Decision: 1. The decision under review, being the decision of the National Disability Insurance Agency:

(a) made on 14 August 2023 under section 100(6) of the National Disability Insurance Scheme Act 2013;

(b) as updated on 25 November 2024 under section 103 of the National Disability Insurance Scheme Act 2013 Administrative Review Tribunal Act 2024;

is set aside under section 105 of the Administrative Review Tribunal Act 2024 and remitted for reconsideration with the directions that:

(a) the statement of participant supports include sufficient funding for:

1. an additional 15 hours for mental health occupational therapy and 6 hours for a therapy assistant per year;
2. an additional 6 hours for physiotherapy;
3. support coordination to be provided at level 3, being specialised support coordination; and
4. low-cost, low risk assistive equipment including a jar opener, easy-on sheets, and hiking sticks.

b) the date by which Agency must reassess the Applicant's plan is 12 months from the date that the above supports are added to the Applicant's plan.

c) the remaining aspects of the statement of participant supports, including plan management, remain unchanged.

.................................[SGD]...................................

NATIONAL DISABILITY INSURANCE SCHEME - Reasonable and Necessary Supports -Decision made without holding a hearing - Getting the NDIS Back on Track Amendments - Section 34(1)(aa) - Impairments which meet the disability requirements - Physical and psychosocial impairments - Ehlers Danlos Syndrome hypermobility type ‑- Degenerative disc disease - Somatic Symptom Disorder - Generalised Anxiety Disorder - Major Depressive Disorder - Transitional Rules - Short Term Accommodation - Mental Health Occupation Therapy - Physiotherapy - Support Coordination - Consumables - Day-to-day living costs - Standard household items - Standard recreational equipment ‑- Standard gym equipment - Standard furniture - Decision set aside and remitted

Administrative Appeals Tribunal Act 1975 (Cth)

Administrative Review Tribunal Act 2024 (Cth)

Administrative Review Tribunal (Consequential and Transitional Provisions No. 1) Act 2024 (Cth)

National Disability Insurance Scheme Act 2013 (Cth)

National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No.1) Act 2024 (Cth)

National Disability Insurance Scheme (Getting the NDIS Back on Track No.1) (NDIS Supports) Transitional Rules 2024

National Disability Insurance Scheme (Getting the NDIS Back on Track No.1) (Miscellaneous Provisions) Transitional Rules 2024

Drake and Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 634

Forrest and National Disability Insurance Agency (NDIS) [2025] ARTA 1131

NDIS Pricing Arrangements and Price Limits 2025-26, published 16 June 2025

Our Guideline: Short Term Accommodation or Respite, published 24 June 2022

1. I have decided to set aside and remit the decision of Agency with directions that the Applicant's statement of participant supports include sufficient funding for:

(a) an additional 15 hours for mental health occupational therapy and 6 hours for a therapy assistant per year > > (b) an additional 6 hours for physiotherapy > > (c) support coordination to be provided at level 3, being specialised support coordination, and > > (d) low-cost, low risk assistive equipment including a jar opener, easy-on sheets, and hiking sticks.

2. The Tribunal is not satisfied that the other supports requested by the Applicant are reasonable and necessary.
3. Consistent with most recent plan, funding is to remain managed by a registered plan management provider.
4. The date by which Agency must reassess the Applicant's plan is 12 months from the date that the above supports are added to the Applicant's plan.
5. This decision is made under section 105 of the Administrative Review Tribunal Act 2024 (Cth) (ART Act). The reasons for this decision are as set out below.

1. The issue before the Tribunal is whether supports requested by the Applicant are reasonable and necessary supports to be funded in the Applicant's statement of participant supports (SPS) for the purposes of sections 33 and 34 of the National Disability Insurance Scheme Act 2013 (Cth) (the NDIS Act).
2. The Applicant is a 50-year-old man who has been a participant the National Disability Insurance Scheme Act (NDIS) since 2021. Mr Cala lives on his own in a unit in Stanthorpe, a rural town which is approximately 220 kilometres from Brisbane, Queensland.
3. Mr Cala was granted access to the NDIS on the basis of impairments attributable to "Other psychosocial disorders, Other Physical & Other Neurological."[1] The evidence before the Tribunal indicates that he is impacted by a complex range of physical, psychosocial and health conditions. These include:
   • Ehlers Danlos Syndrome hypermobility type (hEDS)
   • Generalised Anxiety Disorder (GAD)
   • Somatic Symptom Disorder (SSD)
   • Major Depressive Disorder (MDD)
   • Mild cognitive impairment
   • Postural Orthostatic Tachycardia Syndrome (POTS)
   • Lyme disease
   • Fungal allergy
   • Degenerative disc disease (DDD)
   • Aortic aneurysm repair
   • Inguinal hernia
   • Erythrocytosis; and
   • Fibromyalgia.[2]
4. Ms Hiras, Occupational Therapist (OT) describes the interrelated nature of Mr Cala's impairments as:

Carmelo was diagnosed with Elhers Danlos Syndrome hypermobility type (hEDS) in 2017. This is a genetic connective tissue disorder characterised by generalised joint hypermobility and a wide range of visceral, pelvic, and neurological and cognitive dysfunctions (Castori et al., 2012). Consistent with Carmelo's presentation, overall levels of disability and dysfunction in this condition is generally connected to pain, fatigue and psychosocial distress (Bennett et al., 2021; Scheper et al., 2016). > > The impact of Carmelo's physical symptoms are closely connected with his psychosocial disabilities which include Generalised Anxiety Disorder (GAD) and Somatic Symptom Disorder (SSD). Generalised anxiety disorder is characterised by excessive and uncontrollable worry about various aspects of everyday life. This can cause overthinking, restlessness, fatigue, sleep disruptions and difficulties concentrating. Somatic Symptom Disorder is a condition where individuals experience distress and excessive concerns about physical symptoms, regardless if there is reassurance that there is no medical cause. This focus on symptoms can lead to significant impairments in daily functioning due to excessive emotions, behaviour, or fixation on physical symptoms. > > It is crucial to understand the inter-related nature of Carmelo's physical and psychosocial needs. Carmelo also presents with a range of additional physical health conditions including Postural Orthostatic Tachycardia Syndrome (POTS), Lyme disease, Fungal allergy, degenerative disc disease, previous aortic aneurysm repair, inguinal hernia, erythrocytosis, and fibromyalgia. While these conditions are not listed under his NDIS plan, Carmelo's frequent rumination on his physical symptoms due to his psychosocial conditions mean that his health and disability needs cannot be completely separated. This further highlights psychological impact of managing his hEDS symptoms including joint pain, fatigue and instability on his overall wellbeing. This highlights the complex and interconnected nature of his needs, requiring specialised intervention to manage his physical symptoms in managing his disability needs. Due to his SSD diagnosis, if Carmelo does not feel that his physical symptoms are adequately met in a way that is appropriate for him, he experiences significant psychological distress.[3]

