The six reasonable and necessary criteria are the legislative backbone of every NDIS funding decision. Get them right in your evidence and your funding follows.
Where Reasonable and Necessary Comes From
Section 34 of the National Disability Insurance Scheme Act 2013 sets out the six criteria that must be satisfied before the NDIA will fund a support. These criteria are not optional and are not negotiable — every NDIS funding decision, from a $200 piece of consumable AT to a $700,000 SIL package, is made against the same six tests.
The Six Reasonable and Necessary Criteria
- —The support must assist the participant to pursue the goals, objectives and aspirations in their plan
- —The support must facilitate the participant’s social and economic participation
- —The support must represent value for money
- —The support must be effective and beneficial, having regard to current good practice
- —The support must take into account what it is reasonable to expect families, carers, informal networks and the community to provide
- —The support must be most appropriately funded by the NDIS rather than another service system (health, education, justice, child protection, mainstream housing)
Why FCAs Map to Each Criterion
A strong FCA report does not just describe impairment — it explicitly addresses each of the six criteria for every recommended support. We embed the criteria directly into our report template so the planner can tick each one as they read.
Common Reasons Supports Are Refused as ‘Not Reasonable and Necessary’
- —Insufficient evidence linking the support to the participant’s goals
- —Substitution of informal supports without sustainability analysis
- —Lack of comparative options evidence (especially for AT)
- —Overlap with another service system (health, education, aged care)
- —Quality of life supports framed without disability-specific function
Practical Tips to Strengthen Your Reasonable and Necessary Case
Always reference specific goals, quantify informal supports in hours and intensity rather than assuming they will continue indefinitely, provide comparative quotes for AT, and ensure the FCA explicitly addresses ‘why the NDIS and not another scheme’ for any support that sits near a system boundary.
Amy-Lynne is the Clinical Director at FCA Reports Australia and an AHPRA-registered Physiotherapist. She holds a Doctor of Physiotherapy from Bond University and a Bachelor of Exercise and Sport Science from the University of Tasmania, and leads clinical governance and peer review across the practice's NDIS Functional Capacity Assessments — working alongside Ryan Fuller to deliver defensible clinical evidence to NDIS participants Australia-wide.
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