Submission 2115

28/05/2026

to the Senate Committee,

Re: Submission regarding proposed changes to the National Disability Insurance Scheme (NDIS) via the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026.

My name is Nicole, I am an Occupational Therapist who has been supporting people with disabilities in our community since 2014. I have seen first hand the incredibly positive impact of the NDIS since its inception and implementation. I am writing to express significant concern regarding the proposed reforms and legislative changes to the NDIS. I work closely with people with disability and see the complexity of functional impairment, environmental impacts, support needs, and the realities faced by participants and families every day. These proposed changes risk moving the Scheme further away from individualised, evidence-based disability support and toward a rigid, impersonal system that does not reflect real-world disability impacts.

Our profession has been closely following the proposed changes including the transition to reliance on assessment tools such as I-CAN and PECQ without meaningful interaction and observation of the participant in their environment. Occupational therapists and other allied health and medical professionals are trained over years to assess beyond surface-level presentation: we ask different questions, dig deeper, identify cues, and assess function within different contexts. There is little incentive for assessors to meaningfully investigate complexity, variability, or environmental factors impacting function. In a vulnerable population, this is extremely dangerous. There is no ability for participants or providers to review draft reports before final versions are submitted. This creates substantial risk of inaccuracies going unchallenged. We are being told that assessments will “inform budgets,” however there is very little clarity regarding how this process will actually occur. Further, it appears that the only review pathway may be a repeat support needs assessment, which is vastly different from current review mechanisms. There are also serious concerns regarding who will complete these

Submission 2115

assessments and make determinations regarding disability support needs. Understanding the interaction between person, environment, and occupation (PEO) underpins occupational therapy practice and disability assessment. This is not something that can be replicated by unqualified assessors or reduced to simplistic tools. Removing properly qualified assessment processes places participants at significant risk.

Recommendations:

• Continue to utilise qualified assessors including OTs and other allied health and medical professionals with the expertise and experience to provide comprehensive and accurate assessments for participants.
• Ensure there is a method for review / appeal of decisions relating to NDIS plans, acknowledging that the Agency does not always get it right and there needs to be a reasonable mechanism for review such as the s100 process or ART.

The proposed redefinition of functional capacity is alarming; you are asking us to disregard participants real world experiences and how they manage the impairments caused by their disabilities. Reducing the thoroughness of assessment creates a dangerous situation where unqualified individuals may be making determinations about a persons function without ever meeting them, observing them, or speaking meaningfully with them and their supports. Instead, decisions may rely heavily on self-reports that are not always accurate, with no opportunity to identify inaccuracies through observation or clinical reasoning.

These reforms appear to move away from the International Classification of Functioning (ICF) and from understanding function within the broader context of activity, participation, and environment. The proposed changes redefine function as what a person can do in isolation, without considering the environmental and support factors that influence day-to-day functioning. This is not reflective of real life. Function must always be considered in context.

There is also significant concern regarding the broad powers granted for future rules and classifications that have not yet been released. Different thresholds and assessment methods risk creating inflexible systems that fail to meet real disability support needs. Variable capacity in different environments and situations is a critical reality for many people with disability and cannot simply be ignored.

Submission 2115

Recommendations:

• Ensure that functional capacity assessments consider environmental context, assistive technology needs, informal supports and their limitations, behavioural regulation, fatigue, and sustainability of function over time.
• Utilise qualified assessors including OTs and other allied health and medical professionals with the expertise and experience to provide comprehensive and accurate assessments for participants.
• Recognise that functional capacity fluctuates; there are invisible disabilities and masking presentations which may impact the effectiveness of one-off, telehealth assessments.
• It is vital to consider safety, sustainability, participation and real-world functioning when assessing capacity.

The proposed changes to permanence and “appropriate treatment” requirements are also deeply problematic. The idea that treatments that are financially or geographically inaccessible could be considered “appropriate” and that participants would be excluded from Scheme access if they haven’t been able to undergo them is dangerous. This ignores genuine barriers such as financial limitations, workforce shortages, location, transport access, access to culturally safe care, trauma histories, and lack of specialist services. These barriers are extremely common, particularly in rural and regional areas and for low-income participants, which accounts for many NDIS participants who are unable to work due to their disabilities. The reforms appear manifestly unfair toward those who simply cannot access the treatments being demanded of them.

There is also no clarity around what constitutes “reasonable” treatment, nor who will be making the decisions about what could be considered reasonable. Many people are unable to access services for a variety of reasons. Excluding them from accessing necessary services and supports in clearly unfair and puts a large cohort of Australians at profound risk. The Scheme risks becoming exclusionary and classist.

