Submission 1483

I am an Occupaonal Therapist and co-owner of a small private paediatric therapy clinic in Melbourne’s inner north. We have been operang for 15 years. We provide Occupaonal Therapy and Speech Pathology to children with complex developmental needs, including Ausm, Sensory Processing Disorder, and other developmental challenges.

I am wring this submission in a personal capacity, based on 25 years of clinical work as an Occupaonal Therapist with children and families.

I support the intent to make the NDIS sustainable. No one wants to see the scheme collapse. But I am concerned that several provisions of this Bill will have unintended consequences that harm the children and families I work with, without delivering the savings the government expects. My concerns are praccal, not polical. They come from watching how policy changes impact families and children, and the long term impacts of restricng access to early intervenon.

Defining func+ional capacity

The Bill introduces a definion of funconal capacity that excludes environmental and personal circumstances to assess a child’s “intrinsic ability.” This sounds reasonable in theory. In pracce, a child’s funconing cannot be separated from their environment.

I assess children every week who present very differently depending on the sePng. A child who cannot sit for a formal assessment in a clinic may engage well in their own home with their parent present. A child who appears to have mild delays in a quiet, 1:1 sePng may fall apart enrely in a classroom with 25 other children. The idea that we can assess funconal capacity in a way that strips away context is not how child development works. It is especially problemac for young children and children with ausm, whose capacity is deeply ed to relaonship, familiarity, and sensory environment.

I am also concerned about who will design these assessments and what they will look like. If they are administered by people who do not have paediatric experse, or if they use a ck box approach that does not capture a child’s real profile, children with genuine needs will be excluded. I have seen this happen under the exisng access lists, which already miss many children who do not fit neat diagnosc categories but are significantly impaired in their daily life.

The NDIS rules about thresholds for substanally reduced funconal capacity are not yet developed. This means the Parliament is being asked to pass a Bill where the most consequen*al detail is leR to future rule making. I ask the commiSee to consider whether it is responsible to legislate a framework without the community seeing the actual thresholds that will determine whether a child gets support.

Limits on unscheduled plan reassessments

The Bill restricts who can request a plan reassessment to parcipants and their authorised representaves. It also limits the circumstances in which a reassessment can occur.

Submission 1483

I understand the concern about unscheduled plan re-assessments in a general sense, but I see a different problem. Many of the families I work with are exhausted, overwhelmed, and naviga$ng complex systems. They do not know when they should ask for a reassessment.

They rely on their therapists to $ag when a child’s needs have changed, when equipment has stopped working, or when a new diagnosis changes the picture.

If a child’s condi,on deteriorates or they develop new needs, the gap between when a therapist iden,fies the need and when a parent can navigate a reassessment request could be months. In that *me, the child goes without appropriate support. This is especially true for families from culturally and linguistically diverse backgrounds, families experiencing financial stress, and single parents who are already stretched.

The Bill allows the NDIA to iniate reassessments on their own iniave, which is a safeguard. But I am not confident that the Agency has the workforce or the systems to ideny children whose needs are escala*g. That work currently falls to therapists and families; those that know these children and their needs best.

Strengthen the link between impairment and need for support

This provision requires that supports can only be provided to address needs arising directly from impairments that meet the disability or early interven*on requirements.

The challenge here is that children with developmental delays and disabili*es present with overlapping needs. A child with sensory processing differences may present with behaviours that look like anxiety. A child with a communica$on delay may appear withdrawn or opposi$onal. In my experience, the link between impairment and func$ional need is not always linear or easy to document in a way that sa$sfies a bureaucra$c test.

There is a real risk that children with complex, overlapping presenta$ons will have their support reduced because a delegate decides a par$cular need is not “directly” linked to their listed impairment. This will lead to more *me spent on report wri$ng and appeals, and less *me on therapy. It will also increase demand on the Administra$ve Review Tribunal, which is already struggling.

