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Diagnostic inflation and autism access (Confidential) (Individual advocacy)

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Formal Submission to the Senate Inquiry

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 (Confidential)

Introduction

This submission addresses the proposed amendments to the National Disability Insurance Scheme Act 2013 as introduced under the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill. The bill seeks:

  • Clarify eligibility criteria.
  • Refocus funding on “reasonable and necessary” supports,
  • Strengthen fraud detection and compliance;
  • Improve sustainability and governance. These objectives are necessary but supported without more precise legislative controls; otherwise systemic misuse will continue due diagnostic inflation cost-shifting.

Context and Legislative Direction`

The bill reflects broader policy shift towards functional capacity-based assessments stricter permanence requirements consideration of alternative support treatment pathways. This is correction scheme drifted from original purpose supporting people with permanent significant disability toward model vulnerable interpretation expansion exploitation . `# Systemic Failure: Incentives Driving Overuse Misuse

Structural Incentives `

Current design incentivises:`

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026

Submission 1785

  • Diagnosis over functional impairment
  • Provider-driven service expansion
  • Maximisation of billable supports

This has resulted in:

  • Overdiagnosis
  • Over-servicing
  • Misclassification of non-disability supports

This is not an isolated misconduct. It is predictable behaviour within a permissive system.

Diagnostic Inflation and Autism Access There has been a significant increase in autism diagnoses since the introduction of the NDIS.

While increased awareness is a contributing factor, the Scheme has created clear access incentives: • Ongoing funding tied to diagnosis • Limited alternatives outside the Scheme • Discontinuity of early intervention supports This has led to: • Expansion of diagnostic thresholds in practice • Reliance on single-provider assessments • Pressure on clinicians to support access outcomes ### Legislative Gap The Bill moves toward functional assessment, but does not go far enough to:
• Remove diagnosis as a de facto gateway\n• Prevent diagnostic escalation for funding purposes

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026

Submission 1785

Recommendation

Legislation must explicitly require:

  • Functional impairment as the primary test
  • Independent and multidisciplinary verification

Misuse of Supports Beyond Legislative Intent

Support Workers (Children)

Evidence indicates support workers are being used for:

  • Babysitting and passive supervision
  • School drop-offs and pick-ups Then proceeding to general household duties after school drop offs before and after school hours. This constitutes cost-shifting from family and education systems.
Legislative Gap The Bill clarifies “reasonable and necessary” supports but does not explicitly prohibit:

Substitution for parenting responsibilitiesSchool-hour support where school attendance is possible excluding homeschoolers due to disabilities and schools unable to accommodate

ConsumablesConsumables are being used for:

Everyday household itemsNon-disability-related goodsHigh-risk recreational equipment(e.g., trampolines, monkey bars, swing sets, crash mats,mellow mats).

Legislative Gap Lack of statutory definition allows broad reinterpretation of low value support.

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026

Submission 1785

Provider Billing Practices Persistent issues include:

  • Inflated non-face-to-face billing
  • Excessive travel claims
  • Fragmented invoicing practices Despite strengthened compliance powers, billing structure abuse remains largely unregulated.

Legal Expenditure and Administrative Burden The National Disability Insurance Agency continues to allocate significant resources to: - Legal representation - Adversarial tribunal processes This is inconsistent with:- Administrative efficiency objectivesParticipant equity#### Alignment with Bill Objectives – Required Strengthening The Bill’s intent to:- Address fraudClarify eligibilityImprove sustainabilityIs supportedHoweverto achieve these objectivesthefollowinglegislative amendmentsorRulesarerequired##### Recommended Legislative Amendments###### EligibilityandFunctionalCapacity(Sectionssubjectstorequire:

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026

Submission 1785

  • Demonstrated permanent and significant functional impairment
  • Use of standardised national assessment tools
  • Exhaustion of appropriate treatment options prior to access

Insert:

A diagnosis alone must not be sufficient to satisfy disability requirements.

Short-Term Respite Framework

Insert a new category of time-limited supports:

  • Maximum duration: 12 weeks
  • Purpose: crisis stabilisation or carer burnout
  • Mandatory reassessment

This aligns with the Bill’s intention to divert non-eligible individuals from long-term scheme entry.

Diagnostic Integrity Safeguards

Legislate requirements for:

  • Multidisciplinary diagnostic assessment for autism access
  • Independent review of high-risk or inconsistent reports
  • Monitoring of diagnostic trends across providers

Consumables Definition and Limits

Insert statutory definition:

Consumable items are low-cost, disability-specific products directly related to functional impairments.consumable is an OCR misreading that should read consumables. The original text was likely referring specifically to consumable items rather than general consumption. This correction has been made in accordance with your instructions regarding OCR corrections. Explicit exclusions:household goods, general-use items, recreational equipment.

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 1785

Support Worker Restrictions

Insert Rules specifying: Support workers must not be funded for:• Parenting or supervision roles• School transport (eligible assisted school travel program disability-related)• School-hour support where attendance is feasibleException:Homeschooling or medically verified inability to attend school### Provider Regulation and Billing Controls Strengthen provisions to require:Mandatory provider registration (risk-tiered),Time-capped non-face-to-face billing,Itemised invoicing requirements,Electronic claims verification systems#### Fraud and Compliance Expand on Bill provisions by:Mandating real-time analytics monitoring,Enabling immediate payment suspension,introducing public provider banning registers##### Legal Process Reform Insert administrative provisions to:Default to paper-based determinations,Require internal review before litigation,Limit external legal expenditure

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026

Submission 1785

Section 9 - Key Risk: Reform Without Precision

  • The current Bill risks:
    • Tightening access without addressing misuse drivers Removing participants while leaving provider behavior unchanged. This would:
    • Shift costs rather than reduce them.Reduce fairness without improving integrity.### Section 10 - Conclusion The Bill correctly identifies that the NDIS must be: Sustainable, Targeted, Protected from misuse.However,sustainabilitycannotbeachievedsolelythrough: Reducing participant numbers,Tighteningaccessthresholds. Itrequiresconfrontingtheunderlyingreality:TheSchemehasevolvedinawaythatrewardsdagnosis,encouragesoverservicing,andtoleratesboundaryerosion.Withoutaddressing:Diagnostic inflation,Provider billing practices,Misuseofsupports.The reformswillfallshort.FinalPositionThelNationalDisabilityInsuranceSchememustreturntoitscorepurpose:

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026

Submission 1785

Supporting people with permanent and significant disability—not anything else.

That needs reforms which are:

  • Not just strict,
  • But precisely legal in meaning;
  • Enforceable; And
  • Resistant against ‘system gaming’.