austlii:cth/ARTA/2025/1340
General information, not legal advice.
ARTA
2025-08-14
Original judgment source is linked above.
Edwards and CEO, National Disability Insurance Agency (NDIS) [2025] ARTA 1340 (14 August 2025)
Respondent: CEO, National Disability Insurance Agency
Pursuant to section 114 of the Administrative Review Tribunal Act 2024, the following alteration is made to the statement of reasons for the decision:
Respondent: CEO, National Disability Insurance Agency
Decision: 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 NDIA for reconsideration with a direction that within 14 days of this decision Mr Edwards SOPS includes across a 12 month plan as follows:
(b) 32 hours of Assistance with Daily Living per week to be funded as follows:
(i) 1 hour per day of assistance with self-care activities (weekday daytime and weekend daytime rates);
(ii) 5 hours per weekday of assistance with daily living (weekday daytime rates).
(c) 12 hours of Social and Community Participation per week to be funded as follows:
(e) 5 hours for assessment by an exercise physiologist for the provision of an exercise program.
(f) 26 hours for Level 2 Therapy Assistant per year.
3. All other reasonable and necessary supports in the existing SOPS (which are not funded under paragraphs 1 and 2 (and the subparagraphs to those paragraphs) will be replicated for a period of 12 months apart from the one-off high value assistive technology and one-off continence assessment already funded.
Lower limb paraplegia - reasonable and necessary supports - section 34 National Disability Insurance Scheme Act 2013 (Cth) - parenting with a disability - core support - capacity building support.
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)
FSWN and National Disability Insurance Agency (NDIS) [2025] ARTA 114
NDIS - Operational Guidelines - Reasonable and necessary supports
(a) Mr Edwards;
(b) Mr Edwards long-term partner; and
(c) Ms Bruyn, Applicant's occupational therapist.
(a) $8,000 once-off for continence consumables;
(b) 5 hours for a continence nurse assessment; and
(c) $13,928.61 for SmartDrive MX2+ with Speed Control Dial Power Assist Device.
(b) Core support funding under Assistance with Daily Life comprising of:
(c) Core support funding under Social and Community participation of 20 hours per week for:
(a) Consumables - $500 for low-cost assistive technology.
(b) 21 hours per week of assistance with daily living (replacing the existing support) comprised of:
(i) 2 hours per day of assistance with self-care activities (weekday daytime and weekend rates);
(ii) 5 hours per week of personal domestic assistance (to assist with parental-related tasks, domestic tasks and meal prep); and
(iii) 2 hours per week of house cleaning and other household activities (to assist with cleaning and laundry).
(c) 12 hours of Social and Community Participation hours per week to be funded as follows:
(iii) 6 hours per week at a weekday rate evening rate.
(d) 12 hours for Exercise Physiology per year.
(e) 26 hours for Level 2 Therapy Assistant per year.
(1) People with disability have the same right as other members of Australian society to realise their potential for physical, social, emotional and intellectual development.
(2) People with disability should be supported to participate in and contribute to social and economic life.
(3) People with disability and their families and carers should have certainty that people with disability will receive the care and support they need over their lifetime.
(4) People with disability should be supported to exercise choice, including in relation to taking reasonable risks, in the pursuit of their goals and the planning and delivery of their supports.
(5) People with disability should be supported to receive reasonable and necessary supports, including early intervention supports.
(6) People with disability have the same right as other members of Australian society to respect for their worth and dignity and to live free from abuse, neglect and exploitation.
(7) People with disability have the same right as other members of Australian society to pursue any grievance.
(8) People with disability have the same right as other members of Australian society to be able to determine their own best interests, including the right to exercise choice and control, and to engage as equal partners in decisions that will affect their lives.
(9) People with disability should be supported in all their dealings and communications with the Agency and the Commission so that their capacity to exercise choice and control is maximised in a way that is appropriate to their circumstances and cultural needs.
(9A)People with disability are central to the National Disability Insurance Scheme and should be included in a co-design capacity.
(10) People with disability should have their privacy and dignity respected.
(11) Reasonable and necessary supports for people with disability should:
(a) support people with disability to pursue their goals and maximise their independence; and
(b) `support people with disability to live independently and to be included in the community as fully participating citizens; and
(c) develop and support the capacity of people with disability to undertake activities that enable them to participate in the community and in employment.
(12) The role of families, carers and other significant persons in the lives of people with disability is to be acknowledged and respected.
(12A) The relationship between people with disability and their families and carers is to be recognised and respected.