Reasonable and necessary supports

The Bill clarifies that funding for some supports may be less than the actual cost of providing them. It also introduces principles that will guide what is considered reasonable and necessary, including considera$ion of what is reasonable for the scheme to fund as a whole.

If the NDIS pays less than the cost of providing therapy, providers like my clinic face a simple choice: cross subsidise from other work, reduce quality, or close. Small providers operate on thin margins. We cannot absorb ongoing underpayment. If therapy becomes financially unviable to deliver, therapists will leave the sector or move into private fee for service work. This is already happening.

Submission 1483

For families, this means fewer providers accepng NDIS parcipants and longer waitlists. The families who can afford to pay privately will get care. Those who cannot will go without. That is not equity. That is a two *er system.

Tightening permanence

The Bill introduces the concept of “all appropriate treatment” before an impairment is considered permanent.

For many children, especially those with ausm, the queson of what constutes “all appropriate treatment” is not straighXorward. Ausm is not an illness that gets treated and cured. It is a neurotype. Early intervenon supports skill development, but it does not make the underlying impairment go away. I am concerned that this provision will be used to argue that a child who has not tried a parcular therapy does not have a permanent impairment, even if that therapy is not evidence based, not available locally, or not affordable.

The Bill also links this to access to other service systems. If a child could access supports through a state based program like Thriving Kids, they may be found ineligible for the NDIS even if their impairment is significant. This creates a situa*on where a child’s NDIS access depends on the quality and availability of state services, which vary enormously across the country.

Provider registra+on, claim +meframes, and record keeping

I support measures that address fraud. But some provisions will impose a heavy administra*ve burden on small providers.

The 90 day claim meframe will be challenging for families who are slow to provide informaon or who change plan managers. I spend significant me already chasing invoices and confirming service bookings. A 90 day window means that if a payment is delayed for any reason, the provider loses that income enrely.

Mandatory registraion for all providers will increase costs. Registraon fees, compliance reporng, and audit preparaon are not trivial for a small clinic. These costs will either be passed on to par*cipants (within the price limits) or absorbed. Either way, they reduce the resources available for direct therapy.

As an allied health professional, I already have mulple points of registraon with the federal government. Further duplicaon of this at an NDIA level won’t increase regulaon of an already highly regulated profession, it will simply create more paperwork and greater costs for providers.

The broader impact: workforce and service availability

My main concern is that the combined effect of these changes will accelerate workforce exits from the NDIS market. We are already in a na*onal allied health shortage. The NDIS Review itself acknowledged this. If you add *ghter access, reduced funding, more

Submission 1483

Administrative burden, and more regulatory risk, experienced therapists will leave. Many will move into private practice serving only private paying clients. Others will leave clinical work entirely.

For families, this means longer waitlists and less choice. In many areas this may mean no access to therapy at all. The children who need support most will be the ones who lose access first.

I also note that no provision in this Bill addresses the underlying workforce shortage. There is no investment in training, supervision, or retention of paediatric therapists. The Bill focuses entirely on demand reduction without addressing supply.

Conclusion and Recommendations

I do not oppose reform. The NDIS needs to be sustainable. But this Bill risks creating a system that is financially sustainable in the short term at the cost of long term outcomes for children, families, and communities.

My recommendations are:

• Do not pass the functional capacity provisions into law until the NDIS rules defining thresholds and assessment methods have been published and the community has had a genuine opportunity to review them.
• Amend the plan reassessment provisions to allow treating therapists to flag changes in a child’s needs and trigger a review process, rather than placing the full burden on families.
• Ensure that reasonable and necessary support determinations include a requirement that funding levels are sufficient to cover the cost of delivering quality therapy, not less.
• Include a workforce impact statement with any change that reduces funding or increases regulatory burden, so the Parliament can see the likely effect on service availability.
• Phase the changes to access for children to align with the actual availability of Thriving Kids services, not the planned availability, to avoid gaps in support.

I would be happy to provide further detail to the committee on any of these points.