• Applying a bridge, crown and five porcelain restorations to the lower left-hand side.15

1. The total cost of this four-stage procedure is $31,600.16

1. The Agency submits that dental treatment is not an NDIS support within the meaning of section 34(1)(f) of the NDIS Act and item 12(a), schedule 2 of the Transitional Rules. Item 12(a) states that the following health supports are not NDIS supports:

(a) the diagnosis, early intervention and clinical treatment of health and dental health conditions, including ongoing or chronic health conditions.

1. The Agency also refers to the recent Tribunal decision of Maroti,17 in which Deputy President Dordevic found that clinical treatment of a dental health condition was excluded by item 12(a).

1. Alternatively, the Agency contends that the section 34(1)(aa) of the NDIS Act is not satisfied as the Applicant was only granted access to the scheme for physical impairments relating to her rheumatoid arthritis.

1. The Applicant submits that the deterioration of her teeth is a direct result of her diagnosis of SS and that she was granted access to the NDIS for RA and SS, both of which are autoimmune diseases. The Applicant also submits that:
   • She cannot afford this dental procedure as she receives the disability support pension,
   • The treatment is not available through the public health system,
   • She is unable to afford private health insurance,
   • She has privately paid for restoration of her upper teeth over several years,
   • The general application of the Transitional Rules is unfair and does not account for her individual circumstances,

17 Maroti and CEO, National Disability Insurance Agency (NDIS) [2025] ARTA 1210.

• Without this treatment, she is unable to eat and talk effectively due to temporomandibular joint pain,
• The treatment will improve her self-esteem and confidence for community participation, and
• The Maroti decision is not comparable as it relates to sleep dentistry for poor dental hygiene.

1. I acknowledge the Applicant's strong concerns. I do not doubt the serious and negative impacts of SS on her health and the need for the dental procedure. I also consider that it is likely that the Applicant has permanent impairments from SS and that this condition is likely to be associated with her RA. In this regard I note Professor Hall's opinion that:

... [the Applicant] has a high titre rheumatoid factor and high titre CCP antibody-associated inflammatory arthritis. She also has difficult Sjogren's syndrome with dry mouth and rapidly progressing dental carries, which has left her with seven teeth lost.

... I have explained to her that I think rituximab is the only agent which we have which has the potential to reverse her oral problems as well as her in inflammatory arthritis, which was not touched by etanercept.18

1. I also note that the government Health Direct website says:

The exact cause of Sjögren's syndrome is unknown, though there seems to be a genetic influence. It is more common in:

• females
• people over 40 years of age
• people who have rheumatic diseases, such as rheumatoid arthritis or lupus
• people with a family history of other autoimmune conditions

There is no cure for Sjögren's syndrome. Treatments are used to relieve symptoms and can involve medicines to increase the production of saliva and treat complications.

Complications of Sjögren's syndrome include: increased risk of dental problems ...19

19 https://www.healthdirect.gov.au/sjogrens-syndrome

1. However, I do not consider that I have sufficient information to determine whether the impairments arising from SS meet the disability requirements for the purposes of section 34(1)(aa). This is because it is not clear to me that the impairments from SS result in a substantially reduced functional capacity for self-care or communication. It is also not clear to me the extent to which the recommended treatments will reduce the Applicant's impairments from SS.

1. I also do not consider that I need to make a finding on the application of section 34(1)(aa) in this matter. This is because, regardless of whether SS might, or might not, meet the disability or early intervention requirements, it is clear to me that the requested dental procedure is a clinical treatment of a dental health condition. The dental treatment is therefore excluded from being funded under the NDIS as it is not an NDIS support under section 34(1)(f) and item 12(a) of schedule 2 of the Transitional Rules:

1. I agree with the decision in Maroti. I acknowledge that there are differences between the factual circumstances in Maroti and Ms Puleio's situation. However, item 12(a) applies in the same way on both matters. The support requested is clinical treatment for a dental health condition and is now excluded from being an NDIS support. Therefore, I cannot be satisfied that the Ms Puleio's dental treatment is a reasonable and necessary support to include in her SPS.

Support (b): Pool and recreation centre membership

1. The Applicant is seeking funding for membership to the Ashburton Pool & Recreation Centre being $25.90 per week ($1,346.80 per year). In summary, the Applicant submits that membership:
   • Allows regular exercise, including in water, which will improve her RA symptoms and her physical and mental health,
   • Provides qualified fitness professionals and accessible shower facilities,
   • Increases her social and community participation opportunities, and
   • Is more beneficial and better value for money when compared with physiotherapy sessions.
2. The Agency submits that membership to the pool and recreation centre is not an NDIS support because it is excluded under item 4 of schedule 2 of the Transitional Rules. Item 4 states that the following 'Day-to-day living costs - lifestyle' are not NDIS supports:

(q) general health, fitness, social or recreational activity costs or services;

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

1. While I acknowledge that membership to the pool and recreation centre may be comparably better value than physiotherapy, and provide a range of benefits to the Applicant, there is no doubt that this membership is now excluded under items 4(q) and (r) of schedule 2 of the Transitional Rules. I cannot be satisfied that this membership is an NDIS support as required by section 34(1)(f) of the NDIS Act. As such, membership cannot be a reasonable and necessary support to include in Ms Puleio's SPS.

