Sanchez and National Disability Insurance Agency

This matter concerned an appeal by Ms Sanchez against a decision of the National Disability Insurance Agency (NDIA) regarding her eligibility for certain supports under the National Disability Insurance Scheme (NDIS). The core of the dispute revolved around whether the requested supports were "reasonable and necessary" in accordance with the *National Disability Insurance Scheme Act 2013* (Cth) and relevant operational guidelines, particularly in relation to Ms Sanchez's autism spectrum disorder. The Administrative Appeals Tribunal was tasked with reviewing the NDIA's decision.

The Tribunal was required to determine whether the supports requested by Ms Sanchez were related to her disability, whether they would assist her to pursue her NDIS plan goals, and whether they represented value for money. Specifically, the Tribunal had to consider if the requested supports were evidence-based, likely to be effective and beneficial, and if they were supports that should otherwise be provided through reasonable adjustments by other entities. A key legal issue was the interpretation of "reasonable and necessary supports" as defined by the NDIS Act and the NDIA's operational guidelines, including the requirement for a nexus between the support and the participant's disability.

In its reasoning, the Tribunal emphasised the NDIS Act's focus on a participant's functional capacity and the provision of supports to enable participation in personal and community life. It applied the criteria outlined in the NDIA's Operational Guidelines, which require supports to be related to the disability, help achieve plan goals, be value for money, and be evidence-based. The Tribunal found that Ms Sanchez had not demonstrated a sufficient nexus between her requested supports and her qualifying disability, nor had she provided sufficient evidence of a reduction in her functional capacity that would necessitate the requested level of support. The Tribunal noted Ms Sanchez's demonstrated ability to independently communicate, socialise, manage her daily living activities, and conduct business, which indicated a significant level of functional capacity.

Ultimately, the Tribunal affirmed the NDIA's decision, finding that Ms Sanchez had not satisfied the criteria for reasonable and necessary supports. The Tribunal concluded that the existing support worker hours were sufficient for Ms Sanchez's disability support needs and that the requested additional hours were not demonstrably linked to her disability or likely to improve her functional capacity in a way that warranted NDIS funding. The Tribunal also noted Ms Sanchez's obligation under the NDIS Act to notify the CEO of any changes in circumstances that might affect her plan.