (with two of the support workers to be paid at the high intensity rate, and one of them to be paid at the low intensity rate) as the Fourth Component of Support No.1.[156]
2. Mr Burden describes that between 8:00pm and 12:00am (midnight) each day, that Ms Blesing requires physical assistance at a 3:1 ratio, with "personal care" and "preparing her for bed". This will entail a transfer from her wheelchair into her bed using the gantry hoist. Based on Ms Blesing's Support Worker Level Roster and Task Checklists, it may also involve her being transferred and assisted to shower in the evening.
3. For the same reasons as explained above, the periods during which Ms Blesing is required to be transferred will require high intensity support by Ms Blesing's support workers. The Tribunal does not consider that high intensity supports are required for Ms Blesing during the entirety of the four-hour period from 8pm to midnight but is only required for a two-hour period from 8:00pm to 10:00pm to execute the labour-intensive tasks involved in transferring Ms Blesing into her bed, or on some days, to assist her to shower by transferring her to the shower chair before being transferred into bed. For the reasons outlined above in respect of the period during which the morning routine is carried out, the Tribunal considers that it is effective and beneficial for Ms Blesing if she has support worker assistance between 8:00pm and 10:00pm at "high intensity" rate by three support workers so they are sufficiently skilled and experienced to execute the transfers safely and efficiently.
4. After these tasks have been completed and Ms Blesing is in bed, the Tribunal considers that her needs reduce to a low level. The Tribunal accepts that support should be provided to ensure that there is some supervision for Ms Blesing in the event of an emergency. Between 10:00pm and 12:00am (midnight), the Tribunal concludes Ms Blesing only requires one support worker to supervise, to be paid the "standard" rate. This support worker may assist with any cleaning, washing or ironing requirements that Ms Blesing may have.
5. In conclusion, the Tribunal is satisfied that the provision of support worker assistance at a 3:1 ratio at the "high intensity" rate between 8:00pm and 10:00pm each day, and at a 1:1 ratio at the "standard" rate between 10:00pm and midnight each day, meets the "reasonable and necessary supports" criteria under s 34(1) and is a "reasonable and necessary support" for Ms Blesing. The Tribunal concludes that these supports should be added to Ms Blesing's New SOPS.

Fifth Component - 12am (midnight) to 4:30am each day

1. Ms Blesing is seeking 4.5 hours of overnight 1:1 support between 12:00am (midnight) and 4:30am each day while she is sleeping, being the Fifth Component of Support No.1.[157]
2. It was established during an exchange at the hearing that this support is not a "night-time sleepover" support within the meaning of the NDIS Price Guide (see page 17). A night-time sleepover support is defined as any support to a participant delivered on a weekday, Saturday, Sunday or a Public Holiday which commences before midnight on a day and finishes after midnight on that day, for a continuous period of eight hours or more, and the worker is allowed to sleep when they are not providing support. The Tribunal accepts Ms Blesing's evidence that she only sleeps for four and half hours a night. This means she is awake for at least three and half hours during an overnight shift which might commence at midnight (or just prior). As stated in the NDIS Price Guide, a nighttime sleepover support includes up to two hours of active supports provided to the participant for the duration of the period.[158] A support worker assisting Ms Blesing overnight will be awake for longer than two hours given that Ms Blesing in only asleep for four and half hours in total overnight.
3. Mr Burden describes Ms Blesing as requiring active overnight care in the form of supervision at a 1:1 ratio between 12:00am (midnight) and 4:30am each day. The Tribunal agrees. The primary role of the support worker will be supervisory. The support worker may be required to adjust Ms Blesing to prevent pressure sores but is not required to undertake any lifting or transfers. Ms Blesing will be asleep. This is an opportunity for the support worker to undertake household tasks which will not create any noise, such as ironing. Tasks required during this period are low intensity tasks and the support worker working this shift should be paid at the "standard" rate applicable for "Night Support", as referred to in the NDIS Price Guide.
4. The Tribunal is satisfied that the provision of support worker assistance at a 1:1 ratio at the "standard" rate between 12:00am (midnight) and 4:30am each day, meets the "reasonable and necessary supports" criteria under s 34(1) and is a "reasonable and necessary support" for Ms Blesing. The Tribunal concludes that these supports should be added to Ms Blesing's New SOPS.

Sixth Component - general allocation for administrative and computer assistance for 12 hours per week

1. Ms Blesing is seeking one support worker for 8 hours per week to assist her with "admin" and for 4 hours per week to assist her with "computer" issues at other unspecified times (which equates to 1.71 hours per day) being the Sixth Component of Support No.1.
2. Given the extensive assistive technology used by Ms Blesing and the type of technology being employed by her, including ACC, and given the demands involved in the management of her NDIS plan, the Tribunal is satisfied that Ms Blesing's request for 8 hours per week to assist her with "admin" and for 4 hours per week to assist her with "computer" issues at other unspecified times (which equates to 1.71 hours per day) are a "reasonable and necessary supports" for Ms Blesing and should be added to her New SOPS.

Seventh Component - general allocation for miscellaneous support for 3 hours per day

1. Ms Blesing is seeking 3 hours per day of 1:1 support at the "high intensity" rate at unspecified times being the Seventh Component of Support No.1.
2. The Tribunal does not presently understand the basis for Ms Blesing's request for a general allocation of funding for miscellaneous support for 3 hours per day for support worker assistance at the "high intensity" rate. For this reason, the Tribunal is not satisfied that this requested support meets the "reasonable and necessary supports" criteria. If this funding is intended to fund shadow support worker shifts so that new support workers can learn from support workers who have been working with Ms Blesing for some time, the Tribunal will address this request under Ms Blesing's request for Support No.22 below.
3. The Tribunal concludes that the Seventh Component is not a "reasonable and necessary support" for Ms Blesing and should not be added to the New SOPS.

Eighth Component - general allocation for support for community access and participation for 16 hours per week

1. Ms Blesing is seeking 16 hours per week of support for "Social SCCP" at the "high intensity" rate (equates to 2.29 hours per day) being the Eighth Component of Support No.1.
2. The Tribunal has concluded that Ms Blesing be assisted by support worker at a 2:1 ratio between 10.30am and 10:00pm each day. If Ms Blesing is able to leave her apartment to access the community during this period and she may request that the two support workers assisting, her between these hours accompany her on those community visits. For this reason, Tribunal is not satisfied that it would be effective and beneficial for Ms Blesing to provide Ms Blesing with further funding for support worker assistance for support with community access and participation, because she already has access to support on a 2:1 basis for 12.5 hours every day and those support workers may assist Ms Blesing to facilitate those community visits.
3. The Tribunal concludes that the provision of funding for the Eighth Component is unnecessary and does not meet the "reasonable and necessary supports" criteria. This support will not be added to Ms Blesing's New SOPS.

1. In conclusion, the Tribunal is satisfied that a total of 46.5 hours per day of support worker assistance at the rates specified above for different periods during the day, plus a further general allocation of 12 hours per week for assistance with administrative and computer tasks, should be added as supports to Ms Blesing's New SOPS. The Tribunal concludes that theses supports are, or are likely to be, effective an beneficial for Ms Blesing, represent "value for money", will assist Ms Blesing to pursue her goals and to undertake activities to facilitate her social and economic participation, are necessary to address Ms Blesing's needs arising from her impairments to which s 24 of the NDIS Act applies, takes in to account what is reasonable to expect families, carers, informal networks and the community to provide, and are each "an NDIS support" for Ms Blesing, falling under items 14, 21 and/or 27 of Schedule 1 of the NDIS Supports Transitional Rules. The Tribunal concludes that this support is not more appropriate funded under another general service system.
2. The supports referred to in the above paragraph are to replace any previously funded supports under the Current SOPS for support worker assistance including assistance with administrative and computer tasks.

CONSIDERATION - SUPPORT NO.2 (HAIRDRESSING SERVICES)

1. Support No.2 in the s 53 Order is a request for funding for "3 hours per week for a professional to wash Ms Blesing's hair".

Stage One: Whether the request for Support No.2 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. As mentioned above, the Tribunal must consider as a first stage, whether the Support No.2 is a "reasonable and necessary support" in light of the provisions of the NDIS Act as a whole, including the guiding principles set out in s 4 of the NDIS Act. The basic grooming of a person's hair is a fundamental personal care task. For this reason, the Tribunal is satisfied that the washing and drying, falling short of any styling of the hair, is an everyday personal care task and that if a person requires assistance to undertake these tasks, or to have these tasks undertaken for them, then it would further the objectives under subsections 3(1)(a) and (d) of the NDIS Act, and the guiding principle under s 4(1) of the NDIS Act. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No.2, could be reasonable and necessary supports, as the provision of each such support is aligned with these objectives and this principle.
2. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances, in respect of the Support No.2.

Stage Two: Whether Support No.2 meets the criteria under subsection 34(1) of the NDIS Act

1. Ms Blesing confirmed at the hearing that she is requesting funding for 3 hours per week to have her hair washed by someone who is trained professionally rather than by a support worker. Ms Blesing confirmed that she is aware that the NDIS rules allow for a participant's hair to be washed as an NDIS support, but not for her hair to be cut, styled or dyed.
2. Ms Martin took Ms Blesing to paragraph [52] of her statement of lived experience and to Ms Blesing's statement that she "liked to look smart" and that this was something which is "essential" to her "self-esteem". Ms Martin asked Ms Blesing if this was part of the reason why she was requesting Support No.2. Ms Blesing said disagreed and responded that she "cared about herself" and had not "let herself go, in all this time".
3. In Ms Blesing's statement of lived experience, at paragraph [53], she states that her hair needed to be professionally washed daily, because there is a "daily build-up of sweat, due to her hyperhidrosis". At the hearing, Ms Blesing made a correction to this and said she needed to have her hair washed three times a week (and her hair brushed daily).
4. Ms Blesing referred to a medical report by Dr Wilson, general practitioner, Dulwich Family Practice, dated 28 November 2023, which states that Ms Blesing had reported to the doctor that she experiences significant spasms and issues with neck flexion. Dr Wilson confirmed that, historically, Ms Blesing has had significant issues when her hair was washed by support workers. Ms Blesing said that if her neck gets wet it may trigger a spasm. Dr Wilson indicates in her report that a professional hairdresser has been able to manage this issue better and it has "significantly increased Ms Blesing comfort and ability to engage".[159]
5. Ms Blesing said she could get water on her neck or it "swells up like an eggplant". Ms Blesing also referred to the Tribunal to a letter by Madam Josephine dated 7 May 2024.[160] This letter states that Ms Blesing attended this salon three times a week. Ms Blesing said the hairdresser has a basin set up for her and they have a five-metre extendable hose. Ms Blesing said that she might sometimes go to an alternative hairdresser, or a hairdresser might come to her home.
6. Ms Blesing confirmed that she has a portable basin in her home which connects to the back of her chair. When asked why she does not use the portable basin, Ms Blesing suggested that the carer might move her head and neck "roughly" and that if her neck swells up, it can pinch a nerve, and she can lose her eyesight. Ms Blesing confirmed that if a hairdresser visits her home, they will use the portable basin to wash her hair by connecting it to the sink in her home. When asked why a support worker could not be trained to connect the portable basin to the basin in her home, Ms Blesing said that the hairdresser is "extremely qualified" at washing her hair "without moving heads", has been "doing it for 30 years or more" and has "worked with" Ms Blesing for 10 or 12 years. Ms Blesing said they know how to wash her hair without it creating a problem for her.
7. Ms Blesing confirmed that the cost of the hairdressing service is $55.00. She confirmed that the hairdresser will dry her hair because, as mentioned above, she cannot have wet hair on her neck, or it will spasm. Ms Blesing told the Tribunal the hairdresser will dry her hair with a blow dryer. Ms Blesing was asked if she has ever sought NDIS funding for the cutting and drying of her hair. She said she has not done so and has only ever sought funding for the washing of her hair.
8. At the hearing, Dr Chia was asked whether he would agree that a lack of care when washing Ms Blesing's hair in a particular way, in light of her neck issues, might trigger spasms. Dr Chia agreed with this proposition.
9. In Ms Noble's February 2025 Report, she states that Ms Blesing has "spent many years finding a salon in the city where staff understand her needs and can wash her hair without any issues". Ms Noble states that "training staff to perform this task is challenging due to high turnover, making consistency difficult to maintain". Ms Noble states that the salon visits are "an important community outing that she looks forward to, and shifting this task to a home setting would not only diminish her social engagement but also likely result in a less satisfactory outcome". Ms Noble states that it essential to Ms Blesing to maintain "her personal grooming" because "it allows her to preserve a sense of her former lifestyle".[161]
10. At the hearing, Mr Burden confirmed that in his opinion, Ms Blesing required "some specialised experience" to wash Ms Blesing's hair.

1. In Ms Blesing's Closing Statement, she contends as follows:

(a) the NDIA's classification of the drying component of hair-washing as "styling" is "factually, linguistically, and medically incorrect"; > > (b) "Styling", as defined by the Macquarie Dictionary (8th ed., 2020) and Oxford English Dictionary (2023), means "to design, arrange, or alter hair so as to change or improve a person's appearance"; > > (c) Ms Blesing's "procedure" involves none of these elements and is a "clinical hygiene task essential to maintaining scalp integrity, preventing infection, and managing neurological hypersensitivity"; > > (d) drying is inseparable from washing, as Ms Blesing cannot safely leave her hair damp due to swelling, spasms, loss of balance, and severe pain; > > (e) this requirement has been medically documented since 2004 and was originally funded by "Disability Services", then continuously recognised and supported under the NDIS since 2018; > > (f) the same evidence has been verified by medical professionals and treating providers "across all care settings"; > > (g) the NDIA's ongoing "mischaracterisation of this essential procedure as "styling" demonstrates a fundamental misunderstanding" of Ms Blesing's "established clinical needs"; and > > (h) Support No.2 is a "reasonable and necessary measure" within the meaning of section 34(1)(d) of the NDIS Act 2013 (Cth), as it "directly prevents physical harm and preserves health, safety, and dignity".

1. In the NDIA's Closing Submissions, it contends that Support No.2 should not be provided to the Applicant because:

(a) it should be within the existing skill set of Ms Blesing's support workers to wash and dry her hair; and/or > > (b) with some further training, Ms Blesing's support workers should have the capacity to undertake this activity.

2. Mr Burden observed in his report that hairdressers have specialised techniques to manage sensitivities and risk. When Ms Burden gave oral evidence at the hearing, he said that:

(a) support workers were not necessarily trained in the same way (as professional hairdressers); > > (b) he was not ruling out a support worker being trained to manage sensitivities. They would have the capacity for that training and (risk) assessment; and > > (c) if there was training and equipment, it was possible for support workers to wash Ms Blesing's hair.

3. The NDIA contends that Mr Burden's oral evidence is consistent with the further observations expressed in his report that a specialised hair-washing basin could be adjusted (in Ms Blesing's home) to accommodate her powered wheelchair's tilt-in-space feature, and he also suggested that support workers could be trained to use gentle techniques and tools, such as soft-bristle brushes and no-rinse shampoo, to further minimise discomfort.
4. The NDIA accepts that "supervision or assistance" with hair washing and drying can be "an NDIS support", but that hair styling is "not an NDIS Support" as per item 5(d) of Schedule 2 of the National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (NDIS Supports) Transitional Rules 2024 ('NDIS Supports Transitional Rules'). The NDIA highlights that a quotation provided by Ms Blesing which was issued by Madame Josephine Hairdressers shows that a hair treatment is $54.00 which is made up of $35 for a hair wash and $19 for a blow dry. The NDIA contends that it would appear that Ms Blesing's blow dry represented 35% of the cost of the hairdressing service being provided to her. The NDIA accepts that the task of drying hair may be funded under the NDIS, but that this is different from having a professional blow wave, which the NDIA contends takes more time and care and involves styling. The NDIA contends that "The fact that the blow wave represents more than one-third of the cost of the total hair service suggests that it is not a quick activity being undertaken by the hairdresser just to dry off the Applicant's hair".
5. The NDIA submits that the "blow-waving" of Ms Blesing's hair three times a week is a "hair styling" service, which cannot be funded under the NDIS and that only part of the hairdressing service that could be potentially funded, is the hair washing. However, the NDIA contends further that in Ms Blesing's case, even the blow-waving part of the service should not be funded under the NDIS because Ms Blesing has an "extensive level of support worker assistance" (that is, 35 hours per day) and that it is within the capacity of Ms Blesing's support workers to wash her hair. For this reason, the NDIA contends that funding Support No.2 would amount to a duplication of supports and the frequency of the support sought (three times a week) does not take account of other techniques that the support workers could utilise, such as brushing and dry-hair shampoo. The Tribunal does not accept those other options are feasible in Ms Blesing's case because it accepts Ms Blesing's evidence that she sweats profusely due to her neurological condition.
6. The NDIA also made some contentions about the risk of Ms Blesing misapplying her NDIS funding for this support in the past and that this risk would be heightened if Ms Blesing was provided with funding for this support. With respect to the NDIA and Ms Martin, the Tribunal considers this to be an irrelevant consideration when deciding what type and level of supports a participant should be funded for under the NDIS and so will not take this matter into account.

1. The Tribunal is satisfied that care must taken when Ms Blesing's hair is washed and dried so as to not provoke a neurological response, based upon the evidence of Ms Blesing and her treating doctors, which the Tribunal accepts. At the present time, the Tribunal is satisfied that the persons who possess the skills to wash and dry her hair safely are the qualified hairdressers she has been attending for over ten years. However, the Tribunal accepts the NDIA's proposition that this is a skill that Ms Blesing's support workers, particularly, those working at the "high intensity" rate, would have the capacity to perform if they receive appropriate training from Ms Blesing's hairdressers. In respect of Ms Blesing's request for Support No.1, the Tribunal has concluded that Ms Blesing will be funded for support worker assistance on a 2:1 basis at the "high intensity" rate during the day. This means that two of Ms Blesing's skilled and experienced support workers will be assisting Ms Blesing when she attends the hairdressing appointments at the salon or indeed, if they are to make a home visit to provide this service. Ms Blesing can facilitate the two support workers observing and assisting the qualified hairdresser when undertaking this service three times a week, over the next 12 months and after this time, it is reasonable to expect that the two support workers will have learnt the hairdressers' methods of washing and drying Ms Blesing's hair in a safe manner. After the next 12 months, a transition should occur from Ms Blesing having her hair washed and dried by the qualified hairdressers, to having those tasks performed by Ms Blesing's support workers being paid at the "high intensity" rate.
2. However, in respect of the next 12 month period, the Tribunal is satisfied that an amount of $165.00 per week (that is, $55 multiplied by three) for use by Ms Blesing to engage a qualified hairdresser to wash and dry her hair (but not style it), meets the "reasonable and necessary supports criteria" under s 34(1) of the NDIS Act and should be included in Ms Blesing's New SOPS. The Tribunal concludes that this support is, or is likely to be, effective and beneficial for Ms Blesing, represents "value for money", will assist Ms Blesing to pursue her goals and to undertake activities to facilitate her social and economic participation, is necessary to address Ms Blesing's needs arising from her impairments to which s 24 of the NDIS Act applies, takes into account what is reasonable to expect families, carers, informal networks and the community to provide, and is "an NDIS support" for Ms Blesing because it falls under item 14 of Schedule 1 of the NDIS Supports Transitional Rules. The Tribunal finds that this support is not more appropriate funded under another general service system.

1. Support No.3 in the s 53 Order is a request for funding for "18 hours per week for professional manicures/nail care".

Stage One: Whether the request for Support No.3 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. For the same reasons as set out above in respect of Support No.2, the Tribunal concludes that the provision of Support No.3, could be reasonable and necessary supports, as the provision of each such support is aligned with the objectives and this principle referred to in paragraph [221] above. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support No.3.

Stage Two: Whether Support No.3 meets the criteria under subsection 34(1) of the NDIS Act

1. In Ms Blesing's statement of lived experience, at paragraph [54], Ms Blesing states that she likes to look well-groomed and that the state of her nails is very important to her. At the hearing, Ms Blesing confirmed that she has a trusted and regular nail therapist, "Anna", who looks after her nails, and that she is a "beauty therapist" who works at a beauty salon. Ms Blesing said that Anna knows how to trim her nails in a blunt fashion, so they are not sharp, and she has been doing her nails since Ms Blesing arrived in Adelaide. Ms Blesing said that if her nails are sharp, they might cut the carers when she is experiences a spasm. Ms Blesing asserted that nail care is part of her pain relief, explaining that if her toenails get too long, or move, they can cause her significant pain.
2. When asked about the NDIS funding which has been provided for podiatry services, Ms Blesing said that the podiatrist could help her maintain her toenails, but not her fingernails.
3. Ms Blesing was asked why her support workers were unable to trim her fingernails. Ms Blesing said her fingernails are thickened, hardened and damaged from many years of deterioration. Ms Blesing named one of her support workers and gave evidence that she cannot cut her nails.
4. At the hearing, Dr Chia was informed that the evidence before the Tribunal includes photographs showing that Ms Blesing's fingernails and toes are quite thick and would be difficult to cut. He was asked whether he would agree that a lack of care taken when trimming Ms Blesing's nails might trigger a spasm. Dr Chia agreed with this proposition. Dr Chia said that he thinks that an appropriate podiatrist could try trimming Ms Blesing's toenails but that he was "not sure" whether a podiatrist would be able to trim fingernails as well.
5. In Dr Wilson's Report, she confirms that Ms Blesing is unable to cut her own fingernails or toenails. Dr Wilson does not express an opinion about whether they should be trimmed by podiatrist and/or beauty therapist, rather than by a support worker.

1. In the NDIA's Closing Submissions, it contends as follows:

(a) Ms Blesing confirmed at the hearing that she would agree to the provision of 12 hours per annum for Support No.3, which equates to one hour of nail support per month; > > (b) the NDIA accepts that the trimming of Ms Blesing's nails is "an NDIS support" in accordance with item 14(d) of Schedule 1 to the NDIS Supports Transitional Rules. However, the NDIA refers to item 5(e) in Schedule 2 to the NDIS Supports Transitional Rules which provides that manicures, pedicures, false nail application or removal of any kind, nail painting and removal, nail decorations, nail piercings, hand or foot massage or treatments, are "not an NDIS support"; > > (c) in relation to Ms Blesing's toenails, the NDIA notes that she receives 15 hours per annum of funding for podiatry and that given Ms Blesing's wish to have her toenails trimmed, it is open to her to use some of this funding for this task (if she does not wish her support workers to trim her toenails); > > (d) in relation to her fingernails, the NDIA notes Ms Blesing's evidence at the hearing that due to the thickness of her fingernails, she requires a trained nail professional/beauty therapist to trim and apply nail polish to them; > > (e) the NDIA accepts that the trimming of Ms Blesing's fingernails is not within the expertise of a podiatrist. However, the NDIA contends that Ms Blesing's support workers have the capacity to cut her nails and if the thickness of Ms Blesing's fingernails, necessitates the use of a nail-trimming implement by the support workers, that this requirement should not prevent the support workers from delivering this support; > > (f) the NDIA contends that funding for Support No.3 should not be provided to Ms Blesing because it is duplicative of the assistance she receives from her NDIS-funded podiatrist and support workers; > > (g) if Ms Blesing's preference is to have her nails manicured and polished by a professional at a nail salon, rather than having her support workers undertake the task, this option is available to her but she cannot use her NDIS funding to pay for this service; and > > (h) based on Ms Blesing's evidence on the final day as to her attitude to the spending NDIS funding, the NDIA contends there is a risk that, were the Tribunal to provide her with funding for the cutting of her fingernails, she would misuse it and pay for services that are "not an NDIS support".

2. The Tribunal had decided to disregard the final contention by the NDIA as referred to in paragraph [249(g)] because it is irrelevant to an assessment as to the disability-related supports required by Ms Blesing.
3. Otherwise, the Tribunal accepts the thrust of the NDIA's contentions set out in the above paragraph, specifically:

(a) the Tribunal is satisfied that 15 hours of podiatry services per annum is sufficient to fund the task of the podiatrist trimming Ms Blesing's toenails as and when required. If the podiatrist is not presently skilled to be able to undertake this task, the Tribunal considers that Ms Blesing's support coordinator/s should promptly undertake a search to find a podiatrist for Ms Blesing who possesses the skills and experience to safely trim Ms Blesing's toenails during the podiatry appointments which are currently funded under the NDIS. The Tribunal considers that a qualified podiatrist will be able to manage this task having formally studied the physiology of feet and toenails; and > > (b) the Tribunal is satisfied that a support worker being paid at the "high intensity" rate would be capable of and is reasonably expected to use specialised nail trimming implements designed for hardened nails, to trim Ms Blesing's fingernails during their one of their shifts (already funded under the NDIS). The Tribunal considers that if a nail (or beauty therapist) is able to undertake this task, there is no reason why a "high intensity" support worker would be unable to do so or to be trained to do so. If Ms Blesing's current support workers are unable to do so or to be trained to do so, it is reasonable to expect that Ms Blesing's NDIS-funded support coordinator will search for and connect Ms Blesing with a support workers capable of assisting her at the "high intensity" rate and who possess the requisite skills and experience to undertake this task or who is capable of completing training to undertake this task.

1. The Tribunal concludes that the request for funding for Support No.3 should not be funded under the NDIS because:

(a) it is not necessary, because Ms Blesing is already funded for 15 hours per annum of podiatry services who can trim and file her toenails, and she also funded for a high number of hours of assistance by a high intensity support worker who should be able to trim and file her fingernails; and further and alternatively, > > (b) the criterion under s 34(1)(d) is not met because Support No.3 is, or is not likely to be "effective and beneficial" for Ms Blesing; and further and alternatively, > > (c) Support No.3 will not represent "value for money" considering that it will achieve the same outcome as the other alternative supports referred to in subparagraph [252(a)], which are already funded under Ms Blesing's Current SOPS; and further and alternatively, > > (d) any further funding provided to Ms Blesing for the purpose of trimming and filing her fingernails and toenails would duplicate the supports referred to above which are already provided to her under her Current SOPS and so any duplication of this funding is excluded by operation of r 5.1(3) of the Supports Rules.

CONSIDERATION - SUPPORT NO.4 (IRONING SERVICES)

1. Support No.4 in the s 53 Order is a request for "3 hours per day of ironing services (including Transport)(that is, $185 per day)".

Stage One: Whether the request for Support No.4 is a "reasonable and necessary supports", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of ironing services could be reasonable and necessary supports, as the provision of each such support is aligned with the objectives under s 3(1)(a) of the NDIS Act and the principle under s 4(1) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.4.

Stage Two: Whether Support No.4 meets the criteria under subsection 34(1) of the NDIS Act

1. In Ms Blesing's March 2024 SLE she states as follows:[162]

(a) her bedroom and apartment are "specialist cleaned twice a week" and "all bedding and clothing is sent out for ironing" which "maintains the bacteria control due to the high temperatures of ironing, is far more cost effective and lessens the chance of abscess and sores caused by the dirt and creases on my skin"; > > (a) "skin infections occur when bacteria infect the skin and sometimes the deep tissue beneath the skin. Cellulitis is a common type of skin infection that causes redness, swelling, and pain in the infected area of the skin. Another type of skin infection is skin abscess, which is a collection of pus under the skin. Bacterial Skin Infections: Impetigo and MRGN: While many bacterial skin infections are mild and easily treatable, some can become very serious and even life threatening. In addition, some bacterial infections can be spread to others. This is why prevention is so important"; > > (b) whilst Ms Blesing was in hospital, she said they were trained "as a team" how to manage this "long-term condition" and she referred to "Gowning up and hand protection by the means of gloves (and the need to keep changing the gloves at all times, once contaminated) and masks at all times"; > > (c) Ms Blesing said her "sensitivity has increased" due to allergies in relation to latex and vinyl gloves, which she said she was advised is "common with someone who has MSSA" (MSSA is an acronym for Methicillin-Susceptible Staphylococcus Aureus being a common type of staph bacteria); > > (d) Ms Blesing has precautions in place to ensure that no towels are shared between herself and her support staff and all that her support staff, at a minimum, wear gloves whenever touching her for dressing, repositioning and especially personal care; > > (e) Ms Blesing said that the support staff are also given T-shirts to wear when "on shift" (that do not leave the apartment), "so that carers are kept safe". Ms Blesing said that this "follows the recommendations of Health SA, which we were taught how to follow when in hospital and how to implement in the home".

2. The reference by Ms Blesing for the need for "clinical hygiene management" arises from the assertion in Ms Blesing's March 2024 SLE that she acquired Multi-resistant Gram-Negative ('MRGN') organisms or bacteria at the Royal Adelaide Hospital in early 2020, in the bladder, uterus and surrounding skin of the suprapubic catheter. Ms Blesing asserts, as a lay person, that this condition does not disappear over time. Ms Blesing asserts, as a lay person, this condition can be managed with treatment and quality control maintenance of surroundings, bedding and clothing.[163] The Tribunal has addressed the question of whether there has been a colonisation of this bacterium in Ms Blesing's case, in paragraphs [99] to [108] above.
3. In Ms Blesing's Closing Statement, she states that she experiences "extreme neurological hypersensitivity as a result of advanced multiple sclerosis" and that "this affects the skin, muscles, and sensory system, rendering ordinary environmental factors sources of acute pain and involuntary spasm". Ms Blesing contends that due to this condition, she cannot tolerate standard clothing or rough fabrics. Ms Blesing said that "all linen and clothing must be freshly ironed each day to prevent irritation of the skin and hair follicles, as even minor creases or pressure points cause severe discomfort". Ms Blesing contends that "pillows must also be reconditioned daily to prevent head and neck pain".
4. Ms Blesing states that "visual and auditory stimuli, such as bright or striped clothing, rustling paper or plastic, or electrical device noise, can provoke muscle spasms, blurred vision, or nausea. Carers must therefore operate within strict environmental controls to maintain [Ms Blesing's] safety and physiological stability". Ms Blesing states that these requirements are not preferences but "medical necessities arising from a clinically verified neurological condition". She states that, "they demand precision, consistency, and understanding from a trained and familiar care team".

1. As set out in the NDIA's Closing Submissions, it considers there to be "some uncertainty" as to the reasons why Ms Blesing is requesting Support No.4 and whether the full scope of what she is requesting, can be funded under the NDIS. The NDIA contends that it is not possible for Ms Blesing to argue that the ironing of sheets cannot occur in her apartment, because of her stated need to be in a sterile environment, because it is inconsistent with Ms Blesing's claim for transport supports in the form of hiring accessible taxi services (being a non-sterile vehicle), that would facilitate her making trips around Adelaide and its surrounds (also being to non-sterile environments).
2. The NDIA contends as follows:

(a) Ms Blesing contends that she "requires her full set of bed linen to be professionally ironed and that it is more cost effective for it to be done by a laundry service than for her support workers to iron it". Ms Blesing said that if her bed linen was not ironed, she would develop welts on her skin; > > (b) initially, while giving evidence, Ms Blesing stated that she paid for the laundry service herself. Subsequently, Ms Blesing later sent an email to the Tribunal accepting that this was not the case, which appeared to be a concession that she had been invoicing the NDIA for the laundry service. The NDIA noted that there is currently no funding for laundry services in Ms Blesing's NDIS plan; > > (c) Ms Blesing was asked to provide the Tribunal with invoices for her laundry services. The records Ms Blesing provided to the Tribunal had numerous references to items of clothing being ironed. When Ms Blesing was asked by the NDIA to explain these records, she said that the references to clothing were to the uniforms worn by her support workers. However, the NDIS states it was unclear why Ms Blesing's support workers wore uniforms that required ironing and why Ms Blesing's funding was being utilised for that purpose; > > (d) item 23 of Schedule 1 ("NDIS supports") of the NDIS Supports Transitional Rules state that a participant may be funded for supports that provide assistance with "essential household tasks" that a participant is not able to do, because of their disability, including laundry. On a broad construction of the term "laundry", the NDIA accepts that "it can be taken to encompass ironing" and that the task of ironing an NDIS participant's sheets may, in some circumstances, be considered to be an "essential household task"; > > (e) however, the NDIA does not agree that ironing the support workers' clothes is an "essential household task", particularly when it is unclear as to why the support workers are required to wear a uniform that necessitates ironing. In any event, the NDIA contends that it is not the responsibility of the NDIA to launder the clothes of Ms Blesing's support workers; > > (f) the NDIA notes that Dr Chia, Ms Blesing's treating neurologist, was of the opinion that he did not agree that creases in clothing and bed sheets would, on their own, be likely to cause a skin breakdown or infection for Ms Blesing, when asked about this by the Tribunal at the hearing. The Tribunal prefers Dr Chia's medical evidence about this given his formal medical qualifications over the opinion of Ms Blesing that such measures are required to prevent skin breakdown or infection; and > > (g) the NDIA contends that Ms Blesing's request for the ironing of her bed sheets, and support workers' clothing, arises from a "strongly held personal preference" held by Ms Blesing, "as opposed to any demonstrable clinical need".