1. I would encourage the Applicant to discuss this matter further with her support coordinator and Agency planners. Potentially, hydrotherapy and exercise physiology may be therapeutic supports that are suitable for Ms Puleio. Such therapeutic supports are NDIS supports under item 34, schedule 1 of the Transitional Rules. Some of these services may be able to be delivered in a community or group setting.

1. The Applicant requests level 2 transport funding to improve her participation in social and community activities. Ms Puleio currently receives level 1 transport funding in her SPS.

1. Section 6(2)(b) of the National Disability Insurance Scheme (Old Framework Plans) Determination 2024 (Old Framework Determination) specifies how to work out funding for recurring transport support, being:

(i) unless subparagraph (ii) or (iii) applies - $1,784;

(ii) if subparagraph (iii) does not apply and the participant is working or studying (or both) for less than 15 hours each week, is attending day programs, or requires the supports for social, recreational or leisure activities - $2,676;

_(iii) if the participant is working or studying (or both) for at least 15 hours each week - _

1. Transport funding is also covered in section 12 of the Specific Supports which says:

A participant's transport supports may also include the reasonable and necessary costs of taxis or other private transport options for participants who are not able to travel independently, as well as transport to and from school for students.

A support will not be provided or funded under the NDIS if it relates to day-to-day living costs (rule 5.1(d) of the Supports for Participants Rules).

Day-to-day living costs may include rent, groceries or utility fees, however, this is not an exhaustive list. Transport is an incidental cost of everyday life for most people and, therefore, can also be considered to be a day-to-day living cost.

However, the NDIS may fund day-to-day living costs that are incurred by a participant solely and directly as a result of their disability support needs (rule 5.2(a) of the Supports for Participants Rules).

These additional living costs (i.e. those incurred by a participant solely and directly as a result of their disability support needs) may be funded under the NDIS if they are NDIS supports that meet the NDIS funding criteria.

When considering whether a proposed transport support represents value for money, the NDIA will compare the costs of transport to the overall costs of alternative supports which may provide a similar level of independence or reduce a participant's future needs for supports. For example, vehicle modifications and driving supports.

The NDIA may also consider what options may be available for the participant in their local community, or whether funding other supports has the potential to build a participant's capacity to engage in local community activities.

Transport should only be funded where it has been determined to be reasonable and necessary, where it is an additional cost incurred solely and directly as a result of a participant's disability support needs and, where ancillary to another funded support, it is a cost which the participant would not otherwise incur.

It does not follow, merely because transport is ancillary to a funded support, that it should be funded**.** 20

1. Item 6 of schedule 1 of the Transitional Rules says that 'Assistance with travel or transport arrangements' is an NDIS support unless otherwise provided. The supports in this category include:

Supports that provide transport assistance to participants that cannot travel or use public transport independently.

20 NDIS Operational Guideline: Including Specific Types of Supports in Plans, published 19 November 2024, pages 8 and 9.

(a) transport for the purposes of participants undertaking community-based activities;

(d) costs associated with the use of taxis or private transport; ...

1. In summary, the Agency submits that there is insufficient evidence to find that an increase to level 2 transport funding ($2,676 per year) is reasonable and necessary as:
   • The Applicant does not work, study or attend day programs,
   • The Applicant can drive for a short amount of time,
   • There is limited information about activities she is attending,
   • Transport to the pool and recreation centre is a day-to-day living cost and not related to her disability,
   • There is a lack of evidence that RA prevents her from using public transport,
   • The NDIS is not responsible for the accessibility and reliability of public transport,
   • Increased funding is not value-for-money, and
   • The is no evidence that this increased funding would be effective and beneficial.

1. The Applicant submits that return taxi trips to her weekly art class, and fortnightly physiotherapist, costs between $50 and $70. Level 1 transport funding of $68.61 per fortnight means that she would have to limit herself to one taxi trip every second week. The Applicant also says that she would like to take part in ongoing day classes if she could access these. The Applicant also has safety concerns with using public transport, has identified risks with her autoimmune conditions, and says that she cannot take her dogs with her on public transport. The Applicant also challenges the three levels of funding as she considers that this discriminates against her due to her inability to work or study.

1. I note that there is mixed information about the extent to which the Applicant can drive. As the Agency has agreed to recurring transport funding being included in the Applicant's SPS, I do not consider that I need to revisit whether the Applicant cannot travel or use public transport independently. It remains to be determined what level of funding is appropriate.
2. Overall, I agree with the Agency that there isn't sufficient information regarding the Applicant's transport needs to be satisfied that an increase to level 2 transport funding is reasonable and necessary. Again, I would recommend that Ms Puleio discuss this with her support coordinator. The Applicant may be able to better utilise her current support funding for social and community participation activities. In turn, further information about these activities might assist in assessing a future request for level 2 transport funding.