5. On 14 August 2023, a delegate of the Chief Executive Officer (CEO) of the National Disability Insurance Agency (the Agency) affirmed a decision to approve a SPS for the Applicant. On 19 September 2023, the Applicant applied for a review by the Administrative Appeals Tribunal (AAT) under section 103 of the NDIS Act and section 25 of the Administrative Appeals Tribunal Act 1975 (AAT Act).[4] During the proceeding, the Agency approved a new SPS in a NDIS plan which commenced on 25 November 2024. Under section 103(2) of the NDIS Act, this SPS is also before the Tribunal for review.
6. The Applicant was assisted by a support coordinator for a period during this review. During this time, the Applicant was able to submit several reports and other supporting evidence. By the time the matter was to be heard, the Applicant has become self-represented. Despite his disability, the Applicant's strong preference was to travel to Brisbane for an in-person hearing.
7. The Tribunal attempted to proceed with a hearing on two occasions. The first attempted hearing was scheduled for 12, 13 and 14 March 2025. This was around the time that Cyclone Alfred impacted Brisbane and surrounding areas. The Brisbane registry was temporarily closed on 6 March 2025 and reopened on 10 March 2025. The Tribunal was unable to contact the Applicant to confirm whether he was still intending to travel to Brisbane for the hearing. The Applicant did not attend this hearing but later advised that his allergies had been severely impacted the cyclone.
8. The second attempted hearing was scheduled for 18, 19 and 20 June 2025. Prior to the rescheduled hearing, the Applicant requested that this hearing be adjourned due to medical reasons. On 13 June 2025, the Applicant provided a medical certificate from his GP which indicated that he would not be able to attend a face-to-face medical assessment in Brisbane. The Tribunal advised the parties that the hearing would proceed by telephone.
9. At the commencement of the telephone hearing on 18 June 2025, the Applicant advised that he was too unwell to participate by phone. The Tribunal proposed adjusting the hearing process so that the Applicant was only required to participate for two hours each day with an extended break after each hour. Regrettably, the Applicant experienced a panic attack and was not able to proceed. First Aid Officers from the Tribunal contacted the Applicant and confirmed his safety. The Applicant later advised that an ambulance had been called.
10. On 28 July 2025, I decided to proceed with a hearing on-the-papers under section 106 of the ART Act. Both parties were provided with an opportunity to provide written submissions. Final submissions were received on 2 October 2025.

1. The issue before the Tribunal is whether the following supports are reasonable and necessary for the Applicant:

(a) 28 days per year of Short-Term Accommodation (STA) > > (b) Additional occupational therapy > > (c) Additional physiotherapy > > (d) Additional support coordination > > (e) $2,000 per year for consumables funding > > (f) Assistive technology and equipment including: > > > (i) low cost, low risk equipment for the kitchen, bedroom and bathroom > > > > (ii) hiking sticks > > > > (iii) a treadmill > > > > (iv) sit-stand tables > > > > (v) adjustable chairs, and > > (g) $2,000 for vehicle modifications.

1. The Tribunal was provided with a joint hearing bundle (JHB) by the parties and this was accepted into evidence.[5] The JHB included:

(a) The T-documents,[6] > > (b) Letters and reports from the Applicant's physiotherapists including Ms Hennessey, Ms Read, Ms Meggs, and Ms Mira, > > (c) Letters and reports from the Applicant's OTs including Ms Haugh, Ms Hill, and Ms Hiras, > > (d) Various other allied health reports from a podiatrist, radiologist, speech pathologist counsellor, and dietician, and > > (e) An independent OT report from Ms Donohue.

2. Following the attempted hearings, the Applicant also provided:

(a) A letter from Dr McAulay, the Applicant's treating psychiatrist, > > (b) A 2022 OT report from Ms Chand, > > (c) Further correspondence from Ms Hennessey, physiotherapist, > > (d) Two applications for replacement support determinations for: > > > (i) Tea tree oil, > > > > (ii) Massage, and > > (e) A photo showing swelling and discolouration of the Applicant's feet.

3. The Tribunal also had the benefit of receiving final written submissions from the Agency.

OVERVIEW OF THE NDIS DECISION-MAKING FRAMEWORK[7]

1. Chapter 1, Part 2 of the NDIS Act sets the Act's objects and principles including, for example, that the Act is to support the independence and social and economic participation of people with disability,[8] and that decision-makers are to have regard to the need to ensure the financial sustainability of the scheme.[9]
2. Chapter 3, Part 2 of the NDIS Act deals with participants and their plans and includes further principles in relation to the preparation, variation, reassessment and replacement of plans. This guidance includes that this planning process should, so far as reasonably practicable, be directed by the participant,[10] and be underpinned by the right of the participant to exercise choice and control over his or her life.[11]
3. A participant's plan must include a statement of the participant's goals and aspirations[12] as well as a SPS that includes the reasonable and necessary supports that will be funded by the Agency.[13]
4. In deciding to approve a statement of participant supports, the Agency must have regard to the matters set out in section 33(5), including applying the National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Support Rules), and be satisfied that each support meets the criteria in section 34. The criteria in section 34(1) are that:

(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 ... > > (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.[1]

5. The phrase 'NDIS support' in section 34(1)(f) is defined section 10 which further provides that rules may be made that declare whether a support is (or is not) an NDIS Support. The Minister has made the National Disability Insurance Scheme (Getting the NDIS Back on Track No.1) (NDIS Supports) Transitional Rules 2024 (Transitional Rules). The Transitional Rules set out in detail supports that are (and are not) NDIS supports and commenced on 3 October 2024.
6. While Mr Cala's application for review was made prior to on 3 October 2024, the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No.1) Act 2024 (Back on Track Act) requires that the Transitional Rules apply to this review. Section 32A on the NDIS Act sets out that there are two kinds of plans: being 'new framework plans' and 'old framework plans'. Mr Cala has an 'old framework plan'. Section 129 of the Back on Track Act deals with the application of the amendments to content and approval of 'old framework plans' and states that:

sections 33, 34 and 35 of the National Disability Insurance Scheme Act 2013, as in force on and after the commencement of this Schedule, apply in relation to a statement of participant supports included in an old framework plan for a participant if the statement is approved or varied on or after that commencement. > > ... (a) whether the participant becomes a participant; and > > (b) in the case of a variation - whether the plan comes into effect; > > before, on or after that commencement.

7. The Tribunal on review is now considering whether supports are reasonable and necessary and should be funded as part of an SPS. The Tribunal must apply the amended considerations in sections 33, 34, 35 to the Tribunal's decision-making process.
8. Section 7 of the National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (Miscellaneous Provisions) Transitional Rules 2024 (Miscellaneous Transitional Rules), also requires that a support is most appropriately funded or provided through the NDIS, and not more appropriately funded or provided through other general systems of service delivery or support services. This is equivalent to section 34(1)(f) as it was prior to the commencement of the Back on Track Act.
9. NDIS Operational Guidelines also assist in making decisions in accordance with the NDIS Act. Operational guidelines represent government policy and should be applied by the Tribunal unless there is good reason not to do so.[14] I will refer to these guidelines where relevant below.

1. Section 33(5)(a) of the NDIS Act says that, in deciding whether or not to approve a statement of participant supports, decision-makers must have regard to the participant's statement of goals and aspirations. Mr Cala's most recent plan, which commenced on 25 November 2024, records his goals as being:

(a) I would like to be able improve my muscle strength and tone so I am able to maintain, and possibly improve, my mobility. > > (b) I would like to be able to complete daily living tasks as independently as possible. > > (c) I would like to make friends with others who share a common interest so I can build relationships with others who share my interests. > > (d) Into the future I would like to return to audio engineering so I can be more financially independent.

2. I have had regard to these goals and will refer to them where relevant below.

1. Section 34(1)(aa) requires that, for a support to be considered reasonable and necessary:

(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)

2. As indicated above, the Agency records state that the Applicant met the disability requirements on the basis of "Other psychosocial disorders, Other Physical & Other Neurological" impairments. This description lacks the specific information required for decision-makers, including those at the Agency and the Tribunal, to properly apply section 34(1)(aa).

1. Section 34 include two notes with regards to subsection 34(1)(aa):

Note: For the purposes of paragraph (aa): > > (a) the time at which the disability requirements or the early intervention requirements need to be met is the time the CEO decides to approve the statement of participant supports; and > > (b) a participant's disability support needs arising from an impairment in relation to which the participant meets the disability requirements or the early intervention requirements may be affected by a variety of factors, including environmental factors or the impact of another impairment in relation to which the participant does not meet either of those requirements.

