KXHC and National Disability Insurance Agency

This matter concerned an application by KXHC, an accepted participant of the National Disability Insurance Scheme, seeking review of a decision by the National Disability Insurance Agency (NDIA). The dispute centred on whether funding for a LusioMATE subscription and various complex home modifications constituted "reasonable and necessary supports" under section 34 of the NDIS Act.

The Tribunal was required to determine if the proposed supports met the criteria of subsection 34(1) of the NDIS Act. Specifically, the court had to assess whether the LusioMATE subscription would be effective and beneficial, provide value for money, and assist the Applicant to meet her goals in a way that could not otherwise be achieved. Similarly, the Tribunal needed to consider if the proposed home modifications were reasonable and necessary, particularly in relation to value for money and their ability to assist the Applicant in pursuing her goals and undertaking various activities.

The Tribunal considered sworn evidence from the Applicant's mother and an occupational therapist engaged by the Respondent, alongside reports from allied health professionals. For the LusioMATE, the Applicant relied on evidence from a former physiotherapist who described its motivational and therapeutic benefits, including its ability to extend therapy into daily life and monitor progress. While this evidence was not directly challenged, the Respondent noted that subsequent physiotherapists had not recommended the support and questioned whether it was merely beneficial rather than reasonable and necessary. The Tribunal also reviewed the NDIA's operational guidelines regarding home modifications, which emphasise seeking suitable designs with minimal modifications and obtaining professional advice. The Applicant argued that both the LusioMATE and home modifications satisfied all NDIS funding criteria, including value for money.

The Tribunal set aside the NDIA's decision.