(13) The role of advocacy in representing the interests of people with disability is to be acknowledged and respected, recognising that advocacy supports people with disability by:
(a) promoting their independence and social and economic participation; and
(b) promoting choice and control in the pursuit of their goals and the planning and delivery of their supports; and
(c) maximising independent lifestyles of people with disability and their full inclusion in the community.
(14) People with disability should be supported to receive supports outside the National Disability Insurance Scheme, and be assisted to coordinate these supports with the supports provided under the National Disability Insurance Scheme.
(15) In exercising their right to choice and control, people with disability require access to a diverse and sustainable market for disability supports in which innovation, quality, continuous improvement, contemporary best practice and effectiveness in the provision of those supports is promoted.
(16) Positive personal and social development of people with disability, including children and young people, is to be promoted.
(17) It is the intention of the Parliament that the Ministerial Council, the Minister, the Board, the CEO, the Commissioner and any other person or body is to perform functions and exercise powers under this Act in accordance with these principles, having regard to the need to ensure the financial sustainability of the National Disability Insurance Scheme.
National Disability Insurance Scheme Act 2013 (Cth) (the NDIS Act)
(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).
18. Also relevant to this review is the inclusion of section 10 of the NDIS Act, that was introduced by the Transitional Rules. Section 10 of the NDIS Act provides a definition of what constitutes an 'NDIS support' for the purposes of subsection 34(1)(f) of the NDIS Act. Section 10 of the NDIS Act provides as follows:
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.
Supports that are not NDIS supports
(2) 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.
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:
(c) for all participants - the desirability of supporting and developing the potential contributions of informal supports and networks within their communities.
...with my level of injury, I have no core stability... if I put two hands out in front of me, I fall over. So anything that sort of requires 2 hands at a time is very difficult...anytime like I can do something with one hand and I can brace with the other hand to hold myself upright. But as soon as you like put two hands out in front of you, yeah, core stability can become an issue...that can be tricky.[3]
He's only 2 1/2, but he's like 18 kilograms, nearly 18 kilograms now. So I need a bit of help to get him up onto the change table and, you know, and wrestle him onto there ... change his backside and get him dressed or prepare a lunch for him...we'll go to local parks and he is quite a fast runner... support workers assist me in him not doing a runner on me or scooting away on me. I need that assistance to get him into the car, get him into his car seat, things like that.[4]
Schedule 2 - Supports that generally are not NDIS Supports
(e) babysitting, nannying services, and au pairs.
(e) meeting the early childhood education and care needs of a child.
Stage 1 Ascertain if the requested support is an NDIS Support as defined. This inquiry is focused on the support, not the participant.
Step 1: Determine if the requested support is of a character that falls within the scope of a category of support specified in column 1 of the Table to Schedule 2 of the Transitional Rules by reference to the description of supports that fall within the scope of that category contained in column 2 of the Table.
If the answer to that question is "yes", then stage 1 is complete. The requested support is not a NDIS Support and cannot be approved for inclusion in a SoPS because of s 34(1)(f).
(a) Mr Edwards parenting role is part of his current daily activities;
(b) Mr Edwards is physically present, exercising his parental responsibilities; and
(c) Mr Edwards provides the verbal directions to his support worker for how and when physical movement support is to be undertaken.
Schedule 1 - Supports that are NDIS supports unless otherwise provided
Supports that provide supervision or assistance with personal daily living tasks to help a participant to live as independently as possible in their own home and in the community.
Item 15 Development of daily care and life skills
Supports that provide training and development activities for participants or carers to increase a participant's ability to live as independently as possible (including as part of psychosocial recovery supports).
This includes increasing the participant's ability to independently undertake the following activities:
Subsection 34(1)(aa): Are the supports sought necessary to address the needs arising from the impairment in relation to which Mr Edwards met the disability requirements?
Subsection 34(1)(a) NDIS Act: Will the increased core support assist Mr Edwards to pursue the goals, objectives and aspirations included in his participant's statement of goals and aspirations?
Subsection 34(1)(b) NDIS Act: Will increased core support assist Mr Edwards undertake activities so as to facilitate his social and economic participation?
Subsection 34(1)(c) NDIS Act: Does increased core support represent value for money?
