austlii:cth/ARTA/2025/561
General information, not legal advice.
ARTA
2025-05-14
Original judgment source is linked above.
Sparkes and The Chief Executive Officer, National Disability Insurance Agency (NDIS) [2025] ARTA 561 (14 May 2025)
Respondent: The Chief Executive Officer, National Disability Insurance Agency
Decision: The Tribunal, pursuant to section 105 of the Administrative Review Tribunal Act 2024 (Cth) sets aside the decision under review and remits this matter for reconsideration by the Respondent with a direction that it facilitates the approval of a new statement of participant supports ('SOPS') for the Applicant, which contains the following:
(a) Provisions approving NDIS funding for:
(i) An additional 16 hours of domestic cleaning at the weekday rate for a 'once-off' decluttering of the Applicant's living environment;
(ii) Replication, on a pro rata basis, of all of the other supports in the Applicant's current SOPS.
(b) A provision specifying that the reassessment date will fall on the 12-month anniversary of the date of approval of the new SOPS for the Applicant in accordance with this direction; and
(c) Provisions specifying that the plan management specifications in the new SOPS are to remain the same as specified in the current SOPS.
NATIONAL DISABILITY INSURANCE SCHEME -participant supports - plan review - consumables - domestic cleaning and gardening - transport - short term accommodation - psychology - occupational therapy - physiotherapy - exercise physiology - training and skill development - funding for equestrian support - funding for equine assisted learning - assistive technology - reasonable and necessary supports - consideration of section 34 National Disability Insurance Scheme Act 2013 (Cth) - decision under review set aside and remitted with a direction that a new statement of participant supports be approved for the Applicant
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
National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (Miscellaneous Provisions) Transitional Rules 2024
National Disability Insurance Scheme (Becoming a Participant) Rules - 2016, Access Rules - 5.4
National Disability Insurance Scheme (Supports for Participants) Rules - 1 July 2013, Rules - 3, 5
National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (NDIS Supports) Transitional Rules 2024
Beezley v Repatriation Commission (2015) FCAFC 165
BMCX and CEO of the National Disability Insurance Agency [2025] ARTA 199
JQJT and National Disability Insurance Agency [2016] AATA 478
McGarrigle v National Disability Insurance Agency [2017] FCA 308
Malouf v and CEO of the National Disability Insurance Agency [2025] ARTA 97
Mulligan v National Disability Insurance Agency [2015] FCA 544; (2015) 233 FCR 201.
NDIA v KKTB, by her litigation representative CVY22 [2022] FCAFC 181
National Disability Insurance Agency v WRMF [2020] FCAFC 79; (2020) 276 FCR 415
QDKH, by his litigation representative BGJF v National Disability Insurance Agency [2021] FCAFC 189
Re Drake v Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 60
SCHW and National Disability Insurance Agency [2021] AATA 591
WVGM and CEO of the National Disability Insurance Agency [2025] ARTA 47
NDIS - Operational Guidelines - Reasonable and necessary supports, 22 September 2024.
NDIS - Principles we follow to create your plan, 22 September 2024.
NDIS Pricing Arrangements and Price Limits, 2024/25
(i) Consumables - the provision of incontinence products, mobility aids, and adaptive tools at a cost of $1000.00; > > (ii) Domestic cleaning - 2 hours per week for routine cleaning, including continued decluttering and managing clutter; > > (iii) Gardening - 2 hours per fortnight; > > (iv) Daily life assistance and community participation - 70 hours per week; 10 hours per day, 7 days a week, including weekends and public holidays; > > (v) Transport - Level 3 funding - provision for alternative transport options due to issues related to autism, executive function, incontinence, anxiety; > > (vi) Short-term accommodation ('STA') - 28 days per year for respite and support; > > (vii) Psychology - 26 hours of support, weekly psychology sessions, plus unspecified report writing; > > (viii) Occupational Therapy ('OT') - 26 hours of support, weekly OT sessions, plus unspecified report writing; > > (ix) Physiotherapy - 26 hours of support, weekly physiotherapy sessions, plus unspecified report writing; > > (x) Exercise Physiology - 26 hours of support, weekly exercise physiology sessions, plus unspecified report writing; > > (xi) Training and Skill Development - 52 hours of support, 2 hours per week; > > (xii) Equestrian Support - 52 hours of support, 2 hours per week; > > (xiii) Equine Assisted Learning ('EAL') - 26 hours of support, weekly EAL support, plus unspecified report writing;
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).