2. Note (a) makes it clear that decision-makers do need to consider whether impairments meet the relevant requirements at the time of approving a support. The assessment of a support is not limited to impairments which met the requirements at the time of the initial access decision. Note (b) appears to recognise that a person's supports needs might interact with other factors that do not meet the disability of early intervention requirements.[15]
3. The only submission made with regards to section 34(1)(aa) is an assertion by the Agency that the requested occupational therapy hours are not necessary to address the needs of the Applicant arising from an impairment in relation to which the Applicant meets the disability requirements. The Agency does not elaborate on this submission. More specific submissions would have assisted the Tribunal. At a minimum, if the Agency is seeking to rely on a support not meeting section 34(1)(aa) it should:
   • identify the impairment or impairments which the Agency says the requested support relates to,
   • state the basis on which the impairment does not meet the disability or early intervention requirements, and
   • address note (b) by identifying why the impairment is not to be considered a factor which forms part of a participant's disability support needs supports.
4. Better practice would be for the Agency to identify early in a proceeding which impairments are accepted as meeting the disability or early intervention requirements and whether there are any other impairments which the Agency says do not meet these requirements. This would provide Applicants with an opportunity to address this issue at the earliest opportunity. Following the introduction of section 34(1)(aa) in October 2024, the Agency's decision-makers and reviewers will need to specify the impairments which meet the disability or early intervention requirements as part of their reasoning.
5. The Tribunal does have the benefit of three detailed functional capacity assessments conducted by occupational therapists, Ms Haugh,[16] Ms Hill,[17] and Ms Donohue.[18] Ms Haugh reports that Mr Cala met the NDIS Access requirements based on permanent impairments arising from:
   • psychosocial conditions of MDD, GAD and SSD,
   • physical conditions of hEDS, and
   • physical conditions of stenosis and DDD.[19]
6. Ms Haugh states that the Agency's acceptance of these conditions meeting the access requirements is confirmed in an email from a case manager dated 12 April 2021.[20] The Tribunal has not been provided with a copy of this email. However, the Agency does not dispute the accuracy of this report. I will proceed on the basis that these are the conditions which assessed as being permanent for Mr Cala when he was granted access the NDIS. Ms Haugh also reported that Mr Cala is 'unable' to participate in any of the activities listed in section 24(1)(c).[21] Following the introduction of section 34(1)(aa), decision-makers will need to be more specific about the impairments that arise from conditions, rather than just listing diagnosed, ongoing conditions.
7. I also note the Dr McAulay, Consultant Psychiatrist, describes Mr Cala's impairments as:

Mr Cala's impairments arise from a complex interaction of medical and psychiatric conditions, best understood in grouped domains: > > • Connective tissue disorder, the primary diagnosis being hypermobile Ehlers-Danlos syndrome, under which sits a complex of multiple other conditions, contributing to disability, which have established and evidence based clinical associations or direct causative links with hEDS, including (but not limited to): chronic widespread pain/fibromyalgia syndrome, chronic fatigue, dysautonomia / POTS, a history of cardiothoracic surgery to repair an aortic aneurysm, scoliosis, lower back pain, inguinal hernia, MALS, pubic symphysis dysfunction, gut motility disorders, and varicocoele. > > • Chronic allergy symptoms including confirmed Alternaria allergy. > > • Psychosocial and psychiatric sequelae, including generalised anxiety disorder, somatic symptom disorder, the impacts of long-term social isolation, unemployment and financial distress, and an unsupported carer role for his mother.[22]

8. Ms Hill summarises Mr Cala's impairments as being:

Psychosocial impairment: generalised anxiety disorder and somatic symptom disorder. These are conditions associated with hEDS as described below: > > a. Generalized anxiety disorder is an excessive, uncontrollable worry about everyday issues such as health, work or finances. The causes of anxiety are not fully understood. Some known risk factors that Carmelo has are a compromised childhood with poor attachment to a primary caregiver, life-threatening events such as a MVA or infection, physical health issues, ongoing stressful situations. > > b. Somatic symptom disorder (SSD) is a recently defined diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). It is the manifestation of one or more physical symptoms accompanied by excessive thoughts, emotion, and/or behaviour related to the symptom, which causes significant distress and/or dysfunction. > > These symptoms may or may not be explained by a medical condition. SSD arises from a heightened awareness of various bodily sensations, which are combined with an inclination to interpret these sensations as indicative of medical illness. Longitudinal studies show considerable chronicity. Systematic reviews and meta-analyses have revealed that therapeutic interventions only yield small-to-moderate effect sizes. Chronic limitation of general function, significant psychological disability, and decreased quality of life are frequently observed. > > Ehler Danlos Syndrome (EDS) refers to a group of disorders that all have increased joint hypermobility. The most common of these is called hypermobile EDS (hEDS). This diagnosis was made by Dr Michael Gattas, Consultant Clinical Geneticist of The Royal Brisbane Hospital, in a letter dated 10/10/2017. > > a. hEDS is recognised to be associated with anxiety (Bulbena et. al.). There is growing evidence of links with depression. It is believed that the underlying mechanisms include genetic risks, problems with the automatic control of body functions, sensitivity to external and internal stimuli and decreased sense of position. More recent studies have shown an increased response in emotion processing brain areas which explains the high emotional reactivity seen in Carmelo. > > b. Pain is the most prevalent and disabling symptom in hEDS populations. Pain in hEDS is poorly studied which results in increased disability due to pain as it is not clear how to best manage it. A study in 2022 by De Wandele et al. concluded that there is increased central pain facilitation in eHDS and reduced hypoalgesia (decreased sensitivity to pain) from exercise. This means that Carmelo will not be getting improvement in his pain despite participating in physiotherapy and regularly walking to manage his clotting risk. > > c. Pain feeds into mental health conditions, particularly anxiety and depression increasing the disability burden. > > d. Fatigue is an integral part of living with hEDS, pain and multiple medical conditions. Cognitive fatigue is part of Carmelo's cognitive impairment. Simple tasks become cognitively complex for people with mild cognitive impairment, the person has less ability to rely on procedural memory and must pay greater cognitive attention to sequence through the steps of a task and to deal with minor problems as they arise. The increased cognitive attention required leads to fatigue.[23]

9. Ms Hill reports that Mr Cala experiences a substantially reduced functional capacity with regards to the activities of communication, social interaction, mobility, self-management. The assessment of Ms Donohue is largely consistent with that of Ms Hill and Ms Haugh. However, I would note that Ms Donohue indicates that Mr Cala requires an intermittent level of assistance for with some tasks within the mobility, communication, social interaction, and self-management activities.[24]
10. Based on the information before me, I consider that Mr Cala has the following impairments to which a psychosocial disability is attributable:
    • Low mood, high levels of anxiety, hypervigilance with respect to health symptoms, significant difficulty with communicating his needs, interpersonal difficulties, high levels of distress, reduced skills in emotional regulation, reduced capacity to understand information, and cognitive rigidity.
11. These impairments relate to his diagnosed permanent conditions of GAD, MDD and SSD. The impairments substantially reduce his functional capacity with respect to communication, social interaction, and self-management. They also reduce his capacity for social and economic participation.
12. Mr Cala also has the following physical impairments:
    • reduced strength, endurance and balance,
    • reduced capacity for sitting, bending, lifting, reaching, and climbing stairs, and
    • joint hypermobility with recurrent subluxations and dislocations.
13. These physical impairments relate to his diagnosed permanent conditions of hEDS and DDD. They substantial reduce Mr Cala's functional capacity to undertake mobility activities and impact his social an economic participation.
14. Mr Cala also has sensory and neurological impairments of pain and fatigue. These impairments relate to his diagnosed permanent conditions of hEDS, DDD, and MDD. They substantially reduce Mr Cala's functional capacity to undertake mobility activities and impact his social an economic participation.
15. Mr Cala's physical, psychosocial, neurological and sensory impairments also contribute to a cognitive impairment with regards to memory, concentration, information processing and executive functioning. This impairment substantially reduces his functional capacity with respect to self-management. This cognitive impairment also reduces his capacity for social and economic participation.
16. With regards to note (b), Mr Cala's has many other health conditions including aortic aneurysm repair, inguinal hernia, erythrocytosis, thoracic outlet syndrome, POTS, chronic fatigue syndrome, mast cell activation syndrome, fungal allergy, and Reynaud's syndrome. It is also the complex interaction of Mr Cala's physical, psychosocial and health conditions which together contribute to his increased disability support needs. Mr Cala's regional location is also factor in accessing services. I will refer to these impairments and others factors as needed in my assessment below.

