ZHTH and National Disability Insurance Agency

This matter concerned an application to the Administrative Appeals Tribunal for review of a decision made by the National Disability Insurance Agency (NDIA). The NDIA had made an initial decision regarding the Applicant's NDIS Plan, approving a certain amount for capacity building supports. The Applicant sought an increase to this budget, specifically for Applied Behaviour Analysis (ABA) therapy and Occupational Therapy (OT). The NDIA's internal review upheld the original decision, finding the requested additional supports were not reasonable and necessary under section 34 of the *National Disability Insurance Scheme Act 2013* (Cth), citing concerns about value for money, effectiveness, and the reasonable expectation of other supports. The Applicant then applied to the Tribunal for a review of the internal review decision.

The Tribunal was required to determine whether the additional ABA therapy and OT sought by the Applicant constituted reasonable and necessary supports within the meaning of section 34 of the NDIS Act. Specifically, the court needed to consider the criteria of value for money, effectiveness, and the reasonable expectation of other supports. The Tribunal also had to consider the application of various Supports for Participants Rules, including Rules 3.1-3.4, 7.8, 7.9, 5.1, and 5.2, which set out conditions under which supports would not be funded.

At the hearing, the NDIA conceded that its original decision was not correct and accepted that ABA therapy should be considered a reasonable and necessary support. The NDIA also agreed to the additional hours of OT requested for report writing, removing these items from contention. The remaining issues for the Tribunal to determine were the appropriate number of weekly hours for ABA therapy, the required supervision for this therapy, and associated transport costs. The parties agreed that a Level 2 therapy assistant was necessary.

The Tribunal set aside the NDIA's internal review decision and remitted the matter back to the NDIA with a direction to reconsider the Applicant's request for ABA therapy and attendant costs, taking into account the NDIA's concession that ABA therapy is a reasonable and necessary support.