O’Hearn and National Disability Insurance Agency

This matter concerned an application by Ms O’Hearn for review of a decision by the National Disability Insurance Agency (NDIA) regarding supports to be included in her NDIS plan. The primary dispute before the Administrative Appeals Tribunal (AAT) was whether a requested bathroom modification constituted a "reasonable and necessary" support under the *National Disability Insurance Scheme Act 2013* (Cth).

The AAT was required to determine if the proposed bathroom modification met the criteria for reasonable and necessary supports as defined by section 34 of the NDIS Act, specifically whether it represented value for money and was most appropriately funded or provided through the NDIS. While other supports were initially in dispute, the parties reached agreement on most, leaving only the bathroom modification as the sole issue for determination.

The Tribunal found that the requested bathroom modification, which included the removal of the existing bath and installation of a custom bath with a transfer bench and steps, along with a shower screen, met the criteria for reasonable and necessary supports. The NDIA conceded that the support was appropriate and not more appropriately funded by other service systems. The Tribunal was satisfied that the modification represented value for money, considering the quote of $19,974.22 and the significant benefits to Ms O’Hearn's personal care, safety, and functional capacity, which would also help prevent further functional decline and reduce the need for future supports.

The AAT set aside the NDIA's decision and substituted it with a new decision approving a statement of participant supports. This included the bathroom modifications, increased physiotherapy and hydrotherapy hours, medium-term accommodation, and various other core and capital supports, reflecting a total funded amount of $187,604.31.