PNFK and National Disability Insurance Agency

This matter concerned an application by PNFK, a child with multiple impairments including severe hypoxic ischaemic encephalopathy, profound global developmental delay, cerebral palsy, seizures, and feed intolerance, against the National Disability Insurance Agency. The dispute centred on the provision of reasonable and necessary supports under the National Disability Insurance Scheme, specifically regarding the hours of care and support coordination required for PNFK. The case was heard by Professor R McCallum AO, Member, of the Administrative Appeals Tribunal.

The primary legal issue before the Tribunal was to determine the appropriate quantum of reasonable and necessary supports for PNFK, as defined by section 34 of the National Disability Insurance Scheme Act. This involved assessing the evidence regarding PNFK's profound care needs, including one-on-one supervision, assistance with all daily living activities, and the necessity of respite for her family. The Tribunal was required to consider whether the existing funding and hours allocated in PNFK's participation plan adequately met these needs, particularly in light of her severe medical conditions and dependence.

The Tribunal's reasoning was informed by the detailed evidence presented by PNFK's father, which described the child's extensive medical conditions and her critical need for constant, one-on-one care to prevent distress and life-threatening situations. The parties ultimately reached an agreement on a varied decision, which was made pursuant to section 26(1)(b) of the Administrative Appeals Tribunal Act 1975. This agreement did not represent a final determination on the substantive issues but ensured the continued availability of funding for reasonable and necessary supports until the proceeding was finalised.

The agreed orders varied the Respondent's decision dated 17 June 2017. Key variations included an increase in funding for support coordination to 100 hours, and significant increases in funding for improved daily living and core supports. The Tribunal also detailed specific hours of care to be provided on standard weekdays, weekends, long weekends, during family annual leave, and for public holidays, reflecting an enhanced provision to meet PNFK's complex needs and provide respite for her family.