To date, Plan Managers have had the reasonable and necessary checklists, ensuring that any expenditure:
- Is related to the participants disability;
- assists to meet goals;
- encourages community participation;
- is effective; and
- does not replace other established community supports.
Now, with the release of the NDIS Plan Management guide, the role of NDIS plan management has been further defined with plan managers being encouraged to hang up the checklists, and focus rather on implementing what is actually stated in the Individualised Plan (“Plan”).
“A Plan Manager, or Support Coordinator does not extend to determining whether supports or services which have been purchased are ‘reasonable and necessary’.”
Reasonable and necessary is solely determined by the NDIS delegate and has been decided and documented in the Plan.
What does this mean for Plan Managers and Participants?
Only the plan determines if expenditure is allowable. If it is not in the Plan, then it is not allowed and the participant or any third party cannot use the reasonable and necessary test to make it allowable.
Plan Managers have a responsibility to ensure that a participants spending is in accordance with the plan wording, and stated:
- generally in the plans Core funding showing a clear link to goals
- specifically in the participant’s plan (stated supports),
- within price limits from the NDIS price guide
A plan manager cannot approve payment from plan funds for supports and services that are excluded by NDIS, or that exceed the NDIS price limits. In addition, NDIS Plans will never pay for expenditure that:
- is not linked to a disability;
- replace supports that would usually be provided by family or friends;
- include supports provided by other government agencies (for example, dental, health or hospital services); and
- include any gap fees for Medicare.
Plan Managers will communicate to Participants expenditures that cannot be paid, where there is uncertainty advice needs to be sought by the Local Area Coordinator or NDIS planner.
Plan Managers do not:
- determine what is reasonable and necessary
- decide what supports a person can access
Plan Managers do:
- ensure the plan is implemented as intended, within budget and in accordance with the plan
- enforce the price guide
- support people to understand their plan and the rules around how it can be spent
- not participate in fraud or the misuse of funds