GDDC and National Disability Insurance Agency

This matter concerned an application to review a decision made by a reviewer of the National Disability Insurance Agency (NDIA) regarding supports for a nine-year-old child diagnosed with Autism Spectrum Disorder (ASD) of level 2 severity. The applicant sought an increase in funding for Capacity Building Supports, specifically for greater hours of Applied Behavioural Analysis (ABA) Therapy, Occupational Therapy, and Speech Pathology Therapy. The core dispute revolved around whether these requested supports were reasonable and necessary within the meaning of section 34 of the National Disability Insurance Scheme Act 2013 (Cth), considering factors such as value for money, effectiveness, benefit, and the extent to which informal supports could be relied upon.

The Tribunal was required to determine whether the requested therapies met the criteria of being reasonable and necessary. This involved assessing the evidence presented, including expert opinions, to ascertain if the therapies were effective and beneficial for the applicant's development, particularly in addressing behaviours associated with ASD. The Tribunal also had to consider whether the requested supports represented value for money and took into account what could reasonably be expected from the applicant's family, carers, and community. A key aspect of the determination was evaluating the efficacy of the existing therapy model and whether an alternative approach was warranted due to a perceived lack of significant improvement.

The Tribunal's reasoning focused on the evidence presented regarding the applicant's progress and the effectiveness of the therapies. While acknowledging the applicant's diagnosis and the general benefits of ABA, Occupational Therapy, and Speech Pathology, the Tribunal found that the specific request for increased hours did not fully satisfy all the "reasonable and necessary" criteria, particularly concerning subsections 34(1)(c), (d), and (e) of the NDIS Act. The Tribunal noted differences in expert opinions and the applicant's parents' observations of improvement, but ultimately concluded that the evidence did not sufficiently demonstrate that the requested quantum of support was justified.

Consequently, the Tribunal set aside the NDIA's decision under review. The matter was remitted to the NDIA with a direction to include specific reasonable and necessary supports in the applicant's NDIS plan for a 12-month period. These included 30 hours each of Occupational Therapy, Speech Pathology Therapy, and ABA Therapy, with provisions for initial training, fortnightly sessions, and report writing, as well as provider travel for home and school-based implementation.