Milburn v National Disability Insurance Agency
[2018] AATA 4928
•20 December 2018
Milburn and National Disability Insurance Agency [2018] AATA 4928 (20 December 2018)
Division:National Disability Insurance Scheme Division
File Number(s): 2018/2133
Re:Richelle Milburn
APPLICANT
National Disability Insurance AgencyAnd
RESPONDENT
DECISION
Tribunal: Deputy President J W Constance
Date:20 December 2018
Date of written reasons: 8 February 2019
Place:Sydney
DECISION:For the reasons given orally at the conclusion of the hearing of this matter, the Tribunal decides that:
1.the reviewable decision made 8 November 2017 is set aside;
2.the matter is remitted to the Respondent for reconsideration in accordance with the following direction in relation to the statement of supports in Ms Milburn’s plan current as at the date of this decision;
3.IT IS DIRECTED that Ms Milburn’s current plan be amended to include the following supports from and including the date of the commencement of the plan:
i.transport to and from Ms Milburn’s appointments with her General Practitioner on 12 occasions per calendar year;
ii.transport to and from 16 Specialist medical appointments each calendar year;
iii.transport to and from Ms Milburn’s appointments with her Psychologist on 12 occasions per calendar year;
iv.transport to and from Ms Milburn’s appointments with her Physiotherapist on 12 occasions per calendar year;
v.transport to and from a gymnasium at Sutherland Leisure Centre once per week;
vi.transport to and from Cronulla shopping precinct (or similar) twice per week;
vii.funding for a support person to accompany Ms Milburn to all appointments with health professionals;
viii.funding for a support person on visits to a local shopping centre twice per week for a period of up to two hours on each occasion in substitution for that previously provided;
ix.funding for house cleaning assistance for a period of 260 hours per year in substitution for that previously provided;
x.funding for assistance with meal preparation for 156 hours per year in substitution for that previously provided;
xi.funding for assistance to attend social activities for 468 hours per year in substitution for that previously provided;
xii.funding for the provision of three pairs of bifocal glasses (including one pair of sunglasses) with prism lenses;
xiii.funding for the provision of support by a personal trainer at the gym attended by Ms Milburn for one hour per week.
..............[sgd]..........................................................
J W Constance
Deputy PresidentCATCHWORDS
NATIONAL DISABILITY INSURANCE SCHEME – whether supports are reasonable and necessary – transport and associated carer services – singing lessons – transport and accommodation to visit family – remedial massage – bifocal glasses with prism lenses – specially compounded prescription medicine – Turner Syndrome – Borderline Personality Disorder – fibromyalgia – arthritis – macular degeneration – decision set aside
LEGISLATION
National Disability Insurance Scheme Act 2013 (Cth)
CASES
KLMN and National Disability Insurance Agency [2017] AATA 1815
McGarrigle v National Disability Insurance Agency [2017] FCA 308
Young and National Disability Insurance Agency [2014] AATA 401
SECONDARY MATERIALS
National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth)
WRITTEN REASONS FOR DECISION
Oral reasons given 20 December 2018
8 February 2019
A. INTRODUCTION
Ms Milburn has been a participant in the National Disability Insurance Scheme (NDIS) since mid-2017. The Scheme was established by the National Disability Insurance Scheme Act 2013 (Cth) and is administered by the National Disability Insurance Agency.
On 14 July 2017, Ms Milburn’s NDIS plan came into effect.[1] A copy of Part 3 of the plan is Annexure 1 to these reasons. This part sets out the budget for “reasonable and necessary supports” determined by the Agency.
[1] Exhibit R1 at 56.
By her application, Ms Milburn is asking the Tribunal to review the Agency’s decision (made on 8 November 2017)[2] to refuse to review her plan to include several supports she claims in addition to those already included. This decision is referred to as “the reviewable decision”. The reviewable decision was altered by the Tribunal, with the consent of the parties, by a Section 26 Order made 3 July 2018, and further altered by a Section 26 Order made 12 December 2018. These alterations permitted the supports included in Ms Milburn's plan to continue until finalization of this application.
[2] Exhibit R1 at 6.
Ms Milburn says that the supports she claims are reasonable and necessary and, therefore, should be funded under the Act. These claims will be set out in detail later in these reasons.
For the reasons which follow, the reviewable decision will be set aside. In substitution, a decision will be made to include in Ms Milburn's current plan some, but not all, of the requested supports.
B. BACKGROUND
Ms Milburn is 45 years old. She suffers from several significant medical conditions which have caused her very serious disabilities. By letter of 7 April 2017,[3] Ms Milburn was accepted as a participant in the Scheme.
[3] Exhibit R1 at 31.
Immediately prior to her acceptance into the Scheme, Ms Milburn was provided support under a New South Wales scheme.[4] I have been informed by the Solicitors for the Agency that, for this reason, the Agency’s letter of acceptance did not specify the disabilities in respect of which Ms Milburn was accepted as a participant in the Scheme. On this basis, I have considered all of the disabilities about which Ms Milburn has given evidence in determining which of the supports claimed are properly classified as “reasonable and necessary.”[5] It was not contended on behalf of the Agency that I should proceed otherwise.
[4] Exhibit R1 at 9.
[5] Confirmation of the conditions from which Ms Milburn suffers is to be found in Exhibit R1 at 22.
Ms Milburn's claims for supports
Ms Milburn claims that the following supports should be included in her plan as each of them is “reasonable and necessary” and, therefore, should be funded under the Act:
a.Description: Music therapy
Plan category: Improved daily living
Frequency: One 1 hour session per week
Cost: $125 for one session, 52 weeks per year
Total cost: $6,500
b.Description: Gym membership and personal training
Plan category: Improved daily living
Frequency: Annual membership, personal training twice a week
Cost: $6,943 (incl membership of $850 pa)
c.Description: Transport and accommodation to visit family
Plan category: Improved daily living
Frequency: One visit per year to Sunshine Coast for one week, one visit per year to Batemans Bay for one week
Accommodation: $1075 (Sunshine Coast); $665 (Batemans Bay)
Transport: $358-$740 (flights - Sunshine Coast); $791.70 (shuttle - Batemans Bay)
d.Description: Remedial massage
Plan category: Improved daily living
Frequency: Once per week, 1 hour a week
Cost: $90 per session, 52 weeks per year
Total cost: $4,680
e.Description: 3 pairs of bifocal glasses with prism lenses
Plan category: Assistive technology
Pair one: $734.00
Pair two: $1,017.00
Pair three: $564.95 (sunglasses)
Total cost: $2,315.95
f.Description: Medications specially compounded for allergies
Category: Core supports (consumables)
Cost: $297.34 a month
Total annual cost: $3,568.08
g.Description: Increase in budget for transport and community support
Plan category: Core supports
Cost: Core support budget increases to $85,000 for 12 months.[6]
The Agency has refused to include these supports in Ms Milburn’s plan.
