austlii:cth/ARTA/2025/1116
General information, not legal advice.
ARTA
2025-07-25
Ms J
Original judgment source is linked above.
FDGS and CEO, National Disability Insurance Agency (NDIS) [2025] ARTA 1116 (25 July 2025)
Respondent: CEO, National Disability Insurance Agency
Decision: Pursuant to subsection 105(a) of the Administrative Review Tribunal Act 2024 (Cth) the decision under review is affirmed.
NATIONAL DISABILITY INSURANCE SCHEME -- reasonable and necessary supports - consideration of s 34 National Disability Insurance Scheme Act 2013 (Cth) - occupational therapy - consumables - transport - psychology - speech therapy - hearing aids - short term accommodation - best interest of child - autism level 2 - impairment.
Administrative Review Tribunal (Consequential and Transitional Provisions No. 1) Act 2024
National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No 1) Act 2024 (Cth)
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 (Getting the NDIS Back on Track No. 1) (Miscellaneous Provisions) Transitional Rules 2024 (Cth)
National Disability Insurance Agency v WRMF [2020] FCAFC 79
Drake v Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 634.
NDIS - Operational Guidelines - Reasonable and Necessary supports as at 28 March 2025
NDIS - Operational Guidelines - Short term accommodation
(i) 6 hours for a continence assessment; > > (ii) 6 hours for a speech therapy assessment; > > (iii) 50 hours for occupational therapy; > > (iv) 26 hours for a therapy assistant; > > (v) 10 hours for a psychology assessment; > > (vi) 30 hours for a developmental educator; > > (vii) 10 hours per week for support worker assistance with daily living,
(viii) 4 hours on Saturday for social and community participation for 52
(ix) 45 hours for Specialist Behaviour Support a year and 20 hours for a Positive Behaviour Support plan and training of support workers a year; and
(x) 36 hours for support coordination.
Section 4 - General principles guiding actions under this Act
(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.
31 Principles relating to plans > > The preparation, variation, reassessment and replacement of a participant's plan, and the management of the funding for supports under a participant's plan, should so far as reasonably practicable: > > (a) be individualised; and > > (b) be directed by the participant; and
(c) where relevant, consider and respect the role of family, carers and other persons who are significant in the life of the participant; and
(ca) where relevant, recognise and respect the relationship between participants and their families and carers; and
(d) strengthen and build capacity of families and carers to support participants who are children; and
(da) if the participant and the participant's carer agree - strengthen and build the capacity of families and carers to support the participant in adult life; and
(e) consider the availability to the participant of informal support and other support services generally available to any person in the community; and
(f) support communities to respond to the individual goals and needs of participants; and
(g) be underpinned by the right of the participant to exercise control over his or her own life; and
(h) advance the inclusion and participation in the community of the participant with the aim of achieving his or her individual aspirations; and
(i) maximise the choice and independence of the participant; and
(j) facilitate tailored and flexible responses to the individual goals and needs of the participant; and
(k) provide the context for the provision of disability services to the participant and, where appropriate, coordinate the delivery of disability services where there is more than one disability service provider.
33 Requirements for CEO in approving statement of participant supports
In deciding whether or not to approve a statement of participant supports under subsection (2), the CEO must:
(a) have regard to the participant_'s statement of goals and aspirations; and_
(b) have regard to relevant assessments conducted in relation to the participant_; and_
(c) be satisfied as mentioned in section 34 in relation to the reasonable and necessary supports that will be funded and the general supports that will be provided; and
(d) apply the National Disability Insurance Scheme rules (if any) made for the purposes of section 35_; and_
(e) have regard to the principle that a participant should manage his or her plan to the extent that he or she wishes to do so; and
(f) have regard to the operation and effectiveness of any previous plans of the participant_; and_
(g) have regard to whether section 46 (acquittal of NDIS amounts_) was complied with in relation to any previous_ plan for the participant_._
(f) if the person with disability is a child--the best interests of the child are paramount, and full consideration should be given to the need to:
(iii) strengthen, preserve and promote positive relationships between the child and the child's parents, family members and other people who are significant in the life of the child.
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.
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:
(i) the extent of any risks to the wellbeing of the participant arising from the participant's reliance on the support of family members, carers, informal networks and the community; and
(ii) the suitability of family members, carers, informal networks and the community to provide the supports that the participant requires, including such factors as:
(A) the age and capacity of the participant's family members and carers, including the extent to which family and community supports are available to sustain them in their caring role; and
(B) the intensity and type of support that is required and whether it is age and gender appropriate for a particular family member or carer to be providing that care; and
(C) the extent of any risks to the long-term wellbeing of any of the family members or carers (for example, a child should not be expected to provide care for their parents, siblings or other relatives or be required to limit their educational opportunities); and
(iii) the extent to which informal supports contribute to or reduce a participant's level of independence and other outcomes;
(c) for all participants - the desirability of supporting and developing the potential contributions of in formal supports and networks within their communities.
7.1 The Act limits the supports that can be provided or funded under the NDIS to supports that are not more appropriately funded or provided through other service systems, for example as part of a universal services obligation or in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.
7.2 The considerations set out in this Schedule must be taken into account by the CEO in deciding whether a support is more appropriately provided or funded by the NDIS or another service system.........
