FBHL and National Disability Insurance Agency

The Administrative Appeals Tribunal considered the case of FBHL, a 15-year-old participant in the National Disability Insurance Scheme, and the National Disability Insurance Agency. FBHL, who has multiple complex medical conditions including a traumatic brain injury, intellectual disability, and cerebral palsy, lives with her family on a rural property. The dispute concerned whether funding for a dedicated carers' room and a storage room within the family home constituted "reasonable and necessary" supports under the National Disability Insurance Scheme Act 2013 (Cth).

The Tribunal was required to determine if the proposed supports met the criteria for "reasonable and necessary" as outlined in section 34(1) of the NDIS Act. Specifically, the Tribunal had to assess whether the funding for a carers' room took into account what it is reasonable to expect families, carers, and the community to provide, and whether the proposed storage room represented value for money, considering the benefits and the cost of alternative supports. The Tribunal also needed to consider the effectiveness and benefit of the supports, their alignment with the participant's goals, and whether they were most appropriately funded by the NDIS.

The Tribunal found that the funding for a carers' room went beyond what could reasonably be expected of FBHL's family and carers, particularly given the active overnight support FBHL requires. The Tribunal accepted that FBHL needs intensive, around-the-clock care, including support workers who remain awake and attentive throughout their shifts. However, the Tribunal could not be satisfied that the proposed storage room represented value for money based on the evidence presented. While acknowledging the current storage arrangements were unsuitable, the Tribunal noted that alternative solutions, such as a shed proposed by the Agency, were not adequately assessed, and the potential benefits of a dedicated storage room were unclear, especially in light of expert evidence regarding the storage of oxygen tanks and the possibility of using an oxygen concentrator.

Consequently, the Tribunal decided to set aside the Agency's decision and remit the matter back to the respondent for reconsideration. This reconsideration is to focus on investigating and determining a satisfactory arrangement for FBHL's accommodation and equipment storage needs within 28 days.