[6] Applicant’s Statement of Facts, Issues and Contentions dated 20 July 2018 at [1].
C. OUTLINE OF SCHEME AND RELEVANT PRINCIPLES
In written submissions, the Solicitor for the Agency set out various provisions of the Act, Rules and Guidelines which provide the framework for determining the matters in dispute in this application. I am grateful for the assistance of these submissions, which form the basis of the content of this Part.
Preparation of a participant’s plan
The Chief Executive Officer of the Agency is required to facilitate the preparation of a participant’s plan.[7] The plan must include:
·the participant’s statement of goals and aspirations; and
·a statement of participant supports prepared with the participant and approved by the Chief Executive Officer.[8]
It is to be noted that the statement of goals and aspirations is a statement by the participant and does not require the approval of the Chief Executive Officer. The statement of participant supports must specify the reasonable and necessary supports (if any) that will be funded under the Scheme.
[7] Section 32 of the Act.
[8] Section 33 of the Act.
The provisions of the Act giving the participant alone the right to state his or her goals and aspirations and at the same time requiring the Chief Executive Officer to work with the participant to prepare the statement of supports, and then to approve those supports which will be funded, “strikes a balance between two of the Act’s objects:
(a)the need to enable people with disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports, and
(b)the facilitation of a nationally consistent approach to the access to, and planning and funding of, supports for people with disability.”[9]
[9] Written Submissions of the Respondent dated 28 September 2018 at [8]; the objects of the Act are set out in section 3 of the Act.
Implementing a plan
The plan comes into effect once the Chief Executive Officer has received the participant’s statement of goals and aspirations and approved the statement of participant’s supports.[10]
[10] Section 37(1) of the Act.
Money received by or on behalf of a participant must be spent in accordance with the participant’s plan.[11] An amount paid under the Scheme in respect of reasonable and necessary supports funded in accordance with a participant’s plan is referred to in the Act as the “NDIS amount.”[12]
[11] Section 46(1) of the Act.
[12] Section 9 of the Act.
The objects of the Act
The objects of the Act set out in section 3 make particular reference to the purpose of providing reasonable and necessary supports. Subsection (3)(1) provides, in part:
The objects of this Act are to:
…
(c) support the independence and social and economic participation of people with disability; and
(d) provide reasonable and necessary supports, including early intervention supports, for participants in the National Disability Insurance Scheme launch; and
(e) enable people with disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports; and
(f) facilitate the development of a nationally consistent approach to the access to, and the planning and funding of, supports for people with disability; and
(g) promote the provision of high quality and innovative supports that enable people with disability to maximise independent lifestyles and full inclusion in the community; and
(ga) protect and prevent people with disability from experiencing harm arising from poor quality or unsafe supports or services provided under the National Disability Insurance Scheme; and
(h) raise community awareness of the issues that affect the social and economic participation of people with disability, and facilitate greater community inclusion of people with disability;
…
The objects are to be achieved by “adopting an insurance-based approach, informed by actuarial analysis, to the provision and funding of supports for people with disability.”[13] In giving effect to the objects, regard is to be had to, among other things, “the need to ensure the financial sustainability” of the Scheme and “the provision of services by other agencies, Departments or organisations and the need for interaction between the provision of mainstream services and the provision of supports under the National Disability Insurance Scheme.”[14]
[13] Section 3(2)(b) of the Act.
[14] Section 3(3) of the Act.
General principles guiding action under the Act
The determination of the reasonable and necessary supports to be funded under the Scheme is a vitally important function of the Agency. Section 4 provides a set of principles to guide decision-making in respect of this and other functions under the Act.
The following principles are of particular relevance in making decisions as to reasonable and necessary supports:
(1) People with disability have the same right as other members of Australian society to realise their potential for physical, social, emotional and intellectual development.
…
(3) People with disability and their families and carers should have certainty that people with disability will receive the care and support they need over their lifetime.
(4) People with disability should be supported to exercise choice, including in relation to taking reasonable risks, in the pursuit of their goals and the planning and delivery of their supports.
…
(5) People with disability should be supported to receive reasonable and necessary supports, including early intervention supports.
…
(8) People with disability have the same right as other members of Australian society to be able to determine their own best interests, including the right to exercise choice and control, and to engage as equal partners in decisions that will affect their lives, to the full extent of their capacity.
(9) People with disability should be supported in all their dealings and communications with the Agency and the Commission so that their capacity to exercise choice and control is maximised in a way that is appropriate to their circumstances and cultural needs.
…
(11) Reasonable and necessary supports for people with disability should:
(a) support people with disability to pursue their goals and maximise their independence; and
(b) support people with disability to live independently and to be included in the community as fully participating citizens; and
(c) develop and support the capacity of people with disability to undertake activities that enable them to participate in the community and in employment.
…
(14) People with disability should be supported to receive supports outside the National Disability Insurance Scheme, and be assisted to coordinate these supports with the supports provided under the National Disability Insurance Scheme.
(15) Innovation, quality, continuous improvement, contemporary best practice and effectiveness in the provision of supports to people with disability are to be promoted.
…
Subsection 4(17) further references the need to ensure the financial sustainability of the Scheme.
Although the phrase “reasonable and necessary supports” is not defined in the Act, its meaning can be determined with the assistance of the provisions referred to above. As the Federal Court said in McGarrigle v National Disability Insurance Agency:
Section 13 expressly indicates that a “support” might be a service, or it might be an activity. In my opinion, although s 14 (which deals with funding by the Agency of others to assist the participant rather than the Agency assisting the participant directly) is expressed purposively, its subject matter is also “support” - whether by way of services of activities or any other matter that assists a person with disability in a way that is consistent with the general principles set out in s 4. The word “support” must be given a broad construction in this context, and there is no need for the purposes of this proceeding to seek to give it any comprehensive meaning. Rather, the point to be made is that it is a practical description of the means by which a person with disability is assisted. It is not intended, in my opinion, to encompass funding, especially because what s 14 contemplates is that the Agency will “fund” a support. The Agency cannot “fund” funding.