3. Ms Blesing gave evidence at the hearing that her support workers could not undertake ironing because:

(a) they had "no downtime" to do so and that it would take a support worker eight hours every day to iron the items she requires (based on past experience, Ms Blesing said, of having tried this approach); and > > (b) because Ms Blesing runs a "clean room" and that everything in her apartment needs to be sterilised due to her IBS. The NDIA considers this evidence to be inconsistent with Ms Blesing's further evidence that she attends hair salons three times a week, makes (or wishes to make) multiple trips to restaurants and cafes throughout the week, undertakes regular excursions to galleries and talks and seeks funding for multiple taxi trips a day. The NDIA contends that no weight should be placed on Ms Blesing's evidence that ironing cannot take place in her apartment. The Tribunal agrees with the NDIA in this regard and finds that Ms Blesing's evidence about this is unreliable because it is inconsistent with the projected journeys and activities set out by her in projected travel schedules she produced to the Tribunal in this proceeding; and > > (c) Ms Blesing confirmed that this support would ensure that the clothes that come into contact with her skin are laundered in a way (that is, steamed and sterilised) that is sufficiently sterile, so that it does not cause any outbreak of the MRSA that has colonised her body. As discussed above, there is no evidence to demonstrate a clear diagnosis that Ms Blesing's body is presently colonised by any such bacteria.

4. The NDIA contends that Ms Blesing has not established that Support No.4 is a reasonable and necessary support to be funded under the NDIS, due to the absence of there being a clinical need for the ironing of Ms Blesing's sheets and the uniforms of her support workers. In the alternative, the NDIA submits that the ironing of the Applicant's sheets can be done by her support workers.

1. At the hearing, Dr Chia was asked to express his view about whether an MRSA colonisation, as reported by Ms Blesing, would increase her risk of developing infections on external skin surfaces that might arise from creases on her bed linen and on clothes. Dr Chia said his impression is that MRSA does tend to be associated with an increased risk of skin infection that can be much harder to treat and may be resistant to antibiotic. However, Dr Chia said he is not entirely sure that he can say that creases in clothes would necessarily be likely to cause skin ulcerations. He said it could be plausible with some tougher fabrics, but he imagined that with softer fabrics or in "normal sort of linen", it would be unlikely that a crease on its own is going to significantly increase the risk of a skin breakdown or skin infection. He said he does not think it would necessarily contribute a great deal to skin breakdown or to pressure sores. When asked whether Ms Blesing's immune system is functioning correctly, Dr Chia said that there are a few things which increase Ms Blesing's risk of getting infections in general but that this does not mean that her immune system is dysfunctional.

1. The Tribunal concludes that Support No.4 is not a reasonable or necessary support for Ms Blesing because the medical evidence given by Dr Chia at the hearing is that creases in clothing and bed sheets, on their own, would be unlikely to cause a skin breakdown or infection for Ms Blesing. For this reason, the Tribunal is satisfied that there is no clinical justification for why Ms Blesing bed sheets and her support workers clothing must be ironed when used in Ms Blesing's apartment. The Tribunal accepts that NDIA's contention that the impetus for Ms Blesing's request for Support No.4 arises from Ms Blesing's personal preference to have ironed sheets and that her support workers wear ironed clothes.
2. The Tribunal also accepts the NDIA's alternative position being that if Ms Blesing prefers to have her bed sheets and her support workers' uniforms ironed, she is at liberty to request that her support workers undertake this task while they are fulfilling a shift for her and in particular, at times when Ms Blesing is either resting, sleeping or engaged in other activities which do not require direct support from the support workers. Ms Blesing contends that they do not have sufficient "downtime" to undertake this task. The Tribunal has approved funding for support worker assistance for Ms Blesing which represents a significant increase in the number of hours of support worker assistance and also in increase in the rate of pay for those support workers. Based on the schedule of support worker assistance the Tribunal has concluded is a "reasonable and necessary support" for Ms Blesing, the Tribunal considers that there will be "downtime" for support workers to undertake any ironing tasks that Ms Blesing might request of them to meet Ms Blesing's personal preferences to have these items ironed. The Tribunal is not persuaded on the evidence before the Tribunal that a support worker would not be as efficient when ironing the sheets and clothes, as an external cleaning service.
3. The Tribunal concludes that the mandatory criteria under s 34(1)(d) is not met in respect of this support because it is not, or is not likely to be, effective and beneficial for Ms Blesing. It is not necessary because Ms Blesing's NDIS-funded support workers can undertake this task and in particular, the support worker assisting Ms Blesing between 12:00am (midnight) and 4:30am while Ms Blesing is asleep. For this reason, funding for an ironing service would duplicate the NDIS-funded services already provided to Ms Blesing through the provision of support workers who can complete this task, and so r 5.1(c) of the Supports Rules applies. For this reason, r 5.1(c) operates to exclude this support from being funded under the NDIS.
4. The Tribunal concludes that no funding is to be added to the New SOPS for Support No.4 because it is not a "reasonable and necessary support" for Ms Blesing under the NDIS Act.

CONSIDERATION - SUPPORT NO.5 (CLEANING SERVICES)

1. Support No.5 is the s 53 Order is a request for "9 hours per week for cleaning services (over 3 days)".

Stage One: Whether the request for Support No.5 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of cleaning services could be reasonable and necessary supports, as the provision of each such support is aligned with the objectives under s 3(1)(a) of the NDIS Act and the principle under s 4(1) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.5.

Stage Two: Whether Support No.5 meets the criteria under subsection 34(1) of the NDIS Act

1. In Ms Blesing's Closing Statement, she contends that her support needs are based on Ms Harman's FCA Report, as corroborated by the "occupational therapy and medical reports", which confirm that for Ms Blesing to live safely in the community, she requires "clinical hygiene management" including (among other supports) "clinical cleaning (infection control)" for "environmental sterilisation and hygiene cleaning to prevent hypersensitivity and MRSA (6hrs/week)".
2. At the hearing, Ms Martin asked Ms Blesing during cross-examination why Support No.5 was required given that Ms Blesing already had access to NDIS funding for 16 hours per week for household cleaning and an additional 36 hours per week for assistance with personal domestic activities. Ms Blesing sought to distinguished between the everyday cleaning that her support workers will do, for instance, to clean the dishes, floors and benches, from the cleaning, which is conducted by the household cleaners ('Household Cleaners'), for instance, to clean the toilet, the mould in the shower and the sink. Ms Blesing asserted there was "no time left" for the support workers to do the tasks that are done by the Household Cleaners.
3. Ms Blesing was asked why three 3-hour visits by the Household Cleaners are necessary. Ms Blesing responded that 20 people a day visit her apartment to deliver support worker services over the space of 20 hours and that the wheelchair, and the people, will bring dirt into her apartment. Ms Blesing suggested that if the visits by the Household Cleaners went down to 2-hour visits, which she had trialled, that "it just gets a lot of build-up".
4. In Ms Blesing's Position Paper, she requested funding for a total of 9 hours per week of cleaning services, hence the description for this support in the Final s 53 Order.[164] At the hearing, Ms Blesing confirmed that she is seeking only 6 hours per week (that is, 3 hours on two days per week) for cleaning services.
5. The NDIA highlights that Ms Blesing's plan provides $42,280.96 of funding for "housing cleaning and other activities", equating to 16 hours per week. This was a reference to Ms Blesing's previous SOPS. Ms Blesing's Current SOPS includes a similar provision for 16 hours per week for 52 weeks per annum of "Household tasks. House Cleaning And Other Household Activities - total $48,280.96. This may include: 16 hours per week for 52 weeks at the rate $58.03". The NDIA contends that Ms Blesing has sufficient funding in her plan for cleaning support and that Support No.5 is duplicative of this cleaning support. The NDIA contends that r 5.1(c) of the Supports Rules applies to exclude Support No.5 from being funded under the NDIS.

1. The Tribunal has concluded that Ms Blesing is to be funded for an increased number of hours of assistance from support workers (that is, 46.5 hours per day). Ms Blesing's support workers are able to assist her with daily domestic duties, such as keeping her home clean and hygienic. The Tribunal has concluded that most of the support worker assistance to be provided to Ms Blesing is to be at the "high intensity" rate. Given the Tribunal has concluded that Ms Blesing is to be provided with a 2:1 ratio of support workers for 12.5 hours between 10.30am and 10:00pm, the Tribunal considers that there will be sufficient time within this period each day for one of the support workers to complete household cleaning task for Ms Blesing including the Household Cleaning described by Ms Blesing at the hearing. The Tribunal does not accept that it is necessary for further external cleaners to visit Ms Blesing's home twice a week for three hours to undertake Household Cleaning. The Tribunal considers that this would duplicate the support already available to Ms Blesing through her support workers. The Tribunal agrees with the NDIA and concludes that r 5.1(c) of the Support Rules applies in respect of Support No.5 and that NDIS funding for this support is excluded by operation of this subrule.
2. The Tribunal concludes that funding for Support No.5 is not to be included in Ms Blesing's NDIS plan.

1. Support No.6 in the s 53 Order is a request for "$65 per month for dental hygienist care";

Stage One: Whether the request for Support No.6 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. For the same reasons as set out above in respect of Support No.2, the Tribunal concludes that the provision of Support No.6, could be reasonable and necessary supports, as the provision of each such support is aligned with the objectives and this principle referred to in paragraph [221] above. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support No.6.

Stage Two: Whether Support No.6 meets the criteria under subsection 34(1) of the NDIS Act

1. During cross-examination, Ms Martin asked Ms Blesing to explain the reason for her request for NDIS funding to pay for "deep cleaning of her mouth" once a month. Ms Blesing responded that she cannot do anything or move her jaw. She said she has lost four or five teeth due to a condition known as "dry mouth". Ms Blesing said that she drinks through a straw and "cannot drink enough". Ms Blesing said that her carers cannot "deep clean" (or are not trained to do this task), and that it is hard for her to move her neck without it spasming. Ms Blesing said she ends up with toothpaste everywhere in the mouth. She said that if she uses an electric toothbrush, as was suggested by Mr Burden in his report an alternative option, that it will send her into a "massive spasm" and she will bite down on an electric toothbrush in her mouth.
2. At the hearing, Dr Chia was asked whether the vibrations of an electric toothbrush might cause Ms Blesing to have a spasm. Dr Chia answered that he thinks it is "plausible". He added that he thinks that any sort of movement of the body can trigger intermittent symptoms in people who have MS and spinal cord disease, and vibration is something that is known to set off symptoms in some people.
3. In Ms Noble's February 2025 Report, she states that Ms. Blesing is unable to clean her own teeth. Ms Noble suggested that having another person clean someone's teeth, is "never very successful". Ms Noble suggested that "oral hygiene is also affected by medication and poor nutrition both of which are issues in this case".[165]
4. At the hearing, Ms Blesing confirmed that one of her senior support workers cleaned her teeth every day and also after any vomiting she may experience.
5. The Tribunal considers that further evidence is required before it could be satisfied that this support is a "reasonable and necessary support" and can be funded under the NDIS. The Tribunal has taken into account the evidence of Dr Chia referred to above, but it is non-specific and not definitive in respect of Ms Blesing's individual circumstances. Ms Noble's evidence is inconsistent with Ms Blesing's evidence. Ms Blesing may wish to obtain a report from her dentist which may evidence particular concerns in relation to her dental hygiene or a further medical report by Dr Chia or some other suitably qualified doctor which provides medical evidence about Ms Blesing's reported mouth condition, confirmation that this condition arises from Ms Blesing's impairments, more information about her dental needs arising from these issues, including any reasons why the current daily brushing routine of Ms Blesing's teeth by her support workers is inadequate.

1. At this point and without such further medical and clinical evidence, the Tribunal is not satisfied that Support No.6 is necessary to meet Ms Blesing's needs arising from her disability or that it would be an effective and beneficial support for her. The Tribunal is unable to make any findings that her current daily brushing routine by her support workers is inadequate to meet her dental needs, in light of the impacts of her disability. Ms Blesing is at liberty to make a new request to the NDIA for Support No.6 when she obtains further definitive medical and/or clinical evidence as set out above.

1. In Ms Blesing's Position Paper, she sought $36,447.36 per annum for "Continence: gloves and wiping products, waterproofing, sterilising, specialist straps, mattress cover, therapy products, splints" which includes $5,000 for "consumables". Based on this request, the Tribunal listed Support No.7 in the s 53 Order as a request for "$36,447.36 per annum for continence aids".

Stage One: Whether the request for Support No.7 is a "reasonable and necessary supports", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No. 7 could be reasonable and necessary support, as the provision of this support is aligned with the objectives under subsection 3(1)(a) in the NDIS Act, and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support No.7.

Stage Two: Whether Support No.7 meets the criteria under subsection 34(1) of the NDIS Act

Ms Blesing's request for consumables for continence issues and catheter care

1. Ms Blesing has requested funding for a range of different supports which fall into the general category of consumables for continence issues and catheter care. At the hearing, Ms Blesing informed the Tribunal that she is seeking an increased amount of $53,349.65 for consumables. In the NDIA's Closing Submissions, it contends that Ms Blesing should not be permitted to seek a sum for this category of supports which is more than $36,447.36, because this is the figure that is specified in the s 53 order issued by the Tribunal which confined the issues in dispute in this proceeding. The lesser amount is the amount that was requested by Ms Blesing in May 2025 as set out in her earlier Position Paper. The NDIA told the Tribunal that it does not propose to address any claim by Ms Blesing for a sum above this amount.[166]
2. At the hearing, Ms Blesing informed the Tribunal that she no longer sought to rely upon on the 12-month schedule provided to the Tribunal by her former lawyers from Legal Aid, being Document T14 of the T-Documents. A slightly different version of this document was lodged with the Tribunal in the Joint HTB and is entitled "Joanne Blesing (NDIS - (number omitted) Monthly continence Expenditure Quote" dated 20 September 2023 ('Continence Items Quotation').[167] Ms Blesing told the Tribunal that she is now seeking funding for the items listed in a more recent document entitled "Consumable Expenditure April-24" ('2024 Expenditure List') which add up to a total of $53,349.65.[168]
3. The Expenditure List is an 13-page list of past expenditure by Ms Blesing over a 12-month period between April 2024 and April 2025. It evidences expenditure by Ms Blesing of a mixture of products and also fees for the provision of services (for example, "catheters and changes" as invoiced by Dr Bolt's clinic, podiatry, hand occupational therapy and so on). The Tribunal has decided that is would not be appropriate to treat this expenditure list of products and mixed services, as being a list of requested consumables for the current purposes of assessing what funding should be provided for Support No.7. Ms Blesing has raised this expenditure list at the hearing at a time when the NDIA did not have any opportunity to prepare to and respond to it. A s 53 Order was in place confining the types of supports to be considered under Support No.7. In May 2025, Ms Blesing stated that her position was that she was requesting the items in the Continence Items Quotation which lists 31 separate items. This document is forward looking and constitutes a list of requests rather than being a long list of past expenditure, including many items which are not consumables.
4. The Tribunal has used the Continence Items Quotation which was prepared with assistance from a nursing consultant at Dr John Bolt's office (see handwritten note at the end of the Continence Items Quotation) as the basis of assessing what consumables for continence and catheter care are "reasonable and necessary supports" for Ms Blesing and should be funded under the NDIS.

NDIA accepts that 17 of the requested consumable items are "reasonable and necessary supports"

1. In the NDIA's Closing Submissions, it stated that Ms Blesing was currently funded for $4,881.12 for every-day use items, continence-related equipment, and low-cost AT. The NDIA stated that it had reviewed the Continence Items Quotation and also a further list of items set out in an invoice issued by South Terrace Urology dated 20 September 2023 ('Catheter Items Quotation'),[169] and that it now accepts that the following consumables are "reasonable and necessary supports" for Ms Blesing:

(a) $893.28 per annum for hospital grade bacterial wipes ($77.44 per month); > > (b) $240 per annum for catheter sterile change kit ($20 per month); > > (c) $540.00 per annum for Cello Bluey (Halfsheet 250/box 3 ply continence protection) ($45.00 per month); > > (d) $1,209.60 per annum for Statlock stabilisation device ($100.80 per month); > > (e) $751.20 per annum for Supracath catheter (round silicon 40cm) ($62.60 per month); > > (f) $158.40 per annum for C4 Lignocaine Gel Syr 2% 10ml ($13.20 per month); > > (g) $1,380 per annum for Biological waste bags (MaxValue Tidy Bags 36 Litres Black 1000 bags) ($115 per month); > > (h) $544.80 per annum for Conveen Urinary bag 1500ml Sterile 90cm Tube Clamp Tap ($45.40 per month); > > (i) $273.00 per annum for Alcohol wipes Swap Briempak (5 boxes of 200) ($22.75 per month); > > (j) $146.52 per annum for Clinell Contiplan barrier cloth Pkt x 25 ($12.21 per month); > > (k) $25.80 per annum for kidney dish 235mm plastic ($2.15 per month); > > (l) $227.04 per annum for Cello Rediwipes (box x 100) ($18.92 per month); > > (m) $1,248.00 per annum for irrigation water 5 x 100ml bottle ($104.00 per month); > > (n) $2,640.00 per annum for syringes for catheter irrigation (x10) ($220 per month); > > (o) $520.80 per annum for bed pan slipper ($43.40 per month); > > (p) $1,710.00 per annum for Aaxis drain bags 2000ml non-sterile 90cm tube, no tap ($142.50 per month); and > > (q) $2,333.76 per annum for Dermalux soft towel lotion 5000ml (medical bed bath wash): ($194.48 per month).

2. The total cost of the above items as per the quotations is $14,842.20. The Tribunal does not propose to disturb the agreed position between the parties in respect of these consumables and concludes that they are each "reasonable and necessary supports" to be included in Ms Blesing's New SOPS.

Continence and catheter consumables remaining in dispute

1. There are 9 further continence and catheter care consumables remaining in dispute between the parties, as referred to in the Continence Items Quotation or the Catheter Items Quotation (Supports Nos.7a to 7h below and Microlax enemas, Support 7i).
2. The NDIA contends that the following 4 items should not be funded under the NDIS because they fall within the description of "a day-to-day living cost", specifically, item 3(a) of Schedule 2 of the NDIS Supports Transitional Rules and are "not an NDIS support" for the purpose of s 34(1)(f) of the NDIS Act:

(a) $2,757.12 per annum for the requested liquid soap (specifically, the requested two 1-litre containers of extra hygiene liquid soap for the total cost of $229.76 per month) ('Support No.7a'); > > (b) the requested Tork Xpress flushable multi-fold handtowels ('Support No.7b'); > > (c) brown bags for personal waste products ('Support No.7c'); and > > (d) hand sanitiser ('Support No.7d').

3. The NDIA contends that the following requested items should not be funded under the NDIS because they are personal protective equipment ('PPE') used by Ms Blesing's formal supports:

(a) $3,936.00 per annum of Medicom Safe Touch Advanced Guard Black Nitrile gloves in sizes XS, S, M, L and XL (that is, $328.00 per month) ('Support No.7e'); and > > (b) $501.12 per annum of Medicom SafeMask Premier Procedure 3Ply Earloop Masks (50 per box x 2) ($41.76 per month) ('Support No.7f').

4. The NDIA contends that the following requested items should not be funded under the NDIS because they would duplicate other supports provided under the NDIS and therefore funding for them is excluded by the operation of r 5.1(c) of the NDIS Supports Rules:

(a) Cello Underpads 5-Ply 20 Pads (specifically, this would be a duplication of the requested support, Cello Bluey - see paragraph [245(c)] above) ('Support No.7g'); and > > (b) Roar Wipes Small White (paper/tissue wipes) (specifically, the NDIA contends that this would be a duplication of wipes which the NDIA has agreed to fund - see paragraph [245] above) ('Support No.7h').

Further clarification sought regarding some of these supports

1. While this matter was reserved, the Tribunal sought clarification from the parties in respect of four of these supports. In response, the NDIA lodged further submissions and tendered a Third Supplementary HTB on 6 February 2026.[170]

Certain supports declared to be "not an NDIS support" - s 34(1)(f) of the NDIS Act

1. As a starting point, the Tribunal will consider whether each of Supports Nos.7a to 7h is the type of support declared to be "not an NDIS support", by reason of it falling under any of the items listed in Schedule 2 of the NDIS Support Transitional Rules. If so, the support will not be funded under the NDIS, even if that support also falls within the description of one of the items in Schedule 1 of the NDIS Support Transitional Rules as being "an NDIS support". The reason for this is that Schedule 1 of the NDIS Supports Transitional rules is subject to Schedule 2, in accordance with subsection 10(1), operating in conjunction with subsection 10(4), of the NDIS Act.

1. The Continence Items Quotation provides a description of this item as being "medical soap". Ms Blesing is unable to toilet or shower independently due to her disabilities. She is a required to use a shower chair when showering and she is required to use an enema and to be assisted by others to toilet while she is laying on her bed. Ms Blesing's support workers are required to manually handle Ms Blesing when she is toileting and being showered. Based on the lived experience given by Ms Blesing, the Tribunal finds that there is a higher than usual risk of infection and transmission between Ms Blesing and her support workers of gastrointestinal bacteria, due to the increased presence of faecal matter in the environment as a result of the toileting processes.
2. The Tribunal is satisfied that the extra hygiene liquid soap is used as part of Ms Blesing's hygiene routine to help prevent the spread of bacteria to lessen the risk of infections and illness and that this particular routine arises by reason of her disability. However, the Tribunal considers that the extra hygiene liquid soap falls under item 12(d) of Schedule 2 of the NDIS Supports Transitional Rules. In the NDIA's Further Submissions dated 6 February 2026, the NDIA agreed that the extra hygiene liquid soap would seem to fall under this item.
3. The definition of Item 12(d) as reproduced below:

(d) pharmaceuticals (including prescription medicines and non-prescriptions medicines), biological medicines, vaccines, sunscreens, weight loss products, vitamins, sport or athletic supplements, and homeopathic medicines;

1. The term "pharmaceuticals" is not defined in the NDIS Supports Transitional Rules or in the NDIS Act. The Tribunal notes that the Macquarie dictionary defines the term "pharmaceutical" as follows:[171]

-noun 2. an item, especially a medicine, sold at a pharmacy.

Also, pharmaceutic. [Latin pharmaceuticus, from Greek pharmakeutikos]

Macquarie Dictionary Publishers © Pan Macmillan Australia 2024

1. However, the Macquarie dictionary definition is extremely broad, particularly in consideration of the expanding and broad range of products that can be purchased at pharmacies. For this reason, the Tribunal considers the dictionary definition to be ambiguous and unhelpful when used for the purpose of interpreting the scope of item 12(d) of Schedule 2, particularly in light of the NDIS Act being beneficial legislation. The Tribunal considers that for present purposes, the term "pharmaceutical" in item 12(d) of Schedule 2 should be interpreted as meaning a compound or a mixture of compounds (synthetic or naturally occurring) used on the body either topically or internally for the purposes of diagnosis, treatment of or for the prevention of illness or disease, or for the purpose of preventing or relieving symptoms arising for any health condition or disease.
2. The Tribunal considers that the extra hygiene liquid soap being requested by Ms Blesing is made up of compounds or a mixture of compounds applied to a person's body topically for the prevention of illness, disease or infections. For this reason, the Tribunal concludes that the extra hygiene liquid soap is a "pharmaceutical".
3. The Tribunal concludes that:

(a) s 34(1)(f) of the NDIS Act is not met in respect of Ms Blesing's request for the extra hygiene liquid soap because this product falls within Item 12(d) and so it is declared under Schedule 2 to the NDIS Supports Transitional Rules, to be "not an NDIS support"; and consequently,

(b) Support No.7a is not a "reasonable and necessary support" under s 34(1) of the NDIS Act and funding for this support is not to be included in Ms Blesing's New SOPS.

1. It is not necessary for the Tribunal to proceed to a consideration of the remaining mandatory criteria under s 34(1) of the NDIS Act given that they are cumulative.

Support No.7b - flushable multi-fold handtowels

1. Item 3(a) of Schedule 2 falls under the general category of "day-to-day living costs - food and groceries" and includes (among other items):

(a) groceries including all food, beverage, cleaning, household and health products;

2. The NDIA contends that the flushable multi-fold handtowels fall within item 3(a) of Schedule 2. The Tribunal agrees. They are an alternative product to using toilet paper. The handtowels are household grocery items and for this reason, the Tribunal considers them to be a day-to-day living cost (grocery).
3. The Tribunal concludes that:

(a) s 34(1)(f) of the NDIS Act is not met in respect of Ms Blesing's request for the flushable multi-fold handtowels because this product falls within Item 3(a) and so it is declared under Schedule 2 to the NDIS Supports Transitional Rules, to be "not an NDIS support"; and consequently,

(b) Support No.7b is not a "reasonable and necessary support" under s 34(1) of the NDIS Act for Ms Blesing and funding for this support is not to be included in Ms Blesing's New SOPS.

1. It is not necessary for the Tribunal to proceed to a consideration of the remaining mandatory criteria under s 34(1) of the NDIS Act given that they are cumulative.

Support No.7c - brown bags for personal waste products

1. The NDIA contends that the brown paper bags fall within item 3(a) of Schedule 2. The Tribunal agrees. They are a regular household item. The Tribunal has taken into account the purpose for which they will be used by Ms Blesing, however, the exclusionary effect of them being an item which falls within item 3(a) of Schedule 2 is clear. The brown paper bags are a household grocery item and for this reason, the Tribunal considers them to be a day-to-day living cost (grocery).
2. The Tribunal concludes that:

(a) s 34(1)(f) of the NDIS Act is not met in respect of Ms Blesing's request for the brown paper bags because this product falls within Item 3(a) and so it is declared under Schedule 2 to the NDIS Supports Transitional Rules, to be "not an NDIS support"; and consequently,

(b) Support No.7c is not a "reasonable and necessary support" under s 34(1) of the NDIS Act for Ms Blesing and funding for this support is not to be included in Ms Blesing's New SOPS.

1. It is not necessary for the Tribunal to proceed to a consideration of the remaining mandatory criteria under s 34(1) of the NDIS Act given that they are cumulative.

1. In the NDIA's Further Submissions dated 6 February 2026, the NDIA contends that hand sanitiser would seem to fall under item 12(d) of Schedule 2 of the NDIS Supports Transitional Rules.
2. On 6 February 2026, the NDIA lodged with the Tribunal the Assistive Technology, Home Modifications and Consumables Code Guide 2025-26 issued by the NDIA on 14 October 2025. The Tribunal notes the following NDIS line item listed in this guide (emphasis added):

Continence - consumables 03_092100082_0103_1_1 > > Sterile gloves, sterile water ampoules, normal saline, single use powders, wipes, antiseptic cleansing solutions, skin care (cleansers, barrier and protective creams), odour control, lubricants, hand sanitiser and wound care.

3. The Tribunal has taken into account the inclusion of hand sanitiser in this guide; however, it considers that it must assess whether this item for Ms Blesing is a "reasonable and necessary support" by reference to the criteria in the NDIS Act, operating in conjunction with the Supports Rules and the NDIS Supports Transitional Rules.
4. For the same reasons as outlined under the heading Support No.7a above, the Tribunal concludes that this item is not a "reasonable and necessary support" under the NDIS Act because it is a "pharmaceutical" and therefore falls into the description of item 12(d) of Schedule 2 of the NDIS Supports Transitional Rules. For these reasons, this item is "not an NDIS support" and regardless of whether it falls within Schedule 1 of those rules, the criterion under s 34(1)(f) of the NDIS Act is not met in respect of hand sanitiser, and funding for it should not be included in Ms Blesing's New SOPS. It is not necessary for the Tribunal to proceed to a consideration of the remaining mandatory criteria under s 34(1) of the NDIS Act given that they are cumulative.

1. The NDIA contends that the provision of the requested gloves is personal protective equipment ('PPE') that are to be provided by "support workers providers", and

"are already included in the cost of funding these supports".[172] The NDIA elaborated in its Closing Submissions that in respect of Ms Blesing's request for gloves in sizes XS to XL that it would not fund PPE to be used by formal supports because it is the responsibility of the service provider to provide a safe workplace for support staff and the provision of PPE is included in "the hourly rate". 2. The NDIA acknowledges, in its Further Submissions dated 6 February 2026, that the NDIA has listed "sterile gloves" for continence, as a support that can be funded under the NDIS in the Assistive Technology, Home Modifications and Consumables Code Guide 2025-26 issued by the NDIA on 14 October 2025. Specifically, the Tribunal notes the following line item listed in this guide (emphasis added):

Continence - consumables 03_092100082_0103_1_1 > > Sterile gloves, sterile water ampoules, normal saline, single use powders, wipes, antiseptic cleansing solutions, skin care (cleansers, barrier and protective creams), odour control, lubricants, hand sanitiser and wound care.

3. In the Combined Table of Supports, Ms Blesing appears to accept that she is responsible for providing "all PPE to workers", in light of the NDIA having agreed that she is to "self-manage" her NDIS plan, but only provided that her plan is funded by the NDIA at the "Maximum Rates per hour for workers" at "her revised number of support hours". If provided with the higher hourly rate for the higher revised number of hours, Ms Blesing was content that the requested PPE could be "funded from this pool of money".
4. Firstly, the Tribunal considers that its decision about how many hours of support worker assistance Ms Blesing should be funded for under the New SOPS, or whether this assistance is be funded at the standard hour rate or the high intensity rate, is an irrelevant consideration as to whether the requested gloves intended to be used by Ms Blesing's support workers, are "reasonable and necessary supports" under the NDIS Act.
5. In relation to Support No.7e, in the NDIA's Third Supplementary HTB, it included a document entitled Disability Support Worker Cost Model Assumptions and Methodology 2025-26 (first released on 16 June 2025 with a stated operative date of 1 July 2025) ('DSW Cost Model 2025-26'). This document constitutes policy guidance issued by the NDIA. It was not before the Tribunal at the substantive hearing. Ms Blesing was provided with an opportunity to respond to it before this Decision was handed down.
6. In the DSW Cost Model 2025-26, the NDIA states that it has a role, as market steward, to create an efficient and sustainable consumer driven marketplace for the supply of disability supports. The NDIA states that it regulates the commercial relationships between providers and participants, including through price regulation. The term "provider" is not defined, but it would appear to be broad enough to include a person who is undertaking the duties of a support worker to an NDIS participant who is either employed as an employee or engaged as an independent contract by the participant. The NDIA states that pricing arrangements aim to maintain and increase market supply and help markets grow to a more mature state in the future, while recognising the need for financial sustainability.
7. The NDIA states that the DSW Cost Model 2025-26 is used to determine the price limits for supports that are delivered by disability support workers. The NDIA states that this model (emphasis added), "estimates the fully loaded cost of a billable hour of support considering: base pay; shift loadings; leave entitlements; salary on costs; employee allowances**; operational overheads (including supervision costs, utilisation costs and workers' compensation costs)**; corporate overheads and margin". In the DSW Cost Model 2025-26, the NDIA states that the cost model estimates (emphasis added):

the efficient costs of providing supports by considering: > > • Base Salary costs, including shift loadings. Note that in the Cost Model, costs are based on permanent worker costs. > > • Direct On-costs, which covers those costs of employment associated with Superannuation entitlements, Annual Leave entitlements, Personal Leave entitlements, Long Service Leave entitlements and Employee Allowances. > > • Operational Overheads, which covers those costs that are in the operational control of the provider and include workers compensation costs, utilisation costs (billable versus unbillable hours), supervision costs (including quality and safeguarding costs) and workforce rostering and balance measures such as the share of the workforce that is permanent or casual, and the extent to which overtime is used by the business. > > • Corporate Overheads, which covers those costs incurred to run the administrative side of a business. These costs include the accounting, human resources, legal, marketing, and information technology functions. > > • Margin, which represents the return that the provider makes because of the provision of working capital to the business.