7.13 The NDIS will be responsible for supports that a student requires that are associated with the functional impact of the student's disability on their activities of daily living (that is, those not primarily relating to education or training attainment), such as personal care and support, transport to and from school and specialist supports for transition from school education to further education, training or employment that are required because of the student's disability. Any supports funded by the NDIS will recognise the operational requirements and educational objectives of schools.
7.14 The NDIS will not be responsible for personalising either learning or supports for students that primarily relate to their educational attainment (including teaching, learning assistance and aids, school building modifications and transport between school activities) ...
5.1 A support will not be provided or funded under the NDIS if:
(a) it is likely to cause harm to the participant or pose a risk to others; or
(b) it is not related to the participant's disability; or
(c) it duplicates other supports delivered under alternative funding through the NDIS; or
(d) it relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to a participant's disability support needs.
a) Letter, Dr K, Paediatrician dated 19 May 2022 > > b) Letter, Dr F, GP dated 26 April 2023 > > c) Report, Dr A, Psychologist dated 3 December 2021 > > d) Report, Ms R, Audiologist dated 4 September 2023 > > e) Report, Ms H, Occupational Therapist dated 13 May 2024 > > f) Response to Targeted Questions, Ms H, Occupational Therapist undated > > g) Email, Ms B, Continence Clinical Nurse dated 12 November 2024 > > h) Letter, Dr Ng, Paediatrician dated 14 December 2024
[FDGS] has unbuckled his seatbelt and escaped a Houdini strap and thrown things at me whilst driving... I am on constant high alert. There is no way I can attend appointments without another trained person to help.[12]
We consider what support is reasonable to expect parents to provide at your age. It's normal for parents to provide substantial care and support for children. We consider that it's usual for parents to provide almost all the care and support that young children need.
For example, it's reasonable to expect parents or other family members to provide transport to and from their child's after-school activities. Of course, the amount of care and support for a child without a disability would typically reduce as they get older.
For example, we consider any health, safety or other impacts resulting from what's involved in meeting your disability support needs.[13]
Short Term Accommodation, including respite, is support for when you need to live out of home for a short period. Short Term Accommodation funding can be used for respite to support you and your carers. This gives your carers a short break from their caring role.
[FDGS] did a trial of hearing aids at homeschooling with his Tutor and she and I agree that they helped significantly in filtering out defensive noises encouraging better communication and outcomes with his learning. Hearing Aids are also suggested by [FDGS's] audiologist, supported by a recent hearing test that [FDGS] did.[19]
Doing speech assessments are a waste of time because he knows word structure, he knows sentence structure, he knows how to communicate. But because of his mutism and shutting down, it's more of a psychological problem. And that's why he made so much more psychology. But you keep insisting on speech.[23]
FDGS' mother: But when you have a complex case, it's not a matter of just 10 hours because you've got all different things to look at. You've got developmental needs, you've got emotional, and trauma needs, and you've got language needs, and then you've got developmental needs, and you've got all sorts of different things.
The Respondent: So, if 10 hours for an assessment just wasn't enough, why didn't you go back to the agency and say I need some more assessment funding?
FDGS' mother: Because if he was given ongoing, we could have used the ongoing for the assessments as well.
The Respondent: The ongoing funding comes from what the recommendation is after the assessment is made, doesn't it?
FDGS' mother: Yes, I know. And then we wouldn't have needed more funding without doing the assessment. The assessments wouldn't be necessary if you gave him ongoing funding. That's the reason and that's my answer.[24]
Other capacity building supports in current plan
I live in a rural area that have limited access to positive behaviour specialists. The nearest support is REDACTED and REDCATED and that would mean that travel would take most of the funding which I didn't get. Therefore, this makes it redundant, and I don't need the money for positive behaviour support.[29]
As I said, living in a rural area makes the COS redundant because the supports need to be suitable. So, I have to actually make sure that anyone that interacts with him can meet his needs ... So, I am self-managed, and I engage services myself. It's not a matter of not knowing how to find or engage services. It's usually a matter of either the services don't have enough money to come and see him, or the services are unaware of how to deal with the complex diagnosis of selective mutism plus autism plus central auditory processing disorder plus learning. So, no need for the support coordination.[30]
51 Requirement to notify of a change in circumstances
(1) A participant or a prospective participant must notify the CEO if:
(a) an event or change of circumstances happens that affects, or might affect, his or her access request_, status as a_ participant or plan_; or_
(b) the participant or prospective participant becomes aware that such an event or change of circumstances is likely to happen.
Pursuant to subsection 105(a) of the Administrative Review Tribunal Act 2024 (Cth) the decision under review is affirmed.
Representative for the Applicant: Applicant's mother
Counsel for the Respondent: Mr N Swan, of Counsel
Solicitors for the Respondent: Ms J Thomson, Moray & Agnew
[1] National Disability Insurance Scheme Act 2013 (Cth), s 3(1) (c) - (e).
[2] National Disability Insurance Agency v WRMF [2020] FCAFC 79, 145.
[3] Drake v Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 634.
[4] National Disability Insurance Agency v WRMF [2020] FCAFC 79, 151.
[5] Exhibit 2 - Plan Usage dated 7 July 2025.
[13] National Disability Insurance Agency, Is the support something we would expect your informal supports to provide? (Web Page, 23 July 2025).
[17] National Disability Insurance Agency, What is Short Term Accommodation, including respite? (Web Page, 23 July 2025).