austlii:cth/ARTA/2025/548
General information, not legal advice.
ARTA
2025-05-01
Senior Member J
Original judgment source is linked above.
CBYW and National Disability Insurance Agency (NDIS) [2025] ARTA 548 (1 May 2025)
Respondent: CEO, National Disability Insurance Agency
Pursuant to subsection 105(c)(ii) of the Administrative Review Tribunal Act 2024 (Cth) the decision under review is set aside. The matter is remitted to the Agency for reconsideration with a direction that within 28 days of this decision CBYW's statement of participant supports specifies for Specialist Disability Accommodation as follows:
Limb girdle muscular dystrophy - reasonable and necessary supports - section 34 National Disability Insurance Scheme Act 2013 (Cth) - Specialist Disability Accommodation -- SDA needs requirements - decision remitted
Administrative Review Tribunal (Consequential and Transitional Provisions No. 1) Act 2024 (the Transitional Act) (Cth)
National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No 1) Act 2024 (Cth)- s129
National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth)
National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (NDIS Supports) Transitional Rules 2024 (Cth)
National Disability Insurance Scheme (Specialist Disability Accommodation) Rules 2020 (Cth) - Rules 5, 11, 12, 13, 14, 15, 16, 17, 18
G v Minister for Immigration and Border Protection [2018] FCA 1229
McGarrigle v National Disability Insurance Agency [2017] FCA 308
National Disability Insurance Agency v WRMF [2020] FCAFC 79
Re Drake v Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 60
XYZ v Commonwealth [2006] HCA25; [2006] HCA 25; (2006) 227 CLR 532
Minister for Home Affairs v G [2019] FCAFC 79
NDIS - Operational Guidelines - Reasonable and necessary supports
NDIS Operational Guidelines - Specialist Disability Accommodation as at 14 February 2025
accommodation for a person who requires specialist housing solutions, including to assist with the delivery of supports that cater for the person's extreme functional impairment or very high support needs.
National Disability Insurance Scheme Act 2013 (Cth) (the NDIS Act)
Reasonable and necessary supports > > (1) For the purposes of specifying, in a statement of participant supports, the general supports that will be provided, and the reasonable and necessary supports that will be funded, the CEO must be satisfied of all of the following in relation to the funding or provision of each such support:
(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 most appropriately funded or provided through the National Disability Insurance Scheme, and is not more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or systems of service delivery or support services offered:
(i) as part of a universal service obligation; or
(ii) in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.
(2) The National Disability Insurance Scheme rules may prescribe methods or criteria to be applied, or matters to which the CEO is to have regard, in deciding whether or not he or she is satisfied as mentioned in any of paragraphs (1)(a) to (f).
(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 requirements or the early intervention requirements need to be met is the time the CEO decides to approve the statement of participant supports; and
(b) a participant's disability support needs arising from an impairment in relation to which the participant meets the disability requirements or the early intervention requirements may be affected by a variety of factors, including environmental factors or the impact of another impairment in relation to which the participant does not meet either of those requirements.
(2) The National Disability Insurance Scheme rules may prescribe methods or criteria to be applied or matters to which the CEO is to have regard, in deciding whether or not he or she is satisfied as mentioned in any of paragraphs (1)(aa) to (f). (emphasis of amendments)
17. Subsection 34(1) of the NDIS Act is cumulative and therefore all of the criteria must be met.
Supports that are NDIS supports
(1) Subject to subsections (4) and (9), a support is an NDIS support for a person who is a participant or prospective participant if the support is declared by National Disability Insurance Scheme rules made for the purposes of this subsection to be an NDIS support for:
(a) participants or prospective participants generally; or
(b) a class of participants or prospective participants that includes the person.
Note: The National Disability Insurance Scheme rules may declare a support for the purposes of this subsection by identifying a class of supports (see subsection 13(3) of the Legislation Act 2003).
(2) Before making National Disability Insurance Scheme rules declaring a support for the purposes of subsection (1), the Minister must be satisfied:
(a) for rules to which paragraph (1)(a) applies--that the support is appropriately funded or provided through the National Disability Insurance Scheme for participants or prospective participants generally; or
(b) for rules to which paragraph (1)(b) applies--that the support is appropriately funded or provided through the National Disability Insurance Scheme for participants, or prospective participants, in the relevant class.
(3) National Disability Insurance Scheme rules may declare a support for the purposes of subsection (1) only if at least one of the following applies:
(a) the declaration of the support implements Australia's obligations under:
(i) the Convention on the Rights of Persons with Disabilities done at New York on 13 December 2006; or
(ii) any other agreement with one or more other countries;
(b) the declaration of the support enables the provision of sickness benefits.
