Occupational Therapy Australia

NDIS Access – OTA Submission

– October 2026

Introduction

About Occupational Therapy Australia

OTA is the peak professional body representing occupational therapists nationally.

We empower and elevate over 36,000 occupational therapists who in turn work in partnership with individuals and communities to enable meaningful participation in the activities of life.

We’re the single, unifying connection point for occupational therapists across the nation, leading the profession through education, support, and advocacy, so every occupational therapist is informed, inspired and fulfilled in their profession.

As one of Australia’s largest allied health workforces, occupational therapists provide essential supports across primary care, aged care, disability, mental health, veteran care and more.

About Occupational Therapy

Occupational therapy is a person-centred allied health profession concerned with promoting health, wellbeing and participation through engagement in meaningful and necessary occupations. Occupational therapists understand that a person’s ability to participate is shaped by the interaction between their individual capabilities, the tasks they want to do, their physical and social environment, and the supports available to them.

This way of understanding function sits at the centre of clinical practice. Occupational therapists are trained to assess what a person can do in the context of their actual daily life, at home, at school, at work and in the community. That means looking beyond whether a task can be performed once, in a controlled setting, to whether it can be performed safely, repeatedly and reliably over time, and to what a person needs by way of assistive technology, modification, informal support or the removal of a barrier in order to do so.

It also means recognising that capacity and participation can fluctuate, that what is observed or reported on a single day may not reflect a person’s typical experience across environments and activities, and that communication, cultural context and the interaction between co-occurring conditions can all shape what a good assessment needs to capture.

Occupational therapists are already embedded across the NDIS, conducting functional capacity assessments, recommending assistive technology and home modifications, and supporting people to build the skills and routines that reduce reliance on paid support over time.

Recommendations

Independence and accountability

1. Amend principle 1 to state that no individual access decision may be made, or influenced, by Scheme-wide cost or budget targets.

2. Outcome monitoring and audit:

   • Monitor and report publicly on access outcomes from the outset across a range of factors, including disability type, functional domains, geography, cultural background, access to existing evidence, assessment pathway and contextual data collected at assessment.
   • Set defined thresholds, such as a disproportionate decline rate for any group or pathway, that automatically trigger an independent review of assessment practice.
   • An independent body should also periodically audit a sample of decisions for the quality of the clinical reasoning applied, reported separately from any throughput or cost metrics.

Qualified assessment and clinical governance

3. Amend principle 3 so that access assessments are conducted, or at least clinically overseen, by allied health practitioners who hold relevant qualifications and who can demonstrate the requisite capability through endorsement or other forms of recognition, and documented clinical supervision for those who do not hold such qualifications.

4. Clinical governance pathway:

   • Introduce a defined escalation route where available information indicates that additional clinical expertise is required to understand the person’s needs, including referral to a qualified clinician.
   • Refer borderline or contested applications to a small multidisciplinary panel including relevant allied health expertise.
   • As part of this pathway, a practitioner independent of the NDIA should review every declined application before it is finalised.

A strong evidence base

5. Require input from an independent professional already working with the applicant, including an occupational therapist where relevant, to be a part of every NDIA access decision where required to establish functional impact or resolve uncertainty, even where the NDIA makes the final determination. This input should be proportionate to the complexity of the application, and could take the form of a brief structured template or existing clinical records.

6. Evidence standards and rights:

   • Require in-house assessments to meet a defined minimum evidentiary standard comparable to a report from an independent professional already working with the applicant.

• Confirm the right of applicants and their professionals to submit supplementary evidence at any point before a decision is finalised.

7. Applicants, and where relevant a family member, carer or support worker familiar with their day-to-day functioning, should be given a structured way to provide everyday, pattern-based functional evidence, as a standard input alongside direct observation and clinical or OT evidence.

8. Existing clinical documentation, including reports from a professional already working with the applicant, should be accepted as valid evidence under the new process.

9. Collect contextual and environmental information as part of every NDIS access decision, clearly separated from the access decision itself, so it exists in the person’s record for planning purposes even though it plays no role in determining eligibility.

10. Consider contextual evidence excluded at first assessment where a person seeks review of an access decision.

Assessment that reflects diverse and changing needs

11. Introduce an explicit mechanism to the decision-making process, such as a supplementary evidence pathway, multiple assessment time points, or defined clinical discretion, for circumstances identified as complex, fluctuating or episodic.

12. Validate any assessment tool for First Nations peoples and CALD communities before national rollout, with cultural safety built into assessor training and on-country assessment options, and publish the validation evidence, including which populations were involved in testing.

13. Incorporate an explicit mechanism for evaluating compounding impact into the assessment methodology.

Permanence

14. Require functional evidence of improvement under the permanence test, such as the ability to perform an activity safely, repeatedly and in real-world settings, rather than accepting a clinical or surgical outcome measure as a proxy for functional improvement.

15. Assess permanence against real-world access to treatment - where an identified treatment is not genuinely accessible within a reasonable timeframe, the impairment should be treated as permanent.

16. Explicitly confirm that a person’s right to decline consent to a proposed treatment cannot be treated as a basis for an adverse permanence finding, given the human rights obligations principle 1 already commits to.