Active toddlers need, you know, because we're in a 2 bedroom unit... a 2 year old boy needs to run around on the daily morning and afternoon.[8]
Functional limitations include reduced core balance and stability, loss of bowel and bladder control, and loss of sensation and movement from the chest down resulting in paraplegia, and higher risk of autonomic dysreflexia. Mr Edwards has maintained function and muscle control of his head, neck, shoulders, arms, and hands.[9]
is fully reliant on manual wheelchair use. When seated in the wheelchair, he has reduced trunk control impacting capacity for forward reaching and balancing. He is unable to place weight through his legs and fully relies on his upper limbs to transfer from wheelchair to/from bed, shower commode and car... Due to lower limb paraplegia and poor trunk balance, Mr Edwards is unable to undertake heavy lifting, carrying, extended reaching above or below waist height and bending, which impacts his functional capacity for shopping, cleaning, carrying items...
Provision of Core support for 25 hours per week to support Mr Edwards to look after [redacted] at home, and take [redacted] on outings and ensure safe access into the community. This can be flexibly applied e.g. 5 hours per day x 5 days per week. Support Worker to assist with preparing food, setting up activities, toileting support for [redacted], packing bags, setting up pram and accompanying on outings until [redacted] is old enough to independently toilet himself, and able to listen to verbal instructions and not run away.[10]
Mr Edwards is unable to be independent socially in the community with [redacted] alone, as he is unable to follow his mobile toddler to all areas outside due to his wheelchair use and access barriers in the local parks and communities (e.g. steps, garden beds, road curb access). For social interactions in the community with his son, Mr Edwards requires another person (his partner or a support worker) to be present. Mr Edwards noted he was feeling depressed, anxious and had reduced motivations around social interactions. He expressed frustration about being unable to be spontaneous about activities and social interactions.[11]
Subsection 34(1)(d): Will increased core support be, or likely to be, effective and beneficial for Mr Edwards?
Subsection 34(1)(e): Will the funding of increased core support take account of what it is reasonable to expect families, carers, informal networks and the community to provide?
I am the sole provider of Steven's informal support needs, currently, this amounts to
about 81% of his overall support during a typical week. Steven currently receives NDIS funding for no more than 14 hours of paid support a week, leaving me responsible for an average of 8.4 hours per day.
I am the primary caregiver of our 16-month-old child...due to lack of family
support... I am actively seeking full-time employment, being the main income earner in the relationship which will significantly reduce my capacity to provide necessary supports to Steven.[13]
Issue 2: Increase in core support Assistance with Daily life
(a) 2 hours a day for 5 days a week, and 2 hours for 1 day a weekend for assisted household tasks;
(b) 1 hour a day for 5 days a week and 1 hour for 1 day a weekend for assistance with personal care activities
(c) 2.5 hours a day for 1 day a week for domestic cleaning; and
(d) 1 hour a day for 5 days a week and 2 hours for 1 day a weekend for assistance with meal preparation.
Subsection 34(1)(aa): Are the supports sought necessary to address the needs arising from the impairment in relation to which Mr Edwards met the disability requirements?
Subsection 34(1)(a) NDIS Act: Will the increased core support assist Mr Edwards to pursue the goals, objectives and aspirations included in his participant's statement of goals and aspirations?
Subsection 34(1)(b) NDIS Act: Will increased core support assist Mr Edwards undertake activities so as to facilitate his social and economic participation?
Subsection 34(1)(c) NDIS Act: Does increased core support represent value for money?
a) Mr Pattey, occupational therapist, in his report dated 22 February 2023 observed that Mr Edwards is independent in light meal preparation tasks and is able to participate in main meal preparation, requiring assistance at times due to difficulties accessing particular shelving, appliances or the sink due to his disability.[14] > > b) In her report dated 17 June 2024, the Respondent's occupational therapist Ms Cummings observed independence in essential tasks such as bowel/bladder management, showering, dressing, grooming, transfers, mobility using a manual wheelchair, driving and meal preparation. Ms Cummings did not agree with Mr Pattey's assessment that Mr Edwards functional impairment results in very high person to person support needs.[15] > > c) Ms Bruyn's recommended low-cost aids and capacity building supports will further increase independence in personal care, noting Mr Edwards is largely independent with personal care tasks, with minimum support required due to current home environmental barriers.
(a) 5 hours a week for self-care assistance;
(b) 2.5 hours a week for domestic cleaning;
(c) 7 hours a week for grocery shopping and meal preparation; and
(d) 10 hours a week for daily laundry, placing items in easy reach, making beds, preparation breakfast, lunch and dinner tasks.