…
Whether a support is “reasonable” requires a different assessment to whether a support is “necessary”. Again, it is not necessary in the context of this proceeding to be definitive about the nature and extent of the meaning of the phrase, or its components. It is enough to observe that using the concept of necessity would appear to tie one aspect of the CEO’s assessment to an evaluation of the kinds of factors set out in s 34(1)(a) and (b) and (d). The word “reasonable” would appear to be directed at factors such as those set out in s 34(1)(c) and (f). That is not to say the meaning of each word is exhausted by the factors set out in s 34(1): rather, it is to illustrate the different work that each concept does as an adjective in the phrase “reasonable and necessary supports”.[15]
[15] [2017] FCA 308 at [88] and [91].
Functions of the Agency
Section 118 of the Act outlines the functions of the Agency, which include supporting the independence, and social and economic participation, of people with disability, enabling them to exercise choice and control in the delivery of their supports, and ensuring that their preferences are respected and given appropriate priority. This section also provides that the Agency is to promote the provision of high quality and innovative supports which maximise independent lifestyles and inclusion in the community of people with disability.
By subparagraph 118(1)(b), the Agency has a further function of managing the financial sustainability of the Scheme.
Principles relating to the participation of people with disability
As part of Chapter 3 - Participants and their plans - subsections 17A(1) and (3) provide:
(1) People with disability are assumed, so far as is reasonable in the circumstances, to have capacity to determine their own best interests and make decisions that affect their own lives.
…
(3) The National Disability Insurance Scheme is to:
(a) respect the interests of people with disability in exercising choice and control about matters that affect them; and
(b) enable people with disability to make decisions that will affect their lives, to the extent of their capacity; and
(c) support people with disability to participate in, and contribute to, social and economic life, to the extent of their ability.
Matters which must be taken into account in deciding whether or not to approve a statement of supports
Subsection 33(5) provides:
(5) In deciding whether or not to approve a statement of participant supports under subsection (2), the CEO must:
(a) have regard to the participant's statement of goals and aspirations; and
(b) have regard to relevant assessments conducted in relation to the participant; and
(c) be satisfied as mentioned in section 34 in relation to the reasonable and necessary supports that will be funded and the general supports that will be provided; and
(d) apply the National Disability Insurance Scheme rules (if any) made for the purposes of section 35; and
(e) have regard to the principle that a participant should manage his or her plan to the extent that he or she wishes to do so; and
(f) have regard to the operation and effectiveness of any previous plans of the participant.
Matters of which the decision-maker must be satisfied in relation to the funding or provision of supports
Subsection 34(1) provides:
(1) For the purposes of specifying, in a statement of participant supports, the general supports that will be provided, and the reasonable and necessary supports that will be funded, the CEO must be satisfied of all of the following in relation to the funding or provision of each such support:
(a) the support will assist the participant to pursue the goals, objectives and aspirations included in the participant's statement of goals and aspirations;
(b) the support will assist the participant to undertake activities, so as to facilitate the participant's social and economic participation;
(c) the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;
(d) the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;
(e) the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide;
(f) the support is most appropriately funded or provided through the National Disability Insurance Scheme, and is not more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or systems of service delivery or support services offered:
(i) as part of a universal service obligation; or
(ii) in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.
It is to be noted that all of these conditions must be satisfied in relation to each support.
In McGarrigle v National Disability Insurance Agency the Federal Court said:
Therefore, what is entered in a plan as a support becomes a determinative factor in the administration of the scheme. As the respondent submitted, by s 33(3), supports may be generally described or may be specifically identified. Either way, the function being performed on review by the Tribunal is to approve, vary of modify the supports as set out in a participant plan. In performing that function, the Tribunal must have regard to the matters set out in s 33(5), and form its satisfaction in accordance with s 34.[16]
[16] [2017] FCA 308 at [85].
National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth)
Sections 35 and 209 of the Act provide for the making of rules in connection with the funding or provision of reasonable and necessary, as well as general, supports. I will refer to these rules as the “Supports Rules”. As a Legislative Instrument, the Supports Rules bind the Tribunal in making decisions under the Act.
Part 5 of the Supports Rules sets out general criteria for supports and supports that will not be funded or provided:
General criteria for supports
5.1 A support will not be provided or funded under the NDIS if:
(a) it is likely to cause harm to the participant or pose a risk to others; or
(b) it is not related to the participant’s disability; or
(c) it duplicates other supports delivered under alternative funding through the NDIS; or
(d) it relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to a participant’s disability support needs.
5.2 The day-to-day living costs referred to in paragraph 5.1(d) do not include the following (which may be funded under the NDIS if they relate to reasonable and necessary supports):
(a) additional living costs that are incurred by a participant solely and directly as a result of their disability support needs;
(b) costs that are ancillary to another support that is funded or provided under the participant’s plan, and which the participant would not otherwise incur.
Supports that will not be funded or provided
5.3 The following supports will not be provided or funded under the NDIS:
(a) a support the provision of which would be contrary to:
(i) a law of the Commonwealth; or
(ii) a law of the State or Territory in which the support would be provided;
(b) a support that consists of income replacement.
In its judgement in McGarrigle v National Disability Insurance Agency the Federal Court said, in part:
[The rules] are an important element of the legislative scheme, introducing the ability to modify the operation of ss 33 and 34 by, for example, excluding certain kinds of supports… It is through the Rules that the executive is able to implement, within the federalism constraints imposed in s 209, some policy decision-making about the nature and extent of supports to be provided or funded under the NDIS.[17]
[17] [2017] FCA 308 at [43].
D: EVIDENCE
In this part I set out the evidence and make findings relevant to all of the claims made by Ms Milburn. I will refer to additional evidence in relation to particular supports sought by Ms Milburn later in these reasons.
D1: Evidence of Ms Milburn
Ms Milburn provided written statements dated 23 October 2017[18] and 27 June 2018[19] and gave oral evidence. A summary of her evidence is set out in the following four paragraphs.
[18] Exhibit A2.
[19] Exhibit A1.
All of the supports Ms Milburn claims, and which have been refused by the Agency, are reasonable and necessary by reason of the disabilities arising from the multiple medical conditions from which she suffers.
Turner Syndrome and Borderline Personality Disorder make it difficult for Ms Milburn to control her emotions. She becomes anxious, which inhibits her ability to focus on, and deal with, important tasks.[20]
[20] Exhibit A1 at [3].
Ms Milburn also suffers from arthritis and fibromyalgia, which are physically debilitating. It is important that she remains active and that she controls her weight. Her vision is significantly affected by macular degeneration; in particular, her spatial awareness is compromised.[21]
[21] Transcript, 12 September 2018, at 9.