Recommendations:

• Clarify what the definition of “appropriate treatment” would entail, ensuring that participants aren’t excluded or disadvantaged due to financial barriers, geographic location, inability to access specialists, or medication side effects.

Submission 2115

• Recognition that disability may be permanent, but there remains a role for ongoing therapy or rehabilitation activities to maximise function. This does not mean that a disability disappears, rather it often means that ongoing therapies and treatments are necessary to maintain function, reduce functional decline, or support participation and quality of life.
• Ensure treatment expectations remain realistic, evidence-based and accessible.

The proposed changes to Reasonable and Necessary criteria are also highly concerning. The introduction of considerations around whether comparable supports are available at lower cost, without maintaining the requirement to “achieve the same outcome,” risks fundamentally undermining individualised support provision. Cheaper supports do not necessarily meet functional need. If supports are selected based primarily on cost rather than outcome, participant safety, independence, and wellbeing will be harmed.

The proposed hierarchy prioritising peer-reviewed evidence above participant experience and clinical reasoning is also highly concerning. In many areas of the NDIS, particularly complex behaviours, support ratios, or specialised assistive technology, the evidence base simply does not exist in the form being requested. Lived experience matters. No two participants have identical needs. There is significant risk that planners will reject supports despite strong participant-specific evidence simply because the circumstance does not meet narrow research criteria. Conversely, research evidence alone does not mean a support is appropriate for a specific individual.

The person must remain at the centre of the Scheme. Individualised needs and individualised evidence are essential to achieving good outcomes. Removing flexibility and person-centred decision making will inevitably lead to inappropriate supports, participant deterioration, and greater long-term costs.

Recommendations:

• Ensure “comparable supports” must provide equivalent safety, functional benefit, sustainability, and participation outcomes. Ensure participants are not forced to accept supports that are unsafe, ineffective, inappropriate, or unsustainable.
• Ensure value for money considerations include quality of life, dignity, independence, and long-term participation outcomes.

Submission 2115

Changes to what may be considered a parental responsibility and the increased reliance and pressure on informal supports is also deeply worrying. Families are already providing substantial care. Expecting parents or family members to continue filling increasing gaps in formal support is unrealistic and harmful. The intensity, frequency, and complexity of care required for many children and adults with disability is fundamentally different from ordinary caregiving responsibilities.

Many participants require support well beyond what is expected in ordinary parenting or family care. Delayed skill acquisition, extensive prompting, behavioural supports, personal care, supervision, and safety monitoring can continue far beyond typical developmental stages. Parents and carers cannot realistically provide intensive support 24 hours per day indefinitely. These reforms fail to adequately recognise this reality and risk placing enormous strain on families, particularly women, while negatively impacting their capacity to maintain their own personal and self-care, engagement in meaningful activities, and ultimately paid employment.

Recommendations:

• Recognise the difference between ordinary parenting tasks, and disability-related care intensity and complexity.
• Ensure consideration of caregiver burden, sustainability, sleep disruption, emotional exhaustion, behavioural complexity, and workforce participation impacts.
• Ensure behavioural support, emotional co-regulation and high-intensity supervision needs are appropriately recognised as disability-related support demands.
• Ensure decision-making considers the cumulative impact of caring demands, impact on siblings and family wellbeing, and long-term sustainability of informal care arrangements.

The proposed powers relating to maximum funding amounts, support ratios, or capped levels of support are another significant concern. These measures ignore the reality that two individuals with similar diagnoses on paper may have vastly different support needs in practice. Some participants legitimately require 2:1 or 3:1 supports due to behavioural risks, complex medical needs, or safety concerns. Capping supports without individualised assessment places participants, support workers, and the broader community at risk of harm.

Submission 2115

The proposed powers allowing the Minister to reduce or remove funding for entire groups or classes of support represent a substantial legislative overreach. This includes concerns regarding community participation supports. These supports are not simply “going to the movies” or recreational activities. They enable meaningful participation in community life and support people with disability to engage in society in the same way as others.

The suggestion that funding for these supports could be reduced or removed, with the power for the Minister to decide that this could be reduced by up to 100% is deeply alarming. Community participation supports are essential daily life supports. They enable participants to shop for food, attend appointments, access healthcare, complete banking, maintain safety, and participate in society. Many participants require support both in the community and at home. Their need for decision making assistance, supervision, personal care, and safety support does not disappear based on location. What you will likely end up seeing is that participants will require higher levels of Assistance with Daily Life funding in place of Social, Economic and Community Participation funding. It is an incredibly short-sighted proposed change that won’t save significant amounts on the Scheme, but will negatively impact a large cohort of participants, isolating them from their communities.

