NDIA Accountability Project

Diagnostic inflation and autism access (Confidential)

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Submission 1785

Formal Submission to the Senate Inquiry

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

1. 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 2026.

The Bill seeks to:

  • Clarify eligibility criteria
  • Refocus funding on “reasonable and necessary” supports
  • Strengthen fraud detection and compliance
  • Improve sustainability and governance

These objectives are necessary and supported. However, without more precise legislative controls, the Scheme will continue to be undermined by systemic misuse, diagnostic inflation, and cost-shifting.

2. Context and Legislative Direction

The Bill reflects a broader policy shift toward:

  • Functional capacity-based assessments
  • Stricter permanence requirements
  • Consideration of alternative supports and treatment pathways

This is a necessary correction. The Scheme has drifted from its original purpose of supporting people with permanent and significant disability, toward a model vulnerable to interpretation, expansion, and exploitation.

Systemic Failure: Incentives Driving Overuse and Misuse

3.1 Structural Incentives

The current Scheme design incentivises:

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
  • Prevent diagnostic escalation for funding purposes

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Recommendation

Legislation must explicitly require:

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

5. Misuse of Supports Beyond Legislative Intent

5.1 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 responsibilities
  • School-hour support where school attendance is possible excluding homeschoolers due to disabilities and schools unable to accommodate

5.2 Consumables

Consumables are being used for:

  • Everyday household items
  • Non-disability-related goods
  • High-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.

Submission 1785

5.3 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.

The National Disability Insurance Agency continues to allocate significant resources to:

  • Legal representation
  • Adversarial tribunal processes

This is inconsistent with:

  • Administrative efficiency objectives
  • Participant equity

7. Alignment with Bill Objectives – Required Strengthening

The Bill’s intent to:

  • Address fraud
  • Clarify eligibility
  • Improve sustainability

is supported. However, to achieve these objectives, the following legislative amendments or Rules are required.

8.1 Eligibility and Functional Capacity ( Sections 24–25 )

Amend to require:

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  • 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.”

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8.5 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 feasible

Exception:

  • Homeschooling or medically verified inability to attend school

8.6 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

8.7 Fraud and Compliance

Expand on Bill provisions by:

  • Mandating real-time analytics monitoring
  • Enabling immediate payment suspension
  • Introducing public provider banning registers

Insert administrative provisions to:

  • Default to paper-based determinations
  • Require internal review before litigation
  • Limit external legal expenditure

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Key Risk: Reform Without Precision

The current Bill risks:

  • Tightening access without addressing misuse drivers
  • Removing participants while leaving provider behaviour unchanged

This would:

  • Shift costs rather than reduce them
  • Reduce fairness without improving integrity

Conclusion

The Bill correctly identifies that the NDIS must be:

  • Sustainable
  • Targeted
  • Protected from misuse

However, sustainability cannot be achieved solely through:

  • Reducing participant numbers
  • Tightening access thresholds

It requires confronting the underlying reality: The Scheme has evolved in a way that rewards diagnosis, encourages over-servicing, and tolerates boundary erosion.

Without addressing:

  • Diagnostic inflation
  • Provider billing practices
  • Misuse of supports

The reforms will fall short.

Final Position

The National Disability Insurance Scheme must return to its core purpose:

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Supporting people with permanent and significant disability—nothing more, and nothing less.

That requires reform that is not simply stricter, but legally precise, enforceable, and resistant to system gaming.