17. For episodic, fluctuating or degenerative conditions, permanence should be evidenced through pattern over time, drawing on longitudinal clinical history.

A proportionate and accessible process

18. Tiered assessment model:

    • Adopt a tiered assessment model, where assessment intensity scales to the level of uncertainty about a person’s eligibility.
    • Include a fast-track category for applicants whose existing documentation clearly demonstrates profound, permanent impairment. Base fast-track eligibility on the strength of existing documentation, not diagnosis.

19. Avoid unnecessary reassessment where existing evidence from an appropriately qualified professional already captures the applicant’s functioning in natural settings. Where further assessment is needed, use proportionate and flexible methods that address only the gaps in existing evidence, including video conferencing where appropriate and with the applicant’s consent.

20. Provide a short, structured pre-lodgement tool that tells a prospective applicant, based on their circumstances, roughly what evidence they are likely to need before they apply.

21. Application and guidance materials should be co-designed with people with disability, families and carers, including those with cognitive, communication or complex support needs, so the language and format of what’s required is genuinely accessible.

22. Accompany every decision with a plain-language explanation of the reasoning, listing all evidence considered and explaining where supplementary evidence did not change the outcome, and a named contact point with their phone number and email address.

Workforce and transition readiness

23. Fund targeted training, credentialing pathways and incentives, such as loading or relocation support, to build the assessor workforce in rural, remote and First Nations communities ahead of the 2028 commencement date.

24. Commence the new assessment process region by region, or cohort by cohort, only where the NDIA has verified adequate assessor capacity.

25. Publish a jurisdiction-by-jurisdiction readiness register tracking assessor capacity and distribution, and Foundational Supports and Thriving Kids availability, against the access change timeline.

26. Service readiness and referral:

    • Commence access changes for each cohort, age or need group in a jurisdiction only once the corresponding foundational support or mainstream service is established, funded and operating at adequate capacity, verified against a published readiness benchmark.
    • Where an access decision is negative, automatically trigger a warm referral to foundational or mainstream supports, prioritising people whose contextual evidence shows they may face barriers connecting with them.

27. Guarantee continuity of support for participants reassessed out of the Scheme, such as maintained funding, until an alternative placement is confirmed.

Response to Consultation Questions

Occupational Therapy Australia (OTA) welcomes the opportunity to respond to the Department of Health, Disability and Ageing’s (the Department’s) consultation on NDIS Access.

OTA supports the NDIS because it places people with disability at the centre of decision-making and gives them access to supports they need for a meaningful life. OTA wants a strong, sustainable Scheme that is fair, backed by a skilled workforce and, importantly – accessible.

OTA has engaged constructively with successive efforts to reform the NDIS. Throughout, we have advocated for access decisions built on evidence-based functional assessment, with appropriately qualified allied health professionals, including occupational therapists, central to that process. This approach supports better outcomes for participants and providers and helps the Department realise a more sustainable Scheme.

OTA supports the Department’s intent to move NDIS access to a more consistent, evidence-based footing, and we make this submission as a contribution to that goal. Occupational therapists work with the diverse disability experiences and support needs this reform aims to serve. Our recommendations draw directly on that clinical expertise and the insights gained through supporting people across a range of contexts and circumstances.

Throughout this submission, we show how each recommendation supports the Department’s objectives. In every section, getting the design right the first time is the lower-cost, more effective and durable path for the Scheme and the participants it seeks to serve.

This submission identifies six areas where targeted changes would strengthen the access process, each with a corresponding set of practical recommendations.

1. On the guiding principles, OTA sees merit in strengthening five areas: assessor independence, assessor qualifications, the meaning of ‘standardised’, the role of context and workforce capacity. These changes will help the principles translate into an assessment process that accurately reflects each person’s functional capacity and support needs.

2. On access decision-making process design, our recommendations focus on preserving the evidence base held by professionals already working with the applicant, incorporating layered clinical oversight into the assessment model, reflecting real-world, day-to-day functioning, and building in transparency and equity monitoring from the outset. Together, these give applicants confidence that decisions reflect their circumstances.

3. On reducing administrative burden, OTA supports a proportionate approach for applicants with clearly significant, permanent impairment, provided it reduces assessment activity while maintaining the quality of evidence. Scaling assessment intensity to the level of uncertainty in each decision, and communicating requirements clearly upfront, will make the process simpler for applicants and more efficient for the Department.

4. On working with diverse cohorts, validating the assessment tool for First Nations and culturally and linguistically diverse (CALD) communities, and capturing the compounding impact of co-occurring conditions and variable functioning will support accurate outcomes for all people with disability.

5. On permanence and evidence requirements, our recommendations address the use of existing clinical documentation, the difference between clinical and functional improvement, real-world access to treatment and how permanence is evidenced for fluctuating conditions. Clear evidentiary standards will produce decisions that reflect each person’s lived functional reality and hold up on review.

6. Finally, on the cross-cutting issue of transition and mainstream capacity, OTA raises a serious risk that eligibility boundaries will be enforced before foundational and mainstream services are fully operational. This creates a risk that people are left without any support, leading to declining function and a more costly reliance on hospitals and other acute services. Aligning access changes with service readiness will protect participants and the reform’s credibility.

