Myth Busting: NDIS won't fund that

Submitted by bobb on Wed, 12/1/2022 - 09:55
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Chris Coombes

When chatting with colleagues, planners, or even looking at NDIS resources such as the “Would we fund it” page, you might come away with the impression that the NDIS doesn’t fund a specific support, that it’s forbidden. For example, someone might tell you, “the NDIS does not fund chiropractic”, or “the NDIS does not fund support worker hours for anyone under seven, or psychology for someone in prison without a release date, or yachts, yoga, spaceships, sex toys,” or… whatever. But the NDIS Act is silent on the specific supports that it won’t fund.

The table below lists 36 times where the NDIA has rejected a support, only to have the AAT overturn the NDIA’s decision. To put this in context, the AAT overturned 13 of 18 (72%) NDIS decisions that went to hearing in 2019-20 (Joint Standing Committee Report on Planning 2020: 215). Why does this matter? Imagine a pilot who can land a plane only 28% of the time. If the people trained to get NDIS decisions right are getting it so wrong so often, the blanket “NDIS won’t fund that” myths that circulate in the sector can only be described as misleading. The myth becomes disabling when, upon learning of a forbidden support, a participant withholds a request for that support in a planning meeting. So, what are the known myths?

36 BUSTED myths about supports NDIS won't fund

Myth 1
NDIS doesn’t fund: Chiropractic

 

Myth 2
NDIS doesn’t fund: 14–16 support worker hours per day for a young child living with parents, as found here and here.

 

Myth 3
NDIS doesn’t fund: Gym membership
 
Myth 4
NDIS doesn’t fund: Eyewear, as found here and here.
Myth 5
NDIS doesn’t fund: Literacy course
 
Myth 6
NDIS doesn’t fund: Transport above the NDIA’s imagined “Level 3” category
 
Myth 7
NDIS doesn’t fund: The faster, riskier wheelchair of two options
 
Myth 8
NDIS doesn’t fund: Taxi fares to and from TAFE and the gym
 
Myth 9
NDIS doesn’t fund: Music therapy
 
Myth 10
NDIS doesn’t fund: Personal training
 
Myth 11
NDIS doesn’t fund: Mileage for private vehicle use, as found here and here
 
Myth 12
NDIS doesn’t fund: Aeroplane tickets for carer to travel with participant twice a year
 
Myth 13
NDIS doesn’t fund: Registered nurse to deliver insulin
 
Myth 14
NDIS doesn’t fund: Portable lounge suction pump and oral hygiene devices
 
Myth 15
NDIS doesn’t fund: Multidisciplinary Cognitive Assessment
 
Myth 16
NDIS doesn’t fund: Applied Behaviour Analysis, as found here, here and here
 
Myth 17
NDIS doesn’t fund: Speech therapy – two hours per week for a child, as found here and here
 
Myth 18
NDIS doesn’t fund: Sex therapy, as found here and here
 
Myth 19
NDIS doesn’t fund: Scooter repairs and maintenance
 
Myth 20
NDIS doesn’t fund: Air conditioner
 
Myth 21
NDIS doesn’t fund: Interstate travel and accommodation to fit prosthesis
 
Myth 22
NDIS doesn’t fund: Driveway
 
Myth 23
NDIS doesn’t fund: 160 hours per year of psychology
 
Myth 24
NDIS doesn’t fund: 110 hours per year of behaviour support
 
Myth 25
NDIS doesn’t fund: Medical Alert (life buzzer) ongoing costs
 
Myth 26
NDIS doesn’t fund: Identification and training of assistance dog, as found here, here, here, here and here
 
Myth 27
NDIS doesn’t fund: Dance classes, as found here and here
 
Myth 28
NDIS doesn’t fund: Additional costs for operation of a modified vehicle
 
Myth 29
NDIS doesn’t fund: Stair-climber
 
Myth 30
NDIS doesn’t fund: Trial of one alternative therapy, including:
  • Art therapy
  • Horse therapy
  • Yoga
  • Pilates
 
Myth 31
NDIS doesn’t fund: Visual Alert System
 
Myth 33
NDIS doesn’t fund: Internet
 
Myth 34
NDIS doesn’t fund: A vehicle and vehicle modification
Myth 35
NDIS doesn’t fund: Single dwelling Specialist Disability Accommodation
Myth 36
NDIS doesn’t fund: Modifications for independent space on family residential block, as found here.

Reading decisions

You’ll notice I’ve left out decisions where the AAT agreed with the NDIA about the support not being reasonable and necessary. Even where the AAT agrees that the support is not reasonable and necessary for the participant at the hearing, that support may still be reasonable and necessary for someone else, or for that same person who loses function later. The AAT (following the NDIS Act) places great importance on individual factors like functional capacity plus environmental factors like presence of informal supports, multiple disabled people in the family, and so on. Many of the matters above, such as the vehicle, internet, and sex therapy, were “exceptional” circumstances. While they are not precedents, AAT decisions can offer inspiration when thinking through what supports people have been funded in the past and what evidence they needed to collect.

Tools for social change

Trailblazers who have gone to the AAT have not only helped other participants, Allied Health therapists and planners to consider outside-the-box supports. They’ve also led to decisions that shape policy and public discussion. The AAT and the Federal Court’s decision on WRMF and sex therapy will soon feature in an operational guideline (Senate Questions on Notice 2021).

 

Outside the occasional sensational issue, many decisions will appear unremarkable at first glance. Given that the intention of the NDIS is to promote community participation, you might be wondering why a person must go all the way to the AAT to get a portable suction pump funded (Medcalf). This decision, as well as Mazy vs NDIA, however, invite the NDIA to reconsider where to draw the line between health and disability – where the NDIA won’t fund supports that appear more appropriately funded by the health system. When the NDIA includes decisions like these in operational guidelines and material that you and I can access, participants have more examples, and an understanding of the level of evidence required, from which to draw when seeking similar supports.

Forbidden supports

To the participants, families, and advocates who have endured an external review, you deserve our appreciation for making this list possible. Not only have you finally received the support you need, but you have also busted some myths for others. While I’ve discussed the “what” of AAT decisions, I’ve not addressed the “how” behind securing these supports. The “how” of gathering evidence and arguing for forbidden supports deserves more time and nuance for each support type. Look for our new series called We Wouldn’t Fund It,which dives deep into the learnings from decisions at the AAT level.

Links

Sara Gingold's brilliant analysis of Assistance Animals V NDIA is here.

Stunning analysis of case law contained in 2021 AAT decisions by two leading NDIS lawyers, Chadwick Wong and Dr. Darren O’Donovan, can be found here.

Because I'm not a lawyer and this is not legal advice, do seek some individualised advice. Non-legal advocacy can be found here - and hit up your state legal aid service and ask for a referral to their NDIS reviews team.

from https://teamdsc.com.au/resources/we-wouldnt-fund-that