What do “reasonable and necessary” mean for NDIS home modifications?
What does “reasonable and necessary” mean in the NDIS?
It’s a good question, and one of the most important when planning any NDIS supports, including NDIS home modifications. Understanding which modifications qualify as “reasonable and necessary” is key to a successful funding application.
Understanding what these criteria actually means and how best to address them is essential for avoiding time-consuming resubmissions.
So, what does it mean exactly?
What does “reasonable and necessary” mean in the NDIS? How the NDIS decides what counts as an NDIS modification
The NDIS will provide funding for a wide range of different home modifications – provided that they’re directly disability relevant. This can cover a wide range of different modifications depending on the participant.
Instead of using a set list of approved modifications, the NDIS instead uses the “reasonable and necessary” criteria when determining whether to approve a home modification application. This grants more freedom and flexibility in choosing the right supports for participants’ unique needs and abilities.
What counts as “reasonable and necessary” is open to interpretation, and is a part of the application process that can sometimes be overlooked by both NDIS participants and Occupational Therapists alike. The result is home modification applications that are rejected and wasted time reapplying. Understanding what counts is key to understanding what’s likely to be approved, which in turn is key to a successful application.
How the NDIS decides if a home modification is reasonable and necessary
“Reasonable and necessary” means supports that are essential to supporting participants with their goals (necessary), while also being practical and not excessively expensive (reasonable).
In assessing whether a support is reasonable and necessary, Section 34 of the NDIS Act lists a range of different criteria. While some of these criteria are more relevant than others in most home modification applications, it’s still important to address each of these points.
The proposed support must…
… be directly related to a participant’s disability
The NDIS will not fund home modifications that are irrelevant to the participant’s abilities or the barriers they face in day-to-day life. For example, while it may fund ramp installation for a participant who uses a wheelchair, it’s less likely to fund lighting improvements unless the participant also lives with impaired vision.
… support the participant in pursuing their unique NDIS goals
In addition to directly relating to the participant’s abilities, supports should also directly relate to the participant’s specific NDIS goals. For example, a participant whose goal is to return to full employment may have the sub-goal of getting back behind the wheel. In this case, that can mean applying for vehicle access modifications such as ramps or wheelchair lifts in the garage.
… facilitate participation in society and employment
Social and economic participation are critical to everyday life. Home modifications need to directly or indirectly help participants join in social outings, recreation, work, or study by reducing the disability-related barriers that prevent them from participating.
… represent good value-for-money
In assessing this, the NDIS looks at potential alternatives that could achieve the same goal for a significantly lower cost. For example, when assessing an application for stair lift installation, the NDIS may assess whether the same could feasibly be achieved using ramps. It also considers long-term costs, and whether the proposed support will reduce the need for other supports in the future.
… be effective and beneficial
The modification must either improve the participant’s abilities, or help them continue doing the things they currently do. It must have (or be likely to have) a tangible benefit for the participant based on current evidence, best practices, as well as what’s worked for the participant in the past. Luckily, there’s a long history of different home modifications helping people with disability maintain their independence to refer to.
… account for “informal” supports
While not as relevant for home modifications, support provided by family, friends, and community members is still something that’s considered when assessing applications. The NDIS may not approve applications if it believes it’s a family member’s duty (eg. funding a support worker for certain daily tasks like laundry or cooking if the participant lives with family who are able to help).
… not be more appropriately offered through other funding schemes
There are many other funding schemes available for people with disability. One of the key criteria when assessing NDIS home modification applications is determining whether or not schemes such as Home Care Package (HCP), Department of Veterans Affairs (DVA), Transport Accident Commission (TAC), or Work Cover funding would be more appropriate.
What’s the best way to get a home modification application approved by the NDIS?
The “reasonable and necessary” criteria are relatively broad. This is by design – the goal of the NDIS is to grant participants greater control over their supports, and broader criteria allow participants more flexibility in choosing supports that fit their unique needs.
Participants have more flexibility in what supports they can apply for. Getting them funded however is a different story. The key to success is a home modification application that addresses each of the key points.
Here are some things that can be done to strengthen an application.
A detailed OT report is key
An OT report is a comprehensive document written by an Occupational Therapist following a Functional Capacity Assessment. This report outlines the participant’s abilities and the limitations they face. It follows up by making recommendations for specific supports to support independent living and achieve participants’ goals.
The more detail included in this report, the higher the likelihood of home modifications being approved. In particular, the report should focus on drawing a direct link between the participant’s abilities and goals and the proposed modification, with a particular focus on how the proposed modifications will address those.
Include itemised quotes where possible
One way to demonstrate value-for-money during the application process is to include itemised quotes for all modifications and supports in the proposal. This is especially important for addressing the cost-effectiveness and value-for-money approval criteria.
By providing highly-detailed, itemised quotes for suggested modifications, OTs and participants can increase the likelihood of applications being accepted. The NDIS builder engaged for the project should be able to help here by providing specific numbers.
Directly address the approval criteria
When making a home modification applications, proposals should directly address the “reasonable and necessary” criteria laid out in the NDIS Act. By directly referring to each point, as well as how the proposed modification addresses each point, OTs can maximise the likelihood of a proposal being approved.
Organise documentation in advance
In addition to OT reports and supporting documents, NDIS home modification applications should also feature documents from relevant stakeholders and third parties. Obtaining approvals from body corporates and the council in advance and including them as part of the supporting documentation can improve the odds of a home modification application being approved.
How our NDIS-registered builders can help
Unlike other NDIS-approved builders in Melbourne, the team at Restore Home Modifications come from allied health backgrounds. We have worked on both the clinical and construction side, so our NDIS builders can are able to offer support to both Participants and Occupational Therapists with home modifications applications:
- Determining what’s “necessary and reasonable” for participants
- Drafting home modification applications
- Providing suggestions and alternatives that are more likely to be approved
Whether you’re an Occupational Therapist or an NDIS participant who’s self-manging their funding, get in contact with our builders today. We can be reached on 1300 333 746 – alternatively, click here to request a quote.