8. Table 4 of the DSW Cost Model 2025-26 specifies that loadings between 21.65 per cent for a disability support worker Level 1, and 39.90 per cent for disability support worker Level 4, are applied to the billable cost per hour of a disability support worker, in respect of the "Impact of Operational Overheads". These loadings are significant.
9. In the NDIA's Further Submissions dated 6 February 2026, it contends that the obligations referred to under the Work Health and Safety Act 2011 (Cth) ('WHS Act') and the Work Health and Safety Regulation 2025 (Cth), apply to "service providers" who employ the support workers. However, the Tribunal notes that s 19 of the WHS Act provides that a "person conducting a business or undertaking" ('PCBU') must ensure, so far as is reasonably practicable, that the health and safety of other persons is not put at risk from work carried out as part of the conduct of the business or undertaking. This legislation provides a national framework to secure the health, safety and welfare of employees, contractors and volunteers in all work environments. The PCBU (which may include but is not limited to service providers), must maintain safe systems of work and ensure that workers are trained. This duty is not able to be transferred to others.
10. A PCBU is an individual or organisation that is conducting a business or undertaking whether it be for profit, or not for profit. On 27 October 2025, Ms Blesing lodged a set of agreements between herself and individual support workers, executed on different dates ('SW Agreements'). At the top of the agreements, Ms Blesing specifies the position (that is, support worker or senior support worker), their level, the rate they will be paid for the first initial specified period during which they are being trained, and the "NDIS Rate Type". The agreements state that the person's rates will increase as they are able to work at independent, senior or an advanced level. The agreements link the person to various training materials.
11. Based on the SW Agreements, the Tribunal finds that Ms Blesing is conducting a PCBU in her home and that the support workers who are a party to those agreements attend her home and carry out work in Ms Blesing's PCBU. Rule 36(5) of the Work Health and Safety Regulation 2025 (Cth) ('WHS Regulations') provides that where the duty holder is unable to eliminate a risk, they "must minimise the remaining risk, so far as reasonably practicable, by ensuring the provision and use of suitable personal protective equipment".
12. Rule 44 of the WHS Regulations provide as follows:

44 Provision to workers and use of personal protective equipment > > > (1) This section applies if personal protective equipment is to be used to minimise a risk to health and safety in relation to work at a workplace in accordance with section 36. > > > > (2) The person conducting a business or undertaking who directs the carrying out of work must provide the personal protective equipment to workers at the workplace, unless the personal protective equipment has been provided by another person conducting a business or undertaking.

13. The Tribunal concludes that these statutory obligations apply to Ms Blesing in respect of the support workers working in her home.
14. As mentioned above, the NDIS Price Guide states that the NDIA uses the DSW Model for supports delivered by disability support workers and estimates the fully loaded cost of a billable hour of support, considering factors including employee allowances and operational overheads.[173] The NDIA considers that the provision of PPE falls within the category of "operational overheads", irrespective of whether Ms Blesing engages a service provider or employs support workers directly.[174]
15. The DSW Cost Model 2025-26 does not expressly state that the cost of PPE is included in the definition of an operational overhead. However, the Tribunal considers that given Ms Blesing's obligation to the support workers under the WHS Act and WHS Regulations as set out above, the cost of PPE falls into the description of "supervision costs (including quality and safeguarding costs)" because the gloves are used to prevent the spread of bacteria between the person wearing the gloves, and Ms Blesing when undertaking manual transfers, handling her catheter or assisting her to undertake other personal care tasks including toileting and brushing her teeth. On this basis, it would seem that the gloves are used by the support worker for their protection and is a "safeguarding cost" of Ms Blesing's PCBU.
16. The Tribunal is satisfied that a provision for the cost of the gloves is already included in the billable rates for Ms Blesing's support workers which she is entitled to claim under her core supports budget in relation to the provision of support worker services. For this reason, the Tribunal agrees with the NDIA's contention that the provision of additional funding for Support No.7e would duplicate the provision of funding provided for supervision costs including quality and safeguarding costs already provided for in the funding for Support No.1. The Tribunal concludes that r 5.1(c) of the Support Rules operates to exclude the provision of funding for Support No.7e and that Ms Blesing is able to use some of the funding she may receive for Support No.1 to pay for Support No.7e. Funding for Support No.7e is not to be added to Ms Blesing's New SOPS which will implemented to give effect to this Decision.

1. Ms Blesing has requested face masks. Such equipment is used as protection against the transmission of bacteria and/or viruses from one person to another. The Tribunal finds that the cost of this support is also a safeguarding cost and so it is a supervision cost which an operational overhead. Ms Blesing's PCBU is obligated to pay for this type of PPE. For this reason, the Tribunal concludes that a provision for the requested face masks is already included in the funding approved for support worker assistance for Ms Blesing, for the same reasons as explained above in respect of Support No.7e.
2. The Tribunal concludes that r 5.1(c) of the Support Rules operates to exclude the provision of funding for Support No.7f and that Ms Blesing is able to use some of the funding she may receive for Support No.1 to pay for Support No.7f. Funding for Support 7f is not to be added to Ms Blesing's New SOPS which will implemented to give effect to this Decision.

1. As mentioned above, the NDIA contends that Support No.7g duplicates funding which has already been provided to Ms Blesing for the product "Cello Bluey" - see subparagraph [296(c)] above. Cello Bluey and Cello underpads are the same type of product used for the same purposes. The Tribunal agrees that funding for Support No.7g is excluded by operation of r 5.1(c) of the Support Rules because they are a duplication of the funding provided for the product "Cello Bluey". Funding for Support 7g is not to be added to Ms Blesing's New SOPS which will implemented to give effect to this Decision.

Support No.7h - small white Roar-branded wipes

1. As mentioned above, the NDIA contends that Support No.7h duplicates funding which has already been provided to Ms Blesing for the product as "Cello Rediwipes" - see subparagraph [292(l)] above. Small white Roar-branded wipes and Cello Rediwipes are the same type of product used for the same purposes. The Tribunal agrees that funding for Support No.7h is excluded by operation of r 5.1(c) of the Support Rules because they are a duplication of the funding provided for the product Cello Rediwipes. Funding for Support 7h is not to be added to Ms Blesing's New SOPS which will implemented to give effect to this Decision.

1. Ms Blesing has requested funding to pay for Microlax enemas used to facilitate her bowel movements. Ms Blesing's inability to control her bowel movements without an enema is a symptom of the neurological damage (incomplete) to her spine, arising from her condition of MS. Ms Blesing's inability to control her bowel movements is not a health condition in its own right but rather a symptom of her health condition of MS. The Tribunal concludes that the enema does not fall into the description of Item 12(a) in Schedule 2 of the NDIS Support Transition Rules.
2. The NDIA contends that this item is "classed as a pharmaceutical product" and is the responsibility of the healthcare system to fund and therefore, is "not an NDIS support".[175] In the NDIA's Further Submissions dated 6 February 2026, it contends that this product falls within item 12(d) of Schedule 2 of the NDIS Supports Transitional Rules.
3. The Tribunal agrees and concludes that the enema falls into the definition of "pharmaceuticals" in Item 12(d) in Schedule 2 of the NDIS Supports Transitional Rules, because it is a liquid comprising a mixture of compounds (synthetic or naturally occurring) used internally in Ms Blesing's body for the purposes of relieving a symptom, namely, her inability to control her bowel movements arising from the incomplete neurological damage to her spine.
4. The Tribunal concludes that s 34(1)(f) is not met in respect of Support No.7i. It is not necessary for the Tribunal to proceed to a consideration of the remaining mandatory criteria under s 34(1) of the NDIS Act given that they are cumulative. Funding for Support 7i is not to be added to Ms Blesing's New SOPS which will implemented to give effect to this Decision.

Conclusion in relation to Support No.7 (items 7a to 7i)

1. The Tribunal notes that the Breakdown of Supports (prepared by Mr Dennis) records that Ms Blesing is currently funded for an increased amount of $18,625.04 for "consumables" which is a sufficient provision for the above agreed consumables referred to in paragraph [291] above, totalling $14,842.20. Specifically, the consumables are described in the Breakdown of Supports as follows:

Wound and Pressure Care > > (i) Wound and pressure care - up to the amount of $1,000; > > Low-cost assistive technology (AT), including hearing and disability-related health equipment > > (ii) Low Cost AT - Prosthetics And Orthotics - up to the amount of $1,500.00; > > (iii) Low Cost AT - Personal Care And Safety - up to the amount of $1,000.00; > > (iv) Low Cost AT - up to the amount of $15,125.04.

2. The Tribunal has concluded that no further funding should be included in the New SOPS for Supports Nos. 7a to 7i.

CONSIDERATION - SUPPORTS NOS.8 AND 9 (CUSTOMISED FOOTWEAR & ORTHOTICS)

1. Supports Nos. 8 and 9 are used together as Ms Blesing's footwear. Support No. 8 is a request for "$3,345 per annum for one pair of custom footwear" and Support No.9 is a request for "$1,410 for orthotic devices".

Stage One: Whether the request for Support Nos. 8 and 9 are "reasonable and necessary supports", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support Nos. 8 and 9 could be reasonable and necessary supports, as the provision of these support is aligned with the objectives under subsections 3(1)(a), (c), (d) and (g) in the NDIS Act, and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support Nos. 8 and 9.

Stage Two: Whether Support Nos. 8 and 9 meet the criteria under subsection 34(1) of the NDIS Act

1. At the hearing, Dr Chia gave evidence the importance for Ms Blesing to have the appropriate support under her feet, namely, customised footwear and fitted orthotics. He said that Ms Blesing is likely to have imperfect sensation in her joints and is at a higher risk of injury. It was not in contention between the parties that Ms Blesing requires customised footwear (boots) and orthotics.
2. Initially, Ms Blesing requested $12,705 per annum for three pairs of customised boots. The NDIA did not agree that this request should be funded under the NDIS, because it considers this number of pairs of boots to be excessive. At the hearing, Ms Blesing reduced this request to $3,345.00 for one pair of customised footwear. In the NDIA's Closing Submissions, it accepted that Ms Blesing required one custom-made pair of boots based upon the oral evidence of Ms Blesing and Dr Chia at the hearing.
3. The NDIA refers to the quotation issued by Deleo Orthopaedic Footwear ('Deleo') on 8 February 2024 for a pair of bespoke boots and Velcro straps, for the price of $2,850.00 and for a full-length custom-made orthotic (to be inserted into the boot) for $495.00.[176]
4. The NDIA agreed that a sum of $2,850 for a single pair of custom-made boots (including Velcro straps) in accordance with the Deleo quote, is a "reasonable and necessary support" for Ms Blesing and should be added to her NDIS plan. However, the NDIA contends that Ms Blesing is able to use her approved budget of $1,500 for low-cost orthotics (as of the date of those submissions), to pay for the $495.00 orthotic device in satisfaction of Ms Blesing's request for Support No.9. In Ms Blesing's Current SOPS, the approved budget for "low-cost AT, Prosthetics and Orthotics and personal care and safety" has been increased to $2,500.00. The Tribunal agrees with the NDIA's contention that Support No.9 is able to funded out of Ms Blesing's current approved budget for "low-cost AT, Prosthetics and Orthotics and personal care and safety".

1. The Tribunal concludes that $2,850 for a single pair of custom-made boots (including Velcro straps) is a "reasonable and necessary support" for Ms Blesing and is to be added to her NDIS plan but no additional funding is to be added her plan for the fitted orthotic.

CONSIDERATION - SUPPORT NO.10 (MEAL PREPARATION AND DELIVERY)

1. Support No.10 in the s 53 Order is a request for "$117 per week for meal preparation and delivery".

Stage One: Whether the request for Support No.10 is a "reasonable and necessary supports", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No.10 could be reasonable and necessary support, as the provision of each such support is aligned with the objectives under subsections 3(1)(a) and (c), and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.10.

Stage Two: Whether Support No.10 meets the criteria under subsection 34(1) of the NDIS Act

1. On the second day of the hearing, Ms Blesing confirmed that she is seeking Support No.10 and she referred to a Light n' Easy quotation for the $117.00 per week which "removes the component of the cost for the food". Ms Blesing indicated that she is able to "manage" the food from Light n' Easy without having complications with her condition of IBS.
2. At the hearing, Ms Blesing was asked why her support workers were unable to assist her in respect of meal preparation. Ms Blesing said that due to her IBS, she is "extremely intolerant to most foods". She said that the chemicals and bacteria in cooked and microwaved food causes her "extreme pain". She says it gets worse over time and that stress makes it worse. Ms Blesing said a "controlled kitchen" is "obviously far safer" and that carers do not have training to have a "kitchen of that level". Ms Blesing said that she can have a small dish, like toast with cheese and avocado, prepared at her home but she cannot have a meal prepared there, because of her needs.
3. When asked whether Ms Blesing could tell the support workers what she needed to eat so that she can tolerate it with her IBS, Ms Blesing provided another reason why her support workers could not undertake the task of meal preparation for her. Ms Blesing suggested that they would have to spend "an hour of their time", and that their regime, with her, is "already tight". When asked whether one hour could be added to their time with her, Ms Blesing said that "everything is about what is cheaper". Ms Blesing contends that it would be cheaper for her to receive the meal service.
4. The NDIA contends that Ms Blesing's support workers are able to undertake the task of meal preparation within the time they are already funded under the NDIS to provide assistance to Ms Blesing. The NDIA refers to the breakdown provided at the time of hearing and specifically, to the 36 hours per week that Ms Blesing is funded to receive assistance by a support worker with "personal domestic activities", and a further 16 hours per week for "assistance with household cleaning and other activities").
5. In Dr Wilson's Report, she states that Ms Blesing had reported issues in the past, when support workers had endeavoured to prepare meals for her.[177] However, Dr Wilson does not say what those issues were or express any view about them or whether there is a disability-related need for Ms Blesing to have her meals prepared and delivered by an external meal service provider rather than by her support workers.
6. In the NDIA's Closing Submissions, it contends that Ms Blesing does not require a meal services due to the level of support worker assistance she currently receives. On the first day of the hearing, the NDIA confirmed that this remains its position in respect of Ms Blesing's request for Support No.10. The NDIA contends that the meal service for Ms Blesing would not represent "value for money" under s 34(1)(c) of the NDIS Act and that it would duplicate other services received by Ms Blesing under the NDIS, relying upon the exclusion referred to in r 5.1(c) of the NDIS Supports Rules.[178]

1. There is a paucity of evidence about the cost-effectiveness or not of having Ms Blesing's meal prepared externally and delivered to her or whether she should be funded to have support workers prepare them for her at home. The Tribunal does not accept that a meal delivery service is more capable that a properly skilled support worker to prepare meals that Ms Blesing is able to tolerate in light of her IBS. Ms Blesing is able to convey to her support workers her dietary requirements and the support workers can prepare meals in accordance with those instructions. The Tribunal has concluded that significantly increased number of hours of support worker assistance for Ms Blesing is to be funded under NDIS plan (that is, 46.5 hours per day). In particular during the day, the support workers present at a 2:1 ratio at the "high intensity" rate, will have the opportunity to attend to meal planning, acquiring groceries, meal preparation and cleaning up.
2. The Tribunal concludes that the provision of funding for meal preparation and delivery services would be a duplication of the supports already funded and provided to Ms Blesing in the form of support worker assistance at the level referred to above during which the Tribunal is satisfied they will have the opportunity to attend the tasks of ensuring the Ms Blesing has meals she is able to consume every day. The Tribunal concludes that r 5.1(c) of the Supports Rules applies to exclude NDIS funding for Support No.10. Funding for this support is not to be included in the New SOPS to be approved for Ms Blesing when implementing this Decision.

CONSIDERATION - SUPPORT NO.11 (HIRE TAXIS AND TRANSPORT)

1. Support No.11 in the s 53 Order is a request for "$575 per week for transport to hire taxis and transport". On day two of the hearing, Ms Blesing confirmed that she is seeking this support and referred to having received such support previously.

Stage One: Whether the request for Support No.11 is a "reasonable and necessary supports", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of funding for cost of hire taxis and transport could be reasonable and necessary supports, as the provision of each such support is aligned with the objectives under s 3(1)(c) and s 3(1)(d) of the NDIS Act and the principles under s 4(1) and s 4(11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support No.11.

Stage Two: Whether Support No.11 meets the criteria under subsection 34(1) of the NDIS Act

1. Ms Blesing's request for funding for Support No.11 equates to a funding amount of $29,900 per annum for transport supports (that is, $575 per week). Ms Blesing currently receives an NDIS-funded "recurring transport budget" of $3,456.00.
2. In the NDIA's SFIC, it contended that Ms Blesing's request for funding for Support No.11 is "excessive and not reasonable and necessary".[179] The NDIA accepts that it is "reasonable and necessary" to provide funding to Ms Blesing for "Level 3 transport ($3,456 per year)". However, the NDIA contends there is insufficient evidence to justify Ms Blesing receiving funding beyond Level 3.[180] The NDIA highlighted that this amount (of $3,456) is an increase in funding from the amount in Ms Blesing's NDIS plan (as of the date of the NDIA's SFIC). The NDIA contended that any additional funding "is a day-to-day living cost (r 5.1(d))".
3. Further, in the NDIA's SFIC, it contended that:

(a) Mr Burden's Report indicated that Ms Blesing went into the community three or four times a week in a "wheelchair accessible taxi"; > > (b) the provision or hire of a modified vehicle equipped with a wheelchair lift and secure tie-downs is recommended;[181] and > > (c) such vehicles are "not an NDIS support", because they fall within the description of item 6(b) of Schedule 2 to the Transitional Rules. The Tribunal has considered a separate request by Ms Blesing for funding to hire an accessible van as addressed below under the heading "Consideration - Support No.33 (Hire of Accessible Van)" and has concluded that this is "not an NDIS support" as defined by s 10 of the NDIS Act and consequently, that s 34(1)(f) of the NDIS Act is not met in respect of this requested support and should not be funded under Ms Blesing's NDIS plan.

4. As set out in the NDIA's Closing Submissions, it now contends that the Tribunal does not have the discretion to approve funding for Support No.11 for a different reason, specifically:

(a) subsection 6(2) of the National Disability Insurance Scheme (Old Framework Plans) Determination 2024 (Cth) ('Determination')[182] provides a method for calculating funding amounts per funding period for recurring transport supports; > > (b) under subsection 6(2)(a), the number of funding periods during which recurring transport is considered to be "reasonable and necessary" is identified and expressed as a decimal (for example, if recurring transport is found to be reasonable and necessary in each funding periods in one year, and there are monthly periods, the number would be 0.12); > > (c) the factor (of 0.12) identified in accordance with the above, is then multiplied by: > > > (i) the applicable amount identified in s 6(2)(b) - which is either 6(2)(b)(i), 6(2)(b)(ii) or 6(2)(b)(iii); and > > > > (ii) should a decision-maker find that transport should be included in each funding period, then the annual amount will always equal the amount identified in 6(2)(b); > > (d) the Determination removes any discretion to provide funding for recurring transport support, other than as described in 6(2); and > > (e) the Determination does not include an exception to exceed the amounts identified in 6(2)(b).

5. For those reasons, the NDIA contends that the level of recurring transport supports "can be objectively determined".
6. In the NDIA's Closing Submissions, it contends that:

(a) Ms Blesing currently receives recurring transport funding in the amount of $3,456.00 over the course of her current plan, which includes 12 funding periods; > > (b) this amount of funding equates to Level 3 transport support funding; > > (c) Ms Blesing does not currently work or study for at least 15 hours per week, which means that this amount is incorrect; and > > (d) any funding in addition to the funding provided in accordance with the Determination, would amount to a duplication of supports and be excluded funding under r 5.1(c) of the Supports Rules.

7. The NDIA highlights that Ms Blesing is already receiving the highest level of transport funding that can be provided by the NDIA, and that this level of funding "is generally reserved for participants who need extra transport funding to travel to work and/or study". The NDIA contends that this "elevated level of funding" provides Ms Blesing with "adequate support to attend her medical appointments and to access the community".
8. The NDIA acknowledges that Ms Blesing has lodged a number of tables as to her proposed taxi needs (comprising schedules of weekly travel), and that on the final hearing day Ms Blesing confirmed that she sought to rely upon a table forming Exhibit A16 (which was lodged with the Tribunal on the sixth hearing day on 25 August 2025). The NDIA highlighted that Ms Blesing is seeking 8.65 times of the maximum level of funding that the NDIA generally provides to an NDIS participant under its operational guidelines. The NDIA contends that:

(a) the table put forward by the Applicant is an "unrealistic ambit claim" and suggested that Ms Blesing "needs to put forward a proper basis as to why she should be funded for transport to these outings, which have not occurred"; > > (b) were Ms Blesing to undertake the number of taxi trips set out in the table forming Exhibit A16: > > > (i) she would not have the time to access the capacity building supports that she is currently funded for in her NDIS plan and the significant level of further supports that she is seeking; and > > > > (ii) she would not need the level of support worker assistance that she seeks and that she is funded for; > > (c) Ms Blesing's plan provides her with $39,509.60 funding for support worker assistance community access and recreation, which equates to 10 hours per week of 1:1 support. The NDIA contends that community access in Ms Blesing's table at Exhibit A16 far exceeds this level; > > (d) Ms Blesing has requested funding in her table for taxi trips to therapy supports for which she is not funded, specifically: > > > (i) three neuro-physiotherapy appointments per week; > > > > (ii) three hair-dressing appointments per week; and > > > > (iii) two chiropractor appointments per week; and > > (e) given the extensive level of support worker assistance that Ms Blesing has, and the fact that the Applicant resides in the Adelaide CBD, and has a powered wheelchair, she should be able to access public transport to attend at least some of her appointments without requiring taxi services.

9. The NDIA accepts that Ms Blesing should be provided with the funds to allow her to attend her supports that cannot be easily reached by public transport and undertake a reasonable level of socialisation. However, the NDIA submits that Ms Blesing can do so using the Level 3 funding that has been allocated to her.
10. In McGarrigle v National Disability Insurance Agency, the NDIA submits that:

(a) the NDIS participant in that matter sought taxi funding to travel to and from a five-day a week support that was provided in his plan; > > (b) there was an absence of public transport that could take Mr McGarrigle from his house to the support, and his mother's paid employment prevented her from being able to drive her son to the support and to pick him up; > > (c) the Tribunal (in that matter) agreed that the five return taxi trips were reasonable and necessary but declined to fund all of them, due to its concerns as to the financial sustainability of the NDIS; > > (d) the presiding judge, Justice Mortimer (as she then was), overturned the Tribunal's finding, upon ruling that it needed to be funded in full, if a support has been held to be reasonable and necessary.

11. However, the NDIA contends that it is erroneous to view McGarrigle decision, as authority for the proposition that the NDIA is required to fund a participant for any and all of the transport support that they seek. The NDIA contends that "an analysis needs to take place as to whether the support sought by a participant is reasonable and necessary". The NDIA contends that Ms Blesing seeks transport funding for catching up for lunch, dinners and coffees with her mother, and other family and friends, 11 times a week. The NDIA notes that on two occasions, Ms Blesing is seeking transport funding to drive in the Adelaide Hills for relaxation and/or lunch. The NDIA repeated its contention, as referred to the NDIA's SFIC at paragraph [63], that "this type of taxi usage is a day-to-day living cost, which cannot be funded by the Agency (r 5.1(d))".

Conclusion by the Tribunal in relation to Support No.11

1. In light of the NDIA's recent contentions relating to the recently introduced Determination, the Tribunal does not need to undertake a detailed consideration of the NDIA's contentions other than those relating to this Determination. The Tribunal agrees with and accepts the NDIA's contention that the Tribunal does not have discretion to approve funding for Ms Blesing for recurring transport supports in excess of the amount specified for Level 3 transport, that is, $3,456 per annum, as set out in subclause 6(2)(b)(iii) of the Determination.
2. Section 33 of the NDIS Act prescribes the matters that must be included in a participant's plan. Subsection 33(2) provides that a participant's plan must include a SOPS that specifies (among other matters), "the management of the funding for supports under the plan (see also Division 3)" (subsection 33(2)(d)) and "the management of other aspects of the plan" (subsection 33(2)(e)).
3. In October 2024, amendments to the NDIS Act introduced some new provisions into s 33 of the NDIS Act, specifically, subsection 33(2A) to (2F) inclusive which deal with the categorisation of some supports into groups and the specification in a SOPS of "funding periods" and "funding amounts".
4. Of relevance in this application, subsection 33(2A) of the NDIS Act is reproduced below (emphasis added):

(2A) In addition to the matters mentioned in paragraphs (2)(a) to (e), the statement of participant supports must:

(a) specify that funding will be provided under the plan to or in relation to the participant, for all reasonable and necessary supports funded under the plan taken as a whole, up to a specified amount (the total funding amount ) worked out under subsection (2B); and

(b) in accordance with any requirements determined under subsection (2E) for the purposes of this paragraph, categorise the reasonable and necessary supports specified under paragraph (2)(b) into one or more groups of supports identified in the statement; and

(c) specify that funding will be provided under the plan to or in relation to the participant, for supports in each group identified under paragraph (b) of this subsection, up to an amount (a funding component amount) specified in the statement for the group that is worked out in accordance with any requirements determined under subsection (2E) for the purposes of this paragraph; and

(d) specify that funding will be provided under the plan to or in relation to the participant for reasonable and necessary supports during specified periods (each of which is a funding period).

Note: For paragraph (b), if the statement specifies only a single reasonable and necessary support or class of such supports, the support or class may be categorised and identified as a single group.

1. Since 9 October 2024, subsection 33(2E) now provides that the Minister may determine a range of matters including:

(a) requirements for categorising supports into groups; > > (b) how to work out the funding component amount for a group of supports; > > (c) how to work out when a first funding period is to start; and > > (d) requirements with which the CEO must comply, methods or criteria that the CEO is to apply, and matters that the CEO may, must or must not take into account, in doing any of the following:

(i) working out a funding component amount;

(ii) specifying funding periods for the purposes of paragraph (2C)(a);

(iii) deciding any other matter for the purposes of subsection (2A), (2C) or (2D).

1. The Minister for the NDIS made such a determination on 7 October 2024 which took effect on 9 October 2024. The Tribunal sets out below the provisions in clauses 6(2) and (3) in the Determination which deal with "recurring transport supports". These provisions are relevant to Support No.11 because Ms Blesing is seeking a weekly sum of funding in respect of transport supports, specifically, to be used to pay for hire taxis and transport. For this reason, Ms Blesing is requesting "recurring transport supports" in the quantum of $575 per week (equating to $29,900 per annum).
2. Subclauses 6(2) and (3) provide as follows:

(2) For the purposes of paragraph 33(2A)(c) of the Act, the funding component amount for a group of reasonable and necessary supports consisting of recurring transport supports is, subject to subsection (3) of this section, the amount worked out by multiplying:

(a) the number (which may be a decimal number) of units of the supports that the decision-maker is satisfied are reasonable and necessary for the participant for the period of the plan (where the unit of measure is 1 year); by

(b) whichever of the following is applicable:

(i) unless subparagraph (ii) or (iii) applies - $1,784;

(ii) if subparagraph (iii) does not apply and the participant is working or studying (or both) for less than 15 hours each week, is attending day programs, or requires the supports for social, recreational or leisure activities - $2,676;

(iii) if the participant is working or studying (or both) for at least 15 hours each week - $3,456.

(3) The amount is to be rounded to the nearest cent (rounding 0.5 cents upwards).

381. These provisions reflect NDIA-issued operational guidelines which have been in place for a considerable period of time, and that refer to three different levels of funding for recurring transport supports. The making of the Determination formally confines the provision of recurring transport funding to an NDIS participant, to one of the three levels listed in subclauses 6(2)(b)(i), (ii) or (iii) of the Determination. On this basis, the Tribunal accepts the NDIA's contentions that the Tribunal no longer has the discretion to approve funding for an NDIS participant (such as Ms Blesing) for recurring transport supports of an amount which exceeds the highest of the three levels of funding set out in subclause 6(2)(b) of the Determination, based upon the operation of s 22(2A) of the NDIS Act operating in conjunction with subclause 6(2) of the Determination.

1. Ms Blesing's Current SOPS includes approved funding for Ms Blesing for recurring transport supports at the highest level, that is, Level 3 which equates to $3,456 per annum (to be paid in fortnightly instalments). The Tribunal agrees that this is a "reasonable and necessary support" for Ms Blesing which is subject to a stated requirement set out in the Determination for Level 3, being that the participant is engaged in study or work for more than 15 hours per week. The Tribunal heard evidence that Ms Blesing is she active in the community as a disability advocate. Whilst Ms Blesing is not remunerated for such advocacy, the Tribunal considers that broadly speaking, this activity falls within the concept of work (despite being unpaid work), and so the Tribunal is satisfied that Level 3 transport funding should be made available to Ms Blesing to support her to attend to such activities on a regular basis.
2. It is not necessary for the Tribunal to consider the "reasonable and necessary supports" criteria under s 34(1) of the NDIS Act in respect of Ms Blesing's request for additional funding above the amount of $3,456 per annum, because it has concluded as a matter of law that the Tribunal has no discretion to approve funding for Ms Blesing for recurring transport supports (into which category her request for Support No.11 falls), above the Level 3 funding amount as stipulated in subclause 6(2)(b)(iii) of the Determination. Instead, the current approved funding of $3,456 per annum is to be paid, in fortnightly instalment, as a recurrent transport support for Ms Blesing and is to remain as a continuing support in her new SOPS approved by the CEO in accordance with the Tribunal's directions when implementing this Decision.[183]

CONSIDERATION - SUPPORT NO.12 (OCCUPATIONAL THERAPY)

1. Support No.12 (as well as Supports No.13, 14, 15, 16, 17 and 18 and possibly also, Support No.19) falls within the broad category of supports constituting therapeutic interventions intended to optimise the capacity of the participant or what is colloquially known as capacity building supports or "improved daily living skills" supports.
2. Currently, Ms Blesing has an allocation in her Current SOPS for funding in the sum of $47,094.60 for "improved daily living skills". This budget is specified as being a "Stated" support category and is "plan-managed". The NDIA has imposed monthly funding periods restricting expenditure of this budget to $3,924.55 per month, with any unspent funding to be rolled over to the next month. This funding is stated to be used for:[184]

Improved Daily Living Skills > > Assessment, training or therapy (including Early Childhood Intervention) to help build your skills, independence and community participation. These services can be delivered in groups or individually. > > Therapy supports include 58 hrs of Physiotherapy, 102.5 hrs of Occupational Therapy which includes 2.5 hrs of pelvic alignment for the wheelchair, 15 hrs of podiatrist, 15 hrs of psychologist, 10 hrs of speech pathology and 50 hrs of level 2 therapy assistant. > > Supports to assess and provide strategies to help you build your skills and independence. Your therapists need to provide us with a progress report 6 weeks before your next plan reassessment. > > You can use your therapy budget flexibly for a combination of allied health therapy, including a Therapy Assistant to put therapy strategies into practice and to help you with these. > > Disability-related health supports from a registered nurse 26 hrs > > Disability-related health supports from a clinical nurse consultant 5 hrs

3. Support No.12 as described in the s 53 Order is a request for "Services provided by an occupational therapist including 146 hours per annum for occupational therapy sessions and assistive technology (AT) assessment, 10 hours per annum of OT home automation and 20 hours per annum for an OT wheelchair assessment". This is a request for a total of 176 hours of physiotherapy services per annum.

Stage One: Whether the request for Support No.12 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of occupational therapy could be reasonable and necessary supports, as the provision of such supports are aligned with the objectives under s 3(1)(c) and (d) of the NDIS Act and the principles under subsections 4(1) and (11) of the NDIS Act referred to above. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met, in Ms Blesing's individual circumstances in respect of the Support No.12.