When she gave evidence at the hearing Ms Milburn said:
… my support needs are getting more substantial. Like, I’m having a lot of falls, hence the black eye. So yes, I – it’s just got to a point where I’m not able to function as well as I should be or could be. So I’m needing help – more assistance with getting places like shopping and cleaning and as far as all my other activities go, like, going to the gym and all of that sort of thing, like it says in my statement it’s really important for me – for my longevity and being able to function because I have arthritis and fibromyalgia which is really debilitating. It’s really important for me to keep moving and maintain my weight because with Turner’s syndrome we have a metabolic problem which means that I tend to put on weight very easily and also what compounds that is I have an underactive thyroid so it’s kind of a double whammy. So it’s really important for me to keep active otherwise I risk getting diabetes and heart issues, which are part of Turner’s anyway.[22]
[22] Transcript, 12 September 2018, at 9.
D2: Evidence of Ms Smith, Psychologist
Ms Smith has been Ms Milburn’s primary clinician for the past three years.
Ms Smith provided reports dated 25 October 2017[23] and 6 September 2018.[24] She gave evidence at the hearing as a witness called by the Tribunal.
[23] Exhibit R1 at 49.
[24] Exhibit T3.
On 6 September 2018, Ms Smith reported, in part:
Richelle has been dealt very difficult cards in life. Her physical conditions have had implications for her emotional wellbeing in myriad ways due to the limited capacity of her environment to respond to her in a consistently caring, supportive and nurturing way. Most supports that Richelle receives are time limited, and this is detrimental to her wellbeing given that her disabilities are permanent and have physical, intellectual and emotional sequelae which effect [sic]:
1) mobility
2) communication
3) socialisation
4) self-management.
Richelle has very few informal supports as a consequence of her intellectual and physical impairments.[25]
[25] Exhibit T3 at 3.
At the conclusion of her report Ms Smith made the following recommendation:
In my opinion Richelle Milburn has a number of permanent disabilities that are likely to permanently and substantially reduce her functional capacity in a number of areas. She permanently require [sic] assistance from the NDIS to effectively manage the impacts of these disabilities.
Supports and equipment the patient may benefit from Based on Richelle’s needs and aforementioned goals and aspirations, it is my recommendation that the following services, supports, modification and equipment are required to support her to maintain functional capacity and manage with the impacts of several permanent intellectual, physical and mental health disabilities:
· glasses and/or assistive technology to optimise vision
· advocacy assistance
· transport to medical appointments
· transport for shopping
· intensive social and communication skill training that is appropriate for level of cognitive function
· social support in the home to reduce social isolation
· assistance to research and locate appropriate social groups, and practical assistance/social support to access community groups
· supports to enhance ability to attend community groups
· supports to engage in community activities and improve ability to independently complete activities of daily living
· intervention to assess and address communication, cognitive and social deficits, and to develop a consistent behavioural management plan to improve engagement and effectiveness of support
· practical assistance with household management tasks
· practical assistance with shopping and food preparation
· practical assistance with transport to appointments
· learning/advocacy assistance to maintain relationships and open communication between agencies and service providers
· coaching in communication strategies (in situ).[26]
[26] Exhibit T3 at 7-8.
At the hearing, Ms Smith said that she was aware that Ms Milburn's primary diagnosis was Turner Syndrome. She is treating Ms Milburn for Borderline Personality Disorder but acknowledged that the various symptoms of these conditions interact and are not easily separated.[27]
[27] Transcript, 13 September 2018, at 149.
Ms Smith said that Ms Milburn's conditions were treated by a multidisciplinary team within the community mental health centre. She said that the services of an Occupational Therapist working with Ms Milburn in the home to assist with functionality would be “a great idea.”[28]
[28] Transcript, 13 September 2018, at 159.
D3: Evidence of Ms Curdie-Evans, Occupational Therapist
Ms Curdie-Evans assessed Ms Milburn on 27 June 2018 at the request of the Solicitor for the Agency. She provided a report dated 13 August 2018[29] and gave evidence at the hearing.
[29] Exhibit R7.
Ms Curdie-Evans said that an Occupational Therapist could work with Ms Milburn, her treaters, her psychologist and her support workers to help improve her functional capacity and maintain her physical capacity. A plan and structured program could be developed which would be implemented within the confines of her NDIS plan. A complete community assessment of Ms Milburn's needs is required.
I will refer later to Ms Curdie-Evans’ evidence as to the particular supports sought by Ms Milburn.
E: CONSIDERATION OF THE CLAIMS FOR SUPPORTS ADDITIONAL TO THOSE PROVIDED IN THE EXISTING PLAN
E1: Transport and associated carer services
There are several aspects to Ms Milburn’s claim for supports by way of transport with a driver/carer:
·transport to medical appointments;
·transport to gym sessions, shopping excursions and singing lessons;
·transport from her home to Sydney Airport and return;
·transport to visit family members living on the South Coast of New South Wales.
Evidence of Ms Milburn
Since December 2017, Ms Milburn has engaged the services of Nonabel Transport Services Pty Ltd (Nonabel Transport) to transport her to and from medical appointments, a gym, singing lessons, shopping centres and other venues on a regular basis. She seeks to have the services of this particular provider, including a driver who acts as a carer, funded under the Scheme on a continuing basis.
Ms Milburn’s mother and grandmother live in the Batemans Bay area on the South Coast of New South Wales. Her grandmother lives in a nursing home and her mother is too unwell and does not have the room for Ms Milburn to stay with her. Her family in Queensland also do not have room to accommodate Ms Milburn. Ms Milburn provided a letter from her General Practitioner, dated 2 February 2018,[30] in which the Doctor expresses the view that these family visits allow Ms Milburn to “maintain key relationships which are vital to her emotional wellbeing and that she could not afford to visit on her pension.”
[30] Exhibit A1, Annexure RM2.
Ms Milburn says that she is unable to use public transport and taxis by reason of her physical and mental disabilities. She seeks support under the Scheme to meet her past use of the services of Nonabel Transport and support to enable her to use its services at a similar (and likely increasing) rate on an ongoing basis. She says that the disabilities to which I have already referred require the driver to also act as a carer during trips to and from the various venues she attends.
Summary of services provided by Nonabel Transport from 17 December 2017 to 4 June 2018[31] and from 5 May 2018 to 10 September 2018[32]
[31] Exhibit T1
[32] Exhibit R5.