Note: For subparagraph (a)(i), the Convention on the Rights of Persons with Disabilities is in Australian Treaty Series 2008 No. 12 ([2008] ATS 12) and could in 2024 be viewed in the Australian Treaties Library on the AustLII website (http://www.austlii.edu.au).
Supports that are not NDIS supports
(4) The National Disability Insurance Scheme rules may declare that a support is not an NDIS support for:
(a) participants or prospective participants generally; or
(b) a class of participants or prospective participants.
Note: The National Disability Insurance Scheme rules may declare a support for the purposes of this subsection by identifying a class of supports (see subsection 13(3) of the Legislation Act 2003).
(5) Before making National Disability Insurance Scheme rules declaring a support for the purposes of subsection (4), the Minister must be satisfied:
(a) for rules to which paragraph (4)(a) applies--that the support is not appropriately funded or provided through the National Disability Insurance Scheme for participants or prospective participants generally; or
(b) for rules to which paragraph (4)(b) applies--that the support is not appropriately funded or provided through the National Disability Insurance Scheme for participants, or prospective participants, in the relevant class.
(6) The CEO may determine, in writing, that a support is taken to not be declared under subsection (4) in relation to a participant if:
(a) the support is prescribed by the National Disability Insurance Scheme rules for the purposes of this paragraph; and
(b) the support would, apart from subsection (4), be an NDIS support for the participant; and
(c) the participant applies to the CEO in accordance with subsection (7) for the determination; and
(d) the CEO is satisfied that:
(i) the support would replace one or more other supports that are NDIS supports for the participant; and
(ii) the cost of the support is the same or lower than the total of the costs of the supports it would replace; and
(iii) the support would provide the same or a better outcome for the participant than the supports it would replace; and
(iv) any other conditions specified in the National Disability Insurance Scheme rules for the purposes of this subparagraph are met in relation to the support, the participant, or both.
Note 1: A determination may be revoked under subsection 33(3) of the Acts Interpretation Act 1901.
Note 2: The National Disability Insurance Scheme rules may prescribe a support for the purposes of paragraph (a) by identifying a class of supports (see subsection 13(3) of the Legislation Act 2003).
(a) be in the form (if any) approved by the CEO; and
(b) include any information, and be accompanied by any documents, required by the CEO; and
(c) be made in accordance with any other requirements specified in the National Disability Insurance Scheme rules for the purposes of this paragraph, which may include requirements as to the circumstances in which an application may, or may not, be made.
(8) The National Disability Insurance Scheme rules may make provision for determining any matter for the purposes of subsection (6), including by prescribing requirements with which the CEO must comply, methods or criteria that the CEO is to apply, or matters that the CEO may, must or must not take into account, in deciding whether to make a determination under that subsection.
(9) A support is not an NDIS support for a participant or prospective participant if the support consists of the provision of:
(a) sexual services; or
(b) alcohol; or
(c) drugs, the possession of which is a contravention of a law of the Commonwealth, a State or a Territory.
Value for money > > 3.1 In deciding whether the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, the CEO is to consider the following matters:
(a) whether there are comparable supports which would achieve the same outcome at a substantially lower cost;
(b) whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long-term benefit to, the participant;
(c) whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports);
(d) for supports that involve the provision of equipment or modifications:
(i) the comparative cost of purchasing or leasing the equipment or modifications; and
(ii) whether there are any expected changes in technology or the participant's circumstances in the short term that would make it inappropriate to fund the equipment or modifications;
(e) whether the cost of the support is comparable to the cost of supports of the same kind that are provided in the area in which the participant resides;
(f) whether the support will increase the participant's independence and reduce the participant's need for other kinds of supports (for example, some home modifications may reduce a participant's need for home care).
Effective and beneficial and current good practice
3.2 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to consider the available evidence of the effectiveness of the support for others in like circumstances. That evidence may include:
(a) published and refereed literature and any consensus of expert opinion;
(b) the lived experience of the participant or their carers; or
(c) anything the Agency has learnt through delivery of the NDIS.
3.3 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to take into account, and if necessary seek, expert opinion.
Reasonable family, carer and other support
3.4 In deciding whether funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide, the CEO is to consider the following matters:
(a) for a participant who is a child:
(i) that it is normal for parents to provide substantial care and support for children; and
(ii) whether, because of the child's disability, the child's care needs are substantially greater than those of other children of a similar age; and
(iii) the extent of any risks to the wellbeing of the participant's family members or carer or carers; and
(v) whether the funding or provision of the support for a family would improve the child's capacity or future capacity, or would reduce any risk to the child's wellbeing;
...................................................................................................
