DISCUSSION OF Relevant ASPECTS OF THE LEGISLATIVE SCHEME
22 The objects of the Act are set out in s 3. Relevantly for present purposes, s 3 provides:
3 Objects of Act
(1) The objects of this Act are to:
(a) in conjunction with other laws, give effect to Australia's obligations under the Convention on the Rights of Persons with Disabilities done at New York on 13 December 2006 ([2008] ATS 12); and
…
(d) provide reasonable and necessary supports, including early intervention supports, for participants in the National Disability Insurance Scheme launch; and
…
(2) These objects are to be achieved by:
(a) providing the foundation for governments to work together to develop and implement the National Disability Insurance Scheme launch; and
(b) adopting an insurance-based approach, informed by actuarial analysis, to the provision and funding of supports for people with disability.
(3) In giving effect to the objects of the Act, regard is to be had to:
…
(b) the need to ensure the financial sustainability of the National Disability Insurance Scheme; and
…
23 Section 4 of the Act sets out the general principles guiding actions under the Act. Relevantly, sub-ss (5), (11) and (17) provide:
4 General principles guiding actions under this Act
…
(5) People with disability should be supported to receive reasonable and necessary supports, including early intervention supports.
…
(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.
…
(17) It is the intention of the Parliament that the Ministerial Council, the Minister, the Board, the CEO and any other person or body is to perform functions and exercise powers under this Act in accordance with these principles, having regard to:
…
(b) the need to ensure the financial sustainability of the National Disability Insurance Scheme.
24 The NDIS scheme is not means tested - whether as to the person concerned, their family or community.
25 The National Disability Insurance Scheme Launch Transition Agency, now known as the National Disability Insurance Agency, is established by s 117 of the Act. The Agency is given a general assistance power in s 6 of the Act:
6 Agency may provide support and assistance
To support people with disability to exercise choice and control in the pursuit of their goals, the Agency may provide support and assistance (including financial assistance) to prospective participants and participants in relation to doing things or meeting obligations under, or for the purposes of, this Act.
Note: For example, the Agency might assist a participant to prepare the participant's statement of goals and aspirations by assisting the participant to clarify his or her goals, objectives and aspirations.
26 Its functions are set out in s 118:
118 Functions of the Agency
(1) The Agency has the following functions:
(a) to deliver the National Disability Insurance Scheme so as to:
(i) support the independence, and social and economic participation, of people with disability; and
(ii) enable people with disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports; and
(iii) ensure that the decisions and preferences of people with disability are respected and given appropriate priority; and
(iv) promote the provision of high quality and innovative supports that enable people with disability to maximise independent lifestyles and inclusion in the community; and
(v) ensure that a reasonable balance is achieved between safety and the right of people with disability to choose to participate in activities involving risk;
(b) to manage, and to advise and report on, the financial sustainability of the National Disability Insurance Scheme including by:
(i) regularly making and assessing estimates of the current and future expenditure of the National Disability Insurance Scheme; and
(ii) identifying and managing risks and issues relevant to the financial sustainability of the National Disability Insurance Scheme; and
(iii) considering actuarial advice, including advice from the scheme actuary and the reviewing actuary;
(c) to develop and enhance the disability sector, including by facilitating innovation, research and contemporary best practice in the sector;
(d) to build community awareness of disabilities and the social contributors to disabilities;
(e) to collect, analyse and exchange data about disabilities and the supports (including early intervention supports) for people with disability;
(f) to undertake research relating to disabilities, the supports (including early intervention supports) for people with disability and the social contributors to disabilities;
(g) any other functions conferred on the Agency by or under this Act, the regulations or an instrument made under this Act;
(h) to do anything incidental or conducive to the performance of the above functions.
(2) In performing its functions, the Agency must use its best endeavours to:
(a) act in accordance with any relevant intergovernmental agreements; and
(b) act in a proper, efficient and effective manner.
27 The Agency's function of managing, advising and reporting on the financial sustainability of the scheme should be noted. Sub-paragraphs (i) to (iii) of s 118(1)(b) contemplate detailed information will be available to the Agency.
28 Chapter 2 is entitled "Assistance for people with disability and others". Broadly, it deals in more specificity with the functions of the Agency in s 118(1)(a) to assist people with disability. Sections 13 and 14, which refer to the Agency's function and describe what the Agency may "provide", as well as including a definition of "general support". In my opinion ss 13 and 14 are helpful in ascertaining the meaning of the words "funded or provided" in s 34. They provide:
13 Agency may provide coordination, strategic and referral services etc. to people with disability
(1) The Agency may provide general supports to, or in relation to, people with disability who are not participants.
Note: Chapter 3 deals with the provision of general supports to, or in relation to, participants.
(2) In this Act:
general support means:
(a) a service provided by the Agency to a person; or
(b) an activity engaged in by the Agency in relation to a person;
that is in the nature of a coordination, strategic or referral service or activity, including a locally provided coordination, strategic or referral service or activity.