On the basis of summaries provided by Nonabel Transport and agreed to by Ms Milburn, I am satisfied that the following services have been provided to her during the stated period:
·transport to and from medical, dental and legal appointments;
·transport to and from shopping centres, gym visits and yoga sessions;
·transport to and from Sydney domestic and international airports;
·transport to and from Wollongong and Taren Point;
·cooking and cleaning at Ms Milburn’s home.
These services included the assistance of the driver (in the role of a carer) and included waiting time while Ms Milburn attended appointments.
The total cost of the services provided to Ms Milburn by Nonabel Transport from 17 December 2017 to 4 June 2018 was $46,736.48.[33] This figure included amounts for cooking and cleaning. Excluding those cooking and cleaning costs which can be separately identified, the total for this period is approximately $44,239.00. This equates to approximately $1773.00 per week. This figure still includes some cooking and cleaning costs, but their inclusion would not make a significant difference to the weekly expenses incurred for transport and associated carer services.
[33] Exhibit T1.
Evidence of Ms ElEssraoui, Operations Manager at Nonabel Transport
Ms ElEssraoui provided two statements, one undated[34] and one dated 24 April 2018.[35] Ms ElEssraoui was called to give evidence by the Tribunal.
[34] Exhibit T1.
[35] Exhibit T2.
Ms ElEssraoui estimated that the ongoing cost of services to Ms Milburn, based on her current usage, is $85,000 per year. She described the services being provided as:
1. Transport to medical appointments, Grocery shopping, and general activities which allow her to live her life as autonomously as possible.
2. A carer that assists Richelle during her medical appointments and other outings, which she is unable to get through on her own, due to her being unwell.
3. A cleaner who comes to Richelle’s home once a week to perform all the household tasks that Richelle is unable to undertake. Helps maintain a sustainable living environment.
4. Assistance in cooking meals for Richelle to ensure she has well balanced meals to eat throughout the week.[36]
[36] Exhibit T2.
Ms ElEssraoui does not have any formal qualifications to assess Ms Milburn’s need for the services provided. Ms ElEssraoui alone makes the decisions to provide the services requested, which she bases on her experiences of the needs of the clients of Nonabel Transport. She approves services irrespective of Ms Milburn’s plan under the Scheme and the budget it contains.
Evidence of Ms Smith
Ms Smith recommended that, based on Ms Milburn’s needs, support be funded for transport for medical appointments and for shopping and practical assistance with these activities.[37]
[37] Exhibit T3.
Evidence of Ms Curdie-Evans
In relation to transport to appointments Ms Curdie-Evans reported:
This has ensured that Ms Milburn attends all medical, domestic and instrumental activities of daily living (Centrelink, Court, banks) and self-care (grooming and hairdressing) which is reasonable as a whole. However, the use of 1 on 1 transport is increasing and there is [sic] no functional and social reasons as to why this should occur (other than to attend medical appointments). The use of transport resources as noted previously has not had clear constraints and enabled an increased dependence on 1 on 1 services rather than increasing mainstream independence. The use of transport services on an on call basis and without structure will not in its structural program allow value for money and is not reasonable.[38]
[38] Exhibit R7 at 17.
The alternative proposed by Ms Curdie-Evans is:
Intervention by an Occupational Therapist to complete a community transport assessment and to implement an independent transport with Ms Milburn. This will support Ms Milburn (in conjunction with her psychologist) to increase independence in the community over a designated period of time. It will also provide clear boundaries on the usage of 1 on 1 transport.
These uses of Taxi/Uber will be significantly greater in value for certain transport arrangements. These have been detailed below.
Community transport options could be revisited and would be an alternate options for travel to family/or accommodation.[39]
[39] Exhibit R7 at 17.
Discussion
I understand that Ms Milburn’s dismissive and, at times, aggressive approach to experts who express views contrary to those held by her may often be a consequence of the several medical conditions from which she suffers. This was evident during the hearing. Nevertheless, all participants in the NDIS are subject to the Act, and to the Supports Rules made thereunder. As a decision-maker under the Act, the Tribunal is similarly constrained.
The support to be provided to Ms Milburn by way of transport and associated care has been the major issue in this application. Nonabel Transport is a registered provider under the Act. The company has provided Ms Milburn transport and assistance for appointments and shopping as well as other activities in which Ms Milburn is engaged and which she finds beneficial in dealing with her many significant disabilities.
Between December 2017 and the hearing of this application in September 2018, Nonabel Transport provided Ms Milburn with what appears to have been an “on-call” transport and carer service. The decisions to provide such services, as and when requested by Ms Milburn, were made by Ms ElEssraoui, the Operations Manager. Ms ElEssraoui has no professional qualifications or training to enable her to assess the needs of Ms Milburn or to determine the appropriate manner in which those needs should be met, if they are to be met at all. Ms ElEssraoui told the Tribunal that she is unaware if her supervisor, or anyone else in the organisation, is relevantly qualified.[40]
[40] Transcript, 13 September 2018, at 106 and 109.
As at the date of the hearing, Nonabel Transport had provided transport and carer services to Ms Milburn to a value far in excess of that agreed to be funded under the Scheme. Ms ElEssraoui has given evidence that she was unaware of the budget for the services provided at the time they were provided, and that “I think she [Ms Milburn] needs all the help she can get. At what cost, I don’t know. I’m not qualified to give that.”[41]
[41] Transcript, 13 September 2018, at 133.
Ms ElEssraoui’s approach to meeting Ms Milburn’s requests is illustrated in the following excerpt from her evidence:
I know these people. Like, at the end of the day - and this is not a criticism either but the NDIS looks at a bunch of forms and makes their decisions formulated on those forms. They don’t sit with the actual person. The person number crunching or typing the decisions, they don’t that person on a personal basis [sic]. They don’t know their pains, their ailments. They don’t know what they’re going through. They don’t know the tress [sic], they don’t know the anxiety. They don’t know the medical appointments. They don’t know that their situation is causing extensive stress and pressure on the household. There are people that are looking to give their children away because they can’t take it anymore. That’s not about money. I mean somewhere you have to realise that this - you’re looking at people’s lives. You’re actually looking at people’s lives and it doesn’t come back to the bottom dollar. It’s not always about that.[42]
[42] Transcript, 13 September 2018, at 113-114.
Ms Curdie-Evans, an Occupational Therapist, gave evidence that the actions of Nonabel Transport have enabled Ms Milburn to become increasingly dependent on one-on-one transport rather than increasing mainstream independence:
… when I was at the assessment, the usage of the one-on-one transport appeared to have no limits. There was a capacity to use Nonabel on any day at any set time, so there wasn’t structure. They had overextended the use of transport, whether there was a need or not …[43]
I accept this evidence.