(c) for all participants - the desirability of supporting and developing the potential contributions of informal supports and networks within their communities.
The [Supports Rules] are an important element of the legislative scheme, introducing the ability to modify the operation of ss 33 and 34 by, for example, excluding certain kinds of supports from inclusion in participant plans. It is through the Rules that the executive is able to implement...some policy decision-making about the nature and extent of supports to be provided or funded.
Whether a support is "reasonable" requires a different assessment to whether a support is "necessary". Again, it is not necessary in the context of this proceeding to be definitive about the nature and extent of the meaning of the phrase, or its components. It is enough to observe that using the concept of necessity would appear to tie one aspect of the CEO's assessment to an evaluation of the kinds of factors set out in s 34(1)(a) and (b) and (d). The word "reasonable" would appear to be directed at factors such as those set out in s 34(1)(c) and (f). That is not to say the meaning of each word is exhausted by the factors set out in s 34(1): rather, it is to illustrate the different work that each concept does as an adjective in the phrase "reasonable and necessary supports".
The phrase is a composite phrase. We accept the Agency's submissions that each limb of the phrase should be given work to do. That task is not difficult, or complicated with these two particular words, which are readily understood as conveying different meanings. However, the Parliament has chosen to use a composite phrase rather than to stipulate two distinct requirements, and therefore, as Gleeson CJ cautioned in XYZ v Commonwealth [2006] HCA25; [2006] HCA 25; (2006) 227 CLR 532 at [19], '[t]here are many instances where it is misleading to construe a composite phrase simply by combining the dictionary meanings of its component parts'. > > ... Both adjectives qualify the noun "support", but they do so as a composite phrase. It is not fruitful to split them off and consider them separately, just as it is neither fruitful nor appropriate to attempt any exhaustive or authoritative judicial definition of them. > > Nevertheless, there is no doubt that the contextual use of the phrase in this Act links it to public funding to be provided to a participant. In that context, the phrase connotes supports which meet a threshold which justifies - by reference to the context, objects and guiding principles of the Act and the facts of the case - the expenditure of public funds for that support, for a particular participant. As we have already explained, the phrase also needs to be understood taking into account what has qualified a person as a participant, and the links between a person's impairment and their full participation in the community, in the same variety of ways as persons without a disability might choose to participate.
Justice or injustice is not found within a policy. It is found by looking at the overall circumstances of an individual's case with the principal focus being on the purpose and context of the statutory power, not the executive policy framed to guide it.
Limb Girdle Muscular Dystrophy (LGMD) usually manifests in the proximal muscles around the hips and shoulders and results in progressive weakness of the muscles of the upper and lower limbs, weakness of the breathing (respiratory) muscles, swallowing difficulties and weakness of the heart (cardiac) that can progress to cardiac failure. It also contributes to pain and fatigue.[15]
The current family/standard home is not built to suit CBYW's level of disability and is not conducive to allowing the combination of formal and informal care to be sustainable and or safe for him.
11 Eligibility to receive support for specialist disability accommodation.
A participant is eligible to receive support for specialist disability accommodation under the National Disability Insurance Scheme if the CEO is satisfied that:
(i) has an extreme functional impairment (see section 12); or
(ii) has very high support needs (see section 13); and
(b) the participant meets the SDA needs requirement (see section 14).
Rule 12 SDA Rules: Does CBYW have an extreme functional impairment?
(1) A participant has an extreme functional impairment if:
(a) the impairment results in extremely reduced functional capacity to
undertake, or psychosocial functioning in undertaking, one or more of the
(b) the participant has a very high need for person-to-person supports in
undertaking the activity even with assistive technology, equipment or home
(2) For the purposes of assessing whether a participant has an extreme functional
(a) any assessment or examination conducted in relation to the participant,
including any assessment or examination requested by the CEO under
(b) the daily support requirements of the participant; and
(c) any assessment tool specified by the CEO for the purposes of this
(d) any other matters that the CEO considers appropriate.
Section 14 SDA Rules: Does CBYW meet the SDA 'needs requirement'?
