PYQJ and National Disability Insurance Agency

This matter concerned an application by PYQJ, a child participant in the National Disability Insurance Scheme (NDIS), for review of an internal review decision made by the National Disability Insurance Agency (NDIA). PYQJ's parents sought funding for her to attend the Little Learners program at Autism Partnership, which would provide Applied Behaviour Analysis (ABA) therapy and associated services. The dispute centred on whether these requested supports constituted "reasonable and necessary supports" under section 34(1) of the *National Disability Insurance Scheme Act 2013* (Cth).

The Tribunal was required to determine the type and level of supports that should be considered "reasonable and necessary" and included in PYQJ's statement of participant supports (SOPS). Specifically, the Tribunal had to assess the evidence regarding the necessity of 31 hours of ABA therapy per week, considering its sustainability in light of PYQJ's age and attendance at day-care or kinder. The Tribunal also needed to consider the NDIS principle of increasing community and mainstream participation, and the promotion of a family-centred approach in early intervention.

The Tribunal found that while centre-based ABA therapy and some associated services, such as weekly speech therapy, should be funded, they should not be funded at the level requested. The NDIA's internal review decision had noted insufficient evidence to demonstrate that 31 hours of therapy per week was required for PYQJ to progress towards her NDIS goals, nor that a lesser intensity would be less effective. Furthermore, the NDIA considered that reducing attendance at mainstream day-care or kinder would contravene the NDIS principle of promoting community and mainstream participation. The Tribunal was also concerned about the lack of information regarding family participation in the ABA program and the parents' over-utilisation of previously approved funding, which presented a risk to future supports.

Consequently, the Tribunal set aside the NDIA's decision and remitted the matter with directions to facilitate the making of a new SOPS for PYQJ. This new SOPS was to include some, but not all, of the requested supports, with a warning to PYQJ's parents regarding the expectation to utilise funding in line with the plan's intent and to budget it for the 12-month period.