QTBR and National Disability Insurance Agency

This matter concerned an application by QTBR for review of a decision made by the National Disability Insurance Agency (NDIA) regarding the supports to be included in her NDIS plan. QTBR has multiple severe disabilities, including cerebral palsy, epilepsy, and profound sensorineural deafness. The Administrative Appeals Tribunal (AAT) was required to determine whether certain disputed supports requested by QTBR were reasonable and necessary under subsection 34(1) of the National Disability Insurance Scheme Act 2013 (Cth).

The primary legal issue before the Tribunal was to assess whether the remaining disputed supports, which included funding for an assistance dog, a Thermomix, intensive feeding therapy, communication support, intensive neurological and physical habilitation, low-cost assistive technology, and additional capacity building support for report writing, met the criteria of being "reasonable and necessary" for inclusion in QTBR's NDIS plan. This assessment involved considering the NDIA's Operational Guidelines, which stipulate that supports will not be funded if they are likely to cause harm, are unrelated to the participant's disability, duplicate other funded supports, or relate to day-to-day living costs not attributable to disability needs.

The Tribunal considered the evidence presented, including the testimony of QTBR's mother, regarding the severity and impact of QTBR's conditions, particularly her frequent and severe epileptic seizures and the associated risks. Despite the NDIA having approved a significant amount of funding and agreeing to some previously disputed supports during the proceedings, the Tribunal found that the remaining disputed supports did not meet the criteria for being reasonable and necessary. The Tribunal applied the principles outlined in the NDIS Act and relevant Operational Guidelines, weighing the evidence against these legal standards.

Ultimately, the Tribunal affirmed the NDIA's decision under review. This means that the additional requested supports that remained in dispute were not approved for inclusion in QTBR's NDIS plan, as they were found not to meet the necessary criteria.