Mazy and National Disability Insurance Agency

The Administrative Appeals Tribunal considered a dispute between Ms Mazy, a 53-year-old woman with severe intellectual disability, blindness, and hearing impairment, and the National Disability Insurance Agency (NDIA). Ms Mazy sought funding under the National Disability Insurance Scheme (NDIS) for daily assistance from a registered nurse to administer insulin for her type one diabetes. This support had previously been funded by the NSW Department of Ageing, Disability and Home Care. The NDIA had refused to review Ms Mazy's NDIS plan to include this funding, a decision that was subsequently upheld on internal review. Ms Mazy applied to the Tribunal for a review of the internal review decision.

The Tribunal was required to determine whether the requested nursing support was "reasonable and necessary" for Ms Mazy under the National Disability Insurance Scheme Act 2013. Specifically, the court had to consider two key issues: first, whether the support was "most appropriately funded or provided through the National Disability Insurance Scheme" and not through other general systems of service delivery; and second, whether the support represented "value for money." The NDIA contended that while the support might be effective and beneficial, it was primarily a health-related service and therefore more appropriately funded by the health system, not the NDIS.

The Tribunal found that the NDIA had not discharged its onus to provide evidence supporting its argument for alternative funding. While acknowledging that the NDIS Rules generally exclude funding for the diagnosis and clinical treatment of health conditions, the Tribunal noted that the NDIS would be responsible for supports related to a person's ongoing functional impairment that enable them to undertake daily living activities, including those delivered or supervised by clinically trained practitioners where directly related to a functional impairment and integrally linked to community living. The Tribunal was satisfied that the nursing assistance met several criteria for reasonable and necessary supports, including assisting Ms Mazy in pursuing her goals, facilitating social and economic participation, being effective and beneficial, and that it was not reasonable to expect informal networks to provide it.

The Tribunal set aside the NDIA's decision. In substitution, it ordered that the services of a registered nurse four times per day to assist in the management of Ms Mazy's type 1 diabetes be funded by the National Disability Insurance Scheme as a reasonable and necessary support.