Stage Two: Whether Support No.12 meets the criteria under subsection 34(1) of the NDIS Act

1. In the Combined Table of Supports,[185] Ms Blesing states that 146 hours of occupational therapy is being sought for physical assessments, scripting of assistive technology, reviews and modifications of technology, and physical therapy. Specifically, the services would be used for scripting for a replacement shower chair, annual modifications to powered wheelchair, ceiling hoist and gantry reviews (and prescription as needed), commode and electric bed and mattress reviews and scripting as needed, home automation and communication scripting, low-cost AT prescription, robotic arm prescription, lounge chair prescription and physical therapy. In relation to home automation, the matters Ms Blesing states would be attended to, include the assessment and prescription of AT devices, ongoing assessment of AT devices to be compatible with NDIS goals and daily tasks, multidisciplinary consultation regarding appropriate solution, equipment liaison with suppliers, report writing and documentation, training, set up and education to support workers, and ongoing maintenance and support.
2. In the Combined Table of Supports, Ms Blesing indicates that she is relying upon the Ms Harman's 2025 FCA Report, Ms Noble's 2025 FCA Report and a report by Mr Adrian Polisena, Novita Tech, AT and OT Report, dated 4 December 2023. The Tribunal has taken these reports into account.

1. In the NDIA's Closing Submissions, it contends that 100 hours per annum of occupational therapy is "reasonable and necessary having regard to Ms Blesing's complex needs". The NDIA acknowledges that occupational therapy is also intended to:[186]

(a) accommodate additional time to trial equipment; > > (b) review Ms Blesing's ongoing AT needs; and > > (c) provide strategies to support workers to ensure that Ms Blesing is well supported in her home.

2. The NDIA referred to Mr Burden's Report and his statement that Ms Blesing engages in occupational therapy six times per year and that Mr Burden recommends that this should continue.[187] The NDIA submitted that Mr Burden gave evidence at the hearing, that he considered that between 100 and 120 hours of OT per annum for Ms Blesing was "reasonable and necessary and that this would include all OT-related services, assessments and reports including those relating to AT". The NDIA noted that, similarly, Ms Noble gave oral evidence that an amount equating to two hours of OT support per week was "reasonable", being "an "all up" sum that was not to all be allocated to her for the AT work that she did with the Applicant but that it could also include some hand therapy from an OT".[188]
3. The NDIA submits that the NDIA's position is that 100 hours per annum of OT services for Ms Blesing is "broadly consistent" with the recommendations of Mr Burden and Ms Noble in light of therapies not usually being provided for 52 weeks of the year.[189]

1. Dr Chia gave evidence at the hearing that with MS, most of the disability is permanent, but treatment, particularly physical therapies, can be very helpful in trying to improve the severity of the symptoms that are resulting from the injury that has occurred.
2. Dr Chia gave evidence that even though the Ms Blesing's weakness cannot be fixed, a lot of the symptoms that arise from this abnormality, particularly the severity of the stiffness and pain associated with those things, can be improved significantly through physical therapies, rehabilitation, physiotherapy, occupational therapy and hand therapy. Dr Chia added that while the damage from Ms Blesing's underlying disease cannot be reversed, some of the consequences in terms of the symptoms and its impact on her quality of life can be improved with appropriate therapies.

1. Ms Noble has recommended that Ms Blesing be funded for a total of 520 hours for "all therapy services required" including occupational therapy, physiotherapy, neuro-physiotherapy, speech pathology, chiropractic intervention, podiatry, pain therapy, psychology and "IT specialist support". Ms Noble said this would equate to 10 hours of allied health therapy per week. Ms Noble opines that considering Ms Blesing's "fragile and painful existence", that she does not consider this amount of allied health therapy to be "unreasonable". Ms Noble opines that without these supports, Ms Blesing's "existence will be painful and fraught with danger". Ms Noble states that if these supports are restricted, Ms Blesing's "ability to have any role in her personal care or activities of daily life, will be diminished significantly".[190]
2. Ms Noble states that she has not provided a breakdown of the recommended capacity building supports for the reason that she wishes to give Ms Blesing the "choice and control about the therapy services that she requires at any given time to best suit her needs". Instead, Ms Noble provided "an example" of how the funding for the 520 hours might be used and within this example she suggests that it might be used for weekly two-hour occupational therapy sessions for Ms Blesing.[191] This would equate to 104 hours of occupational therapy per annum.

(a) Ms Blesing has a multidisciplinary team already providing her with support and that she should continue with her current supports, was well as considering additional support from a dietician and a speech therapist;[192] > > (b) it may be possible for Ms Blesing to engage in "a higher intensity of support through a targeted rehabilitation program, provided she has rehabilitation-oriented goals". Mr Burden stated that a mainstream multidisciplinary therapy program such as "Day Rehabilitation involving physiotherapy, psychology, exercise physiology, speech pathology, dietetics and occupational therapy could offer a "boost" of capacity building for Ms Blesing";[193] > > (c) regular reviews by an occupational therapist to assess and recommend home modifications would be beneficial; > > (d) the expected outcome from "these supports" include improved nutritional status, enhanced communication abilities, and a safer, more accessible living environment; > > (e) the above improvements would collectively contribute to Ms Blesing maintaining her participation and quality of life, allowing her to engage more fully in her daily activities and community interactions.

2. Mr Burden gave evidence at the hearing that he did not consider that there are clear clinical justifications put forward in support of Ms Noble's proposition that Ms Blesing be funded for 530 hours of therapeutic intervention. The Tribunal agrees and for this reason the Tribunal prefers the evidence of Mr Burden over the evidence of Ms Noble in relation to the request for funding for occupational therapy services. Specifically, the Tribunal notes Mr Burden's recommendation that between 100 and 120 hours of OT per annum for Ms Blesing is reasonable and necessary and that this would include all OT-related services, assessments and reports including those relating to AT. At the hearing, Ms Noble conceded that an amount equating to two hours of OT support per week is required by Ms Blesing, but this appeared to exclude occupational therapy services provided in relation to assistive technology (but would include some hand therapy).

1. Based on the recommendation of Mr Burden, the Tribunal finds that Ms Blesing requires 100 hours per annum of occupational therapy services plus an additional 2.5 hours for occupational therapy advice in relation to the pelvic alignment for Ms Blesing's wheelchair. Funding for 100 hours of occupational therapy services will provide for an average of two hours of occupational services each week over the next 12 months disregarding a one-week break between Christmas and New Year. During those sessions the occupational therapist may work with Ms Blesing to optimise her capacity for social and economic participation and daily living skills, write any reports which are required including reports relating to assistive technology or progress reports for the NDIA, write clinical notes, provide guidance to Ms Blesing's support workers as to appropriate strategies or how to use assistive technology, undertake periodical clinical care meetings or telephone conversations with Ms Blesing's treating medical and clinical team or her support workers as required during these sessions, as well as providing Ms Blesing with any other miscellaneous occupational therapy services required over the next 12 months.
2. The Tribunal concludes that 102.5 hours of occupational therapy services for the next 12-month period is, or is likely to be, effective and beneficial for Ms Blesing, represents "value for money", will assist Ms Blesing to pursue her goals and to undertake activities to facilitate her social and economic participation, is necessary to address Ms Blesing's needs arising from her impairments to which s 24 of the NDIS Act applies, takes in to account what is reasonable to expect families, carers, informal networks and the community to provide, and is "an NDIS support" for Ms Blesing falling under item 34 ("therapeutic supports") of Schedule 1 of the NDIS Supports Transitional Rules.
3. The Tribunal has considered whether this support is more appropriately funded under another general service system rather than under the NDIS. The NDIA did not put any detailed submissions to the Tribunal to contend that this criterion (under s 34(1)(f) as it was worded before the October 2024 amendments, but which still applies due to provisions in the National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (Miscellaneous Provisions) Transitional Rules 2024), was not met in respect of Ms Blesing's request for Support No.12 (of the other therapeutics supports claimed by her). The benefits arising under the Medicare Benefits Scheme ('MBS') vary, depending upon the program under which allied health therapy is claimed. In the case of occupational therapy, the length of the sessions is not clearly specified under the program, except to say they must go for at least 20 minutes. The therapist is entitled to charge the person an additional out of pocket fee, but it is not clear in Ms Blesing's case whether any out-of-pocket fee would be charged and if so, what this fee might be. There is a significant limitation to the number of sessions per year able to be accessed under the Allied Health Services for Chronic Disease Management program/plan, specifically, eligible consumers can access no more than five sessions per calendar year shared across all eligible allied health professionals. Ms Blesing's requirements for allied health therapy greatly exceeds this number of sessions per annum. The Tribunal does not consider that it has enough clear information about the benefits Ms Blesing might be entitled to under the MBS programs to be able to find that it is more appropriate for Ms Blesing to access this support through the MBS rather than the NDIS and based on the information set out above, the Tribunal does not consider the MBS to be a more appropriate system to provide Ms Blesing with occupational therapy. The same applies in respect of the therapies in Supports No.13, No.14, No.15, No.16 and No.17.
4. Accordingly, the Tribunal concludes that funding under Ms Blesing's Current SOPS for 102.5 hours of occupational therapy services per annum is a "reasonable and necessary support" for Ms Blesing under the NDIS Act and is to be replicated in Ms Blesing's New SOPS.

CONSIDERATION - SUPPORT NO.13 (SPEECH PATHOLOGY)

1. Support No.13 in the s 53 Order is a request for "48 hours per annum for services to be provided by a speech pathologist".

Stage One: Whether the request for Support No.13 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of speech pathology could be reasonable and necessary supports, as the provision of such supports are aligned with the objectives under s 3(1)(c) and (d) of the NDIS Act and the principles under subsections 4(1) and (11) of the NDIS Act referred to above. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support No.13.

Stage Two: Whether Support No.13 meets the criteria under subsection 34(1) of the NDIS Act

1. In the Combined Table of Supports,[194] Ms Blesing refers to Ms Clifton's speech pathology report dated 15 February 2024 ('Ms Clifton's Report'), specifically, her recommendation that Ms Blesing should be provided with 44 hours per annum of speech pathology services. Ms Blesing also contends that Ms Clifton confirmed her opinion in this regard, when she gave oral evidence at the hearing. The NDIA states it is prepared to fund Ms Blesing for 10 hours of speech therapy support and the trial of the Tobii Dynavox, which is being requested by Ms Blesing.[195] The NDIA does not accept that Ms Blesing should be funded for speech pathology services other than in respect of those items because it contends that the requested additional funding cannot be considered "value for money" under subsection 34(1)(c) or that it is "effective and beneficial" under subsection 34(1)(d) of the NDIS Act.
2. The NDIA highlights Mr Burden's Report in which he states that a speech therapist could address any communication difficulties arising from Ms Blesing's weak voice and breathing challenges and that this therapy could enhance Ms Blesing's ability to communicate effectively, thereby improving her engagement with support workers and health care providers. Mr Burden opined that speech pathology review is essential for maintaining Ms Blesing's health and wellbeing and to prevent hospital admissions due to aspirational pneumonia.[196] However, Mr Burden does not specify in his report the number of hours of speech pathology he is recommending for Ms Blesing. This is appropriate given that Mr Burden's qualifications and work experience are as an occupational therapist and not a speech pathologist.
3. Ms Clifton gave oral evidence at the hearing. She said that she was planning to undertake weekly therapy with Ms Blesing to establish some "baselines" for where her breath support and "ability to increase and decrease alternate tone" and then to provide some training to Ms Blesing and her support workers so they can conduct "voice therapy" every day. The objective is to improve Ms Blesing's capacity to sustain her voice for longer periods and so that she develops a stronger and louder voice. Ms Clifton said that speech clarity would also be another benefit of this voice therapy. Ms Clifton confirmed that she considers that Ms Blesing would need to be funded for:

(a) 16 hours for her to undertake the voice work with Ms Blesing; > > (b) 4 hours for her to train Ms Blesing's support workers to undertake the therapy with her on a daily basis; > > (c) 10 hours per annum for her to prepare a report on dysphagia (eating, drinking, swallowing issues) to come up with some recommended strategies and therapies; > > (d) 4 hours for her to prepare an assistive technology report.

4. Ms Clifton said the voice work would become a "self-sustaining model that doesn't need a therapist involved". She said that it would need to be well-documented. Ms Clifton said there is capacity to create a PowerPoint or video training video to account for changes over time in Ms Blesing's support workers.
5. In relation to dysphagia, Ms Clifton said she had not undertaken an formal assessment of Ms Blesing to see if she is drinking, eating and swallowing properly. She referred to there being a history of Ms Blesing having "double pneumonia" and "a vomit reflex". Ms Clifton said it was best practice to have a formal guideline in place. She said that 10 hours is "fairly standard" for a couple of appointments, a review, to prepare a guideline and for any training that is required.
6. Ms Clifton was asked why the report on assistive technology was required noting that Ms Clifton's Report was largely focussed on a recommendation about Ms Blesing trialling the Tobii Dynavox device. Ms Clifton confirmed that the Tobii Dynavox was being trialled to see if it is a "successful and appropriate" technology for Ms Blesing. Ms Clifton said if it is, an NDIS AT template would need to be completed and these are "quite lengthy". Ms Clifton said the trial of the Tobii Dynavox goes for 12 weeks and it costs about six-and-a-half thousand dollars. She said it is a communication device which uses the person's eye gaze, and it also has home modification functionality (environmental controls). Ms Clifton said this device will cost $18,775 plus $2,238 for the mounting that can be moved from room to room on a rolling floor stand (less the cost of the trial).
7. Ms Clifton was asked for her opinion about what the right timing would be for Ms Blesing to transition to this type of equipment. Ms Clifton responded by reporting that Ms Blesing's head mouse causes irritation on Ms Blesing's nose and has caused deep indents. She also referred to it causing soreness on Ms Blesing's chin and that it requires Ms Blesing to tip her head back and forward (constant micro movements) which had been reported to cause an increase in tone in her shoulder and neck and to cause pain. She said the Tobii Dynavox was less intrusive and more dignified.
8. In the TAS, the NDIA states that it has agreed to fund the cost of the 12-week trial of the Tobii Dynavox I-16 device and mounting costing approximately $6,541.50.[197]
9. Ms Clifton was asked about the discrepancy between the total number of hours of speech pathology recommenced by her (44 hours per annum) and the number of hours that are requested by Ms Blesing (48 hours per annum). Ms Clifton confirmed that she is recommending 44 hours.

1. The Tribunal found Ms Clifton to be a forthright and credible witness and that she had legitimate clinical justifications for each of the four components she was recommending for Ms Blesing for a total of 44 hours of speech pathology services per annum. Ms Clifton's clinical justifications were not challenged by the NDIA at the hearing during cross examination. The Tribunal accepts Ms Clfiton's evidence. The Tribunal is not satisfied that there is evidence if any clinical justification to an increase this support to 48 hours as requested by Ms Blesing. This additional four hours is not a "reasonable and necessary support" for Ms Blesing because it is not effective and beneficial and it presently unknown what those four additional hours of speech therapy would be used for.
2. In relation to the fourth component of the 4 hours to be used for an AT report, the Tribunal considers that this time can be spent preparing an AT report in respect of the Tobii Dynavox device if the trail is successful or if this is not required, it can be used to prepare a detailed progress report to be provided to the NDIA at the time the New SOPS is reassessed. For this reason, the Tribunal considers this component is, or is likely to be, "effective and beneficial" for Ms Blesing.
3. In conclusion, the Tribunal is satisfied that Ms Blesing requires 44 hours of speech pathology services over the next 12 months based on the evidence given by Ms Clifton. This may need to be changed in subsequent years as Ms Blesing's needs for speech therapy services change.
4. The Tribunal concludes that 44 hours of speech pathology services for the next 12-month period is, or is likely to be, effective and beneficial for Ms Blesing, represents "value for money", will assist Ms Blesing to pursue her goals and to undertake activities to facilitate her social and economic participation, is necessary to address Ms Blesing's needs arising from her impairments to which s 24 of the NDIS Act applies, takes in to account what is reasonable to expect families, carers, informal networks and the community to provide, and is "an NDIS support" for Ms Blesing falling under item 34 ("therapeutic supports") of Schedule 1 of the NDIS Supports Transitional Rules. This support is not more appropriately funded under another general service system.
5. Accordingly, the funding under Ms Blesing's Current SOPS for 10 hours of speech pathology services per annum is to be increased to 44 hours in Ms Blesing's New SOPS, to cover the next 12 month-period. Further, a sum of $6,541.50 for a 12-week trial of the Tobii Dynavox I-16 device including mounting costs, is to be added to Ms Blesing's New SOPS when implementing this Decision.

1. Support No.14 in the s 53 Order is a request for "18 hours per annum for services to be provided by a hand physiotherapist" which was later clarified as being a request for hand therapy by an occupational therapist.

Stage One: Whether the request for Support No.14 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of hand therapy provided by an occupational therapist could be reasonable and necessary supports, as the provision of such supports are aligned with the objectives under s 3(1)(c) and (d) of the NDIS Act and the principles under subsections 4(1) and (11) of the NDIS Act referred to above. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support No.14.

Stage Two: Whether Support No.14 meets the criteria under subsection 34(1) of the NDIS Act

1. In Ms Blesing's Position Paper, she requested 18 hours per annum for services to be provided by a "hand physiotherapist". In the Combined Table of Supports, when Ms Blesing was prompted to state the evidence, she was relying upon, in support of this requested support, she referred to a letter by Ms Erica Elliot dated 6 May 2024.[198]
2. Ms Elliot is an accredited hand therapist from Adelaide Hand Therapy who saw Ms Blesing on the same date as her report following a referral by Dr Ang for review of the flexed posture of her left hand and right index finger. The treatment described in this report included the provision of left palm protector and a right index extension splint, as well as a "passive range of motion". Ms Elliot has recommended in this report that Ms Blesing receive regular review of the provided splints comprising 60 minute appointments (number unspecified and it is not specified what type of therapist will conduct those appointments), review in one month of current regime and six-monthly reviews with "hand therapy" as well as "regular and frequent reviews for nail care with an appropriately qualified practitioner", noting that a podiatrist may be able to provide this service as they are regularly reviewing Ms Blesing in relation to her feet and toenails.
3. The Tribunal understands Ms Elliot to recommending that Ms Blesing have hand therapy with her as an occupational therapist once every six months. It is not possible to make out any further recommendations that Ms Elliot is making in this letter for Ms Blesing to receive other types of therapy for her hand and finger flexion issues. This recommendation was not challenged by the NDIA save for it contending that Ms Blesing's Current SOPS included funding for 58 hours of physiotherapy and 50 hours of level 2 therapy assistant support and this funding is sufficient to meet Ms Blesing's requests for Supports No.14, No.15 and No.16 combined and the provision of additional funding to Ms Blesing would amount to a duplication of supports.
4. The Tribunal accepts the unchallenged recommendations of Ms Erica and is satisfied that funding for two one-hour therapy sessions with an accredited hand therapist, who is an occupational therapist, is a "reasonable and necessary support" for Ms Blesing based on the clinical evidence of Ms Elliot and the photographs showing the deformation which has developed in Ms Blesing's hands.
5. The Tribunal concludes that two hours of occupational therapy services (by an accredited hand therapist) for the next 12-month period is, or is likely to be, effective and beneficial for Ms Blesing, represents "value for money", will assist Ms Blesing to pursue her goals and to undertake activities to facilitate her social and economic participation, is necessary to address Ms Blesing's needs arising from her impairments to which s 24 of the NDIS Act applies, takes in to account what is reasonable to expect families, carers, informal networks and the community to provide, and is "an NDIS support" for Ms Blesing falling under item 34 ("therapeutic supports") of Schedule 1 of the NDIS Supports Transitional Rules. This support is not more appropriately funded under another general service system.
6. Accordingly, the funding under Ms Blesing's Current SOPS for an additional two hours of occupational therapy services (by an accredited hand therapist) per annum is a "reasonable and necessary support" for Ms Blesing and is to be included in her New SOPS.

CONSIDERATION - SUPPORT NO.15 (NEUROPHYSIOTHERAPIST OR HYDROTHERAPY WITH A PHYSIOTHERAPIST)

1. Support No.15 in the s 53 Order is a request for "104 hours per annum for services to be provided by a neuro-physiotherapist or 'hydrotherapy with physio'".

Stage One: Whether the request for Support No.15 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of neurophysiotherapy services or hydrotherapy with a physiotherapist could be reasonable and necessary supports, as the provision of such supports are aligned with the objectives under subsections 3(1)(c) and (d) and the principles under subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support No.15.

Stage Two: Whether Support No.15 meets the criteria under subsection 34(1) of the NDIS Act

1. In the Combined Table of Supports, Ms Blesing confirms that she is seeking 78 hours of neurophysiotherapy as recommended by her treating neurophysiologist, Ms Beltrame from Botanical Integrated Therapies. In column of this table setting out Ms Blesing's position regarding Support No.15, she does not press any request for the provision of "hydrotherapy with a physiotherapist" and the Tribunal notes that this was requested by Ms Blesing as part of her request for Support No.16 (see below under the next heading).
2. In Ms Beltrame report dated 8 January 2025 ('Ms Beltrame's 2025 Report'),[199] Ms Beltrame recommends that Ms Blesing receives neurophysiotherapy twice a week for six months and then, once a week for a further six months, equating to 78 hours over the next 12 months. At the hearing, Ms Beltrame elaborated that her understanding was that Ms Blesing has not had physiotherapy for quite a while, so she imagined that Ms Blesing's body has "deconditioned significantly" since she last saw her. Ms Beltrame said she was recommending the twice weekly sessions for the first 26 weeks because it is "quite critical to sort of stabilise her body" during this stage. Ms Beltrame states that each of these sessions will include the training of support workers in respect of manual handling or organised support worker training as needed, timed with activities of daily living.
3. Ms Beltrame confirmed that the recommended 78 hours per annum includes time spent on support worker training in respect of manual handling.
4. At the hearing, Ms Beltrame gave evidence that she would need to review Ms Blesing again in respect of her recommendations. When asked about outcome measures, Ms Beltrame said this is complicated to assess with standardised outcome measures and that the idea of physiotherapy is to help the support workers move Ms Blesing's body, so she is in less pain and less reactive to handling. She added that physiotherapy is there to reduce injury. Ms Beltrame concluded by saying that the outcome measures would be a lessening of pain on the pain scale and a reduced incidence of subluxations to her joints (caused by strong spasms), and issues with her skin integrity. Ms Beltrame gave evidence that she witnessed Ms Blesing having a spasm in 2024. She said that when it happens Ms Blesing needs a gentle massage and then the muscles are held in specific ways on her forearm or scapula until the muscles calm down and the relaxed joint relocates. Ms Beltrame said that subluxation is a milder form of dislocation. She said that hospitalisation is not required when Ms Blesing experiences spasms.
5. In Ms Beltrame's 2025 Report, she states that Ms Blesing has a very sensitive body and she experiences pain daily due to being still for too long (that is, sitting in her chair for more than 10 hours per day). Ms Beltrame states that Ms Blesing can experience extreme excruciating pain if she is poorly handled by her support workers. Ms Beltrame states that prior to 2023, Ms Blesing had access to highly trained and experienced support workers and that she "rarely needed more than 2 carers (occasionally 3)" for activities of daily living. Ms Beltrame states that those support workers minimised Ms Blesing's pain and handling. Ms Beltram said that Ms Blesing's deterioration since 2023 and lack of physiotherapy or occupational therapy input "to train up carers" has resulted in Ms Blesing needing four support workers for her morning activities of daily living routine. Ms Beltrame states that Ms Blesing has been to her general practitioner and pain specialists in the past to trial medication management for her pain, but her "sensitivity and negative response to medication proved too dangerous for her health".[200]
6. Ms Beltrame explains is her report that Ms Blesing finds movements performed by inexperienced support workers to be extremely painful and it can set off full body spasms and trigger dysautonomia symptoms (that is, dizziness, sweating, fight and flight responses). Ms Beltrame states that Ms Blesing experiences pain with prolonged sitting in her chair if her sitting posture or leg positions are not perfectly positioned. Further, Ms Beltrame states that due to the spasticity, Ms Blesing's wrist and elbow joints can sublux, and if moved poorly by support workers, she can experience excruciating pain (rated at 10 out of 10 on the pain scale where 10 is the worst pain possible). Ms Beltrame explained that Ms Blesing's hypersensitivity and joint vulnerability creates great complexity and overwhelm for support workers helping her to move her body. She opined that support workers need training to move Ms Blesing's limbs carefully and to find the most comfortable positions for her limbs and torso, with all manual handling.[201]
7. Ms Beltrame opines in her report that without "desensitisation physiotherapy", Ms Blesing's body causes her extreme pain, and her spasticity patterning worsens with manual handling. She states that Ms Blesing reports after physiotherapy, her tolerance to manual handling by support workers is "bearable" and the support workers "appreciate moving a more compliant softer body with less spasms".
8. Ms Beltrame stated the "physiotherapy goals" as being:

(a) to reduce Ms Blesing's "body hypersensitivity"; > > (b) to minimise deterioration of Ms Blesing's neck and upper limbs, especially on the right-hand side to help her use her communication and mobility devices; > > (c) to maintain her voice volume; > > (d) to facilitate training between Ms Blesing's experienced and new support workers in relation to movement of her limbs and torso to minimise spasm reaction and pain.

9. Ms Beltrame explained that she will deliver "hands on" therapy to increase Ms Blesing's "joint proprioception and soft tissue mobilisation around her spine and neck". This will involve "gentle and specific mobilisation" of Ms Blesing's limbs and torso "to help regulate the hypersensitivity in her limbs". Ms Beltrame states that:

(a) she will deliver integrated manual therapy, using "fascial techniques" to help regulate Ms Blesing's autonomic nervous system responses, and administer acupuncture for her pain and to improve Ms Blesing's body awareness; > > (b) she will deliver active assisted movements of Ms Blesing's neck and arms to help with her pelvic and torso movements which, in turn, will assist with improved posture, reduce pain, improve speech clarity as Ms Blesing's diaphragm will work better; > > (c) she will "educate" Ms Blesing's support workers to reduce Ms Blesing's pain with manual handling and improve their efficiency and safety; > > (d) she will encourage "standing endurance" during the day and use of the Moto med to improve Ms Blesing's upper limb activation; > > (e) she states that passive or active assisted movements are "very regulating" for Ms Blesing's nervous system and allows her to improve her body awareness, which reduces her pain and tolerance with manual handling.[202]

10. At the hearing, Ms Beltrame was asked about her title of being a neuro-physiotherapist and how this was different from a general physiotherapist. Ms Beltrame said they will need to have a number of years of experience in this field and that they can become a "titled physiotherapist" if they complete a certificate course through the Australian Physiotherapy Association by undertaking an examination which is assessed by a peer review (by a board of experienced neurological physiotherapists).
11. Ms Beltrame said she commenced working in the field of neurophysiotherapy 30 years ago and has always worked in the neurological rehabilitation area. Ms Beltrame said that there is quite a big difference in learning. She explained that neurological physiotherapists have a very unique understanding of the biomechanics of the body and are experts in manual handling, specifically, making sure that the person is not injured during manual handling. Ms Beltrame said they are trained to help a person who had sustained injury to the neurological system to regulate spasticity so the person can move "normally and safely", and achieve better outcomes in terms of transfer, gait and functional movement. The Tribunal accepts this evidence and is satisfied that it would be effective and beneficial for Ms Blesing to have access to regular services provided by a neurological physiotherapist. The Tribunal must consider the appropriate level of such services based on the evidence before it.
12. The NDIA considers that the number of therapeutic health interventions requested by Ms Blesing overall is excessive. In the NDIA's Closing Submissions, it contends that:

(a) Ms Blesing's current plan includes funding for 58 hours of physiotherapy and 50 hours of "level 2 therapy assistant" support which is sufficient to meet her needs; > > (b) taken together, Ms Blesing's request for Support No. 14 to Support No.17 inclusive, comes to 306 hours per year, which equates to 5.88 hours per week; > > (c) if the funding for a chiropractor is included, Ms Blesing's request is for a total of 358 hours per annum (or 6.88 hours per week) of services; > > (d) if Ms Blesing is funded for 146 hours of occupational therapy, she will be requesting 504 hours of physiotherapy, chiropractor and occupational therapy support, which comes to 9.69 hours per week; > > (e) these levels of capacity-building supports are excessive; > > (f) Ms Harman's recommendations that Ms Blesing be funded for approximately 163 hours of physiotherapy and 158 hours of therapy assistance are "too high".

13. The NDIA relies upon the oral evidence of Mr Burden at the hearing that while he considers that capacity building supports for Ms Blesing are "absolutely important" for her, the clinical reasoning advanced for the level of supports being sought is inadequate. The NDIA contends that this remains that case and that Ms Beltrame and Ms Harman have not provided a sufficient justification for the number of hours of therapeutic supports they have recommended. The NDIA contends that these supports could not be considered "value for money" under s 34(1)(c) or "effective and beneficial" under s 34(1)(d).
14. The NDIA also contends that the therapy goals articulated by Ms Beltrame and Ms Harman are similar which indicates those two supports are duplicative and that the exclusion in r 5.1(c) of the Supports Rules applies.
15. At the hearing, Ms Beltrame was asked whether she agreed that the NDIA's intended provision of 50 hours per annum of general physiotherapy and a further 50 hours per annum of Level 2 therapy assistance was sufficient for Ms Blesing. Ms Beltrame said she would "certainly agree" and that she was "relieved" to see that Ms Harman was involved. Ms Beltrame described Ms Harman as an expert in manual handling. But then Ms Beltrame said she agreed with Ms Harman's assessment that once a week of physiotherapy and once a week for the therapy assistant, was probably not enough because it would only allow for the physiotherapy assistant to be trained in a few specific joints.
16. Ms Beltrame explained that Ms Blesing's body and spasticity (and working with her) is quite complicated. She said that a therapy assistant would not have the knowledge to "troubleshoot a problem" if something arose whilst doing a technique, so it is most likely not going to be adequate. For this reason, Ms Beltrame said she agreed with Ms Harman's report that physiotherapy twice a week and then a therapy assistant twice a week, at least for the first year is a good staring position to be managing Ms Blesing's spasticity in her body to achieve better outcomes and to stabilise her body. Ms Beltrame gave evidence after the first 12 months a reassessment could occur to see if she requires intervention at this intensity for the following 12 months. Ms Beltram mentioned again that Ms Blesing's body is complicated and that "you really need to be able to treat and assess at the same time as you are working with" her, and that a Level 2 therapy assistant could get into strife endeavouring to follow up a basic program that Ms Beltrame as set up for them if there is to be only one session per week.
17. Then, Ms Beltrame agreed to a proposition put to her that a therapy assistant should not be used for the first year, and that standard physiotherapy be carried out for twice weekly sessions with Ms Blesing, under Ms Beltrame's supervision (consisting of meetings between Ms Beltrame and Ms Blessing once every quarter). Ms Beltrame also agreed that a comprehensive review by her could be undertaken at the end of the year for the purpose of putting new recommendations to the NDIA about the structure of this type of intervention going forward. Then, Ms Beltrame added that she felt that this approach could work for Ms Blesing but that she could not "100 per cent guarantee that that's going to work".