[43] Transcript, 13 September 2018, at 79.
Ms Milburn’s treating Psychologist, Ms Smith, described as “excellent” the proposal that Ms Milburn have the assistance of an Occupational Therapist to assess Ms Milburn’s needs.[44]
[44] Transcript, 13 September 2018, at 158.
It is most unfortunate that, through Ms ElEssaroui, Nonabel Transport has acted in a way that has contributed to Ms Milburn becoming dependent on a level of care which cannot be provided under the Scheme. This is not in Ms Milburn’s best interests. While I acknowledge those provisions of the Act which emphasise the importance of the wishes and choices of participants, they do not mean that a participant and/or a registered provider can determine the supports to be funded. Obviously the Scheme would be unsustainable if it operated on such a basis.
Based on the evidence of Ms Curdie-Evans and Ms Smith, I have decided that the supports in Ms Milburn's current plan should be amended to include specific provision for transport and associated carer services. I emphasise that my reasons relate to the supports included in the current plan which is about to be reviewed, if the review has not already taken place. It is clear from the evidence before me that a full assessment of Ms Milburn's needs for transport and carer services should be carried out by an appropriately qualified expert. It is to be hoped that Ms Milburn will co-operate with this process. In my view, without such an assessment it will be very difficult for a decision-maker to reach a conclusion as to the reasonableness and necessity of the supports Ms Milburn may seek from time to time.
E.2: Music therapy
Ms Milburn gave evidence that attending one-on-one singing lessons was an enjoyable activity which improved her mood and social interaction.[45] She regards the lessons as being music therapy as they provide mindfulness and relaxation.[46] Ms Milburn seeks support to resume lessons with the same singing teacher she attended in the past.
[45] Transcript, 12 September 2018, at 14.
[46] Transcript, 12 September 2018, at 50.
In the opinion of Ms Curdie-Evans, Ms Milburn has not engaged in music therapy. She agreed that music therapy could be an option, “however, there are a number of other alternative treatments Ms Milburn is using and should be of greater priority.”[47]
[47] Exhibit R7 at 16.
On the basis of the evidence before me, I am not satisfied that the singing lessons for which Ms Milburn seeks funding are music therapy. I agree with the Agency’s contention that they are a recreational activity which should not be funded under the Scheme as “such activity falls within the range of recreational activity that members of the community are required to access privately, in this case at significant personal expense.”[48]
[48] Written Submissions of the Respondent dated 28 September 2018 at [62].
Ms Milburn is strongly of the opinion that she should be able to have the singing teacher of her choice. While this is true it does not follow that this activity should be funded under the Scheme. To support such a proposition, the Tribunal would need evidence of, amongst other things, the nature of the lessons, their therapeutic value, and their value for money. There is no such evidence in this matter.
E.3: Gym membership and personal training
I accept Ms Curdie-Evans’ evidence that:
Attendance at the local leisure centre by Ms Milburn does facilitate both social and community access. In addition, it assists her to maintain her physical condition and functional capacity in everyday living. Due to the nature of her illness, monitoring of her exercise program is required to ensure it is suitable as her physical condition can vary from day to day due to her changing medical conditions. A structured review process should be put in place with a personal trained.[49]
[49] Exhibit R7 at 16.
Further, I accept Ms Curdie-Evans’ evidence that the gym membership “is of value to maintain and improve Ms Milburn’s physical and psychological wellbeing,” but that personal training twice a week is not reasonable or of value.[50]
[50] Exhibit R7 at 16.
It was argued on behalf of the Agency that attending a gym (as distinct from the engagement of a personal trainer) is a part of the activities of everyday living. I do not accept this argument. I am satisfied that in Ms Milburn’s situation, the funding of gym membership satisfies all of the requirements of section 34 of the Act.
I have considered the provisions of the Supports Rules, in particular the rule that a support will not be funded if it relates to “day-to-day” living costs. I note the examples given of rent, groceries, and utility fees. While these are only examples, they are indicative of the costs of living which most members of the community incur in one form or another.
The same cannot be said of gym membership fees. While the Agency may be correct in saying that many people engage in fitness activities at a gym, it does not follow that the costs of gym membership “relates to day-to-day living costs”. In my view, it is in the nature of discretionary spending for those who do not suffer from a disability. On the basis of Ms Curdie-Evans’ evidence, I am satisfied that, in Ms Milburn’s case, it is attributable to her support needs.
I am satisfied that funding should be available for Ms Milburn to have membership of an appropriate gym and for support by a personal trainer for one hour per week. This is based on the evidence of Ms Curdie-Evans.
As recommended by Ms Curdie-Evans, a structured review should be put in place with a personal trainer. These are matters to be considered when Ms Milburn’s plan is being reviewed.
E.4: Transport and accommodation to visit family and to attend a conference
Ms Milburn is seeking funding for one visit per year each to the Sunshine Coast in Queensland and to Batemans Bay on the New South Wales South Coast. As set out earlier in these reasons, funding is sought for transport and accommodation.
Ms Milburn says that she needs transport by Nonabel Transport to and from Sydney Airport to enable her to travel to Queensland. She requires the services of a driver/carer to assist her with checking in luggage. She is able to travel alone on the flights to and from Queensland.
To enable her to visit her mother and grandmother in Batemans Bay in New South Wales, Ms Milburn says that she needs the assistance of a driver/carer to travel to and from Batemans Bay, a distance of approximately 275km each way. Ms Milburn says that her disabilities prevent her from travelling this distance by public transport.
Ms Milburn also gave evidence that for various reasons (including the lack of space) she is unable to stay with any of her relatives when visiting. She seeks accommodation at a commercial establishment.
As part of her core supports, Ms Milburn also seeks funding for travel, accommodation and attendance fees at a biannual Turner Syndrome conference. The expenses of her attendance at this conference were met under the State scheme as it was recognised as a valuable activity.[51]
[51] Exhibit A1 at [29].
The evidence Ms Smith
While Ms Smith recommended in her report that Ms Milburn be provided assistance for transport for medical appointments and shopping, she did not recommend the provision of transport or accommodation to visit family.
The evidence of Ms Curdie-Evans
In the opinion of Ms Curdie-Evans, it is appropriate for a community transport plan to be developed for Ms Milburn with the support of her family, case manager, and an Occupational Therapist. This should allow Ms Milburn to travel to the South Coast by public transport. The cost of a good quality fold-out bed to allow Ms Milburn to be accommodated by family members is approximately $270.00 to $350.00.[52]
[52] Exhibit R7 at 18.