The transfer of pricing authority to the Minister, rather than an independent body, also raises concerns regarding transparency and accountability. Notably, recommendations regarding pricing reform have not been publicly released despite requests.

Submission 2115

The proposed reforms fail to adequately recognise the importance of whole-of-person assessment. The Administrative Review Tribunal has previously reinforced the importance of considering the whole person and the real-world impact of disability. People cannot be compartmentalised into isolated impairments without considering how those impairments interact. For example, where a participant requires bariatric equipment due to intersecting disabilities and health conditions, these factors cannot simply be excluded from consideration because they do not fit neatly into a narrow definition. Disability is complex, interconnected, and individual.

Recommendations:

• Ensure the legislation recognises the interaction between impairment, environment, participation barriers, and support needs. Avoid overly narrow interpretations that separate disability from real-world context.
• Maintain alignment with the social model of disability and occupational participation principles. Ensure supports that prevent crisis, safeguarding risk, social isolation, or unsafe living arrangements remain recognised as disability-related supports.

The proposed processes for requesting additional supports during a plan period are concerning. A 90-day decision timeframe is far too long for participants experiencing rapid deterioration, housing instability, behavioural escalation, or support breakdown. Delays of weeks or months may place participants at significant risk of harm. The requirement for “significant change” may also unfairly disadvantage participants experiencing gradual decline, fluctuating conditions, or accumulating risk factors. There appears to be no clear urgent review pathway. Temporary changes, such as informal carers becoming unavailable due to illness or respite needs, still have very real impacts on participants and cannot simply be dismissed.

Recommendations:

• Retain shorter reassessment decision timeframes, particularly where safety or crisis issues are present.
• Create clear urgent reassessment pathways for safeguarding concerns, hospital discharge, carer breakdown, housing instability, behavioural escalation, and significant functional deterioration.
• Ensure gradual, cumulative and fluctuating changes can still trigger reassessment.

Submission 2115

• Ensure evidence requirements remain realistic and accessible.
• Ensure reassessment systems remain responsive to real-world risk, not just administrative thresholds.

There are also substantial concerns regarding proposed pricing and quality changes, including panel arrangements for SIL and plan management providers, which may disproportionately harm small businesses and reduce participant choice and control.

The proposed registration and enrolment systems must also become affordable and accessible, particularly for smaller providers and sole practitioners who play critical roles within the disability sector.

Finally, foundational supports remain unclear and underdeveloped, yet participants are already being removed or excluded from the Scheme without those replacement supports being in place. This is putting people at risk of severe harm, with some reporting suicidal isolation due to the proposed changes and fear around the proposed changes.

These reforms collectively increase reliance on unpaid informal supports, reduce individualised care, weaken safeguards for participants and families, and risk excluding vulnerable people from essential supports. They also risk undermining early intervention and effective support delivery, which will likely increase long-term costs and negative outcomes. The NDIS was designed to support people with disability to live safe, meaningful, and participatory lives. These proposed changes move away from individualised, evidence-based disability support and toward rigid systems that fail to reflect the complexity of real human functioning.

The short consultation and submission timeframe surrounding these reforms has also negatively impacted people with disability, their families, and providers attempting to understand and respond to highly complex legislative changes. This has not been a collaborative, co-designed or transparent process at all.

It is not the fault of participants that the government could not accurately forecast the number of Australians with disabilities who require substantial support. It is not fair to punish a

Submission 2115

vulnerable and marginalised group in the way that these reforms would. Removing funding from this group does not reduce the need for support. It instead leaves people with no where to turn.

We can all acknowledge that changes are needed in the NDIS space to protect those participants who need it most. The proposed changes are not an ethical solution to the Schemes fundamental issues. Reform around inefficient internal processes, inability of the NDIS to meet any of their own timeframes for review and decisions, and review of the high spend relating to legal fees disputing reasonable and necessary participant supports would be a much more effective, ethical and justified approach to these reforms.

I urge the Committee to carefully reconsider these reforms and ensure that participants, families, and lived experience remain central to any future changes to the Scheme. Work with community leaders to create meaningful change, including looking internally at the NDIA and how we can make this system work without putting hundreds of thousands of Australians at risk.

Yours sincerely,

Nicole Caldow

Occupational Therapist

Dandenong North, Victoria