1. The Agency's decision under review says that the Applicant requests 28 days of STA.[25] Ms Hill, Occupational Therapist, says that Mr Cala is requesting STA for 2 days per month (24 days per year) so that Mr Cala can:

... sometimes stay in Brisbane/Gold Coast instead of going home between appointments. I have explained to Carmelo that he may not meet the criteria for STA. STA is support for when a participant needs to live out of home for a short period. It gives the person a chance to try new things, a place to make new friends and develop new skills. This would be very beneficial for Carmelo. He lives a very restricted life and has minimal contact with people who are not his treating health professionals. His activities are all focused on health management due to his SSD. Carmelo says that he would like to try mini golf, go to the beach, try different food and shop for clothing and shoes with a support worker. There is very little variety in Stanthorpe where he lives. He would like to explore how he could adapt what he learns during the STA to home. He gets to interact with a variety of people when he is out and about and connects with people he has met before. This would allow him to be more social and to connect with a wider variety of people. He feels there is less judgement when he is away. He would like support to set up the STA and to clean it so he can stay there free of his allergies. Carmelo lives alone so it is not needed to give his carers a short break from their caring role. The NDIS website does not state that STA is solely for people whose carers require respite or that it is only for people who need 24-hour support which is the reason the planner gave for refusing to fund STA.[26]

(a) does not represent value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, > > (b) will not be effective and beneficial for the Applicant, having regard to current good practice, and > > (c) is not required as the Applicant is funded $17,565.60 for community-based activities to develop, build and maintain friendships and relationships.

...whilst STA has the ancillary benefit of developing skills and making new friends, the primary purpose of STA is for situations where the participant or informal carers need to be away from the usual living arrangements for a transient period of time, for reasons such as respite or giving informal carers a break. If the primary purpose is for skills and social relationship building, then there are other supports that are available that can achieve this goal, such as psychology and occupational therapy support, and assistance to access social and recreational activities.

4. This submission with regards to the purpose of STA relies on the description of STA in the NDIS Price Guide[27] and the STA Guideline.[28] I note that the STA Guideline was published in 2022 and has not been updated to refer to whether STA is an NDIS Support in the Transitional Rules. Schedule 1, item 5, of the Transitional Rules includes a category 'Assistance with daily life tasks in a group or shared living arrangement'. Supports that are NDIS supports in this category, unless otherwise provided, are:

Supports that provide assistance with or supervision of daily living tasks to > > participants in a shared living environment. > > This includes the following: > > (a) supports provided on a temporary or ongoing basis; > > (b) supports for short term accommodation and respite; > > (c) supports provided to participants living in residential aged care facilities.

5. From the information before the Tribunal, I am unsure whether Mr Cala is seeking assistance or supervision in a shared living environment. I am confident that STA is not being sought for the purpose of respite. It is not clear to me that the STA requested by Mr Cala is an NDIS support within the meaning of this item.
6. STA is sought to broaden Mr Cala's social experiences. I agree with the Agency that Mr Cala has funding for community-based activities. To the extent that STA is intended to be used for access to community activities it is a duplication of these supports which is prevented from being funded under rule 5.1(c) of the Support Rules.
7. In my view, the STA that Mr Cala is requesting may also be prevented from being funded under schedule 2, item 4(o) of the Transitional Rules. This item say that the following are not NDIS supports:

(o) accommodation to attend or participate in work, study, music, theatre, cinema, sporting events or conferences, or any other social, business, private, public, formal or informal event

8. Overall, I am not satisfied that the STA requested by the Applicant is a reasonable and necessary support to be included in his SPS under section 34 of the NDIS Act.

1. The Agency submits that the Applicant is seeking 67 hours of OT per year and that his current plan includes $9,311.52 for OT. This equates to 48 hours on the rate in the NDIS price guide. Ms Hill recommends 63 hours of mental health OT and 6 hours for a therapy assistant as follows:

• Fortnightly telehealth Appointments (26 x 1.5 hours) > > • Home visits to Stanthorpe (2 x 2 hours) > > • Travel costs for each home visit (2 x 1 hour) > > • Review report (4 hours) > > • Low-cost low-risk assistive technology prescription and report writing (10 hours) > > • Non-Face to Face including liaison with other health professionals and support coordinator (8 hours) > > • Therapy assistant support will be used where appropriate. (estimate of 6 hours) [29]

2. Ms Hills' report outlines the following functional outcomes that are intended to be achieved through intensive OT interventions:

1. Carmelo will examine and adapt his beliefs and expectations about his health and physical symptoms. > > 2. Carmelo will learn how to reduce stress. > > 3. Carmelo will learn how to cope with physical symptoms and reduce his preoccupation with symptoms. > > 4. Carmelo will reduce his avoidance of situations and activities due to uncomfortable physical sensations. > > 5. Carmelo will improve his daily functioning at home. > > 6. Carmelo will improve his daily functioning in relationships. > > 7. Carmelo will improve his daily functioning in social situations.[30]

3. Ms Hill connects these functional outcomes with Mr Cala's NDIS goals and refers to literature on current best practice in managing SSD. Ms Hill also explains how Mr Cala's communication challenges increase the time required for therapy sessions. Ms Hill emphasises the benefits of this OT support saying:

Without this support there is a high risk that Carmelo's preoccupation with his symptoms will increase and his mental health will decline further with associated increasing social isolation and reduced quality of life. He is likely to spend increasing amounts of time seeking medical and surgical solutions to symptoms that will not benefit from such interventions. These patients frequently doctor shop, with each new health professional repeating tests and diagnostic interventions which becomes an unreasonable burden on the health system. > > ... > > Without intervention Carmelo's social and economic participation is likely to further decrease. His burden on the health system is likely to increase. His mental and physical health is likely to become worse as a result of his efforts to improve it. If this occurs his overall physical and mental disabilities may result in an increased need for NDIS core supports.[31]

4. The Agency submits that 67 hours of OT is not reasonable and necessary as it:

(a) is not necessary to address the needs of the Applicant arising from an impairment in relation to which the Applicant meets the disability requirements,

(b) will not assist the Applicant to pursue the goals, objectives and aspirations included in his statement of goals and aspirations,

(c) will not assist the Applicant to undertake activities, so as to facilitate his social and economic participation,

(d) does not represent value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, and

(e) will not be effective and beneficial for the Applicant, having regard to current good practice.