These recommendations offer the Department a practical pathway to an access process that is fair, evidence-based and sustainable, and that delivers the correct decision the first time.

Questions 1 and 2 - Guiding principles

OTA supports the intent of the seven draft principles and welcomes the Department’s move toward a more consistent, evidence-based approach to NDIS access. Strengthening five areas would help the principles translate effectively into an operating assessment process. Incorporating these changes will help access decisions accurately reflect a person’s functional capacity and support needs.

A) Building in assessor independence

Principle 1 invokes the NDIS Act and Australia’s human rights obligations, including procedural fairness, which ordinarily requires separation between the decision-maker and any party with an interest in the outcome. These reforms are tied to a government commitment to limit NDIS cost growth to 5–6% a year. If National Disability Insurance Agency (NDIA) staff conduct assessments, the assessor and the interested party become one and the same, which introduces an unresolved conflict of interest.

Should the Department proceed with in-house NDIA assessors, this must be paired with binding safeguards to mitigate this conflict of interest: a rule preventing budget or savings targets from influencing individual decisions, independent review of declines and downgrades before finalisation and public reporting on decision patterns by cohort.

We also note that for the Department, compliance with the NDIS Act and Australia’s human rights obligations – even in principle – are not optional. The current wording of principle 1 does not reflect the binding nature of these obligations. Replacing “should” with “must”, and “aligned to” with “compliant with”, would correct this.

Recommendation 1 – OTA recommends amending principle 1 to state that no individual access decision may be made, or influenced, by Scheme-wide cost or budget targets.

Recommendation 2(c) – OTA recommends that an independent body periodically audit a sample of decisions for the quality of the clinical reasoning applied, reported separately from any throughput or cost metrics.

Recommendation 4(c) – OTA recommends that as part of a clinical governance pathway, a practitioner independent of the NDIA should review every declined application before it is finalised.

B) Defining assessor qualifications

Principle 3 commits to methods that are reliable, valid and equitable. These methods work best in the hands of a person with the skills to interpret them in context, including where functioning varies, communication styles differ, cultural and environmental factors apply or multiple conditions interact.

Occupational therapists and other allied health professionals are specifically trained and qualified to assess a person’s function. They learn the requisite skills and gain clinical expertise through tertiary allied health qualifications, practical placements, and rigorous continuous professional development.

Occupational therapists are also regulated by Ahpra, which adds a further safeguard to ensure quality and safety.

To ensure the requisite levels of capability are met, some systems utilise endorsement or recognition processes. For example, Medicare’s Better Access program uses OTA’s mental health endorsement program to ensure that occupational therapists working within Better Access are not only suitably qualified but have the specific mental health capabilities to work with that cohort. This endorsement program enables endorsed occupational therapists to provide mental health services under a range of government funding schemes.

OTA welcomes a model that uses appropriately qualified assessors and encourages the Department to consider how it will ensure the workforce has the right capabilities for this role. The evidence for this, and how it can be built into the assessment model, is set out under Question 3 below.

Recommendation 3 – OTA recommends amending principle 3 so that access assessments are conducted, or at least clinically overseen, by allied health practitioners who hold relevant qualifications and who can demonstrate the requisite capability through endorsement or other forms of recognition, and documented clinical supervision for those who do not hold such qualifications.

Recommendation 5 – OTA recommends requiring input from an independent professional already working with the applicant, including an occupational therapist where relevant, to be a part of every NDIA access decision where required to establish functional impact or resolve uncertainty, even where the NDIA makes the final determination. This input should be proportionate to the complexity of the application, and could take the form of a brief structured template or existing clinical records.

C) Clarifying “standardised” and responding to complexity

The term ‘standardised’ has a specific clinical meaning across allied health, including in occupational therapy, that differs from its use in the consultation paper, where it appears to mean a single assessment applied to everyone. Occupational therapists already use a mix of standardised and non-standardised tools as part of functional capacity assessment, depending on the person and context.

OTA supports both principle 3 (consistent and standardised) and principle 5 (works for people whose disability is complex, fluctuating, episodic or not immediately visible). Reconciling the two is challenging but achievable with careful design. A consistent national framework that allows assessors to apply clinical judgement and capture how a person’s functional capacity changes over time will give participants confidence that their assessment reflects their individual circumstances.

Recommendation 11 – OTA recommends introducing an explicit mechanism to the decision-making process, such as a supplementary evidence pathway, multiple assessment time points, or defined clinical discretion, for circumstances identified as complex, fluctuating or episodic.

Recommendation 4(a) – OTA recommends, as part of a clinical governance pathway, introducing a defined escalation route where available information indicates that additional clinical expertise is required to understand the person’s needs, including referral to a qualified clinician.

See also Recommendation 3 (appropriately qualified assessors).

D) Capturing context alongside functional capacity

Section 9B of the amended NDIS Act defines functional capacity in a context that excludes, as far as possible, an applicant’s environmental and personal circumstances. This now serves a specific legislative purpose within the NDIS for determining access. It is important to distinguish this specific purpose and legislative definition from best practice functional capacity assessments conducted by occupational therapists, which are guided by the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) as the internationally recognised framework for understanding functioning and disability.