1. The Tribunal notes that Ms Beltrame signed off her report as being an "APA Titled Neurological Physiotherapist". The Tribunal is satisfied that Ms Beltrame is a specialist physiotherapist who has extensive experience working with persons who have neurological conditions. It was also clear from Ms Beltrame's evidence at the hearing that she regards Ms Harman (who is a general physiotherapist) to be an expert in manual handling.
2. The Tribunal considers that Ms Beltrame provides adequate clinical justification as to why Ms Blesing requires specialist neurological physiotherapy as well as by a general physiotherapist. The Tribunal accepts that the treatment outlined by Ms Beltrame in her report is likely to improve the ability of Ms Blesing's support workers to move Ms Blesing while minimising the adverse effects of such manual handling such a potential injury to her. The Tribunal accepts that the neurological physiotherapy will assist by developing strategies and techniques to be employed by Ms Blesing's other clinicians and her support workers, to handle Ms Blesing in a way that minimise the pain to her. This also involves therapy to reduce Ms Blesing's hypersensitivity.
3. At the hearing, clarification was sought from Ms Beltrame as to whether she was recommending that Ms Blesing have neurological physiotherapy and standard physiotherapy or whether she should be treated by a single physiotherapist. Ms Beltrame responded by saying that it would be difficult to find a neurological physiotherapist (or even a general physiotherapist) to engage in the treatment of Ms Blesing twice a week. When asked whether she knew how many neurological physiotherapists are based in Adelaide, Ms Beltrame was unable to answer. She stated that as for herself, she would not be able to manage to see Ms Blesing twice a week but that she could manage to see her once a week. When asked whether it would be beneficial for Ms Blesing to receive the proposed two physiotherapy sessions per week by the same physiotherapist, Ms Beltrame answered in the negative. When asked whether she could oversee a standard physiotherapist who would deliver the twice weeks sessions with Ms Blesing for continuity, Ms Beltrame said she would need to assess their hands on skills to ensure they were capable of handling Ms Blesing's body and capability. She said her answer would be "yes" if she has confidence that "they were able to manage it".
4. From the evidence given by Ms Beltrame at the hearing, it would appear that at least one of the reasons why a neurological physiotherapist is not used as Ms Blesing's sole physiotherapist is because her availability is limited and while she could do one session per week, she cannot do two sessions per week.
5. The Tribunal considers that there is likely to be some element of duplication by having both a neurological physiotherapist and a non-specialist physiotherapist undertake the "hands on" treatment of Ms Blesing simultaneously. However, the Tribunal is unable to ignore the reality that there is a risk that Ms Blesing may struggle to find a neurological physiotherapist who can make themselves available for all of the "hands on" physiotherapy sessions she requires each week.
6. The Tribunal is satisfied that there are clinical justifications for a neurological physiotherapist playing a role on Ms Blesing's clinical care team, based on Ms Beltrame's 2025 Report and her oral evidence at the hearing. However, the Tribunal considers that role of the neurological physiotherapist should be limited to an advisory role, focussed on providing adequate specialist guidance and instructions to Ms Blesing's other treating clinicians, mainly her standard physiotherapist (Ms Harman), and her support workers. The Tribunal does not consider that in light of Ms Harman's involvement with Ms Blesing, that there is an active "hands on" role that Ms Beltrame should be playing in Ms Blesing's clinical care team. Further, the Tribunal considers there is no requirement for Ms Beltrame (or any neurological physiotherapist) to devote any significant time on delivering therapy to improve Ms Blesing's voice control because this therapy is already proposed to be delivered by Ms Blesing's speech pathologist. In this regard, the Tribunal has concluded that 16 hours per annum for speech pathology services for voice work is now to be funded in the New SOPS for Ms Blesing (see subparagraph [407(a)]), as this would be a duplication of supports and thereby funding for it is excluded under r 5.1 (c) of the Supports Rules.
7. Instead, the Tribunal considers that the focus of neurological physiotherapist should be limited to devising strategies and instructions to be passed onto Ms Blesing's standard physiotherapist and her support workers in respect of their "hands on" treatment and manual handing of Ms Blesing. The Tribunal is not satisfied that it would requires 78 hours per annum for this type of advisory role to be fulfilled by a specialist neurological physiotherapist. For this reason, the Tribunal is not satisfied that the recommended 78 hours of neurological physiotherapy for Ms Blesing is, or is likely to be, effective and beneficial, in the context of a standard physiotherapist on Ms Blesing's clinical care team already delivering the primary "hands on" physical therapy.
8. Ms Beltrame was asked about the stated goals of the proposed chiropractic services for Ms Blesing and asked whether she agreed that they appeared to be similar to her stated goals of the neurophysiotherapy. Ms Beltrame struggled to provide a clear answer. She was asked whether she had ever spoken to Mr Draysey to ensure that their therapies were not doubling up. She said she had never spoken to him. When asked why they had not spoken, Ms Beltrame said it was a good question and that she did not have an answer for it. She said she had gone out of her way to speak to the other physiotherapist and occupational therapist working with Ms Blesing. Ms Beltrame gave evidence that she had not spoken to Ms Blesing's speech pathologist. When asked whether the therapy in relation to voice work was a duplication, Ms Beltrame answered that unless she spoke to the speech pathologist about, she is unable to answer this question from her perspective or a physiotherapist's perspective. Ms Beltrame went onto say that she thinks that a speech pathologist does not have the "hands on" skills to support the diaphragm and to move the torso. Ms Beltrame suggested that this would be an adjunct to Ms Blesing achieving her goal. When asked if she was clear about what a speech pathology's role might be, Ms Beltrame said she would "need to check" adding that she had never seen a speech pathologist "mobilise someone's talk".
9. When Ms Beltrame was asked whether she considers that there is something missing in respect of Ms Blesing's different interventions, being that there is no clinical lead for them, Ms Beltrame agreed and remarked that "I think this would be an excellent idea". When asked who Ms Beltrame considered to be the natural clinical lead for Ms Blesing, Ms Beltrame said suggested Ms Harman because of her experience as a physiotherapist as well as being a manual handling expert. Ms Beltrame gave evidence that she would be comfortable with Ms Harman working under her supervision as Ms Blesing's standard physiotherapist.
10. During re-examination of Ms Beltrame, Ms Blesing referred to Ms Blesing previously having had team meetings before her NDIS funding was reduced, and that they used to have a "team approach". Ms Beltrame responded by saying that she could not recall having been part of a "big team communication session". She said she had spent time speaking to Mr Steven Wilson, Ms Noble, the "other neurophysiotherapy" ("Eileen") and Ms Blesing's support workers. She said that this included "Ivan" who is a support worker and a chiropractor but that this was a while ago. Ms Blesing pointed out that her voice problems have developed more recently.
11. Despite Ms Beltrame not having had any recent conversations with Ms Blesing's chiropractor about the respective therapeutic interventions to be provided to Ms Blesing, the Tribunal is satisfied that it is reasonable for a provision to be made for 3 hours of services once every quarter to be provided by a neurological physiotherapist to Ms Blesing, for the purpose of this type of therapist to provide high-level therapeutic advice, strategies and training to Ms Blesing's standard physiotherapist and support workers (equating to 12 hours per annum),[203] with a further allowance of 6 hours for the preparation by the neurological physiotherapist of periodic progress reports for submission to the NDIA and for the development of any guidance materials specific to Ms Blesing's needs to be used by the standard treating physiotherapist or the support workers. This type and level of intervention would align broadly with Ms Beltrame's recommendations at the hearing and the confidence she has in Ms Harman to be able to work under her clinical supervision as described above.
12. The Tribunal concludes that funding for a total of 18 hours of services by a neurological physiotherapist is, or is likely to be, effective and beneficial for Ms Blesing, represents value for money, will assist Ms Blesing to pursue her goals and to undertake activities to facilitate her social and economic participation, is necessary to address Ms Blesing's needs arising from her impairments to which s 24 of the NDIS Act applies, takes in to account what is reasonable to expect families, carers, informal networks and the community to provide, and is "an NDIS support" for Ms Blesing falling under item 34 ("therapeutic supports") of Schedule 1 of the NDIS Supports Transitional Rules. This support is not more appropriately funded under another general service system for the reasons set out above.
13. Accordingly, the funding under Ms Blesing's Current SOPS for 18 hours per annum of services by a neurological physiotherapist is a "reasonable and necessary support" for Ms Blesing and is to be included in her New SOPS.

CONSIDERATION - SUPPORT NO.16 (STANDARD PHYSIOTHERAPIST)

1. Support No.16 in the s 53 Order is a request for "52 hours per annum for services to be provided by a physiotherapist".

Stage One: Whether the request for Support No.16 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of physiotherapy services could be reasonable and necessary supports, as the provision of such supports are aligned with the objectives under subsections 3(1)(c) and (d) and the principles under subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support No.16.

Stage Two: Whether Support No.16 meets the criteria under subsection 34(1) of the NDIS Act

1. In Ms Blesing's Position Paper she requested 52 hours per year for services to be provided by a physiotherapist. In the Combined Table of Supports, Ms Blesing confirms that she is now seeking 108 hours of physiotherapy per annum in total, comprising:

(a) 78 hours of physiotherapy (land based or hydrotherapy); > > (b) 16 hours to undertake a functional capacity assessment; > > (c) 10 hours "of Manual Handling Plan"; and > > (d) 4 hours of physiotherapy manual handling training for carers.

2. In the Combined Table of Supports, the NDIS states that 58 hours per annum of physiotherapy for Ms Blesing is a "reasonable and necessary support". The NDIA does not adopt the recommendations made by either Mr Burden or Ms Harman about the number of hours of physiotherapy required by Ms Blesing. Mr Burden has recommended that Ms Blesing has four hours of combined physiotherapy per week (that is, a combination of standard physiotherapy and neurological physiotherapy). Ms Harman recommended that Ms Blesing have 163 hours of standard physiotherapy per annum.
3. The NDIA highlights that item 12(c) of Schedule 2 to the NDIS Supports Transitional Rules declares the following to be "not an NDIS support": time-limited, recovery-oriented services and therapies:

(a) where the predominant purpose is treatment directly related to the person's health status; or > > (b) that are provided after a recent medical or surgical event, with the aim of improving the person's functional status, including post-acute rehabilitation or post-acute care.

4. The NDIA contends that to the extent Ms Blesing is seeking therapy funding for the above purposes, including for rehabilitation from her fall in 2022, it cannot be funded by the NDIS. The Tribunal does not accept this contention. It has been about three or four years since Ms Blesing's fall when she fractured her legs. The Tribunal is not satisfied that Ms Blesing's treatment at the present time could be fairly characterised as there having been a "recent medical or surgical event" or that the treatment is "post-acute rehabilitation or post-acute care". The Tribunal is satisfied the treatment proposed by Ms Harman in the form of standard physiotherapy is to optimise Ms Blesing's functional capacity and to reduce the functional impacts of Ms Blesing's permanent impairments arising from her disability. The Tribunal does not consider that Support No. 16 falls into item 12(c) of Schedule 2. The Tribunal is satisfied that Support No. 16 falls into under item 34 ("therapeutic supports") of Schedule 1 of the NDIS Supports Transitional Rules.
5. The NDIA also contends, as referred to above in respect of Support No.15, that the supports of neurophysiology and physiology are duplicative and that r 5.1(c) of the Supports Rules applies. The NDIA contends that physiotherapy at the level requested by Ms Blesing and her requested neurophysiology is not "effective and beneficial" for Ms Blesing under s 34(1)(d), nor does it represent "value for money" under s 34(1)(c) of the NDIS Act.[204]

1. The Tribunal is satisfied that for the next 12 months that Ms Blesing be funded for two 2-hour sessions of "hands on" standard physiotherapy per week (excluding the week between Christmas and New Year), which will involve home visit sessions with Ms Blesing and her support workers. The Tribunal is not satisfied that any further assistance is required by Level 2 therapy assistants during this time based on the evidence given by Ms Beltrame at the hearing as set out above. This means that the standard physiotherapist would be working without a therapy assistant during the next 12 months and under the supervision of a neurological physiotherapist as referred to above.
2. Leading up to the reassessment of the New SOPS, Ms Blesing's clinicians can assess at that later stage, whether it is an appropriate time to add therapy assistants to Ms Blesing's clinical team after the end of the New SOPS, once Ms Blesing's condition has stabilised following the reported interruptions in recent times of her regular allied health interventions.
3. In addition to the physiotherapy sessions, Ms Blesing has requested 16 hours of funding to pay for her physiotherapist to undertake a functional capacity assessment. The Tribunal is satisfied that is an appropriate to make a provision of 10 hours per annum which the treating physiotherapist may use to prepare progress reports for submission to the NDIA as required. Some of these reports may be functional capacity assessment reports or may involve the filling out AT templates if further AT funding is being requested.
4. The Tribunal is not satisfied that funding for more than 10 hours per annum is, or is likely to effective and beneficial, or would represent value for money, because detailed and extensive functional capacity reports in respect of Ms Harman have been prepared not all that long ago for the purpose of this proceeding. Further, given the physiotherapist will be "hands on" with Ms Blesing for intensive periods each week, there will be no requirement for her to spend significant amounts of time assessing Ms Blesing's functional capacity. The physiotherapist is expected to become extremely familiar with Ms Blesing's level of functional capacity as a direct result of engaging with her during the intensive schedule of regular physiotherapy sessions.
5. The Tribunal notes that funding is sought in respect of a "Manual Handling Plan". The Tribunal notes that a manual handling plan has already been developed for Ms Blesing. The Tribunal accepts that modifications and enhancements will need to be made to this plan periodically, as Ms Blesing's impairments and their impacts on her functional capacity and the equipment she is using for transfers, changes and evolves over time. The Tribunal is also mindful of Dr Chia's evidence that he considers Ms Blesing's condition to be stable. On balance, the Tribunal considers any adjustments required to be made to the manual handling plan can be made during the twice weekly 2-hour physiotherapy sessions being an intensive level of therapeutic support to delivered to one individual.
6. The Tribunal also considers that any training of Ms Blesing's support workers is appropriately conducted during the twice weekly 2-hour physiotherapy sessions.
7. The Tribunal does not think anything turns on whether the physiotherapy services delivered to Ms Blesing are delivered in land or in water nor whether they occur at Ms Blesing's home, in the physiotherapist's clinic or in the community. If Ms Blesing's wishes to use some or all of her weekly allocation of funding for physiotherapy sessions to attend a hydrotherapy class guided by a physiotherapist, she is at liberty to expend this budget of funding for this purpose.
8. Accordingly, the Tribunal concludes that funding for a total of 214 hours per annum of services by a standard physiotherapist (working under the supervision of a neurological physiotherapist but without any therapy assistants), comprising two 2-hour weekly "hands on" sessions for 51 weeks per annum, and a further 10 hours for report writing, is a "reasonable and necessary support" for Ms Blesing because this level of intervention:

(a) is, or is likely to be, effective and beneficial for Ms Blesing; > > (b) represents value for money; > > (c) will assist Ms Blesing to pursue her goals and to undertake activities to facilitate her social and economic participation; > > (d) is necessary to address Ms Blesing's needs arising from her impairments to which s 24 of the NDIS Act applies; > > (e) takes into account what is reasonable to expect families, carers, informal networks and the community to provide; > > (f) is "an NDIS support" for Ms Blesing falling under item 34 ("therapeutic supports") of Schedule 1 of the NDIS Supports Transitional Rules. The Tribunal concludes that this support is not more appropriately funded under another general service system for the reasons set out above.

CONSIDERATION - SUPPORT NO.17 (LEVEL 2 THERAPY ASSISTANT)

1. Support No.17 in the s 53 Order is a request for "132 hours per annum for services to be provided by a Level 2 therapy assistant".

Stage One: Whether the request for Support No.17 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of services provided by a therapy assistant could be reasonable and necessary supports, as the provision of such supports are aligned with the objectives under subsections 3(1)(c) and (d) and the principles under s 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support No.17.

Stage Two: Whether Support No.17 meets the criteria under subsection 34(1) of the NDIS Act

1. In the Combined Table of Supports, Ms Blesing has requested funding for 132 hours per annum of services by a Level 2 therapy assistant (comprising 45-to-60-minute sessions and travel to a local pool with hoist capacity). Ms Blesing refers to Ms Harman's 2025 Report and Ms Harman's 2024 Report in support of her request.
2. As mentioned above, the NDIA contends that Ms Blesing's current plan includes funding for 58 hours of physiotherapy, and 50 hours of "level 2 therapy assistant" support, which is sufficient to meet her needs and that taken together, Ms Blesing's request for Support Nos. 14 to 17 inclusive, amount to 306 hours per year of therapeutic intervention, which equates to 5.88 hours per week.

1. Having considered the evidence referred to above in respect of Supports Nos.15 and 16, the Tribunal was persuaded by the oral evidence at the hearing given by Ms Beltrame that now is not an appropriate time for Ms Blesing to receive assistance from Level 2 therapy assistants. In fact, Ms Beltrame had some reservations about whether therapy assistants would be able to handle the complexity of Ms Blesing's situation, particularly if Ms Blesing has experienced some deconditioning as a result of recent interruptions in the provision of allied health therapy interventions to her. The Tribunal finds that based on Ms Beltrame's reservations and expressed preference for a standard physiotherapist to undertake the twice weekly two-hour sessions under her supervision and to do so in the absence of therapy assistants, that the Tribunal cannot be satisfied, at this stage at least, the funding for therapy assistant is, or likely to be, effective and beneficial or value for money. Instead, the Tribunal has approved funding for a standard physiotherapist to undertake this intensive program of sessions with Ms Blesing, her neurological physiotherapist, and Ms Blesing's support workers. This will assist to improve the capability of Ms Blesing's support workers, who will be mostly paid at the "high intensity" rate under the New SOPS, so that they can optimise the assistance they are able to provide to Ms Blesing when conducting manual handling activities.
2. As mentioned above, the clinicians can reassess Ms Blesing 12 months from now and provide recommendations as to an optimal physical therapy program for Ms Blesing (potentially involving a combination of neurological physiotherapy, standard physiotherapy and the use of therapy assistants and/or support workers going forward, if this is clinically indicated). But for now, the Tribunal concludes that Support No. 17 meets the criteria under s 34(1)(c) and/or (d) of the NDIS Act. The criteria under s 34(1) of the NDIS Act are cumulative so it is not necessary for the Tribunal to progress to a consideration of the criteria under this provision. The Tribunal concludes that Support No. 17 is not a "reasonable and necessary support" under s 34(1) of the NDIS Act at this stage and funding not be included for it in the New SOPS to be implemented in accordance with this Decision.

1. Support No.18 in the s 53 Order is a request for "52 hours per annum for services by a chiropractor".

Stage One: Whether the request for Support No.18 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of chiropractic services could be reasonable and necessary supports, as the provision of such supports are aligned with the objectives under subsections 3(1)(c) and (d) and the principles under subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support No.18.

Stage Two: Whether Support No.18 meets the criteria under subsection 34(1) of the NDIS Act

1. In Ms Blesing's Position Paper she has requested 52 hours per annum of services by a chiropractor. In the Combined Table of Supports, Ms Blesing states that she relies upon Dr Draysley's evidence and also Ms Harman's 2025 Report. Ms Harman's notes that Ms Blesing typically attended 30-minute sessions twice a week.
2. In the NDIA's Closing Submissions, it contends as follows in relation to Ms Blesing's request for funding for Support No.18:

(a) the NDIA acknowledges that services provided by a chiropractor are not a support which is expressly excluded, that is, such services do not fall into the description of an item which is declared to be "not an NDIS Support"; > > (b) Support No.18 cannot be considered reasonable and necessary because the therapy and its goals appear to largely mirror those of physiotherapy (in which case, r 5.1(c) of the Support Rules would apply to exclude funding for this support); > > (c) Dr Draysey told the Tribunal at the hearing that the work that he did with Ms Blesing was probably not different to what a physiotherapist would do, elaborating that a physiotherapist may not have access to the same equipment as him, but that some of the "mobilisation" and "muscle facilitation work" he undertook with Ms Blesing could be done by a physiotherapist; > > (d) the NDIA has specified that supports in her plan to be "Stated", to facilitate her spending on supports being undertaken in accordance with her plan. However, the NDIA states that in respect of this support, it should be open to Ms Blesing to direct some of the 58 hours of funding for physiotherapy support to pay for services by a chiropractor, should she wish to do so and that the NDIA would not object to this; > > (e) otherwise, the NDIA considers it to be duplicative if she is to be funded for 58 hours of support from her physiotherapist and 52 hours of further support from her chiropractor; > > (f) the NDIA also notes the evidence of Ms Blesing before the Tribunal that, if she is not provided with funding for pain therapy under her plan, that she considers that she would need to see Dr Draysey more frequently, as his treatment provides her with pain relief. The NDIA contends that if Ms Blesing is attending the chiropractor for the purposes of pain relief, as she has told the Tribunal, the support should not be funded because pain therapy is the responsibility of the mainstream health system and is not an NDIS support: item 12(a) of Schedule 2 of the Transitional Rules.

3. Dr Draysey provided two reports in respect of Ms Blesing dated 7 July 2023 ('Dr Draysey's July 2023 Report');[205] and dated 18 December 2023 ('Dr Draysey's December 2023 Report').[206]
4. In Dr Draysey's July 2023 Report he states that he commenced providing chiropractic services to Ms Blesing in January 2022. He states she had appointments twice weekly and noted that she has received service from other chiropractors at his clinic.
5. Dr Draysey states that chiropractic care is an established and effective therapy for symptomatic management of MS and the primary goal is to "help maintain and restore the function of the neuromusculoskeletal system". He states that "chiropractors work on the function of the entire nervous system, compared with other manual therapies such as physiotherapy, which may only focus on local musculature, joint injuries or the site of pain". He states that literature has demonstrated that chiropractic treatment has "an effect on the quality-of-life improvement in patients suffering from chronic conditions" such as MS.
6. Dr Draysey states that the aim of the treatment is to improve strength and coordination, reduce pain and spasticity, reduce stress in the nervous system, improve functionality of the body, improve posture and spinal health and increase flexibility and mobility. He states that having worked with Ms Blesing over the previous 12 months it had assisted with improving her nervous system control, allowing greater voice projection and communication, ability to breathe, her posture, had reduced pain and spasticity and that she has greater overall confidence in abilities, which he states, "facilitates increased social participation".
7. Dr Draysey refers to Ms Blesing receiving chiropractic care while she is seated. He claims that through chiropractic care, that Ms Blesing has been able to return to using her powered wheelchair after the leg fractures and that without this care, she would have remained in her manual wheelchair. The clinical reasoning behind this assertion is not explained in his report. He claims that Ms Blesing and her support workers have noticed that Ms Blesing is better able to sit upright in her chair and her improvement in posture and positioning allows for easier transfers into Ms Blesing's lifter, allowing her a greater freedom of movement when in bed. He says this significantly reduces the impact of Ms Blesing's disability. He recommends that Ms Blesing continue with bi-weekly appointments to help minimise her loss of function, improve her mobility, reduce her pain and suffering and to help prevent accelerated deterioration of her condition and increasing her disability.[207]
8. In Dr Draysey's December 2023 Report, he states that Ms Blesing has been unable to continue with her bi-weekly chiropractic sessions due to financial constraints and has received such care on an ad-hoc basis. He says that the reduction in frequency of care has resulted in Ms Blesing experiencing a significant decrease in her quality of life. Dr Draysey states that Ms Blesing has experienced a deterioration in her strength and a loss of coordination and muscular control. He states that she has experienced an increase in the frequency and intensity of her pain and muscular spasms, her posture has deteriorated and she has experienced a loss of flexibility. Dr Draysey said the recent lack of regular "physical and manual therapy" has resulted in Ms Blesing experiencing reduced mobility and independence. He strongly recommends that she resume bi-weekly chiropractic care.
9. At the hearing, Dr Draysey confirmed that Ms Blesing attends chiropractic services infrequently (about once a month). The sessions last for 30 minutes. Ms Blesing attends the clinic for the chiropractic sessions. Dr Draysey gave evidence that chiropractic treatment would seem to be the care that provides her with the most benefit for her disability. He said it seems to be the care that reduces her reliance on other people to care for her, and which improves her sleep and her transfers. When asked what he does with Ms Blesing during the sessions, he said that she does "quite a bit of soft tissue work" and "some cold laser therapy as well". He explained that he is not manipulating Ms Blesing's spine. When asked what soft tissue work meant, he gave evidence that he uses his hands to massage her soft tissue on the upper trapezius, arms, radial heads, extensors and flexors. He said that he might do some joint mobilisation as well involving her elbows, shoulders and carpal. He said this is done to improve Ms Blesing's range of motion. He said he will use another stretching/relaxation technique called PNF (proprioceptive neuromuscular facilitation). He said that sometimes they will undertake a postural assessment as to how she is sitting in her chair and this might involve manoeuvring her hips or shoulders in the chair.
10. The Tribunal asked Dr Draysey how the treatments described above were different from what a physiotherapist might be working on with Ms Blesing. His answer was "It's probably not" and that it might the same as what the physiotherapist does. He explained that it is not about the "brand of therapy that you use" but "it's about the individual clinician that you're working with" and "finding a practitioner that understands what your needs are and is able to work with you". The Tribunal asked Mr Draysey whether the type of things he is working on with Ms Blesing would fall within the remit of what a physiotherapist might do with patient. His response was, "It might, yes, because we work from the same body of evidence and we have the same very similar techniques with a lot of stuff that we do". He added that they have the same scope of practice, but they might not have access to the same equipment. He provided cold laser therapy (used to reduce inflammation) or therapeutic ultrasound as possible examples. Then he said that some physiotherapists do have this equipment and some do not. He added that only a few have the cold laser therapy machine.
11. Dr Dayley gave evidence that Ms Blesing has a better experience from have chiropractic sessions bi-weekly rather than once a week. When asked how many sessions Ms Blesing was having with her neurological and standard physiotherapist, he said "I'm not sure" except that he knew she was seeing a physiotherapist regularly and that perhaps it was twice a week. When asked if he stood by his opinion that Ms Blesing requires two chiropractic sessions when she is having two physiotherapy sessions per week, he said it would really depend on what the physiotherapist was saying. He suggested that if a "generic physiotherapist" was coming to do "some stuff" with Ms Blesing, that he "did not know that she would be receiving the best possible care". He was also concerned that she might not be seeing, regularly, the same practitioners who are following the same plan that is working towards the same goals. He said he did not think that Ms Blesing would benefit as much than she would if she is working with a team of people who are trying to make sure that she remains mobile and active and able to participate in life.
12. During cross-examination, Ms Martin asked Dr Draysey if he had conversation with other members of Ms Blesing's treating team. He said he does not do so but would like to. He said "our communication goes through" Ms Blesing and he needs to work out through her what the other practitioners are doing.

1. Having considered the documentary and oral evidence given by Dr Draysey, the Tribunal is not satisfied that the chiropractic service that he and others from his clinic provide to Ms Blesing, vary significantly from the physiotherapy she has been receiving from Ms Harman. The Tribunal considers that it would be beneficial for Ms Blesing if there is continuity in the therapist providing physical therapy interventions to Ms Blesing, as alluded to by Dr Draysey. This will be established upon Ms Blesing being provided with funding for Support Nos. 15 and 16 (as supplemented by Support No.14).
2. The Tribunal finds the provision of chiropractic services is unnecessary and would duplicate Support Nos. 15 and 16 (as supplemented by Support No.14). The Tribunal concludes that r 5.1(c) of the Support Rules applies and excludes funding being provide to Ms Blesing for Support No.18. Further and in the alternative, in the context of Ms Blesing being funded to receive Support Nos. 15 and 16 (as supplemented by Support No.14), funding for Support No.18 is not, or not likely to be, effective and beneficial for Ms Blesing, nor would this support represent value for money.
3. The Tribunal concludes that Support No.18 in Ms Blesing's circumstances is not a "reasonable and necessary support" for the above reasons. The Tribunal notes that the NDIA has indicated that it was content for some of Ms Blesing's funding for physiotherapy to be used, flexibly, to pay for chiropractic supports but otherwise this funding is to be specified as a "Stated" support. The Tribunal grants leave to the NDIA to prepare the New SOPS in such a way as to afford Ms Blesing this flexibility should it wish to do so. The Tribunal does not endorse this approach as it considers that Ms Blesing would benefit over the next 12 months from having her "physical therapy" supports consolidated and delivered by Ms Harman and Ms Beltrame only (and also the hand therapist), based on the evidence given by Ms Beltrame at the hearing.

1. Support No.19 in the s 53 Order is a request for "26 hours per annum for "pain therapy"".

Stage One: Whether the request for Support No.19 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of pain therapy could be reasonable and necessary supports, as the provision of such supports are aligned with the objectives under subsections 3(1)(d) and (c) and the principles referred to under s 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of the Support No.19.

Stage Two: Whether Support No.19 meets the criteria under subsection 34(1) of the NDIS Act

1. In the Combined Table of Supports, Ms Blesing was prompted to confirm her position in respect to Support No.19. There is no statement made by Ms Blesing in the table to confirm that she is still requesting this support or to describe what it is and at what level of funding she is seeking. There is reference only to the general provisions under the NDIS Act and associated rules in relation to "reasonable and necessary supports" and to some NDIA operational guidelines, but no further particulars are provided. Ms Blesing's Closing Statement, nor Ms Blesing's Final Submission, articulated the request in respect of Support No.19. The Tribunal understands Ms Blesing to be requesting "26 hours per annum for "pain therapy" as specified in Ms Blesing's Position Paper.
2. The best the Tribunal is able to understand this request is that Ms Blesing would like to receive some funding which might go towards her accessing pain management services with the desired outcome of better managing her pain. Pain management interventions can be undertaken by a range of medical and clinical specialists as part of a pain management clinic. Such clinics are available through the public health system or there are also private services available. They would typically entail a specialist pain physician to provide medical advice and treatment about ways of a managing a person's pain and in particular, pharmacological pain treatments which may be available.
3. At the hearing, Ms Beltrame gave evidence that it had "been a while" since Ms Blesing had been reviewed by a pain specialist and that she considered that there may be some medication they could offer Ms Blesing that would support her pain response. Ms Beltrame remarked that pain medication had "come a long way" since Ms Blesing was last reviewed. Ms Beltrame acknowledged that Ms Blesing is incredibly sensitive to medication, indicating there might something available for her despite her sensitivity to medication.
4. In the NDIA's Closing Submissions, it contends that Support No.22 cannot be funded under the NDIS because pain therapy is the responsibility of the mainstream health system and is "not an NDIS support" on account of item 12(a) of Schedule 2 of the NDIS Supports Transitional Rules.
5. The Tribunal asked Dr Chia if he had ever referred Ms Blesing to a pain management clinic. Dr Chia remarked that Ms Blesing has said that part of it is knowing how to manage and cope with her pain, given the traumatic experience she had with the (leg) fractures. He said there could be some benefits to Ms Blesing seeing a chronic pain physician and there may be some benefits in terms of coping strategies and cognitive behavioural strategies, however, Dr Chia said Ms Blesing's chronic pain is not going to be curable, and this suggested treatment is not something likely to "completely revolutionise her", in terms of her pain severity and experience. He said that this suggested intervention will be "quite limited" because of her interventional abilities and the potential for medications to have adverse effects on Ms Blesing, in relation to her breathing and respiration.

1. To the extent that the pain therapy being requested by Ms Blesing comprises (in part or in whole) the services of a specialist pain physician to give her medical advice and treatment in respect of her pain, the Tribunal is satisfied that this component of Support No. 19 falls into item 12(a) of Schedule 2 as contended for by the NDIA as it is a "Health" support under subsection (a) as it involves the "clinical treatment of health ... conditions, including ongoing or chronic health conditions".
2. To the extent that the other aspects of the "pain therapy" being requested by Ms Blesing comprise allied health therapeutic interventions, the Tribunal concludes that this would duplicate the suite of therapeutic interventions for which Ms Blesing will be funded under the New SOPS as a consequence of this Decision. In particular, the "physical therapy"-related supports now approved for Ms Blesing will involve treatments in respect of which the treatment goal is to minimise Ms Blesing's hypersensitivity and pain levels.
3. The Tribunal concludes that r 5.1(c) of the NDIS Rules applies in relation to this component of Support No.19 and excludes the provision of NDIS funding of it, as it will duplicate her other NDIS-funded allied health therapeutic interventions.
4. Further and alternatively, there has been insufficient evidence put forward by Ms Blesing for the Tribunal to be satisfied that Support No.19 would be an effective and beneficial for her or value for money. The Tribunal concludes that Support No.19 is not a "reasonable and necessary support" for Ms Blesing and is not to be included in her New SOPS.

CONSIDERATION - SUPPORT NO.22 (TRAINING FOR SUPPORT WORKERS)

1. Support No.22 in the s 53 Order is a request for "416 hours per annum for "training for carers" to be provided by the Applicant's senior support workers".

Stage One: Whether the request for Support No.22 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No.22 could be reasonable and necessary support, as the provision of each such support is aligned with the objectives under subsections 3(1)(a), (c), (d) and (g) and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.22.