1. The Agency also relies on the recommendation of Ms Hiras that 25 OT hours are required for assistive technology assessment, liaison and report writing. In my view, Ms Hiras' recommendation was focussed on specific OT hours required for assistive technology assessment and is distinct from the recommendation made by Ms Hill, rather than being in contradiction to Ms Hill. Unfortunately, the independent OT arranged by the Agency was not asked to provide an opinion on the recommended number of OT hours.
2. In my view, the recommended OT hours are necessary to address the needs of Mr Cala arising from impairments in relation to which he meets the disability requirements. Specifically, these therapy hours are necessary to address Mr Cala's complex needs arising from his psychosocial, physical, sensory, cognitive and neurological impairments which meet the disability requirements.[32]
3. I accept Ms Hill's recommendation and consider that 63 hours of mental health OT and 6 hours of therapy assistance is reasonable and necessary. The therapy will assist Mr Cala with his goals of improved capacity for completing daily living tasks and building relationships.[33] In turn, this will assist with Mr Cala's social participation.[34]
4. Ms Hills' recommendations have been formulated based on her clinical experience, knowledge of the Applicant and are based on current good practice.[35] Ms Hill has appropriately adjusted her recommendations to reduce costs by using telehealth and a therapy assistant. This OT intervention is designed to prevent further deterioration in Mr Cala's functional capacity and prevent increased cost to the NDIS and health system. In my view this support is value-for-money relative to the benefits achieved. [36] I am not satisfied that there are lower cost alternatives that achieve the same outcome.[37] Mr Cala has very limited informal supports. I do not consider that family, informal supports or community supports are reasonably available to assist Mr Cala with this support.[38]
5. Therapeutic supports are an NDIS support under item 34, schedule 1 of the Transitional Rules. I do not consider that this mental health OT is clinical treatment for Mr Cala's health condition or directly related to Mr Cala's health status for the purpose of item 12, schedule 2 of the Transitional Rules. I also do not consider that this mental health OT is clinical treatment for Mr Cala's mental health conditions under item 13, schedule 2 of the Transitional Rules.[39] The Agency does not contend that Mental Health OT is not an NDIS support. I consider that mental health OT is most appropriately funded under the NDIS as it relates directly to the Applicant's functional capacity and disability needs. It is not more appropriately provide under the health or mental health systems of support.[40] Overall, I consider that these OT and therapy assistant hours are a reasonable and necessary support to be funded in the Applicant's SPS.
6. However, I do not consider that the separate 25 hours of OT recommended by Ms Hiras are reasonable and necessary.[41] In part, this would be a duplication of the 10 hours of assistive technology prescription and report writing included in Ms Hill's services. I am also not satisfied that 25 hours for this purpose is value-for-money or effective for Mr Cala. I will discuss the further below with regards to Mr Cala's request an adjustable chair. This detailed assessment did not lead to an effective outcome for Mr Cala.

1. The Agency submits Mr Cala seeks 42 hours per year of physiotherapy and that his current plan includes funding for 36 hours per year of physiotherapy. The Agency submits the current funding is sufficient as it exceeds the recommendation of Ms Mira, physiotherapist, for 26 hours per year. However, I note that Ms Mira's recommendation is specific to 'physiotherapy that targets the areas of the neck and perilaryngeal area'. Ms Mira makes this recommendation due to Mr Cala's:

... difficulty with swallowing, sensation of chocking, throat tightness and cough. [Mr Cala] has a complex medical history that has likely contributed to an imbalance and increased load in the muscles of the neck and perilaryngeal area. These dysfunctional muscle imbalances significantly impact his swallowing, voice and breathing and are a significant contributor to his primary symptoms.[42]

2. The need for this specialised physiotherapy is supported by Mr Cala's speech pathologist, Ms Perkins.[43] I note Ms Perkins also identifies some related 'maladaptive' behaviours, saying:

Carmelo presents as a complex patient with multiple conditions impacting voice, swallowing and his upper airway. Some of his behaviours surrounding swallowing are maladaptive. I tried to explain this to him. Excessive muscle tension/imbalance, posture, respiratory pattern and his large base of tongue are all impacting on swallowing. > > Carmelo expends considerable effort to swallow and there is a laryngeal/perilaryngeal focus to this effort. Excessive muscle tension in the perilaryngeal muscles can extend to include pharyngeal constrictors and deep muscles of the neck. The impact of such excessive tension shortens and stiffens the muscles which can interfere with swallowing, voice and breathing. > > ... Unloading laryngeal muscle tension could be a focus for treatment and may include relaxed throat diaphragmatic breathing, circumlaryngeal massage and semi occluded vocal tract exercises. Carmelo has previously accessed the services of a specialist head and neck physiotherapist. Attendance for weekly therapy provided relief of symptoms.[44]

3. Ms Mira is not the only physiotherapist involved with Mr Cala. Ms Meggs recommends 41 hours of physiotherapy to address more general impairments related to his hEDS. These recommended hours include 1 hour per fortnight of physiotherapy treatment, along with 10 hours for complex case management, and 3 hours for reporting.[45] Ongoing physiotherapy is also supported by Ms Hill. However, I note the Ms Hill also states that:

While Carmelo needs to see a physiotherapist to manage his EDS, he also needs to monitor and keep in check his preoccupation with his somatic symptoms.[46]

4. On my reading of the physiotherapy reports, Mr Cala's treaters recommend 52 treatment hours, being 26 fortnightly sessions with a head and neck physiotherapist, and 26 fortnightly sessions with a physiotherapist with expertise in hEDS. An additional 13 hours is requested for report writing and complex case management. This makes a total of 65 physiotherapy hours which are recommended. In my view, Mr Cala's request for 42 hours is reasonable and necessary. While this is less than the total hours recommended, I consider that it is likely that Mr Cala will not be able to attend some of these sessions due to his health conditions. I also consider that Mr Cala is likely to be eligible for 5 physiotherapy sessions through a chronic condition management plan provided through the health system.[47] If 42 physiotherapy hours are not sufficient, it will also be open to Mr Cala and his treaters to request additional funding if needed.
5. Overall, I consider that and additional 6 hours for physiotherapy treatment is reasonable and necessary. Physiotherapy is necessary to address the needs of the Applicant arising from impairments in relation to which the Applicant meets the disability requirements. Specifically, these therapy hours are necessary to address Mr Cala's needs arising from his physical, sensory, and neurological impairments which meet the disability requirements. These impairments primarily relate to his permanent condition of hEDS.[48]
6. Physiotherapy will assist Mr Cala with his goals of improved mobility and capacity for completing daily living tasks.[49] This will also assist with Mr Cala's social participation.[50] The physiotherapy hours are recommended by appropriately qualified allied health practitioners with reference to current good practice. [51] Physiotherapy is designed to improve capacity and reduce costs to the NDIS. Physiotherapy is value-for-money relative to the benefits achieved.[52] I am not satisfied that there are lower cost alternatives that achieve the same outcome.[53] In reaching this conclusion, I have considered what is reasonable for family, informal or community supports to provide.[54]
7. Therapeutic supports are an NDIS support under item 34, schedule 1 of the Transitional Rules. I do not consider that this physiotherapy is clinical treatment for Mr Cala's health condition or directly related to Mr Cala's health status for the purpose of item 12, schedule 2 of the Transitional Rules. Physiotherapy for Mr Cala's impairments arising from hEDS are most appropriately funded under the NDIS as it relates directly to the Applicant's functional capacity and disability needs. It is not more appropriately provided under the health system.[55] The Agency does not contend otherwise. Overall, I consider that these physiotherapy hours are a reasonable and necessary support to be funded in the Applicant's SPS.