The new definition of functional capacity is inconsistent with the ICF definition, which frames functional capacity as arising from the interaction between a person’s health condition, environment and personal factors, not as a fixed, context-free property of the person 1.

None of the seven principles require environmental or contextual evidence as an assessment input, even though the same impairment can have very different real-world impact on a person’s functioning and participation depending on housing, physical environment, informal supports, geography, culture, communication context, and access to services. Even a well-designed, flexible standardised tool will produce a misleading result if it scores impairment in isolation from context.

Occupational therapy models, research and practice recognise that functional capacity is shaped by context. Occupational therapists assess a person within their own environment and daily routines, taking into account the supports, barriers and demands that influence how they function. This approach gives the most accurate picture of a person’s support needs.

OTA recognises the legislative purpose of section 9B, and contends that capturing context alongside it both keeps assessment aligned with the ICF and gives the Department a fuller picture for planning.

Recommendation 9 – OTA recommends collecting contextual and environmental information as part of every NDIS access decision, clearly separated from the access decision itself, so it exists in the person’s record for planning purposes even though it plays no role in determining eligibility.

Recommendation 10 – OTA recommends contextual evidence excluded at first assessment be considered where a person seeks review of an access decision.

Recommendation 26(b) – OTA recommends that where an access decision is negative, this automatically trigger a warm referral to foundational or mainstream supports, prioritising people whose contextual evidence shows they may face barriers connecting with them.

1 World Health Organization. International classification of functioning, disability and health (ICF). Retrieved September 16, 2026, from https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health

E) Building workforce capacity

The assessment model depends on assessors capable of the clinical reasoning that principle 3 requires, and the cultural safety required by principles 5 and 6. Building that workforce at the scale and distribution the reform requires is a precondition for success. However, none of the seven principles address whether an adequately trained, equitably distributed workforce exists to deliver the assessments being described.

Ensuring workforce capacity will make it possible to deliver accessibility, consistency and equity of access, particularly in rural, remote and First Nations communities, where the relevant workforce is thinnest to begin with and hardest to grow quickly.

OTA encourages the NDIA to consider commissioning a workforce capacity and distribution study, covering its own assessor workforce, before finalising the assessment model, so design decisions account for workforce capacity.

Recommendation 23 – OTA recommends funding targeted training, credentialing pathways and incentives, such as loading or relocation support, to build the assessor workforce in rural, remote and First Nations communities ahead of the 2028 commencement date.

Recommendation 24 – OTA recommends commencing the new assessment process region by region, or cohort by cohort, only where the NDIA has verified adequate assessor capacity.

Recommendation 25 – OTA recommends publishing a jurisdiction-by-jurisdiction readiness register tracking assessor capacity and distribution, and Foundational Supports and Thriving Kids availability, against the access change timeline.

See also Recommendation 3 (appropriately qualified assessors).

How addressing these issues benefits the Scheme

Strengthening these five areas benefits the Department as much as applicants. Getting an access decision right the first time is materially cheaper and more defensible than correcting it after the fact.

Independent assessment by appropriately qualified professionals reduces the number of decisions that are appealed, overturned or require early reassessment when a person’s plan doesn’t match their circumstances. This directly supports the Department’s cost-sustainability objective.

Resolving the balance between principle 3 (consistent and standardised) and principle 5 (responsive to diverse needs) at the design stage, before the assessment tool is finalised, is the most cost-effective point to get it right.

Capturing context at assessment gives the Department a clearer picture of a participant’s needs from day one, reducing the number of plans that require early revision. It also builds a longitudinal evidence base to refine the model over time and helps identify where targeted assessment is needed at the planning stage.

Investing in workforce capacity early is what makes the other principles operable, supporting consistent decisions and fewer appeals.

Question 3 - Access decision-making process design

OTA supports a fair, consistent, transparent, disability-informed and evidence-based process for accessing the Scheme. Meeting these objectives should anchor the work ahead. However, doing so will depend on specific, practical design choices about what type of evidence is gathered, who gathers it, how flexible the process can be, and how outcomes are monitored once the system is operating.

If done well, the process can accurately reflect a person’s functional capacity and support needs.

The recommendations below focus on four design elements: preserving the evidence base, clinical qualifications and oversight, assessment design that reflects real-world function, and transparency, equity monitoring and applicant experience.

Preserving the evidence base

Professionals who are already working with an applicant bring valuable and relevant contextual and longitudinal evidence that can strengthen in-house assessments. Environmental, cultural and other evidence is central to understanding a person’s support needs and should carry real weight in decisions. The value of any in-house assessment will depend on how it is held to account, how it interacts with other evidence, and how visible the process is to the people it affects.

Recommendation 6(a) – OTA recommends requiring in-house assessments to meet a defined minimum evidentiary standard comparable to a report from an independent professional already working with the applicant.

Recommendation 6(b) – OTA recommends confirming the right of applicants and their professionals to submit supplementary evidence at any point before a decision is finalised.

See also Recommendations 5 (clinician input), 9 (collecting contextual information) and 10 (contextual evidence on review).