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: > > (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. > > Note: For the purposes of (aa): > > (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). (Tribunal emphasis to indicate amendments)
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 ). > > (7) An application under paragraph (6)(c) must: > > (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. > > General criteria for supports > > 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. > > 5.2 The day-to-day living costs referred to in paragraph 5.1(d) do not include the following (which may be funded under the NDIS if they relate to reasonable and necessary supports): > > (a) additional living costs that are incurred by a participant solely and directly as a result of their disability support needs; > > (b) costs that are ancillary to another support that is funded or provided under the participant's plan, and which the participant would not otherwise incur.
The person's impairment or impairments are, or are likely to be, permanent...
An impairment is, or is likely to be, permanent (see paragraph 5.1(b)) only if there are no known, available and appropriate evidence-based clinical, medical or other treatments that would be likely to remedy the impairment.
'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.'
The phrase is a composite phrase. ... 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) 227 CLR532 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. (Tribunal emphasis)
Ms Lisa Davis, occupational therapist, Synergy Rehab Solutions
Ms Siobhan Hooper, Registered Nurse, Illuminate Care Service
Ms Katee Maller, occupational therapist, Ability Action Australia
Mr Cameron Wallace, physiotherapist, Sunshine Coast Rehabilitation and Exercise Physiology
Ms Jessica Radford, accredited exercise physiologist, Sunshine Coast Rehabilitation and Exercise Physiology
Ms Melissa Ford, psychologist, Nurturing Minds
Mr Jacques-Yves Chollet, Manager 'Chollet & Co', cleaner and support worker
Ms Mathilde Sormani, 'Equine Specialist', Horses and Humans
A request under section 36 of the NDIS Act is made for the purpose of gathering information about matters to be included in the participant's plan. An unsurprising natural consequence of refusing a request to gather further such information may be that, in some cases, the decision-maker will conclude that it does not have sufficient information to approve particular supports sought by the participant be included in the plan. On review, the consequence of an applicant continuing to refuse to consent to the gathering of certain evidence may lead the Tribunal to conclude that it does not have sufficient information to determine that particular supports sought to be included in the plan are reasonable and necessary and should be funded by the NDIS. It may therefore be in the interests of an applicant for review to participate in the gathering of any relevant evidence.[72]
...provide integrated support for self-care, accommodation, food and activities in a centre or group residence for short periods...[for] participants [who] may require temporary comprehensive supports that are different from their usual arrangements...and may include a period of respite, which aims to support ongoing caring arrangements between participants and their carers. STA/respite allows the opportunity for the participant to be supported by someone else whilst providing their carer with short term breaks from their usual caring responsibilities.
Support 9 Physiotherapy and Support 10 - Exercise Physiology
(h) costs associated with recreational sports and activities, including membership costs, venue hire fees, uniforms and footwear.
Supports that generally are not NDIS supports > > 9 Not evidence based - alternative and complementary therapies (i) animal therapy, including puppy therapy and goat therapy;
46 Acquittal of NDIS amounts > > Requirement to spend money only on NDIS supports and in accordance with plan
(1) A participant who receives an NDIS amount, or a person who receives an NDIS amount on behalf of a participant:
(a) may spend the money only on NDIS supports for the participant; and
(b) must spend the money in accordance with the participant's plan (subject to paragraph (a)).
I certify that the preceding 167 (one hundred and sixty-seven) paragraphs are a true copy of the reasons for the decision herein of General Member S Smith.
