Submission 1571 - Supplementary Submission

Subject: Independent Expert Brieﬁng on the “Arises Directly” Rule – Key Risks for Today’s Final Committee Report

Dear Senator,

I am writing as an independent clinician and systems-governance specialist ahead of the ﬁnal report tabling today. While individual clauses like the “arises directly” rule are deeply ﬂawed, my broader analysis isolates how this legislation creates severe, compounding friction across our healthcare, education, and early intervention systems.

My expertise lies in auditing and picking apart these complex, cross-domain contradictions at a macro level.

I have already provided the Committee with two detailed submissions:

A macroeconomic risk assessment of the Thriving Kids Bill
A structural and administrative risk analysis of the NDIS Amendment Bill

My analyses draw on my background as a Registered Nurse with postgraduate training in Mental Health and Neuroscience, and formal qualiﬁcations in Early Childhood Teaching, which inform my understanding of developmental trajectories, functional impairment, and early intervention needs. I also serve as the Nursing Representative on the Justice Health Clinical Ethics Advisory Panel, contributing to ethical oversight and system-level risk assessment.

Multiple stakeholders, including peak bodies, allied health organisations, and legal experts, have raised concerns about the “arises directly” rule. However, none have mapped the clinical, operational, legal, and ﬁscal contradictions comprehensively. My submissions consolidate these domains into a single, evidence-aligned analysis to support the Committee’s ﬁnal scrutiny.

To assist the Committee before the final report is tabled today, the following questions target the core contradictions created by the rule:

Operational Feasibility: Which assessment tool will the NDIA use to determine whether a support “arises directly” from a single impairment, given that the I-CAN does not measure causation, does not isolate a single impairment, and is based on the ICF model of interacting functional impacts?
Clinical evidence base: Can the Department identify any national guideline or overarching framework, including: Australia’s Disability Strategy 2021–2031, the Autism CRC, or any other NHMRC-approved frameworks, that supports a single-source causation model for disability, given that all existing national frameworks mandate the multi-factorial Social Model of Disability?

Submission 1571 - Supplementary Submission

Tool–legislation contradiction: How will the NDIA apply a causation test using an assessment tool that explicitly measures environmental, behavioural, sensory and emotional impacts, all of which would be excluded under a single-impairment rule?

Below is a short summary of how my analysis compares to other stakeholders:

Peak disability bodies: Raised clinical misalignment and exclusion of secondary impairments.
Allied health organisations: Raised multi-factorial disability and ICF conﬂict.
Legal academics: Raised improper purpose, fettering, and ultra vires risks.
NDIS Review: Emphasised functional assessment and warned against unmet need.
State governments: Raised cost-shifting and system capacity concerns.
My analysis: Integrates all of the above and maps operational impossibility, tool-legislation contradiction, guideline contradiction, ICF contradiction, legal vulnerability, ﬁscal escalation, and contradiction with the Bill’s purpose. It serves as the only consolidated, cross-domain structural analysis available to the Committee.

Summary of Structural Contradictions

The “arises directly” rule creates structural contradictions across clinical practice, operaional capability, administrative law, and ﬁscal modelling. These are not implementation issues; they arise from incompatibility with existing assessment tools, national guidelines, and statutory frameworks.

The NDIA’s Support Needs Assessment measures support needs, not causation, and cannot isolate a single impairment.
National guidelines (Autism CRC, ADHD) deﬁne disability as muli-facorial and do not support single-source causation.
The rule replaces funcional assessmenl with causion, contradicting the NDIS Review.
The rule removes environmental and secondary impairments, contradicting the NDIS Act and ICF.
No tool, framework, or evidence standard exists to apply the rule consistently or lawfully.

Submission 1571 - Supplementary Submission

The rule invites ultra vires decisions, improper purpose, fettering, and procedural fairness breaches.
Deterioration risk (15–25% annually) and crisis costs ($50k–$100k per child) exceed projected savings.
The rule increases deterioration, lifetime NDIS costs, and state system demand.

If it would assist you or your team during the upcoming chamber debates, I am available to provide independent, evidence-based advisory input, in writing. Beyond the mechanics of this speciﬁc rule, my work focuses on identifying and mapping complex, system-wide inconsistencies and their broader structural implications across federal, state, and mainstream sectors. I welcome the opportunity to clarify any of the cross- domain contradictions identiﬁed above.

Kind Regards,

Nicola Ross

GradDip Mental Health and Neuroscience

BNursing/BEarly Childhood Teaching (0-5)

Nursing Representative, Justice Health Clinical Ethics Advisory Panel