Clinical qualifications and oversight

Functional capacity assessment requires clinical reasoning to identify diverse presentations of disability, communication difficulty and co-occurring conditions, which is why who conducts or oversees an assessment matters as much as the tool used.

Evidence from occupational therapy research supports this. Rogers and Holm (2016) note that almost a century of occupational therapy practice has shown a complete picture of a person’s functioning requires

multiple assessment methods. 2 Self-report, carer reports, direct observation of tasks and impairment measures each capture different aspects of functioning, and their results can conflict. Making sense of these different sources requires professional reasoning. A single assessment, interpreted without clinical expertise, risks producing an incomplete or misleading picture of a person’s functional capacity.

The NDIA’s preference for a standardised assessment does not remove the need for clinical expertise. Interpreting the results of any tool, and understanding what they mean for a person’s functional capacity, remains a professional reasoning task. Qualification requirements should reflect the complexity of that judgement. Where assessors do not hold this expertise themselves, the risk can still be managed through a defined qualification standard, ongoing training, clinical supervision by allied health professionals and a clear pathway for complex or contested applications to reach appropriately qualified judgement.

Recommendation 4(b) – OTA recommends referring borderline or contested applications to a small multidisciplinary panel including relevant allied health expertise.

See also Recommendations 2(c) (independent audits), 3 (appropriately qualified assessors), 4(a) (escalation route for additional clinical expertise), and 4(c) (independent review of declined applications).

Assessment design that reflects real-world function

A person’s everyday functioning is best understood through evidence gathered over time and across settings. Factors such as cognitive functioning or the interaction between co-occurring conditions may only surface later in an assessment and can change the picture entirely. Fluctuating or episodic functioning is best understood through everyday routines, drawing on evidence from the person and, with their consent, others who know their day-to-day circumstances.

Recommendation 7 – OTA recommends that applicants, and where relevant, a family member, carer or support worker familiar with their day-to-day functioning, be given a structured way to provide everyday, pattern-based functional evidence, as a standard input alongside direct observation and clinical or OT evidence.

See also Recommendations 6(b) (supplementary evidence) and 11 (mechanism for complex, fluctuating or episodic circumstances).

Transparency, equity monitoring and applicant experience

Monitoring outcomes across groups from the outset allows the Department to identify and address inequity early.

2 Rogers, J. C., & Holm, M. B. (2016). Functional assessment in mental health: Lessons from occupational therapy. Dialogues in Clinical Neuroscience, 18(2), 145–154. https://doi.org/10.31887/DCNS.2016.18.2/jrogers

Disability type is the easiest dimension to measure, but on its own it offers a limited view. People with the same diagnosis can have very different support needs, and a diagnosis-based lens runs counter to the support needs focus of the reforms. Inequity is just as likely to arise from an applicant’s circumstances or from the assessment process itself. Meaningful monitoring should therefore capture a range of factors, including:

• disability type
• functional domains affected
• geography and remoteness
• First Nations status and cultural and linguistic background
• whether the applicant had access to existing clinical evidence or reports
• the assessment pathway used, such as a single short assessment compared with a longer or multi-part assessment.

Process factors are especially important. If applicants without existing reports, or those assessed in a single short session, are more likely to be found ineligible, this points to a procedural problem rather than the applicant’s needs.

Recommendation 2(a) – OTA recommends monitoring and reporting publicly on access outcomes from the outset across a range of factors, including disability type, functional domains, geography, cultural background, access to existing evidence, assessment pathway and contextual data collected at assessment.

Recommendation 2(b) – OTA recommends setting defined thresholds, such as a disproportionate decline rate for any group or pathway, that automatically trigger an independent review of assessment practice.

Access decisions determine whether a person can receive the supports they need to participate in daily life, making the process high-stakes for applicants and their families. Some applicants may have cognitive, communication or psychosocial disability, or speak English as an additional language. Clear, plain language explanations helps them understand a decision and what they can do next. A clear point of contact and transparent reasoning help applicants navigate the process with confidence, provide further evidence where needed and exercise their review rights.

Recommendation 22 – OTA recommends every decision be accompanied by a plain-language explanation of the reasoning, listing all evidence considered and explaining where supplementary evidence did not change the outcome, and a named contact point with their phone number and email address.

See also Recommendations 6(b) (supplementary evidence) and 9 (collecting contextual information).

How addressing these issues benefits the Scheme

The four design elements will contribute to supporting the Department to make accurate, well-evidenced decisions in designing the access model and pathway.

A more robust and relevant evidence base, held to a consistent standard and open to correction before finalisation, produces fewer decisions that are overturned on appeal or require early reassessment once a mismatch between the plan and the person’s actual circumstances becomes apparent.

Layered clinical oversight, comprising defined qualification requirements, supervision, an escalation pathway and independent audit, makes the resulting decisions sounder and less vulnerable to being challenged than ones produced by an administrative process alone, and gives the Department its own early warning system for where oversight is falling short before it surfaces as a pattern of appeals or adverse findings.

Building flexibility into the assessment format reduces the risk of a technically complete but practically inaccurate picture of a person’s support needs, which is the scenario most likely to generate downstream disputes.