(1) A participant meets the SDA needs requirement if, when compared to other supports alone, combined specialist disability accommodation and other supports would:
(a) better assist the participant to pursue the goals, objectives and aspirations set out in the participant's statement of goals and aspirations; and
(b) be more effective and beneficial, where possible, in:
(i) mitigating or alleviating the impact of the participant's impairment upon the participant's functional capacity; and
(ii) preventing the deterioration of the participant's functional capacity; and
(iii) improving the participant's functional capacity; and
(iv) maintaining or promoting the participant's ability to build capacity, including in the medium or long term; and
(v) maintaining or promoting the participant's opportunities to develop skills; and
(c) if the participant has very high supports needs - be more effective and beneficial, where possible, in:
(i) reducing the participant's future needs for supports which might be required due to inappropriate accommodation; an
(ii) assisting the participant to pursue goals related to life opportunities and life transitions; and
(d) if the participant has an extreme functional impairment - be more effective in providing the participant with stability and continuity of support; and
(2) For the purposes of paragraph (1)(e), regard must be had to the following matters if the participant has very high support needs:
(a) whether combined specialist disability accommodation support and other supports would be likely to substantially improve the life stage outcomes for, and be of long‑term benefit to, the participant;
(b) the cost of providing the participant with supports needed to live in accommodation other than specialist disability accommodation, taking into account:
(i) whether those supports may be shared with other participants; and
(ii) limitations of the participant's informal support network.,
We need to confirm specialist disability accommodation combined with your other supports will lead to better outcomes. For example, we look at whether it will:
• improve, maintain or prevent your functional capacity from getting worse
• create better connections with your family, community, health services, education, and employment'. (Tribunal emphasis)
The word "support" must be given a broad construction in this context, and there is no need for the purposes of this proceeding to seek to give it any comprehensive meaning. Rather, the point to be made is that it is a practical description of the means by which a person with disability is assisted. It is not intended, in my opinion, to encompass funding, especially because what s 14 contemplates is that the Agency will "fund" a support. The Agency cannot "fund" funding.
Rule 14(1)(a) SDA Rules: Will the combination of SDA together with other supports better assist CBYW to pursue his goals, objectives and aspirations as compared to other supports alone?
Rule 14(1)(b) SDA Rules: Will the combination of SDA together with other supports be more effective and beneficial for CBYW?
Rule 14(1)(d) SDA Rules: Will the combination of SDA together with other supports be more effective in providing CBYW with stability and continuity of support?
Rule 14(1)(e) SDA Rules: Does the combination of SDA together with other supports represent better value for money than other supports alone?
People with disability and their families and carers should have certainty that people with disability over their lifetime.
Subsection 34(1)(aa): Are the supports sought necessary to address the needs of CBYW arising from the impairment in relation to which he met the disability requirements?
Subsection 34(1)(a) NDIS Act: Will SDA assist CBYW to pursue the goals, objectives and aspirations included in his participant's statement of goals and aspirations?
Subsection 34(1)(b) NDIS Act: Will SDA assist CBYW to undertake activities so as to facilitate his social and economic participation?
Subsection 34(1)(c) NDIS Act: Does SDA represent value for money?
Subsection 34(1)(d): Will SDA be, or likely to be, effective and beneficial for CBYW?
Subsection 34(1)(e): Will the funding of SDA take account of what it is reasonable to expect families, carers, informal networks and the community to provide?
Subsection 34(1)(f): Is SDA an 'NDIS Support'
The provision of specialist disability accommodation which is accommodation for a participant who requires specialist housing solutions, including to assist with the delivery of supports that cater for the person's extreme functional impairment or very high support needs
The CEO must determine the following matters for an eligible participant:
(a) the SDA building type that is appropriate to support the eligible participant (see section 16);
(b) the SDA design category that is appropriate to support the eligible participant (section 17);
(c) the area in which the specialist disability accommodation is to be located (see section 18);
(d) whether the specialist disability accommodation is to be provided as an in-kind support.
I certify that the preceding 179 (one hundred and seventy-nine) paragraphs are a true copy of the reasons for the decision herein of Senior Member J Collins.
[7] Section 129 of the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No 1) Act 2024.
[8] McGarrigle v National Disability Insurance Agency [2017] FCA 308 ('McGarrigle').
[10] National Disability Insurance Agency v WRMF [2020] FCAFC 79 ('WRMF').
[11] Minister for Home Affairs v G [2019] FCAFC 79 at [18].
[15] Report by Michael Morris dated 24 July 2024.
[19] See para 66 - wheelchair and commode must be removed from room for transfers.
[35] Upon satisfaction of the matters referred to in [121].
[36] Upon satisfaction of the matters referred to in [121].
[38] SFIC dated 28 February 2025 at para 37.
[39] SFIC dated 28 February 2025 at para 37.
[40] SFIC dated 28 February 2025 at para 37.
[42] SFIC dated 28 February 2025 at para 37.
[43] SFIC dated 28 February 2025 at para 37.
[46] Applicant's response to the Agency's SFIC.
(2006) 227 CLR 532