[3] EB-7, Annexures A and C. In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) replaced Asperger's with the umbrella term Autism Spectrum Disorder (ASD). www.healthdirect.gov.au
[4] Pursuant to section 33(2) of the NDIS Act. H10/T6. Plan from 10 November 2021-10 November 2022.
[5] Pursuant to s100 of the NDIS Act. H8/T4.
[9] Item 68 of the National Disability Insurance Scheme Amendment (Participant Service Guarantee and Other Measures) Act 2022 with effect from 1 July 2022.
[11] H15 and H16. T1A and T2. The second internal review decision was dated 17 September 2024.
[13] H1 [25]. H84, Plan 17 March 2025 to 16 September 2025. EB-5 breakdown of current SOPS.
[16] Oral evidence of Ms Sparkes. EB-8 [3].
[21] Section 4(1) of the NDIS Act. EB-8, pp 16-20.
[22] Section 129 Amending Act. NDIS Amendment (Getting the NDIS Back on Track No 1) Act 2024.
[23] See Beezley v Repatriation Commission (2015) FCAFC 165 at {68}. Per North, Tracey and Mortimer JJ. See also National Disability Insurance Agency v WRMF [2020] FCAFC 79; (2020) 276 FCR 415 at [201].
[24] Section 33(1), 33(2) and 33(7) of the NDIS Act.
[25] McGarrigle v National Disability Insurance Agency [2017] FCA 308 ('McGarrigle') [43].
[26] National Disability Insurance Agency v WRMF [2020] FCAFC 79 ('WRMF') [149]-[151].
[27] WRMF [141]. Cited with approval in NDIA v KKTB, by her litigation representative CVY22 [2022] FCAFC 181 [129].
[28] See SCHW and National Disability Insurance Agency [2021] AATA 591 [13] where DP Constance referred to Re Drake and Minister for Immigration and Ethnic Affairs (No 2) [1979] AATA 179; (1979) 2 ALD 634.
[29]Operational guidelines: 'Reasonable and necessary supports' on 22 September 2024; 'Principles we follow to create your plan' on 22 September 2024; and 'Creating your plan' on 28 February 2025, Transport Funding on 3 October 2024. Short Term Accommodation or Respite on 24 June 2022. NDIS Pricing Arrangements and Price Limits 2024.25 on 1 October 2024.
[33] Oral evidence of Ms Sparkes. EB-4, p. 1.
[42] EB-1, H23, continues at EB-2, H23, pp287-310; pp 1-14.
[63] Oral evidence of Ms Sparkes and EB-8, p. 18.
[66] Mulligan and National Disability Insurance Agency [2015] FCA 544.
[67] The Mulligan decision was with respect to an access application.
[72] MDCT and National Disability Insurance Agency [2020] AATA 6036 [25]. See also NJSC and NDIA [2022] AATA 4449 [100], [105]. TMJV and National Disability Insurance Agency [2022] AATA 2053 [42].
[76] Also considered by Ms Davis' report, Ms Hooper's report, and Ms Ford's report.
[83] Operational guidelines Transport funding.
[84] EB-7 [37]. See Rule 5.1(d). See JQJT and National Disability Insurance Agency [2016] AATA 478 [35].
[85] Re Drake and Minister for Immigration and Ethnic Affairs (No 2) (1970 46 FLR 409 [420]-[421].
[86] NDIS Pricing Arrangements page 47.
[91] EB-7 at [59]. NDIS Pricing Arrangements and Price Limits, 2024/25, p. 73.
[93] EB-8, p. 13. See Schedule 2, item 27.
[94] Section 10 of the NDIS Act and the Transitional Rules. See WVGM v Chief Executive Office of the National Disability Insurance Agency [2025] ARTA 47 at [208].
[95] Oral evidence of Ms Sparkes. EB-8, p. 14. EB-2, H37.
(2015) 233 FCR 201
(2020) 276 FCR 415