Finally, monitoring outcomes from the outset, paired with a defined threshold for acting on it, is a lower-cost way to catch and correct design problems early, while a named contact point and a plain-language explanation of each decision reduce the volume of general enquiries, complaints and appeals that come from applicants unable to get a direct answer about their own case.

Question 4 - Reducing administrative burden and proportionate approaches

OTA supports designing a proportionate approach for applicants with clearly significant, permanent impairment, but proportionality should reduce the volume and duplication of assessment activity, while maintaining the quality of evidence relied on. A tiered approach, where assessment intensity scales to how much uncertainty there is about a person’s eligibility, would achieve this without lowering evidentiary depth for anyone. Applicants whose eligibility is less clear would still receive a fuller assessment.

The two goals in this question, reducing administrative burden and making the process easier and more equitable to understand, are related but distinct. Burden reduction is answered by how assessment effort is allocated, through tiering and a clearly evidenced fast-track category. Understanding what’s needed is answered separately, through how information is communicated before and during the process, via pre-lodgement guidance and genuinely accessible materials.

For the Department, a well-designed proportionate pathway delivers a direct efficiency gain. Redirecting effort toward applications where it resolves uncertainty about eligibility is a lower-cost way to manage assessment volume. Clearer upfront guidance also delivers an efficiency gain, reducing the enquiry and complaint load that comes from applicants and families who don’t understand what evidence is required until an application is rejected or returned as incomplete.

Remote assessment offers a further way to reduce burden, particularly for applicants in rural and remote areas where the assessor workforce is thinnest. Where an appropriately qualified professional has already assessed a person in their natural setting, video conferencing can complement that evidence and reduce travel and wait times. Video conferencing carries risk to disabled people when used inappropriately, and as such, the Department should consider developing guidelines, informed by allied health expertise, to

support the use of videoconferencing. OTA is currently developing guidelines on telehealth, and video conferencing in order to guide emerging best practice.

Recommendation 18(a) – OTA recommends adopting a tiered assessment model, where assessment intensity scales to the level of uncertainty about a person’s eligibility.

Recommendation 18(b) – OTA recommends introducing a fast-track category for applicants whose existing documentation clearly demonstrates profound, permanent impairment. Eligibility should be based on the strength of existing documentation, not diagnosis.

Recommendation 19 – OTA recommends avoiding unnecessary reassessment where existing evidence from an appropriately qualified professional already captures the applicant’s functioning in natural settings. Where further assessment is needed, we recommend using proportionate and flexible methods that address only the gaps in existing evidence, including video conferencing where appropriate and with the applicant’s consent.

Recommendation 20 – OTA recommends providing a short, structured pre-lodgement tool that tells a prospective applicant, based on their circumstances, roughly what evidence they are likely to need before they apply.

Recommendation 21 – OTA recommends co-designing application and guidance materials with people with disability, families and carers, including those with cognitive, communication or complex support needs, so the language and format of what’s required is genuinely accessible.

See also Recommendations 5 (clinician input), 22 (plain-language decisions) and 23 (rural and remote workforce).

Question 5 - Working for diverse cohorts

A single assessment model, however well designed, will not automatically work equally well for every applicant’s case. Designing for the needs of diverse cohorts early is materially cheaper than correcting for them once the process operates at scale, and ensures a smoother applicant experience.

First Nations and culturally and linguistically diverse (CALD) communities

Any decision-making process must operate through culturally safe, on-country assessors, and provide translated and alternative-format materials as standard. Evidence shows that a tool developed and validated on a general population cannot be assumed to produce valid or culturally safe results for First Nations and CALD communities without deliberate design and testing. 3

3 O’Gradey-Lee, M., Schultz, C., & Hudson, J. L. (2026). The development of a cultural validity assessment tool for First Nations people. Australian & New Zealand Journal of Psychiatry, 60(3), 282–291. https://doi.org/10.1177/00048674251393167

Validating the tool for these cohorts delivers three benefits: accurate outcomes, mitigation of potential harm arising from a culturally unsafe process, and a process applicants trust enough to engage with fully.

Recommendation 12 – OTA recommends validating any assessment tool for First Nations peoples and CALD communities before national rollout, with cultural safety built into assessor training and on-country assessment options, and publishing the validation evidence, including which populations were involved in testing.

See also Recommendations 2(a) (outcome monitoring) and 23 (First Nations workforce).

Overlapping and compounding impact

Co-occurring conditions are common among NDIS applicants. A physical and a psychosocial disability occurring together can produce greater functional impact than either alone. An assessment methodology that explicitly captures this compounding impact will accurately reflect need across a significant share of the caseload.

Recommendation 13 – OTA recommends incorporating an explicit mechanism for evaluating compounding impact into the assessment methodology.

See also Recommendation 4(b) (multidisciplinary panel).

Fluctuating, degenerative and episodic disability

Capacity can vary across days and environments. Occupational therapy evidence is valuable here because it describes the interaction between impairment, environment, task demands, informal supports and risk. Assessors trained to consider fluctuating function, cumulative fatigue and the difference between doing an activity once and sustaining it safely over time will produce more accurate results.