Stage Two: Whether Support No.22 meets the criteria under subsection 34(1) of the NDIS Act

1. In Ms Blesing's Position Paper she requested funding for 416 hours for training to be provided to new support workers by Ms Blesing's senior support workers. This equates to 8 hours per week to pay for a new support worker to be trained by a senior support worker.
2. In the NDIS Price Guide, the NDIA states that shadow shifts may be claimed where the participant has complex individual support needs that are best met by introducing a new worker to the participant before it is reasonable that they commence providing the support independently - for example, where the specific individual support needs include very limited communication; behaviour support needs, and/or medical needs/procedures such as ventilation or Home Enteral Nutrition. The NDIS Price Guide also states that where the individual would require shadow shifts to assist with the introduction of new workers, and this is the desired method by the participant or their family, the provide may claim for up to 6 hours of weekday support per annum.[208]

1. In the NDIA's Closing Submissions, it contends as follows:

(a) at the hearing, Ms Blesing confirmed that funding for Support No.22 would be used to pay for her more experienced support workers to train other new support workers assisting her. Ms Blesing is seeking funding which will equate to a total of eight hours per week over an annual period; > > (b) it is wholly unclear to the NDIA why Ms Blesing is seeking this level of support for the purpose of her senior support workers training other support workers; > > (c) during the hearing, the NDIA asked Ms Blesing's speech therapist, Ms Clifton, if she proposed to film the training that she wished to provide to Ms Blesing's support workers so that it would be available to all of her support workers, as there had been a turnover of staff. The NDIA notes that after this exchange, Ms Blesing told the Tribunal that, while there had been staff turnover in the past when her plan was Agency-managed, that this was no longer the case; > > (d) the NDIA contends that this raises further questions as to why Ms Blesing's senior support workers need to spend one day per week training her other support workers, if there is no longer any significant staff turnover; > > (e) if Ms Blesing is to be provided with this support, along with the 4:1 ratio of support worker assistance that she seeks, at times, there would be a day a week when she would, effectively, have five support workers around her. As set out above, the Tribunal has concluded that a 4:1 ratio of support worker assistance for Ms Blesing is not a "reasonable and necessary support" for Ms Blesing; > > (f) the NDIA notes that Ms Blesing's occupational therapist and physiotherapist already provides training to Ms Blesing's support workers. As such, the NDIA contends that funding for a further layer of training of support workers by Ms Blesing's senior support workers, would be excluded by operation of r 5.1(c) of the Support Rules; and > > (g) if Ms Blesing is seeking that some of the funding be provided for her support workers to attend the training, the current NDIS Pricing Arrangements and Price Limits (page 18) provides that: "The costs of training and up-skilling staff, and of supervision, are included in the base price limits for supports and are not considered billable non face-to-face supports."

1. The Tribunal acknowledges the statement in the NDIS Price Guide referred to by the NDIA in subparagraph [512(g)] above. The Tribunal considers that the training referred to on page 18 of the NDIS Price Guide is a reference to generic training rather than training required in relation to Ms Blesing's individual disability-related needs.
2. The Tribunal accepts Ms Blesing's evidence that there is no longer a high degree of turnover of her staff and that the support staffing situation is more stable now that the Agency-management specifications in her plan were removed. The Tribunal finds that Ms Blesing's requirement for training to assist in introducing new support staff into her team of support workers, and to learn about her disability-related needs is not as great as it used to be. However, Ms Blesing has a sizable team of support workers assisting her, so it can be expected that there will be inevitable turnover from this team, time to time, and that the new support workers will require training specific to Ms Blesing's individual needs.
3. The Tribunal has approved funding for support worker assistance at the 3:1 ratio at the "high intensity" rate for the periods during which the intensive morning routine is undertaken and for two hours in the evening when Ms Blesing is transferred into her bed. During these times, the support workers assisting Ms Blesing will be actively engaged in undertaking the required tasks. This does present an opportunity for a new support worker to observe and to assist under supervision of the more senior support workers. Ms Blesing can also talk through the duties and her individual needs with any new support worker. At the hearing, Mr Burden said that Ms Blesing was very active in the sense of advocating her needs. He gave an example where he had observed Ms Blesing instructing a support worker, who was applying pressure to one of her legs, to cease doing so because the pressure was inadequate and that they should swap over with one of the other support workers. Mr Burden said that Ms Blesing is able to give directions within the bounds of her communications challenges. The Tribunal accepts this evidence from Mr Burden.
4. It is appropriate that funding be provided for the training of new support workers as contemplated by the NDIS Price Guide in relation to the specific individual disability-related support needs of Ms Blesing, however, this training should not involve the general upskilling or training of a support worker. If any of Ms Blesing's support workers are not skilled to the level for which they are being paid, her support coordinator/s should proactively link Ms Blesing to alternative support workers who possess an adequate level of skills and experience. The billable rate that the support workers are being paid reflects that the support workers are expected to have a minimum level of general skills in carrying our tasks to assist a participant.
5. The training to be funded under the NDIS is limited to the time taken to train a new support worker about Ms Blesing's individual disability-related support needs only. The Tribunal considers that a reasonable level of funding for such training in Ms Blesing's circumstances, is six hours per support worker. In light of the large size of Ms Blesing's support team, the Tribunal considers there may be in the vicinity of 20 new supports workers being introduced into Ms Blesing's support team each year. Accordingly, the Tribunal considers that a provision of 120 hours per annum of support worker assistance to provide 6 hours of training for each of the projected 20 support workers per year is a reasonable provision to allow for the new support workers to engage in shadow shifts before they are expected to commence undertaking their role with Ms Blesing substantively.
6. In conclusion, the Tribunal is satisfied that 120 hours per annum of support worker assistance at the "standard" rate (because the support worker will be observing and assisting rather than undertaking tasks as one of the primary support workers):

(a) is, or is likely to be, effective and beneficial for Ms Blesing; > > (b) represents "value for money"; > > (c) will assist Ms Blesing to pursue her goals and to undertake activities to facilitate her social and economic participation; > > (d) is necessary to address Ms Blesing's needs arising from her impairments to which s 24 of the NDIS Act applies; > > (e) takes into account what is reasonable to expect families, carers, informal networks and the community to provide; and > > (f) is "an NDIS support" for Ms Blesing and not more appropriately provided under another general service system.

7. The Tribunal concludes that 120 hours per annum of support worker assistance at the "standard" rate is a "reasonable and necessary support" for Ms Blesing and concludes that it should be added to the New SOPS to be implemented in accordance with this Decision. This is to be specified as a "Stated" support for the reasons set out below and so that these funds are preserved to meet these new support staff training needs, as and when they arise throughout the year.

CONSIDERATION - SUPPORT NO.24 (SUPPORT COORDINATION)

1. Support No.24 in the s 53 Order is a request for "4 hours per week for Level 3 support coordination services".

Stage One: Whether the request for Support No.24 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No.24, could be reasonable and necessary supports, as the provision of each such support is aligned with the objectives under subsections 3(1)(a), (c) and (d) and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.24.

Stage Two: Whether Support No.24 meets the criteria under subsection 34(1) of the NDIS Act

1. The NDIA has approved funding in Ms Blesing's Current SOPS for $29,068.00 in respect of "Support Coordination and Psychosocial Recovery Coaches". This is specified as a "Stated" support category and is "plan-managed". The NDIA has imposed monthly funding periods restricting expenditure of this budget to $2,422.37 per month, with any unspent funding to be rolled over to the next month. Consistent with the Breakdown of Supports, the budget description in the Current SOPS refers to the "coordination of supports" and that funding is allocated for:

(a) 100 hours of Level 2 support coordination; and > > (b) 100 hours of Level 3 support coordination.

2. When Ms Blesing was prompted to state her position about the request for 208 hours of Level 3 support coordination services (as referred to in the s 53 Order), in the Combined Table of Supports), Ms Blesing contends that reducing coordination services from current levels "because of an aspiration by NDIA is unrealistic". Ms Blesing does not state what she believes this aspiration to be. Ms Blesing also contends that "Time taken to deal with all businesses including telecommunications, Banks, Government agencies especially NDIA, worker Superannuation compliance and the ATO's STP2 requirements, security of all business account functions requiring MFA (Multi Factor Authentication) means there is and will be an increasing demand for support in the future, not a reduction". There is no further elaboration by Ms Blesing in her Closing Statement as to her requested increase in funding for support coordination services.

1. In the NDIA's Closing Submissions, it states that the NDIA considers 100 hours of level 3 support coordination for Ms Blesing is reasonable and necessary and that this support is in in addition to the 100 hours of level 2 support coordination that she is funded for in her plan. The NDIA submits that this level of support coordination services has regard to Ms Blesing's complex support needs, and the high level of engagement that is required with providers and mainstream supports. The NDIA contends that Ms Blesing is linked with all relevant providers, and there is insufficient information to support her request for additional funding. The NDIA considers that it is unlikely that Ms Blesing will require "the total level of support", which the Tribunal understands to mean the current level of approved funding for Ms Blesing at present for support coordination services.
2. The NDIA highlighted that Ms Noble considers 100 hours of support coordination (in total) for Ms Blesing is reasonable. The evidence of Ms Blesing's support coordinator, Ms Rake, at the hearing declined to offer her opinion about the number of support coordination services required by Ms Blesing over the next 12 months because she regarded herself as having a vested interest in the outcome. Ms Rake suggested that it was appropriate for another party to set the level of support coordination services that Ms Blesing is to receive.
3. The NDIA notes that if Ms Blesing is to be funded for 4 hours per week of level 3 support coordination, as requested by her, this would add up to 208 hours of level three support coordination per annum, in addition to the 100 hours of level 2 support coordination per annum. The NDIA contends that this will add up to 308 hours of support coordination services per year and that this level of support coordination services for Ms Blesing, is "excessive".

1. Whether Ms Blesing is requesting 208 hours of Level 3 support coordination in total, or a combination of 100 hours of Level 2 support coordination and a further 200 Level 3 support coordination services, the Tribunal agrees with the NDIA that there is insufficient evidence before the Tribunal to demonstrate why the current level of funding allocated under Ms Blesing's NDIS plan is inadequate. The Tribunal considers that it is appropriate for Ms Blesing to have two support coordinators providing services to her, given the complexity of her situation and the importance that the flow of appropriately skilled support workers to Ms Blesing is proactive and well managed so that this support continues without interruption. The impression gained by the Tribunal at the hearing was that Ms Blesing has engaged other persons, such as Ms Hesketh, Ms Bartholomew and Ms Cameron, to attend to tasks which should appropriately be managed by support coordinators. The Tribunal considers that Ms Blesing should take steps to engage a Level 2 support coordinator to take over some of their roles and to centralise the management of Ms Blesing's NDIS supports and the links to those supports, as well as assisting her to link with other mainstream supports.
2. In the absence of any detailed particulars about what the Level 3 support coordinator would be doing for Ms Blesing, after she exhausts the initial funded 100 hours, particularly in light of overall reliability of Ms Blesing's support workers having now returned to a stable footing (according to Ms Blesing), the Tribunal is not satisfied that the provision of any more hours of Level 3 support coordination services for Ms Blesing above the initial 100 hours for which she is currently funded, is, or is likely to be, effective and beneficial for her. The Tribunal concludes that the mandatory criterion under s 34(1)(d) of the NDIS Act is not met.
3. On this basis, the Tribunal concludes that Support No.24 is not a "reasonable and necessary support" for Ms Blesing under the NDIS Act. The Tribunal considers the current funding for support coordination services for Ms Blesing is adequate, that is, funding for 100 hours of Level 3 support coordination services and a further 100 hours for Level 2 support coordination services and this funding should be replicated in her New SOPS.

CONSIDERATION - SUPPORT NO.25 (WHEELCHAIR MAINTENANCE AND REPAIRS)

1. Support No.25 in the s 53 Order is a request for "AT - Wheelchair maintenance and repairs (including backrest and cushions)".

Stage One: Whether the request for Support No.25 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No.25 could be reasonable and necessary support, as the provision of each such support is aligned with the objectives under subsections 3(1)(a), (c), (d) and (g) and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.25.

Stage Two: Whether Support No.25 meets the criteria under subsection 34(1) of the NDIS Act

1. Support No.25 (as well as Supports No.26, 27 and 34) fall under the general category of assistive technology or a provision for the maintenance, repair or rental of assistive technology (or "capital supports" budget). Ms Blesing is currently funded for supports which fall into this category/budget (specified as being "plan-managed" and that it is a "Stated" support category), as follows (according to the Breakdown of Supports):[209]

Assistive Technology (AT): $27,507.56 > > Mid cost AT between $1,500 and $15,000 per item > > Prosthesis - Lower Limb - Not Defined, up to the amount of $3,345.00; > > Shower Commode - Wheeled - High complexity need, up to the amount of $10,000.00; > > Communication AT - Simple Button or Keys with Voice Output, up to the amount of $2,283.00; > > Communication and Information - Computer interfaces, up to the amount of $1,000.00 > > Pressure reduction mattress/overlay, up to the amount of $1,201.56 > > AT Device Positioning / Mounting Systems, up to the amount of $2,800.00; > > Recreation AT - Game Interface, up to the amount of $500.00; > > Communication AT - Simple Button or Keys with Voice Output, up to the amount of $1,687.00; > > Transfer AT - Mobile Hoist including Slings (x2), up to the amount of $4,691.00; > > Assistive Technology Maintenance, Repair and Rental budget of $11,441.50. Maintenance and repairs of AT supports > > Repairs and Maintenance - Wheeled Mobility Minor up to the quoted amount of $1,000.00; > > Repairs and Maintenance - Transfer AT up to the quoted amount of $1,600.00; > > Repairs and Maintenance - Other AT, up to the quoted amount of $400.00; > > Repairs and Maintenance - Other AT, up to the quoted amount of $400.00; > > Wheelchair or Scooter - Battery or Charger, up to the quoted amount of $1,000.00; > > Repairs and Maintenance - Wheeled Mobility Minor, up to the quoted amount of $500.00. > > Rental or trial of AT supports > > AT Rental - Communication and Computer access up to the quoted amount of $6,541.50.

2. Ms Blesing owns a powered Levo-branded standing wheelchair and a manual Levo-branded wheelchair. She said she mostly uses her powered wheelchair. The powered wheelchair is valued in the vicinity of $72,000,[210] and the manual wheelchair in the vicinity of $8,000. Ms Blesing gave evidence that there was a period of about two years after she fractured her leg that she did not use it, but it all other times she uses the powered wheelchair on a daily basis. Ms Blesing's manual wheelchair is used infrequently by comparison.
3. In the Combined Table of Supports, Ms Blesing was prompted to clarify the items she is seeking as part of Support No.25 and the evidence she relies upon. Mr Hesketh, on behalf of Ms Blesing, provided information in her nominated column of the Combined Table of Support, referring to different documents, quotations and a further updated table was prepared and added at the end of the document by Ms Hesketh. Despite his best endeavours, it was difficult for the Tribunal to comprehend from this information, what Ms Blesing's position in respect of Support No.25. For instance, some of the specified costs of the items set out for Support No.25 did not match the quoted cost of the corresponding items as shown in the quotations which were referred to by Ms Blesing. However, Ms Blesing confirmed that she is seeking a total amount of $20,950 over the next 12-month period for Support No.25.
4. The Tribunal requested that the parties make a further endeavour to provide greater clarity about the position of the parties in respect of Supports No. 25 (as well as Supports No.26 to No.38). The parties jointly prepared the Combined Table of AT Supports No.25 to No.38 as referred to above. In this table, Ms Blesing confirms that she is seeking the following specific items which amount to a total of $22,874.31 of requested funding for this support:

Powered (Levo Standing) Wheelchair[211]

**_(a) (Support No.25 - Item 1) $3,800 per annum for "ongoing service, maintenance and repairs" (including three callouts), as per Medimart quotation dated 22 January 2025;

(b) (Support No.25 - Item 2) $2,324.31 for wheels and damper system, as per Aidacare invoice dated 16 December 2024;

(c) (Support No.25 - Item 3) $4,800 for "parts, motor and drive cables", as per Medimart quotation dated 22 January 2025;

(d) (Support No.25 - Item 4) $4,000 for two custom-made Endurafoam-branded cushions and hypertex covers (that is, $2,000 each), as per Medimart quotation dated 22 January 2025. Ms Blesing said she uses three cushions placed inside the cover;

(a) (Support No.25 - Item 5) $1,050 to replace the "backrest", as per Medimart quotation dated 22 January 2025;

(b) (Support No.25 - Item 6) $450 to for "cable replacement", as per Medimart quotation dated 22 January 2025. When Ms Blesing was asked how this item differed from the provision of $4,800 for "part motor cables ect", she stated that her powered wheelchair has three different cables being the drive cable, control panel cable and motor cable and that the quote for $450 "could be for the control cable";

(c) (Support No.26 - Item 7) $900 for six "new tyres" (that is, $150 each), as per Medimart quotation dated 22 January 2025. The Tribunal notes that the service provider who issued the quotation, states that the tyres are "worn to point the tube is exposed".

Total: $17,324.31

_**

(d) (Support No.25 - Item 8) $1,800 for "servicing and maintenance" (including three callouts per year), as per Medimart quotation dated 22 January 2025;

(e) (Support No.25 - Item 9) $500 for "callouts and deliveries";

(f) (Support No.25 - Item 10) $700 for "parts and motor cables" and also "stands", as per Medimart quotation dated 22 January 2025_._ Ms Blesing states that "they already require repair";[212]

(g) (Support No.25 - Item 11) $550 for one "cables and arm (side) guards and for armrests".

(h) (Support No.25 - Item 12) $900 for one "new cushion", as per Medimart quotation dated 22 January 2025;

(i) (Support No.25 - Item 13) $500 for replacement of one set of tyres, as per Medimart quotation dated 22 January 2025; and

(j) (Support No.25 - Item 14) $600 for the replacement of the footplates (or hangers) on her manual wheelchair.

Total: $5,550

1. Initially, the NDIA had approved funding for Support No.25 of $500 for maintenance and repair of Ms Blesing's manual wheelchair and a further $800 for the maintenance and repair of her powered wheelchair. The Tribunal notes that this aligns with the estimated annual cost of manual and powered wheelchair maintenance and repairs as specified by the NDIA in its operational guidance entitled, "NDIS Assistive Technology - Guide for funding of annual repairs and maintenance funding".[213] There is no explanation in this guidance document as to how the NDIA arrived at these estimates and these figures are stated to be "examples and will be adjusted up or down based on" the participant's "needs".[214]
2. In the Combined Table of AT Supports Nos. 25 to 38,[215] the NDIA suggests that Ms Blesing should use her existing capital building funding to conduct a complete review of mobility. The NDIA indicates a willingness to replace Ms Blesing's wheelchairs consistent with recommendations of the mobility review and suggests that the replacement of the wheelchairs can be arranged through a "change of circumstances" process with the NDIA (which the Tribunal understands to be a reference by the NDIA to an unscheduled plan review under s 48 of the NDIS Act). The NDIA also states in the Combined Table of AT Supports Nos. 25 to 38, that it agrees to double its previously approved funding, to make a provision of $1,000 for the manual wheelchair and a provision of $1,600 for the powered wheelchair (as now incorporated in the Current SOPS).
3. The Tribunal notes that Ms Blesing is currently funded for the following four items relating to the maintenance and repairs of her wheelchairs:

Repairs and Maintenance - Wheeled Mobility Minor up to the quoted amount of $1,000.00; > > Repairs and Maintenance - Transfer AT up to the quoted amount of $1,600.00; > > Wheelchair or Scooter - Battery or Charger, up to the quoted amount of $1,000.00; > > Repairs and Maintenance - Wheeled Mobility Minor, up to the quoted amount of $500.00.

4. At the hearing on 20 October 2025, Ms Martin elaborated that Ms Blesing's powered wheelchair is now five years old, and that given its age, it is most appropriate that Ms Blesing have a "full assessment" to ensure she "gets a wheelchair that is most suitable", and "which supports her needs". Ms Martin said that the NDIA is prepared to fund "essentially, a new wheelchair to provide a replacement", so that Ms Blesing has "exactly what she needs". Ms Martin said she has received "instructions" and that the NDIA's understanding is that the lifespan of a wheelchair is between five and eight years. Ms Martin contends that it is "more cost-effective to look at a replacement", noting Ms Blesing's requests. Ms Martin said that Ms Blesing's requests for maintenance and repairs would fall away, if her wheelchair were replaced.
5. At the hearing on 20 October 2025, Ms Blesing refuted that the lifespan of her wheelchair would be for the duration as projected by the NDIA. Instead, Ms Blesing asserted that the life span of a wheelchair was ten years. When asked what this assertion was based upon, Ms Blesing said that the "supplier" and also the South Australian Disability Services body had told her this. The Tribunal considers that those reported representations are inconsistent with the reality that Ms Blesing's powered and manual wheelchairs, by her own evidence, are in need of expensive and expansive repairs.
6. Ms Blesing said she is not requesting the replacement of her wheelchair at this time. There was no compelling reason put forward by Ms Blesing as to why she has refused to accept the NDIA's offer that she be funded for replacement wheelchairs. When asked about this at the hearing, Ms Blesing's response was that she believed that adequate maintenance "should be funded as standard". The Tribunal does not consider the issues of ongoing general maintenance and the question of whether an item should be periodically replaced, to be mutually exclusive. The Tribunal considers that it is reasonable and necessary for there to be a provision in Ms Blesing's NDIS plans for her to pay for any repairs or maintenance which may arise and that these funds should be specified as a "Stated" support. It would also seem warranted that the quantum of this amount should be a lesser amount in the years following the acquisition of a new manual or powered wheelchair and higher in later years as the wheelchairs age. It is reasonable for a stage to be reached where it will be more cost-effective, as suggested by the NDIS in this instance, for the wheelchairs to be replaced as an alternative to the provision of funding for expensive and expansive repairs. At that stage, if Ms Blesing wishes to keep the wheelchair instead of replacing it, and as a consequence the wheelchair requires expensive repairs, Ms Blesing would of course be at liberty to pay for those repairs and maintenance privately. But this choice should not lead to an outcome where the NDIS funds are expended for expensive repairs when a complete replacement of the wheelchairs is, on the evidence, a more cost-effective alternative.
7. The NDIA contends that Ms Blesing's request for current and projected expensive repairs and maintenance to her current wheelchairs would not meet the "value for money" criterion under the NDIS Act when compared to alternative supports, being to purchase new wheelchairs. The Tribunal agrees. Given the quantum of the projected repairs and maintenance outlined by Ms Blesing and the suppliers in the Combined Table of AT Supports Nos. 25 to 38 which totals $22,874.31 over a one-year period, the Tribunal is unable to accept that it would be reasonable to approve such funds for Ms Blesing in circumstances where the NDIA has offered to fund the purchase of new wheelchairs, following the provision of an updated mobility assessment.

Support No.25 - Item 2: Specific request for funding to replace Ms Blesing's powered wheelchair wheels and damper system

1. In the Combined Table of AT Supports Nos. 25 to 38, Ms Blesing seeks $2,324.12 for the replacement of her powered wheelchair wheels and damper system (as distinct from the tyres). The NDIA contends that this support is not reasonable and necessary because "funding will be provided for a new wheelchair. In the meantime, the applicant can use the existing repair and maintenance budget".[216]
2. At the hearing, Ms Blesing gave evidence that the wheels were last replaced in December 2024. The Tribunal asked Ms Blesing why the wheels required replacement so frequently, given they were last replacement in December 2024. Ms Blesing gave evidence that it was required due to her usage of her wheelchair. Ms Blesing said she "lives in it". Ms Blesing added that if she is not in her bed, she will be in her wheelchair. Ms Blesing confirmed that the cost of this repair (in December 2024) was paid for out of her NDIS funding.
3. The Tribunal does not consider there to be any evidence before the Tribunal to support Ms Blesing's technical proposition that the powered wheelchair wheels and damper system (as distinct from the tyres on the wheels) on her wheelchair require replacement every 12 months. When asked why Ms Blesing considered it to be necessary to replace the tyres and damper system, her response was that Peter World Scooter had recommended that the "tyres" be replaced every 12 months. This recommendation is irrelevant to Support No.25 - Item 2 because the powered wheelchair wheels and damper system, are separate and distinct components from the tyres on the powered wheelchair.
4. The Tribunal asked Ms Blesing whether there was a report or a quote from a supplier in the evidence before the Tribunal indicating that the wheels and damper system (as distinct from the tyres) required replacement every 12 months. Ms Blesing referred, generally, to Steven Wilson's Report and an unspecified OT report. The Tribunal was unable to locate any such recommendations. Ms Blesing indicated at the hearing that "all we have, is the past history" of the two chairs in the last 15 years. However, inconsistent with this suggestion, Ms Blesing gave evidence that she has had her wheels and the damper system, replaced only once in the last five years during which she has owned her current powered wheelchair. Ms Blesing sought to explain this by informing the Tribunal that in the first two years after she broke her legs, that she could not get back into her chair (so she had not used it much).
5. The Tribunal accepts that the tyres on the powered wheelchairs might require replacement every 12 months but is not satisfied that there is sufficient evidence before it to positively find that it is reasonable for the wheels and damper system on her wheelchair to be replaced every 12 months. The Tribunal concludes that for this reason, the requested funding intended to be used in the next 12 months to replace the damper system is unnecessary and should not be funded Ms Blesing's New SOPS.
6. On this basis, the Tribunal is not satisfied that a provision for another replacement of those wheels and damper system in the next 12 months is a reasonable and necessary support for Ms Blesing. The Tribunal is not satisfied that there is evidence before it to find that those items require replacement again so soon after they were last replaced in December 2024.

Support No.25 - Item 2: Specific request for funding to replace the footplate (or hanger) on Ms Blesing's manual wheelchair

1. The NDIA states in the Table of Agreed Support that it has agreed to fund this item. This table confirms that Ms Blesing has accepted this offer and that (as of the date of this table) it had not been incorporated into her SOPS. Accordingly, when making this Decision, the Tribunal will direct that a provision approving $600 for the quoted cost to repair the footplate (or hanger) on her manual wheelchair, be included in Ms Blesing's New SOPS. The Tribunal considers this item to be time sensitive, as it is likely to be a potential safety hazard if it is not fixed awaiting the replacement of Ms Blesing's manual wheelchair.

1. The Tribunal concludes that the criterion under s 34(1)(c) of the NDIS Act is not met in respect of Ms Blesing's requested Support No.25 which she has quantified in the sum of $22,874.31 over a one-year period, because it does not represent "value for money" in that the costs of the support are not reasonable, relative to the benefits to be achieved and cost of alternative supports. The reason for this is that the Tribunal agrees with the NDIA's suggestion about the need for the replacement of Ms Blesing's wheelchairs. Taking a long-term view, the Tribunal is satisfied that this is the most cost-effective way of dealing with requested Support No.25.
2. Ms Blesing was unable to demonstrate to the Tribunal's satisfaction that there is a proper basis for the proposition that she ought to be funded for requested expensive repairs instead of replacing the wheelchairs. Ms Blesing provided a quotation issued by Medimart, as mentioned above, but the Tribunal does not accept this quotation. At face value, the figures in the Medimart quotation dated 22 January 2025 appear to be excessive or if this number and level of repairs and maintenance to Ms Blesing's wheelchairs are truly warranted, it would imply that it has come time for both wheelchairs to be replaced.
3. The Tribunal agrees with Ms Blesing's contention that it should be standard practice for there to be a provision in her SOPS for ongoing maintenance and repairs to her two wheelchairs. It would appear from the operational guidance "Assistive technology - Guide for funding of annual repairs and maintenance funding" that the NDIA also agrees with this as a broad proposition. The Tribunal agrees that Ms Blesing should have a provision of funding in her NDIS plan to pay for repairs and maintenance over the next 12 months, but does not accept Ms Blesing's projections as to quantum of the amount of this provisional funding, for the reasons set out above.
4. Mr Burden gave evidence at the hearing that in his experience as an occupational therapist, as a "general rule of thumb", a provision of 10 per cent of the cost of AT equipment is usually a good guide for projecting a forward budget for repairs and maintenance. Ms Blesing's two wheelchairs are items of AT equipment. Mr Burden is an experienced and qualified occupational therapist, and the Tribunal accepts his evidence about the use of this "general rule of thumb" at the present time, to estimate an appropriate provision for ongoing repairs and maintenance to AT, including Ms Blesing's manual and powered wheelchairs.
5. Accordingly, the Tribunal considers it appropriate that a provision be made in Ms Blesing's NDIS plan for repairs and maintenance to her manual and powered wheelchairs for the next 12-month period of an amount equal to 10 per cent of the combined value of her manual and powered wheelchairs. The combined value of the wheelchairs is in the vicinity of $80,000 and 10 per cent of this figure is $8,000 per annum. Once approved, Ms Blesing can use this provisional budget, as required, to maintain and repair her current, or indeed any new powered or manual wheelchairs she might acquire over the next 12-month period, once she has exhausted any avenues open to her to seek a remedy from the retailer or manufacturer under any applicable product warranties.
6. The Tribunal considers it appropriate that this funding budget for ongoing wheelchair repairs and maintenance be specified as a "Stated" budget or support. This specification will mean that the approved funds cannot be spent, flexibly, on any other supports, ensuring that it is ready and available if and when repairs and maintenance to Ms Blesing's wheelchairs become necessary over the next 12 months.
7. If an unexpected costly item of repair or replacement of Ms Blesing's wheelchairs arises over the next 12 months, which exceeds the provision of funding of $8,000 per annum, as identified by the NDIA, Ms Blesing is at liberty to request a specific amount of funding be added to her SOPS by way of a plan variation if this is possible under the NDIS Act or as an unscheduled plan review under s 48 of the NDIS Act.
8. The Tribunal acknowledges that the tyres on Ms Blesing's powered wheelchair require urgent repair now, because the quotation being relied upon by Ms Blesing expressly states that the tyres are "worn to point the tube is exposed". In this regard, the Tribunal concludes that it is reasonable to make an additional amount of funding of $900 available to Ms Blesing for the overdue replacement of those six tyres is a "reasonable and necessary support", in addition to the standard provision of a 10 per cent budget for other general repairs and maintenance to Ms Blesing's wheelchairs.
9. The NDIA highlights that Ms Blesing has access to funds which may be directed to engage an occupational therapist to undertake the mobility assessment which has been suggested by the NDIA, and to make recommendations about the replacement of her wheelchairs, which, on the evidence before the Tribunal, are likely to be a more cost-effective option than for her to continue paying for several different costly repairs to or the replacement of the various components of the wheelchair.
10. The Tribunal concludes that Ms Blesing's requested repair costs do not represent "value for money" within the meaning of s 34(1)(c) of the NDIS Act, when compared to the cost of replacing her powered wheelchair, as has been suggested by Mr Burden and the NDIA. Instead, the Tribunal is satisfied that a sum of $8,000 as a general provision for the maintenance and repair of her manual and powered wheelchair over the next 12 months, together with the further sum of $900 to replace the tyres of her powered wheelchair and $800 for the footer (or hanger) on her manual wheelchair. The Tribunal is satisfied that those two supports meet the "reasonable and necessary supports" criteria for Ms Blesing over the next 12-month period and are to be added to Ms Blesing's New SOPS.

CONSIDERATION - SUPPORT NO.26 (ROBOTIC ARM TRIAL)

1. Support No.26 in the s 53 Order is a request for "AT - Robotic arm (trial) $7,000" ('Robotic Arm').

Stage One: Whether the request for Support No.26 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No.26 could be reasonable and necessary support, as the provision of each such support is aligned with the objectives under subsections 3(1)(a), (c), (d) and (g) and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.26.

Stage Two: Whether Support No.26 meets the criteria under subsection 34(1) of the NDIS Act

1. At the hearing and in the Combined Table of AT Supports Nos. 25 to 38, Mr Hesketh confirmed that Ms Blesing is requesting:[217]

(a) $4,000, relying on a quotation issued by Active Mobility Systems dated 23 November 2018 for a "JACO Trial Adelaide";[218] and > > (b) an unspecified amount to mount the robotic arm onto Ms Blesing's powered wheelchair seat plate. The Tribunal was informed that the supplier would not provide a quote for the mounting cost.

