PBZB and National Disability Insurance Agency

This matter concerned an application by PBZB, a seven-year-old boy diagnosed with Autism Spectrum Disorder (Level 2), and his parents, against a decision of the National Disability Insurance Agency (NDIA). The dispute centred on the NDIA's refusal to fund Applied Behavioural Analysis (ABA) therapy as a reasonable and necessary support under PBZB's NDIS plan. The NDIA's internal review had affirmed the initial decision, finding that the requested ABA therapy did not meet the criteria of being value for money or effective and beneficial, particularly in light of existing funded supports and PBZB's age.

The Tribunal was required to determine whether the NDIA's decision to refuse funding for ABA therapy was correct, specifically considering the criteria for reasonable and necessary supports under section 34 of the NDIS Act 2013 (Cth). This involved assessing whether the proposed therapy was value for money, effective, and beneficial, and whether the Tribunal had jurisdiction to consider the inclusion of supports from the date of approval of a Statement of Participant Supports. The Tribunal also had to consider the weight to be given to the evidence presented.

The Tribunal found that the NDIA reviewer had erred in their assessment of the evidence regarding the ABA therapy. While acknowledging the NDIA's discretion in determining the weight of evidence, the Tribunal concluded that the reviewer had not adequately considered the evidence supporting the effectiveness and necessity of ABA therapy for PBZB, particularly in preparing him for school. The Tribunal noted that the reviewer's assessment of "value for money" and "effective and beneficial" was based on an insufficient understanding of the proposed therapy and the existing supports. The Tribunal also confirmed its jurisdiction to consider supports from the date of approval of a Statement of Participant Supports.

Consequently, the Tribunal set aside the NDIA's decision and remitted the matter back to the NDIA for reconsideration. The NDIA was directed to facilitate the approval of a new Statement of Participant Supports for PBZB, incorporating the necessary therapeutic interventions as outlined in the Tribunal's decision.