See Recommendations 7 (pattern-based functional evidence) and 11 (mechanism for complex, fluctuating or episodic circumstances).

How addressing these issues benefits the Scheme

Each of the three cohort-specific risks below carries a distinct but related cost to the Department if left unaddressed.

A tool validated for First Nations and CALD applicants gives the Department a defensible, disability-informed process consistent with its anti-discrimination and human rights obligations.

A scoring methodology that fails to capture compounding impact from co-occurring conditions matters directly for Scheme sustainability. Capturing compounding impact accurately at access gives the Department a reliable basis for planning and forecasting.

Failing to capture fluctuating or episodic presentations accurately has a specific and predictable cost - applicants assessed on an unrepresentative day are more likely to be found ineligible, or under-supported, in ways that generate appeals, reassessment requests and complaints once their actual day-to-day experience diverges from the assessment record.

Question 6 – Permanence and evidence requirements

OTA encourages the Department to refine the requirement to exhaust ‘all appropriate treatment’ so it reflects the ways in which many disabilities present over a lifetime, minimises evidentiary burden, supports equity for people in rural and underserved areas and upholds a participant’s right to decline treatment.

Each of the four issues below describes how a permanence test can produce a technically defensible decision that does not reflect a person’s actual, lived functional reality - whether because evidence was discarded, a clinical measure was mistaken for a functional one, treatment access was assumed, or a single assessment moment was treated as representative of a fluctuating condition.

Existing evidence and burden on individuals

Existing clinical documentation, often built up over years of treatment and across multiple professionals, should not be disregarded simply because it was not produced under the new process. Transition arrangements should work with professionals already working with the person, not impose a hard cut-over that requires participants to re-evidence conditions already extensively documented under the current Scheme.

Decisions about permanence and likely improvement should draw on evidence from qualified health practitioners: diagnosis, treatment history, prognosis, functional capacity, assistive technology needs, environmental barriers, and a person’s ability to perform daily activities safely, repeatedly and independently.

Recommendation 8 – OTA recommends that existing clinical documentation, including reports from a professional already working with the applicant, be accepted as valid evidence under the new process.

See also Recommendations 5 (clinician input) and 6(b) (supplementary evidence).

A reduction in impairment does not equal an improvement in functional capacity

Treating clinical improvement and functional improvement as equivalent risks finding people ineligible on a clinical measure that does not reflect their day-to-day functional reality. An access test built around this conflation will be systematically biased toward the conditions where clinical and functional improvement happen to track closely together. Conversely, it will work against those conditions, including many musculoskeletal, neurological and paediatric conditions, where they do not.

A child with cerebral palsy may attain the ability to walk after lower limb surgery, without necessarily having the capacity to walk safely between classrooms at school across a full day, manage stairs during a fire evacuation, or sustain mobility through a full school week without cumulative fatigue or pain.

Recommendation 14 – OTA recommends requiring functional evidence of improvement under the permanence test, such as the ability to perform an activity safely, repeatedly and in real-world settings, rather than accepting a clinical or surgical outcome measure as a proxy for functional improvement.

Real-world access to treatment, not theoretical treatability, should determine permanence

A person could be found ineligible because a treatment might reduce their impairment, even where it is not genuinely accessible due to cost, geography or waitlists, effectively penalising people for healthcare access barriers entirely outside their control.

This risk mirrors a pattern already present elsewhere in the Scheme - NDIS processes already require some participants and providers, for example in arthritis, fibromyalgia and chronic pain presentations, to demonstrate no further medical option exists before assistive technology is approved.

Extending this logic through the permanence test risks embedding this same barrier earlier in the process, at the point of access, where it has the greatest consequence.

OTA also notes that a person cannot be compelled to undergo medical treatment. Finding someone ineligible for the NDIS because a treatment exists, when they have not consented and would not consent to it, is misaligned with principle 1 (compliant with the human rights of people with disability). Confirming this at the design stage would provide legal certainty for the Department.

Recommendation 15 – OTA recommends assessing permanence against real-world access to treatment - where an identified treatment is not genuinely accessible within a reasonable timeframe, the impairment should be treated as permanent.

Recommendation 16 – OTA recommends the Department explicitly confirm that a person’s right to decline consent to a proposed treatment cannot be treated as a basis for an adverse permanence finding, given the human rights obligations principle 1 already commits to.

One-off assessment risk

A single-point assessment risks capturing an unrepresentative day, understating or overstating functional impact for conditions that vary over time, such as some psychosocial disability, neurological and chronic pain presentations.

A permanence test built on a single observation cannot distinguish a person’s baseline from a temporarily good or bad presentation on the day of assessment, and will systematically disadvantage exactly the conditions where day-to-day variability is a defining clinical feature.

Recommendation 17 – OTA recommends that for episodic, fluctuating or degenerative conditions, permanence be evidenced through pattern over time, drawing on longitudinal clinical history.

See also Recommendations 7 (pattern-based functional evidence) and 11 (mechanism for complex, fluctuating or episodic circumstances).

How addressing these issues benefits the Scheme

Robust evidentiary standards give the Department durable decisions that hold up on review and maintain public confidence.