1. The Agency submits that the Applicant has requested 50 hours per year of level 3 support coordination. The Applicant presently has funding in his SPS for 24 hours of level 2 support coordination. Mr Cala's counsellor, Ms Sykes recommends 50 hours per year of support coordination:
   • To assist Mr Cala to be able to manage his funds effectively and for Mr Cala to work towards obtaining his goals.
   • To assist Mr Cala to connect to new supports and broker supports and services in line with a participant's wishes and their plan budget.
   • To assist Mr Cala with communication and collaboration between his providers, particularly regarding assistive technology.
   • To assist Mr Cala, to maximise the support and funding available to him and build capacity and capability to understand his plan, navigate the NDIS and make his own decisions.[56]
2. Ms Hill, recommends level 3 support coordination, stating that:

Carmelo has definite ideas about what he wants and what works for him. He can communicate these ideas but requires extra time to express his thoughts and to hear what other people have to say. He has a mild cognitive impairment, so he struggles to understand what people tell him. His ideas about how he thinks things should happen make it hard for him to accept how the NDIS actually works. He is misled by the general advertising by the NDIS and interprets it literally and does not "get" what is not explicitly stated. He focuses on choice and control and the personalization of the plan and goals. He cannot factor in the reasonable and necessary criteria which severely limit his ability to make choices and build a support package that meets his needs. His needs are unique, and the NDIS standard packages of care are not applicable in his situation. Carmelo needs a minimum of two years of support coordination, and it must be accepted that he may need to trial a couple of support coordinators before finding one who meets his needs. The NDIS could consider funding level 3 support coordination funding to enable Carmelo to engage someone with tertiary level skills who can understand his unique situation and provide the just right support he needs and who is able to provide effective decision-making support that does not impinge on Carmelo's right to make his own decisions. Carmelo should be supported by the Complex Support Needs Pathway in the NDIA.[57]

3. The Respondent submits that there is insufficient evidence which indicates why the current support coordination funding does not meet the Applicant's needs and how the additional support coordination hours are intended to be used. On balance, I agree with the Agency with regards to the number of hours requested. As I understand it, Mr Cala is very reluctant to have support workers assisting him in his home with his daily living tasks. His mental health OT and physiotherapy hours will be set with fixed appointments. Hours will be included in his SPS for his mental health OT to liaise with other health professionals. His physiotherapists also propose to use some hours towards case management. This would largely seem to leave a support coordinator to assist with communication between Mr Cala's support team and with coordinating support workers for community access and transport. 24 hours of support coordination per year does seem sufficient for this. If this proves to be insufficient, additional hours may be requested. This is best considered once a support coordinator has been reengaged and has work with Mr Cala for a period. Based on the current information before me, I am not satisfied that an additional 26 hours of support coordination is a reasonable and necessary support to be included in Mr Cala's SPS.
4. With regards to the recommendation for level 3 support coordination, I note that the Agency's website provides the following descriptions:

Level 1: Support Connection > > Support to help a participant understand their plan, connect with NDIS providers and community, mainstream and other supports to get the most out of their NDIS plan. > > It should also increase participant's confidence and skills to manage their plan independently. > > Level 2: Coordination of supports > > Support to put in place a mix of supports to increase a participant's capacity to maintain relationships, manage tasks, live more independently and be included in their community. > > It builds the participant's confidence and skills to direct their lives, not just their services. > > Level 3: Specialist support coordination > > A higher level of support for participants whose situations are more complex and who need specialist support. > > A specialist support coordinator will assist participants to manage challenges in their support environment and ensure a consistent delivery of service.[58]

5. The Agency's website also indicates that level 3 specialist support coordinators are expected to complete the following activities above what is provided at level 2:

Address complex barriers > > Specialist support coordinators should help overcome complex barriers that affect participants' ability to access and maintain appropriate supports. They should work with participants, their families and carers to:

• identify and understand the barriers impacting the participant's ability to access, use and maintain their supports
• find and try solutions to address these barriers
• establish a process to overcome these barriers, including prioritising factors that need to be addressed first and what supports need to be in place immediately.

Design a service plan for complex support needs, where appropriate > > Sometimes a participant may need a service plan to address significant complexities in their life. > > Specialist support coordinators should work with the participant, their families and carers to identify a broad network of a supports - funded or other supports - that can help the participant use their plan. > > Specialist support coordinators should design a service plan which:

• ensures all services can work effectively and cohesively together to help a participant to pursue their goals
• establishes processes to enable communication, cooperation and collaboration within the participant's network of funded and non-funded supports
• helps the participant, their family and carers to resolve issues and unexpected situations
• ensures a consistent delivery of service and access to relevant supports in a crisis or unplanned event.

Once a service plan is designed, a participant's support coordinator can help the participant and their support network put the service plan into action.[59]

1. Based on the material before me, and my interactions with Mr Cala during several directions hearings, I consider that Mr Cala is confronted by complex barriers that affect his ability to access and maintain appropriate supports. With Mr Cala's SSD, and rigid beliefs as to what supports the Agency should fund and how these supports should be provided, there is a real risk that he will seek to access supports which are not funded in his SPS, or otherwise over or under utilise funds in a way which does not provide him with an optimal level of support. In Mr Cala's circumstances, I consider that level 3 support coordination is warranted.
2. Level 3 support coordination is necessary to address Mr Cala's needs arising from his psychosocial impairments of SSD and GAD which meet the disability requirements.[60] Level 3 support coordination will assist Mr Cala with his goal of completing daily living tasks as independently as possible.[61] It will also assist with Mr Cala's social participation.[62] Level 3 support coordination is recommended by an appropriately qualified allied health practitioners with reference to current good practice.[63] Level 3 support coordination is value-for-money relative to the benefits achieved.[64] I am not satisfied that level 2 support coordination is a lower cost alternative that achieves the same outcome.[65] In reaching this conclusion, I have considered what is reasonable for family, informal or community supports to provide.[66]
3. Support coordination is an NDIS support under item 33, schedule 1 of the Transitional Rules. It is not excluded under any item in schedule 1 of the Transitional Rules. Support coordination is most appropriately funded under the NDIS as it relates directly to the use of supports in the Applicant's SPS. It is not more appropriately provide under another system.[67] The Agency does not contend otherwise. Overall, I consider that level 3 support coordination is a reasonable and necessary support to be funded in the Applicant's SPS.

1. The Agency submits that the Applicant seeks an increase in his consumables funding to $2,000 per year and that the Applicant currently has a budget of $1,500 for consumables. The Agency does not dispute that the Applicant requires a level of funding for consumables. Ms Hill recommends consumables funding of $2,160 per year. This figure is based on Ms Hill's calculation of Mr Cala's use of face-masks, being:

Duck masks cost him $180 a packet and he uses 10 packets a year. He uses 1 packet per month of the blue masks which cost $20-30 a packet. That is, $2160 per year.[68]

2. The Agency submits that face-masks are excluded under item 3(a), schedule 2 of the Transitional Rules. This item relates to the category 'Day-to-day living costs - food and groceries' and says that the following are not NDIS supports:

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

3. In my view, face-masks are excluded from being an NDIS support under the Transitional Rules as they are health products. As such I cannot be satisfied that including consumable funding for purchasing face-masks is a reasonable and necessary support to be included in Mr Cala's SPS under section 34 of the NDIS Act.
4. I note that Mr Cala has applied to the CEO for a replacement support determination with regards to tea tree oil. This is a matter for the CEO and the Tribunal does not have a role in making or reviewing replacement support determinations.

