VXDY and National Disability Insurance Agency

This matter concerned an application by VXDY against a decision of the National Disability Insurance Agency (NDIA) regarding the provision of reasonable and necessary supports under the National Disability Insurance Scheme. The dispute centred on whether four specific supports – access to a sex worker, podiatry, remedial massage, and physiotherapy – should be funded by the NDIA. The Tribunal was required to determine if these supports were reasonable and necessary in light of VXDY's diagnosed mental and physical health conditions, which he stated were exacerbated by a workplace injury.

The legal issues before the Tribunal were whether the requested supports met the criteria of being "reasonable and necessary" under the National Disability Insurance Scheme Act 2013 (Cth). This involved considering the purpose of the Act, the legislative context, and the specific facts of VXDY's case, including the link between his impairments and his full participation in the community. The Tribunal also had to consider whether these supports were effective and beneficial according to best practice, and whether they duplicated other forms of therapeutic support.

The Tribunal reasoned that while sexual activity and expression could legitimately fall within the scope of the Act, the specific support of a sex worker was not considered reasonable and necessary in this instance. The NDIA contended that this support was not value for money, as other comparable supports might achieve similar outcomes at a lower cost, and that it was not effective or beneficial according to good practice. The Tribunal noted that physiotherapy was excluded by rule 7.5(a) and (c) of the NDIS rules, which prohibit funding for the clinical treatment of ongoing health conditions or goal-oriented therapies directly related to a person's health.

Ultimately, the Tribunal set aside the NDIA's decision and substituted it with a decision that the requested supports, namely access to a sex worker, podiatry, remedial massage, and physiotherapy, were not reasonable and necessary supports and therefore not to be funded by the NDIS.