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What is Reasonable and necessary?

“Reasonable and necessary” is the statutory test the NDIA applies when deciding whether to fund a support. The support must relate to the participant’s disability, represent value for money, be likely to be effective and beneficial, take account of informal supports, and not be the responsibility of another service system such as health or education.

The test comes from section 34 of the NDIS Act. Every funding decision, and every dispute about one, turns on it.

For providers, the practical consequence is evidentiary: a support is easier to justify at plan review when progress notes actually show what was delivered and what changed. Notes written as a compliance chore rather than a record of outcomes are the reason plans get cut.

Related terms

NDISThe NDIS is Australia’s national scheme for funding supports for people with permanent and significant disability. Each participant receives an individual plan with funded budgets, and chooses the providers who deliver their supports. It is administered by the National Disability Insurance Agency and funds around 700,000 Australians.NDIAThe NDIA is the Commonwealth agency that administers the NDIS. It assesses eligibility, approves participant plans and budgets, sets the price limits providers may charge, and pays claims submitted by registered providers. It is distinct from the NDIS Quality and Safeguards Commission, which regulates provider conduct.Progress notesProgress notes are the written record of what happened during a support: what was delivered, how the participant responded, and anything of concern. They are the primary evidence that a claimed support was actually provided, and they are what an auditor, a plan reviewer or a coroner reads when a decision is questioned.ParticipantA participant is a person whose access to the NDIS has been approved and who holds an individual, funded NDIS plan. The term is used in place of “client” or “patient” throughout the scheme, reflecting that the person directs their own supports rather than receiving a service allocated to them.

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