Payments by NDIS or payments by health system?

Young v National Disability Insurance Agency [2014] AATA 401 is the second AAT decision regarding the National Disability Insurance Scheme. This application for review focused on whether the costs of certain ‘reasonable and necessary supports’ should be paid by the NDIS or funded through the health system.

The applicant suffered diabetes, emphysema and other medical conditions: [1]. He was accepted as meeting the age, residence and disability criteria but the supports approved did not include claims for a  portable oxygen concentrator or an insulin pump. Health funding was available for some forms of oxygen supply, but not usually for a portable oxygen concentrator: [11]. Health funding was available for injection insulin, but not for a pump (other than for persons under 18 years of age: [22].

The decision focused on section 34(1)(f) of the Act:

(f) the support is most appropriately funded or provided through the National Disability Insurance Scheme, and is not more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or systems of service delivery or support services offered: 
    (i) as part of a universal service obligation; or 
    (ii) in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.

At [36] the Tribunal appears not to have accepted that the absence of the two items claimed would prevent the applicant from undertaking all activities of daily living.

The Tribunal held at [40] that the fact that the health system does not fund what is essentially clinical treatment or some other form of support that is more appropriately funded through the health system, does not make it the responsibility of the NDIS.