2. The JACO robotic arm is different from the OBI feeding device as requested by Ms Blesing (see Support No.34 below). The JACO robotic arm is a six-axis robotic manipulator arm with a three-fingered hand. It can be used by multiple controls. This product in intended to assist persons with upper extremity disabilities to perform complex actions. The types of tasks it could assist with include everyday activities, such as picking up glasses, holding a fork or opening a door. However, there would appear to be some functional overlap between this device and the purpose of the OBI feeding device in that both devices are designed to assist a person to feed themselves independently. The JACO robotic has additional functional purposes.
3. The NDIA does not accept that this support should be funded under the NDIS because it asserts there is "insufficient evidence to justify the need for this item" and that it cannot be considered "value for money" having regard to the rules (citing r 3.1(a), (b), (c) and (f) of the Supports Rules).
4. In the Combined Table of Supports, Ms Blesing indicates that she relies upon Ms Noble's April 2023 Report and also Ms Beltrame's report dated 27 November 2021 ('Ms Beltrame's 2021 Report').[219]
5. In Ms Noble's April 2023 Report, Ms Noble opines that Ms Blesing needs a robotic arm that will work with her current powered wheelchair. She said that this device would enable Ms Blesing to be more independent and allow her to do more things for herself, such as getting a drink or allowing someone entry through the door or to get some food out of the fridge and to feed herself. Ms Noble states that "we have been unable to get a trial of the Australian-made product and have other companies looking to source a trial product for Ms Blesing that will work with the Levo wheelchair".[220] Ms Noble adds that Ms Blesing is currently unable to enter and exit her building without assistance and she needs to have the robotic arm as it will increase her independence and self-esteem significantly and allow her to do some things for herself. She mentioned that suppliers have been reluctant to provide trials of this device in South Australia so alternative solutions were being sourced from outside Australia.[221]
6. In Ms Beltrame's 2021 Report, Ms Beltrame states that she supports the occupational therapy goals of trialling and using a robotic arm to allow Ms Blesing "to be fully independent of carers in some community/recreational/social activities" and she attaches a link to information about the JACO robotic arm.[222]
7. In the NDIA's Closing Submissions, the NDIA acknowledged that Mr Burden's evidence about Support No.26 was "somewhat equivocal" but that he considered that the use of a robotic arm could enhance Ms Blesing's ability to participate in, or to complete some activities of daily living, given her physical limitations due to MS. Specifically, Mr Burden described Ms Blesing's impairments and stated that "a robotic arm, integrated with her powered wheelchair, could provide her with the capability to perform tasks that are otherwise impossible due to her physical constraints". At the hearing, Mr Burden was asked why he had underlined the word "could" in his report. Mr Burden said the device had "not been trialled" and he added that use of robotic arms is "not common practice", due to their cost. He said that while this device is "not necessarily experimental", the trial will experiment with whether the robotic arm would have some utility for the person using it. Further, the NDIA contends that Ms Blesing is funded for "24/7 supports" and so funding for a robotic arm would duplicate these other NDIS supports and so r 5.1(c) for the Support Rules applies to exclude the funding for the robotic arm.
8. While the Tribunal understands the NDIA's contention about the duplication of supports in light of Ms Blesing being funded for support worker assistance around the clock, specifically, under the New SOPS for 46.5 hours of support worker assistance per day to do the tasks for Ms Blesing that she is unable to do. However, with respect, this is a narrow view because one the overarching objectives of the NDIS to provide its participants with innovative supports, such as innovative assistive technology, in an endeavour to increase their independence. If the support, once trialled, proves to be effective, it is expected that it will serve to reduce Ms Blesing's need for support by her support workers as there are certain daily tasks she may be able to build the capacity to do for herself.

1. Given the recommendations of Ms Noble and Ms Beltrame and the acceptance by Mr Burden of the potential for this device to be beneficial for Ms Blesing, the Tribunal is satisfied that there is sufficient justification as to why a trial of the robotic arm should be undertaken to test whether it is an assistive technology that Ms Blesing should have access to on an ongoing basis. The Tribunal notes Ms Noble's caution that it may be difficult to arrange for a supplier to provide a trial of this product to Ms Blesing. For this reason, the Tribunal will express this support as being a trail of a robotic arm which is designed to achieve the same or similar outcomes as the JACO robotic arm to provide flexibility for this funding to be used on a robotic arm from a different supplier. Any change in supplier is to be endorsed by Ms Noble and Ms Beltrame before the trial fee is paid using NDIS funding.
2. The Tribunal concludes that a provision of funding in the sum of $5,000 will be sufficient to enable Ms Blesing to undertake a trial of a robotic arm which is designed to achieve the same or similar outcomes as the JACO robotic arm and any fees associated with mounting this device on Ms Blesing's powered wheelchair, is a "reasonable and necessary support" for Ms Blesing because the trial of this support for her:

(a) is, or is likely to be, effective and beneficial for Ms Blesing but testing whether it is an effective assistive technology which should have ongoing access to; > > (b) represents value for money; > > (c) will assist Ms Blesing to pursue her goals (noting the one of her goals is increase her capacity and level of independence through various assistive technologies and therapies), and to undertake activities to facilitate her social and economic participation (by allowing her to access the community more easily and to potentially be able to open doors independently); > > (d) is necessary to address Ms Blesing's needs arising from her impairments to which s 24 of the NDIS Act applies; > > (e) takes into account what is reasonable to expect families, carers, informal networks and the community to provide; > > (f) is "an NDIS support" for Ms Blesing falling under item 9 of Schedule 1 of the NDIS Supports Transitional Rules. This support category is described as "assistive products for personal care and safety" and it includes the "provision of assistive products for self-care activities and participation in self-care" and includes item 9(g) being "services to assess and prescribe, deliver, adjust and train a participant in successful use of an assistive product". It does not fall under any of the items in Schedule 2 as being "not an NDIS support". There were no contentions made to the Tribunal that this support is more appropriately funded under another general service system.

CONSIDERATION - SUPPORT NO.27 (AT MAINTENANCE AND REPAIRS)

1. Support No.27 in the s 53 Order is a request for "AT - "other maintenance and repairs" $8,000 to $10,000".

Stage One: Whether the request for Support No.27 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No.27 could be reasonable and necessary support, as the provision of each such support is aligned with the objectives under subsections 3(1)(a), (c), (d) and (g) and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.27.

Stage Two: Whether Support No.27 meets the criteria under subsection 34(1) of the NDIS Act

AT items in respect of which Ms Blesing is seeking maintenance, replacement or repair

1. In the Combined Table of AT Supports Nos. 25 to 38, Ms Blesing listed seven separate items of AT in respect of which she is seeking maintenance, replacement or repair, specifically:

(a) $437.50 per annum for replacement of her shower commode "Kcare" custom seat including freight of $39.50 - as per Medimart invoice issued in December 2022; > > (b) $1,400 per annum for maintenance to her Arjo Electric bed; > > (c) funding for two new replacement specialist Airflex mattresses per year; > > (d) $720 for six replacement leg straps per annum at the cost of $120 per strap; > > (e) $2,324.12 for the replacement of her powered wheelchair damper system for - as per Aidacare invoice dated 27 September 2024;[223] > > (f) $1,097.62 for two "Guldmann" Sling Basic High (L) for floor or ceiling hoist (including delivery); > > (g) $572.00 for two "XtraCare" transfer "Universal Elastic Straps - Large" ($286.00 per strap) - as per quote from XtraCare dated 17 September 2025.[224]

First AT item: shower commode (which includes a seat) [225]

1. At the hearing on 20 October 2025, Ms Martin confirmed that NDIA has queried why Ms Blesing's current shower commode is 20 years old and that the NDIA would agree, subject to Ms Blesing's view, to provide a replacement, as a "mid-cost AT budget".
2. Ms Blesing told the Tribunal at the hearing that it has always been noted that the commode would need to be replaced at some stage. Ms Blesing said it was the seat which is the issue. Ms Blesing said the commode itself is very sturdy. Ms Blesing said it "could be replaced" but she does not see why this is needed because she says it is not broken.
3. Ms Blesing was asked if she was happy for the shower chair/commode to be replaced if there is a provision of funding for it in her NDIS plan to be replaced. Ms Blesing answered in the affirmative. The Tribunal foreshadowed that it could make a direction for funding to be provided to replace Ms Blesing's shower commode (which is to include a seat), subject to Ms Blesing obtaining a quotation for it. The NDIA agreed with this proposed course and confirmed that an "updated quotation" was required.
4. The Tribunal put a proposition to Ms Blesing that if she is purchased a new shower chair/commode that there would be no requirement for any maintenance or repairs to the new commode. Ms Blesing agreed with this proposition in respect of this AT item. The Tribunal indicated that it was minded to grant liberty to the parties to the Tribunal, in the event, they are unable to reach agreement in relation to the quantum of this support based on quotation/s which are submitted by Ms Blesing. The NDIA confirmed at the hearing that it would not require any AT report from Ms Blesing in relation to this item and that it would require two quotations.
5. The parties have reached agreement in relation to the First AT item of Support No.27. Based on this agreement, the Tribunal will direct that the NDIA include a provision in the New SOPS to be approved for Ms Blesing for funding for a replacement shower chair/commode (which is to include a seat) subject to the provision of two quotations for this item by Ms Blesing to the NDIA.[226] Further, the Tribunal grants liberty to the parties to apply to the Tribunal if they are unable to reach agreement about the quantum of this agreed item.

Second AT item: maintenance of the electric bed

1. Ms Blesing seeks $1,400 per annum for maintenance to her Arjo Electric bed.
2. At the hearing on 20 October 2025, the NDIA confirmed that it agrees to fund Ms Blesing an amount of $350.00 for the maintenance of her electric bed. The NDIA added that it requests further information from Ms Blesing about the purchase of her electric bed and mattresses and the warranties provided with them. The NDIA said that it expected that Ms Blesing would make a claim against that warranty.
3. Ms Blesing told the Tribunal she is not seeking a replacement of her electric bed. Ms Bartholomaeus referred the Tribunal to a quote dated 15 October 2025 from Aidacare showing the general maintenance of the electric bed would be $110.00 with a callout fee of $158.40. The Tribunal referred Ms Blesing to the NDIA's position being that it considered $350 was reasonable and necessary being an amount which is higher than the figures quoted by Aidacare on 15 October 2025. Ms Blesing said she agreed with this, and she undertook that she would assert any rights she might have under the manufacturer's warranty for the electric bed before expending this NDIS funding.

1. This support was in dispute between the parties at hearing. It is necessary to traverse the evidence about this requested support as it appears to have resulted in a subsequent agreement reached between the parties that Ms Blesing is to receive NDIS funding for a King Single electric bed and a King Single customised mattress, subject to Ms Blesing obtaining a quote for those items.[227]

Fourth AT item: six leg straps (different from leg straps used in the wheelchair)

1. Ms Blesing seeks $720 for six replacement leg straps per annum at the cost of $120 per strap. At the end of the hearing, Ms Martin submitted that the NDIA considers that this support is not reasonable or necessary because the replacement of the wheelchair should resolve this support and further, the current budget approved for the maintenance and repair of her wheelchair can be utilised, given that the NDIA proposes to double it. The Tribunal raised with the NDIA that it had understood the requested leg straps were different from the leg straps used as an extension of the wheelchair. Instead, they are big straps which wrap around Ms Blesing's legs to hold them in place. Ms Blesing confirmed this was correct.
2. The NDIA did not subsequently indicate that it would accept that the six large leg straps are "reasonable and necessary supports" for Ms Blesing. The Tribunal also notes that the NDIA did not include a reference to the requested funding for this item in the Table of Agreed Supports lodged after the hearing. The evidence revealed that Ms Blesing experienced spasms of her body. When she is undergoing a transfer, Ms Blesing will require the use of straps to hold her legs in position. The Tribunal considers that the straps is an AT item which is reasonable required by Ms Blesing and it should be funded under the NDIS, just as the wheelchair leg straps are used to keep her legs in place when she is sitting in her wheelchairs. Ms Blesing in unable to move any part of her legs independently due to her disability. The Tribunal concludes this item is a "reasonable and necessary support" for Ms Blesing and is to be included in the New SOPS.

Fifth AT item: replacement of powered wheelchair damper system

1. This requested item has been dealt with by the Tribunal in its consideration of Support No.25 as it is appropriately characterised as an item of requested maintenance and repairs to her powered wheelchair.

1. Ms Blesing seeks $1,097.62 for two "Guldmann" Sling Basic High (L) for floor or ceiling hoist (including delivery). In the Combined Table of AT Supports Nos. 25 to 38, the NDIA states that it agreed to fund this requested support.

1. Ms Blesing seeks $572.00 for two "XtraCare" transfer "Universal Elastic Straps - Large" ($286.00 per strap). In the Combined Table of AT Supports Nos. 25 to 38, the NDIA states that it agreed to fund this requested support.

CONSIDERATION - SUPPORT NO.33 (HIRE OF ACCESSIBLE VAN)

1. Support No.33 in the s 53 Order is a request for "$21,840 to hire (and trial) a suitable accessible van".

Stage One: Whether the request for Support No.33 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No.33 could be reasonable and necessary support, as the provision of each such support is aligned with the objectives under subsections 3(1)(a), (c), (d) and (g) and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.33.

Stage Two: Whether Support No.33 meets the criteria under subsection 34(1) of the NDIS Act

1. The NDIA contends that Support No.33 falls within the description of item 6(b) of the Schedule 2 of the NDIS Supports Transitional Rules and for this reason, s 34(1)(f) of the NDIS Act is not met because Support No.33 is "not an NDIS support". Item 6(b) describes the category of supports in Column 1 as "Day-to-day living costs - travel and transport" and the supports in column 2 as follows (emphasis added):

(b) vehicles, including motor vehicles, motorbikes, watercraft, all-terrain vehicles, standard bikes and scooters, and other recreational vehicles;

2. At the hearing, Ms Blesing contends that the accessible vehicle (which she has requested) is "not a domestic use vehicle". However, the Tribunal notes that the description of "vehicles, including motor vehicles" in item 6(b) of Schedule 2, is not limited or qualified to a particular type of vehicle or motor vehicle. The Tribunal considers that this type of support would include an accessible as requested by Ms Blesing. There is also no limitation or qualification in the description of item 6(b) as to whether the support is attained through purchasing it or hiring it. Accordingly, the Tribunal considers that a request for funding to hire an accessible van as sought by Ms Blesing falls within this description of a support which is declared to be "not an NDIS support".

1. It follows that funding for this support cannot be approved under Ms Blesing's NDIS plan as the criterion under s 34(1)(f) of the NDIS Act that the support be "an NDIS support" (as defined in s 10 of the NDIS Act) is not met. It is not necessary for the Tribunal to consider the other criteria under s 34(1) as they are cumulative. The Tribunal concludes that Support No.33 is not a "reasonable and necessary support" under the NDIS Act and is not to be added to the New SOPS to be implemented in accordance with this Decision.

CONSIDERATION - SUPPORT NO.34 (PURCHASE OBI FEEDING DEVICE)

1. Support No.34 in the s 53 Order is a request for "Approximately $14,210.60 for an OBI feeding device".

Stage One: Whether the request for Support No.34 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No.34 could be reasonable and necessary support, as the provision of each such support is aligned with the objectives under subsections 3(1)(a), (c), (d) and (g) and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.34.

Stage Two: Whether Support No.34 meets the criteria under subsection 34(1) of the NDIS Act

1. The Tribunal notes the contents of the 26-page "Assessment Template - General Assistive Technology - OBI Meal Assist" form ('OBI AT Form') signed by Ms Noble and Ms Blesing on 14 June 2023. On page 12, Ms Noble states that a one-hour trial of this device took place at Ms Blesing's apartment with the reported result that Ms Blesing was able to manipulate the device and successfully get herself something to eat when she needed it. This trial was described by Ms Noble as being "very successful".[228] The Tribunal notes that in Ms Noble's February 2025 Report, Ms Noble states that "Ms Blesing needs to trial an OBI feeding device to give her more independence and to allow her to get something to eat when she is done".
2. On page 13 of Ms Noble's Report, she described this device as a self-feeding arm with four compartment plates and reports that Ms Blesing was able to the feed herself four different foods with the controls, using a switch attached to her wheelchair.[229] On the OBI AT Form, Ms Noble identified an alternative option being to arrange for Ms Blesing's staff to feed her. Ms Noble suggested that this is "an unreliable solution" because her staff "do not often turn up for their shift" and that the "NDIS" has "cut her funds", so Ms Blesing is not able to pay her staff and is "left with no food through the day".[230] Ms Blesing gave evidence at the hearing that the situation with respect to have regular access to support workers has since stabilised due to changes in the plan management settings in her plan.
3. On the OBI AT Form, Ms Noble suggests that the feeding device could be set up where Ms Blesing's computer is situated, to enable her to eat while she is working on the computer, without her needing to wait for the support worker to turn up. Ms Noble said that even if the support worker is available, using the robotic feeding device would "give Joanne control and independence and the choice of four different foods. It will also allow her to control how often and when she gets the next spoon full". Ms Noble states that "There will not be any changes required to funded and informal supports and no environmental modifications will be required". Ms Noble states that Ms Blesing would be able to get herself some to eat "when she is left alone in her apartment all day".[231] Ms Noble states that this device is approved by the Therapeutic Goods Administration and available for sale in Australia.
4. The Tribunal also notes the "Technical Advice - Ratio of Support & OBI Feeding" dated 28 July 2023 authored by a member of the NDIA's Technical Advisory Branch.[232] The author made a recommendation (to the relevant delegate of the CEO) that the OBI feeding device does not meet the criterion under s 34(1)(c) of the NDIS Act, because Ms Blesing is funded under the NDIS for 24/7 support on a one-to-one basis and the funding for the purchase of the robotic feeding device would be a duplication of supports. The author considers that the criterion under s 34(1)(d) of the NDIS Act is not met because Ms Blesing is funded for 24/7 care, and it is expected there would be an emergency plan available for support workers and Ms Blesing to follow, in the event that the next rostered support worker does not attend for their shift. The author concludes that there should not be times when the participant is without support, necessitating the use of the OBI device.
5. In this proceeding, the NDIA contends that the provision of a robotic feeding arm would result in the duplication of supports that are already provided to her under the NDIS, being substantial NDIS funding to pay for support workers "around the clock" who are able to assist Ms Blesing with her feeding.
6. The Tribunal notes the quotation dated 29 May 2023 in respect of the cost of purchasing and delivering an "OBI Feeding Device", being $13,187.14, which includes plate, placement, two spoons, a charger and two switches. The quoted cost to freight this item is $82.50 and the cost of three extra plates is $648.84, and two spoons is $292.12.[233]
7. The Tribunal notes that in Mr Burden's Report, he was asked what assistive technologies or strategies "would improve the safety and effectiveness of feeding" and whether he would recommend any changes to any strategies in Ms Blesing's current routine. Mr Burden stated that an OBI robotic feeding device may wish to be used to enhance the safety and effectiveness of feeding. He said this could be explored as an option to improve Ms Blesing's sense of independence with feeding. Mr Burden said it would need to be trialled for "over at least 1 week in order to determine its effectiveness and the potential to reduce the overall cost of care for Ms Blesing". Mr Burden opined that "Current strategies could also be improved by incorporating regular training sessions for carers on the use of these technologies and the latest techniques in dysphagia management. Continuous evaluation and adaptation of her mealtime routine, informed by professional assessments, would ensure that her needs are consistently met in a safe and effective manner".[234]

1. For a support to be funded under the NDIS, it must be both "reasonable" and "necessary". Based on the evidence of Ms Noble and Mr Burden set out above, which was not substantively challenged at the hearing, the Tribunal concludes that Support No. 34 meets the criteria under s 34(1) of the NDIS Act. Consistent with the objectives of the NDIS Act, Ms Blesing should be supported under the NDIS in respect of innovative technologies such as a robotic feeding arm.
2. The Tribunal finds that a trial of this device will facilitate an exploration as to whether the OBI feeding arm is suitable for Ms Blesing. Ms Blesing has already had a short (cursory) trial of the device, and the signs were positive based on Ms Noble's reports. The Tribunal accepts Mr Burden's evidence that at least a one-week trial should take place to test suitability for Ms Blesing. If the proposed week-long trial of the device is successful, and Ms Blesing is supported to acquire the device, it will enable Ms Blesing to become independent in respect of the task of feeding, being a significant activity of daily living. Given the JACO robotic arm (Support No.26) has greater functionality than the OBI feeding arm, Ms Blesing may wish to consider trialling the JACO feeding arm first and if this is unsuccessful pursue a trial of the OBI feeding device as an alternative.

CONSIDERATION - SUPPORT NO.37 (REPAIRS AND MAINTENANCE OF GANTRY HOIST)

1. In the earlier version of the s 53 Order, Support No.37 was stated as a request for "$4,500 for repairs " based on Ms Blesing request for this item in Ms Blesing's Position Paper.
2. In the Final s 53 Order, Support No.37 is struck out with a note that this support was "Agreed". At the time of making this order, the Tribunal was advised that this support was agreed between the parties. Upon review of the documents lodged with the Tribunal, it would appear that this support is still in dispute between the parties. Specifically, in the Combined Tables of Supports Nos. 25 to 28, Ms Blesing confirms that she is requesting two separate items:

(a) Support No.37a: four hand controls (as well as a callout fee and labour charge),[235] and > > (b) Support No.37b: cost to replace one battery (as well as a callout fee).[236]

Stage One: Whether the request for Support No.37 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No.37 could be reasonable and necessary support, as the provision of each such support is aligned with the objectives under subsections 3(1)(a), (c), (d) and (g) and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.37.

Stage Two: Whether Support No.37 meets the criteria under subsection 34(1) of the NDIS Act

1. In the Combined Tables of Supports Nos. 25 to 28, Ms Blesing refers to the Medimart quotes for these items that she is relying upon.[237] Those quotes show that the cost of Support No. 37a is $1,687.00 for one hand control (including the callout fee and labour charge for each), and the cost of Support 37b is $890.00. Ms Blesing states that the total cost is $4,750. This would appear to be a typographical error. The quotes referred to in this paragraph provide prices for Support Nos. 37a and 37b which amount to $7,638.00 (that is, 4 hand controls x $1,687.00 each for Support No.37a and $890 for Support No.37b = $7,638.00). This is an increase in the $4,500 amount that Ms Blesing sought in Ms Blesing's Position Paper. Some confusion arises from the additional table added by Mr Cameron at the end of the Combined Tables of Supports Nos. 25 to 28, where he seems to request $5,061.00 or possibly, $4,500 for Ms Blesing per year for Support No.37. This information cannot be reconciled with the information in the main table as referred to above which is a request for $7,638.00 based on the figures in the quotation.
2. In the Combined Tables of AT Supports Nos. 25 to 28, the NDIA states that in relation to Support No.37a that it agrees to replace one hand controller which should come with a warranty consistent with the quote provided. There is no indication by the NDIA that it has agreed to provide any further funding for projected repairs of Ms Blesing's gantry hoist.
3. The gantry hoist owned by Ms Blesing is a Molift Duo Gantry with a Molift Air 205 Motor. The Tribunal was informed that it was purchased in 2021 for the price of $15,175. Ms Blesing said that it has "heavy use". It was not apparent that the NDIA objects to a provision being made in Ms Blesing's New SOPS for repairs that may need to be made over the next 12 months. The Tribunal accepts that it is quite possible for the battery of the gantry hoist to require replacement and perhaps also the charger for the hand control and the hand control itself. There is no technical evidence before the Tribunal to suggest that it is reasonable to expect that the hand controller and charger would require replacement more than once a year and certainly no evidence to support Ms Blesing's suggestion that they might require replacement four times a year. Using Mr Burden's suggested rule of thumb, 10 per cent of the purchase price for this item is $1,517.50. The Tribunal considers the request for funding of Support Nos. 37a and 37b in the sum of $7,638.00 (or even $4,500 or $5,061.00 as stated by Mr Cameron in his table), is unreasonable. It equates to half of the purchase price of the equipment. The Tribunal is not satisfied that funding for the replacement of four hand controllers and chargers per year for this equipment is a reasonable and necessary support, nor would not represent value for money. The Tribunal accepts that it reasonable to expect that the gantry hoist battery and the hand controller and charger may require replacement once a year and that Ms Blesing should be funded a sum of $2,577.00 as per the quote to cover the cost to replace those items.
4. If the components referred to by Ms Blesing require replacement more than once a year, Ms Blesing will be a liberty to ask the NDIA to vary her plan if permitted under the provisions in the NDIS Act to do so, or to undertake an unscheduled plan review under s 48 of the NDIS Act to approve increased funding for this support or to request funding for the replacement of this item.

1. The Tribunal concludes that a provision of funding in the sum of $2,577 per annum is likely to be sufficient to enable Ms Blesing to undertake projected repairs of her gantry hoist, and is a "reasonable and necessary support" for Ms Blesing because this support:

(a) is, or is likely to be, effective and beneficial for Ms Blesing at it ensure that her gantry hoist remains operational; > > (b) represents value for money; > > (c) will assist Ms Blesing to pursue her goals; > > (d) is necessary to address Ms Blesing's needs arising from her impairments to which s 24 of the NDIS Act applies; > > (e) takes into account what is reasonable to expect families, carers, informal networks and the community to provide; > > (f) is "an NDIS support" for Ms Blesing falling under item 9 of Schedule 1 of the NDIS Supports Transitional Rules. This support category is described as "assistive products for personal care and safety" and it includes the "provision of assistive products for self-care activities and participation in self-care", specifically, item 9(h) being "maintenance, spare parts and consumable items specific to an assistive product". It does not fall under any of the items in Schedule 2 as being "not an NDIS support". There were no contentions made to the Tribunal that this support is more appropriately funded under another general service system.

CONSIDERATION - SUPPORT NO.39 (ONE COMPUTER MOUSE HEADSET)

1. Ms Blesing is seeking funding for four computer mouse headsets per annum. The NDIA is willing to fund two headsets per annum for Ms Blesing as well as the bite switches that Ms Blesing has requested (including freight costs) over the next 12 months.

Stage One: Whether the request for Support No.39 is a "reasonable and necessary support", taking into account the NDIS Act as a whole

1. In light of the provisions of the NDIS Act as a whole, the Tribunal is satisfied that the provision of Support No.39 could be reasonable and necessary support, as the provision of each such support is aligned with the objectives under subsections 3(1)(a), (c), (d) and (g) and the principles referred to subsections 4(1) and (11) of the NDIS Act. The Tribunal will now proceed, as a second stage, as articulated in the decision of Public Trustee of South Australia, to consider whether the mandatory criteria under subsection 34(1) of the NDIS Act are met in Ms Blesing's individual circumstances in respect of Support No.39.

Stage Two: Whether Support No.39 meets the criteria under subsection 34(1) of the NDIS Act

1. The cost of one computer mouse headset is $1,460.00. The Tribunal acknowledges that Ms Blesing is extremely active on her computer given the daily activities she described to the Tribunal the hearing in her role as a disability advocate and her involvement in other community projects. The Tribunal is satisfied that Ms Blesing frequently uses her computer mouse headset throughout the year.
2. The Tribunal is not satisfied that the computer mouse headset (being the primary component of apparatus) requires replacement more than twice a year. Ms Blesing is at liberty to obtain more concrete technical evidence (for example, a report from the supplier) to explain why the durability of its equipment cannot be expected to last for longer than six months, noting the context of the high level of use it will have by Ms Blesing. If such evidence is able to be obtained, Ms Blesing is at liberty to present it to the NDIA for its further reconsideration, either is a plan variation if this is permissible under the NDIS Act, or as part of unscheduled plan review under s 48 of the NDIS Act.

1. The Tribunal concludes that additional funding for one extra computer mouse headset (on top of the provision of two computer mount headsets agreed to by the NDIA) is not a "reasonable and necessary support" for Ms Blesing and is not to be added to the New SOPS.

1. As mentioned above, the plan management issues falling for consideration by the Tribunal in this matter are:

(a) whether the plan management specifications should be changed to being "self-managed" as requested by Ms Blesing; > > (b) whether monthly funding periods and amounts should be imposed in respect of the NDIS budgets or supports in Ms Blesing's SOPS; and > > (c) whether the budgets or supports in Ms Blesing's SOPS should be specified as being "Stated" budgets or supports.

2. Ms Blesing's Current SOPS specifies that almost all of the funding in her plan is to be "plan-managed". Ms Blesing would like this to be changed to being "self-managed". The NDIA contends that there is evidence before the Tribunal which supports a conclusion that Ms Blesing's plan should not be "self-managed", after referring to some of the criteria in the National Disability Insurance Scheme (Management of Funding) Rules 2024 (Cth) ('Funding Management Rules') which commenced operation on 17 December 2024.[238] These rules are made under the NDIS Act, for the purpose of s 44(5) and s 74(6) of the NDIS Act.[239]
3. Of relevance in this application, s 44(5) of the NDIS Act authorises the prescription of criteria of such rules that the CEO must apply and the matters the CEO is to have regard to in considering whether s 46 (acquittal of NDIS amounts) would be unlikely to be complied with, if a participant, registered plan manager or plan nominee is to manage the funding for supports under an NDIS plan to any extent. Rule 5(2)(e) of the Funding Management Rules requires the decision-maker to consider the participant's ability or capacity to make decisions or to appropriately manage finances, taking into account any support or assistance they are likely to receive in doing so, when considering whether the type of plan management requested by the participant is likely to pose an unreasonable risk. The NDIA also highlights that it would be relevant for the Tribunal to consider:

(a) Ms Blesing's history of compliance with s 46 in relation to the management of the funding for particular supports under a participant's plan while she was responsible for managing the funding for those supports - r 6(2)(a); > > (b) whether Ms Blesing has engaged in any conduct involving fraud or the mismanagement or misapplication of funds or other assets - r 6(2)(c); > > (c) Ms Blesing's ability or capacity to make decisions or to appropriately manage finances, taking into account any support or assistance she is likely to receive to do so - r 6(2)(e).

4. The NDIA, in its submissions, acknowledges Mr Burden's opinion that "Ms Blesing's cognitive capacity is well-preserved, enabling her to participate actively in her care planning and advocate for her needs". [240]
5. The NDIA considers that the risks associated with self-management in Ms Blesing's case can be mitigated by the imposition of monthly funding periods in her plan. The NDIA contends that in the absence of any funding periods, it would not be appropriate for Ms Blesing's plan to self-manage her NDIS funding, because of Ms Blesing's history of non-compliance with s 46 of the NDIS Act and because the NDIA contends that there is evidence of the misapplication of funds.[241]
6. The NDIA sought to rely upon evidence it lodged with the Tribunal about history of Ms Blesing's expenditure of NDIS funding. Mr Dennis, on behalf of the NDIA, lodged a witness statement dated 14 October 2025 asserting that Ms Blesing has had 21 NDIS plans approved since 1 February 2018, when she was first granted access to the NDIS.
7. It is appropriate for the Tribunal to consider as an initial step whether it agrees with the NDIA's decision to impose monthly funding periods in Ms Blesing's NDIS plan and to specify that some her supports (or the budgets for them) are "Stated" supports (or budgets). If the Tribunal reaches a view that it is not appropriate to propose those measures, it will proceed with a consideration as to whether Ms Blesing's NDIS funding or portions of it should be self-managed without those measures in place, as requested by Ms Blesing. If the Tribunal considers it appropriate to include either or both of these measures of monthly funding periods and "Stated" supports in Ms Blesing's plan, the NDIA's position is that it is content for the funds in Ms Blesing's NDIS plan to be "self-managed".

1. The Determination referred to above in the section of this Decision relating to Support No.11 (which came into effect on 9 October 2024), provides for the imposition of periodic funding periods within a participant's NDIS plan. Specifically, clause 7 of the Determination provides as follows:

Matters to be taken into account > > (1) A decision-maker must take into account the matters mentioned in subsection (2) in specifying for the purpose of paragraph 33(2C)(b) of the Act when funding periods are to start and end. > > (2) The matters are as follows:

(a) whether section 46 of the Act is unlikely to be complied with in relation to the plan;

(b) whether the participant is at risk of experiencing fraud or financial exploitation;

(c) whether a funding period of a particular duration would likely result in the participant experiencing physical, mental or financial harm;

(d) whether any of the following is an insolvent under administration:

(i) the participant;

(ii) ...

(iii) ...

(e) whether there is a risk of an event mentioned in paragraph 45(4)(c) of the Act occurring in relation to the plan;

(f) the total funding amount for the plan;

(g) the nature and cost of the reasonable and necessary supports specified in the plan;

(h) any preference the participant has expressed as to the duration of the funding periods;

(i) whether the participant has requested the CEO to vary or conduct a reassessment of any of the participant's plans on more than one occasion without giving the CEO information or documents demonstrating a change in the participant's circumstances;

(j) whether section 46 of the Act has not been complied with in relation to any of the participant's plans.