1. The Applicant requests several items of low-cost AT including: a garment steamer, clothes airer, sleeping pillows, steam mop, clothes dryer, and microwave. Some of these items have been recommended by the Applicant's OT, Ms Parasiliti.21 The Agency submits that all these low-cost AT items are excluded under item 1(i) of schedule 2 of the Transitional Rules. Item 1(i) states that 'standard household items, appliances, tools or products' are not NDIS supports. Section 4 of the Transitional Rules also defines 'standard item' to mean:

... an item that is not modified or adapted to address the functional impairments of the participant or prospective participant.

1. The Applicant submits that the 'blanket' application of these rules does not consider her individual circumstances. The Applicant also identifies several inconsistencies in the Agency's decisions which are under review. While I am sympathetic to the Applicant's concerns regarding the application of the Transitional Rules, there is really no way to avoid the conclusion that parliament intended the rules are to be applied to all participants. The Tribunal is required to apply these rules and has not been given a discretion to arrive a different conclusion based on individual circumstances. The Applicant's concerns with inconsistencies in the Agency's decision-making is also now less relevant to the Tribunal's decision-making. This is because the Tribunal is making a fresh decision, and the Agency's decision-makers were not required to apply the Transitional Rules.

1. The items requested are not modified or adapted to address the Applicant's functional impairments. They are standard household items and are therefore excluded from being funded in the Applicant's SPS. I cannot be satisfied that these items are NDIS supports as

required by section 34(1)(f) of the NDIS Act. As such, these items cannot be a reasonable and necessary supports to include in Ms Puleio's SPS.

1. Section 7 of the Transitional Rules also sets out that 'Standard commercially available household items' can the subject of a replacement support determination for the purpose of section 10(6) of the NDIS Act. I note that the JHB includes some correspondence between the parties with regards to requesting replacement support determinations for these items.22 This is a matter for the CEO as the Tribunal does not have a role in making or reviewing replacement support determinations.

Support (e): Mid-cost AT: orthopaedic mattress

1. The Applicant requests funding for an orthopaedic mattress. This has been recommended by the Applicant's chiropractor, Dr Livis who says:

Catherine has been diagnosed with Rheumatoid arthritis, causing inflammation, pain and stiffness in multiple joints affecting her sleep resulting in a reduced capacity to complete her Activities of Daily Living and complying with her rehabilitation.

Providing Catherine with a supportive orthopedic mattress will reduce her overall pain levels and improve her functional capacity. Considering the natural history of chronic joint and soft tissue injuries that are slow to respond to conservative management, deterioration and further debility is inevitable once mechanical and structural changes have occurred in the affected articulations including her right shoulder and cervical spine.23

1. Ms Puleio has not provided a quote for a mattress or a completed AT assessment. She has indicated that is looking at the 'Tempur' brand and will need assistance from her support coordinator to organise selection of a suitable product.24 An internet search indicates that the brand 'Tempur-Pedic' has mattresses ranging from around $2,000 to $10,000.25

1. The Agency's Assistive Technology Guideline states that AT items costing between $1,500 and $15,000 are considered 'mid-cost' assistive technology. The supporting information required for mid-cost AT is described as follows:

25 https://www.tempurpedic.com/shop-mattresses/

How can you get mid cost assistive technology in your plan?

You'll need to give us evidence that your mid cost assistive technology is right for you. The evidence can be a letter, email or report from your assistive technology advisor. Your advisor must tell us:

• the assistive technology you need
• why the assistive technology is the best value, over other supports, to help with your disability support needs
• how the assistive technology will help with your disability support needs and help you pursue the goals in your plan
  • an estimate of how much the assistive technology costs.

The evidence you give us doesn't need to be a formal assessment but it does need to be in writing so we can keep it for our records.26

It is accepted by the Respondent that a queen size mattress may be a reasonable and necessary support pending consideration and receipt of further information about trials of comparable mattresses with regard to value for money, and effective and beneficial outcomes for her impairments. At hearing the Applicant accepted that the Respondent required this information but she said she needed help from a support co-ordinator to help her organise obtaining this information. The Applicant's plan has now been varied to include 40 hours of level 2 support co-ordination. This funding can be used to assist the Applicant to obtain the additional information requested by the Respondent.

1. Presently, I agree with the Agency. The Tribunal does not have information about what mattress is recommended, the basis of this recommendation, or how much the mattress will cost. This is not sufficient to consider whether a specific orthopaedic mattress is value-for-money. At this point-in-time, I cannot be satisfied that funding for an orthopaedic mattress should be included in Ms Puleio's SPS. I recommend that Ms Puleio work with her support coordinator to provide further information to the Agency with regards to a suitable orthopaedic mattress.

26 NDIS Operational Guideline: Assistive Technology (equipment, technology and devices) published 20 December 2023.

1. The decision under review, being the decision of the Agency made on 6 February 2024, as updated on 12 August 2025, to approve a statement of participants supports under sections 33(2) and 100(6) of the National Disability Insurance Scheme Act 2013, is affirmed.