14 Agency may provide funding to persons or entities
The Agency may provide assistance in the form of funding for persons or entities:
(a) for the purposes of enabling those persons or entities to assist people with disability to:
(i) realise their potential for physical, social, emotional and intellectual development; and
(ii) participate in social and economic life; and
(b) otherwise in the performance of the Agency's functions.
29 Chapter 3 is entitled "Participant and their Plans". Section 17A enshrines and gives prominence in the legislative scheme to principles of autonomy and self-determination for people with disability. The preconditions to, and consequences of, becoming a participant (see ss 18 to 30) can be put to one side as Mr McGarrigle's status as a participant was common ground.
30 Part 2 of Chapter 3 deals with Participants' Plans. Plans are the key implementation mechanism for NDIS funding. That is because s 39 of the Act provides:
39 Agency must comply with the statement of participant supports
The Agency must comply with the statement of participant supports in a participant's plan.
31 Approval of a plan by the CEO (or a delegate of the CEO - see s 202 of the Act) is, by reason of s 37(1)(b) one of the two steps which brings a plan into effect. A plan cannot be varied but can be replaced: see s 37(2) and (3). Payments made in accordance with a participant plan are called "NDIS amounts" in the scheme. There is a requirement that funds received by a participant (or a person on behalf of a participant) must be spent "in accordance with the participant's plan": s 46(1). The monies received are otherwise inalienable. There are detailed provisions for determining whether it is appropriate for a participant to manage funds herself or himself, or whether another person should manage (and therefore receive) the funds on her or his behalf: see ss 42 to 44.
32 Division 2 of Part 2 of Chapter 3 contains the core provisions relevant to the disposition of this application. Section 32 imposes a duty on the CEO to facilitate the preparation of a participant's plan. Rules can be made (see s 32A) about how and when this is to occur.
33 Section 33 deals with the matters that must be included in a participant's plan. It is also, as I have noted, the provision which identifies the approval function to be performed by the CEO. It provides:
33 Matters that must be included in a participant's plan
(1) A participant's plan must include a statement (the participant's statement of goals and aspirations) prepared by the participant that specifies:
(a) the goals, objectives and aspirations of the participant; and
(b) the environmental and personal context of the participant's living, including the participant's:
(i) living arrangements; and
(ii) informal community supports and other community supports; and
(iii) social and economic participation.
(2) A participant's plan must include a statement (the statement of participant supports), prepared with the participant and approved by the CEO, that specifies:
(a) the general supports (if any) that will be provided to, or in relation to, the participant; and
(b) the reasonable and necessary supports (if any) that will be funded under the National Disability Insurance Scheme; and
(c) the date by which, or the circumstances in which, the Agency must review the plan under Division 4; and
(d) the management of the funding for supports under the plan (see also Division 3); and
(e) the management of other aspects of the plan.
(3) The supports that will be funded or provided under the National Disability Insurance Scheme may be specifically identified in the plan or described generally, whether by reference to a specified purpose or otherwise.
(4) The CEO must endeavour to decide whether or not to approve the statement of participant supports as soon as reasonably practicable, including what is reasonably practicable having regard to section 36 (information and reports).
(5) In deciding whether or not to approve a statement of participant supports under subsection (2), the CEO must:
(a) have regard to the participant's statement of goals and aspirations; and
(b) have regard to relevant assessments conducted in relation to the participant; and
(c) be satisfied as mentioned in section 34 in relation to the reasonable and necessary supports that will be funded and the general supports that will be provided; and
(d) apply the National Disability Insurance Scheme rules (if any) made for the purposes of section 35; and
(e) have regard to the principle that a participant should manage his or her plan to the extent that he or she wishes to do so; and
(f) have regard to the operation and effectiveness of any previous plans of the participant.
(6) To the extent that the funding for supports under a participant's plan is managed by the Agency, the plan must provide that the supports are to be provided only by a registered provider of supports.
(7) A participant's plan may include additional matters, including such additional matters as are prescribed by the National Disability Insurance Scheme rules.
Note: For example, a participant's plan may include arrangements for ongoing contact with the Agency.
(8) A participant's statement of goals and aspirations need not be prepared by the participant in writing, but if it is prepared other than in writing, the Agency must record it in writing.
Note: Section 38 requires a copy of a participant's plan to be provided to him or her.
34 There are several matters to note about s 33. The term "supports" is assigned an inclusive meaning by s 9 of the Act as including "general supports". In turn, "general supports" is given a more specific meaning by s 13(2) of the Act which I have set out at [28] above. It can be seen that general supports are those provided by the Agency itself to the participant.
35 Although it does not use the term expressly, in my opinion it is clear that the assistance identified in s 14 (which the Agency funds, but does not provide) is the subject matter of s 33(2)(b): that is, the "reasonable and necessary supports (if any) that will be funded" under the NDIS.
36 It is the funding for "reasonable and necessary supports" which becomes, once approved and a participant plan is in effect, the "NDIS amount" for the purposes of s 45 and related provisions. The term "NDIS amount" is defined in s 9 to mean:
NDIS amount means an amount paid under the National Disability Insurance Scheme in respect of reasonable and necessary supports funded under a participant's plan.
