SMYG and National Disability Insurance Agency

This matter concerned an application by SMYG (the Applicant) against the National Disability Insurance Agency (the Respondent) regarding the provision of reasonable and necessary supports under the National Disability Insurance Scheme. The Applicant, who has autism spectrum disorder, development coordination disorder, social anxiety disorder, hypermobility spectrum disorder, and an intellectual disability, sought reimbursement for past transport supports that had not been included in a previous plan. The Administrative Appeals Tribunal was required to determine whether it had the jurisdiction to order the Respondent to reimburse or backpay the Applicant for these past transport supports.

The Tribunal considered its powers under the National Disability Insurance Scheme Act 2013 (Cth), specifically section 99, which outlines the types of decisions that are reviewable. While the Tribunal was satisfied that Level 2 transport support was reasonable and necessary for the Applicant during the period of Plan A, and that other agreed supports such as psychology, pool membership, and School Leaver Employment Supports (SLES) were also reasonable and necessary, it concluded that it lacked the power to order the Agency to reimburse the Applicant for transport support that had not been funded in Plan A. The Tribunal noted that the Agency had subsequently included transport support in later plans and agreed that Level 3 transport support was reasonable and necessary once the Applicant was receiving SLES funding.

Despite acknowledging the Applicant's mother's request for reimbursement, the Tribunal determined that any such reimbursement for monies expended on transport support prior to the implementation of its decision, and the calculation of any reimbursed amount, was a matter for the Agency. Consequently, the Tribunal set aside the internal review decisions and remitted the matter for reconsideration. The directions included funding Level 2 transport support for a specific period, along with psychology, pool membership, and SLES funding, and Level 3 transport support from the date of implementation. The Respondent was directed to determine the appropriate mechanism for the provision of transport support funding and any reimbursement.