...assist with personal care routines (showering, dressing, toileting), including clothing adjustments and incidental supports to reduce burden of care on his partner and enable her to resume full-time employment. [Partner] can provide this support on the weekends.[16]
Mr Edwards is able to prepare some meals at BBQ and at a small table outside, but unable to prepare daily meals at kitchen bench or sink due to non-adjustable bench and insufficient space for wheelchair; i.e. he is unable to get his legs under the bench to reach and prepare food. Reported and observed difficulties to reach above head height when seated in a wheelchair to storage above; unable to easily reach down to items and cupboards below knee height. He requires someone to be present to assist with meal preparation on those days... He is able to shop for small items that can easily be carried in a backpack or bag on his lap. He is unable to do large grocery shopping activities and relies on informal supports or support workers to provide assistance for heavier shopping tasks.[17]
Mr Edwards will wash and dry himself. He stated that it is hard to reach everywhere, and due to the poor drainage and small space, he is limited with using the handheld shower hose especially over his back. Anna stated that she offers to assist but Mr Edwards would prefer to shower himself...The environment does appear to be a limiting factor with Mr Edwards capacity to reach all areas of his body while washing. His back sits out of the shower recess as the mobile commode cannot fit inside the shower. Additionally, water is difficult to contain in the wet area. I recommend a fully accessible shower with adequate circulation space to enable Mr Edwards to reach all areas and wash himself. If on occasion, Mr Edwards has a bowel accident he will get assistance from Anna to wash up his back and backside. I consider that with an accessible shower, Mr Edwards would not require assistance from Anna.[18]
Mr Edwards stated that Anna does the main meal preparation. He explained he knows how to cook but is limited with the current kitchen due to poor circulation space, no roll under benches, and difficult to access power points, cupboards and appliances...washing machine and dryer are located on the balcony...washing machine and dryer at floor level would improve Mr Edwards' independence in this task. It is unclear if current environment allows for dryer to be moved to floor level.[19]
Subsection 34(1)(d): Will increased core support be, or likely to be, effective and beneficial for Mr Edwards?
attends daily showers of an evening while sitting on his shower commode chair. Routine monitoring of his global skin integrity is performed twice a day, and any areas of concern are usually successfully managed in the home setting with the assistance of his partner.[22]
i. Changing bedsheets for Steven in response to unforeseen bladder or bowel movements;
ii. Mopping and disinfecting the bathroom, including Steven's shower chair and assisting him with undressing when he has soiled himself;
iii. Assisting Steven with washing, rinsing and drying harder-to-reach areas during his daily shower routine [due to] reduced range of motion;
iv. Assisting Steven with pulling up or adjusting lower body clothing as required;
v. Assisting Steven in performing light meal preparation tasks, including passing appliances and food and accessing out-of-reach kitchen items;
vi. Providing wound care support when required for hard-to-reach areas, including securing bandages or medical strapping as required.[23]
The apartment's kitchen has high benches and top cupboards that Steven cannot reach, limiting his ability to participate in food preparation, cooking on the gas stove and cleaning the kitchen. This has a negative impact on both his and my mental health and well-being. Steven can now only safely cook food on the outside portable BBQ with assistance.[25]
Subsection 34(1)(e): Will the funding of increased core support take account of what it is reasonable to expect families, carers, informal networks and the community to provide?
Subsection 34(1)(f): Is the increased core support an 'NDIS Support'
Issue 3: Increase in core support for social and community participation
a. 2 hours an evening for two weekdays per week and 4 hours for one day per weekend for recreational activities; and
b. 2 hours per weekday and 2 hours for one day per weekend for assisted community outings.
a) 3 hours per week at a Saturday rate; > > b) 3 hours per week at a Sunday rate; and > > c) 6 hours per week at a weekday evening rate.
Issue 3: Increase to consumables and capital supports
(b) 32 hours of Assistance with Daily Living per week to be funded as follows:
(i) 1 hour per day of assistance with self-care activities (weekday daytime and weekend daytime rates);
(ii) 5 hours per weekday of assistance with daily living (weekday daytime rates).
(c) 12 hours of Social and Community Participation per week to be funded as follows:
(e) 5 hours for assessment by an exercise physiologist for the provision of an exercise program.
(f) 26 hours for Level 2 Therapy Assistant per year.
3. All other reasonable and necessary supports in the existing SOPS (which are not funded under paragraphs 1 and 2 (and the subparagraphs to those paragraphs) will be replicated for a period of 12 months apart from the one-off assistive technology and one-off continence assessment already funded.
[1] Section 129 of the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No 1) Act 2024.
[7] BIJD v National Disability Insurance Agency [2018] AATA 2971 at [41].