Support (f): Assistive technology and equipment

1. Ms Hill recommends a range of equipment and assistive technology for Mr Cala, as follows:

Low-cost, low risk equipment for the kitchen, bedroom and bathroom at $2500, which should reduce to a small amount annually for replacement items in 2 - 3 years. This would include items such as a jar opener, cooking pot with 2 handles, easy-on sheets for the bed, wall mounted magnifying mirror so he can see to do personal cares without putting his neck in an awkward position. > > Hiking sticks so he can walk outside on uneven ground - $ 50 - 100. This will give Carmelo confidence and increase his physical activity with resulting improvement in his mental and physical health. > > Treadmill exercise walker that Carmelo can set up himself and which will fit in his unit. Approximate cost, $800. Cheaper treadmills are available but have few features and shorter lifespan. Generally, the more you pay the longer they last. This price is a good entry price. Exercise, particularly walking, is recommended for a wide range of conditions that he has. Fear of exercising outdoors, risks of infection in a gym and difficulty with regulating temperature all point to home exercise equipment as a good solution. Carmelo should consult with his exercise physiologist before purchase. > > Sit - stand tables for his living room and office nook to enable correct positioning of his body to engage in activity. As this positioning changes from day to day, a sit - stand desk will allow precise ergonomic positioning. Carmelo has trialed many options and solutions to his seating problems over the years. He has done this during and prior to becoming an NDIS participant. The cost of this has largely been born by Carmelo and has encompassed a wide range of low-cost solutions in the market. Because of his mental health impairment he has been unable to make effective use of advice from LACs and he has had difficulty independently engaging a support coordinator so that he does not understand NDIS reasonable and necessary requirements and the process the NDIS require to approve AT he requires. > > Seating > > a. Dining chair solution to support him to sit and eat at a dining table. The chair needs to be scripted. Carmelo has been referred to an OT with experience in prescribing seating. > > b. Office chair (as above). The chair needs to have multiple adjustment points to position and/or support his head and neck, trunk and upper limbs correctly. An office chair is used for extended periods and needs to be ergonomically sound. Carmelo has trialed multiple chairs from a variety of stores. Price range $600 to $2100.[69]

1. The Agency submits that a jar opener, cooking pots with two handles, easy-on sheets, and a wall-mounted magnifying mirror are excluded under item 1(i) of schedule 2 of the Transitional Rules as they are 'standard household items, appliances, tools or products'. With regards to cooking pots with two handles, I agree with the Agency. In my view, cooking pots are readily available with either one of two handles. Cooking pots with two handles are a standard configuration for this household item. I also agree that a wall-mounted mounted magnifying mirror is a standard household item. These are a widely available and commonly used item regardless of whether a person has reduced functional capacity.
2. However, I do not agree that a jar opener and easy-on sheets are standard household items. Both products are designed to assist a person with reduced functional capacity to carry out domestic tasks and are something more than a standard household product. For example, an internet search for 'easy-on' sheets return a range of results, some of which appear to be standard fitted sheets, but others are accessibility products which include zips or grab handles. The latter, in my view, are not standard household items. With Mr Cala's hEDS and DDD he will not be able to lift a mattress to apply a standard fitted sheet. He will require sheets which are designed to be changed without this level of manual handling. Similarly, while some jar openers can be very simple gripping devices, there are also automated openers which are specifically designed for use by people with reduced functional capacity. With Mr Cala's hEDS he is unlikely to benefit from the standard varieties of jar openers which would still require him to grip and twist the device.
3. In my view, a jar opener and easy-on sheets these products fall within items 8(a) and (b) of schedule 1 of the Transitional Rules being_:_

Assistive products for household tasks > > The provision of assistive products that support a participant to carry out domestic > > and everyday actions and tasks within a participant's home. > > This includes the following: > > (a) assistive products for the preparation of food and drink; > > (b) assistive products to facilitate house cleaning, gardening or laundry;

1. The Agency submits that hiking sticks are excluded under item 4(g), schedule 2 of the Transitional Rules as being 'standard recreational equipment and tools, including toys, balls and racquets.' This exclusion needs to be read in the context of the item 4 category being 'Day-to-day living costs - lifestyle' and the other items that are excluded in this category. I note that the following item (4)(h) excludes 'costs associated with recreational sports and activities, including membership costs, venue hire fees, uniforms and footwear.' I agree that hiking sticks can be considered standard recreational equipment when they are used for hiking. However, this is not the context for which hiking sticks are recommended for Mr Cala. It is not realistic that Mr Cala will be engaging in hiking as a recreational activity.
2. Whether hiking sticks are, or are not, an NDIS support also needs to be consider with reference to schedule 1. Hiking sticks are recommended to improve Mr Cala's ability to move outside of his home on uneven ground. In this way, hiking sticks are more properly considered to fall within item 28(a) of schedule 1 of the Transitional Rules, being:

Personal mobility equipment > > The provision of personal mobility equipment that supports or replaces a participant's capacity to move indoors and outdoors and to transfer from one place to another. > > This includes the following:

1. I agree with the Agency's submission that a treadmill is excluded under item 4(r) of schedule 2 of the Transitional Rules:

(r) membership and entry to a recreational club and standard gym equipment;

2. The recommended treadmill is standard gym equipment. I acknowledge that this may seem inconsistent with my conclusion on hiking sticks above given that Mr Cala is not using the treadmill for a recreational purpose. Unlike hiking sticks, which can be considered an assistive product for walking, there is no category in schedule 1 of the Transitional Rules that might displace the exclusion of 'standard gym equipment' in item 4(r). The only item in schedule 1 that deals with exercise is item 18. This item relates to the activities of personal training or exercise physiology rather than exercise equipment.

1. I agree with the Agency's submission that a sit-stand desk is excluded under item 1(j) of schedule 2 of the Transitional Rules being 'standard furniture, fixtures or fittings'. There are a wide range of sit-stand desks available and these are common items that are used by people without reduced functional capacity.
2. I have also considered whether a sit-stand desk or table instead falls with item 9(f) of schedule 1 of the Transitional Rules being:

Assistive products for personal care and safety > > Provision of assistive products for self-care activities and participation in self-care. > > This includes the following: > > ... > > (f) furniture and other products that are adapted or specifically made to be placed > > in or added to a participant's home (including indoor and outdoor areas) to > > help with movement, positioning and other safety needs, including entry and > > exit of the environment ...

3. I consider that a sit-stand desk is excluded as being 'standard furniture' in the context of a home office or study. It is less clear to me whether a sit-stand table in Mr Cala's living room would fall within item 1(j) of schedule 2 or item 9(f) of schedule 1 of the Transitional Rules. Presently, I do not have enough information about what sit-stand table is sought for Mr Cala's living room to properly consider the application of the Transitional Rules to this support. I also do not have enough information to consider the other criteria in section 34, including whether the sit-stand table is value-for-money, as no product has been identified.

1. I am less persuaded that the adjustable chairs are excluded by item 1(j) of schedule 2 of the Transitional Rules being 'standard furniture, fixtures or fittings'. A suitable adjustable chair has been carefully considered by Ms Hiras through a mid-cost assistive technology assessment.[70] In my view, the level of adjustability required for Mr Cala's postural needs, neck support and seat angle adjustability are beyond what would be considered as standard. However, despite consideration of over 60 chairs, and in-depth trials of 12 chairs, Ms Hiras was not able to recommend an appropriate chair, saying:

While some of the other chairs trialled were able to meet most of the above criteria, Carmelo did not feel that these chairs were appropriate or provided adequate symptom relief. Carmelo's perception of his physical symptoms are an integral part of his SSD diagnosis. This highlights that Carmelo needs to feel that his symptoms are adequately managed in a way that is appropriate for him, and his rigid thinking precludes him from openly considering other, reasonable options presented.[71] > > ... > > The purchase of the following item [KAB ACS Executive, $5,627.00 incl. delivery] has been deemed to be clinically appropriate. However, the therapist has deemed that the reasonable and necessary criteria for funding through the NDIS cannot be met in the prescription of this assistive technology device. > > This related to the participant's psychosocial disability which has limited his perception of appropriate AT solutions. The physical and psychosocial factors of Carmelo's conditions must be considered together to allow for the successful implementation of assistive technology.[72] [emphasis in original]

2. Based on Ms Hiras' assessment, I am not satisfied that adjustable chairs that meet Mr Cala's expectations represent value-for-money for the purpose of section 34(1)(c). Based on the current information, I cannot be satisfied that adjustable chairs are a reasonable and necessary support to be included in Mr Cala's SPS.
3. As mentioned above, the outcome of this report was a factor in my consideration of Ms Hiras' recommended OT hours for assessment and trials of assistive technology. I am not satisfied that this level of assessment represented value-for-money given that a suitable chair was not able to be identified. In my view, Mr Cala will need to adjust his expectations of what is reasonable and necessary for the NDIS to fund. His mental health OT should be able to assist with this.