Getting these evidentiary standards right the first time is a lower-cost path to a durable, defensible Scheme than resolving these same questions case by case through review and appeal. Each of the four issues below contributes to this risk in a specific way.

Using existing clinical evidence avoids duplication and draws on the most detailed record available.

Relying on clinical improvement as a proxy for functional improvement will produce incorrect eligibility findings at a predictable and recurring rate, each one a candidate for appeal. These findings will weaken confidence in the assessment model precisely in the cases most likely to attract clinical and legal scrutiny, such as those involving children.

Anchoring permanence to theoretical treatability (as opposed to real-world treatment access) creates a legal exposure the Department should resolve at the design stage, whereas a test anchored to real-world access is both more accurate and considerably harder to successfully challenge on human rights or administrative law grounds.

Finally, a permanence test vulnerable to single-day variability is a test vulnerable to inconsistent outcomes for materially similar applicants, difficult to defend as fair or evidence-based under the Department’s own guiding principles, and likely to invite exactly the kind of appeal and reassessment volume a more durable, pattern-based evidentiary standard would avoid.

Cross-cutting issue: transition and mainstream capacity

This falls outside the numbered questions but affects when access changes should take effect. OTA supports the NDIS sitting alongside, not replacing, a properly resourced mainstream and foundational support system. Aligning the timeline with service readiness will allow eligibility changes to take effect as alternative supports come online.

Thriving Kids, the most advanced element of Foundational Supports, began state-delivered services from 1 October 2026 and is not expected to reach full national scale until 1 January 2028, the same date NDIS access changes take effect.

The gap is starkest for children aged 9 and over. Thriving Kids covers only children aged 8 and under, yet many older children and adults may lose developmental delay or autism-related NDIS access under the new criteria, with no support pathway or funding announced.

This mismatch between the pace of eligibility tightening and service establishment is heightened for children near the Thriving Kids age and severity bands, and for rural and remote communities where mainstream infrastructure is thinnest to begin with.

Recommendation 26(a) – OTA recommends commencing access changes for each cohort, age or need group in a jurisdiction only once the corresponding foundational support or mainstream service is established, funded and operating at adequate capacity, verified against a published readiness benchmark.

Recommendation 27 – OTA recommends guaranteeing continuity of support for participants reassessed out of the Scheme, such as maintained funding, until an alternative placement is confirmed.

See also Recommendations 24 (staged commencement), 25 (readiness register) and 26(b) (warm referral).

How addressing these issues benefits the Scheme

For the Department, sequencing access changes to actual service readiness is what protects the reform’s credibility and the Department’s own capacity to absorb its effects.

A jurisdiction found to have tightened access ahead of an available alternative faces a materially harder set of problems than a delayed rollout - participants with nowhere to go, service systems and courts scrutinising a policy that removed support before replacing it, and a reform narrative that shifts from securing the Scheme’s future to a story about people falling through the gap between two systems.

A published readiness register and a guarantee of continuity both address this the same way, by making the risk visible and manageable before it becomes a crisis.

Conclusion

OTA wants NDIS access reform to succeed, and this submission has been written in that spirit.

Every recommendation is aimed at the same outcome we set out at the start of this submission - a Scheme that places people with disability at the centre of decision-making, with access decisions that are fair, consistent and correct the first time.

At its best, the NDIS enables participants to build independence, connect with their communities and take part in the activities and occupations that matter to them. Occupational therapists see these outcomes every day, when the right supports help a person live more independently, reduce their reliance on paid support and participate in daily life on their own terms. An access process that accurately identifies who needs the Scheme, and what those needs are, lays the best possible foundation for these outcomes.

Aligning reform with these outcomes is important in part because getting these decisions right in the first instance will support cost containment and sustainability, without compromising on outcomes for the people with disability for whom the Scheme was designed to support. In practice:

• Independent assessment by an appropriately qualified assessor controls cost over time.
• Incorporating context and everyday, pattern-based evidence produces plans that fit a person’s actual circumstances from day one.
• Clear evidentiary standards for permanence produce decisions that hold up on review, avoiding issues that compound into the volume of appeals and litigation that this reform is intended to reduce.
• Sequencing access changes to genuine service readiness protects the reform’s credibility, reducing the reputational and legal risk of participants losing support before an alternative exists.

Occupational therapists bring direct practice experience of understanding functioning and participation where disability is complex, fluctuating or less visible, offering important insight into what an effective and equitable access assessment needs to capture.

That experience is why OTA has consistently called for evidence-based functional assessment, and for appropriately qualified professionals, including occupational therapists, to be central to access decisions.

We have incorporated that expertise into this submission because it strengthens the case for reform, and to ensure these reforms deliver outcomes that best serve participants, their supporters, and the Government.

As set out throughout this submission, addressing these concerns now serves the Department’s own interest. Doing so builds a Scheme that is fair, sustainable and backed by a skilled workforce, and helps ensure the NDIS continues to serve the very participants it exists for.

OTA would welcome the opportunity to discuss this submission further, and can be reached at policy@otaus.com.au

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This Guideline sets out the actions needed to develop and approve an OTA Position Statement. It also provides a framework for the Position Statement document to ensure comprehensiveness and clarity.