37 Subsection 33(3), when it speaks of the supports "that will be funded or provided" is therefore referring to both general supports provided by the Agency (s 13), and "reasonable and necessary supports" funded by the Agency (s 14), but provided by others.
38 The matters set out in s 33(5) are mandatory aspects of the CEO's approval function, and therefore on review, mandatory aspects of the Tribunal's approval function. Section 33(5)(c) requires the CEO to be "satisfied as mentioned in s 34 in relation to the reasonable and necessary supports that will be funded and the general supports that will be provided". This directs attention to six matters set out in s 34 of which the CEO must be satisfied.
39 Although s 34 is headed "reasonable and necessary supports", it in fact expressly deals with both general supports (provided by the Agency under s 13) and reasonable and necessary supports (funded by the Agency under s 14). The six matters it sets out in paras (a) to (f) must, as the provision states, be considered by the CEO in relation to each support proposed in the plan. It provides:
34 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).
40 The key constructional choice in the present circumstances is whether, when s 34 uses the verb "funded" or the noun "the funding", it means - for each reasonable and necessary support - full funding of each support, or whether those words should be construed as including, or extending to, partial funding of each support.
41 Although the phrase "reasonable and necessary supports" is used throughout the legislative scheme, including in the objects and principles provisions, it is not defined. Its meaning can be derived from the context in which it is used, especially in my opinion s 4(11), which sets out what reasonable and necessary supports should enable and empower people with a disability to do, read with s 14 which sets out the purposes for which funding for reasonable and necessary supports is provided.
42 Section 35 of the Act is headed "National Disability Insurance Scheme rules for statement of participant supports" and provides:
(1) The National Disability Insurance Scheme rules may make provision in connection with the funding or provision of reasonable and necessary supports or general supports, including but not limited to prescribing:
(a) methods or criteria to be applied, or matters to which the CEO is to have regard, in deciding, the reasonable and necessary supports or general supports that will be funded or provided under the National Disability Insurance Scheme; and
(b) reasonable and necessary supports or general supports that will not be funded or provided under the National Disability Insurance Scheme; and
(c) reasonable and necessary supports or general supports that will or will not be funded or provided under the National Disability Insurance Scheme for prescribed participants.
(2) The National Disability Insurance Scheme rules referred to in subsection (1) may relate to the manner in which supports are to be funded or provided and by whom supports are to be provided.
(4) The National Disability Insurance Scheme rules referred to in subsection (1) may relate to how to take into account:
(a) lump sum compensation payments that specifically include an amount for the cost of supports; and
(b) lump sum compensation payments that do not specifically include an amount for the cost of supports; and
(c) periodic compensation payments that the CEO is satisfied include an amount for the cost of supports.
(5) The National Disability Insurance Scheme rules referred to in subsection (1) may relate to how to take into account amounts that a participant or prospective participant did not receive by way of a compensation payment because he or she entered into an agreement to give up his or her right to compensation.
43 The rules are legislative instruments to be made by the Minister: see s 209. Section 209, sub-paras (4) to (7) constrain the rule-making power to preserve the federal characteristics of the NDIS. The National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth) (the Rules) are an important element of the legislative scheme, introducing the ability to modify the operation of ss 33 and 34 by, for example, excluding certain kinds of supports from inclusion in participant plans. It is through the Rules that the executive is able to implement, within the federalism constraints imposed in s 209, some policy decision-making about the nature and extent of supports to be provided or funded under the NDIS.
44 Part 6A of Chapter 6 of the Act provides for annual reports by an actuary into the financial sustainability of the NDIS, risks, trends, and estimates of future expenditure. Section 180B, which is in Pt 6A, is in the following terms:
180B Duties of scheme actuary
Duties relating to annual financial sustainability report
(1) The scheme actuary must do all of the following each time an annual report is being prepared by the Board members under section 46 of the Public Governance, Performance and Accountability Act 2013:
(a) assess:
(i) the financial sustainability of the National Disability Insurance Scheme; and
(ii) risks to that sustainability; and
(iii) on the basis of information held by the Agency, any trends in provision of supports to people with disability;
(b) consider the causes of those risks and trends;
(c) make estimates of future expenditure of the National Disability Insurance Scheme;
(d) prepare a report of that assessment, consideration and estimation;
(e) prepare a summary of that report that includes the estimates described in paragraph (c).
Duty to make quarterly estimates of future expenditure
(2) At least once each quarter, the scheme actuary must make estimates of the future expenditure of the National Disability Insurance Scheme and advise the CEO of the estimates. For this purpose, quarter means a period of 3 months starting on 1 July, 1 October, 1 January or 1 April.
Note: The CEO must give the Board a copy of the advice under subsection 159(7).
Duty to provide information and advice on request
(3) The scheme actuary must, on request from the Board or the CEO, provide actuarial information or advice.
Duty to report concerns to Board
(4) If the scheme actuary has significant concerns about the financial sustainability of the National Disability Insurance Scheme, or the risk management processes of the Agency, he or she must report those concerns to the Board as soon as reasonably practicable.