Considerations under subclauses 7(2)(a) and (j)

1. The Tribunal must consider whether Ms Blesing has not complied with s 46 of the NDIS Act in respect of any of her plans and is unlikely to comply with s 46 in respect of any new plan. Subsection 46(1) provides that funding "must spend the money in accordance with the participant's plan". There is a notation at the bottom of s 46 which states as follows:

Note 1: A failure to comply with this subsection (including due to the operation ofsubsection (1A) or (1B)) may lead to a variation of the participant's plan under section 47A: > > (a) to change the management of the funding for supports under the plan (see sections 43 and 74); or > > (b) for a new framework plan - to specify a proportion of flexible funding that may be spent only on specified NDIS supports for the participant (or to change such a proportion); or > > (c) for any plan - to reduce the duration of funding periods for particular funding under the plan and the amount of funding that will be provided during any particular funding period.

2. There was a factual dispute between the parties in this proceeding, as to whether Ms Blesing has used her NDIS funding under her past NDIS plans, as she was obligated to do under s 46. The NDIA asserted that Ms Blesing has a history of having depleted her NDIS funding early (that is, before the allocated plan duration), or had misspent some of it. Ms Blesing refuted these allegations and sought to provide evidence to show that she has used her NDIS funding in accordance with s 46 or to explain any perceptions that she may have misused her NDIS funding.

Historic concerns raised with Ms Blesing about the management of funding in her July 2022 NDIS plan

1. The Tribunal notes that on 13 December 2022, a "Complex Supports Needs" planner sent an email to Ms Blesing, following a telephone discussion with her about the planner's concern at that time that she was going to run out of NDIS funding in her current at the rate it was being claimed.[242] The planner noted that a total of $730,955.59 was approved as core funding for Ms Blesing plan which was to last for a 12 month. However, the planner set out in his email to Ms Blesing that over a two-month period (that is, August and September 2022), $500,604.65 has been claimed for "in_-home support for personal care, domestic activities and community access_". The planner states that this equates to Ms Blesing having received one-to-one active support by more than five support workers for 24 hours per day during this two-month period.[243] The planner notes that $25,693.03 had also been claimed for consumables over this two-month period. The planner sought an explanation from Ms Blesing.[244]
2. In this December 2022 email, the planner referred to a new plan having been approved for Ms Blesing on 28 July 2022 reflecting a decision which had been made by the NDIA's Home and Living Team who had assessed that Ms Blesing should be provided with 1:1 support on a 24/7 basis and with a provision for 3:1 support for 4 hours of the day. The planner states he was not sure if Ms Blesing had been provided with a copy of the Home and Living Team decision and he attached it to his email for Ms Blesing's attention. The planner referred to approval of the new plan on 28 July 2022 and that he had noted on the "NDIS system" "a number of emails and phone calls were made when this plan was approved trying to contact" Ms Blesing to "implement the plan".[245] Ms Blesing refutes that accuracy of this statement.[246]

Ms Blesing first became aware of her July 2022 NDIS plan in December 2023

1. In Ms Blesing's March 2024 SLE, she states that in December 2023, an NDIA planner had advised her about the existence of the 28 July 2022 NDIS plan over the telephone. Ms Blesing said this was the first time she had been made aware of it, that is, 100 days after this plan was issued.[247] Ms Dennis states in his witness statement that he was instructed by the NDIA that Ms Blesing was informed about changes to her NDIS plan, including in relation to plan management, "within the plans themselves" (that is, the plans address the funded supports and plan management and were provided to Ms Blesing when they were created). This submission is valid if it can be demonstrated that Ms Blesing was given a copy of the plan. Ms Blesing says she did not receive it.
2. The Tribunal notes an email from the NDIA planner (Darrin B) on 13 December 2023 which followed his telephone call with Ms Blesing (referred to above). Darrin B advises that he is Ms Blesing's "new planner" and that he is concerned that she is going to run out of funding in her plan at the rate that Ms Blesing is claiming it. Darrin B asserts in his email that over a nine-week period that Ms Blesing has claimed $500,604.65 for support worker services which he asserts would equate to her using more than five support workers for 24 hours per day, in the context of there being a provision of $730.955.59 intended to cover the 12-month period of the plan. Darrin B also sought feedback from Ms Blesing as to why $25,693.03 had been claimed for the same nine-week period on "consumables". He referred to the NDIA's Claims and Payments Integrity Team having sought similar information from Ms Blesing.
3. Darrin B also referred to a decision which had been made in June 2022 by the NDIA Home and Living Team to the effect that Ms Blesing was still eligible for SDA and for one-to-one support on a 24/7 basis with four hours per day being three-to-one support. He says he is not sure if Ms Blesing was provided with this letter and refers to attaching it to his email. He also referred to the new plan for Ms Blesing made on 28 July 2022 and refers to attaching it to his email. Darrin B states that he had noticed on the NDIS system that a "number of emails and phone calls were made when this plan was approved trying to contact" Ms Blesing "to implement the plan". There were also notes on the system that certain requested supports had been declined.[248] This evidence is not before the Tribunal.
4. In the absence of any further evidence to confirm that the NDIA provided Ms Blesing with the 28 July 2022 plan at the time it was made, the Tribunal accepts Ms Blesing's evidence that she only first became aware of her July 2022 NDIS plan in December 2023 and finds accordingly.

The level of NDIS supports in her July 2022 NDIS plan was reduced

1. In Ms Blesing's March 2024 SLE, at states that the 28 July 2022 NDIS plan had made significant changes to her funding including:[249]

(a) changing her core supports funding to supported independent living ('SIL') funding; > > (b) reducing her core support funding by an equivalent of $96,000 per annum, in circumstances where, in Ms Blesing's view, it needed to increase by over $200,000; > > (c) reducing her "My Improved Daily Living" funding by an equivalent of $5,800 per annum; > > (d) reducing her support coordination funding by an equivalent of $5,800 per annum.

NDIA sought information from Ms Blesing in February and March 2023 about certain payment claims but it was sent to the wrong postal address

1. The Tribunal notes that the NDIA appears to have sent correspondence to Ms Blesing dated 8 March 2023, informing her of its intention to cancel six claims for payments and to raise a debt against her in the sum of $202,346.84 after it had not received a response from Ms Blesing to an earlier letter dated 3 February 2023, purportedly sent to Ms Blesing.[250] Now that Ms Blesing has a copy of this letter, she highlights that it was posted to the wrong apartment in her apartment block (that is, the unit number was inserted incorrectly by the NDIA). The same applies in respect of an earlier request for information which the NDIA sent to Ms Blesing on 30 November 2022.[251] The Tribunal finds that the NDIA sent this correspondence to the incorrect postal address and that Ms Blesing did not receive it.

Debt for $202,345.84 raised by the NDIA against Ms Blesing on 8 March 2023

1. Ms Blesing states that on 14 February 2023, the NDIS web portal had started to reject some of her claims for payments and upon making a telephone enquiry with the NDIA, she was told it was a technical issue. Ms Blessing states that on 14 March 2023, the NDIS web portal ceased making any payments to her at all. She said she followed with the NDIA up by telephone and was not advised that the NDIA had made a debt determination in respect of her NDIS funding (in the sum of $202,346.84), on 8 March 2023. In Ms Blesing's 24 March 2024 SLE, she states that she had no knowledge of any review or any outstanding request for information, until a "Beck J" had emailed her on 24 March 2023, following which she said he had promptly provided the documents for review.[252]

Ms Blesing and her team were advised in June 2023 by the NDIA that her request to self-manage her NDIS plan was declined and that she could seek an internal review

1. On 19 June 2023, a senior planner from the Complex Supports Needs Branch of the NDIA sent an email to Ms Lake, Ms Blesing and Ms Bartholomaeus, advising as follows:

(a) Ms Blesing's NDIS plan was reassessed on 22 March 2023 and "self-management was formally declined"; > > (b) Ms Blesing had incurred a debt of $202,346.84 for a service period of 42 days, which is to be paid to NDIA. This debt resulted from a review completed by the "Claims and Payments Team"; > > (c) the senior planner has had "several" conversations with Ms Blesing previously, explaining that this is not an issue that could be resolved by Service Delivery (Planning) and that she would need to re-direct any query or explanation she has for the debt, to Claims and Payments via claimsandpayments.integrity@ndis.gov.au or by contacting NDIA's debt recovery team; > > (d) the senior planner could not provide Ms Blesing with the contact details for their debt recovery team (as he did not have them) and that he did not have access to the system used to store correspondence with Ms Blesing regarding Claims and Payments, so he could not respond to Ms Blesing's claim that she did not receive any communication; > > (e) the senior planner acknowledged that the letter advising Ms Blesing of the debt determination has the wrong postal address on it, and that he did not know if it was posted by mail or sent to her by email; > > (f) confirmation was provided as to the most appropriate email addresses for Ms Blesing; > > (g) he said the NDIA must take the debt raised seriously and they had used the evidence from the NDIA's Claims and Payments Integrity Team, to indicate that the existence of the debt for claims which were unsubstantiated and uncorrected by Ms Blesing, demonstrated an unreasonable risk if Ms Blesing was to self-manage her NDIS plan; > > (h) Ms Blesing has been advised that she must pay back each claim in order to resubmit the claims, and resolve the debt; > > (i) Ms Blesing could elect to seek an internal review and she may wish to provide additional evidence to support the reasons why she disagrees with the NDIA's decision. The senior planner said he could not say what that evidence might look like for Ms Blesing but that she may wish to submit a personal statement addressing the matter; > > (j) an internal review request would be looked at by an independent decision maker, and they will decide whether the evidence provided is suitable; > > (k) funding has been approved for SIL support and SDA and Ms Blesing may seek a review of those decisions; and > > (l) the senior planner confirmed that the NDIA has not considered Ms Blesing's parents and informal supports in her current or past NDIS plans, so this could not be considered to be a "change of circumstances".

Ms Blesing engaged a lawyer to represent her and correspondence with the NDIA followed in June 2023 about the debt determination and decision which had been made not to allow Ms Blesing to self-manage the funding in her plan

1. The Tribunal notes that Ms Blesing engaged a lawyer, Ms Elizabeth Connolly, in relation to these issues. On 21 June 2023, Ms Connolly wrote to the NDIA Claims and Payments Integrity Team to advise that Ms Blesing has never received the 3 February 2023 letter, nor the attached documents referred to in the email from Darrin B dated 21 December 2022, including Ms Blesing's new NDIS plan approved dated 28 July 2022. Ms Connolly requested that these documents be sent to her, as well as the letter referred to by the planner that was sent by the Claims and Payments Integrity Team pre-dating his 21 December 2022 email.
2. In Ms Conolly's letter, she also refers to an email sent directly by the NDIA to Ms Blesing on 16 June 2023, attaching a subsequent NDIS plan which states that it commenced on 21 March 2023. Ms Connolly states that this was the first time that Ms Blesing had seen the 21 March 2023 NDIS plan.[253] This 21 March 2023 NDIS plan removed the "self-management" specifications. Ms Blesing states that the NDIA did so, without any prior discussion with her.[254]

In August 2023, the NDIA reversed its decision to cancel payments claims and confirmed that no debt was owed by Ms Blesing to the NDIA

1. On 29 August 2023, a Director of the Claims and Payments Integrity Team wrote to Ms Connolly (copying in Ms Blesing), to advise that:[255]

(a) Ms Blesing had sent "substantiation" to the NDIA in relation to the six claims by Ms Blesing which had been cancelled (that is, the basis for the debt determination); > > (b) based on the additional information provided by or on behalf of Ms Blesing, the Team had reversed the "cancellation" of the six claims totalling $202,345.84; > > (c) confirmed there is no debt was owed by Ms Blesing to the NDIA; and > > (d) a letter of finalisation of the review would be sent to Ms Blesing.

2. The Tribunals finds that no payment claims by Ms Blesing have been cancelled by the NDIA and that she does not owe any debt to the NDIA.

Support available to Ms Blesing in respect of managing her NDIS plan and the expenditure of NDIS funds from it

1. At the hearing on 20 October 2025, Ms Blesing informed the Tribunal that she had become aware in the last week that Mr Hesketh has moved into a work role, elsewhere, which would mean he would only assist her (going forward) and that he will do so in the evenings. Ms Blesing said that Mr Hesketh will only be helping her for 8 hours per week doing administration.

Allegations of early plan depletion by Ms Blesing

1. As mentioned above, the NDIA alleges that Ms Blesing has a history of depleting the funding in her NDIS plans prematurely (that is, before the notional plan period has ended).
2. The history of plan expenditure was addressed at the hearing on 20 and 21 October 2025. Ms Blesing was in attendance and was supported by her "bookkeeper", Mr Cameron, and Ms Bartholomeus. Ms Hesketh was not in attendance as he was otherwise occupied with unrelated work commitments.
3. On 20 October 2025, the NDIA lodged an excel spreadsheet entitled "Plan Utilisation" which was prepared by or with the assistance of Ms Dennis ('Expenditure Spreadsheet'). The Expenditure Spreadsheet lists 21 different NDIS plans which have been approved for Ms Blesing spanning a total period of approximately seven years between 8 June 2018 and 22 July 2026. The Tribunal is satisfied that this evidence demonstrates, objectively or as a matter of fact, a history of early plan depletion by Ms Blesing.
4. This was addressed directly with Ms Blesing at the hearing, and her responses reflected a lack of understanding of Ms Blesing about her obligations under s 46 of the NDIS Act. Ms Blesing remained focussed on the level of support that she used to be funded for and also the level of funding which she considers she is entitled to be funded for, based on the recommendations of her treating clinical team and other persons supporting her, rather than being focussed on the level of approved funding under her plans. The Tribunal is not satisfied that Ms Blesing accepts that she needs to abide by the lower levels of funding for supports as approved by the NDIA under her SOPS from time to time. There was no substantive acceptance by Ms Blesing at the hearing, and in her written submissions, that she is bound by the obligations under s 46 to contain her expenditure in accordance with the approved levels of NDIS funding under her SOPS.
5. The consequence of Ms Blesing's misunderstandings in this regard is that there are many instances where objectively, she has overspent her NDIS funding leaving her with insufficient funds in her plan to last the notional plan duration, thereby, prompting the NDIA to put in place a new plan for Ms Blesing in order to ensure continuity of supports for her so that she is kept safe. If the NDIA had not exercised its discretion to reinstate Ms Blesing's funds but putting in place a new plan, Ms Blesing would have been in grave danger as her daily supports would have ceased.
6. Ms Blesing's insufficient insight about her obligations under s 46 and the demonstrated inability of those supporting and assisting to have kept her spending to a pace which would avoided the early plan depletion, as evidenced by the Expenditure Spreadsheet, is the reason why the Tribunal considers that the decision of the NDIA to impose monthly funding periods and amounts and to specify many of the budgets and supports as "Stated" supports is the preferrable decision. The Tribunal concludes that monthly funding periods and amounts should remain in Ms Blesing's plan and that all of her supports should be specified as being "Stated" supports as referred to in this Decision. The Tribunal is satisfied that unrestricted NDIS funding in Ms Blesing's SOPS would pose an unreasonable financial risk to Ms Blesing in respect of the continuity of her NDIS funding.
7. The Tribunal acknowledges Ms Blesing's stated concerns that she considers that the imposition of funding restrictions upon her might cause cash flow problems which may jeopardise her ability to receive the supports she requires. The Tribunal does not accept this evidence by Ms Blesing given the magnitude of some of the funding amounts, particularly in respect of her primary budget for support worker assistance which is well in excess of $80,000 per month under her current plan (and this amount will increase with the Tribunal's decision that she receive an increase in funding to provide for 46.5 hours of support worker assistance per day under the New SOPS). Ms Blesing has regular access to a bookkeeper (Mr Cameron) and some limited administrative assistance from Ms Hesketh. Mr Cameron, Mr Hesketh and Ms Blesing's support coordinators are able to work together to devise strategies to enable Ms Blesing to better manage her spending in a manner that will minimise potential cash flows issues.
8. If problems still arise, Ms Blesing's support coordinator/s can assist Ms Blesing to link her to alternative administrative or accounting support that she requires to adequately manage cash flow issues. With all due respect, the Tribunal does not share the same confidence that Ms Blesing has, that she is able to adequately the pace of her expenditure so that early depletion of her plans ceases to be a problem for her. In reaching this conclusion, the Tribunal has taken into account Ms Blesing past experiences and the extensive training she has received. The difficultly lies in Ms Blesing's incomplete understanding or her unwillingness to accept her obligations has under s 46 of the NDIS Act as demonstrated by her expenditure history to date.

1. The Tribunal sets aside the decisions under review referred to in paragraph [8] of the Statement of Reasons, and remits this matter for reconsideration by the NDIA in accordance with a direction that it facilitates the approval of a New SOPS for Ms Joanne Blesing, which contains the following provisions:

(a) a provision specifying that the reassessment date of Ms Blesing's NDIS plan will fall on the 12-month anniversary of the date of approval of the New SOPS; > > (b) provisions approving funding in the New SOPS for Ms Blesing for the following supports: > > > (i) Support No.1: as a "Stated" support, a total of 46.5 hours per day of support worker assistance comprising the following components: > > > > (ii) between 4:30am to 5:00am each day, 30 minutes per day of support worker assistance at a 1:1 ratio at the "standard" rate (equating to 30 mins per day); > > > > (iii) between 5:00am to 5:30am each day, 30 minutes per day of support worker assistance at a 3:1 ratio at the "high intensity" rate (equates to 1.5 hours per day); > > > > (iv) between 5:30am to 6:30am each day, 1 hour per day of support worker assistance at a 3:1 ratio at the "high intensity" rate (equates to 3 hours per day); > > > > (v) between 6:30am to 8:00am each day, 1.5 hours per day of support worker assistance at a 3:1 ratio at the "high intensity" rate (equates to 4.5 hours per day); > > > > (vi) between 8:00am and 10.30am each day, 2.5 hours per day of support worker assistance at a 3:1 ratio at the "high intensity" rate (equates to 7.5 hours per day); > > > > (vii) between 10.30am and 6:00pm each day, 7.5 hours per day of support worker assistance at a 2:1 ratio at the "high intensity" rate (equates to 15 hours per day); > > > > (viii) between 6:00pm and 7:30pm each day, 1.5 hours per day of support worker assistance at a 1:1 ratio at the "standard" rate (equates to 1.5 hours per day); > > > > (ix) between 7:30pm and 8:00pm each day, 30 minutes per day of support worker assistance at a 1:1 ratio at the "standard" rate (equates to 30 minutes per day); > > > > (x) between 8:00pm and 10:00pm each day, 2 hours per day of support worker assistance at a 3:1 ratio at the "high intensity" rate (equates to 6 hours per day); > > > > (xi) between 10:00pm and 12:00am (midnight) each day, 2 hours per day of support worker assistance at a 1:1 ratio at the "standard" rate (equates to 2 hours per day); > > > > (xii) between 12:00am (midnight) and 4:30am each day, 4.5 hours per day of support worker assistance at a 1:1 ratio at the "standard" rate (equates to 4.5 hours per day); > > (c) Support 1: as a "Stated" support, 8 hours per week, at unspecified times, of support worker assistance to assist Ms Blesing with "admin"; > > (d) Support 1: as a "Stated" support, 4 hours per week to assist her with "computer" issues at other unspecified times; > > (e) Support No.2: as a "Stated" support, $8,580 per annum (that is, $165.00 per week or $55 for three appointments per week), to be used by Ms Blesing to engage a qualified hairdresser to carefully wash and dry her hair (but not style it), in a way that will prevent an adverse neurological response by Ms Blesing, provided that Ms Blesing's funded support workers, being paid at the "high intensity" rate, attend all hairdressing appointments with Ms Blesing over the next 12 months to observe how the hairdresser undertakes this task safely, with the expectation that Ms Blesing's support workers will commence undertaking these tasks for Ms Blesing in her home in 12 months from now or earlier if the support workers consider that they have acquired competence to be able to do so; > > (f) Support No.3: as a "Stated" support, replication of the current funding approved for 15 hours of podiatry services (which can include, among other things, trimming Ms Blesing's toenails) but otherwise, no other funding is to be included for "professional manicures/nail care"; > > (g) Support No.7: as a "Stated" support, replication of the funding already approved for Ms Blesing in the Current SOPS under the hearing "Consumables" in the sum of $18,625.04 which can be used to purchase the items of continence aids, including consumables (valued at $14,842.20 per annum) as agreed between the parties, comprising: > > > (i) $893.28 per annum for hospital grade bacterial wipes ($77.44 per month); > > > > (ii) $240 per annum for catheter sterile change kit ($20 per month); > > > > (iii) $540.00 per annum for Cello Bluey (Halfsheet 250/box 3 ply continence protection) ($45.00 per month); > > > > (iv) $1,209.60 per annum for Statlock stabilisation device ($100.80 per month); > > > > (v) $751.20 per annum for Supracath catheter (round silicon 40cm) ($62.60 per month); > > > > (vi) $158.40 per annum for C4 Lignocaine Gel Syr 2% 10ml ($13.20 per month); > > > > (vii) $1,380 per annum for Biological waste bags (MaxValue Tidy Bags 36 Litres Black 1000 bags) ($115 per month); > > > > (viii) $544.80 per annum for Conveen Urinary bag 1500ml Sterile 90cm Tube Clamp Tap ($45.40 per month); > > > > (ix) $273.00 per annum for Alcohol wipes Swap Briempak (5 boxes of 200) ($22.75 per month); > > > > (x) $146.52 per annum for Clinell Contiplan barrier cloth Pkt x 25 ($12.21 per month); > > > > (xi) $25.80 per annum for kidney dish 235mm plastic ($2.15 per month); > > > > (xii) $227.04 per annum for Cello Rediwipes (box x 100) ($18.92 per month); > > > > (xiii) $1,248.00 per annum for irrigation water 5 x 100ml bottle ($104.00 per month); > > > > (xiv) $2,640.00 per annum for syringes for catheter irrigation (x10) ($220 per month); > > > > (xv) $520.80 per annum for bed pan slipper ($43.40 per month); > > > > (xvi) $1,710.00 per annum for Aaxis drain bags 2000ml non-sterile 90cm tube, no tap ($142.50 per month); and > > > > (xvii) $2,333.76 per annum for Derma Lux soft towel lotion 5000ml (medical bed bath wash): ($194.48 per month). > > > > Part of the balance of funds remaining, after the above items have been purchased, that is, $3,782.84, may be used to pay for the requested orthotic device for $1,410 (that is, Support No.9). > > (h) Support No.8: as a "Stated" support, $2,850 for a single pair of custom-made boots (including Velcro straps); > > (i) Support No.11: as a "Stated" support, $3,456 per annum is to be paid, in fortnightly instalments, as a recurrent transport support. No other funding will be approved for Ms Blesing for transport supports; > > (j) Support No.12: as a "Stated" support, replication of the funding in Ms Blesing's Current SOPS for 102.5 hours per annum of occupational therapy services in the New SOPS (which is to replace the previously funded 102.5 hours for occupational therapy); > > (k) Support No.13: as a "Stated" support, 44 hours per annum for services to be provided by a speech pathologist (which is to replace the previously funded 10 hours per annum for such services); > > (l) Support No.14: as a "Stated" support, 2 hours per annum of occupational therapy services (by an accredited hand therapist); > > (m) Support No.15: as a "Stated" support, 18 hours per annum of services by a neurological physiotherapist, comprising:

• 12 hours per annum of high-level specialist therapeutic advice and training to be delivered to Ms Blesing's standard physiotherapist and support workers (comprising 3-hour sessions per quarter); and
• 6 hours per annum for the preparation by the neurological physiotherapist of progress reports to be provided to the NDIA and for the preparation of any guidance materials, specific to Ms Blesing's needs, to be used by the standard treating physiotherapist or the support workers on an ongoing basis;

(n) Support No.16: as a "Stated" support, a total of 214 hours per annum of services by a standard physiotherapist (working under the supervision of a neurological physiotherapist but without any therapy assistants), comprising two 2-hour weekly "hands on" sessions for 51 weeks per annum, and a further 10 hours per annum for report writing by the physiotherapist (which is to replace the previously funded 58 hours per annum for physiotherapy and 50 hours of Level 2 therapy assistant); > > (o) Support No.20: as a "Stated" support, 15 hours per annum of psychology services, as agreed;[256] > > (p) Support No.21: as a "Stated" support, replication of the previously funded 15 hours per annum of podiatry services, as agreed;[257] > > (q) Support No.22: as a "Stated" support, 120 hours per annum of support worker assistance at the "standard" rate to be used to train new support workers being introduced to Ms Blesing's team of support workers and the training is to be directed to the individual disability-related needs of Ms Blesing and is not general training intended to upskill the support worker. This is to be specified as a "Stated" support; > > (r) Support No.24: as a "Stated" support, replication of the current funding allocated to Ms Blesing for this type of support, namely, 100 hours of Level 2 support coordination services and 100 hours of Level 3 support coordination services; > > (s) Support No.25: $9,500 per annum for powered and manual wheelchair maintenance and repairs comprising: > > > (i) as a "Stated" support, $8,000 per annum for general repairs and maintenance of Ms Blesing's powered wheelchair and her manual wheelchair; > > > > (ii) as a "Stated" support, $900 for the quoted cost of replacing the six tyres on Ms Blesing's powered wheelchair, as this is considered by the Tribunal to be an urgent repair required because the tubes are reported by the supplier to be showing through the tyres; and > > > > (iii) as a "Stated" support, $600 for the quoted cost to repair the footplate (or hanger) on her manual wheelchair, as agreed between the parties.[258] The Tribunal is satisfied this is an urgent repair likely to be a safety hazard; > > > > [The Tribunal NOTES that the NDIA undertakes to fund new wheelchairs for Ms Blesing to replace her current wheelchairs. The Tribunal encourages Ms Blesing to arrange for an urgent occupational therapy mobility assessment and for the provision of quotations to the NDIA for new wheelchairs. This Tribunal considered that this avenue should be pursued by Ms Blesing as a matter of priority for the reasons set out in the Statement of Reasons below]; > > (t) Support No.26: as a "Stated" support, $5,000 to be used to pay for a trial of a robotic arm which is designed to achieve the same or similar outcomes as the JACO robotic arm and any applicable fees associated with mounting this device on Ms Blesing's powered wheelchair; > > (u) Support No.27a: as a "Stated" support, purchase of a replacement shower Chair/commode (which is to include a seat) at an approximated cost of $3,500 plus $450 for a customised seat, subject to the provision by Ms Blesing of two quotations for this item to the NDIA, as agreed.[259] Liberty is granted to the parties to apply to the Tribunal if they are unable to reach agreement about the quantum of this agreed item; > > (v) Support No.27b: as a "Stated" support, $268.40 per annum in respect of Ms Blesing's electric bed, comprising $110.00 per annum for the general maintenance of the electric bed, and $158.40 for a callout fee. At the hearing, Ms Blesing undertook to the NDIA that she would assert any rights she might have under the manufacturer's warranty for the electric bed, before expending this budget of NDIS funding; > > (w) Support No.27c: as a "Stated" support, the cost of a King Single Electric Bed and customised King Single mattress subject to the provision of a quotation for those products, as agreed;[260] > > (x) Support No.27d: as a "Stated" support, $720 per annum for six replacement large leg straps (used separately from the wheelchair leg straps) at the cost of $120 per strap, as agreed;[261] > > (y) Support No.27e: as a "Stated" support, $1,097.62 for two "Guldmann" Sling Basic High (L) for floor or ceiling hoist (including delivery), as agreed;[262] > > (z) Support No.27f: as a "Stated" support, $572.00 per annum for two chest "XtraCare" transfer "Universal Elastic Straps - Large" ($286.00 per strap), as agreed;[263] > > (aa) Support No.28: as a "Stated" support, $500 for a modified beach chair with large wheels, as agreed;[264] > > (bb) as agreed between the parties, $10,950.50 for wheelchair modifications comprising:[265] > > > (i) as a "Stated" support, $8,500 (approximately) for custom controller system for the powered wheelchair; > > > > (ii) as a "Stated" support, $1,250 for modification of powered wheelchair anterior leg supports; > > > > (iii) as a "Stated" support, $700.50 for modification of switch access locations on the powered wheelchair; and > > > > (iv) as a "Stated" support, $500 for modification of the backrest of the powered wheelchair to improve comfort and pelvic alignment;[266] > > (cc) Support No.34: as a "Stated" support, the cost of a one-week trial of the OBI feeding device, subject to the provision of a quotation; > > (dd) Support No.35: as a "Stated" support, $6,541.50 for a 12-week trial of a Tobii Dynavox I-16 device and mounting fee, as agreed;[267] > > (ee) Support No.36: as a "Stated" support, backup mobile (or portable) floor hoist (quote and updated AT assessment pending), as agreed;[268] > > (ff) Support No.37: as a "Stated" support, $2,577 per annum for projected repairs to Ms Blesing's gantry hoist, as partially agreed;[269] > > (gg) Support No.38: as a "Stated" support, $2,800 for supply and installation of one battery per annum for the sit-to-stand lifter, as agreed;[270] > > (hh) Support No.39: as a "Stated" support, funding for two computer mouse headsets per annum and requested number of mouthpieces per annum (including freight costs), as agreed by the NDIA;[271] and > > (ii) replication of any supports in Ms Blesing's current NDIS plan which have not been replaced by the new funded supports referred to in this paragraph, and except for any one-off supports for which the funding provided for such items has already been expended by Ms Blesing; and > > (jj) replication of the monthly funding periods specified in Ms Blesing's current NDIS plan, as adjusted based on the new level of approved supports referred to above; and > > (kk) the addition of any further supports that the CEO (or her delegate) considers to be "reasonable and necessary supports" for Ms Blesing.

1. The magnitude and complexity of the issues in this proceeding was exceptional. The Tribunal considers it appropriate to grant general liberty to apply to the parties to make an application to the Tribunal should the parties require clarification in relation to the final directions made or if they wish to bring any obvious errors or omissions to the Tribunal's attention. The Tribunal's intention is to provide assistance to the parties to assist them in understanding what is required to facilitate the New SOPS for Ms Blesing as soon as possible or to clarify any areas of confusion given the complexity to this matter.

18 to 22 August 2025, 25 to 28 August 2025, 30 September 2025, 1, 20 and 21 October 2025

Ms Joanne Blesing, Mr Thomas Hesketh & Mr Alistair Cameron

[1] These supports are agreed between the parties - see Table of Agreed Supports lodged with the Tribunal on 29 October 2025 in accordance with the Tribunal's direction ('TAS'), page 3 (item 9).

[3] TAS, page 3 (unnumbered item under item 8).

[4] TAS, page 1 (item 3) and from an exchange with the Tribunal at the hearing about Support 27a.

[6] Combined Table of AT Supports Nos.25 to 38, PDF page 5.

[7] Combined Table of AT Supports Nos.25 to 38, PDF page 5.

[9] TAS, page 8 (item 11) and exchange between the parties and the Tribunal at the hearing.

[10] TAS, page 2 and 3 (item 8). This would appear to constitute a settlement reached between the parties in respect of Supports No.29 to No.32.

[17] Ms Blesing gave evidence at the hearing that she has had the condition of MS for approximately 21 years.

[18] An earlier plan breakdown was provided before the hearing, in respect of Ms Blesing's SOPS which preceded her Current SOPS.

[19] This was communicated to the parties by correspondence sent by the Registry of the Tribunal.

[20] Ms Blesing states that her revised figures for only the core supports component is $2,403,869 per annum - see PDF page 2 of the Combined Table of Supports.

[21] Except for those budgets which are required to be plan-managed, such as the budget for support coordination.

[23] The Tribunal notes the opening statement by the delegate of the CEO in the Internal Review Decision that "the initial review was based on the plan approved on 22 March 2023 however to ensure continuity of supports, and with [Ms Blesing's] approval, the original internal review request was withdrawn to allow for a plan variation. The internal view request has been subsequently based on the current plan approved 2(sic) June 2023". This June date would appear to be an error as a different date for the SOPS, that is, "23 June 2023" is identified at the commencement of the Internal Review Decision. Nothing turns on this discrepancy.

[24] Section 53 orders were issued on 18 August 2025, 29 August 2025, and 21 October 2025.

[25] For clarity, this list includes previous supports requested by Ms Blesing which have been struck out on account of them no longer remaining as a support in dispute between the parties.

[26] This support was in fact not agreed between the parties and so the Tribunal has considered whether it should be funded under the NDIS - see paragraphs [612] to [619].

[31] Exhibit A34. At the hearing, Ms Blesing's "bookkeeper", Mr Alaistair Cameron, said he had finalised this document before Mr Dennis had submitted his table (which the Tribunal takes to be Mr Dennis' Affidavit dated 14 October 2025).