Summary for Assistive Technology and Equipment

1. I consider that a jar opener, easy-on sheets, and hiking sticks are low-cost, low risk items of equipment which are reasonable and necessary supports to be include in Mr Cala's SPS. These items are necessary to address Mr Cala's needs arising from his physical impairments related to his hEDS and DDD which meet the disability requirements.[73] They will assist Mr Cala with his goal of completing daily living tasks as independently as possible.[74] Through reducing his overall activity load these products will also assist with Mr Cala's social and economic participation.[75] The products are recommended by an appropriately qualified allied health practitioner with reference to current good practice.[76] The low cost items are value-for-money relative to the benefits achieved.[77] I am not satisfied that there are lower cost alternatives that achieve the same outcome.[78] In reaching this conclusion, I have considered what is reasonable for family, informal or community supports to provide.[79]
2. A jar opener is an NDIS support under item 8(a) of schedule 1 of the Transitional Rules. Easy-on sheets are an NDIS support under item 8(b) of schedule 1 of the Transitional Rules. Neither item is excluded under item 1(i) of schedule 2 of the Transitional Rules. Hiking sticks are an NDIS support under item 28(a) of schedule 1 of the Transitional Rules and are not excluded under item 4(g) of schedule 2 of the Transitional Rules. Assistive equipment is most appropriately funded under the NDIS and is not more appropriately provide under another system.[80]

1. The Agency submits that the Applicant has requested $2,000 for car modifications to adjust his driver's seat. The Agency also submits that:
   • the Applicant presently has funding for $5,000.00 for repairs and maintenance of assistive technology.
   • there is insufficient evidence before the Tribunal which demonstrates that the Applicant requires additional funding.
2. This repairs and maintenance funding is a 'stated support' in Mr Cala's plan and expressly cannot be used for anything else. However, the SPS also states that this support can be used to trial assistive technology. Ms Hill says the following with regards to Mr Cala's needs for adjustments to his car seat:

A seating solution for his car is required. Carmelo drives long distances and often cannot manage appointments when he arrives due to pain and stiffness. He has difficulty getting out of the car. He has trialed a pump-up lumbar support which has resulted in some improvement. It has a bulb that you pump up manually using your fingers and this can result in pain in his hands and an inadequate result. This is complex as his hEDS, Raynaud's disease, MVA pain, fatigue, POTS and vascular problems all contribute. I am unable to estimate the cost of a solution for this and Carmelo needs to be funded to see an OT with advanced clinical skills in this area. Carmelo has been referred to an OT with experience in prescribing seating. This OT has advised that the assessment, trials and training process will require 20 hours of OT funding.[81]

3. Ms Haugh also recommends a specialised assessment saying:

Carmelo expressed interest in having his car reviewed for modifications, mainly the implementation of braces in both the driver and passenger seats to maintain his posture and reduce risk of pain when travelling in the car on uneven roads. Carmelo additionally expressed interesting in having the transmission of his car changed from manual to automatic to further manage pain and fatigue symptoms, Carmelo did acknowledge the age of his car is likely to be an issue with regard to any car modifications. Carmelo is recommended to liaise with his treating practitioners who have had long term involvement with him and specialise in the area of his primary disability (EDS), to discuss the suitability and implementation of these items. Additionally, if any car modifications are required, Carmelo requires referral to a driving assessor / car modification specialist Occupational Therapist to review his driving capacity, seated position, and overall car to implement any required modifications.[82]

4. This specialised assessment seems to have progressed in part with Ms Hiras more recently reporting that:

Carmelo has trialled several low-cost postural supports and cushions but has not been able to find a solution that is suitable for him. Carmelo has attended an initial assessment and trial with a driving assessor occupational therapist and additional appointment with a vehicle modifier. An adequate solution was not able to be found due to the size and age of his vehicle.[83]

5. Presently, I agree with the Agency that there is insufficient information to be satisfied that vehicle modifications are a reasonable and necessary support for Mr Cala. The Tribunal does not have an assessment report which includes details of what modifications are recommended, how much they will cost, or whether they will be safe to implement with Mr Cala's current vehicle and driving capacity. Based on the current information, I cannot conclude that the requested funding for vehicle modifications should be included in Mr Cala's SPS.

1. The decision of the Agency is set aside and remitted for reconsideration with the directions that:

(a) the statement of participant supports include sufficient funding for: > > > (i) an additional 15 hours for mental health occupational therapy and 6 hours for a therapy assistant per year; > > > > (ii) an additional 6 hours for physiotherapy; > > > > (iii) support coordination to be provided at level 3, being specialised support coordination; and > > > > (iv) low-cost, low risk assistive equipment including a jar opener, easy-on sheets, and hiking sticks. > > (b) the date by which Agency must reassess the Applicant's plan is 12 months from the date that the above supports are added to the Applicant's plan. > > (c) the remaining aspects of the statement of participant supports, including plan management, remain unchanged.

[1] Respondent's Statement of Facts, Issues and Contentions, paragraph 1.

[3] Report dated 8 February 2024, pages 275 and 276 of the Joint Hearing Bundle.

[4] On 14 October 2024, the (AAT) became the Administrative Review Tribunal (the Tribunal). Under the transitional provisions in the Administrative Review Tribunal (Consequential and Transitional Provisions No. 1) Act 2024 (the Transitional Act), proceedings in the AAT that were not finalised before 14 October 2024 are to be continued and finalised by the Tribunal. Anything done in relation to the proceeding before 14 October 2024 is taken to have been done by the Tribunal.

[5] The document numbering in the hearing bundle index is adopted throughout these reasons.

[6] Which are all the records that the Agency considered when making the decision under review as required by section 37 of the AAT Act.

[7] I have used a similar overview in other decisions.

[14] Re Drake and Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 634.

[15] For a more detailed analysis of section 34(1)(aa) see Forrest and National Disability Insurance Agency (NDIS) [2025] ARTA 1131, from paragraph 57.

[16] Report dated 30 March 2023, JHB, page 55.

[17] Report dated 10 December 2023, JHB, page 235.

[18] Report dated 24 December 2024, JHB, page 325.

[22] Letter dated 6 August 2025, page 2.

[27]NDIS Pricing Arrangements and Price Limits 2025-26, published 16 June 2025.

[28]Our Guideline: Short Term Accommodation or Respite, published 24 June 2022.

[40] Section 7 of the Miscellaneous Transitional Rules.

[42] Letter dated 6 February 2024, JHB, page 296.

[47] https://www.servicesaustralia.gov.au/allied-health-referrals-for-gp-chronic-condition-management-plans

[55] Section 7 of the Miscellaneous Transitional Rules.

[56] Report dated 12 December 2023, JHB, page 261.

[58] https://www.ndis.gov.au/providers/working-provider/support-coordinators

[59] https://www.ndis.gov.au/providers/working-provider/support-coordinators/specialist-support-coordination

[67] Section 7 of the Miscellaneous Transitional Rules.

[70] Report dated 15 February 2024, JHB, page 304.

[80] Section 7 of the Miscellaneous Transitional Rules.

[83] Report dated 8 February 2024, JHB, page 279.