Discussion
The Agency accepts that visiting family members is beneficial for Ms Milburn and that it would be distressing for Ms Milburn not to see her family for lengthy periods. I agree.
The Agency argued that, notwithstanding their beneficial value, the family visits should not be funded under the Scheme. It was put that such visits are no different for Ms Milburn than for any other member of the community wishing to visit family. On the evidence in this application, visiting family is not an activity that is related to her disabilities and funding under the Scheme would amount to income replacement, contrary to rule 5.3(b) of the Supports Rules.
I agree with the argument put on behalf of the Agency. In any event, there is insufficient evidence before me indicating that family visits are of therapeutic value. Further, I accept the evidence of Ms Curdie-Evans that there are alternatives available which represent greater value for money than the funding sought by Ms Milburn. These need to be investigated.
There is not sufficient evidence to allow me to be satisfied that the support sought in relation to the Turner Syndrome conference meets any of the requirements of subsection 34(1) of the Act. It may be appropriate, following proper assessment, that some support be made available in this regard, but this is a matter to be considered in relation to future plans.
As with a number of the other supports claimed, Ms Milburn took the view that funding should be provided for the conference as it had been provided under the earlier State scheme. It is important for Ms Milburn to understand that the simple fact of the provision of a particular support under another scheme does not mean it will be funded under the NDIS. To be funded under the NDIS, the support must meet the requirements of the Act and the Support Rules made thereunder.
E.5: Remedial massage
Ms Milburn seeks funding for a one-hour session of remedial massage once per week. The cost is $90.00 per session.
Ms Milburn gave evidence that the massage sessions she seeks to have funded assist her to cope with the pain associated with arthritis and fibromyalgia. When questioned about the nature of the massage, Ms Milburn said that it is “just remedial massage, just general massage. It’s nothing special, it’s just remedial massage.”[53] The day spa Ms Milburn seeks funding to attend was chosen by her and is near her home. There is no suggestion that the particular type of massage provided was determined as a result of any professional advice.
[53] Transcript, 12 September 2018, at 21.
The website of the day spa does not indicate that the massages offered are of particular therapeutic value.[54]
[54] Exhibit R3.
I accept the evidence of Ms Curdie-Evans that:
Intermittent use of remedial massage can be of benefit for chronic illness in partnership with other treatments. However, it should not be provided without a structured plan and on a weekly basis.[55]
[55] Exhibit R7 at 17.
The Solicitor for the Agency argued that the type of massage for which Ms Milburn seeks funding is a leisure activity. I agree with the submission that Ms Milburn has not provided information as to the qualifications of those providing the massages or the nature of the services provided.
When she gave evidence, Ms Milburn indicated that she is prepared to go to a physiotherapist for remedial massage to help with pain management. Remedial massage by a physiotherapist has been of assistance to her in the past.[56]
[56] Transcript, 12 September 2018, at 22-23.
While I am not satisfied that massage at a day spa should be funded under the Scheme, I note that Ms Milburn’s current plan is about to be reviewed and it is appropriate for consideration to be given to funding of appropriate massage according to a structured plan. This would satisfy the requirement of delivery of services in accordance with best practice.[57]
[57] Transcript, 13 September 2018, at 83.
E.6: Three pairs of bifocal glasses with prism lenses
In relation to the support sought Ms Milburn said that:
It is a symptom of Turners Syndrome that I have macular degeneration but also experience difficulties with spatial awareness. Having double vision also means my glasses need to be fitted with prism lenses.
Also, because I am photo sensitive I have significant issues with glare, so I need to have these glasses coated with anti-glare film.
…
I am currently without any everyday glasses as both pairs have broken. I am surviving on my sunglasses which are no good because I cannot read anything with them and I keep bumping into things and falling over because of my problems with depth perception. It’s basically dangerous for me to be with them and I keep bumping into things and falling over because of my problems with depth perception. It’s basically dangerous for me to be wearing sunglasses every day.[58]
This will provide Ms Milburn with a spare pair of glasses as well as a separate pair of sunglasses.
[58] Exhibit A1 and [30]-[31] and [33].
Ms Curdie-Evans gave evidence that this request was reasonable and that supply of the glasses would increase Ms Milburn’s capacity for social participation. She reported that the only alternative was the supply of standard lenses rather than prism lenses.[59]
[59] Exhibit R7 at 16.
The Agency argued that “[as] a general matter, glasses are everyday items that the NDIS would not fund, and therefore are day-to-day expenses caught by r 5.1(d) or having the effect of providing income replacement contrary to r 5.3(b).”[60] It was argued further that glasses are more appropriately funded through the health system (see subsection 34(1)(f) of the Act).
[60] Respondent’s Statement of Issues, Facts and Contentions dated 22 August 2018 at [32].
As to the appropriate source of funding it was put on behalf of Ms Milburn that:
s34(1) f): New South Wales Spectacles Program (“NSWMP”) funded by the DFCS provides free glasses and optical aids to financially disadvantaged residents of NSW. However, this program is means tested. One of the requirements of the means test is that a single person must have total assets of less than $500. Although, household items are not included under the assets test the Applicant has assets in access of $500 and is therefore ineligible to apply. The Applicant requires bifocal prism lenses and anti-glare coatings due to her photosensitivity. Enquiries made by the Applicant indicate that the even [sic] if she were eligible to apply under the NSWSP, anti-glare coatings, multifocal, and prism lenses are all only available at extra cost which due to her impecuniosity she would not be able to fund herself.[61]
[61] Applicant’s Statement of Facts, Issues and Contentions dated 20 July 2018 at [25].
On the basis of the evidence of Ms Milburn and Ms Curdie-Evans, I am satisfied that requirements (a) to (e) of subsection 34(1) of the Act are met. It remains to consider whether the support requested is most appropriately funded under the Scheme (see subsection 34(1)(f)).
On the evidence before me, I am not satisfied that prism lenses with the necessary coating are available to Ms Milburn through the New South Wales scheme. She is not eligible to apply for assistance under that scheme.
The test set out in subsection 34(1)(f) is whether the support is “most appropriately funded” [emphasis added] under the Scheme. The test refers to the appropriateness of the funding, not the support itself. In circumstances where a support satisfies the other requirements for funding, the requirements of subsection 34(1)(f) are met if that support is, for whatever reason, unavailable to the participant. This is consistent with the Tribunal’s decision in KLMN and National Disability Insurance Agency.[62]
[62] [2017] AATA 1815.
