QXDY and National Disability Insurance Agency

This matter concerned an application by QXDY (the applicant) against the National Disability Insurance Agency (the respondent) regarding the determination of reasonable and necessary supports under the National Disability Insurance Scheme Act 2013 (Cth). The core dispute revolved around whether certain requested supports, specifically transport and one dance class per week, were reasonable and necessary for the applicant, who had been diagnosed with Autism Spectrum Disorder (ASD) and other conditions including solar urticaria and photo aggravated eczema. The Tribunal was tasked with assessing these supports against the criteria set out in the Act.

The legal issues before the Tribunal were whether the disputed supports met the definition of "reasonable and necessary" as defined by section 33(2)(b) of the Act. This required the Tribunal to consider whether the supports satisfied the criteria in section 34(1) of the Act, which include whether the support would help the participant's social and economic participation, represent value for money, and be effective and beneficial having regard to good practice. The Tribunal also implicitly considered whether the supports related to the applicant's diagnosed disabilities and whether they could be harmful.

The Tribunal's reasoning focused on the evidence presented, particularly the statement of the applicant's mother, who provided detailed information about the applicant's medical history and management plan. While acknowledging the mother's strong views on the diagnosis of solar urticaria, the Tribunal found the evidence insufficient to sustain the request for transport, as it did not directly demonstrate how it would assist the applicant's development or participation, represent value for money, or be effective and beneficial. However, the Tribunal was satisfied that one dance class per week was a reasonable and necessary support, given the applicant's ASD diagnosis.

Accordingly, the Tribunal varied the reviewable decision to include one dance class per week as a funded support. The Tribunal also expressed a strong opinion that the applicant's mother and the respondent should collaborate to identify a qualified dermatologist to establish a conclusive diagnosis of the applicant's skin condition, thereby ensuring appropriate future supports.