CXZS and National Disability Insurance Agency

The Administrative Appeals Tribunal considered the case of CXZS (the applicant) and the National Disability Insurance Agency (NDIA). The dispute concerned the applicant's request for funding for Applied Behaviour Analysis (ABA) therapy at 20 hours per week for 48 weeks, along with program supervision for six hours per month for 12 months, as a reasonable and necessary support under the National Disability Insurance Scheme.

The primary legal issue before the Tribunal was whether the applicant's requested supports satisfied the criteria set out in subsection 34(1) of the National Disability Insurance Scheme Act 2013 (Cth). Specifically, the Tribunal was required to determine if the supports represented value for money (paragraph 34(1)(c)) and if they would be or were likely to be effective and beneficial (paragraph 34(1)(d)). The NDIA accepted that the supports met other criteria under subsection 34(1).

The Tribunal's reasoning focused on the lack of probative evidence to demonstrate that the requested intensity and duration of ABA therapy were reasonable and beneficial for an older child who had already received intensive ABA therapy since a young age. While acknowledging the general efficacy of ABA therapy for children with autism spectrum disorder, the Tribunal found no evidence to establish an optimal number of hours for older children, the context of "more hours" within their existing environment, or the specific benefits of increased hours in this particular case. The Tribunal applied the principles from *McGarrigle v National Disability Insurance Agency* regarding the assessment of "reasonable and necessary supports," emphasising that such a determination must be based on evidence.

Ultimately, the Tribunal was not satisfied that the applicant's requested supports met the requirements of subsection 34(1) of the Act. Consequently, the decision under review, which affirmed the NDIA's decision to not fund the requested supports, was affirmed.