The Solicitor for the Agency referred me to the Tribunal’s decision in Young and National Disability Insurance Agency in which the Tribunal said, in part:
Whether or not funding is available through other general systems is not the test of whether it is most appropriately funded or provided through the NDIS. The fact that the health system does not fund entirely, or even at all, what is essentially clinical treatment, or some other form of support that is more appropriately funded through the health system, does not make it the responsibility of the NDIS.[63]
That decision is distinguishable from the facts of the present application, in that the Tribunal decided that the support being sought was “essentially clinical treatment”. Such treatment is not funded under the Scheme.[64]
[63] [2014] AATA 401 at [41].
[64] National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth), r 7.5.
E.7: Specially compounded prescription medicine
Ms Milburn has to have some of her prescription medications especially compounded, being those which would otherwise contain ingredients to which she is allergic. The compounding of medication is not a benefit available to her under the Commonwealth Pharmaceutical Benefits Scheme.[65]
[65] Exhibit A1 at [35]-[36].
A Health Summary Sheet[66] provided by Ms Milburn's General Practitioner, Dr Hoffman, lists the medications she is taking by reason of her Turner Syndrome.
[66] Exhibit A1, Annexure RM8.
Ms Curdie-Evans reported that the specially compounded medicine increases Ms Milburn’s capacity to manage her medical conditions and therefore maintain her social participation.
I do not have sufficient evidence before me to support the conclusion that the need for specially compounded medications is related to Ms Milburn's disabilities. In any event, as has been argued on behalf of the Agency, even if the cost was related to Ms Milburn’s disabilities, I am unable to decide on the available evidence how much of the cost of the medications is attributable to those disabilities. This is a matter which may be considered in future plans.
F. CONCLUSION
My decision only requires changes to Ms Milburn's plan of 14 July 2017.
This matter highlights the importance of a Participant in the NDIS co-operating with the Agency to ensure that the best evidence is available to enable a decision-maker to make the proper decision as to the reasonable and necessary supports which should be funded under the Scheme. Such evidence will usually be forthcoming when there is full co-operation between the Participant and the Agency.
The reviewable decision made 8 November 2017 will be set aside.
The matter will be remitted to the Respondent for reconsideration in accordance with the following Direction in relation to the statement of supports in Ms Milburn’s plan which came into effect on 14 July 2017:
(a)IT IS DIRECTED that Ms Milburn’s current plan be amended to include the following supports from and including the date of the commencement of the plan:
(i)transport to and from Ms Milburn’s appointments with her General Practitioner on 12 occasions per calendar year;
(ii)transport to and from 16 Specialist medical appointments each calendar year;
(iii)transport to and from Ms Milburn’s appointments with her Psychologist on 12 occasions per calendar year;
(iv)transport to and from Ms Milburn’s appointments with her Physiotherapist on 12 occasions per calendar year;
(v)transport to and from a gymnasium at Sutherland Leisure Centre once per week;
(vi)transport to and from Cronulla shopping precinct (or similar) twice per week;
(vii)funding for a support person to accompany Ms Milburn to all appointments with health professionals;
(viii)funding for a support person on visits to a local shopping centre twice per week for a period of up to two hours on each occasion in substitution for that previously provided;
(ix)funding for house cleaning assistance for a period of 260 hours per year in substitution for that previously provided;
(x)funding for assistance with meal preparation for 156 hours per year in substitution for that previously provided;
(xi)funding for assistance to attend social activities for 468 hours per year in substitution for that previously provided;
(xii)funding for the provision of three pairs of bifocal glasses (including one pair of sunglasses) with prism lenses;
(xiii)funding for the provision of support by a personal trainer at the gym attended by Ms Milburn for one hour per week.
I certify that the preceding 110 (one hundred and ten) paragraphs are a true copy of the reasons for the decision herein of Deputy President J W Constance
.................[sgd].......................................................
Associate
Dated: 8 February 2019
Date(s) of hearing: 12-13 September 2018, 20 December 2018, 29 January 2019 Solicitors for the Respondent: Australian Government Solicitor ANNEXURE A
Part 3: My supports
These are the supports that will help me work towards my goals.Family and friends
These are who the NDIS calls informal supports.My informal supports
·step sister - phone support only
·grandmother - phone support only
·cousin - phone support only
Services and community groups
These supports might include things like health or mental health services, schools or education services, community groups, sporting or hobby clubs, or other government services. These are what the NDIS calls ‘community and mainstream’ supports.My community and mainstream supports
·optometrist
·ophthalmologist
·mental health
·allergy/immunology
·gastroenterologist
·gynaecologist
·neurologist
·endocrinologist
·singing lessons
·yogo [sic]
·gym
NDIS reasonable and necessary supports budgets
I can choose how I spend the amount in each budget listed below by checking the NDIS price list and the matching supports on the NDIS website at ndis.gov.au/participantsWhere a support is listed in my plan as ‘stated’, I must purchase this support as it is described in my plan. I cannot swap ‘stated’ supports for any other supports.
Support area: Assistive technology Budget: $2,500.00 Details: STATED ITEM: Funding for your assistive technology to be considered based on recommendation submitted from a relevant practitioner to NDIS (that is a completed assessment and relevant quote). This recommendation will be considered against the reasonable and necessary consideration [Quote Required] How will the supports be paid: NDIS will pay my support provider directly for these supports
Support area: Improved daily living Budget: $3,511.40 Details: Individual assessment, therapy and/or training (includes assistive technology) (x20) How will the supports be paid: NDIS will pay my support provider directly for these supports
Support area: Increased social and community participation Budget: $700.00 Details: Contribution towards Community Participation Activities How will the supports be paid: NDIS will pay my support provider directly for these supports
Support area: Support coordination Budget: $7,000.00 Details: The participant has been streamed as a [sic] Intensive level participant because of her complex needs. Based on the complexity and capacity factors within the NDIA Coordination of Supports Framework it is reasonable and necessary to fund {number} hours of Support Coordination to assist plan implementation. This funded support will assist to achieve the goals in this plan, complement and build capacity of the participant and/or their informal supports. How will the supports be paid: NDIS will pay my support provider directly for these supports
Support area: Transport Budget: $1,606.00 Details: This funding is a contribution towards any transports related costs you incur during the plan period. This amount will be paid fortnightly into your nominated bank account on a pro-rata basis. How will the supports be paid: NDIS will pay me directly for these supports
Support area: Core supports Budget: $29,648.55 Details: Establishment Fee for Personal Care/Community Access (x1)
Assistance with personal domestic activities (x8)
Ass. to access community, social/rec acts - Standard composite (x4)
How will the supports be paid: NDIS will pay my support provider directly for these supports
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